NR 567 Final Exam – Advanced Pharmacology for the
AGACNP
EXAM OVERVIEW
The NR 567 (Advanced Pharmacology for the Adult-Gerontology Acute Care Nurse
Practitioner) final exam at Chamberlain University is a cumulative, proctored
assessment covering pharmacotherapy topics from the latter weeks of the course.
Exam Format:
• Format: Examplify Online Proctored
• Questions: 100 multiple-choice questions
• Time Limit: 2 hours
Key Topics Covered:
• Neuropharmacology & Antiseizure Drugs
• Anticoagulants, Antiplatelets & Thrombolytics
• Antiarrhythmics & Vasoactive Agents
• Endocrine Pharmacology (Thyroid, Diabetes, Corticosteroids)
• Oncology Pharmacology & Chemotherapy Principles
• Infectious Disease & Antibiotic Stewardship
• Pharmacokinetics/Pharmacodynamics (volume of distribution, hepatic
metabolism, renal clearance, half-life, protein binding)
• Psychopharmacology (antidepressants, antipsychotics, mood stabilizers,
benzodiazepines)
• Pain Management & Emergency Pharmacology
• Geriatrics & Polypharmacy
SECTION 1: NEUROPHARMACOLOGY & PSYCHIATRIC
DRUGS (Questions 1–30)
,Question 1: Which medication should be given to patients presenting to the ED with
altered mental status, seizures, or both, if concern for Wernicke-Korsakoff syndrome
exists?
A) Folate (Folic acid)
B) Chlordiazepoxide (Librium)
C) Thiamine (Vitamin B1)
D) Lorazepam (Ativan)
Correct Answer: C) Thiamine (Vitamin B1)
Rationale: Wernicke-Korsakoff syndrome results from thiamine (vitamin B1) deficiency,
commonly seen in patients with alcohol use disorder or malnutrition. Thiamine should be
administered before glucose to prevent precipitating acute neurological symptoms. This is
a critical emergency intervention.
Question 2: A 35-year-old female with long-standing anxiety treated with diazepam
(Valium) triples her daily dose due to increased stress. She is found lethargic and
obtunded. Which agent should be administered?
A) Naloxone (Narcan)
B) Flumazenil (Romazicon)
C) Activated charcoal
D) Thiamine
Correct Answer: B) Flumazenil (Romazicon)
Rationale: Flumazenil is a competitive benzodiazepine antagonist at the GABA-A receptor
that reverses the sedative effects of benzodiazepine overdose. However, caution is needed
as it may precipitate seizures in benzodiazepine-dependent patients. Naloxone is used for
opioid overdose, not benzodiazepines.
Question 3: Which antiseizure medication is preferred for a generalized seizure disorder
in a 25-year-old pregnant female?
,A) Phenobarbital (Solfoton)
B) Valproate (Valproic acid)
C) Levetiracetam (Keppra)
D) Topiramate (Topamax)
Correct Answer: C) Levetiracetam (Keppra)
Rationale: Levetiracetam is preferred in pregnancy due to its lower teratogenic risk profile.
Valproate is associated with neural tube defects and an increased risk of autism spectrum
disorder. Phenobarbital and topiramate also carry higher risks compared to levetiracetam.
Question 4: Which of the following is the least preferable initial treatment for status
epilepticus?
A) Lorazepam (Ativan)
B) Diazepam (Valium)
C) Propofol (Diprivan)
D) Fosphenytoin (Cerebyx)
Correct Answer: C) Propofol (Diprivan)
Rationale: Benzodiazepines (lorazepam, diazepam) are the first-line treatment for status
epilepticus. Fosphenytoin is used for refractory status epilepticus. Propofol is generally
reserved for refractory cases requiring anesthetic doses and is not a first-line initial
treatment.
Question 5: A patient on risperidone (Risperdal) has developed hyperprolactinemia.
What is the most likely cause?
A) Dopamine receptor blockade in the tuberoinfundibular pathway
B) Serotonin receptor blockade
C) Histamine receptor blockade
D) Alpha-1 receptor blockade
Correct Answer: A) Dopamine receptor blockade in the tuberoinfundibular
pathway
, Rationale: Antipsychotics like risperidone block dopamine D2 receptors in the
tuberoinfundibular pathway, which disinhibits prolactin secretion from the anterior
pituitary, leading to hyperprolactinemia. This can cause galactorrhea, gynecomastia, and
sexual dysfunction.
Question 6: Which statement is true regarding lithium versus valproic acid for bipolar
disorder?
A) Lithium works faster than valproic acid
B) Valproic acid works faster and has a better side effect profile, but lithium is better at
reducing suicidal ideation
C) Lithium has a better side effect profile than valproic acid
D) Valproic acid is superior for reducing suicidal ideation
Correct Answer: B) Valproic acid works faster and has a better side effect profile,
but lithium is better at reducing suicidal ideation
Rationale: Valproic acid has a more rapid onset of action and generally better tolerability,
but lithium has unique anti-suicidal effects that make it preferred in patients at risk for
suicide. Both are mood stabilizers used in bipolar disorder.
Question 7: A patient on an MAOI presents with severe hypertension, headache, and
diaphoresis after eating aged cheese. What is the most likely diagnosis?
A) Serotonin syndrome
B) Hypertensive crisis (tyramine reaction)
C) Neuroleptic malignant syndrome
D) Anticholinergic toxicity
Correct Answer: B) Hypertensive crisis (tyramine reaction)
Rationale: MAOIs inhibit the breakdown of tyramine, which is found in aged cheeses,
cured meats, and fermented foods. Tyramine causes the release of norepinephrine, leading
to hypertensive crisis. This is a medical emergency requiring immediate intervention.
AGACNP
EXAM OVERVIEW
The NR 567 (Advanced Pharmacology for the Adult-Gerontology Acute Care Nurse
Practitioner) final exam at Chamberlain University is a cumulative, proctored
assessment covering pharmacotherapy topics from the latter weeks of the course.
Exam Format:
• Format: Examplify Online Proctored
• Questions: 100 multiple-choice questions
• Time Limit: 2 hours
Key Topics Covered:
• Neuropharmacology & Antiseizure Drugs
• Anticoagulants, Antiplatelets & Thrombolytics
• Antiarrhythmics & Vasoactive Agents
• Endocrine Pharmacology (Thyroid, Diabetes, Corticosteroids)
• Oncology Pharmacology & Chemotherapy Principles
• Infectious Disease & Antibiotic Stewardship
• Pharmacokinetics/Pharmacodynamics (volume of distribution, hepatic
metabolism, renal clearance, half-life, protein binding)
• Psychopharmacology (antidepressants, antipsychotics, mood stabilizers,
benzodiazepines)
• Pain Management & Emergency Pharmacology
• Geriatrics & Polypharmacy
SECTION 1: NEUROPHARMACOLOGY & PSYCHIATRIC
DRUGS (Questions 1–30)
,Question 1: Which medication should be given to patients presenting to the ED with
altered mental status, seizures, or both, if concern for Wernicke-Korsakoff syndrome
exists?
A) Folate (Folic acid)
B) Chlordiazepoxide (Librium)
C) Thiamine (Vitamin B1)
D) Lorazepam (Ativan)
Correct Answer: C) Thiamine (Vitamin B1)
Rationale: Wernicke-Korsakoff syndrome results from thiamine (vitamin B1) deficiency,
commonly seen in patients with alcohol use disorder or malnutrition. Thiamine should be
administered before glucose to prevent precipitating acute neurological symptoms. This is
a critical emergency intervention.
Question 2: A 35-year-old female with long-standing anxiety treated with diazepam
(Valium) triples her daily dose due to increased stress. She is found lethargic and
obtunded. Which agent should be administered?
A) Naloxone (Narcan)
B) Flumazenil (Romazicon)
C) Activated charcoal
D) Thiamine
Correct Answer: B) Flumazenil (Romazicon)
Rationale: Flumazenil is a competitive benzodiazepine antagonist at the GABA-A receptor
that reverses the sedative effects of benzodiazepine overdose. However, caution is needed
as it may precipitate seizures in benzodiazepine-dependent patients. Naloxone is used for
opioid overdose, not benzodiazepines.
Question 3: Which antiseizure medication is preferred for a generalized seizure disorder
in a 25-year-old pregnant female?
,A) Phenobarbital (Solfoton)
B) Valproate (Valproic acid)
C) Levetiracetam (Keppra)
D) Topiramate (Topamax)
Correct Answer: C) Levetiracetam (Keppra)
Rationale: Levetiracetam is preferred in pregnancy due to its lower teratogenic risk profile.
Valproate is associated with neural tube defects and an increased risk of autism spectrum
disorder. Phenobarbital and topiramate also carry higher risks compared to levetiracetam.
Question 4: Which of the following is the least preferable initial treatment for status
epilepticus?
A) Lorazepam (Ativan)
B) Diazepam (Valium)
C) Propofol (Diprivan)
D) Fosphenytoin (Cerebyx)
Correct Answer: C) Propofol (Diprivan)
Rationale: Benzodiazepines (lorazepam, diazepam) are the first-line treatment for status
epilepticus. Fosphenytoin is used for refractory status epilepticus. Propofol is generally
reserved for refractory cases requiring anesthetic doses and is not a first-line initial
treatment.
Question 5: A patient on risperidone (Risperdal) has developed hyperprolactinemia.
What is the most likely cause?
A) Dopamine receptor blockade in the tuberoinfundibular pathway
B) Serotonin receptor blockade
C) Histamine receptor blockade
D) Alpha-1 receptor blockade
Correct Answer: A) Dopamine receptor blockade in the tuberoinfundibular
pathway
, Rationale: Antipsychotics like risperidone block dopamine D2 receptors in the
tuberoinfundibular pathway, which disinhibits prolactin secretion from the anterior
pituitary, leading to hyperprolactinemia. This can cause galactorrhea, gynecomastia, and
sexual dysfunction.
Question 6: Which statement is true regarding lithium versus valproic acid for bipolar
disorder?
A) Lithium works faster than valproic acid
B) Valproic acid works faster and has a better side effect profile, but lithium is better at
reducing suicidal ideation
C) Lithium has a better side effect profile than valproic acid
D) Valproic acid is superior for reducing suicidal ideation
Correct Answer: B) Valproic acid works faster and has a better side effect profile,
but lithium is better at reducing suicidal ideation
Rationale: Valproic acid has a more rapid onset of action and generally better tolerability,
but lithium has unique anti-suicidal effects that make it preferred in patients at risk for
suicide. Both are mood stabilizers used in bipolar disorder.
Question 7: A patient on an MAOI presents with severe hypertension, headache, and
diaphoresis after eating aged cheese. What is the most likely diagnosis?
A) Serotonin syndrome
B) Hypertensive crisis (tyramine reaction)
C) Neuroleptic malignant syndrome
D) Anticholinergic toxicity
Correct Answer: B) Hypertensive crisis (tyramine reaction)
Rationale: MAOIs inhibit the breakdown of tyramine, which is found in aged cheeses,
cured meats, and fermented foods. Tyramine causes the release of norepinephrine, leading
to hypertensive crisis. This is a medical emergency requiring immediate intervention.
