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NR 508 FINAL REVIEW QUESTIONS AND
VERIFIED ANSWERS GRADED A+ LATEST
UPDATE 2025/ 2026
When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include:
- The medication may cause sedation and they should not drive.
- Constipation is a common side effect and they should increase fluids and fiber.
- Patients should not take any other acetaminophen-containing medications at the same time.
- All of the above - CORRECT ANSWER >> All of the above
Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be:
- Ibuprofen (Advil)
- Acetaminophen with hydrocodone (Vicodin)
- Oxycodone (Oxycontin)
- Oral morphine (Roxanol) - CORRECT ANSWER >> Ibuprofen (Advil)
Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first- line medication would be:
- Ibuprofen (Advil)
- Acetaminophen with hydrocodone (Vicodin)
- Oxycodone (Oxycontin)
- Oral morphine (Roxanol) - CORRECT ANSWER >> Acetaminophen with hydrocodone (Vicodin)
Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:
- Slurred speech and insomnia
- Bradycardia and confusion
- Dizziness and orthostatic hypotension
- Insomnia and decreased appetite - CORRECT ANSWER >> Insomnia and decreased appetite
Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes:
- ADHD symptoms
- Routine height and weight checks
- Amount of methylphenidate being used
- All of the above - CORRECT ANSWER >> All of the above
When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor:
- Blood pressure
- Blood glucose levels
- Urine ketone levels
- Liver function - CORRECT ANSWER >> Blood pressure
Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for:
- Hypokalemia
- Impotence
- Decreased renal function
- Inability to concentrate - CORRECT ANSWER >> Decreased renal function
While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-counter drugs without first consulting the provider because:
- Cimetidine is metabolized by the CYP 3A4 isoenzymes
- Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
- Both 1 and 2
- Neither 1 nor 2 - CORRECT ANSWER >> Both 1 and 2
Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should include:
- White blood cell counts with the drug dosage increased for elevations above 10,000 feet
- Liver function tests with the drug dosage stopped for alanine aminotransferase values twice that of normal
- Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
- Serum glucose levels with the drug dosage increased for levels greater than 120 mg/dL - CORRECT ANSWER >> Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it:
- Decreases the amount of calcium inside the cell
- Reduces stroke volume
- Increases the activity of the Na+/K+/ATPase pump indirectly
- Decreases heart rate - CORRECT ANSWER >> Decreases the amount of calcium inside the cell
Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker?
- Bradycardia
- Hepatic impairment
- Increased contractility
- Edema of the hands and feet - CORRECT ANSWER >> Edema of the hands and feet
Patient teaching related to amlodipine includes:
- Increase calcium intake to prevent osteoporosis from a calcium blockade.
- Do not crush the tablet; it must be given in liquid form if the patient has trouble swallowing it.
- Avoid grapefruit juice as it affects the metabolism of this drug.
- Rise slowly from a supine position to reduce orthostatic hypotension. - CORRECT ANSWER >> Avoid grapefruit juice as it affects the metabolism of this drug.
Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:
- Started at about half the usual dosage
- Not increased over the usual dosage for an adult
- Given once daily because of memory issues in the older adult
- Withheld if she experiences gastroesophageal reflux - CORRECT ANSWER >> Started at about half the usual dosage
Larry has heart failure, which is being treated with digoxin because it exhibits:
- Negative inotropism
- Positive chronotropism
- Both 1 and 2
- Neither 1 nor 2 - CORRECT ANSWER >> Neither 1 nor 2
Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes:
- Hemoglobin
- Serum potassium
- Blood urea nitrogen
- Serum glucose - CORRECT ANSWER >> Serum potassium
Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct.
- Older adults because of reduced renal function
- Monitor your own blood pressure and pulse daily.
- Take a hot shower or bath if you feel dizzy.
- Use a sunscreen on exposed body surfaces. - CORRECT ANSWER >> Take a hot shower or bath if you feel dizzy.
The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test is ordered. Which is a correct response?
- Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.
- Amiodarone damages the thyroid gland and can result in inflammation of that gland, causing hyperthyroidism.
- Amiodarone is a broad spectrum drug with many adverse effects. Many different tests need to be done before it is given.
- Amiodarone can cause corneal deposits in up to 25% of patients. - CORRECT ANSWER >> Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.
Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because:
- It is a long-acting drug with potential for toxicity.
- Nitrate tolerance can develop.
- Orthostatic hypotension is a common adverse effect.
- It must be taken with milk or food. - CORRECT ANSWER >> Nitrate tolerance can develop.
Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be:
- This is a parasympathetic response to the vasodilating effects of the drug.
- Headaches are common side effects with these drugs. How severe are they?
- This is associated with your smoking. Let's work on having you stop smoking.
- This is not related to your medication. Are you under a lot of stress? - CORRECT ANSWER >> Headaches are common side effects with these drugs. How severe are they?
In teaching about the use of sublingual nitroglycerine, the patient should be instructed:
- To swallow the tablet with a full glass of water
- To place one tablet under the tongue if chest pain occurs and allow it to dissolve
- To take one tablet every 5 minutes until the chest pain goes away
- That it should "burn" when placed under the tongue or it is no longer effective - CORRECT ANSWER >> To place one tablet under the tongue if chest pain occurs and allow it to dissolve
Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to:
- Become a vegetarian because this disorder is associated with eating red meat.
- Stop taking the drug if abdominal cramps and diarrhea develop.
- Report muscle weakness or tenderness and dark urine to his provider immediately.
- Expect "hot flash" sensations during the first 2 weeks of therapy. - CORRECT ANSWER >> Report muscle weakness or tenderness and dark urine to his provider immediately.
Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor?
- Elevated serum transaminase
- Increased serum creatinine
- Elevated creatinine kinase
- Increased white blood cell counts - CORRECT ANSWER >> Increased white blood cell counts
Because of the pattern of cholesterol synthesis, reductase inhibitors are given:
- In the evening in a single daily dose
- Twice daily in the morning and the evening
- With each meal and at bedtime
- In the morning before eating - CORRECT ANSWER >> In the evening in a single daily dose
Janice has elevated LDL, VLDL, and triglyceride levels. Niaspan, an extended-release form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism and excretion, which of the following laboratory results should be monitored?
- Serum alanine aminotransferase
- Neither 1 nor 2 - CORRECT ANSWER >> Should be administered separately from other drugs by at least 4 hours
Colestipol comes in a powdered form. The patient is taught to:
- Take the powder dry and follow it with at least 8 ounces of water
- Take it with a meal to enhance its action on fatty food
- Mix the powder with 4 to 6 ounces of milk or fruit juice
- Take after the evening meal to coincide with cholesterol synthesis - CORRECT ANSWER >> Mix the powder with 4 to 6 ounces of milk or fruit juice
The choice of diuretic to use in treating hypertension is based on:
- Presence of diabetes with loop diuretics being used for these patients
- Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range
- Ethnicity with aldosterone antagonists best for African Americans and older adults
- Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL - CORRECT ANSWER >> Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range
Direct renin inhibitors have the following properties. They:
- Are primarily generic drugs
- Are a renin-angiotensin-aldosterone system (RAAS) medication that is safe during pregnancy
- Can be used with an angiotensin-converting enzyme and angiotensin II receptor blocker medications for stronger impact
- "Shut down" the entire RAAS cycle - CORRECT ANSWER >> "Shut down" the entire RAAS cycle
When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true?
- Both have major issues with a dry, irritating cough
- Both contribute to some retention of potassium
- ARBs have a stronger impact on hypertension control than ACE medications
- ARBs have stronger diabetes mellitus renal protection properties than ACE medications - CORRECT ANSWER >> Both contribute to some retention of potassium
What does the provider understand about the issue of "Diabetic Renal Protection" with angiotensin- converting enzyme (ACE) medications? Diabetes mellitus patients:
- Have a reduced rate of renal progression, but still need to be discontinued when advanced renal issues present
- Who start these medications never progress to renal nephropathy
- With early renal dysfunction will see it reverse when on ACE medications
- Without renal issues are the only ones who benefit from ACE protection - CORRECT ANSWER >> Have a reduced rate of renal progression, but still need to be discontinued when advanced renal issues present
What dermatological issue is linked to Amiodarone use?
- Increased risk of basal cell carcinoma
- Flare up of any prior psoriasis problems
- Development of plantar warts
- Progressive change of skin tone toward a blue spectrum - CORRECT ANSWER >> Progressive change of skin tone toward a blue spectrum
Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why?
- Increased risk of priapism
- Profound hypotension
- Development of blue discoloration to the visual field
- Inactivation of the ED medication effect - CORRECT ANSWER >> Profound hypotension
Digoxin levels need to be monitored closely when the following medication is started:
- Loratadine
- Diphenhydramine
- Ipratropium
James is a 52-year-old overweight smoker taking theophylline for his persistent asthma. He tells his provider he is going to start the Atkin's diet for weight loss. The appropriate response would be:
- Congratulate him on making a positive change in his life.
- Recommend he try stopping smoking instead of the Atkin's diet.
- Schedule him for regular testing of serum theophylline levels during his diet due to increased excretion of theophylline.
- Decrease his theophylline dose because a high-protein diet may lead to elevated theophylline levels. - CORRECT ANSWER >> Recommend he try stopping smoking instead of the Atkin's diet.
Li takes theophylline for his persistent asthma and calls the office with a complaint of nausea, vomiting, and headache. The best advice for him would be to:
- Reassure him this is probably a viral infection and should be better soon
- Have him seen the same day for an assessment and theophylline level
- Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better
- Order a theophylline level at the laboratory for him - CORRECT ANSWER >> Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better
Tiotropium bromide (Spiriva) is an inhaled anticholinergic:
- Used for the treatment of chronic obstructive pulmonary disease (COPD)
- Used in the treatment of asthma
- Combined with albuterol for treatment of asthma exacerbations
- Combined with fluticasone for the treatment of persistent asthma - CORRECT ANSWER >> Used for the treatment of chronic obstructive pulmonary disease (COPD)
Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes:
- Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day
- Beclomethasone needs to be used every day to treat her asthma
- Report any systemic side effects she is experiencing, such as weight gain
- Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate bronchodilation - CORRECT ANSWER >> Beclomethasone needs to be used every day to treat her asthma
When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed:
- Montelukast twice a day is started when there is an asthma exacerbation.
- Patients may experience weight gain on montelukast.
- Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.
- Lethargy and hypersomnia may occur when taking montelukast. - CORRECT ANSWER >> Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.
Montelukast (Singulair) may be prescribed for:
- A 6-year-old child with exercise-induced asthma
- A 2-year-old child with moderate persistent asthma
- An 18-month-old child with seasonal allergic rhinitis
- None of the above; montelukast is not approved for use in children - CORRECT ANSWER >> A 2-year- old child with moderate persistent asthma
The known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include:
- Albuterol
- MMR vaccine
- Insulin
- None of the above - CORRECT ANSWER >> None of the above
When educating patients who are starting on inhaled corticosteroids, the provider should tell them that:
- They need to get any live vaccines before starting the medication.
- Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective.
- Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush.
- Double the dose if one tablet is not effective - CORRECT ANSWER >> Take the dimenhydrinate 15 minutes before it is needed
Decongestants such as pseudoephedrine (Sudafed):
- Are Schedule III drugs in all states
- Should not be prescribed or recommended for children under 4 years of age
- Are effective in treating the congestion children experience with the common cold
- May cause drowsiness in patients of all ages - CORRECT ANSWER >> Should not be prescribed or recommended for children under 4 years of age
Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population:
- Older adults
- Hypertensive patients
- Infants
- All of the above - CORRECT ANSWER >> All of the above
Martin is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be:
- Oral pseudoephedrine
- Oral phenylephrine
- Nasal oxymetazoline
- Nasal azelastine - CORRECT ANSWER >> Nasal oxymetazoline
The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5-year-old child is:
- Fluids and symptomatic care
- Dextromethorphan and guaifenesin syrup (Robitussin DM for Kids)
- Guaifenesin and codeine syrup (Tussin AC) - CORRECT ANSWER >> Fluids and symptomatic care
Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendation is:
- Ibuprofen 400 mg three times a day
- Acetaminophen, not to exceed 4 grams per day
- Prescribe acetaminophen with codeine - CORRECT ANSWER >> Acetaminophen, not to exceed 4 grams per day
Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to:
- Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case.
- Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.
- Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission.
- Draw anticoagulation studies to make sure she does not have dangerously high bleeding times. - CORRECT ANSWER >> Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.
The safest drug to use to treat pregnant women who require anticoagulant therapy is:
- Low-molecular-weight heparin
- Warfarin
- Aspirin
- Heparin - CORRECT ANSWER >> Heparin
The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients?
- Pregnant women
- Elderly men
- Overweight or obese patients
- Patients with multiple comorbidities - CORRECT ANSWER >> Overweight or obese patients
- The patient will need regular anticoagulant studies while on clopidogrel. - CORRECT ANSWER >> Do not take any herbal products without discussing it with the provider.
For patients taking warfarin, INRs are best drawn:
- Monthly throughout therapy
- Three times a week throughout therapy
- Two hours after the last dose of warfarin to get an accurate peak level
- In the morning if the patient takes their warfarin at night - CORRECT ANSWER >> In the morning if the patient takes their warfarin at night
Patients receiving heparin therapy require monitoring of:
- Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy
- Electrolytes for elevated potassium levels in the first 24 hours of therapy
- INR throughout therapy to stay within the range of 2.
- Blood pressure for hypertension that may occur in the first 2 days of treatment - CORRECT ANSWER >> Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy
The routine monitoring recommended for low molecular weight heparin is:
- INR every 2 days until stable, then weekly
- aPTT every week while on therapy
- Factor Xa levels if the patient is pregnant
- White blood cell count every 2 weeks - CORRECT ANSWER >> Factor Xa levels if the patient is pregnant
When writing a prescription for warfarin it is common to write _________ on the prescription.
- OK to substitute for generic
- The brand name of warfarin and Do Not Substitute
- PRN refills
- Refills for 1 year - CORRECT ANSWER >> The brand name of warfarin and Do Not Substitute
Education of patients who are taking warfarin includes discussing their diet. Instructions include:
- Avoiding all vitamin K-containing foods
- Avoiding high-vitamin K-containing foods
- Increasing intake of iron-containing foods
- Making sure they eat 35 grams of fiber daily - CORRECT ANSWER >> Avoiding high-vitamin K- containing foods
Patients who are being treated with epoetin alfa need to be monitored for the development of:
- Thrombocytopenia
- Neutropenia
- Hypertension
- Gout - CORRECT ANSWER >> Thrombocytopenia
The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that:
- ESAs no longer be prescribed to patients with chronic renal failure
- The risk of tumor development be explained to cancer patients on ESA therapy
- Patients should no longer receive ESA therapy to prepare for allogenic transfusions
- ESAs be prescribed only to patients younger than age 60 years - CORRECT ANSWER >> The risk of tumor development be explained to cancer patients on ESA therapy
When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in:
- 6 weeks if they are a cancer patient
- 1 week if they have chronic renal failure
- 2 weeks if they are taking it for allogenic transfusion
- Each week throughout therapy - CORRECT ANSWER >> 6 weeks if they are a cancer patient
Jim is having a hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed:
