Family Nurse Practitioner Test Pharmacology 2 — Questions and Answers
Question 1: A patient with atrial fibrillation is started on digoxin. The FNP should counsel the patient to report which EARLY sign of toxicity?
- Nausea, vomiting, and visual disturbances (Correct answer)
- Chest pain
- Shortness of breath
- Edema
Correct answer: Nausea, vomiting, and visual disturbances
Early digoxin toxicity classically presents with GI symptoms (nausea, vomiting) and yellow-green visual halos before more serious cardiac arrhythmias occur.
Question 2: The FNP prescribes an oral fluoroquinolone. Which patient education point is MOST critical?
- Avoid antacids within 2 hours of the dose and report tendon pain immediately (Correct answer)
- Take with a full glass of milk
- Expect pink discoloration of urine
- Avoid sunlight for 48 hours only
Correct answer: Avoid antacids within 2 hours of the dose and report tendon pain immediately
Fluoroquinolones chelate with divalent cations in antacids reducing absorption, and carry a Black Box Warning for tendinopathy and tendon rupture.
Question 3: A patient with hypothyroidism is also started on cholestyramine. The FNP should advise that levothyroxine be taken:
- At least 4 hours before or after cholestyramine (Correct answer)
- With cholestyramine to improve absorption
- At bedtime to avoid interactions
- Every other day to reduce binding
Correct answer: At least 4 hours before or after cholestyramine
Cholestyramine binds levothyroxine in the GI tract and significantly impairs its absorption, requiring a 4-hour separation.
Question 4: Which medication used for type 2 diabetes is associated with the highest risk of hypoglycemia?
- Glipizide (sulfonylurea) (Correct answer)
- Metformin (biguanide)
- Sitagliptin (DPP-4 inhibitor)
- Empagliflozin (SGLT-2 inhibitor)
Correct answer: Glipizide (sulfonylurea)
Sulfonylureas stimulate insulin secretion regardless of blood glucose levels, making hypoglycemia their primary adverse effect.
Question 5: A patient taking allopurinol for gout asks about alcohol use. The FNP explains that:
- Alcohol raises uric acid levels and can trigger gout flares, undermining treatment (Correct answer)
- Allopurinol interacts with alcohol to cause flushing
- Moderate alcohol is safe and does not affect uric acid
- Red wine specifically is protective against gout
Correct answer: Alcohol raises uric acid levels and can trigger gout flares, undermining treatment
Alcohol, especially beer and spirits, increases uric acid production and decreases renal excretion, worsening gout control.
Question 6: The FNP is treating an uncomplicated UTI in a non-pregnant woman. Which antibiotic is preferred as FIRST-LINE according to current guidelines?
- Nitrofurantoin or trimethoprim-sulfamethoxazole (Correct answer)
- Ciprofloxacin
- Amoxicillin-clavulanate
- Cephalexin
Correct answer: Nitrofurantoin or trimethoprim-sulfamethoxazole
IDSA guidelines recommend nitrofurantoin (5 days) or TMP-SMX (3 days) as first-line for uncomplicated UTI to preserve fluoroquinolones for more serious infections.
Family Nurse Practitioner Test Pharmacology 2
A patient with atrial fibrillation is started on digoxin.
The FNP should counsel the patient to report which EARLY sign of toxicity?