NURS 6521 - Advanced Pharmacology Final Exam 2026/2027 -
Edition – 100 Questions & 100% Verified Answers
Overview
NURS 6521 focuses on advanced pharmacology for APRNs:
pharmacokinetics/dynamics, autonomic, neuro, CV, endocrine, antimicrobials, psych,
pain, and prescribing in special populations. Format: A-D, correct answer in bold
Green, rationale.100 Questions
1. Which term describes the fraction of unchanged drug reaching systemic
circulation?
A. Half-life
B. Clearance
C. Bioavailability
D. Volume of distribution
Rationale: Bioavailability (F) = % of dose reaching systemic circulation. IV = 100%.
Oral affected by first-pass.
2. Zero-order kinetics is exhibited by which drug at therapeutic doses?
A. Digoxin
B. Phenytoin
C. Metformin
D. Lisinopril
Rationale: Phenytoin, ethanol, aspirin at high doses = zero-order = constant amount
cleared per time, not %. Risk toxicity.
3. A drug is 95% protein bound. In hypoalbuminemia, the NP expects:
A. Decreased free drug
B. Increased free drug, risk toxicity
C. Decreased volume of distribution
D. Increased metabolism
Rationale: Only free drug is active. ↓ albumin = ↑ free fraction = ↑ effect/toxicity for
highly bound drugs like warfarin, phenytoin.
4. CYP2D6 poor metabolizer is prescribed codeine for pain. Expected result?
A. Enhanced analgesia
B. Poor analgesia
C. Increased sedation
D. Increased nausea
Rationale: Codeine is prodrug → morphine via CYP2D6. Poor metabolizers get little
conversion → no pain relief.
5. A patient on warfarin starts fluconazole. INR likely to:
A. Decrease
B. Increase
C. Stay same
D. Fluctuate randomly
Rationale: Fluconazole inhibits CYP2C9 → ↓ warfarin metabolism → ↑ INR, bleeding
risk.
, 6. Which receptor when stimulated causes bronchodilation?
A. Alpha-1
B. Beta-1
C. Beta-2
D. Muscarinic-3
Rationale: B2 activation = bronchodilation, vasodilation, glycogenolysis. B1 = heart.
7. Atropine overdose causes which toxidrome?
A. Cholinergic
B. Anticholinergic
C. Sympathomimetic
D. Opioid
Rationale: Atropine = anticholinergic: “mad as hatter, blind as bat, dry as bone, red as
beet, hot as hare.”
8. First-line drug for anaphylaxis in a patient taking a beta-blocker?
A. Diphenhydramine
B. Epinephrine IM, may need glucagon
C. Methylprednisolone
D. Albuterol
Rationale: Epi still first-line. Beta-blockers blunt epi response, so glucagon may be
needed for refractory cases.
9. Which drug is a direct renin inhibitor?
A. Losartan
B. Lisinopril
C. Aliskiren
D. Spironolactone
Rationale: Aliskiren inhibits renin. ARBs block AT1 receptor. ACEi block conversion.
10. A patient on metoprolol should avoid sudden discontinuation due to risk of:
A. Hypotension
B. Rebound HTN, angina, MI
C. Bradycardia
D. Hyperglycemia
Rationale: BB withdrawal → upregulation of receptors → rebound tachycardia, HTN,
ischemia. Taper.
11. Which CCB has most negative inotropic effect?
A. Amlodipine
B. Nifedipine
C. Verapamil
D. Nicardipine
Rationale: Non-DHP verapamil/diltiazem ↓ contractility. DHP like amlodipine more
vascular selective.
12. Statin most potent at LDL lowering?
A. Pravastatin 40mg
B. Simvastatin 40mg
C. Rosuvastatin 20mg
D. Lovastatin 40mg
Edition – 100 Questions & 100% Verified Answers
Overview
NURS 6521 focuses on advanced pharmacology for APRNs:
pharmacokinetics/dynamics, autonomic, neuro, CV, endocrine, antimicrobials, psych,
pain, and prescribing in special populations. Format: A-D, correct answer in bold
Green, rationale.100 Questions
1. Which term describes the fraction of unchanged drug reaching systemic
circulation?
A. Half-life
B. Clearance
C. Bioavailability
D. Volume of distribution
Rationale: Bioavailability (F) = % of dose reaching systemic circulation. IV = 100%.
Oral affected by first-pass.
2. Zero-order kinetics is exhibited by which drug at therapeutic doses?
A. Digoxin
B. Phenytoin
C. Metformin
D. Lisinopril
Rationale: Phenytoin, ethanol, aspirin at high doses = zero-order = constant amount
cleared per time, not %. Risk toxicity.
3. A drug is 95% protein bound. In hypoalbuminemia, the NP expects:
A. Decreased free drug
B. Increased free drug, risk toxicity
C. Decreased volume of distribution
D. Increased metabolism
Rationale: Only free drug is active. ↓ albumin = ↑ free fraction = ↑ effect/toxicity for
highly bound drugs like warfarin, phenytoin.
4. CYP2D6 poor metabolizer is prescribed codeine for pain. Expected result?
A. Enhanced analgesia
B. Poor analgesia
C. Increased sedation
D. Increased nausea
Rationale: Codeine is prodrug → morphine via CYP2D6. Poor metabolizers get little
conversion → no pain relief.
5. A patient on warfarin starts fluconazole. INR likely to:
A. Decrease
B. Increase
C. Stay same
D. Fluctuate randomly
Rationale: Fluconazole inhibits CYP2C9 → ↓ warfarin metabolism → ↑ INR, bleeding
risk.
, 6. Which receptor when stimulated causes bronchodilation?
A. Alpha-1
B. Beta-1
C. Beta-2
D. Muscarinic-3
Rationale: B2 activation = bronchodilation, vasodilation, glycogenolysis. B1 = heart.
7. Atropine overdose causes which toxidrome?
A. Cholinergic
B. Anticholinergic
C. Sympathomimetic
D. Opioid
Rationale: Atropine = anticholinergic: “mad as hatter, blind as bat, dry as bone, red as
beet, hot as hare.”
8. First-line drug for anaphylaxis in a patient taking a beta-blocker?
A. Diphenhydramine
B. Epinephrine IM, may need glucagon
C. Methylprednisolone
D. Albuterol
Rationale: Epi still first-line. Beta-blockers blunt epi response, so glucagon may be
needed for refractory cases.
9. Which drug is a direct renin inhibitor?
A. Losartan
B. Lisinopril
C. Aliskiren
D. Spironolactone
Rationale: Aliskiren inhibits renin. ARBs block AT1 receptor. ACEi block conversion.
10. A patient on metoprolol should avoid sudden discontinuation due to risk of:
A. Hypotension
B. Rebound HTN, angina, MI
C. Bradycardia
D. Hyperglycemia
Rationale: BB withdrawal → upregulation of receptors → rebound tachycardia, HTN,
ischemia. Taper.
11. Which CCB has most negative inotropic effect?
A. Amlodipine
B. Nifedipine
C. Verapamil
D. Nicardipine
Rationale: Non-DHP verapamil/diltiazem ↓ contractility. DHP like amlodipine more
vascular selective.
12. Statin most potent at LDL lowering?
A. Pravastatin 40mg
B. Simvastatin 40mg
C. Rosuvastatin 20mg
D. Lovastatin 40mg
