NSG 527 ADVANCED NURSING
PRACTICE FINAL EXAM QUESTIONS
AND ANSWERS
1. Which physiological change in the elderly significantly affects the distribution of highly
lipophilic drugs like diazepam?
A. Decreased total body water
B. Decreased serum albumin levels
C. Increased percentage of body fat
D. Increased hepatic blood flow
Answer: C
Conceptual Explanation: In elderly patients, the proportion of body fat increases while
lean muscle mass decreases. Lipophilic drugs have a larger volume of distribution in these
patients, leading to a longer half-life.
2. A patient with a history of heart failure is prescribed an ACE inhibitor. Which biochemical
mechanism explains the development of the characteristic ‘dry cough’?
A. Increase in circulating levels of bradykinin
,B. Inhibition of aldosterone secretion
C. Direct irritation of the bronchial mucosa by the drug molecule
D. Decreased production of Angiotensin II
Answer: A
Conceptual Explanation: ACE inhibitors block the enzyme responsible for breaking down
bradykinin. The accumulation of bradykinin in the lungs causes the dry, persistent cough
associated with this drug class.
3. In the context of the cytochrome P450 system, how does a ‘prodrug’ behave when
administered alongside a potent CYP2D6 inhibitor?
A. The half-life of the drug will be shortened.
B. The drug will reach toxic levels rapidly.
C. The therapeutic effect will be significantly diminished.
D. The drug’s bioavailability will increase.
Answer: C
Conceptual Explanation: Prodrugs require enzymatic conversion (often by CYP450
enzymes) to become active. If the converting enzyme is inhibited, the active form of the
drug is not produced, resulting in therapeutic failure.
, 4. Under the ‘Incident To’ billing rules for Medicare, which of the following is a mandatory
requirement for a Nurse Practitioner to bill 100% of the physician fee schedule?
A. The NP must be the one who established the initial plan of care.
B. The physician must be physically present in the room during the encounter.
C. The service must be for a new patient or a new medical problem.
D. The physician must be in the office suite and immediately available.
Answer: D
Conceptual Explanation: ‘Incident To’ billing requires the physician to be in the office
suite and the NP to be treating an existing problem under a plan of care established by the
physician.
5. What is the primary pathophysiological mechanism behind Type II Diabetes Mellitus?
A. Absolute insulin deficiency due to beta-cell destruction
B. Peripheral insulin resistance and relative insulin deficiency
C. Autoimmune destruction of the alpha cells in the pancreas
D. Excessive secretion of glucagon by the liver
Answer: B
Conceptual Explanation: Type II Diabetes is characterized by the body’s cells becoming
resistant to insulin, paired with a compensatory but eventually insufficient insulin
production by the pancreas.
PRACTICE FINAL EXAM QUESTIONS
AND ANSWERS
1. Which physiological change in the elderly significantly affects the distribution of highly
lipophilic drugs like diazepam?
A. Decreased total body water
B. Decreased serum albumin levels
C. Increased percentage of body fat
D. Increased hepatic blood flow
Answer: C
Conceptual Explanation: In elderly patients, the proportion of body fat increases while
lean muscle mass decreases. Lipophilic drugs have a larger volume of distribution in these
patients, leading to a longer half-life.
2. A patient with a history of heart failure is prescribed an ACE inhibitor. Which biochemical
mechanism explains the development of the characteristic ‘dry cough’?
A. Increase in circulating levels of bradykinin
,B. Inhibition of aldosterone secretion
C. Direct irritation of the bronchial mucosa by the drug molecule
D. Decreased production of Angiotensin II
Answer: A
Conceptual Explanation: ACE inhibitors block the enzyme responsible for breaking down
bradykinin. The accumulation of bradykinin in the lungs causes the dry, persistent cough
associated with this drug class.
3. In the context of the cytochrome P450 system, how does a ‘prodrug’ behave when
administered alongside a potent CYP2D6 inhibitor?
A. The half-life of the drug will be shortened.
B. The drug will reach toxic levels rapidly.
C. The therapeutic effect will be significantly diminished.
D. The drug’s bioavailability will increase.
Answer: C
Conceptual Explanation: Prodrugs require enzymatic conversion (often by CYP450
enzymes) to become active. If the converting enzyme is inhibited, the active form of the
drug is not produced, resulting in therapeutic failure.
, 4. Under the ‘Incident To’ billing rules for Medicare, which of the following is a mandatory
requirement for a Nurse Practitioner to bill 100% of the physician fee schedule?
A. The NP must be the one who established the initial plan of care.
B. The physician must be physically present in the room during the encounter.
C. The service must be for a new patient or a new medical problem.
D. The physician must be in the office suite and immediately available.
Answer: D
Conceptual Explanation: ‘Incident To’ billing requires the physician to be in the office
suite and the NP to be treating an existing problem under a plan of care established by the
physician.
5. What is the primary pathophysiological mechanism behind Type II Diabetes Mellitus?
A. Absolute insulin deficiency due to beta-cell destruction
B. Peripheral insulin resistance and relative insulin deficiency
C. Autoimmune destruction of the alpha cells in the pancreas
D. Excessive secretion of glucagon by the liver
Answer: B
Conceptual Explanation: Type II Diabetes is characterized by the body’s cells becoming
resistant to insulin, paired with a compensatory but eventually insufficient insulin
production by the pancreas.
