NR565 / NR 565 Advanced Pharmacology
Fundamentals Final Exam
Professional Assessment | Updated 2026 Standards
EXAM OVERVIEW
The NR565 Advanced Pharmacology Fundamentals Final Exam is a comprehensive
assessment designed to evaluate advanced knowledge and clinical decision-making
skills in pharmacology. Candidates are tested on their ability to apply evidence-based
principles to drug therapy, interpret pharmacokinetic and pharmacodynamic data, and
integrate pharmacologic concepts across multiple organ systems. The exam
emphasizes critical thinking, patient safety, and adherence to current professional
standards, ensuring that examinees are prepared to deliver high-quality pharmacologic
care in diverse clinical settings.
EXAM FEATURES
• ✓ 68 Professional multiple choice Questions
• ✓ Realistic Professional Scenarios and Case Studies
• ✓ Evidence-Based Practice Standards and Guidelines
• ✓ Current 2026 Professional Practice Requirements
• ✓ Comprehensive Answer Key with Detailed Rationales
• ✓ Covers 7 Major Professional Domains
CORE TESTING AREAS
→ Autonomic Nervous System Pharmacology (11 Questions)
→ Cardiovascular Pharmacology (8 Questions)
→ Central Nervous System Pharmacology (12 Questions)
→ Endocrine Pharmacology (12 Questions)
→ Pharmacokinetics & Pharmacodynamics (14 Questions)
→ Receptor Theory & Drug Interactions (6 Questions)
→ Safe Prescribing & Clinical Decision (14 Questions)
Page 1
,Pharmacokinetics & Pharmacodynamics (14 Questions)
Question 1
A 72-year-old male with atrial fibrillation is maintained on warfarin 5 mg daily. He develops
a urinary tract infection and is prescribed ciprofloxacin 500 mg twice daily. After five days,
his INR rises to 4.5, and he reports mild bruising. Consider the metabolic pathway of
warfarin and the known enzyme effects of fluoroquinolones. Which pharmacokinetic
interaction best explains the elevated INR?
A. Ciprofloxacin induces CYP2C9, increasing warfarin metabolism and decreasing its
plasma concentration.
B. Ciprofloxacin inhibits CYP2C9, decreasing warfarin metabolism and increasing its
plasma concentration.
C. Ciprofloxacin induces P-glycoprotein, enhancing warfarin efflux and reducing its
bioavailability.
D. Ciprofloxacin competes for plasma protein binding sites, displacing warfarin and raising
free drug levels.
Correct Answer
Ciprofloxacin inhibits CYP2C9, decreasing warfarin metabolism and increasing its plasma
concentration.
Rationale:
Ciprofloxacin is a CYP2C9 inhibitor, which reduces warfarin clearance, leading to higher plasma levels and an
elevated INR and increases bleeding risk.
Page 2
,Question 2
A 45-year-old man with newly diagnosed hypertension is prescribed the oral prodrug
losartan, which requires hepatic conversion by CYP2C9 to its active metabolite. Two
weeks later, he begins treatment for depression with fluoxetine, a known potent inhibitor
of CYP2C9. After the addition of fluoxetine, he reports that his blood pressure remains
elevated despite adherence to the losartan regimen. Which of the following best describes
the expected pharmacodynamic outcome of this drug interaction?
A. Increased conversion to the active metabolite, enhancing therapeutic effect.
B. Decreased conversion to the active metabolite, reducing therapeutic effect.
C. No change in conversion, as fluoxetine does not affect CYP2C9.
D. Complete inhibition of drug absorption, leading to no systemic exposure.
Correct Answer
Decreased conversion to the active metabolite, reducing therapeutic effect.
Rationale:
Fluoxetine strongly inhibits CYP2C9, so the prodrug is less converted to its active form, resulting in markedly
reduced therapeutic effect.
Question 3
Mrs. L, a 58-year-old woman with stage 3 chronic kidney disease (creatinine clearance
~45 mL/min), is prescribed the ACE inhibitor lisinopril for hypertension. Lisinopril is
eliminated primarily unchanged by the kidneys. Considering her reduced renal function,
which pharmacokinetic parameter of lisinopril is most likely to be significantly altered,
thereby necessitating a dose adjustment?
A. Clearance (renal elimination rate)
B. Volume of distribution
C. Bioavailability
D. Protein binding
Correct Answer
Clearance (renal elimination rate)
Rationale:
Reduced renal function decreases drug clearance, leading to higher plasma concentrations; therefore dose
adjustment based on clearance is required to prevent toxicity.
Page 3
, Question 4
A 58-year-old woman with chronic kidney disease (creatinine clearance ≈ 25 mL/min) is
prescribed Drug Y, an oral antihypertensive that is eliminated unchanged by the kidneys
and has a half‑life of 8 hours in individuals with normal renal function. To avoid drug
accumulation, which dosing adjustment is most appropriate?
A. Administer 100 mg every 8 hours
B. Administer 100 mg every 24 hours
C. Administer 50 mg every 12 hours
D. Administer 50 mg every 24 hours
Correct Answer
Administer 50 mg every 24 hours
Rationale:
Reducing the dose and extending the interval compensates for decreased clearance, preventing excess
plasma concentrations in renal impairment.
Question 5
A 28-year-old male with severe bacterial pneumonia is receiving vancomycin 1 g IV every
12 hours. After 48 hours, a trough level drawn immediately before the next dose is 5
µg/mL, whereas the therapeutic target is 15-20 µg/mL. Which adjustment to the dosing
regimen is most appropriate to achieve a therapeutic trough concentration?
A. Increase the dose per administration while keeping the 12‑hour interval
B. Decrease the dosing interval to every 8 hours without changing the dose
C. Switch to a continuous infusion after a loading dose
D. Discontinue vancomycin and start linezolid
Correct Answer
Increase the dose per administration while keeping the 12‑hour interval
Rationale:
Raising each dose raises steady‑state concentrations, directly increasing trough levels to reach the
therapeutic range.
Page 4
Fundamentals Final Exam
Professional Assessment | Updated 2026 Standards
EXAM OVERVIEW
The NR565 Advanced Pharmacology Fundamentals Final Exam is a comprehensive
assessment designed to evaluate advanced knowledge and clinical decision-making
skills in pharmacology. Candidates are tested on their ability to apply evidence-based
principles to drug therapy, interpret pharmacokinetic and pharmacodynamic data, and
integrate pharmacologic concepts across multiple organ systems. The exam
emphasizes critical thinking, patient safety, and adherence to current professional
standards, ensuring that examinees are prepared to deliver high-quality pharmacologic
care in diverse clinical settings.
EXAM FEATURES
• ✓ 68 Professional multiple choice Questions
• ✓ Realistic Professional Scenarios and Case Studies
• ✓ Evidence-Based Practice Standards and Guidelines
• ✓ Current 2026 Professional Practice Requirements
• ✓ Comprehensive Answer Key with Detailed Rationales
• ✓ Covers 7 Major Professional Domains
CORE TESTING AREAS
→ Autonomic Nervous System Pharmacology (11 Questions)
→ Cardiovascular Pharmacology (8 Questions)
→ Central Nervous System Pharmacology (12 Questions)
→ Endocrine Pharmacology (12 Questions)
→ Pharmacokinetics & Pharmacodynamics (14 Questions)
→ Receptor Theory & Drug Interactions (6 Questions)
→ Safe Prescribing & Clinical Decision (14 Questions)
Page 1
,Pharmacokinetics & Pharmacodynamics (14 Questions)
Question 1
A 72-year-old male with atrial fibrillation is maintained on warfarin 5 mg daily. He develops
a urinary tract infection and is prescribed ciprofloxacin 500 mg twice daily. After five days,
his INR rises to 4.5, and he reports mild bruising. Consider the metabolic pathway of
warfarin and the known enzyme effects of fluoroquinolones. Which pharmacokinetic
interaction best explains the elevated INR?
A. Ciprofloxacin induces CYP2C9, increasing warfarin metabolism and decreasing its
plasma concentration.
B. Ciprofloxacin inhibits CYP2C9, decreasing warfarin metabolism and increasing its
plasma concentration.
C. Ciprofloxacin induces P-glycoprotein, enhancing warfarin efflux and reducing its
bioavailability.
D. Ciprofloxacin competes for plasma protein binding sites, displacing warfarin and raising
free drug levels.
Correct Answer
Ciprofloxacin inhibits CYP2C9, decreasing warfarin metabolism and increasing its plasma
concentration.
Rationale:
Ciprofloxacin is a CYP2C9 inhibitor, which reduces warfarin clearance, leading to higher plasma levels and an
elevated INR and increases bleeding risk.
Page 2
,Question 2
A 45-year-old man with newly diagnosed hypertension is prescribed the oral prodrug
losartan, which requires hepatic conversion by CYP2C9 to its active metabolite. Two
weeks later, he begins treatment for depression with fluoxetine, a known potent inhibitor
of CYP2C9. After the addition of fluoxetine, he reports that his blood pressure remains
elevated despite adherence to the losartan regimen. Which of the following best describes
the expected pharmacodynamic outcome of this drug interaction?
A. Increased conversion to the active metabolite, enhancing therapeutic effect.
B. Decreased conversion to the active metabolite, reducing therapeutic effect.
C. No change in conversion, as fluoxetine does not affect CYP2C9.
D. Complete inhibition of drug absorption, leading to no systemic exposure.
Correct Answer
Decreased conversion to the active metabolite, reducing therapeutic effect.
Rationale:
Fluoxetine strongly inhibits CYP2C9, so the prodrug is less converted to its active form, resulting in markedly
reduced therapeutic effect.
Question 3
Mrs. L, a 58-year-old woman with stage 3 chronic kidney disease (creatinine clearance
~45 mL/min), is prescribed the ACE inhibitor lisinopril for hypertension. Lisinopril is
eliminated primarily unchanged by the kidneys. Considering her reduced renal function,
which pharmacokinetic parameter of lisinopril is most likely to be significantly altered,
thereby necessitating a dose adjustment?
A. Clearance (renal elimination rate)
B. Volume of distribution
C. Bioavailability
D. Protein binding
Correct Answer
Clearance (renal elimination rate)
Rationale:
Reduced renal function decreases drug clearance, leading to higher plasma concentrations; therefore dose
adjustment based on clearance is required to prevent toxicity.
Page 3
, Question 4
A 58-year-old woman with chronic kidney disease (creatinine clearance ≈ 25 mL/min) is
prescribed Drug Y, an oral antihypertensive that is eliminated unchanged by the kidneys
and has a half‑life of 8 hours in individuals with normal renal function. To avoid drug
accumulation, which dosing adjustment is most appropriate?
A. Administer 100 mg every 8 hours
B. Administer 100 mg every 24 hours
C. Administer 50 mg every 12 hours
D. Administer 50 mg every 24 hours
Correct Answer
Administer 50 mg every 24 hours
Rationale:
Reducing the dose and extending the interval compensates for decreased clearance, preventing excess
plasma concentrations in renal impairment.
Question 5
A 28-year-old male with severe bacterial pneumonia is receiving vancomycin 1 g IV every
12 hours. After 48 hours, a trough level drawn immediately before the next dose is 5
µg/mL, whereas the therapeutic target is 15-20 µg/mL. Which adjustment to the dosing
regimen is most appropriate to achieve a therapeutic trough concentration?
A. Increase the dose per administration while keeping the 12‑hour interval
B. Decrease the dosing interval to every 8 hours without changing the dose
C. Switch to a continuous infusion after a loading dose
D. Discontinue vancomycin and start linezolid
Correct Answer
Increase the dose per administration while keeping the 12‑hour interval
Rationale:
Raising each dose raises steady‑state concentrations, directly increasing trough levels to reach the
therapeutic range.
Page 4
