NR 567 Exam 4 V1 | NR 567 Advanced
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 4) |
Chamberlain College of Nursing
1. A patient with hypothyroidism is prescribed levothyroxine. Which instruction is most critical
for the AGACNP to include in the teaching plan to ensure optimal absorption?
A. Take the medication with a full glass of milk at bedtime.
B. Take the medication immediately after the largest meal of the day.
C. Take the medication on an empty stomach, 30 to 60 minutes before breakfast.
D. Administer the dose concurrently with calcium carbonate supplements.
Answer: C
Rationale: Levothyroxine absorption is significantly impaired by food and certain minerals
like calcium or iron. To achieve consistent therapeutic levels, patients must take it on an
empty stomach in the morning. Failure to follow this timing can lead to fluctuating TSH levels
and poor symptom control.
2. Select All That Apply: The AGACNP is reviewing the medical record of a patient with Type 2
Diabetes for whom metformin is being considered. Which of the following conditions are
contraindications or require extreme caution for metformin therapy?
A. Estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m².
,B. Active chronic alcoholism.
C. Acute myocardial infarction or cardiogenic shock.
D. History of seasonal allergic rhinitis.
E. Severe hepatic impairment.
F. Metabolic acidosis, including diabetic ketoacidosis.
Answer: A, B, C, E, F
Rationale: Metformin carries a black box warning for lactic acidosis, which is more likely to
occur in patients with renal or hepatic insufficiency. Conditions that predispose a patient to
hypoxia, such as acute MI or shock, also increase the risk of lactic acid accumulation. Alcohol
can potentiate metformin’s effect on lactate metabolism and should be avoided in excess.
3. A patient on phenytoin for a seizure disorder presents with a serum phenytoin level of 28
mcg/mL. Which clinical finding should the AGACNP expect to observe first?
A. Gingival hyperplasia
B. Hirsutism
C. Steven-Johnson Syndrome
D. Nystagmus and ataxia
Answer: D
Rationale: The therapeutic range for phenytoin is 10 to 20 mcg/mL. Levels above 20 mcg/mL
typically manifest as CNS toxicity, starting with nystagmus and progressing to ataxia and
,sedation. Gingival hyperplasia is a long-term side effect and not an acute indicator of toxicity
levels.
4. The AGACNP is managing a patient on Glargine (Lantus) insulin. What characteristic of this
insulin is most important for the nurse practitioner to remember when dosing?
A. It provides a basal level of insulin with no discernible peak.
B. It has a peak effect approximately 6 hours after injection.
C. It should be mixed with Lispro to provide a rapid onset.
D. It is administered intravenously in cases of DKA.
Answer: A
Rationale: Insulin glargine is a long-acting basal insulin that forms microprecipitates in the
subcutaneous tissue, allowing for a steady release over 24 hours. Because it lacks a peak, it
reduces the risk of nocturnal hypoglycemia compared to NPH insulin. It must never be mixed
with other insulins in the same syringe because the acidic pH of glargine will cause the other
insulin to precipitate.
5. A patient with Grave’s disease is started on Methimazole. Why might the AGACNP prefer
Methimazole over Propylthiouracil (PTU) for a non-pregnant adult?
A. Methimazole has a lower risk of severe hepatotoxicity compared to PTU.
B. PTU is much more expensive than Methimazole.
C. Methimazole does not cross the blood-brain barrier.
, D. PTU requires dosing only once per day.
Answer: A
Rationale: Methimazole is generally preferred because it has a longer half-life, allowing for
once-daily dosing, and is less toxic to the liver. PTU carries a black box warning for severe
liver injury and acute liver failure. PTU is usually reserved for the first trimester of pregnancy
or for patients who cannot tolerate methimazole.
6. When prescribing Levodopa/Carbidopa for Parkinson’s disease, the AGACNP explains that the
purpose of Carbidopa is to:
A. Directly stimulate dopamine receptors in the basal ganglia.
B. Cross the blood-brain barrier to reduce tremors directly.
C. Inhibit the peripheral decarboxylation of levodopa, increasing its availability to the CNS.
D. Decrease the incidence of orthostatic hypotension.
Answer: C
Rationale: Carbidopa does not cross the blood-brain barrier and has no therapeutic effect on
its own. It acts by inhibiting the enzyme dopa decarboxylase in the periphery, which prevents
levodopa from being converted to dopamine before it reaches the brain. This allows more
levodopa to enter the brain and reduces peripheral side effects like nausea and vomiting.
7. Select All That Apply: Which of the following side effects should the AGACNP monitor for in a
patient receiving long-term high-dose Prednisone therapy?
A. Osteoporosis and increased fracture risk.
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 4) |
Chamberlain College of Nursing
1. A patient with hypothyroidism is prescribed levothyroxine. Which instruction is most critical
for the AGACNP to include in the teaching plan to ensure optimal absorption?
A. Take the medication with a full glass of milk at bedtime.
B. Take the medication immediately after the largest meal of the day.
C. Take the medication on an empty stomach, 30 to 60 minutes before breakfast.
D. Administer the dose concurrently with calcium carbonate supplements.
Answer: C
Rationale: Levothyroxine absorption is significantly impaired by food and certain minerals
like calcium or iron. To achieve consistent therapeutic levels, patients must take it on an
empty stomach in the morning. Failure to follow this timing can lead to fluctuating TSH levels
and poor symptom control.
2. Select All That Apply: The AGACNP is reviewing the medical record of a patient with Type 2
Diabetes for whom metformin is being considered. Which of the following conditions are
contraindications or require extreme caution for metformin therapy?
A. Estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m².
,B. Active chronic alcoholism.
C. Acute myocardial infarction or cardiogenic shock.
D. History of seasonal allergic rhinitis.
E. Severe hepatic impairment.
F. Metabolic acidosis, including diabetic ketoacidosis.
Answer: A, B, C, E, F
Rationale: Metformin carries a black box warning for lactic acidosis, which is more likely to
occur in patients with renal or hepatic insufficiency. Conditions that predispose a patient to
hypoxia, such as acute MI or shock, also increase the risk of lactic acid accumulation. Alcohol
can potentiate metformin’s effect on lactate metabolism and should be avoided in excess.
3. A patient on phenytoin for a seizure disorder presents with a serum phenytoin level of 28
mcg/mL. Which clinical finding should the AGACNP expect to observe first?
A. Gingival hyperplasia
B. Hirsutism
C. Steven-Johnson Syndrome
D. Nystagmus and ataxia
Answer: D
Rationale: The therapeutic range for phenytoin is 10 to 20 mcg/mL. Levels above 20 mcg/mL
typically manifest as CNS toxicity, starting with nystagmus and progressing to ataxia and
,sedation. Gingival hyperplasia is a long-term side effect and not an acute indicator of toxicity
levels.
4. The AGACNP is managing a patient on Glargine (Lantus) insulin. What characteristic of this
insulin is most important for the nurse practitioner to remember when dosing?
A. It provides a basal level of insulin with no discernible peak.
B. It has a peak effect approximately 6 hours after injection.
C. It should be mixed with Lispro to provide a rapid onset.
D. It is administered intravenously in cases of DKA.
Answer: A
Rationale: Insulin glargine is a long-acting basal insulin that forms microprecipitates in the
subcutaneous tissue, allowing for a steady release over 24 hours. Because it lacks a peak, it
reduces the risk of nocturnal hypoglycemia compared to NPH insulin. It must never be mixed
with other insulins in the same syringe because the acidic pH of glargine will cause the other
insulin to precipitate.
5. A patient with Grave’s disease is started on Methimazole. Why might the AGACNP prefer
Methimazole over Propylthiouracil (PTU) for a non-pregnant adult?
A. Methimazole has a lower risk of severe hepatotoxicity compared to PTU.
B. PTU is much more expensive than Methimazole.
C. Methimazole does not cross the blood-brain barrier.
, D. PTU requires dosing only once per day.
Answer: A
Rationale: Methimazole is generally preferred because it has a longer half-life, allowing for
once-daily dosing, and is less toxic to the liver. PTU carries a black box warning for severe
liver injury and acute liver failure. PTU is usually reserved for the first trimester of pregnancy
or for patients who cannot tolerate methimazole.
6. When prescribing Levodopa/Carbidopa for Parkinson’s disease, the AGACNP explains that the
purpose of Carbidopa is to:
A. Directly stimulate dopamine receptors in the basal ganglia.
B. Cross the blood-brain barrier to reduce tremors directly.
C. Inhibit the peripheral decarboxylation of levodopa, increasing its availability to the CNS.
D. Decrease the incidence of orthostatic hypotension.
Answer: C
Rationale: Carbidopa does not cross the blood-brain barrier and has no therapeutic effect on
its own. It acts by inhibiting the enzyme dopa decarboxylase in the periphery, which prevents
levodopa from being converted to dopamine before it reaches the brain. This allows more
levodopa to enter the brain and reduces peripheral side effects like nausea and vomiting.
7. Select All That Apply: Which of the following side effects should the AGACNP monitor for in a
patient receiving long-term high-dose Prednisone therapy?
A. Osteoporosis and increased fracture risk.
