NR 568 Advanced Pharmacology for the
AGPCNP ACTUAL EXAM 2025/2026 |
Midterm Exam Comprehensive Review |
Chamberlain University | New Update |
Verified Q&A | Pass Guaranteed - A+
Graded
UNIT 1: PHARMACOKINETICS AND
PHARMACODYNAMICS IN THE OLDER
ADULT (20 Questions)
Q1: An 82-year-old patient with chronic kidney disease (eGFR 35 mL/min) is prescribed a
medication that is primarily renally eliminated. Which adjustment is most appropriate?
A. Standard loading dose, decreased maintenance dose [CORRECT]
B. Standard loading and maintenance doses with increased monitoring
C. Decreased loading dose, standard maintenance dose
D. Increased loading dose to achieve therapeutic levels
,Rationale: In renal impairment, the loading dose typically remains unchanged because it depends
on volume of distribution. The maintenance dose should be reduced based on renal function to
prevent drug accumulation and toxicity. Standard doses (B) risk toxicity. Decreased loading dose
(C) may result in subtherapeutic levels. Increased loading dose (D) increases toxicity risk without
benefit.
Chamberlain Note: Remember "Loading stays, maintenance decreases" for renal dosing.
Q2: According to the Beers Criteria, which medication class should generally be avoided in older
adults due to increased risk of falls, cognitive impairment, and delirium?
A. ACE inhibitors
B. Benzodiazepines [CORRECT]
C. Statins
D. Beta-blockers
Rationale: Benzodiazepines are listed as potentially inappropriate in the Beers Criteria due to
increased risk of falls, fractures, cognitive impairment, delirium, and dependence. ACE inhibitors
(A), statins (C), and beta-blockers (D) are not categorically avoided but require monitoring.
Q3: Which age-related change in pharmacokinetics results in increased volume of distribution for
lipophilic drugs?
A. Decreased gastric pH
B. Decreased hepatic blood flow
C. Increased body fat percentage [CORRECT]
D. Decreased plasma albumin
,Rationale: Older adults have increased body fat (from 18-36% in men, 33-45% in women) and
decreased lean body mass. Lipophilic drugs distribute more extensively into adipose tissue,
increasing volume of distribution. Decreased gastric pH (A) affects absorption. Decreased hepatic
blood flow (B) affects metabolism. Decreased plasma albumin (D) increases free drug
concentration for protein-bound drugs.
Q4: A 78-year-old patient is prescribed warfarin. Which age-related pharmacokinetic change
increases the risk of bleeding?
A. Increased gastric emptying time
B. Decreased CYP450 enzyme activity [CORRECT]
C. Increased creatinine clearance
D. Increased lean body mass
Rationale: Decreased CYP450 enzyme activity in older adults impairs metabolism of drugs like
warfarin (metabolized by CYP2C9), leading to increased drug levels and bleeding risk. Increased
gastric emptying time (A) is incorrect—gastric emptying is decreased. Creatinine clearance (C) and
lean body mass (D) both decrease with age.
Q5: Which pharmacodynamic change in older adults increases sensitivity to CNS depressants?
A. Decreased number of CNS receptors
B. Increased blood-brain barrier permeability
C. Decreased receptor affinity
D. Altered receptor sensitivity and homeostatic mechanisms [CORRECT]
, Rationale: Older adults exhibit increased sensitivity to CNS drugs due to altered receptor
sensitivity, changes in neurotransmitter systems, and impaired homeostatic mechanisms—not
necessarily changes in receptor number or affinity. The blood-brain barrier remains relatively
intact.
Q6: According to START/STOPP criteria, which scenario represents potentially inappropriate
prescribing?
A. Prescribing aspirin for secondary prevention of myocardial infarction
B. Prescribing donepezil for mild-to-moderate Alzheimer's dementia
C. Prescribing a long-acting benzodiazepine for insomnia in an older adult [CORRECT]
D. Prescribing metformin for type 2 diabetes with eGFR >45 mL/min
Rationale: STOPP criteria identify potentially inappropriate medications. Long-acting
benzodiazepines should be avoided in older adults due to prolonged sedation, falls, and cognitive
impairment. Aspirin for secondary prevention (A), donepezil for dementia (B), and metformin with
adequate renal function (D) are all appropriate.
Q7: Which statement best describes polypharmacy in the older adult population?
A. The use of any prescription medication in adults over 65
B. The concurrent use of 5 or more medications [CORRECT]
C. The use of potentially inappropriate medications only
D. The unnecessary duplication of drug classes
AGPCNP ACTUAL EXAM 2025/2026 |
Midterm Exam Comprehensive Review |
Chamberlain University | New Update |
Verified Q&A | Pass Guaranteed - A+
Graded
UNIT 1: PHARMACOKINETICS AND
PHARMACODYNAMICS IN THE OLDER
ADULT (20 Questions)
Q1: An 82-year-old patient with chronic kidney disease (eGFR 35 mL/min) is prescribed a
medication that is primarily renally eliminated. Which adjustment is most appropriate?
A. Standard loading dose, decreased maintenance dose [CORRECT]
B. Standard loading and maintenance doses with increased monitoring
C. Decreased loading dose, standard maintenance dose
D. Increased loading dose to achieve therapeutic levels
,Rationale: In renal impairment, the loading dose typically remains unchanged because it depends
on volume of distribution. The maintenance dose should be reduced based on renal function to
prevent drug accumulation and toxicity. Standard doses (B) risk toxicity. Decreased loading dose
(C) may result in subtherapeutic levels. Increased loading dose (D) increases toxicity risk without
benefit.
Chamberlain Note: Remember "Loading stays, maintenance decreases" for renal dosing.
Q2: According to the Beers Criteria, which medication class should generally be avoided in older
adults due to increased risk of falls, cognitive impairment, and delirium?
A. ACE inhibitors
B. Benzodiazepines [CORRECT]
C. Statins
D. Beta-blockers
Rationale: Benzodiazepines are listed as potentially inappropriate in the Beers Criteria due to
increased risk of falls, fractures, cognitive impairment, delirium, and dependence. ACE inhibitors
(A), statins (C), and beta-blockers (D) are not categorically avoided but require monitoring.
Q3: Which age-related change in pharmacokinetics results in increased volume of distribution for
lipophilic drugs?
A. Decreased gastric pH
B. Decreased hepatic blood flow
C. Increased body fat percentage [CORRECT]
D. Decreased plasma albumin
,Rationale: Older adults have increased body fat (from 18-36% in men, 33-45% in women) and
decreased lean body mass. Lipophilic drugs distribute more extensively into adipose tissue,
increasing volume of distribution. Decreased gastric pH (A) affects absorption. Decreased hepatic
blood flow (B) affects metabolism. Decreased plasma albumin (D) increases free drug
concentration for protein-bound drugs.
Q4: A 78-year-old patient is prescribed warfarin. Which age-related pharmacokinetic change
increases the risk of bleeding?
A. Increased gastric emptying time
B. Decreased CYP450 enzyme activity [CORRECT]
C. Increased creatinine clearance
D. Increased lean body mass
Rationale: Decreased CYP450 enzyme activity in older adults impairs metabolism of drugs like
warfarin (metabolized by CYP2C9), leading to increased drug levels and bleeding risk. Increased
gastric emptying time (A) is incorrect—gastric emptying is decreased. Creatinine clearance (C) and
lean body mass (D) both decrease with age.
Q5: Which pharmacodynamic change in older adults increases sensitivity to CNS depressants?
A. Decreased number of CNS receptors
B. Increased blood-brain barrier permeability
C. Decreased receptor affinity
D. Altered receptor sensitivity and homeostatic mechanisms [CORRECT]
, Rationale: Older adults exhibit increased sensitivity to CNS drugs due to altered receptor
sensitivity, changes in neurotransmitter systems, and impaired homeostatic mechanisms—not
necessarily changes in receptor number or affinity. The blood-brain barrier remains relatively
intact.
Q6: According to START/STOPP criteria, which scenario represents potentially inappropriate
prescribing?
A. Prescribing aspirin for secondary prevention of myocardial infarction
B. Prescribing donepezil for mild-to-moderate Alzheimer's dementia
C. Prescribing a long-acting benzodiazepine for insomnia in an older adult [CORRECT]
D. Prescribing metformin for type 2 diabetes with eGFR >45 mL/min
Rationale: STOPP criteria identify potentially inappropriate medications. Long-acting
benzodiazepines should be avoided in older adults due to prolonged sedation, falls, and cognitive
impairment. Aspirin for secondary prevention (A), donepezil for dementia (B), and metformin with
adequate renal function (D) are all appropriate.
Q7: Which statement best describes polypharmacy in the older adult population?
A. The use of any prescription medication in adults over 65
B. The concurrent use of 5 or more medications [CORRECT]
C. The use of potentially inappropriate medications only
D. The unnecessary duplication of drug classes
