NR565 Advanced Pharmacology Fundamentals
Final Exam - 2026-2027 | Core Principles &
Prescribing Mastery
Chamberlain University | 60 integrative items | APRN board-level rigor
DOMAIN 1 ‑ PK/PD & Autonomic Nervous System (15 Qs)
Q1. A 72-year-old man with AF starts warfarin. He takes cimetidine for GERD. Cimetidine
increases warfarin effect by:
A. Inducing CYP2C9
B. Inhibiting CYP2C9 (correct)
C. Competing for plasma protein binding
D. ↑ renal excretion
Rationale: Cimetidine inhibits CYP450 → ↓ warfarin metabolism → ↑ INR/bleed risk.
Q2. A 65-year-old woman with T2DM (A1c 7.8 %) on metformin 1 g BID develops AKI (Cr
2.4 mg/dL). Most appropriate action?
A. Continue current dose
B. Reduce to 500 mg daily
C. Stop metformin (correct)
,D. Switch to insulin glargine
Rationale: Metformin contraindicated if eGFR <30 (lactic acidosis risk).
Q3. A 58-year-old man with HTN on atenolol 50 mg daily has BP 150/90. HR 48. Best
explanation for suboptimal control?
A. Atenolol peak effect missed
B. Atenolol reduces CO via β1 block → limits dose titration (correct)
C. Atenolol is α-agonist
D. Atenolol induces vasodilation
Rationale: β1-blockade lowers HR/CO; bradycardia prevents up-titration.
Q4. A 28-year-old woman with asthma uses ipratropium PRN. Which receptor mediates
bronchodilation?
A. M₁ antagonism
B. M₂ antagonism
C. M₃ antagonism (correct)
D. β₂ agonism
Rationale: Ipratropium blocks M₃ on airway smooth muscle → ↓ cGMP → dilation.
Q5. A 6-year-old (20 kg) needs PO phenytoin 5 mg/kg BID. Stock is 125 mg/5 mL.
Volume per dose?
A. 2 mL
, B. 4 mL (correct)
C. 6 mL
D. 8 mL
Rationale: 5 mg/kg × 20 kg = 100 mg; 125 mg/5 mL → (100/125) × 5 = 4 mL.
Q6. A 70-year-old man with BPH starts tamsulosin. Which adverse effect requires
teaching?
A. Urinary frequency
B. Retrograde ejaculation (correct)
C. HTN
D. Bradycardia
Rationale: α1A-selective blockade in bladder neck/proximal urethra → ejaculatory
dysfunction.
Q7. A 45-year-old woman with HTN on lisinopril 10 mg daily has K 5.8 mEq/L, Cr 1.8
mg/dL. Next step?
A. Increase lisinopril to 20 mg
B. Add HCTZ 25 mg
C. Stop lisinopril (correct)
D. Give kayexalate
Rationale: ACEi-induced hyperkalemia + AKI → hold drug first.
Final Exam - 2026-2027 | Core Principles &
Prescribing Mastery
Chamberlain University | 60 integrative items | APRN board-level rigor
DOMAIN 1 ‑ PK/PD & Autonomic Nervous System (15 Qs)
Q1. A 72-year-old man with AF starts warfarin. He takes cimetidine for GERD. Cimetidine
increases warfarin effect by:
A. Inducing CYP2C9
B. Inhibiting CYP2C9 (correct)
C. Competing for plasma protein binding
D. ↑ renal excretion
Rationale: Cimetidine inhibits CYP450 → ↓ warfarin metabolism → ↑ INR/bleed risk.
Q2. A 65-year-old woman with T2DM (A1c 7.8 %) on metformin 1 g BID develops AKI (Cr
2.4 mg/dL). Most appropriate action?
A. Continue current dose
B. Reduce to 500 mg daily
C. Stop metformin (correct)
,D. Switch to insulin glargine
Rationale: Metformin contraindicated if eGFR <30 (lactic acidosis risk).
Q3. A 58-year-old man with HTN on atenolol 50 mg daily has BP 150/90. HR 48. Best
explanation for suboptimal control?
A. Atenolol peak effect missed
B. Atenolol reduces CO via β1 block → limits dose titration (correct)
C. Atenolol is α-agonist
D. Atenolol induces vasodilation
Rationale: β1-blockade lowers HR/CO; bradycardia prevents up-titration.
Q4. A 28-year-old woman with asthma uses ipratropium PRN. Which receptor mediates
bronchodilation?
A. M₁ antagonism
B. M₂ antagonism
C. M₃ antagonism (correct)
D. β₂ agonism
Rationale: Ipratropium blocks M₃ on airway smooth muscle → ↓ cGMP → dilation.
Q5. A 6-year-old (20 kg) needs PO phenytoin 5 mg/kg BID. Stock is 125 mg/5 mL.
Volume per dose?
A. 2 mL
, B. 4 mL (correct)
C. 6 mL
D. 8 mL
Rationale: 5 mg/kg × 20 kg = 100 mg; 125 mg/5 mL → (100/125) × 5 = 4 mL.
Q6. A 70-year-old man with BPH starts tamsulosin. Which adverse effect requires
teaching?
A. Urinary frequency
B. Retrograde ejaculation (correct)
C. HTN
D. Bradycardia
Rationale: α1A-selective blockade in bladder neck/proximal urethra → ejaculatory
dysfunction.
Q7. A 45-year-old woman with HTN on lisinopril 10 mg daily has K 5.8 mEq/L, Cr 1.8
mg/dL. Next step?
A. Increase lisinopril to 20 mg
B. Add HCTZ 25 mg
C. Stop lisinopril (correct)
D. Give kayexalate
Rationale: ACEi-induced hyperkalemia + AKI → hold drug first.
