NURS 6521 - Advanced Pharmacology Final Exam 2026/2027 -
Edition 100 Questions & Verified Answers
Overview
NURS 6521 Advanced Pharmacology covers: pharmacokinetics/dynamics, ANS, CNS,
CV, endocrine, antimicrobials, anticoagulation, psych, pain, special populations, and
prescribing. This Exam set emphasizes application, safety, and “choose best” scenarios
for NP boards. Correct answer in bold Green.
Questions 1-25: Pharm Principles, ANS, CV
1. A drug with high first-pass metabolism is given PO. Compared to IV, the PO
dose must be:
A. Lower
B. Higher
C. The same
D. Given more frequently
Rationale: High first-pass → significant hepatic metabolism before systemic circulation
→ lower bioavailability → higher PO dose needed vs IV.
2. Which statement about volume of distribution (Vd) is true?
A. Hydrophilic drugs have large Vd
B. Lipophilic drugs have large Vd
C. Vd determines half-life only
D. Vd is not affected by protein binding
Rationale: Lipophilic drugs distribute to tissues/fat → large Vd. Hydrophilic stay in
plasma → small Vd. Vd = dose/concentration.
3. A patient takes a CYP2D6 prodrug codeine. If the patient is a CYP2D6 poor
metabolizer, the effect will be:
A. Increased analgesia
B. Decreased analgesia
C. Increased toxicity
D. No change
Rationale: Codeine must be metabolized to morphine via CYP2D6. Poor metabolizer =
less morphine = ↓ analgesia.
4. Phenytoin exhibits zero-order kinetics at therapeutic levels. This means:
A. A constant fraction is eliminated per unit time
B. A constant amount is eliminated per unit time
C. Half-life is constant
D. Dose changes cause linear level changes
Rationale: Zero-order = saturable metabolism. Constant amount removed → small
dose ↑ causes large level ↑.
5. Which beta-blocker has intrinsic sympathomimetic activity and is less likely to
cause bradycardia?
A. Metoprolol
B. Propranolol
, C. Pindolol
D. Atenolol
Rationale: Pindolol, acebutolol have ISA = partial agonist → less HR ↓, useful if
bradycardia concern.
6. A patient on donepezil for Alzheimer’s develops bradycardia. Mechanism?
A. Beta-1 blockade
B. Increased acetylcholine → vagal tone
C. Alpha-1 agonism
D. Sodium channel blockade
Rationale: Cholinesterase inhibitors ↑ ACh → ↑ vagal tone → bradycardia, GI upset.
7. Atropine is used to treat which toxicity?
A. Beta-blocker overdose
B. Organophosphate poisoning
C. Opioid overdose
D. Calcium channel blocker overdose
Rationale: Organophosphates inhibit AChE → cholinergic crisis. Atropine blocks
muscarinic effects. Pralidoxime reactivates AChE.
8. A 72yo with HFpEF and HTN. Which drug class is NOT indicated to reduce
mortality?
A. ARNI
B. CCB
C. ACEi
D. Beta-blocker
Rationale: In HFpEF, no drug class has clear mortality benefit yet. Use for HTN control.
CCBs don’t reduce mortality; BB/ACE/ARNI do in HFrEF.
9. Nitroglycerin is contraindicated within 24h of which drug?
A. Metoprolol
B. Sildenafil
C. Lisinopril
D. Atorvastatin
Rationale: PDE-5 inhibitors + nitrates → profound hypotension. Avoid sildenafil 24h,
tadalafil 48h.
10. A patient on spironolactone develops gynecomastia. Alternative K-sparing
diuretic?
A. HCTZ
B. Furosemide
C. Eplerenone
D. Amiloride
Rationale: Spironolactone antiandrogen effects → gynecomastia. Eplerenone selective,
no antiandrogen SE.
11. Digoxin mechanism of action?
A. Beta-1 agonist
B. Na/K ATPase inhibitor → ↑ intracellular Ca
C. Ca channel blocker
D. PDE inhibitor
Edition 100 Questions & Verified Answers
Overview
NURS 6521 Advanced Pharmacology covers: pharmacokinetics/dynamics, ANS, CNS,
CV, endocrine, antimicrobials, anticoagulation, psych, pain, special populations, and
prescribing. This Exam set emphasizes application, safety, and “choose best” scenarios
for NP boards. Correct answer in bold Green.
Questions 1-25: Pharm Principles, ANS, CV
1. A drug with high first-pass metabolism is given PO. Compared to IV, the PO
dose must be:
A. Lower
B. Higher
C. The same
D. Given more frequently
Rationale: High first-pass → significant hepatic metabolism before systemic circulation
→ lower bioavailability → higher PO dose needed vs IV.
2. Which statement about volume of distribution (Vd) is true?
A. Hydrophilic drugs have large Vd
B. Lipophilic drugs have large Vd
C. Vd determines half-life only
D. Vd is not affected by protein binding
Rationale: Lipophilic drugs distribute to tissues/fat → large Vd. Hydrophilic stay in
plasma → small Vd. Vd = dose/concentration.
3. A patient takes a CYP2D6 prodrug codeine. If the patient is a CYP2D6 poor
metabolizer, the effect will be:
A. Increased analgesia
B. Decreased analgesia
C. Increased toxicity
D. No change
Rationale: Codeine must be metabolized to morphine via CYP2D6. Poor metabolizer =
less morphine = ↓ analgesia.
4. Phenytoin exhibits zero-order kinetics at therapeutic levels. This means:
A. A constant fraction is eliminated per unit time
B. A constant amount is eliminated per unit time
C. Half-life is constant
D. Dose changes cause linear level changes
Rationale: Zero-order = saturable metabolism. Constant amount removed → small
dose ↑ causes large level ↑.
5. Which beta-blocker has intrinsic sympathomimetic activity and is less likely to
cause bradycardia?
A. Metoprolol
B. Propranolol
, C. Pindolol
D. Atenolol
Rationale: Pindolol, acebutolol have ISA = partial agonist → less HR ↓, useful if
bradycardia concern.
6. A patient on donepezil for Alzheimer’s develops bradycardia. Mechanism?
A. Beta-1 blockade
B. Increased acetylcholine → vagal tone
C. Alpha-1 agonism
D. Sodium channel blockade
Rationale: Cholinesterase inhibitors ↑ ACh → ↑ vagal tone → bradycardia, GI upset.
7. Atropine is used to treat which toxicity?
A. Beta-blocker overdose
B. Organophosphate poisoning
C. Opioid overdose
D. Calcium channel blocker overdose
Rationale: Organophosphates inhibit AChE → cholinergic crisis. Atropine blocks
muscarinic effects. Pralidoxime reactivates AChE.
8. A 72yo with HFpEF and HTN. Which drug class is NOT indicated to reduce
mortality?
A. ARNI
B. CCB
C. ACEi
D. Beta-blocker
Rationale: In HFpEF, no drug class has clear mortality benefit yet. Use for HTN control.
CCBs don’t reduce mortality; BB/ACE/ARNI do in HFrEF.
9. Nitroglycerin is contraindicated within 24h of which drug?
A. Metoprolol
B. Sildenafil
C. Lisinopril
D. Atorvastatin
Rationale: PDE-5 inhibitors + nitrates → profound hypotension. Avoid sildenafil 24h,
tadalafil 48h.
10. A patient on spironolactone develops gynecomastia. Alternative K-sparing
diuretic?
A. HCTZ
B. Furosemide
C. Eplerenone
D. Amiloride
Rationale: Spironolactone antiandrogen effects → gynecomastia. Eplerenone selective,
no antiandrogen SE.
11. Digoxin mechanism of action?
A. Beta-1 agonist
B. Na/K ATPase inhibitor → ↑ intracellular Ca
C. Ca channel blocker
D. PDE inhibitor
