NR 508 Advanced Pharmacology Final
Exam 2025/2026 – Verified Questions
and Correct Answers | Chamberlain
Question 1
A nurse practitioner (NP) is prescribing for a patient with type 2 diabetes mellitus. Which
medication is first-line per ADA guidelines?
A. Insulin glargine
B. Glyburide
C. Metformin
D. Pioglitazone
Rationale: The American Diabetes Association (ADA) recommends metformin as the first-line
oral therapy for type 2 diabetes due to its efficacy in lowering A1C by 1-2%, favorable safety
profile, and low risk of hypoglycemia. It works by decreasing hepatic glucose production and
improving insulin sensitivity, as evidenced by randomized trials showing reduced cardiovascular
risk compared to sulfonylureas like glyburide.
Question 2
A patient with hypertension is started on lisinopril. What is the primary mechanism of action?
A. Blocks calcium channels
C. Inhibits angiotensin-converting enzyme
B. Acts as a beta-blocker
D. Inhibits sodium reabsorption
Rationale: Lisinopril, an ACE inhibitor, blocks the conversion of angiotensin I to II, reducing
vasoconstriction and aldosterone release, per JNC-8 guidelines. This lowers blood pressure with
evidence from trials showing a 10-15 mmHg systolic reduction in essential hypertension.
Question 3
Which adverse effect should an NP monitor for in a patient taking atorvastatin?
A. Hypoglycemia
B. Hyperkalemia
C. Myopathy
D. Bradycardia
Rationale: Statins like atorvastatin inhibit HMG-CoA reductase, reducing cholesterol synthesis
but risking myopathy (muscle pain or weakness) in 1-5% of patients, per ACC/AHA lipid
,guidelines. Monitoring creatine kinase and symptoms ensures safe prescribing, as
rhabdomyolysis is a rare but serious complication.
Question 4
A patient with asthma is prescribed albuterol. What is its drug class?
A. Anticholinergic
C. Short-acting beta-2 agonist
B. Leukotriene modifier
D. Corticosteroid
Rationale: Albuterol is a SABA, stimulating beta-2 receptors to relax bronchial smooth muscle
for rapid bronchodilation, per GINA asthma guidelines. It’s used for acute symptom relief, with
evidence showing peak effect in 5-20 minutes, unlike maintenance therapies like corticosteroids.
Question 5
For a patient with bipolar disorder, which mood stabilizer requires regular serum level
monitoring?
A. Lamotrigine
C. Lithium
B. Valproate
D. Carbamazepine
Rationale: Lithium’s narrow therapeutic index (0.6-1.2 mEq/L) necessitates regular monitoring
to prevent toxicity (tremor, nephrogenic diabetes insipidus), as per APA guidelines. Evidence
from trials supports its efficacy in mania but highlights risks requiring safe prescribing practices.
Question 6
A patient on warfarin requires a dose adjustment. What lab value guides this?
A. Platelet count
B. Hemoglobin
C. INR
D. aPTT
Rationale: Warfarin, a vitamin K antagonist, is monitored via INR (2-3 for most indications) to
balance anticoagulation and bleeding risk, per ACCP guidelines. INR reflects prothrombin time,
ensuring therapeutic efficacy in conditions like atrial fibrillation.
Question 7
Which antibiotic is contraindicated in a patient with a penicillin allergy?
A. Azithromycin
, B. Doxycycline
C. Amoxicillin
D. Levofloxacin
Rationale: Amoxicillin, a penicillin derivative, risks cross-reactivity in penicillin-allergic
patients (5-10% incidence), per IDSA guidelines. Non-beta-lactam antibiotics like azithromycin
are safer alternatives for infections like community-acquired pneumonia.
Question 8
An NP prescribes spironolactone for heart failure. What electrolyte should be monitored?
A. Sodium
C. Potassium
B. Calcium
D. Magnesium
Rationale: Spironolactone, a potassium-sparing diuretic, risks hyperkalemia, especially in heart
failure patients on ACE inhibitors, per ESC guidelines. Monitoring potassium prevents
arrhythmias, with evidence showing a 15% risk reduction in mortality when used appropriately.
Question 9
A patient with GERD is prescribed omeprazole. What is its mechanism?
A. Neutralizes gastric acid
B. Blocks histamine receptors
C. Inhibits proton pump
D. Enhances mucosal protection
Rationale: Omeprazole, a PPI, irreversibly inhibits H+/K+-ATPase in parietal cells, reducing
acid secretion by 90%, per ACG guidelines. It’s first-line for GERD, with trials showing superior
healing of esophagitis compared to H2 blockers like ranitidine.
Question 10
Which medication is first-line for generalized anxiety disorder?
A. Diazepam
B. Buspirone
C. Sertraline
D. Alprazolam
Rationale: SSRIs like sertraline are first-line per APA guidelines due to efficacy in reducing
anxiety symptoms (50-60% response rate) and lower dependence risk compared to
benzodiazepines like alprazolam. Sertraline enhances serotonin reuptake inhibition, supported by
RCT data.
Exam 2025/2026 – Verified Questions
and Correct Answers | Chamberlain
Question 1
A nurse practitioner (NP) is prescribing for a patient with type 2 diabetes mellitus. Which
medication is first-line per ADA guidelines?
A. Insulin glargine
B. Glyburide
C. Metformin
D. Pioglitazone
Rationale: The American Diabetes Association (ADA) recommends metformin as the first-line
oral therapy for type 2 diabetes due to its efficacy in lowering A1C by 1-2%, favorable safety
profile, and low risk of hypoglycemia. It works by decreasing hepatic glucose production and
improving insulin sensitivity, as evidenced by randomized trials showing reduced cardiovascular
risk compared to sulfonylureas like glyburide.
Question 2
A patient with hypertension is started on lisinopril. What is the primary mechanism of action?
A. Blocks calcium channels
C. Inhibits angiotensin-converting enzyme
B. Acts as a beta-blocker
D. Inhibits sodium reabsorption
Rationale: Lisinopril, an ACE inhibitor, blocks the conversion of angiotensin I to II, reducing
vasoconstriction and aldosterone release, per JNC-8 guidelines. This lowers blood pressure with
evidence from trials showing a 10-15 mmHg systolic reduction in essential hypertension.
Question 3
Which adverse effect should an NP monitor for in a patient taking atorvastatin?
A. Hypoglycemia
B. Hyperkalemia
C. Myopathy
D. Bradycardia
Rationale: Statins like atorvastatin inhibit HMG-CoA reductase, reducing cholesterol synthesis
but risking myopathy (muscle pain or weakness) in 1-5% of patients, per ACC/AHA lipid
,guidelines. Monitoring creatine kinase and symptoms ensures safe prescribing, as
rhabdomyolysis is a rare but serious complication.
Question 4
A patient with asthma is prescribed albuterol. What is its drug class?
A. Anticholinergic
C. Short-acting beta-2 agonist
B. Leukotriene modifier
D. Corticosteroid
Rationale: Albuterol is a SABA, stimulating beta-2 receptors to relax bronchial smooth muscle
for rapid bronchodilation, per GINA asthma guidelines. It’s used for acute symptom relief, with
evidence showing peak effect in 5-20 minutes, unlike maintenance therapies like corticosteroids.
Question 5
For a patient with bipolar disorder, which mood stabilizer requires regular serum level
monitoring?
A. Lamotrigine
C. Lithium
B. Valproate
D. Carbamazepine
Rationale: Lithium’s narrow therapeutic index (0.6-1.2 mEq/L) necessitates regular monitoring
to prevent toxicity (tremor, nephrogenic diabetes insipidus), as per APA guidelines. Evidence
from trials supports its efficacy in mania but highlights risks requiring safe prescribing practices.
Question 6
A patient on warfarin requires a dose adjustment. What lab value guides this?
A. Platelet count
B. Hemoglobin
C. INR
D. aPTT
Rationale: Warfarin, a vitamin K antagonist, is monitored via INR (2-3 for most indications) to
balance anticoagulation and bleeding risk, per ACCP guidelines. INR reflects prothrombin time,
ensuring therapeutic efficacy in conditions like atrial fibrillation.
Question 7
Which antibiotic is contraindicated in a patient with a penicillin allergy?
A. Azithromycin
, B. Doxycycline
C. Amoxicillin
D. Levofloxacin
Rationale: Amoxicillin, a penicillin derivative, risks cross-reactivity in penicillin-allergic
patients (5-10% incidence), per IDSA guidelines. Non-beta-lactam antibiotics like azithromycin
are safer alternatives for infections like community-acquired pneumonia.
Question 8
An NP prescribes spironolactone for heart failure. What electrolyte should be monitored?
A. Sodium
C. Potassium
B. Calcium
D. Magnesium
Rationale: Spironolactone, a potassium-sparing diuretic, risks hyperkalemia, especially in heart
failure patients on ACE inhibitors, per ESC guidelines. Monitoring potassium prevents
arrhythmias, with evidence showing a 15% risk reduction in mortality when used appropriately.
Question 9
A patient with GERD is prescribed omeprazole. What is its mechanism?
A. Neutralizes gastric acid
B. Blocks histamine receptors
C. Inhibits proton pump
D. Enhances mucosal protection
Rationale: Omeprazole, a PPI, irreversibly inhibits H+/K+-ATPase in parietal cells, reducing
acid secretion by 90%, per ACG guidelines. It’s first-line for GERD, with trials showing superior
healing of esophagitis compared to H2 blockers like ranitidine.
Question 10
Which medication is first-line for generalized anxiety disorder?
A. Diazepam
B. Buspirone
C. Sertraline
D. Alprazolam
Rationale: SSRIs like sertraline are first-line per APA guidelines due to efficacy in reducing
anxiety symptoms (50-60% response rate) and lower dependence risk compared to
benzodiazepines like alprazolam. Sertraline enhances serotonin reuptake inhibition, supported by
RCT data.
