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EXAMS
(2026) Pharmacology Questions | Clinical Nursing (PDF) | Questions &
Answers (Verified Answers) With Rationales ( Update)
This Document Contains:
200 Questions with Correct, Detailed and Verified Answers
2026/2027 Actual Exam Testbank
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
Page 1
,Question 1
A 45-year-old patient with type 2 diabetes and chronic kidney disease (eGFR 35 mL/min/1.73 m²)
is being started on metformin. The patient's current medications include lisinopril, atorvastatin,
and glipizide. Which of the following is the most appropriate consideration regarding metformin
therapy?
A) Metformin is contraindicated due to eGFR <45 and risk of lactic acidosis; an alternative agent
should be prescribed.
B) Metformin can be used at a reduced dose with close monitoring of renal function and serum lactate.
C) Metformin is safe at any eGFR because it is renally eliminated and accumulates in renal tissue.
D) Metformin should be initiated at full dose but discontinued if eGFR drops below 30.
Answer: A) Metformin is contraindicated due to eGFR <45 and risk of lactic acidosis; an alternative
agent should be prescribed.
Explanation: Metformin is contraindicated when eGFR is <30 mL/min/1.73 m² and should be used
with caution when eGFR is 30-45, with dose reduction. At eGFR 35, the risk of lactic
acidosis is increased; thus, an alternative agent is recommended. Options B and D
underestimate the risk; option C is incorrect because metformin accumulation increases
toxicity.
Question 2
A patient on warfarin for mechanical heart valve requires antibiotic therapy for a urinary tract
infection. Which of the following antibiotics is most likely to potentiate warfarin's effect by
inhibiting its metabolism via CYP2C9?
A) Ciprofloxacin
B) Fluconazole
C) Amoxicillin
D) Nitrofurantoin
Answer: B) Fluconazole
Explanation: Fluconazole is a potent inhibitor of CYP2C9, the primary enzyme responsible for
metabolizing S-warfarin, leading to increased INR and bleeding risk. Ciprofloxacin
inhibits CYP1A2 but not CYP2C9. Amoxicillin and nitrofurantoin have minimal CYP
interactions.
Page 2
,Question 3
A patient with a history of opioid use disorder is being treated with buprenorphine/naloxone. The
patient presents with acute pain following a traumatic injury. Which of the following is the most
appropriate approach to pain management?
A) Discontinue buprenorphine and initiate full-dose morphine as needed.
B) Continue buprenorphine and add a nonsteroidal anti-inflammatory drug and acetaminophen.
C) Increase the buprenorphine dose to provide additional analgesia.
D) Discontinue buprenorphine and initiate methadone for pain.
Answer: B) Continue buprenorphine and add a nonsteroidal anti-inflammatory drug and
acetaminophen.
Explanation: Buprenorphine has a high affinity for mu-opioid receptors, blocking the effects of full
agonists. The best approach is to continue buprenorphine to maintain stability and use
multimodal non-opioid analgesics. Discontinuing buprenorphine risks withdrawal and
inadequate pain control. Increasing buprenorphine may not provide sufficient analgesia
due to ceiling effect. Methadone can be used but requires careful monitoring and is not
first-line in this scenario.
Question 4
Which of the following statements best describes the mechanism of action of angiotensin
receptor-neprilysin inhibitor (ARNI) therapy in heart failure with reduced ejection fraction?
A) Inhibition of angiotensin II type 1 receptors and neprilysin, leading to increased natriuretic peptides
and reduced vasoconstriction.
B) Blockade of beta-1 adrenergic receptors and inhibition of neprilysin, resulting in decreased heart
rate and increased natriuresis.
C) Inhibition of angiotensin-converting enzyme and neprilysin, causing decreased aldosterone and
increased bradykinin.
D) Antagonism of mineralocorticoid receptors and neprilysin, leading to reduced sodium retention and
increased vasodilation.
Answer: A) Inhibition of angiotensin II type 1 receptors and neprilysin, leading to increased
natriuretic peptides and reduced vasoconstriction.
Explanation: ARNI (e.g., sacubitril/valsartan) combines an angiotensin receptor blocker (valsartan)
with a neprilysin inhibitor (sacubitril). Neprilysin degrades natriuretic peptides; its
inhibition increases their levels, promoting vasodilation and natriuresis. Option B
describes beta-blocker plus neprilysin inhibition; option C describes ACE inhibitor plus
neprilysin inhibition (not ARNI); option D describes mineralocorticoid receptor
antagonist plus neprilysin inhibition.
Page 3
, Question 5
A patient on digoxin for atrial fibrillation develops nausea, visual disturbances (yellow-green
halos), and bradycardia. Serum digoxin level is 3.2 ng/mL. Which of the following is the most
appropriate initial intervention?
A) Administer digoxin immune Fab (Digibind) immediately.
B) Hold digoxin, monitor ECG, and correct hypokalemia if present.
C) Administer atropine for bradycardia and continue digoxin at reduced dose.
D) Start phenytoin for arrhythmias and continue digoxin.
Answer: B) Hold digoxin, monitor ECG, and correct hypokalemia if present.
Explanation: Digoxin toxicity is evident with symptoms and level >2 ng/mL. Initial management
includes holding the drug, monitoring ECG, and correcting electrolyte imbalances
(especially hypokalemia, which exacerbates toxicity). Digoxin immune Fab is reserved
for life-threatening arrhythmias or severe toxicity. Atropine may be used for
symptomatic bradycardia but does not treat toxicity. Phenytoin is not first-line.
Question 6
A patient with major depressive disorder has been on a selective serotonin reuptake inhibitor
(SSRI) for 6 weeks with minimal improvement. The decision is made to switch to a different
antidepressant. Which of the following strategies minimizes the risk of serotonin syndrome?
A) Taper the SSRI over 1 week and start the new agent immediately at a low dose.
B) Discontinue the SSRI abruptly and start the new agent the next day.
C) Cross-taper by gradually reducing SSRI while gradually increasing the new agent over 2-4 weeks.
D) Add the new agent to the SSRI and then taper the SSRI after 2 weeks.
Answer: C) Cross-taper by gradually reducing SSRI while gradually increasing the new agent over
2-4 weeks.
Explanation: Cross-tapering reduces the risk of serotonin syndrome by avoiding high combined
serotonergic activity. Abrupt discontinuation of SSRI can cause withdrawal, and
immediate initiation of another serotonergic agent increases risk. Option A's rapid taper
is too fast; option D's overlap period may still cause excessive serotonin.
Page 4
Download Download
EXAMS
(2026) Pharmacology Questions | Clinical Nursing (PDF) | Questions &
Answers (Verified Answers) With Rationales ( Update)
This Document Contains:
200 Questions with Correct, Detailed and Verified Answers
2026/2027 Actual Exam Testbank
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
Page 1
,Question 1
A 45-year-old patient with type 2 diabetes and chronic kidney disease (eGFR 35 mL/min/1.73 m²)
is being started on metformin. The patient's current medications include lisinopril, atorvastatin,
and glipizide. Which of the following is the most appropriate consideration regarding metformin
therapy?
A) Metformin is contraindicated due to eGFR <45 and risk of lactic acidosis; an alternative agent
should be prescribed.
B) Metformin can be used at a reduced dose with close monitoring of renal function and serum lactate.
C) Metformin is safe at any eGFR because it is renally eliminated and accumulates in renal tissue.
D) Metformin should be initiated at full dose but discontinued if eGFR drops below 30.
Answer: A) Metformin is contraindicated due to eGFR <45 and risk of lactic acidosis; an alternative
agent should be prescribed.
Explanation: Metformin is contraindicated when eGFR is <30 mL/min/1.73 m² and should be used
with caution when eGFR is 30-45, with dose reduction. At eGFR 35, the risk of lactic
acidosis is increased; thus, an alternative agent is recommended. Options B and D
underestimate the risk; option C is incorrect because metformin accumulation increases
toxicity.
Question 2
A patient on warfarin for mechanical heart valve requires antibiotic therapy for a urinary tract
infection. Which of the following antibiotics is most likely to potentiate warfarin's effect by
inhibiting its metabolism via CYP2C9?
A) Ciprofloxacin
B) Fluconazole
C) Amoxicillin
D) Nitrofurantoin
Answer: B) Fluconazole
Explanation: Fluconazole is a potent inhibitor of CYP2C9, the primary enzyme responsible for
metabolizing S-warfarin, leading to increased INR and bleeding risk. Ciprofloxacin
inhibits CYP1A2 but not CYP2C9. Amoxicillin and nitrofurantoin have minimal CYP
interactions.
Page 2
,Question 3
A patient with a history of opioid use disorder is being treated with buprenorphine/naloxone. The
patient presents with acute pain following a traumatic injury. Which of the following is the most
appropriate approach to pain management?
A) Discontinue buprenorphine and initiate full-dose morphine as needed.
B) Continue buprenorphine and add a nonsteroidal anti-inflammatory drug and acetaminophen.
C) Increase the buprenorphine dose to provide additional analgesia.
D) Discontinue buprenorphine and initiate methadone for pain.
Answer: B) Continue buprenorphine and add a nonsteroidal anti-inflammatory drug and
acetaminophen.
Explanation: Buprenorphine has a high affinity for mu-opioid receptors, blocking the effects of full
agonists. The best approach is to continue buprenorphine to maintain stability and use
multimodal non-opioid analgesics. Discontinuing buprenorphine risks withdrawal and
inadequate pain control. Increasing buprenorphine may not provide sufficient analgesia
due to ceiling effect. Methadone can be used but requires careful monitoring and is not
first-line in this scenario.
Question 4
Which of the following statements best describes the mechanism of action of angiotensin
receptor-neprilysin inhibitor (ARNI) therapy in heart failure with reduced ejection fraction?
A) Inhibition of angiotensin II type 1 receptors and neprilysin, leading to increased natriuretic peptides
and reduced vasoconstriction.
B) Blockade of beta-1 adrenergic receptors and inhibition of neprilysin, resulting in decreased heart
rate and increased natriuresis.
C) Inhibition of angiotensin-converting enzyme and neprilysin, causing decreased aldosterone and
increased bradykinin.
D) Antagonism of mineralocorticoid receptors and neprilysin, leading to reduced sodium retention and
increased vasodilation.
Answer: A) Inhibition of angiotensin II type 1 receptors and neprilysin, leading to increased
natriuretic peptides and reduced vasoconstriction.
Explanation: ARNI (e.g., sacubitril/valsartan) combines an angiotensin receptor blocker (valsartan)
with a neprilysin inhibitor (sacubitril). Neprilysin degrades natriuretic peptides; its
inhibition increases their levels, promoting vasodilation and natriuresis. Option B
describes beta-blocker plus neprilysin inhibition; option C describes ACE inhibitor plus
neprilysin inhibition (not ARNI); option D describes mineralocorticoid receptor
antagonist plus neprilysin inhibition.
Page 3
, Question 5
A patient on digoxin for atrial fibrillation develops nausea, visual disturbances (yellow-green
halos), and bradycardia. Serum digoxin level is 3.2 ng/mL. Which of the following is the most
appropriate initial intervention?
A) Administer digoxin immune Fab (Digibind) immediately.
B) Hold digoxin, monitor ECG, and correct hypokalemia if present.
C) Administer atropine for bradycardia and continue digoxin at reduced dose.
D) Start phenytoin for arrhythmias and continue digoxin.
Answer: B) Hold digoxin, monitor ECG, and correct hypokalemia if present.
Explanation: Digoxin toxicity is evident with symptoms and level >2 ng/mL. Initial management
includes holding the drug, monitoring ECG, and correcting electrolyte imbalances
(especially hypokalemia, which exacerbates toxicity). Digoxin immune Fab is reserved
for life-threatening arrhythmias or severe toxicity. Atropine may be used for
symptomatic bradycardia but does not treat toxicity. Phenytoin is not first-line.
Question 6
A patient with major depressive disorder has been on a selective serotonin reuptake inhibitor
(SSRI) for 6 weeks with minimal improvement. The decision is made to switch to a different
antidepressant. Which of the following strategies minimizes the risk of serotonin syndrome?
A) Taper the SSRI over 1 week and start the new agent immediately at a low dose.
B) Discontinue the SSRI abruptly and start the new agent the next day.
C) Cross-taper by gradually reducing SSRI while gradually increasing the new agent over 2-4 weeks.
D) Add the new agent to the SSRI and then taper the SSRI after 2 weeks.
Answer: C) Cross-taper by gradually reducing SSRI while gradually increasing the new agent over
2-4 weeks.
Explanation: Cross-tapering reduces the risk of serotonin syndrome by avoiding high combined
serotonergic activity. Abrupt discontinuation of SSRI can cause withdrawal, and
immediate initiation of another serotonergic agent increases risk. Option A's rapid taper
is too fast; option D's overlap period may still cause excessive serotonin.
Page 4
