1
NR 565 MIDTERM EXAM CHAMBERLAIN ADVANCED
PHARMACOLOGY] ACTUAL QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026
Q&A | INSTANT DOWNLOAD PDF
*Core Domains:
• Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics
• Cytochrome P450 Drug Interactions
• Cardiovascular and Renal Pharmacology
• Endocrine and Metabolic Pharmacology
• Neurological and Psychiatric Pharmacology
• Infectious Disease and Antimicrobial Stewardship
• Oncology, Immunology, and Pain Management
• Respiratory, Gastrointestinal, and Dermatologic Pharmacology
• Adverse Drug Reactions and Black Box Warnings
• Evidence-Based Prescribing and Patient Education*
Introduction:
This comprehensive midterm examination assesses the advanced knowledge,
clinical reasoning, and evidence-based prescribing skills required for graduate
nursing practice. The exam includes 100 multiple-choice and scenario-based
questions aligned with NR 565 course content, covering advanced
pharmacotherapeutics, drug interactions, cytochrome P450 metabolism, adverse
effect monitoring, and management of complex disease states. Questions require
integration of pathophysiology, pharmacology, and patient-specific factors to
select the most appropriate therapy and education. Successful performance
pg. 1
,2
confirms readiness to prescribe safely, monitor for adverse reactions, and optimize
medication regimens across the lifespan in advanced practice roles.
SECTION ONE: QUESTIONS 1–100
1. A patient with type 2 diabetes is prescribed empagliflozin. Which adverse
effect requires immediate patient education?
A. Hypoglycemia
B. Genital mycotic infections and dehydration
C. Weight gain
D. Hyperkalemia
B. Genital mycotic infections and dehydration
RATIONALE: Empagliflozin is an SGLT2 inhibitor that increases urinary
glucose, predisposing to genital candidiasis and osmotic diuresis with
dehydration. Hypoglycemia is uncommon unless combined with insulin or
sulfonylureas.
2. A patient taking warfarin is prescribed fluconazole. The nurse practitioner
should monitor closely for:
A. Warfarin resistance
B. Warfarin toxicity and bleeding due to CYP2C9 inhibition
C. Hypokalemia
D. Hypoglycemia
B. Warfarin toxicity and bleeding due to CYP2C9 inhibition
RATIONALE: Fluconazole inhibits CYP2C9, the enzyme that metabolizes
S-warfarin, increasing INR and bleeding risk. The warfarin dose may need
reduction with close monitoring.
3. Which medication is contraindicated in a patient with asthma if a
nonselective beta-blocker is prescribed?
A. Albuterol
B. Propranolol
C. Lisinopril
D. Furosemide
B. Propranolol
pg. 2
,3
RATIONALE: Propranolol blocks beta-2 receptors, causing
bronchospasm and worsening asthma. Cardioselective beta-blockers may
be safer but still require caution.
4. A patient with heart failure is started on carvedilol. Which finding indicates
a therapeutic response?
A. Increased heart rate and blood pressure
B. Decreased heart rate, improved ejection fraction, and reduced
hospitalizations
C. Worsening edema
D. Increased BNP
B. Decreased heart rate, improved ejection fraction, and reduced
hospitalizations
RATIONALE: Carvedilol is a beta-blocker that reduces heart rate,
improves left ventricular function over time, and decreases mortality and
hospitalizations in heart failure.
5. Which cytochrome P450 enzyme metabolizes the largest number of
commonly prescribed drugs?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C9
B. CYP3A4
RATIONALE: CYP3A4 is the most abundant CYP enzyme and metabolizes
more than 50% of clinically used drugs, making it a major source of drug
interactions.
6. A patient is prescribed clopidogrel. The nurse should teach that clopidogrel
is a prodrug requiring activation by which enzyme?
A. CYP3A4
B. CYP2C19
C. CYP2D6
D. CYP1A2
B. CYP2C19
RATIONALE: Clopidogrel is a prodrug converted to its active metabolite
pg. 3
, 4
by CYP2C19. Patients with CYP2C19 loss-of-function alleles may have
reduced antiplatelet effect.
7. A patient with major depressive disorder has been on sertraline for 8 weeks
with partial response. Which medication is FDA-approved as adjunctive
therapy?
A. Buspirone
B. Aripiprazole
C. Diazepam
D. Propranolol
B. Aripiprazole
RATIONALE: Aripiprazole, an atypical antipsychotic, is FDA-approved as
adjunctive treatment for major depressive disorder when SSRI response is
inadequate.
8. A patient is prescribed metformin and is scheduled for a CT scan with IV
contrast. Which action should the nurse anticipate?
A. Continue metformin as scheduled
B. Hold metformin before and for at least 48 hours after contrast, and
monitor renal function
C. Administer metformin with extra fluids only
D. Discontinue metformin permanently
B. Hold metformin before and for at least 48 hours after contrast, and
monitor renal function
RATIONALE: IV contrast can cause acute kidney injury. Metformin
accumulation in renal impairment increases lactic acidosis risk. Metformin
is typically held before and after contrast.
9. A patient with atrial fibrillation has a CHA2DS2-VASc score of 4. Which
therapy is most appropriate for stroke prevention?
A. Aspirin only
B. Apixaban or another direct oral anticoagulant
C. Clopidogrel
D. No antithrombotic therapy
B. Apixaban or another direct oral anticoagulant
RATIONALE: With a CHA2DS2-VASc score ≥2 in men, oral
pg. 4
NR 565 MIDTERM EXAM CHAMBERLAIN ADVANCED
PHARMACOLOGY] ACTUAL QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026
Q&A | INSTANT DOWNLOAD PDF
*Core Domains:
• Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics
• Cytochrome P450 Drug Interactions
• Cardiovascular and Renal Pharmacology
• Endocrine and Metabolic Pharmacology
• Neurological and Psychiatric Pharmacology
• Infectious Disease and Antimicrobial Stewardship
• Oncology, Immunology, and Pain Management
• Respiratory, Gastrointestinal, and Dermatologic Pharmacology
• Adverse Drug Reactions and Black Box Warnings
• Evidence-Based Prescribing and Patient Education*
Introduction:
This comprehensive midterm examination assesses the advanced knowledge,
clinical reasoning, and evidence-based prescribing skills required for graduate
nursing practice. The exam includes 100 multiple-choice and scenario-based
questions aligned with NR 565 course content, covering advanced
pharmacotherapeutics, drug interactions, cytochrome P450 metabolism, adverse
effect monitoring, and management of complex disease states. Questions require
integration of pathophysiology, pharmacology, and patient-specific factors to
select the most appropriate therapy and education. Successful performance
pg. 1
,2
confirms readiness to prescribe safely, monitor for adverse reactions, and optimize
medication regimens across the lifespan in advanced practice roles.
SECTION ONE: QUESTIONS 1–100
1. A patient with type 2 diabetes is prescribed empagliflozin. Which adverse
effect requires immediate patient education?
A. Hypoglycemia
B. Genital mycotic infections and dehydration
C. Weight gain
D. Hyperkalemia
B. Genital mycotic infections and dehydration
RATIONALE: Empagliflozin is an SGLT2 inhibitor that increases urinary
glucose, predisposing to genital candidiasis and osmotic diuresis with
dehydration. Hypoglycemia is uncommon unless combined with insulin or
sulfonylureas.
2. A patient taking warfarin is prescribed fluconazole. The nurse practitioner
should monitor closely for:
A. Warfarin resistance
B. Warfarin toxicity and bleeding due to CYP2C9 inhibition
C. Hypokalemia
D. Hypoglycemia
B. Warfarin toxicity and bleeding due to CYP2C9 inhibition
RATIONALE: Fluconazole inhibits CYP2C9, the enzyme that metabolizes
S-warfarin, increasing INR and bleeding risk. The warfarin dose may need
reduction with close monitoring.
3. Which medication is contraindicated in a patient with asthma if a
nonselective beta-blocker is prescribed?
A. Albuterol
B. Propranolol
C. Lisinopril
D. Furosemide
B. Propranolol
pg. 2
,3
RATIONALE: Propranolol blocks beta-2 receptors, causing
bronchospasm and worsening asthma. Cardioselective beta-blockers may
be safer but still require caution.
4. A patient with heart failure is started on carvedilol. Which finding indicates
a therapeutic response?
A. Increased heart rate and blood pressure
B. Decreased heart rate, improved ejection fraction, and reduced
hospitalizations
C. Worsening edema
D. Increased BNP
B. Decreased heart rate, improved ejection fraction, and reduced
hospitalizations
RATIONALE: Carvedilol is a beta-blocker that reduces heart rate,
improves left ventricular function over time, and decreases mortality and
hospitalizations in heart failure.
5. Which cytochrome P450 enzyme metabolizes the largest number of
commonly prescribed drugs?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C9
B. CYP3A4
RATIONALE: CYP3A4 is the most abundant CYP enzyme and metabolizes
more than 50% of clinically used drugs, making it a major source of drug
interactions.
6. A patient is prescribed clopidogrel. The nurse should teach that clopidogrel
is a prodrug requiring activation by which enzyme?
A. CYP3A4
B. CYP2C19
C. CYP2D6
D. CYP1A2
B. CYP2C19
RATIONALE: Clopidogrel is a prodrug converted to its active metabolite
pg. 3
, 4
by CYP2C19. Patients with CYP2C19 loss-of-function alleles may have
reduced antiplatelet effect.
7. A patient with major depressive disorder has been on sertraline for 8 weeks
with partial response. Which medication is FDA-approved as adjunctive
therapy?
A. Buspirone
B. Aripiprazole
C. Diazepam
D. Propranolol
B. Aripiprazole
RATIONALE: Aripiprazole, an atypical antipsychotic, is FDA-approved as
adjunctive treatment for major depressive disorder when SSRI response is
inadequate.
8. A patient is prescribed metformin and is scheduled for a CT scan with IV
contrast. Which action should the nurse anticipate?
A. Continue metformin as scheduled
B. Hold metformin before and for at least 48 hours after contrast, and
monitor renal function
C. Administer metformin with extra fluids only
D. Discontinue metformin permanently
B. Hold metformin before and for at least 48 hours after contrast, and
monitor renal function
RATIONALE: IV contrast can cause acute kidney injury. Metformin
accumulation in renal impairment increases lactic acidosis risk. Metformin
is typically held before and after contrast.
9. A patient with atrial fibrillation has a CHA2DS2-VASc score of 4. Which
therapy is most appropriate for stroke prevention?
A. Aspirin only
B. Apixaban or another direct oral anticoagulant
C. Clopidogrel
D. No antithrombotic therapy
B. Apixaban or another direct oral anticoagulant
RATIONALE: With a CHA2DS2-VASc score ≥2 in men, oral
pg. 4
