NUR 635 Final Exam Study Guide | Pharmacology
for Advanced Practice Nursing - Comprehensive
Exam with Verified Answers and Detailed
Rationales | Latest Update 2026/2027 - Edition
Question 1
The first-line drug choice for a previously healthy adult patient diagnosed with community-
acquired pneumonia would be:
A. Ciprofloxacin
B. Azithromycin
C. Amoxicillin
D. Doxycycline
Answer: B
Rationale: Azithromycin is a first-line treatment for community-acquired pneumonia in
previously healthy adults without comorbidities. It provides coverage for both typical and
atypical pathogens. Ciprofloxacin (A) is not first-line for CAP. Amoxicillin (C) does not
cover atypical pathogens. Doxycycline (D) is an alternative but not the preferred first-line
agent.
Question 2
Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and
lymphadenopathy. Initial evaluation and treatment includes:
A. Reassuring her she has a viral infection and to call if she isn't better in 4 or 5 days
B. Ruling out a hypersensitivity reaction that may lead to multi-organ failure
C. Rapid strep test and symptomatic care if strep test is negative
D. Observation only, with further assessment if she worsens
Answer: B
Rationale: Lamotrigine can cause a hypersensitivity reaction presenting with fever, rash, and
lymphadenopathy. This is a serious, potentially life-threatening reaction that can progress to
multi-organ failure. Immediate evaluation and discontinuation of the medication are required.
Question 3
Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis
due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides
monitoring his schizophrenia symptoms, the patient should be assessed by his primary care
1
,provider:
A. For excessive weight loss
B. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms
(EPS)
C. Monthly for tolerance to the haloperidol
D. Only by the mental health provider, as most NPs in primary care do not care for mentally
ill patients
Answer: B
Rationale: The AIMS test is used to assess for extrapyramidal symptoms and tardive
dyskinesia in patients taking antipsychotics like haloperidol. Patients on long-acting
antipsychotics require regular monitoring for EPS and tardive dyskinesia.
Question 4
Digoxin levels need to be monitored closely when the following medication is started:
A. Loratadine
B. Diphenhydramine
C. Ipratropium
D. Albuterol
Answer: D
Rationale: Albuterol and other beta-agonists can cause hypokalemia, which increases the risk
of digoxin toxicity. When albuterol is initiated in a patient on digoxin, digoxin levels and
potassium levels should be monitored closely.
Question 5
Harold, a 42-year-old African American, has moderate persistent asthma. Which of the
following asthma medications should be used cautiously, if at all?
A. Betamethasone, an inhaled corticosteroid
B. Salmeterol, an inhaled long-acting beta-agonist
C. Albuterol, a short-acting beta-agonist
D. Montelukast, a leukotriene modifier
Answer: B
Rationale: Salmeterol carries a Black Box Warning due to an increased risk of asthma-related
death, particularly in African American patients. LABAs should be used cautiously and
always in combination with an inhaled corticosteroid.
Question 6
2
,Tiotropium bromide (Spiriva) is an inhaled anticholinergic:
A. Used for the treatment of chronic obstructive pulmonary disease (COPD)
B. Used in the treatment of asthma
C. Combined with albuterol for treatment of asthma exacerbations
D. Combined with fluticasone for the treatment of persistent asthma
Answer: A
Rationale: Tiotropium is an inhaled anticholinergic bronchodilator indicated for maintenance
treatment of COPD. It is not typically used for asthma and is not used for acute exacerbations.
Question 7
Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of
albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of
beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes:
A. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs
per day
B. Beclomethasone needs to be used every day to treat her asthma
C. Report any systemic side effects she is experiencing, such as weight gain
D. Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to
facilitate bronchodilation
Answer: B
Rationale: Inhaled corticosteroids like beclomethasone need to be used daily for their anti-
inflammatory effects, even when the patient is asymptomatic. They are controller medications,
not rescue medications.
Question 8
When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be
instructed:
A. Montelukast twice a day is started when there is an asthma exacerbation
B. Patients may experience weight gain on montelukast
C. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking
montelukast
D. Lethargy and hypersomnia may occur when taking montelukast
Answer: C
Rationale: Montelukast carries a Black Box Warning for neuropsychiatric events including
aggression, anxiety, depression, and suicidal thoughts. Patients and caregivers should be
educated to report mood changes immediately.
Question 9
3
, When educating patients who are starting on inhaled corticosteroids, the provider should tell
them that:
A. They need to get any live vaccines before starting the medication
B. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective
C. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent
thrush
D. They can triple the dose number of inhalations of medication during colds to prevent
needing systemic steroids
Answer: C
Rationale: Inhaled corticosteroids can cause oral candidiasis (thrush). Patients should rinse
their mouth with water and spit after each use to prevent this complication.
Question 10
Howard is a seventy-two-year-old male who occasionally takes diphenhydramine for his
seasonal allergies. Monitoring for this patient taking diphenhydramine would include
assessing for:
A. Urinary retention
B. Cardiac output
C. Peripheral edema
D. Skin for rash
Answer: A
Rationale: First-generation antihistamines like diphenhydramine have anticholinergic effects
that can cause urinary retention, especially in elderly patients. This is a significant concern in
older adults.
Question 11
Second generation antihistamines such as loratadine (Claritin) are prescribed for seasonal
allergies because they are:
A. More effective than first generation antihistamines
B. Less sedating than the first generation antihistamines
C. Prescription products, therefore are covered by insurance
D. Able to be taken with CNS sedatives, such as alcohol
Answer: B
Rationale: Second-generation antihistamines are less sedating because they do not cross the
blood-brain barrier as readily as first-generation antihistamines. This makes them preferred for
daytime use.
Question 12
4
for Advanced Practice Nursing - Comprehensive
Exam with Verified Answers and Detailed
Rationales | Latest Update 2026/2027 - Edition
Question 1
The first-line drug choice for a previously healthy adult patient diagnosed with community-
acquired pneumonia would be:
A. Ciprofloxacin
B. Azithromycin
C. Amoxicillin
D. Doxycycline
Answer: B
Rationale: Azithromycin is a first-line treatment for community-acquired pneumonia in
previously healthy adults without comorbidities. It provides coverage for both typical and
atypical pathogens. Ciprofloxacin (A) is not first-line for CAP. Amoxicillin (C) does not
cover atypical pathogens. Doxycycline (D) is an alternative but not the preferred first-line
agent.
Question 2
Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and
lymphadenopathy. Initial evaluation and treatment includes:
A. Reassuring her she has a viral infection and to call if she isn't better in 4 or 5 days
B. Ruling out a hypersensitivity reaction that may lead to multi-organ failure
C. Rapid strep test and symptomatic care if strep test is negative
D. Observation only, with further assessment if she worsens
Answer: B
Rationale: Lamotrigine can cause a hypersensitivity reaction presenting with fever, rash, and
lymphadenopathy. This is a serious, potentially life-threatening reaction that can progress to
multi-organ failure. Immediate evaluation and discontinuation of the medication are required.
Question 3
Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis
due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides
monitoring his schizophrenia symptoms, the patient should be assessed by his primary care
1
,provider:
A. For excessive weight loss
B. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms
(EPS)
C. Monthly for tolerance to the haloperidol
D. Only by the mental health provider, as most NPs in primary care do not care for mentally
ill patients
Answer: B
Rationale: The AIMS test is used to assess for extrapyramidal symptoms and tardive
dyskinesia in patients taking antipsychotics like haloperidol. Patients on long-acting
antipsychotics require regular monitoring for EPS and tardive dyskinesia.
Question 4
Digoxin levels need to be monitored closely when the following medication is started:
A. Loratadine
B. Diphenhydramine
C. Ipratropium
D. Albuterol
Answer: D
Rationale: Albuterol and other beta-agonists can cause hypokalemia, which increases the risk
of digoxin toxicity. When albuterol is initiated in a patient on digoxin, digoxin levels and
potassium levels should be monitored closely.
Question 5
Harold, a 42-year-old African American, has moderate persistent asthma. Which of the
following asthma medications should be used cautiously, if at all?
A. Betamethasone, an inhaled corticosteroid
B. Salmeterol, an inhaled long-acting beta-agonist
C. Albuterol, a short-acting beta-agonist
D. Montelukast, a leukotriene modifier
Answer: B
Rationale: Salmeterol carries a Black Box Warning due to an increased risk of asthma-related
death, particularly in African American patients. LABAs should be used cautiously and
always in combination with an inhaled corticosteroid.
Question 6
2
,Tiotropium bromide (Spiriva) is an inhaled anticholinergic:
A. Used for the treatment of chronic obstructive pulmonary disease (COPD)
B. Used in the treatment of asthma
C. Combined with albuterol for treatment of asthma exacerbations
D. Combined with fluticasone for the treatment of persistent asthma
Answer: A
Rationale: Tiotropium is an inhaled anticholinergic bronchodilator indicated for maintenance
treatment of COPD. It is not typically used for asthma and is not used for acute exacerbations.
Question 7
Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of
albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of
beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes:
A. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs
per day
B. Beclomethasone needs to be used every day to treat her asthma
C. Report any systemic side effects she is experiencing, such as weight gain
D. Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to
facilitate bronchodilation
Answer: B
Rationale: Inhaled corticosteroids like beclomethasone need to be used daily for their anti-
inflammatory effects, even when the patient is asymptomatic. They are controller medications,
not rescue medications.
Question 8
When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be
instructed:
A. Montelukast twice a day is started when there is an asthma exacerbation
B. Patients may experience weight gain on montelukast
C. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking
montelukast
D. Lethargy and hypersomnia may occur when taking montelukast
Answer: C
Rationale: Montelukast carries a Black Box Warning for neuropsychiatric events including
aggression, anxiety, depression, and suicidal thoughts. Patients and caregivers should be
educated to report mood changes immediately.
Question 9
3
, When educating patients who are starting on inhaled corticosteroids, the provider should tell
them that:
A. They need to get any live vaccines before starting the medication
B. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective
C. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent
thrush
D. They can triple the dose number of inhalations of medication during colds to prevent
needing systemic steroids
Answer: C
Rationale: Inhaled corticosteroids can cause oral candidiasis (thrush). Patients should rinse
their mouth with water and spit after each use to prevent this complication.
Question 10
Howard is a seventy-two-year-old male who occasionally takes diphenhydramine for his
seasonal allergies. Monitoring for this patient taking diphenhydramine would include
assessing for:
A. Urinary retention
B. Cardiac output
C. Peripheral edema
D. Skin for rash
Answer: A
Rationale: First-generation antihistamines like diphenhydramine have anticholinergic effects
that can cause urinary retention, especially in elderly patients. This is a significant concern in
older adults.
Question 11
Second generation antihistamines such as loratadine (Claritin) are prescribed for seasonal
allergies because they are:
A. More effective than first generation antihistamines
B. Less sedating than the first generation antihistamines
C. Prescription products, therefore are covered by insurance
D. Able to be taken with CNS sedatives, such as alcohol
Answer: B
Rationale: Second-generation antihistamines are less sedating because they do not cross the
blood-brain barrier as readily as first-generation antihistamines. This makes them preferred for
daytime use.
Question 12
4
