Family Nurse Practitioner Test Pharmacology 1 — Questions and Answers
Question 1: A patient with heart failure and hypertension is started on lisinopril. The FNP should monitor for which MOST common side effect?
- Dry, nonproductive cough (Correct answer)
- Hyperkalemia
- Angioedema
- Renal failure
Correct answer: Dry, nonproductive cough
ACE inhibitors like lisinopril commonly cause a dry cough due to accumulation of bradykinin in the airways.
Question 2: The FNP prescribes metformin for a newly diagnosed type 2 diabetic. Which contraindication should be screened for FIRST?
- eGFR <30 mL/min/1.73 m² (Correct answer)
- HbA1c >9%
- BMI >35
- Age >65 years
Correct answer: eGFR <30 mL/min/1.73 m²
Metformin is contraindicated with significant renal impairment (eGFR <30) due to risk of lactic acidosis from drug accumulation.
Question 3: A patient taking warfarin reports adding daily vitamin K supplements. The FNP anticipates which effect on INR?
- Decreased INR due to increased clotting factor synthesis (Correct answer)
- Increased INR due to bleeding risk
- No effect on INR
- Variable effect depending on warfarin dose
Correct answer: Decreased INR due to increased clotting factor synthesis
Vitamin K is a cofactor for clotting factor synthesis; supplementing it antagonizes warfarin's anticoagulant effect, lowering the INR.
Question 4: Which antibiotic class is MOST appropriate for treating community-acquired pneumonia in a healthy adult without comorbidities?
- Macrolides (e.g., azithromycin) (Correct answer)
- Fluoroquinolones (e.g., levofloxacin)
- Cephalosporins (e.g., ceftriaxone)
- Beta-lactams + macrolide combination
Correct answer: Macrolides (e.g., azithromycin)
IDSA/ATS guidelines recommend macrolide monotherapy as first-line for outpatient CAP in previously healthy patients with no antibiotic use in the past 3 months.
Question 5: A patient on fluoxetine is prescribed tramadol for pain. The FNP's GREATEST concern is:
- Serotonin syndrome (Correct answer)
- QT prolongation
- Opioid respiratory depression
- Drug-induced hepatitis
Correct answer: Serotonin syndrome
Tramadol inhibits serotonin reuptake; combined with SSRIs like fluoxetine, this dramatically increases the risk of serotonin syndrome.
Question 6: The FNP is initiating a statin in a patient. Which laboratory test should be checked at baseline and periodically?
- Liver function tests (ALT/AST) (Correct answer)
- Renal function (BUN/creatinine)
- Complete blood count
- Thyroid-stimulating hormone
Correct answer: Liver function tests (ALT/AST)
Statins can rarely cause hepatotoxicity, so baseline and periodic liver function monitoring is recommended per guidelines.
Family Nurse Practitioner Test Pharmacology 1
A patient with heart failure and hypertension is started on lisinopril.
The FNP should monitor for which MOST common side effect?