NP NP Pharmacology & Prescribing

Question 1

A nurse practitioner prescribes metformin for a patient with type 2 diabetes. Which condition is an absolute contraindication to metformin use?

Accepted Answer

eGFR < 30 mL/min/1.73m²

Answer

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to the risk of lactic acidosis from drug accumulation.

Question 2

When prescribing warfarin, which INR target range is appropriate for a patient with atrial fibrillation and no mechanical heart valve?

Accepted Answer

2.0–3.0

Answer

For non-valvular atrial fibrillation, the target INR range is 2.0–3.0 to balance stroke prevention with bleeding risk.

Question 3

A patient is started on lisinopril and develops a dry, persistent cough. What is the most appropriate next step?

Accepted Answer

Switch to an ARB such as losartan

Answer

ACE inhibitor–induced cough is a class effect caused by bradykinin accumulation; switching to an ARB eliminates this side effect.

Question 4

Which schedule II controlled substance requires a new written or electronic prescription for each fill in most US states and cannot be called in by phone?

Accepted Answer

Oxycodone

Answer

Oxycodone is a Schedule II opioid; federal law prohibits oral prescriptions for Schedule II substances, requiring a written or electronic prescription for each supply.

Question 5

An NP prescribes azithromycin for a patient already taking amiodarone. What is the primary safety concern?

Accepted Answer

Prolonged QT interval and risk of torsades de pointes

Answer

Both azithromycin and amiodarone independently prolong the QT interval; combining them significantly increases the risk of potentially fatal arrhythmias.

NP - Nurse Practitioner Practice Test

NP - Nurse Practitioner Practice Test

NP NP Pharmacology & Prescribing