NR565 FINAL EXAM QUESTIONS AND CORRECT SOLUTIONS JUST RELEASED THIS YEAR………...
Core Domains:
- Advanced Pharmacology and Pharmacotherapeutics
- Pharmacokinetics and Pharmacodynamics
- Pharmacotherapy for Acute and Chronic Conditions
- Medication Safety and Prescribing Practices
- Evidence-Based Pharmacologic Decision-Making
- Pharmacologic Management Across the Lifespan
- Drug Interactions and Adverse Effects
- Regulatory and Legal Aspects of Prescribing
- Patient Education and Adherence
- Monitoring and Evaluation of Therapeutic Outcomes
Introduction
This comprehensive examination is designed to assess advanced pharmacologic knowledge and clinical decision-
making skills essential for the nurse practitioner role. It evaluates the candidate's ability to understand
pharmacokinetic and pharmacodynamic principles, apply evidence-based pharmacotherapy for acute and chronic
conditions, and safely prescribe medications across diverse patient populations. The exam emphasizes real-world
clinical scenarios to assess the ability to manage complex medication regimens, identify drug interactions, monitor
adverse effects, and educate patients. Through a rigorous multiple-choice format, candidates will demonstrate
their capacity to integrate pharmacologic knowledge into holistic, patient-centered care.
SECTION ONE: QUESTIONS 1 – 100
,1. A patient with type 2 diabetes mellitus has a glycated hemoglobin (A1C) of 9.2% despite being on
metformin 1000 mg twice daily. Which medication should the advanced practice nurse consider adding as a
second-line agent?
A. Pioglitazone
B. Glipizide
C. SGLT2 inhibitor
D. Insulin glargine
🟢 C. SGLT2 inhibitor
🔴 RATIONALE: SGLT2 inhibitors (e.g., empagliflozin, canagliflozin) are recommended as second-line agents
after metformin in patients with type 2 diabetes, especially those with cardiovascular disease or risk factors.
They reduce cardiovascular mortality and hospitalizations for heart failure. While other options are possible,
SGLT2 inhibitors have additional benefits beyond glycemic control.
2. A 65-year-old patient is started on lisinopril for hypertension. The advanced practice nurse should monitor
for which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
🟢 A. Hyperkalemia
🔴 RATIONALE: ACE inhibitors (like lisinopril) can cause hyperkalemia by inhibiting aldosterone secretion, which
decreases potassium excretion. Serum potassium should be monitored, especially in patients with renal
impairment, diabetes, or those taking potassium-sparing diuretics or potassium supplements.
3. A patient with a history of heart failure with reduced ejection fraction (HFrEF) is prescribed
sacubitril/valsartan. The advanced practice nurse should instruct the patient to report which potential
,adverse effect?
A. Hyperkalemia
B. Angioedema
C. Hypotension
D. All of the above
🟢 D. All of the above
🔴 RATIONALE: Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) that can cause
hyperkalemia, angioedema, and hypotension. Patients should be educated on these potential adverse effects
and instructed to report signs of angioedema (swelling of the face, lips, tongue, throat) immediately.
4. A patient is prescribed warfarin and has an international normalized ratio (INR) of 1.8. The target INR for
this patient's condition is 2.0-3.0. What is the most appropriate action by the advanced practice nurse?
A. Increase the warfarin dose
B. Decrease the warfarin dose
C. Maintain the current dose
D. Administer vitamin K
🟢 A. Increase the warfarin dose
🔴 RATIONALE: An INR of 1.8 is below the therapeutic range (2.0-3.0), indicating subtherapeutic
anticoagulation and an increased risk of thrombosis. The warfarin dose should be increased to bring the INR
into the therapeutic range. Vitamin K is used to reverse warfarin in cases of supratherapeutic INR or bleeding.
5. A patient with asthma is prescribed an inhaled corticosteroid. The advanced practice nurse should instruct
the patient to rinse the mouth after each use to prevent which complication?
A. Oral candidiasis
B. Gingivitis
C. Stomatitis
, D. Xerostomia
🟢 A. Oral candidiasis
🔴 RATIONALE: Inhaled corticosteroids can suppress local immunity in the oropharynx, allowing overgrowth
of Candida species and causing oral candidiasis (thrush). Rinsing the mouth with water (and spitting it out) after
each use helps remove residual medication and prevent this complication.
6. A 72-year-old patient with chronic kidney disease (CKD) is started on an ACE inhibitor. The advanced
practice nurse should monitor which laboratory value to assess for a potential adverse effect?
A. Serum creatinine
B. Serum potassium
C. Serum sodium
D. Both A and B
🟢 D. Both A and B
🔴 RATIONALE: ACE inhibitors can cause a rise in serum creatinine (indicating decreased renal function) and
hyperkalemia. In patients with CKD, these effects are particularly important to monitor. Serum creatinine and
potassium should be checked before initiating therapy and periodically thereafter.
7. A patient is prescribed a statin for hyperlipidemia. The advanced practice nurse should monitor which
laboratory value to assess for a potential adverse effect?
A. Liver function tests (AST, ALT)
B. Serum creatinine
C. Serum potassium
D. Complete blood count
🟢 A. Liver function tests (AST, ALT)
🔴 RATIONALE: Statins can cause hepatotoxicity, although it is rare. Liver function tests (AST, ALT) should be
Core Domains:
- Advanced Pharmacology and Pharmacotherapeutics
- Pharmacokinetics and Pharmacodynamics
- Pharmacotherapy for Acute and Chronic Conditions
- Medication Safety and Prescribing Practices
- Evidence-Based Pharmacologic Decision-Making
- Pharmacologic Management Across the Lifespan
- Drug Interactions and Adverse Effects
- Regulatory and Legal Aspects of Prescribing
- Patient Education and Adherence
- Monitoring and Evaluation of Therapeutic Outcomes
Introduction
This comprehensive examination is designed to assess advanced pharmacologic knowledge and clinical decision-
making skills essential for the nurse practitioner role. It evaluates the candidate's ability to understand
pharmacokinetic and pharmacodynamic principles, apply evidence-based pharmacotherapy for acute and chronic
conditions, and safely prescribe medications across diverse patient populations. The exam emphasizes real-world
clinical scenarios to assess the ability to manage complex medication regimens, identify drug interactions, monitor
adverse effects, and educate patients. Through a rigorous multiple-choice format, candidates will demonstrate
their capacity to integrate pharmacologic knowledge into holistic, patient-centered care.
SECTION ONE: QUESTIONS 1 – 100
,1. A patient with type 2 diabetes mellitus has a glycated hemoglobin (A1C) of 9.2% despite being on
metformin 1000 mg twice daily. Which medication should the advanced practice nurse consider adding as a
second-line agent?
A. Pioglitazone
B. Glipizide
C. SGLT2 inhibitor
D. Insulin glargine
🟢 C. SGLT2 inhibitor
🔴 RATIONALE: SGLT2 inhibitors (e.g., empagliflozin, canagliflozin) are recommended as second-line agents
after metformin in patients with type 2 diabetes, especially those with cardiovascular disease or risk factors.
They reduce cardiovascular mortality and hospitalizations for heart failure. While other options are possible,
SGLT2 inhibitors have additional benefits beyond glycemic control.
2. A 65-year-old patient is started on lisinopril for hypertension. The advanced practice nurse should monitor
for which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
🟢 A. Hyperkalemia
🔴 RATIONALE: ACE inhibitors (like lisinopril) can cause hyperkalemia by inhibiting aldosterone secretion, which
decreases potassium excretion. Serum potassium should be monitored, especially in patients with renal
impairment, diabetes, or those taking potassium-sparing diuretics or potassium supplements.
3. A patient with a history of heart failure with reduced ejection fraction (HFrEF) is prescribed
sacubitril/valsartan. The advanced practice nurse should instruct the patient to report which potential
,adverse effect?
A. Hyperkalemia
B. Angioedema
C. Hypotension
D. All of the above
🟢 D. All of the above
🔴 RATIONALE: Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) that can cause
hyperkalemia, angioedema, and hypotension. Patients should be educated on these potential adverse effects
and instructed to report signs of angioedema (swelling of the face, lips, tongue, throat) immediately.
4. A patient is prescribed warfarin and has an international normalized ratio (INR) of 1.8. The target INR for
this patient's condition is 2.0-3.0. What is the most appropriate action by the advanced practice nurse?
A. Increase the warfarin dose
B. Decrease the warfarin dose
C. Maintain the current dose
D. Administer vitamin K
🟢 A. Increase the warfarin dose
🔴 RATIONALE: An INR of 1.8 is below the therapeutic range (2.0-3.0), indicating subtherapeutic
anticoagulation and an increased risk of thrombosis. The warfarin dose should be increased to bring the INR
into the therapeutic range. Vitamin K is used to reverse warfarin in cases of supratherapeutic INR or bleeding.
5. A patient with asthma is prescribed an inhaled corticosteroid. The advanced practice nurse should instruct
the patient to rinse the mouth after each use to prevent which complication?
A. Oral candidiasis
B. Gingivitis
C. Stomatitis
, D. Xerostomia
🟢 A. Oral candidiasis
🔴 RATIONALE: Inhaled corticosteroids can suppress local immunity in the oropharynx, allowing overgrowth
of Candida species and causing oral candidiasis (thrush). Rinsing the mouth with water (and spitting it out) after
each use helps remove residual medication and prevent this complication.
6. A 72-year-old patient with chronic kidney disease (CKD) is started on an ACE inhibitor. The advanced
practice nurse should monitor which laboratory value to assess for a potential adverse effect?
A. Serum creatinine
B. Serum potassium
C. Serum sodium
D. Both A and B
🟢 D. Both A and B
🔴 RATIONALE: ACE inhibitors can cause a rise in serum creatinine (indicating decreased renal function) and
hyperkalemia. In patients with CKD, these effects are particularly important to monitor. Serum creatinine and
potassium should be checked before initiating therapy and periodically thereafter.
7. A patient is prescribed a statin for hyperlipidemia. The advanced practice nurse should monitor which
laboratory value to assess for a potential adverse effect?
A. Liver function tests (AST, ALT)
B. Serum creatinine
C. Serum potassium
D. Complete blood count
🟢 A. Liver function tests (AST, ALT)
🔴 RATIONALE: Statins can cause hepatotoxicity, although it is rare. Liver function tests (AST, ALT) should be
