NR565 Advanced Pharmacology Fundamentals
Midterm Exam Review Bank - 2026-2027 | Core
Concepts & Prescribing Principles
Director, Advanced Pharmacology Education – Chamberlain University
Bank Code: NR565-MID-26/27 | Total Items: 130 | Time Guideline: 2
min/item | Pass Mark: 77 % (100/130)
Cognitive Spread: 40 % Application | 40 % Analysis | 20 % Knowledge
General Instructions:
● Assume all patients are adults unless stated otherwise.
● Rounding: Creatinine-clearance to nearest 1 mL/min; drug doses to nearest
practical tablet size unless specified.
● Laboratory normals: Na 135–145 mEq/L, K 3.5–5.0 mEq/L, Cr 0.6–1.2 mg/dL,
ALT 10–40 U/L, INR 0.8–1.2, TSH 0.4–4.0 mIU/L.
MODULE 1 Pharmacokinetics & Pharmacodynamics (Q1-20)
1. A nurse practitioner understands that a drug with a high first-pass effect will have
which primary characteristic?
A. Excreted unchanged in the urine.
B. Significantly higher oral dose required compared to intravenous dose.
C. Rapidly distributed to adipose tissue.
D. Long elimination half-life.
Answer: B
C: Concept = first-pass hepatic metabolism.
,L: High oral extraction → ↓ bioavailability → higher mg needed orally.
E: Basic PK principle (e.g., propranolol, morphine).
A: A = renal excretion; C = Vd; D = t½ unrelated to first-pass.
R: Always verify oral equianalgesic tables when switching routes.
2. A 72-year-old male (HF, CrCl 38 mL/min) receives drug X (90 % renally
unchanged). NP anticipates:
A. Increased loading dose.
B. Decreased maintenance dose and/or extended dosing interval.
C. Switch to sublingual formulation.
D. Monitor CYP450 inhibition.
Answer: B
C: Renal dosing adjustment.
L: ↓ CrCl → ↓ clearance → accumulation risk.
E: Standard practice (e.g., aminoglycosides, lithium).
A: Loading dose depends on Vd, not clearance.
R: Calculate adjusted dose using CrCl; monitor drug levels if available.
3. Phenytoin 300 mg/day (therapeutic window 10–20 mg/L) – level 8 mg/L with
new-onset seizures. Albumin 2.8 g/dL (nl 3.5–5). Correct action:
A. Increase dose to 400 mg/day immediately.
B. Interpret level as sub-therapeutic (corrected for hypoalbuminemia) and
increase dose cautiously.
C. Switch to fosphenytoin IV.
D. Check phenobarbital level.
Answer: B
C: Protein binding & hypoalbuminemia.
,L: Low albumin → ↑ free (active) fraction; total level underestimates effect.
E: Corrected total level ≈ measured ÷ (0.2 × albumin + 0.1).
A: Could cause toxicity if free level already high.
R: Target corrected total 10–20 mg/L or free 1–2 mg/L.
4. Drug X (Vd 2 L/kg, t½ 40 h) – loading dose calculation for 70 kg man to reach 10
mg/L (F 0.8):
A. 700 mg
B. 1,750 mg
C. 2,100 mg
D. 875 mg
Answer: B
C: Loading dose = (Cp × Vd) ÷ F.
L: Vd = 2 L/kg × 70 kg = 140 L; desired Cp = 10 mg/L.
E: (10 mg/L × 140 L) ÷ 0.8 = 1,750 mg.
R: Round to nearest practical strength after calculation.
5. Which parameter is most critically affected by chronic kidney disease when
prescribing a renally-cleared drug?
A. Volume of distribution.
B. Elimination (renal) clearance.
C. Protein binding.
D. Absorption rate.
Answer: B
C: Renal clearance directly impacted by CKD.
L: CrCl ↓ → clearance ↓ → dose adjustment needed.
, E: Fundamental PK.
R: Adjust maintenance dose/interval; Vd (A) usually unchanged.
6. A CYP2D6 ultra-rapid metabolizer will most likely exhibit:
A. Sub-therapeutic response to codeine.
B. Increased risk of statin myopathy.
C. Prolonged half-life of diazepam.
D. Enhanced response to clopidogrel.
Answer: A
C: Pharmacogenomics → ↑ conversion codeine → morphine → toxicity OR ↓ active drug
if pro-drug.
L: Ultra-rapid → ↑ enzyme activity.
E: FDA boxed warning for codeine in children (respiratory depression).
R: Avoid codeine; use morphine directly or non-opioid.
7. A drug with zero-order kinetics (e.g., phenytoin) demonstrates:
A. Constant half-life regardless of plasma concentration.
B. A fixed amount of drug eliminated per unit time.
C. Exponential decline in plasma concentration.
D. Linear relationship between dose and steady-state level.
Answer: B
C: Zero-order = saturation of elimination processes.
L: Small dose increases → disproportionate ↑ level.
E: Classic example: phenytoin, ethanol.
R: Monitor levels frequently when adjusting dose.
Midterm Exam Review Bank - 2026-2027 | Core
Concepts & Prescribing Principles
Director, Advanced Pharmacology Education – Chamberlain University
Bank Code: NR565-MID-26/27 | Total Items: 130 | Time Guideline: 2
min/item | Pass Mark: 77 % (100/130)
Cognitive Spread: 40 % Application | 40 % Analysis | 20 % Knowledge
General Instructions:
● Assume all patients are adults unless stated otherwise.
● Rounding: Creatinine-clearance to nearest 1 mL/min; drug doses to nearest
practical tablet size unless specified.
● Laboratory normals: Na 135–145 mEq/L, K 3.5–5.0 mEq/L, Cr 0.6–1.2 mg/dL,
ALT 10–40 U/L, INR 0.8–1.2, TSH 0.4–4.0 mIU/L.
MODULE 1 Pharmacokinetics & Pharmacodynamics (Q1-20)
1. A nurse practitioner understands that a drug with a high first-pass effect will have
which primary characteristic?
A. Excreted unchanged in the urine.
B. Significantly higher oral dose required compared to intravenous dose.
C. Rapidly distributed to adipose tissue.
D. Long elimination half-life.
Answer: B
C: Concept = first-pass hepatic metabolism.
,L: High oral extraction → ↓ bioavailability → higher mg needed orally.
E: Basic PK principle (e.g., propranolol, morphine).
A: A = renal excretion; C = Vd; D = t½ unrelated to first-pass.
R: Always verify oral equianalgesic tables when switching routes.
2. A 72-year-old male (HF, CrCl 38 mL/min) receives drug X (90 % renally
unchanged). NP anticipates:
A. Increased loading dose.
B. Decreased maintenance dose and/or extended dosing interval.
C. Switch to sublingual formulation.
D. Monitor CYP450 inhibition.
Answer: B
C: Renal dosing adjustment.
L: ↓ CrCl → ↓ clearance → accumulation risk.
E: Standard practice (e.g., aminoglycosides, lithium).
A: Loading dose depends on Vd, not clearance.
R: Calculate adjusted dose using CrCl; monitor drug levels if available.
3. Phenytoin 300 mg/day (therapeutic window 10–20 mg/L) – level 8 mg/L with
new-onset seizures. Albumin 2.8 g/dL (nl 3.5–5). Correct action:
A. Increase dose to 400 mg/day immediately.
B. Interpret level as sub-therapeutic (corrected for hypoalbuminemia) and
increase dose cautiously.
C. Switch to fosphenytoin IV.
D. Check phenobarbital level.
Answer: B
C: Protein binding & hypoalbuminemia.
,L: Low albumin → ↑ free (active) fraction; total level underestimates effect.
E: Corrected total level ≈ measured ÷ (0.2 × albumin + 0.1).
A: Could cause toxicity if free level already high.
R: Target corrected total 10–20 mg/L or free 1–2 mg/L.
4. Drug X (Vd 2 L/kg, t½ 40 h) – loading dose calculation for 70 kg man to reach 10
mg/L (F 0.8):
A. 700 mg
B. 1,750 mg
C. 2,100 mg
D. 875 mg
Answer: B
C: Loading dose = (Cp × Vd) ÷ F.
L: Vd = 2 L/kg × 70 kg = 140 L; desired Cp = 10 mg/L.
E: (10 mg/L × 140 L) ÷ 0.8 = 1,750 mg.
R: Round to nearest practical strength after calculation.
5. Which parameter is most critically affected by chronic kidney disease when
prescribing a renally-cleared drug?
A. Volume of distribution.
B. Elimination (renal) clearance.
C. Protein binding.
D. Absorption rate.
Answer: B
C: Renal clearance directly impacted by CKD.
L: CrCl ↓ → clearance ↓ → dose adjustment needed.
, E: Fundamental PK.
R: Adjust maintenance dose/interval; Vd (A) usually unchanged.
6. A CYP2D6 ultra-rapid metabolizer will most likely exhibit:
A. Sub-therapeutic response to codeine.
B. Increased risk of statin myopathy.
C. Prolonged half-life of diazepam.
D. Enhanced response to clopidogrel.
Answer: A
C: Pharmacogenomics → ↑ conversion codeine → morphine → toxicity OR ↓ active drug
if pro-drug.
L: Ultra-rapid → ↑ enzyme activity.
E: FDA boxed warning for codeine in children (respiratory depression).
R: Avoid codeine; use morphine directly or non-opioid.
7. A drug with zero-order kinetics (e.g., phenytoin) demonstrates:
A. Constant half-life regardless of plasma concentration.
B. A fixed amount of drug eliminated per unit time.
C. Exponential decline in plasma concentration.
D. Linear relationship between dose and steady-state level.
Answer: B
C: Zero-order = saturation of elimination processes.
L: Small dose increases → disproportionate ↑ level.
E: Classic example: phenytoin, ethanol.
R: Monitor levels frequently when adjusting dose.
