2026 NR 565 Final Exam
QUESTION 1
A patient with chronic kidney disease (eGFR 40 mL/min) is prescribed a medication that
is 70% renally excreted. The NP should anticipate:
A) No dose adjustment needed
B) A longer half-life requiring dose reduction or extended interval
C) Faster drug elimination
D) Increased protein binding
CORRECT ANSWER: B) A longer half-life requiring dose reduction or extended
interval
RATIONALE: Renal impairment reduces drug clearance, prolonging half-life. Dose
reduction or extended intervals prevent accumulation and toxicity while maintaining
therapeutic levels.
QUESTION 2
A patient is started on rifampin for tuberculosis. The NP should counsel the patient
about potential interactions with:
A) Oral contraceptives
B) Metformin
C) Lisinopril
D) Levothyroxine
,CORRECT ANSWER: A) Oral contraceptives
RATIONALE: Rifampin is a potent CYP450 inducer that reduces the efficacy of oral
contraceptives. Alternative or additional contraception is recommended.
QUESTION 3
A patient on phenytoin develops a serum level of 28 mcg/mL (therapeutic range 10-20).
The NP should monitor for:
A) Nystagmus, ataxia, and confusion
B) Hypotension
C) Hyperglycemia
D) Weight loss
CORRECT ANSWER: A) Nystagmus, ataxia, and confusion
RATIONALE: Phenytoin toxicity presents with nystagmus, ataxia, diplopia, and confusion.
Levels > 20 mcg/mL are associated with toxicity.
QUESTION 4
A patient with type 2 diabetes and heart failure is prescribed pioglitazone. The NP
should monitor for:
A) Weight loss
B) Edema and fluid retention
C) Hypoglycemia
D) Hypertension
,CORRECT ANSWER: B) Edema and fluid retention
RATIONALE: Pioglitazone can cause fluid retention, which may exacerbate heart failure.
It is contraindicated in NYHA Class III-IV heart failure.
QUESTION 5
A patient on warfarin has an INR of 1.2. The NP should:
A) Increase warfarin dose
B) Decrease warfarin dose
C) Administer vitamin K
D) Continue current dose
CORRECT ANSWER: A) Increase warfarin dose
RATIONALE: An INR of 1.2 is subtherapeutic for most indications (target usually 2-3).
Dose increase is needed to achieve therapeutic anticoagulation.
QUESTION 6
A patient on clopidogrel is a poor metabolizer due to CYP2C19 polymorphism. The NP
should consider:
A) Increasing clopidogrel dose
B) Switching to ticagrelor or prasugrel
C) Adding aspirin only
D) No change needed
, CORRECT ANSWER: B) Switching to ticagrelor or prasugrel
RATIONALE: Poor metabolizers of CYP2C19 have reduced clopidogrel activation.
Ticagrelor and prasugrel are alternatives that do not require CYP2C19 activation.
QUESTION 7
A patient on digoxin develops visual disturbances (yellow-green halos). This is a sign of:
A) Digoxin toxicity
B) Normal side effect
C) Drug allergy
D) Withdrawal
CORRECT ANSWER: A) Digoxin toxicity
RATIONALE: Visual disturbances, including yellow-green halos, are classic signs of
digoxin toxicity. Serum digoxin level should be checked immediately.
QUESTION 8
A patient with hyperthyroidism is started on methimazole. The NP should monitor for:
A) Agranulocytosis
B) Weight gain
C) Hyperkalemia
D) Hepatomegaly
QUESTION 1
A patient with chronic kidney disease (eGFR 40 mL/min) is prescribed a medication that
is 70% renally excreted. The NP should anticipate:
A) No dose adjustment needed
B) A longer half-life requiring dose reduction or extended interval
C) Faster drug elimination
D) Increased protein binding
CORRECT ANSWER: B) A longer half-life requiring dose reduction or extended
interval
RATIONALE: Renal impairment reduces drug clearance, prolonging half-life. Dose
reduction or extended intervals prevent accumulation and toxicity while maintaining
therapeutic levels.
QUESTION 2
A patient is started on rifampin for tuberculosis. The NP should counsel the patient
about potential interactions with:
A) Oral contraceptives
B) Metformin
C) Lisinopril
D) Levothyroxine
,CORRECT ANSWER: A) Oral contraceptives
RATIONALE: Rifampin is a potent CYP450 inducer that reduces the efficacy of oral
contraceptives. Alternative or additional contraception is recommended.
QUESTION 3
A patient on phenytoin develops a serum level of 28 mcg/mL (therapeutic range 10-20).
The NP should monitor for:
A) Nystagmus, ataxia, and confusion
B) Hypotension
C) Hyperglycemia
D) Weight loss
CORRECT ANSWER: A) Nystagmus, ataxia, and confusion
RATIONALE: Phenytoin toxicity presents with nystagmus, ataxia, diplopia, and confusion.
Levels > 20 mcg/mL are associated with toxicity.
QUESTION 4
A patient with type 2 diabetes and heart failure is prescribed pioglitazone. The NP
should monitor for:
A) Weight loss
B) Edema and fluid retention
C) Hypoglycemia
D) Hypertension
,CORRECT ANSWER: B) Edema and fluid retention
RATIONALE: Pioglitazone can cause fluid retention, which may exacerbate heart failure.
It is contraindicated in NYHA Class III-IV heart failure.
QUESTION 5
A patient on warfarin has an INR of 1.2. The NP should:
A) Increase warfarin dose
B) Decrease warfarin dose
C) Administer vitamin K
D) Continue current dose
CORRECT ANSWER: A) Increase warfarin dose
RATIONALE: An INR of 1.2 is subtherapeutic for most indications (target usually 2-3).
Dose increase is needed to achieve therapeutic anticoagulation.
QUESTION 6
A patient on clopidogrel is a poor metabolizer due to CYP2C19 polymorphism. The NP
should consider:
A) Increasing clopidogrel dose
B) Switching to ticagrelor or prasugrel
C) Adding aspirin only
D) No change needed
, CORRECT ANSWER: B) Switching to ticagrelor or prasugrel
RATIONALE: Poor metabolizers of CYP2C19 have reduced clopidogrel activation.
Ticagrelor and prasugrel are alternatives that do not require CYP2C19 activation.
QUESTION 7
A patient on digoxin develops visual disturbances (yellow-green halos). This is a sign of:
A) Digoxin toxicity
B) Normal side effect
C) Drug allergy
D) Withdrawal
CORRECT ANSWER: A) Digoxin toxicity
RATIONALE: Visual disturbances, including yellow-green halos, are classic signs of
digoxin toxicity. Serum digoxin level should be checked immediately.
QUESTION 8
A patient with hyperthyroidism is started on methimazole. The NP should monitor for:
A) Agranulocytosis
B) Weight gain
C) Hyperkalemia
D) Hepatomegaly
