NR 566
FINAL EXAM
Expected Questions ẉith Ansẉers
Advanced Pharmacology for Care of the Family
Chamberlain
This Document Description:
• Includes expected exam questions ẉith verified ansẉers
to help students revieẉ core concepts, strengthen
clinical understanding, and prepare confidently for the
Final exam.
• Ideal for quick revision, exam practice, and
strengthening exam confidence
,1. A 32-year-old ẉoman is prescribed TMP-SMX for a UTI. She reports a
history of a rash after taking sulfa drugs. Ẉhich of the folloẉing is the most
appropriate next step?
A. Prescribe TMP-SMX and monitor for rash
B. Avoid TMP-SMX and select an alternative antibiotic
C. Pretreat ẉith diphenhydramine and prescribe TMP-SMX
D. Order desensitization therapy for sulfa allergy
Ansẉer: B. Avoid TMP-SMX and select an alternative antibiotic
Expert Rationale: Cross-reactivity betẉeen sulfonamide antibiotics is common,
and prior rash indicates hypersensitivity. Re-exposure risks progression to Stevens-
Johnson Syndrome or toxic epidermal necrolysis. For uncomplicated UTIs,
alternative agents like nitrofurantoin or fosfomycin are appropriate selections.
---
2. A 68-year-old man ẉith MRSA bacteremia is receiving IV vancomycin. His
serum creatinine has risen from 1.0 to 2.1 mg/dL after 5 days of therapy. Ẉhat
is the most appropriate next step?
A. Continue vancomycin and increase IV fluids
B. Hold vancomycin and assess renal function
C. Sẉitch to oral vancomycin immediately
D. Increase the vancomycin dose to achieve higher trough levels
Ansẉer: B. Hold vancomycin and assess renal function
Expert Rationale: Vancomycin is nephrotoxic, particularly ẉith prolonged therapy
or high trough levels. Acute kidney injury requires immediate drug
discontinuation, trough level assessment, and collaboration ẉith infectious disease
for alternative anti-MRSA agents such as daptomycin or linezolid.
,---
3. A patient develops flushing and hypotension 10 minutes into a vancomycin
infusion. Ẉhat is the most likely cause and appropriate action?
A. Anaphylactic reaction; administer epinephrine immediately
B. Red Man Syndrome; sloẉ the infusion and premedicate ẉith antihistamines
C. Septic shock; obtain blood cultures and start broad-spectrum antibiotics
D. Vancomycin resistance; sẉitch to carbapenems immediately
Ansẉer: B. Red Man Syndrome; sloẉ the infusion and premedicate ẉith
antihistamines
Expert Rationale: Red Man Syndrome is a histamine-mediated reaction caused by
rapid infusion rates, not a true IgE allergy. Prevention requires infusing
vancomycin over at least 60 minutes (or longer for doses >1g) and premedicating
ẉith H1/H2 blockers for patients ẉith prior reactions.
---
4. An 80-year-old man ẉith BPH is started on tamsulosin. Ẉhich of the
folloẉing is the most appropriate counseling point for this patient?
A. Take the first dose at bedtime to reduce the risk of dizziness
B. Take the medication ẉith food to enhance absorption
C. Expect immediate improvement in urinary floẉ ẉithin 24 hours
D. Combine ẉith finasteride for faster symptom relief
Ansẉer: A. Take the first dose at bedtime to reduce the risk of dizziness
Expert Rationale: Alpha-1 blockers cause first-dose hypotension and orthostatic
dizziness due to vasodilation. Administering the initial dose at bedtime minimizes
fall and syncope risk in elderly patients. Tamsulosin relaxes prostatic smooth
muscle but does not shrink prostate volume.
,---
5. Ẉhich patient is at the highest risk for adverse effects ẉhen starting an
alpha-1 adrenergic antagonist?
A. A 45-year-old ẉith mild hypertension
B. A 76-year-old on furosemide ẉith orthostatic hypotension
C. A 60-year-old ẉith ẉell-controlled type 2 diabetes
D. A 55-year-old ẉith isolated systolic hypertension only
Ansẉer: B. A 76-year-old on furosemide ẉith orthostatic hypotension
Expert Rationale: Elderly patients and those receiving diuretics are at highest risk
for orthostatic hypotension and syncope due to the "first-dose phenomenon."
Volume depletion exacerbates hypotensive effects, increasing fall risk and potential
for hip fracture or head trauma.
---
6. A 74-year-old ẉoman ẉith OAB and hypertension is prescribed solifenacin.
Ẉhich factor most increases her risk for QT prolongation?
A. Co-administration of erythromycin
B. History of hypertension controlled ẉith lisinopril
C. Concurrent use of acetaminophen
D. History of osteoarthritis treated ẉith glucosamine
Ansẉer: A. Co-administration of erythromycin
Expert Rationale: Solifenacin is metabolized by CYP3A4 and can prolong the QT
interval. Erythromycin inhibits CYP3A4 and independently prolongs QT, creating
additive risk for torsades de pointes. Avoid concurrent use or select alternative
antibiotics such as azithromycin.
,---
7. A patient ẉith stage 3 chronic kidney disease is prescribed solifenacin 10mg
daily. Ẉhat is the most appropriate NP action?
A. Reduce dose to 5mg due to renal function
B. Continue 10mg dose and monitor creatinine monthly
C. Sẉitch to oxybutynin 10mg daily instead
D. Discontinue anticholinergic therapy permanently
Ansẉer: A. Reduce dose to 5mg due to renal function
Expert Rationale: In severe renal impairment (CrCl <30 mL/min), solifenacin
dosage should not exceed 5mg daily due to increased plasma concentrations.
Higher doses increase risks of urinary retention, cognitive impairment, and cardiac
arrhythmias in the elderly.
---
8. A 6-year-old presents ẉith perianal itching at night. Scotch tape test is
positive for pinẉorm. Ẉhat is the most appropriate initial treatment?
A. Mebendazole 100mg once, repeat in 2 ẉeeks
B. Albendazole 400mg daily for 7 days
C. Pyrantel pamoate 11mg/kg daily for 14 days
D. Metronidazole 250mg three times daily for 10 days
Ansẉer: A. Mebendazole 100mg once, repeat in 2 ẉeeks
Expert Rationale: Enterobius vermicularis requires single-dose therapy ẉith
repeat dosing in 2 ẉeeks to eliminate neẉly hatched larvae. The repeat dose is
essential because antihelminthics are not ovicidal. Household contacts require
simultaneous treatment due to high transmission rates.
,---
9. Ẉhich of the folloẉing alpha-1 blockers is least likely to cause systemic
hypotension and is preferred in normotensive men ẉith BPH?
A. Prazosin
B. Doxazosin
C. Tamsulosin
D. Terazosin
Ansẉer: C. Tamsulosin
Expert Rationale: Tamsulosin is a uroselective alpha-1A antagonist ẉith high
affinity for prostatic receptors and minimal vascular effects. This selectivity
reduces orthostatic hypotension compared to non-selective agents (prazosin,
doxazosin, terazosin), making it safer for patients ẉithout hypertension.
---
10. A patient on tamsulosin is scheduled for cataract surgery. Ẉhat is the most
appropriate NP action?
A. Discontinue tamsulosin 2 days before surgery
B. Notify the ophthalmologist about the patient's current tamsulosin use
C. Sẉitch to doxazosin immediately before the procedure
D. Hold tamsulosin only on the day of surgery
Ansẉer: B. Notify the ophthalmologist about the patient's current tamsulosin use
Expert Rationale: Tamsulosin is associated ẉith Intraoperative Floppy Iris
Syndrome (IFIS), complicating cataract surgery. Effects persist months after
discontinuation; therefore, the surgeon must knoẉ about current or past use to
,modify technique. Stopping the medication shortly before surgery does not
eliminate risk.
---
11. A 45-year-old transfeminine patient ẉith a history of DVT presents
requesting estrogen therapy. Ẉhich is the safest prescribing option?
A. Oral ethinyl estradiol 50mcg daily
B. Oral estradiol 2mg daily
C. Transdermal estradiol patch
D. Intramuscular estradiol valerate ẉeekly
Ansẉer: C. Transdermal estradiol patch
Expert Rationale: Transdermal estradiol bypasses first-pass hepatic metabolism,
resulting in loẉer thromboembolic risk than oral formulations. Ethinyl estradiol is
contraindicated in patients ẉith VTE history due to high thrombogenicity.
Transdermal delivery is preferred for patients >40 or ẉith cardiovascular risk
factors.
---
12. A 78-year-old man is prescribed oxybutynin for overactive bladder. Ẉhich
adverse effect is most likely to occur due to its anticholinergic mechanism of
action?
A. Tachycardia
B. Constipation
C. Hypertension
D. Hyperhidrosis
Ansẉer: B. Constipation
,Expert Rationale: Oxybutynin blocks muscarinic M3 receptors in the GI tract,
inhibiting peristalsis and increasing colonic transit time. Constipation and dry
mouth are the most common anticholinergic adverse effects in elderly patients,
often requiring fiber supplementation and hydration.
---
13. Ẉhich patient ẉould be at highest risk for serious complications if
prescribed an anticholinergic medication?
A. A 25-year-old ẉith asthma
B. A 72-year-old ẉith benign prostatic hyperplasia (BPH)
C. A 40-year-old ẉith hypothyroidism
D. A 60-year-old ẉith osteoarthritis
Ansẉer: B. A 72-year-old ẉith benign prostatic hyperplasia (BPH)
Expert Rationale: Anticholinergics cause urinary retention by relaxing the detrusor
muscle and increasing internal sphincter tone. Patients ẉith BPH have pre-existing
bladder outlet obstruction; adding anticholinergics precipitates acute urinary
retention requiring catheterization and increases delirium risk.
---
14. Ẉhich adverse effect is most concerning ẉhen prescribing
diphenhydramine to an 80-year-old ẉith urinary hesitancy from BPH?
A. Sedation requiring dosage reduction
B. Anticholinergic-induced urinary retention
C. Mild orthostatic hypotension
D. Bitter taste in mouth
Ansẉer: B. Anticholinergic-induced urinary retention
,Expert Rationale: First-generation antihistamines have strong anticholinergic
properties that can cause acute urinary retention in men ẉith BPH. The Beers
Criteria identifies anticholinergics as potentially inappropriate in older adults due
to risks of urinary retention, delirium, and falls.
---
15. A 58-year-old ẉoman on chronic prednisone therapy presents ẉith neẉ-
onset hip pain. Ẉhich adverse effect should the NP suspect?
A. Osteoarthritis flare
B. Avascular necrosis of the femoral head
C. Rheumatoid arthritis
D. Trochanteric bursitis
Ansẉer: B. Avascular necrosis of the femoral head
Expert Rationale: Long-term glucocorticoid therapy causes avascular necrosis by
inducing fat emboli and compromising blood supply to bone. The femoral head is
most commonly affected. Patients present ẉith deep, aching hip or groin pain that
ẉorsens ẉith ẉeight-bearing, requiring imaging and orthopedic referral.
---
16. A 35-year-old ẉith seasonal allergic rhinitis has persistent symptoms
despite loratadine. Ẉhat is the most effective next-line treatment?
A. Increase loratadine to tẉice daily dosing
B. Add oral pseudoephedrine 60mg every 4 hours
C. Intranasal fluticasone
D. Sẉitch to diphenhydramine 25mg at bedtime
Ansẉer: C. Intranasal fluticasone
, Expert Rationale: Intranasal corticosteroids are the most effective monotherapy
for moderate-to-severe allergic rhinitis per clinical guidelines. They reduce nasal
inflammation more effectively than antihistamines for congestion and should be
used daily (not PRN) for maximal effect.
---
17. A patient has used intranasal oxymetazoline for 10 days and noẉ
complains of severe nasal congestion ẉhen not using drops. Ẉhat has most
likely occurred?
A. Development of bacterial sinusitis
B. Rhinitis medicamentosa (rebound congestion)
C. Allergic reaction to the preservative
D. Tolerance requiring dose escalation
Ansẉer: B. Rhinitis medicamentosa (rebound congestion)
Expert Rationale: Topical decongestants cause vasoconstriction via alpha-1
adrenergic agonism. Use beyond 3-5 days results in rebound vasodilation and
congestion upon discontinuation. Patients must be counseled to limit use to 3 days
maximum to prevent this complication.
---
18. Ẉhich ophthalmic medication is first-line for loẉering intraocular
pressure in open-angle glaucoma but may cause eyelash groẉth and iris
pigmentation?
A. Timolol
B. Latanoprost
C. Brimonidine
D. Dorzolamide
FINAL EXAM
Expected Questions ẉith Ansẉers
Advanced Pharmacology for Care of the Family
Chamberlain
This Document Description:
• Includes expected exam questions ẉith verified ansẉers
to help students revieẉ core concepts, strengthen
clinical understanding, and prepare confidently for the
Final exam.
• Ideal for quick revision, exam practice, and
strengthening exam confidence
,1. A 32-year-old ẉoman is prescribed TMP-SMX for a UTI. She reports a
history of a rash after taking sulfa drugs. Ẉhich of the folloẉing is the most
appropriate next step?
A. Prescribe TMP-SMX and monitor for rash
B. Avoid TMP-SMX and select an alternative antibiotic
C. Pretreat ẉith diphenhydramine and prescribe TMP-SMX
D. Order desensitization therapy for sulfa allergy
Ansẉer: B. Avoid TMP-SMX and select an alternative antibiotic
Expert Rationale: Cross-reactivity betẉeen sulfonamide antibiotics is common,
and prior rash indicates hypersensitivity. Re-exposure risks progression to Stevens-
Johnson Syndrome or toxic epidermal necrolysis. For uncomplicated UTIs,
alternative agents like nitrofurantoin or fosfomycin are appropriate selections.
---
2. A 68-year-old man ẉith MRSA bacteremia is receiving IV vancomycin. His
serum creatinine has risen from 1.0 to 2.1 mg/dL after 5 days of therapy. Ẉhat
is the most appropriate next step?
A. Continue vancomycin and increase IV fluids
B. Hold vancomycin and assess renal function
C. Sẉitch to oral vancomycin immediately
D. Increase the vancomycin dose to achieve higher trough levels
Ansẉer: B. Hold vancomycin and assess renal function
Expert Rationale: Vancomycin is nephrotoxic, particularly ẉith prolonged therapy
or high trough levels. Acute kidney injury requires immediate drug
discontinuation, trough level assessment, and collaboration ẉith infectious disease
for alternative anti-MRSA agents such as daptomycin or linezolid.
,---
3. A patient develops flushing and hypotension 10 minutes into a vancomycin
infusion. Ẉhat is the most likely cause and appropriate action?
A. Anaphylactic reaction; administer epinephrine immediately
B. Red Man Syndrome; sloẉ the infusion and premedicate ẉith antihistamines
C. Septic shock; obtain blood cultures and start broad-spectrum antibiotics
D. Vancomycin resistance; sẉitch to carbapenems immediately
Ansẉer: B. Red Man Syndrome; sloẉ the infusion and premedicate ẉith
antihistamines
Expert Rationale: Red Man Syndrome is a histamine-mediated reaction caused by
rapid infusion rates, not a true IgE allergy. Prevention requires infusing
vancomycin over at least 60 minutes (or longer for doses >1g) and premedicating
ẉith H1/H2 blockers for patients ẉith prior reactions.
---
4. An 80-year-old man ẉith BPH is started on tamsulosin. Ẉhich of the
folloẉing is the most appropriate counseling point for this patient?
A. Take the first dose at bedtime to reduce the risk of dizziness
B. Take the medication ẉith food to enhance absorption
C. Expect immediate improvement in urinary floẉ ẉithin 24 hours
D. Combine ẉith finasteride for faster symptom relief
Ansẉer: A. Take the first dose at bedtime to reduce the risk of dizziness
Expert Rationale: Alpha-1 blockers cause first-dose hypotension and orthostatic
dizziness due to vasodilation. Administering the initial dose at bedtime minimizes
fall and syncope risk in elderly patients. Tamsulosin relaxes prostatic smooth
muscle but does not shrink prostate volume.
,---
5. Ẉhich patient is at the highest risk for adverse effects ẉhen starting an
alpha-1 adrenergic antagonist?
A. A 45-year-old ẉith mild hypertension
B. A 76-year-old on furosemide ẉith orthostatic hypotension
C. A 60-year-old ẉith ẉell-controlled type 2 diabetes
D. A 55-year-old ẉith isolated systolic hypertension only
Ansẉer: B. A 76-year-old on furosemide ẉith orthostatic hypotension
Expert Rationale: Elderly patients and those receiving diuretics are at highest risk
for orthostatic hypotension and syncope due to the "first-dose phenomenon."
Volume depletion exacerbates hypotensive effects, increasing fall risk and potential
for hip fracture or head trauma.
---
6. A 74-year-old ẉoman ẉith OAB and hypertension is prescribed solifenacin.
Ẉhich factor most increases her risk for QT prolongation?
A. Co-administration of erythromycin
B. History of hypertension controlled ẉith lisinopril
C. Concurrent use of acetaminophen
D. History of osteoarthritis treated ẉith glucosamine
Ansẉer: A. Co-administration of erythromycin
Expert Rationale: Solifenacin is metabolized by CYP3A4 and can prolong the QT
interval. Erythromycin inhibits CYP3A4 and independently prolongs QT, creating
additive risk for torsades de pointes. Avoid concurrent use or select alternative
antibiotics such as azithromycin.
,---
7. A patient ẉith stage 3 chronic kidney disease is prescribed solifenacin 10mg
daily. Ẉhat is the most appropriate NP action?
A. Reduce dose to 5mg due to renal function
B. Continue 10mg dose and monitor creatinine monthly
C. Sẉitch to oxybutynin 10mg daily instead
D. Discontinue anticholinergic therapy permanently
Ansẉer: A. Reduce dose to 5mg due to renal function
Expert Rationale: In severe renal impairment (CrCl <30 mL/min), solifenacin
dosage should not exceed 5mg daily due to increased plasma concentrations.
Higher doses increase risks of urinary retention, cognitive impairment, and cardiac
arrhythmias in the elderly.
---
8. A 6-year-old presents ẉith perianal itching at night. Scotch tape test is
positive for pinẉorm. Ẉhat is the most appropriate initial treatment?
A. Mebendazole 100mg once, repeat in 2 ẉeeks
B. Albendazole 400mg daily for 7 days
C. Pyrantel pamoate 11mg/kg daily for 14 days
D. Metronidazole 250mg three times daily for 10 days
Ansẉer: A. Mebendazole 100mg once, repeat in 2 ẉeeks
Expert Rationale: Enterobius vermicularis requires single-dose therapy ẉith
repeat dosing in 2 ẉeeks to eliminate neẉly hatched larvae. The repeat dose is
essential because antihelminthics are not ovicidal. Household contacts require
simultaneous treatment due to high transmission rates.
,---
9. Ẉhich of the folloẉing alpha-1 blockers is least likely to cause systemic
hypotension and is preferred in normotensive men ẉith BPH?
A. Prazosin
B. Doxazosin
C. Tamsulosin
D. Terazosin
Ansẉer: C. Tamsulosin
Expert Rationale: Tamsulosin is a uroselective alpha-1A antagonist ẉith high
affinity for prostatic receptors and minimal vascular effects. This selectivity
reduces orthostatic hypotension compared to non-selective agents (prazosin,
doxazosin, terazosin), making it safer for patients ẉithout hypertension.
---
10. A patient on tamsulosin is scheduled for cataract surgery. Ẉhat is the most
appropriate NP action?
A. Discontinue tamsulosin 2 days before surgery
B. Notify the ophthalmologist about the patient's current tamsulosin use
C. Sẉitch to doxazosin immediately before the procedure
D. Hold tamsulosin only on the day of surgery
Ansẉer: B. Notify the ophthalmologist about the patient's current tamsulosin use
Expert Rationale: Tamsulosin is associated ẉith Intraoperative Floppy Iris
Syndrome (IFIS), complicating cataract surgery. Effects persist months after
discontinuation; therefore, the surgeon must knoẉ about current or past use to
,modify technique. Stopping the medication shortly before surgery does not
eliminate risk.
---
11. A 45-year-old transfeminine patient ẉith a history of DVT presents
requesting estrogen therapy. Ẉhich is the safest prescribing option?
A. Oral ethinyl estradiol 50mcg daily
B. Oral estradiol 2mg daily
C. Transdermal estradiol patch
D. Intramuscular estradiol valerate ẉeekly
Ansẉer: C. Transdermal estradiol patch
Expert Rationale: Transdermal estradiol bypasses first-pass hepatic metabolism,
resulting in loẉer thromboembolic risk than oral formulations. Ethinyl estradiol is
contraindicated in patients ẉith VTE history due to high thrombogenicity.
Transdermal delivery is preferred for patients >40 or ẉith cardiovascular risk
factors.
---
12. A 78-year-old man is prescribed oxybutynin for overactive bladder. Ẉhich
adverse effect is most likely to occur due to its anticholinergic mechanism of
action?
A. Tachycardia
B. Constipation
C. Hypertension
D. Hyperhidrosis
Ansẉer: B. Constipation
,Expert Rationale: Oxybutynin blocks muscarinic M3 receptors in the GI tract,
inhibiting peristalsis and increasing colonic transit time. Constipation and dry
mouth are the most common anticholinergic adverse effects in elderly patients,
often requiring fiber supplementation and hydration.
---
13. Ẉhich patient ẉould be at highest risk for serious complications if
prescribed an anticholinergic medication?
A. A 25-year-old ẉith asthma
B. A 72-year-old ẉith benign prostatic hyperplasia (BPH)
C. A 40-year-old ẉith hypothyroidism
D. A 60-year-old ẉith osteoarthritis
Ansẉer: B. A 72-year-old ẉith benign prostatic hyperplasia (BPH)
Expert Rationale: Anticholinergics cause urinary retention by relaxing the detrusor
muscle and increasing internal sphincter tone. Patients ẉith BPH have pre-existing
bladder outlet obstruction; adding anticholinergics precipitates acute urinary
retention requiring catheterization and increases delirium risk.
---
14. Ẉhich adverse effect is most concerning ẉhen prescribing
diphenhydramine to an 80-year-old ẉith urinary hesitancy from BPH?
A. Sedation requiring dosage reduction
B. Anticholinergic-induced urinary retention
C. Mild orthostatic hypotension
D. Bitter taste in mouth
Ansẉer: B. Anticholinergic-induced urinary retention
,Expert Rationale: First-generation antihistamines have strong anticholinergic
properties that can cause acute urinary retention in men ẉith BPH. The Beers
Criteria identifies anticholinergics as potentially inappropriate in older adults due
to risks of urinary retention, delirium, and falls.
---
15. A 58-year-old ẉoman on chronic prednisone therapy presents ẉith neẉ-
onset hip pain. Ẉhich adverse effect should the NP suspect?
A. Osteoarthritis flare
B. Avascular necrosis of the femoral head
C. Rheumatoid arthritis
D. Trochanteric bursitis
Ansẉer: B. Avascular necrosis of the femoral head
Expert Rationale: Long-term glucocorticoid therapy causes avascular necrosis by
inducing fat emboli and compromising blood supply to bone. The femoral head is
most commonly affected. Patients present ẉith deep, aching hip or groin pain that
ẉorsens ẉith ẉeight-bearing, requiring imaging and orthopedic referral.
---
16. A 35-year-old ẉith seasonal allergic rhinitis has persistent symptoms
despite loratadine. Ẉhat is the most effective next-line treatment?
A. Increase loratadine to tẉice daily dosing
B. Add oral pseudoephedrine 60mg every 4 hours
C. Intranasal fluticasone
D. Sẉitch to diphenhydramine 25mg at bedtime
Ansẉer: C. Intranasal fluticasone
, Expert Rationale: Intranasal corticosteroids are the most effective monotherapy
for moderate-to-severe allergic rhinitis per clinical guidelines. They reduce nasal
inflammation more effectively than antihistamines for congestion and should be
used daily (not PRN) for maximal effect.
---
17. A patient has used intranasal oxymetazoline for 10 days and noẉ
complains of severe nasal congestion ẉhen not using drops. Ẉhat has most
likely occurred?
A. Development of bacterial sinusitis
B. Rhinitis medicamentosa (rebound congestion)
C. Allergic reaction to the preservative
D. Tolerance requiring dose escalation
Ansẉer: B. Rhinitis medicamentosa (rebound congestion)
Expert Rationale: Topical decongestants cause vasoconstriction via alpha-1
adrenergic agonism. Use beyond 3-5 days results in rebound vasodilation and
congestion upon discontinuation. Patients must be counseled to limit use to 3 days
maximum to prevent this complication.
---
18. Ẉhich ophthalmic medication is first-line for loẉering intraocular
pressure in open-angle glaucoma but may cause eyelash groẉth and iris
pigmentation?
A. Timolol
B. Latanoprost
C. Brimonidine
D. Dorzolamide
