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NR568 Final Exam (2024/2025 Update) –
Advanced Pharmacology for Adult-Gerontology
Primary Care NP | Chamberlain – Verified
Questions and Correct Answers
Question 1: Medication Administration
A 65-year-old patient is prescribed lisinopril for hypertension. Which baseline assessment is
most important before initiating therapy?
A. Blood glucose level.
B. Serum potassium level.
C. Liver function tests.
D. Complete blood count.
Correct Answer: B
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia, especially in older adults or
those with renal impairment. Monitoring serum potassium (B) is critical before starting therapy.
Blood glucose (A) is not directly affected. Liver function (C) is less relevant for lisinopril. A
complete blood count (D) is not a primary concern. Red: Monitoring potassium prevents life-
threatening arrhythmias due to hyperkalemia.
Question 2: Adverse Effects
A patient on sertraline reports nausea and insomnia. What is the nurse practitioner’s best action?
A. Discontinue sertraline immediately.
B. Educate the patient about managing side effects and monitor.
C. Switch to a different SSRI without consultation.
D. Administer a PRN benzodiazepine.
Correct Answer: B
Rationale: Nausea and insomnia are common side effects of sertraline, an SSRI, and often
improve with time. Education and monitoring (B) are appropriate initial steps. Discontinuing (A)
or switching (C) without provider guidance is premature. Benzodiazepines (D) are not indicated
for these side effects. Red: Patient education supports adherence while monitoring ensures
side effects do not worsen.
Question 3: Drug Interactions
, 2
A patient on warfarin is prescribed fluconazole. What should the nurse practitioner monitor for?
A. Hypoglycemia.
B. Increased INR levels.
C. Hyperkalemia.
D. Bradycardia.
Correct Answer: B
Rationale: Fluconazole inhibits CYP2C9, increasing warfarin’s anticoagulant effect and INR
levels, risking bleeding (B). Hypoglycemia (A), hyperkalemia (C), and bradycardia (D) are not
primary concerns with this interaction. Red: Monitoring INR prevents bleeding complications
from enhanced anticoagulation.
Question 4: Client Education
A patient is prescribed metformin for type 2 diabetes. Which instruction should the nurse
practitioner include?
A. Take the medication on an empty stomach.
B. Take the medication with meals to reduce gastrointestinal upset.
C. Expect weight gain as a side effect.
D. Stop the medication if mild diarrhea occurs.
Correct Answer: B
Rationale: Metformin should be taken with meals (B) to minimize gastrointestinal side effects
like nausea or diarrhea. Taking it on an empty stomach (A) increases side effects. Weight gain
(C) is not typical; metformin may promote weight loss. Stopping for mild diarrhea (D) is
unnecessary without provider guidance. Red: Proper administration enhances adherence and
reduces side effects.
Question 5: Pharmacodynamics
Which medication is most likely to cause orthostatic hypotension in an older adult?
A. Metformin.
B. Amlodipine.
C. Levothyroxine.
D. Albuterol.
Correct Answer: B
Rationale: Amlodipine, a calcium channel blocker, can cause vasodilation, leading to orthostatic
hypotension, especially in older adults (B). Metformin (A), levothyroxine (C), and albuterol (D)
do not typically cause this effect. Red: Recognizing this risk helps prevent falls in older
adults.
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Question 6: Pharmacokinetics
A patient with renal impairment is prescribed a medication. Which drug requires dose adjustment
due to decreased clearance?
A. Lorazepam.
B. Enalapril.
C. Prednisone.
D. Sertraline.
Correct Answer: B
Rationale: Enalapril, an ACE inhibitor, is renally cleared and requires dose adjustment in renal
impairment (B). Lorazepam (A) is metabolized by the liver, prednisone (C) is not primarily
renally cleared, and sertraline (D) has minimal renal excretion. Red: Dose adjustments prevent
toxicity in renal impairment.
Question 7: Adverse Effects
A patient on clozapine develops a fever and sore throat. What is the nurse practitioner’s priority
action?
A. Administer an antipyretic.
B. Obtain a complete blood count (CBC).
C. Encourage fluid intake.
D. Reassure the patient that this is temporary.
Correct Answer: B
Rationale: Fever and sore throat in a patient on clozapine may indicate agranulocytosis, a life-
threatening side effect requiring a CBC to check white blood cell counts (B). Antipyretics (A)
and fluids (C) are secondary. Reassurance (D) dismisses a serious concern. Red: Early
detection of agranulocytosis prevents severe complications.
Question 8: Drug Interactions
A patient on phenytoin is prescribed cimetidine. What should the nurse practitioner monitor for?
A. Decreased seizure control.
B. Increased phenytoin levels.
C. Hypotension.
D. Hypoglycemia.
Correct Answer: B
Rationale: Cimetidine inhibits phenytoin metabolism, increasing phenytoin levels and risking
toxicity (B). Decreased seizure control (A) is unlikely. Hypotension (C) and hypoglycemia (D)
are not primary concerns. Red: Monitoring phenytoin levels prevents toxicity symptoms like
ataxia or nystagmus.
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Question 9: Client Education
A patient is prescribed albuterol for asthma. Which statement indicates understanding of the
teaching?
A. “I will take this medication daily to prevent asthma attacks.”
B. “I will use this inhaler when I have trouble breathing.”
C. “I should expect weight gain with this medication.”
D. “I will stop using it if I feel shaky.”
Correct Answer: B
Rationale: Albuterol, a short-acting beta-agonist, is used as needed for acute asthma symptoms
(B). It is not a daily controller (A). Weight gain (C) is not a side effect. Shaking (D) is a common
side effect that does not warrant stopping without provider guidance. Red: Proper use ensures
effective symptom relief and adherence.
Question 10: Medication Administration
A nurse practitioner is prescribing levothyroxine. Which instruction is correct for administration?
A. Take at bedtime with food.
B. Take on an empty stomach in the morning.
C. Take with calcium supplements to enhance absorption.
D. Take every other day to prevent toxicity.
Correct Answer: B
Rationale: Levothyroxine is best absorbed on an empty stomach in the morning (B) to ensure
consistent levels. Taking with food (A) or calcium (C) reduces absorption. Daily dosing (D) is
required for efficacy. Red: Correct administration optimizes thyroid hormone replacement.
Question 11: Adverse Effects
A patient on atorvastatin reports muscle pain and weakness. What is the nurse practitioner’s
priority action?
A. Encourage increased physical activity.
B. Check creatine kinase (CK) levels.
C. Reassure the patient that this is normal.
D. Administer a PRN analgesic.
Correct Answer: B
Rationale: Muscle pain and weakness with atorvastatin suggest myopathy or rhabdomyolysis,
requiring CK level evaluation (B). Activity (A) may worsen symptoms. Reassurance (C)
dismisses a serious concern. Analgesics (D) do not address the underlying issue. Red: Early
detection prevents progression to rhabdomyolysis.
NR568 Final Exam (2024/2025 Update) –
Advanced Pharmacology for Adult-Gerontology
Primary Care NP | Chamberlain – Verified
Questions and Correct Answers
Question 1: Medication Administration
A 65-year-old patient is prescribed lisinopril for hypertension. Which baseline assessment is
most important before initiating therapy?
A. Blood glucose level.
B. Serum potassium level.
C. Liver function tests.
D. Complete blood count.
Correct Answer: B
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia, especially in older adults or
those with renal impairment. Monitoring serum potassium (B) is critical before starting therapy.
Blood glucose (A) is not directly affected. Liver function (C) is less relevant for lisinopril. A
complete blood count (D) is not a primary concern. Red: Monitoring potassium prevents life-
threatening arrhythmias due to hyperkalemia.
Question 2: Adverse Effects
A patient on sertraline reports nausea and insomnia. What is the nurse practitioner’s best action?
A. Discontinue sertraline immediately.
B. Educate the patient about managing side effects and monitor.
C. Switch to a different SSRI without consultation.
D. Administer a PRN benzodiazepine.
Correct Answer: B
Rationale: Nausea and insomnia are common side effects of sertraline, an SSRI, and often
improve with time. Education and monitoring (B) are appropriate initial steps. Discontinuing (A)
or switching (C) without provider guidance is premature. Benzodiazepines (D) are not indicated
for these side effects. Red: Patient education supports adherence while monitoring ensures
side effects do not worsen.
Question 3: Drug Interactions
, 2
A patient on warfarin is prescribed fluconazole. What should the nurse practitioner monitor for?
A. Hypoglycemia.
B. Increased INR levels.
C. Hyperkalemia.
D. Bradycardia.
Correct Answer: B
Rationale: Fluconazole inhibits CYP2C9, increasing warfarin’s anticoagulant effect and INR
levels, risking bleeding (B). Hypoglycemia (A), hyperkalemia (C), and bradycardia (D) are not
primary concerns with this interaction. Red: Monitoring INR prevents bleeding complications
from enhanced anticoagulation.
Question 4: Client Education
A patient is prescribed metformin for type 2 diabetes. Which instruction should the nurse
practitioner include?
A. Take the medication on an empty stomach.
B. Take the medication with meals to reduce gastrointestinal upset.
C. Expect weight gain as a side effect.
D. Stop the medication if mild diarrhea occurs.
Correct Answer: B
Rationale: Metformin should be taken with meals (B) to minimize gastrointestinal side effects
like nausea or diarrhea. Taking it on an empty stomach (A) increases side effects. Weight gain
(C) is not typical; metformin may promote weight loss. Stopping for mild diarrhea (D) is
unnecessary without provider guidance. Red: Proper administration enhances adherence and
reduces side effects.
Question 5: Pharmacodynamics
Which medication is most likely to cause orthostatic hypotension in an older adult?
A. Metformin.
B. Amlodipine.
C. Levothyroxine.
D. Albuterol.
Correct Answer: B
Rationale: Amlodipine, a calcium channel blocker, can cause vasodilation, leading to orthostatic
hypotension, especially in older adults (B). Metformin (A), levothyroxine (C), and albuterol (D)
do not typically cause this effect. Red: Recognizing this risk helps prevent falls in older
adults.
, 3
Question 6: Pharmacokinetics
A patient with renal impairment is prescribed a medication. Which drug requires dose adjustment
due to decreased clearance?
A. Lorazepam.
B. Enalapril.
C. Prednisone.
D. Sertraline.
Correct Answer: B
Rationale: Enalapril, an ACE inhibitor, is renally cleared and requires dose adjustment in renal
impairment (B). Lorazepam (A) is metabolized by the liver, prednisone (C) is not primarily
renally cleared, and sertraline (D) has minimal renal excretion. Red: Dose adjustments prevent
toxicity in renal impairment.
Question 7: Adverse Effects
A patient on clozapine develops a fever and sore throat. What is the nurse practitioner’s priority
action?
A. Administer an antipyretic.
B. Obtain a complete blood count (CBC).
C. Encourage fluid intake.
D. Reassure the patient that this is temporary.
Correct Answer: B
Rationale: Fever and sore throat in a patient on clozapine may indicate agranulocytosis, a life-
threatening side effect requiring a CBC to check white blood cell counts (B). Antipyretics (A)
and fluids (C) are secondary. Reassurance (D) dismisses a serious concern. Red: Early
detection of agranulocytosis prevents severe complications.
Question 8: Drug Interactions
A patient on phenytoin is prescribed cimetidine. What should the nurse practitioner monitor for?
A. Decreased seizure control.
B. Increased phenytoin levels.
C. Hypotension.
D. Hypoglycemia.
Correct Answer: B
Rationale: Cimetidine inhibits phenytoin metabolism, increasing phenytoin levels and risking
toxicity (B). Decreased seizure control (A) is unlikely. Hypotension (C) and hypoglycemia (D)
are not primary concerns. Red: Monitoring phenytoin levels prevents toxicity symptoms like
ataxia or nystagmus.
, 4
Question 9: Client Education
A patient is prescribed albuterol for asthma. Which statement indicates understanding of the
teaching?
A. “I will take this medication daily to prevent asthma attacks.”
B. “I will use this inhaler when I have trouble breathing.”
C. “I should expect weight gain with this medication.”
D. “I will stop using it if I feel shaky.”
Correct Answer: B
Rationale: Albuterol, a short-acting beta-agonist, is used as needed for acute asthma symptoms
(B). It is not a daily controller (A). Weight gain (C) is not a side effect. Shaking (D) is a common
side effect that does not warrant stopping without provider guidance. Red: Proper use ensures
effective symptom relief and adherence.
Question 10: Medication Administration
A nurse practitioner is prescribing levothyroxine. Which instruction is correct for administration?
A. Take at bedtime with food.
B. Take on an empty stomach in the morning.
C. Take with calcium supplements to enhance absorption.
D. Take every other day to prevent toxicity.
Correct Answer: B
Rationale: Levothyroxine is best absorbed on an empty stomach in the morning (B) to ensure
consistent levels. Taking with food (A) or calcium (C) reduces absorption. Daily dosing (D) is
required for efficacy. Red: Correct administration optimizes thyroid hormone replacement.
Question 11: Adverse Effects
A patient on atorvastatin reports muscle pain and weakness. What is the nurse practitioner’s
priority action?
A. Encourage increased physical activity.
B. Check creatine kinase (CK) levels.
C. Reassure the patient that this is normal.
D. Administer a PRN analgesic.
Correct Answer: B
Rationale: Muscle pain and weakness with atorvastatin suggest myopathy or rhabdomyolysis,
requiring CK level evaluation (B). Activity (A) may worsen symptoms. Reassurance (C)
dismisses a serious concern. Analgesics (D) do not address the underlying issue. Red: Early
detection prevents progression to rhabdomyolysis.
