NR565 Advanced Pharmacology Fundamentals
Week 8 Final Exam Actual Exam 2026/2027 |
Questions with Verified Answers | 100% Correct |
Pass Guaranteed
SECTION 1: Prescribing Principles & Safety (15 Questions)
Q1: A 28-year-old woman with epilepsy controlled on lamotrigine 200 mg BID requests
prepregnancy counseling. She plans to conceive in 3 months. Which action is MOST
appropriate?
A. Continue lamotrigine at current dose throughout pregnancy
B. Switch to levetiracetam prior to conception due to more favorable pregnancy
pharmacokinetics and safety data
C. Discontinue all antiseizure drugs during the first trimester
D. Start folic acid 0.4 mg daily when she becomes pregnant
Correct Answer: B
Rationale: Guidance: AAN/ACOG recommend prepregnancy optimization. Lamotrigine
clearance ↑ 50-70% in pregnancy → risk of seizures. Levetiracetam has linear kinetics
and better pregnancy registry outcomes. Folic acid 4 mg daily should be started ≥1
,month pre-conception (not 0.4 mg). Monitoring: Drug levels q-trimester & 6 wk
post-partum. Black-Box: None for levetiracetam vs. dose-dependent lamotrigine skin
rash risk.
Q2: Which medication carries an FDA Black-Box warning for increased suicidal ideation
in young adults?
A. Metoprolol
B. Lisinopril
C. Sertraline
D. Metformin
Correct Answer: C
Rationale: FDA BBW: All SSRIs ↑ risk of suicidal thoughts in ages 18-24 during
initiation/dose changes. NP Action: Weekly face-to-face or telephone contact for first 4
weeks, then bi-weekly × 4 weeks. Document mood, agitation, akathisia. Distractors:
β-blockers, ACE-I, biguanides lack this warning.
Q3: A 45-year-old is started on clozapine for treatment-resistant schizophrenia.
Monitoring absolutely required by REMS is:
A. Monthly liver function tests
B. Weekly absolute neutrophil count (ANC) for 6 months, then bi-weekly
C. Quarterly ECG
D. Annual eye exams
, Correct Answer: B
Rationale: REMS Requirement: ANC baseline ≥ 1500/μL; weekly × 6 mo → bi-weekly × 6
mo → monthly after 1 yr. Hold if ANC < 1000; discontinue if < 500 or agranulocytosis.
Registry: Must document in Clozapine REMS before each dispense. Other labs: LFTs,
lipids, glucose are recommended but not REMS-mandated.
Q4: A 65-year-old with CKD stage 4 (eGFR 25 mL/min/1.73 m²) is prescribed metformin
1000 mg BID. The NP should:
A. Reduce dose to 500 mg daily
B. Stop metformin immediately; eGFR < 30 is contraindicated
C. Continue and monitor lactate monthly
D. Switch to extended-release at same dose
Correct Answer: B
Rationale: FDA BBW/2020 labeling: Metformin contraindicated if eGFR < 30 due to lactic
acidosis risk. Dose adjustment: 500 mg daily if eGFR 30-45; consider discontinuation if
eGFR < 45 and no benefit. Monitoring: Lactate levels not routine; watch for acidosis
symptoms. Distractors: Any dose (A, D) is unsafe; lactate (C) not sufficient safeguard.
Q5: A 70-year-old on warfarin (INR 2.3) is prescribed fluconazole 200 mg daily for 14
days. The most important action is:
A. Proceed as prescribed
B. Check INR in 3-5 days and reduce warfarin dose preemptively
Week 8 Final Exam Actual Exam 2026/2027 |
Questions with Verified Answers | 100% Correct |
Pass Guaranteed
SECTION 1: Prescribing Principles & Safety (15 Questions)
Q1: A 28-year-old woman with epilepsy controlled on lamotrigine 200 mg BID requests
prepregnancy counseling. She plans to conceive in 3 months. Which action is MOST
appropriate?
A. Continue lamotrigine at current dose throughout pregnancy
B. Switch to levetiracetam prior to conception due to more favorable pregnancy
pharmacokinetics and safety data
C. Discontinue all antiseizure drugs during the first trimester
D. Start folic acid 0.4 mg daily when she becomes pregnant
Correct Answer: B
Rationale: Guidance: AAN/ACOG recommend prepregnancy optimization. Lamotrigine
clearance ↑ 50-70% in pregnancy → risk of seizures. Levetiracetam has linear kinetics
and better pregnancy registry outcomes. Folic acid 4 mg daily should be started ≥1
,month pre-conception (not 0.4 mg). Monitoring: Drug levels q-trimester & 6 wk
post-partum. Black-Box: None for levetiracetam vs. dose-dependent lamotrigine skin
rash risk.
Q2: Which medication carries an FDA Black-Box warning for increased suicidal ideation
in young adults?
A. Metoprolol
B. Lisinopril
C. Sertraline
D. Metformin
Correct Answer: C
Rationale: FDA BBW: All SSRIs ↑ risk of suicidal thoughts in ages 18-24 during
initiation/dose changes. NP Action: Weekly face-to-face or telephone contact for first 4
weeks, then bi-weekly × 4 weeks. Document mood, agitation, akathisia. Distractors:
β-blockers, ACE-I, biguanides lack this warning.
Q3: A 45-year-old is started on clozapine for treatment-resistant schizophrenia.
Monitoring absolutely required by REMS is:
A. Monthly liver function tests
B. Weekly absolute neutrophil count (ANC) for 6 months, then bi-weekly
C. Quarterly ECG
D. Annual eye exams
, Correct Answer: B
Rationale: REMS Requirement: ANC baseline ≥ 1500/μL; weekly × 6 mo → bi-weekly × 6
mo → monthly after 1 yr. Hold if ANC < 1000; discontinue if < 500 or agranulocytosis.
Registry: Must document in Clozapine REMS before each dispense. Other labs: LFTs,
lipids, glucose are recommended but not REMS-mandated.
Q4: A 65-year-old with CKD stage 4 (eGFR 25 mL/min/1.73 m²) is prescribed metformin
1000 mg BID. The NP should:
A. Reduce dose to 500 mg daily
B. Stop metformin immediately; eGFR < 30 is contraindicated
C. Continue and monitor lactate monthly
D. Switch to extended-release at same dose
Correct Answer: B
Rationale: FDA BBW/2020 labeling: Metformin contraindicated if eGFR < 30 due to lactic
acidosis risk. Dose adjustment: 500 mg daily if eGFR 30-45; consider discontinuation if
eGFR < 45 and no benefit. Monitoring: Lactate levels not routine; watch for acidosis
symptoms. Distractors: Any dose (A, D) is unsafe; lactate (C) not sufficient safeguard.
Q5: A 70-year-old on warfarin (INR 2.3) is prescribed fluconazole 200 mg daily for 14
days. The most important action is:
A. Proceed as prescribed
B. Check INR in 3-5 days and reduce warfarin dose preemptively
