Prescribing for Nurse Practitioners – 150- Question Drug Safety Test Bank (Updated)Answers And Rationale Included (2025/2026)

Prescribing for Nurse Practitioners – 150-
Question Drug Safety Test Bank
(Updated)Answers And Rationale Included
(2025/2026)

1. Which of the following is the most appropriate first-line treatment
for uncomplicated hypertension in an adult patient without
comorbidities?
A) Lisinopril
B) Hydrochlorothiazide
C) Atenolol
D) Clonidine
Rationale: Thiazide diuretics are recommended as first-line therapy for
uncomplicated hypertension according to most guidelines due to
efficacy and cardiovascular outcome benefits.
2. A patient on warfarin presents with an elevated INR of 5.2 but no
bleeding. The best next step is:
A) Continue current dose
B) Hold warfarin and monitor INR
C) Administer vitamin K immediately
D) Increase warfarin dose
Rationale: For INR >4.5 without bleeding, guidelines recommend
holding the dose and close monitoring. Vitamin K is reserved for higher
INR or bleeding.
3. Which of the following medications is most likely to cause drug-
induced lupus?
A) Methotrexate

,B) Hydralazine
C) Ibuprofen
D) Prednisone
Rationale: Hydralazine and procainamide are classic causes of drug-
induced lupus; monitoring for symptoms is important.
4. Which antibiotic is contraindicated in pregnancy due to risk of
permanent tooth discoloration in the fetus?
A) Penicillin
B) Cephalexin
C) Tetracycline
D) Azithromycin
Rationale: Tetracyclines cross the placenta and can cause permanent
teeth discoloration and inhibition of bone growth.
5. A patient develops a maculopapular rash after starting lamotrigine.
The best next action is:
A) Continue therapy
B) Reduce dose
C) Discontinue immediately
D) Switch to another anticonvulsant after 1 week
Rationale: Lamotrigine can cause severe cutaneous reactions including
Stevens-Johnson syndrome; discontinuation is required at the first sign
of rash.
6. Which medication requires regular serum level monitoring due to
narrow therapeutic index?
A) Lisinopril
B) Metformin
C) Lithium
D) Amlodipine

,Rationale: Lithium has a narrow therapeutic index; levels must be
monitored to avoid toxicity.
7. Which of the following is a high-alert medication requiring two
identifiers for administration?
A) Acetaminophen
B) Heparin
C) Ibuprofen
D) Loratadine
Rationale: Heparin is considered high-alert due to risk of fatal errors;
protocols require verification with two patient identifiers.
8. A 65-year-old patient with chronic kidney disease (CKD) requires pain
management. Which medication should be avoided?
A) Acetaminophen
B) NSAIDs
C) Opioids (adjusted)
D) Topical analgesics
Rationale: NSAIDs can worsen kidney function in CKD patients;
acetaminophen and adjusted opioids are safer.
9. Which class of drugs is most likely to cause QT prolongation?
A) Beta-blockers
B) ACE inhibitors
C) Macrolide antibiotics
D) Diuretics
Rationale: Macrolides (e.g., azithromycin, erythromycin) and some
fluoroquinolones can prolong the QT interval, increasing arrhythmia
risk.
10. Which is the most appropriate counseling point for a patient
starting ACE inhibitors?

, A) Report persistent dry cough
B) Avoid sun exposure
C) Take with grapefruit juice
D) Limit potassium intake to zero
Rationale: ACE inhibitors can cause a persistent dry cough due to
increased bradykinin; patients should be counseled to report this.
11. Which anticoagulant is safe for use in pregnancy for
thromboprophylaxis?
A) Warfarin
B) Dabigatran
C) Rivaroxaban
D) Heparin
Rationale: Heparin does not cross the placenta, making it safe for
anticoagulation during pregnancy.
12. A patient on digoxin presents with nausea, vomiting, and visual
disturbances. The likely cause is:
A) Hypokalemia
B) Digoxin toxicity
C) Hyperthyroidism
D) Renal failure
Rationale: Digoxin toxicity often presents with GI and visual symptoms;
monitoring levels and electrolytes is essential.
13. Which of the following drugs is most likely to cause serotonin
syndrome when combined with SSRIs?
A) Tramadol
B) Ibuprofen
C) Furosemide
D) Atenolol