1
NR 667 / NR667 CEA FINAL EXAM (CHAMBERLAIN COLLEGE OF
NURSING) | 2025 COMPLETE NR 667 ACTUAL EXAM WITH
CORRECT VERIFIED ANSWERS | ALREADY GRADED A+ EXAM |
BRAND NEW
Section 1: Advanced Pharmacology & Prescribing (Q1–20)
Q1. A 65-year-old patient with atrial fibrillation is maintained on warfarin. The INR
today is 3.8 (therapeutic range 2.0–3.0). The patient denies any bleeding. What is
the most appropriate next action?
A. Continue current warfarin dose
B. Hold warfarin and administer vitamin K immediately
C. Hold one or two doses of warfarin and recheck INR
D. Administer fresh frozen plasma
Answer: C
Rationale: For an INR of 3.8 without active bleeding, holding a dose and
rechecking is appropriate. Vitamin K is reserved for serious bleeding or markedly
elevated INR (>10). Continuing the dose would risk supratherapeutic levels.
Q2. Which of the following medications is most likely to cause a persistent, dry
cough as a side effect?
A. Losartan
B. Lisinopril
C. Amlodipine
D. Metoprolol
Answer: B
Rationale: ACE inhibitors like lisinopril inhibit the breakdown of bradykinin,
leading to accumulation and a characteristic dry cough. ARBs like losartan do not
cause this effect.
pg. 1
,2
Q3. A patient with type 2 diabetes is started on metformin. Which lab value
should be monitored periodically due to a rare but serious adverse effect?
A. Liver function tests
B. Serum creatinine and eGFR
C. Serum potassium
D. Thyroid-stimulating hormone
Answer: B
Rationale: Metformin carries a risk of lactic acidosis, particularly in patients with
renal impairment. Renal function should be monitored; the drug is
contraindicated if eGFR is below 30 mL/min.
Q4. An elderly patient is prescribed amitriptyline for neuropathic pain. Which
adverse effect is of greatest concern in this population?
A. Diarrhea
B. Orthostatic hypotension and anticholinergic effects
C. Weight loss
D. Hypertension
Answer: B
Rationale: Tricyclic antidepressants have strong anticholinergic properties
(confusion, constipation, urinary retention) and cause orthostatic hypotension,
increasing fall risk in older adults. They are on the Beers list.
Q5. A febrile child with a viral illness should not be given aspirin due to the risk of:
A. Stevens-Johnson syndrome
B. Reye's syndrome
C. Kawasaki disease
D. Anaphylaxis
Answer: B
Rationale: Aspirin use in children with viral infections has been linked to Reye's
syndrome, a life-threatening condition involving encephalopathy and liver failure.
pg. 2
,3
Q6. Which of the following antibiotics is contraindicated in children under 8 years
of age due to the risk of permanent teeth discoloration?
A. Amoxicillin
B. Azithromycin
C. Tetracycline
D. Cephalexin
Answer: C
Rationale: Tetracyclines bind to calcium in developing teeth, causing permanent
yellow-brown discoloration and enamel hypoplasia. They are avoided in children
under 8 and in pregnancy.
Q7. A 72-year-old patient with heart failure and an ejection fraction of 30% is on
carvedilol, lisinopril, and furosemide. Which additional medication has been
shown to reduce mortality in this population?
A. Digoxin
B. Spironolactone
C. Diltiazem
D. Amlodipine
Answer: B
Rationale: Mineralocorticoid receptor antagonists (spironolactone, eplerenone)
reduce mortality in heart failure with reduced ejection fraction (HFrEF). Digoxin
reduces hospitalizations but not mortality.
Q8. A patient on a statin reports new-onset muscle pain and dark urine. What is
the priority action?
A. Order a lipid panel
B. Discontinue the statin and order a creatine kinase (CK) level
C. Add coenzyme Q10
D. Switch to a different statin
pg. 3
, 4
Answer: B
Rationale: Muscle pain with dark urine (myoglobinuria) suggests rhabdomyolysis,
a rare but life-threatening adverse effect of statins. The statin must be stopped,
and CK and renal function assessed immediately.
Q9. Which of the following is a common adverse effect of bisphosphonates like
alendronate?
A. Constipation
B. Esophageal irritation
C. Hypercalcemia
D. Weight gain
Answer: B
Rationale: Bisphosphonates can cause severe esophagitis and esophageal ulcers.
Patients must take them with a full glass of water, remain upright for at least 30
minutes, and not eat or drink during that time.
Q10. A patient on lithium should be counseled to maintain consistent intake of
which electrolyte?
A. Potassium
B. Calcium
C. Magnesium
D. Sodium
Answer: D
Rationale: Lithium and sodium compete for reabsorption in the renal tubules. Low
sodium intake/depletion increases lithium reabsorption, raising the risk of
toxicity. Keep sodium intake stable.
Q11. The first-line pharmacotherapy for generalized anxiety disorder (GAD) is:
A. Benzodiazepines
B. Selective serotonin reuptake inhibitors (SSRIs)
pg. 4
NR 667 / NR667 CEA FINAL EXAM (CHAMBERLAIN COLLEGE OF
NURSING) | 2025 COMPLETE NR 667 ACTUAL EXAM WITH
CORRECT VERIFIED ANSWERS | ALREADY GRADED A+ EXAM |
BRAND NEW
Section 1: Advanced Pharmacology & Prescribing (Q1–20)
Q1. A 65-year-old patient with atrial fibrillation is maintained on warfarin. The INR
today is 3.8 (therapeutic range 2.0–3.0). The patient denies any bleeding. What is
the most appropriate next action?
A. Continue current warfarin dose
B. Hold warfarin and administer vitamin K immediately
C. Hold one or two doses of warfarin and recheck INR
D. Administer fresh frozen plasma
Answer: C
Rationale: For an INR of 3.8 without active bleeding, holding a dose and
rechecking is appropriate. Vitamin K is reserved for serious bleeding or markedly
elevated INR (>10). Continuing the dose would risk supratherapeutic levels.
Q2. Which of the following medications is most likely to cause a persistent, dry
cough as a side effect?
A. Losartan
B. Lisinopril
C. Amlodipine
D. Metoprolol
Answer: B
Rationale: ACE inhibitors like lisinopril inhibit the breakdown of bradykinin,
leading to accumulation and a characteristic dry cough. ARBs like losartan do not
cause this effect.
pg. 1
,2
Q3. A patient with type 2 diabetes is started on metformin. Which lab value
should be monitored periodically due to a rare but serious adverse effect?
A. Liver function tests
B. Serum creatinine and eGFR
C. Serum potassium
D. Thyroid-stimulating hormone
Answer: B
Rationale: Metformin carries a risk of lactic acidosis, particularly in patients with
renal impairment. Renal function should be monitored; the drug is
contraindicated if eGFR is below 30 mL/min.
Q4. An elderly patient is prescribed amitriptyline for neuropathic pain. Which
adverse effect is of greatest concern in this population?
A. Diarrhea
B. Orthostatic hypotension and anticholinergic effects
C. Weight loss
D. Hypertension
Answer: B
Rationale: Tricyclic antidepressants have strong anticholinergic properties
(confusion, constipation, urinary retention) and cause orthostatic hypotension,
increasing fall risk in older adults. They are on the Beers list.
Q5. A febrile child with a viral illness should not be given aspirin due to the risk of:
A. Stevens-Johnson syndrome
B. Reye's syndrome
C. Kawasaki disease
D. Anaphylaxis
Answer: B
Rationale: Aspirin use in children with viral infections has been linked to Reye's
syndrome, a life-threatening condition involving encephalopathy and liver failure.
pg. 2
,3
Q6. Which of the following antibiotics is contraindicated in children under 8 years
of age due to the risk of permanent teeth discoloration?
A. Amoxicillin
B. Azithromycin
C. Tetracycline
D. Cephalexin
Answer: C
Rationale: Tetracyclines bind to calcium in developing teeth, causing permanent
yellow-brown discoloration and enamel hypoplasia. They are avoided in children
under 8 and in pregnancy.
Q7. A 72-year-old patient with heart failure and an ejection fraction of 30% is on
carvedilol, lisinopril, and furosemide. Which additional medication has been
shown to reduce mortality in this population?
A. Digoxin
B. Spironolactone
C. Diltiazem
D. Amlodipine
Answer: B
Rationale: Mineralocorticoid receptor antagonists (spironolactone, eplerenone)
reduce mortality in heart failure with reduced ejection fraction (HFrEF). Digoxin
reduces hospitalizations but not mortality.
Q8. A patient on a statin reports new-onset muscle pain and dark urine. What is
the priority action?
A. Order a lipid panel
B. Discontinue the statin and order a creatine kinase (CK) level
C. Add coenzyme Q10
D. Switch to a different statin
pg. 3
, 4
Answer: B
Rationale: Muscle pain with dark urine (myoglobinuria) suggests rhabdomyolysis,
a rare but life-threatening adverse effect of statins. The statin must be stopped,
and CK and renal function assessed immediately.
Q9. Which of the following is a common adverse effect of bisphosphonates like
alendronate?
A. Constipation
B. Esophageal irritation
C. Hypercalcemia
D. Weight gain
Answer: B
Rationale: Bisphosphonates can cause severe esophagitis and esophageal ulcers.
Patients must take them with a full glass of water, remain upright for at least 30
minutes, and not eat or drink during that time.
Q10. A patient on lithium should be counseled to maintain consistent intake of
which electrolyte?
A. Potassium
B. Calcium
C. Magnesium
D. Sodium
Answer: D
Rationale: Lithium and sodium compete for reabsorption in the renal tubules. Low
sodium intake/depletion increases lithium reabsorption, raising the risk of
toxicity. Keep sodium intake stable.
Q11. The first-line pharmacotherapy for generalized anxiety disorder (GAD) is:
A. Benzodiazepines
B. Selective serotonin reuptake inhibitors (SSRIs)
pg. 4
