NR 508 Advanced Pharmacology Final Exam 2025
A patient is diagnosed as having stage 2 Alzheimer’s disease and elects to take donepezil
(Aricept). The patient asks the primary care nurse practitioner (NP) how long the
medication will be needed. The NP should tell the patient that donepezil must be taken:
Answer: Indefinitely, as long as it provides benefit.
RATIONALE: Donepezil is used to manage symptoms of Alzheimer’s disease and is
typically continued as long as it provides symptomatic improvement.
A 45-year-old patient with type 2 diabetes mellitus is started on metformin. The primary
care NP should advise the patient to:
A. Take the medication with meals to reduce gastrointestinal side effects.
B. Avoid all carbohydrates while on metformin.
C. Stop taking the medication if they experience hypoglycemia.
D. Take the medication only at bedtime.
Answer: A. Take the medication with meals to reduce gastrointestinal side effects.
RATIONALE: Metformin commonly causes GI side effects like nausea and diarrhea.
Taking it with meals helps minimize these effects. Hypoglycemia is rare with metformin
alone.
A 55-year-old patient develops Parkinson’s disease characterized by unilateral tremors
only. The primary care NP will refer the patient to a neurologist and should expect
initial treatment to be:
Answer: Levodopa-carbidopa (Sinemet).
RATIONALE: Levodopa-carbidopa is the first-line treatment for Parkinson’s disease.
It helps replenish dopamine levels in the brain, alleviating motor symptoms like
tremors. Early-stage Parkinson’s disease with mild symptoms is typically managed with
this medication.
A 60-year-old patient with hypertension is prescribed lisinopril. The NP should monitor
for which potential side effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypoglycemia
D. Hypernatremia
Answer: A. Hyperkalemia
RATIONALE: ACE inhibitors like lisinopril can cause hyperkalemia by reducing
aldosterone secretion. Potassium levels should be monitored regularly.
,A patient has been treated for Rocky Mountain spotted fever, and the infectious disease
specialist is treating the patient with doxycycline 100 mg orally for 7 days. The patient
comes to the clinic for follow-up care with the primary care NP at the end of therapy and
reports persistent fever, headache, and myalgia. The NP will consult with the infectious
disease specialist and order:
Answer: Continue doxycycline for an additional 7 days.
RATIONALE: Persistent symptoms may indicate inadequate treatment. Rocky
Mountain spotted fever typically requires a longer course of doxycycline if symptoms
persist.
A 30-year-old patient with a history of migraines is prescribed sumatriptan. The NP
should instruct the patient to:
A. Take the medication daily for prevention.
B. Use the medication at the first sign of a migraine.
C. Avoid using the medication if they have a history of asthma.
D. Take the medication only if the headache lasts more than 24 hours.
Answer: B. Use the medication at the first sign of a migraine.
RATIONALE: Sumatriptan is most effective when taken early during a migraine
attack. It is not used for prevention.
A 70-year-old patient with osteoporosis is prescribed alendronate. The NP should advise
the patient to:
A. Take the medication with a full glass of water and remain upright for 30 minutes.
B. Take the medication at bedtime.
C. Take the medication with orange juice to enhance absorption.
D. Crush the tablet if they have difficulty swallowing.
Answer: A. Take the medication with a full glass of water and remain upright for 30
minutes.
RATIONALE: Alendronate can cause esophageal irritation. Taking it with water and
staying upright reduces this risk.
A 50-year-old patient with gastroesophageal reflux disease (GERD) is prescribed
omeprazole. The NP should advise the patient to:
A. Take the medication on an empty stomach.
B. Take the medication with meals.
C. Take the medication only when symptoms occur.
D. Take the medication at bedtime.
, Answer: A. Take the medication on an empty stomach.
RATIONALE: Proton pump inhibitors (PPIs) like omeprazole are most effective when
taken 30 minutes before a meal.
A 25-year-old patient is diagnosed with bacterial vaginosis. The NP should prescribe:
A. Metronidazole
B. Fluconazole
C. Clotrimazole
D. Acyclovir
Answer: A. Metronidazole
RATIONALE: Metronidazole is the first-line treatment for bacterial vaginosis.
Fluconazole and clotrimazole are antifungals, and acyclovir is for viral infections.
A 40-year-old patient with a history of peptic ulcer disease is prescribed naproxen for
arthritis pain. The NP should also prescribe:
A. Omeprazole
B. Metformin
C. Diphenhydramine
D. Acetaminophen
Answer: A. Omeprazole
RATIONALE: NSAIDs like naproxen can exacerbate peptic ulcers. A PPI like
omeprazole helps protect the gastric lining.
A 10-year-old child is diagnosed with strep throat. The NP should prescribe:
A. Amoxicillin
B. Ciprofloxacin
C. Metronidazole
D. Acyclovir
Answer: A. Amoxicillin
RATIONALE: Amoxicillin is the first-line treatment for strep throat caused by Group
A Streptococcus.
A 65-year-old patient with atrial fibrillation is prescribed warfarin. The NP should
advise the patient to:
A. Avoid foods high in vitamin K.
B. Take the medication with grapefruit juice.
C. Stop taking the medication if they experience bruising.
D. Take the medication only when they feel palpitations.
A patient is diagnosed as having stage 2 Alzheimer’s disease and elects to take donepezil
(Aricept). The patient asks the primary care nurse practitioner (NP) how long the
medication will be needed. The NP should tell the patient that donepezil must be taken:
Answer: Indefinitely, as long as it provides benefit.
RATIONALE: Donepezil is used to manage symptoms of Alzheimer’s disease and is
typically continued as long as it provides symptomatic improvement.
A 45-year-old patient with type 2 diabetes mellitus is started on metformin. The primary
care NP should advise the patient to:
A. Take the medication with meals to reduce gastrointestinal side effects.
B. Avoid all carbohydrates while on metformin.
C. Stop taking the medication if they experience hypoglycemia.
D. Take the medication only at bedtime.
Answer: A. Take the medication with meals to reduce gastrointestinal side effects.
RATIONALE: Metformin commonly causes GI side effects like nausea and diarrhea.
Taking it with meals helps minimize these effects. Hypoglycemia is rare with metformin
alone.
A 55-year-old patient develops Parkinson’s disease characterized by unilateral tremors
only. The primary care NP will refer the patient to a neurologist and should expect
initial treatment to be:
Answer: Levodopa-carbidopa (Sinemet).
RATIONALE: Levodopa-carbidopa is the first-line treatment for Parkinson’s disease.
It helps replenish dopamine levels in the brain, alleviating motor symptoms like
tremors. Early-stage Parkinson’s disease with mild symptoms is typically managed with
this medication.
A 60-year-old patient with hypertension is prescribed lisinopril. The NP should monitor
for which potential side effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypoglycemia
D. Hypernatremia
Answer: A. Hyperkalemia
RATIONALE: ACE inhibitors like lisinopril can cause hyperkalemia by reducing
aldosterone secretion. Potassium levels should be monitored regularly.
,A patient has been treated for Rocky Mountain spotted fever, and the infectious disease
specialist is treating the patient with doxycycline 100 mg orally for 7 days. The patient
comes to the clinic for follow-up care with the primary care NP at the end of therapy and
reports persistent fever, headache, and myalgia. The NP will consult with the infectious
disease specialist and order:
Answer: Continue doxycycline for an additional 7 days.
RATIONALE: Persistent symptoms may indicate inadequate treatment. Rocky
Mountain spotted fever typically requires a longer course of doxycycline if symptoms
persist.
A 30-year-old patient with a history of migraines is prescribed sumatriptan. The NP
should instruct the patient to:
A. Take the medication daily for prevention.
B. Use the medication at the first sign of a migraine.
C. Avoid using the medication if they have a history of asthma.
D. Take the medication only if the headache lasts more than 24 hours.
Answer: B. Use the medication at the first sign of a migraine.
RATIONALE: Sumatriptan is most effective when taken early during a migraine
attack. It is not used for prevention.
A 70-year-old patient with osteoporosis is prescribed alendronate. The NP should advise
the patient to:
A. Take the medication with a full glass of water and remain upright for 30 minutes.
B. Take the medication at bedtime.
C. Take the medication with orange juice to enhance absorption.
D. Crush the tablet if they have difficulty swallowing.
Answer: A. Take the medication with a full glass of water and remain upright for 30
minutes.
RATIONALE: Alendronate can cause esophageal irritation. Taking it with water and
staying upright reduces this risk.
A 50-year-old patient with gastroesophageal reflux disease (GERD) is prescribed
omeprazole. The NP should advise the patient to:
A. Take the medication on an empty stomach.
B. Take the medication with meals.
C. Take the medication only when symptoms occur.
D. Take the medication at bedtime.
, Answer: A. Take the medication on an empty stomach.
RATIONALE: Proton pump inhibitors (PPIs) like omeprazole are most effective when
taken 30 minutes before a meal.
A 25-year-old patient is diagnosed with bacterial vaginosis. The NP should prescribe:
A. Metronidazole
B. Fluconazole
C. Clotrimazole
D. Acyclovir
Answer: A. Metronidazole
RATIONALE: Metronidazole is the first-line treatment for bacterial vaginosis.
Fluconazole and clotrimazole are antifungals, and acyclovir is for viral infections.
A 40-year-old patient with a history of peptic ulcer disease is prescribed naproxen for
arthritis pain. The NP should also prescribe:
A. Omeprazole
B. Metformin
C. Diphenhydramine
D. Acetaminophen
Answer: A. Omeprazole
RATIONALE: NSAIDs like naproxen can exacerbate peptic ulcers. A PPI like
omeprazole helps protect the gastric lining.
A 10-year-old child is diagnosed with strep throat. The NP should prescribe:
A. Amoxicillin
B. Ciprofloxacin
C. Metronidazole
D. Acyclovir
Answer: A. Amoxicillin
RATIONALE: Amoxicillin is the first-line treatment for strep throat caused by Group
A Streptococcus.
A 65-year-old patient with atrial fibrillation is prescribed warfarin. The NP should
advise the patient to:
A. Avoid foods high in vitamin K.
B. Take the medication with grapefruit juice.
C. Stop taking the medication if they experience bruising.
D. Take the medication only when they feel palpitations.
