NR 566 ADVANCED PHARMACOLOGY FOR CARE OF THE FAMILY
APPROVED FINAL EXAM 2026/2027 & HIGH YIELD PRACTICE
QUESTIONS COMPLETE ACCURATE TEST ACTUAL QUESTIONS
WITH WELL ELABORATED ANSWERS & RATIONALES (100%
EXPERT VERIFIED SOLUTIONS) LATEST UPDATED VERSION 2026
EDITION |GUARANTEED SUCCESS A+ (BRAND NEW!) JUST
RELEASED
A 45-year-old female with type 2 diabetes and chronic kidney disease (eGFR 35
mL/min) requires initiation of an SGLT2 inhibitor for glycemic control and
cardiovascular risk reduction. Which agent is most appropriate based on renal
dosing considerations?
A) Dapagliflozin – no dose adjustment needed but avoid if eGFR <25
B) Empagliflozin – can be initiated if eGFR >30 and continued until eGFR <20
C) Canagliflozin – start at 100 mg daily and reduce to 50 mg if eGFR <45
D) Ertugliflozin – contraindicated if eGFR <45
CORRECT ANSWER: B Rationale: Empagliflozin is approved for initiation at eGFR
>30 mL/min and can be continued until eGFR falls below 20 mL/min. Dapagliflozin
is not recommended for initiation if eGFR <25 but can be used down to 25;
canagliflozin is not recommended if eGFR <30; ertugliflozin is not recommended
for initiation if eGFR <45. The patient’s eGFR of 35 makes empagliflozin the safest
and most appropriate choice.
A 28-year-old pregnant patient at 32 weeks gestation presents with acute
uncomplicated cystitis. Which antibiotic regimen is preferred?
A) Nitrofurantoin 100 mg twice daily for 5 days
B) Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days
C) Ciprofloxacin 250 mg twice daily for 3 days
,D) Doxycycline 100 mg twice daily for 7 days
CORRECT ANSWER: A Rationale: Nitrofurantoin is a first-line agent for
uncomplicated cystitis in pregnancy (except near delivery due to risk of hemolytic
anemia in neonate, but 32 weeks is acceptable). TMP-SMX is avoided in the third
trimester due to risk of kernicterus and neonatal hemolysis. Fluoroquinolones are
avoided in pregnancy due to risk of cartilage damage. Doxycycline is
contraindicated in pregnancy due to teratogenicity and tooth discoloration.
A 72-year-old male with heart failure with reduced ejection fraction (HFrEF) on
sacubitril/valsartan develops angioedema. What is the most appropriate next
step?
A) Discontinue sacubitril/valsartan and initiate lisinopril
B) Continue sacubitril/valsartan and add diphenhydramine
C) Discontinue sacubitril/valsartan and avoid ARBs and ACE inhibitors
permanently
D) Reduce sacubitril/valsartan dose by 50% and monitor for 24 hours
CORRECT ANSWER: C Rationale: Angioedema with sacubitril/valsartan (an
ARB/neprilysin inhibitor) contraindicates future use of any ACE inhibitor or ARB
because of the shared risk of bradykinin-mediated angioedema. Continuing or
switching to lisinopril would increase risk of recurrent, potentially life-threatening
angioedema. Antihistamines treat symptoms but do not prevent recurrence. Dose
reduction is not safe after angioedema.
Which antidepressant is most likely to cause a positive urine drug screen for
amphetamines due to a true metabolic cross-reaction?
A) Sertraline
B) Bupropion
C) Escitalopram
D) Trazodone
,CORRECT ANSWER: B Rationale: Bupropion and its metabolites (especially
hydroxybupropion) can cross-react with amphetamine immunoassays, producing
false-positive results. Sertraline, escitalopram, and trazodone do not commonly
cause this cross-reactivity.
A 55-year-old male with generalized anxiety disorder is prescribed buspirone.
Which statement regarding buspirone’s pharmacology is correct?
A) Onset of therapeutic effect is within 24-48 hours
B) It has no abuse potential and does not cause physical dependence
C) It potentiates the effects of alcohol and benzodiazepines via GABA potentiation
D) It should be taken on an empty stomach to maximize absorption
CORRECT ANSWER: B Rationale: Buspirone has no known abuse potential, does
not produce tolerance or physical dependence, and is not a controlled substance.
Onset of therapeutic effect is delayed (1-2 weeks). It does not potentiate alcohol
or benzodiazepines (no GABAergic activity). Food increases buspirone
bioavailability, though consistent administration is key.
A 62-year-old female with atrial fibrillation and a CHA2DS2-VASc score of 4 is
started on apixaban. Which of the following is a correct dose adjustment
recommendation for apixaban?
A) Reduce dose to 2.5 mg twice daily if any two of the following: age ≥80, weight
≤60 kg, serum creatinine ≥1.5 mg/dL
B) Use 5 mg twice daily for all patients regardless of renal function
C) Reduce dose to 2.5 mg daily if CrCl <15 mL/min
D) Avoid use if eGFR <30 mL/min and use warfarin instead
CORRECT ANSWER: A Rationale: Apixaban dose reduction to 2.5 mg twice daily is
recommended if at least two of the following criteria are met: age ≥80 years,
body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. Standard dose is 5 mg twice
daily. Apixaban can be used with caution in severe renal impairment (CrCl 15-29
, mL/min) with dose reduction; it is not absolutely avoided. CrCl <15 mL/min lacks
data.
A 35-year-old female with migraine with aura seeks preventive therapy. Which
medication is contraindicated due to increased risk of stroke?
A) Propranolol
B) Topiramate
C) Combined oral contraceptives
D) Amitriptyline
CORRECT ANSWER: C Rationale: Combined oral contraceptives are relatively
contraindicated in migraine with aura due to increased risk of ischemic stroke,
especially if other vascular risk factors exist. Propranolol, topiramate, and
amitriptyline are all acceptable preventive options without this specific stroke
risk.
A 68-year-old male with chronic pain from osteoarthritis has been on ibuprofen
800 mg three times daily for 3 months. He now presents with new-onset
hypertension and pedal edema. Which of the following changes is most
appropriate?
A) Switch to naproxen 500 mg twice daily
B) Add hydrochlorothiazide 25 mg daily
C) Discontinue ibuprofen and initiate acetaminophen 1000 mg three times daily
as needed
D) Continue ibuprofen and add lisinopril 10 mg daily
CORRECT ANSWER: C Rationale: NSAIDs cause sodium retention, edema, and
worsening blood pressure control. The safest step is to discontinue the NSAID and
use acetaminophen for osteoarthritis pain. Switching to another NSAID
(naproxen) does not eliminate the class effect. Adding an antihypertensive may
APPROVED FINAL EXAM 2026/2027 & HIGH YIELD PRACTICE
QUESTIONS COMPLETE ACCURATE TEST ACTUAL QUESTIONS
WITH WELL ELABORATED ANSWERS & RATIONALES (100%
EXPERT VERIFIED SOLUTIONS) LATEST UPDATED VERSION 2026
EDITION |GUARANTEED SUCCESS A+ (BRAND NEW!) JUST
RELEASED
A 45-year-old female with type 2 diabetes and chronic kidney disease (eGFR 35
mL/min) requires initiation of an SGLT2 inhibitor for glycemic control and
cardiovascular risk reduction. Which agent is most appropriate based on renal
dosing considerations?
A) Dapagliflozin – no dose adjustment needed but avoid if eGFR <25
B) Empagliflozin – can be initiated if eGFR >30 and continued until eGFR <20
C) Canagliflozin – start at 100 mg daily and reduce to 50 mg if eGFR <45
D) Ertugliflozin – contraindicated if eGFR <45
CORRECT ANSWER: B Rationale: Empagliflozin is approved for initiation at eGFR
>30 mL/min and can be continued until eGFR falls below 20 mL/min. Dapagliflozin
is not recommended for initiation if eGFR <25 but can be used down to 25;
canagliflozin is not recommended if eGFR <30; ertugliflozin is not recommended
for initiation if eGFR <45. The patient’s eGFR of 35 makes empagliflozin the safest
and most appropriate choice.
A 28-year-old pregnant patient at 32 weeks gestation presents with acute
uncomplicated cystitis. Which antibiotic regimen is preferred?
A) Nitrofurantoin 100 mg twice daily for 5 days
B) Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days
C) Ciprofloxacin 250 mg twice daily for 3 days
,D) Doxycycline 100 mg twice daily for 7 days
CORRECT ANSWER: A Rationale: Nitrofurantoin is a first-line agent for
uncomplicated cystitis in pregnancy (except near delivery due to risk of hemolytic
anemia in neonate, but 32 weeks is acceptable). TMP-SMX is avoided in the third
trimester due to risk of kernicterus and neonatal hemolysis. Fluoroquinolones are
avoided in pregnancy due to risk of cartilage damage. Doxycycline is
contraindicated in pregnancy due to teratogenicity and tooth discoloration.
A 72-year-old male with heart failure with reduced ejection fraction (HFrEF) on
sacubitril/valsartan develops angioedema. What is the most appropriate next
step?
A) Discontinue sacubitril/valsartan and initiate lisinopril
B) Continue sacubitril/valsartan and add diphenhydramine
C) Discontinue sacubitril/valsartan and avoid ARBs and ACE inhibitors
permanently
D) Reduce sacubitril/valsartan dose by 50% and monitor for 24 hours
CORRECT ANSWER: C Rationale: Angioedema with sacubitril/valsartan (an
ARB/neprilysin inhibitor) contraindicates future use of any ACE inhibitor or ARB
because of the shared risk of bradykinin-mediated angioedema. Continuing or
switching to lisinopril would increase risk of recurrent, potentially life-threatening
angioedema. Antihistamines treat symptoms but do not prevent recurrence. Dose
reduction is not safe after angioedema.
Which antidepressant is most likely to cause a positive urine drug screen for
amphetamines due to a true metabolic cross-reaction?
A) Sertraline
B) Bupropion
C) Escitalopram
D) Trazodone
,CORRECT ANSWER: B Rationale: Bupropion and its metabolites (especially
hydroxybupropion) can cross-react with amphetamine immunoassays, producing
false-positive results. Sertraline, escitalopram, and trazodone do not commonly
cause this cross-reactivity.
A 55-year-old male with generalized anxiety disorder is prescribed buspirone.
Which statement regarding buspirone’s pharmacology is correct?
A) Onset of therapeutic effect is within 24-48 hours
B) It has no abuse potential and does not cause physical dependence
C) It potentiates the effects of alcohol and benzodiazepines via GABA potentiation
D) It should be taken on an empty stomach to maximize absorption
CORRECT ANSWER: B Rationale: Buspirone has no known abuse potential, does
not produce tolerance or physical dependence, and is not a controlled substance.
Onset of therapeutic effect is delayed (1-2 weeks). It does not potentiate alcohol
or benzodiazepines (no GABAergic activity). Food increases buspirone
bioavailability, though consistent administration is key.
A 62-year-old female with atrial fibrillation and a CHA2DS2-VASc score of 4 is
started on apixaban. Which of the following is a correct dose adjustment
recommendation for apixaban?
A) Reduce dose to 2.5 mg twice daily if any two of the following: age ≥80, weight
≤60 kg, serum creatinine ≥1.5 mg/dL
B) Use 5 mg twice daily for all patients regardless of renal function
C) Reduce dose to 2.5 mg daily if CrCl <15 mL/min
D) Avoid use if eGFR <30 mL/min and use warfarin instead
CORRECT ANSWER: A Rationale: Apixaban dose reduction to 2.5 mg twice daily is
recommended if at least two of the following criteria are met: age ≥80 years,
body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. Standard dose is 5 mg twice
daily. Apixaban can be used with caution in severe renal impairment (CrCl 15-29
, mL/min) with dose reduction; it is not absolutely avoided. CrCl <15 mL/min lacks
data.
A 35-year-old female with migraine with aura seeks preventive therapy. Which
medication is contraindicated due to increased risk of stroke?
A) Propranolol
B) Topiramate
C) Combined oral contraceptives
D) Amitriptyline
CORRECT ANSWER: C Rationale: Combined oral contraceptives are relatively
contraindicated in migraine with aura due to increased risk of ischemic stroke,
especially if other vascular risk factors exist. Propranolol, topiramate, and
amitriptyline are all acceptable preventive options without this specific stroke
risk.
A 68-year-old male with chronic pain from osteoarthritis has been on ibuprofen
800 mg three times daily for 3 months. He now presents with new-onset
hypertension and pedal edema. Which of the following changes is most
appropriate?
A) Switch to naproxen 500 mg twice daily
B) Add hydrochlorothiazide 25 mg daily
C) Discontinue ibuprofen and initiate acetaminophen 1000 mg three times daily
as needed
D) Continue ibuprofen and add lisinopril 10 mg daily
CORRECT ANSWER: C Rationale: NSAIDs cause sodium retention, edema, and
worsening blood pressure control. The safest step is to discontinue the NSAID and
use acetaminophen for osteoarthritis pain. Switching to another NSAID
(naproxen) does not eliminate the class effect. Adding an antihypertensive may
