NRG 200 PHARMACOLOGY PRACTICE EXAM – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD
AND PASS | LATEST EXAM UPDATE 2026/2027
Core Domains
• Pharmacokinetics and Pharmacodynamics
• Autonomic Nervous System Pharmacology
• Cardiovascular and Renal Pharmacology
• Central Nervous System Pharmacology
• Endocrine Pharmacology
• Chemotherapy and Antimicrobial Agents
• Toxicology and Overdose Management
• Pain Management and Anesthetics
• Legal, Ethical, and Professional Standards in Pharmacology
• Pharmacogenomics and Individualized Medicine
Introduction
This comprehensive practice examination is designed to assess your foundational
and applied knowledge in pharmacology, aligning with the core competencies
required for the NRG 200 certification. The exam integrates multiple-choice
questions and clinical scenario-based items to evaluate your ability to apply
pharmacological principles in real-world decision-making. You will be tested on
drug mechanisms, therapeutic applications, adverse effects, drug interactions, and
patient-specific considerations, including legal and ethical standards. Emphasis is
placed on critical thinking, clinical reasoning, and the safe, effective application of
,pharmacological agents. This exam serves as a robust tool to identify strengths,
address knowledge gaps, and enhance exam readiness.
SECTION ONE: QUESTIONS 1–50
1. A patient is receiving intravenous (IV) gentamicin for a severe gram-negative
infection. The nurse notes that the patient’s serum creatinine level has
increased from 1.0 mg/dL to 2.5 mg/dL over 48 hours. Which of the following
actions is most appropriate?
A. Increase the infusion rate to ensure therapeutic levels
B. Continue the current dose but monitor serum drug levels
C. Hold the next dose and notify the prescribing provider
D. Administer a loop diuretic to enhance drug excretion
🟢 Correct Answer: C. Hold the next dose and notify the prescribing provider
🔴 Explanation: Gentamicin is an aminoglycoside antibiotic with significant
nephrotoxic potential. The acute rise in serum creatinine indicates acute kidney
injury (AKI), likely drug-induced. The most appropriate action is to hold the next
dose and notify the provider for dose adjustment or discontinuation, as
continued administration could worsen renal impairment. Increasing the rate or
continuing the dose would exacerbate toxicity, and diuretics do not enhance
aminoglycoside excretion in AKI.
2. A patient with type 2 diabetes mellitus is prescribed metformin. Which of the
following laboratory values should be monitored routinely to prevent a serious
adverse effect?
,A. Serum potassium
B. Serum creatinine and BUN
C. Hemoglobin A1c
D. Liver function tests
🟢 Correct Answer: B. Serum creatinine and BUN
🔴 Explanation: Metformin carries a risk of lactic acidosis, especially in patients
with renal impairment. Routine monitoring of serum creatinine and blood urea
nitrogen (BUN) is essential to assess renal function and adjust dosing accordingly.
While other parameters are relevant to diabetes management, they are not
specific to preventing metformin’s most severe adverse effect.
3. A patient is prescribed warfarin for atrial fibrillation. Which patient statement
indicates a need for further teaching?
A. "I will take my warfarin at the same time every day."
B. "I need to have my blood drawn regularly to check my INR."
C. "I can take aspirin if I have a headache, since it helps with my heart."
D. "I should avoid drinking alcohol while on this medication."
🟢 Correct Answer: C. "I can take aspirin if I have a headache, since it helps with
my heart."
🔴 Explanation: Warfarin is an anticoagulant that increases bleeding risk. Aspirin
also has antiplatelet effects, and concurrent use significantly increases the risk of
bleeding. Patients should avoid additional anticoagulant or antiplatelet agents
unless specifically prescribed and monitored. Taking aspirin for a headache
without provider approval is unsafe and indicates a need for further education.
, 4. A patient is receiving furosemide for heart failure. Which assessment finding
is most concerning for a potential adverse effect?
A. Serum potassium of 3.2 mEq/L
B. Blood pressure of 110/70 mmHg
C. Urine output of 500 mL over 8 hours
D. Serum sodium of 138 mEq/L
🟢 Correct Answer: A. Serum potassium of 3.2 mEq/L
🔴 Explanation: Furosemide is a loop diuretic that can cause significant
electrolyte imbalances, particularly hypokalemia. A serum potassium of 3.2 mEq/L
is below the normal range (3.5–5.0 mEq/L) and increases the risk of cardiac
arrhythmias, especially in patients with heart failure who may also be on digoxin.
This finding is more concerning than the other options, which are within
acceptable ranges or expected findings.
5. Which of the following medications is a non-selective beta-blocker that may
exacerbate asthma or COPD?
A. Metoprolol
B. Atenolol
C. Propranolol
D. Esmolol
🟢 Correct Answer: C. Propranolol
🔴 Explanation: Propranolol is a non-selective beta-blocker (blocks both β1 and
β2 receptors). Blockade of β2 receptors in the bronchial smooth muscle can lead
to bronchoconstriction, making it contraindicated in patients with asthma or
COPD. Metoprolol, atenolol, and esmolol are cardioselective (β1-blockers) and
have less effect on pulmonary function.
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD
AND PASS | LATEST EXAM UPDATE 2026/2027
Core Domains
• Pharmacokinetics and Pharmacodynamics
• Autonomic Nervous System Pharmacology
• Cardiovascular and Renal Pharmacology
• Central Nervous System Pharmacology
• Endocrine Pharmacology
• Chemotherapy and Antimicrobial Agents
• Toxicology and Overdose Management
• Pain Management and Anesthetics
• Legal, Ethical, and Professional Standards in Pharmacology
• Pharmacogenomics and Individualized Medicine
Introduction
This comprehensive practice examination is designed to assess your foundational
and applied knowledge in pharmacology, aligning with the core competencies
required for the NRG 200 certification. The exam integrates multiple-choice
questions and clinical scenario-based items to evaluate your ability to apply
pharmacological principles in real-world decision-making. You will be tested on
drug mechanisms, therapeutic applications, adverse effects, drug interactions, and
patient-specific considerations, including legal and ethical standards. Emphasis is
placed on critical thinking, clinical reasoning, and the safe, effective application of
,pharmacological agents. This exam serves as a robust tool to identify strengths,
address knowledge gaps, and enhance exam readiness.
SECTION ONE: QUESTIONS 1–50
1. A patient is receiving intravenous (IV) gentamicin for a severe gram-negative
infection. The nurse notes that the patient’s serum creatinine level has
increased from 1.0 mg/dL to 2.5 mg/dL over 48 hours. Which of the following
actions is most appropriate?
A. Increase the infusion rate to ensure therapeutic levels
B. Continue the current dose but monitor serum drug levels
C. Hold the next dose and notify the prescribing provider
D. Administer a loop diuretic to enhance drug excretion
🟢 Correct Answer: C. Hold the next dose and notify the prescribing provider
🔴 Explanation: Gentamicin is an aminoglycoside antibiotic with significant
nephrotoxic potential. The acute rise in serum creatinine indicates acute kidney
injury (AKI), likely drug-induced. The most appropriate action is to hold the next
dose and notify the provider for dose adjustment or discontinuation, as
continued administration could worsen renal impairment. Increasing the rate or
continuing the dose would exacerbate toxicity, and diuretics do not enhance
aminoglycoside excretion in AKI.
2. A patient with type 2 diabetes mellitus is prescribed metformin. Which of the
following laboratory values should be monitored routinely to prevent a serious
adverse effect?
,A. Serum potassium
B. Serum creatinine and BUN
C. Hemoglobin A1c
D. Liver function tests
🟢 Correct Answer: B. Serum creatinine and BUN
🔴 Explanation: Metformin carries a risk of lactic acidosis, especially in patients
with renal impairment. Routine monitoring of serum creatinine and blood urea
nitrogen (BUN) is essential to assess renal function and adjust dosing accordingly.
While other parameters are relevant to diabetes management, they are not
specific to preventing metformin’s most severe adverse effect.
3. A patient is prescribed warfarin for atrial fibrillation. Which patient statement
indicates a need for further teaching?
A. "I will take my warfarin at the same time every day."
B. "I need to have my blood drawn regularly to check my INR."
C. "I can take aspirin if I have a headache, since it helps with my heart."
D. "I should avoid drinking alcohol while on this medication."
🟢 Correct Answer: C. "I can take aspirin if I have a headache, since it helps with
my heart."
🔴 Explanation: Warfarin is an anticoagulant that increases bleeding risk. Aspirin
also has antiplatelet effects, and concurrent use significantly increases the risk of
bleeding. Patients should avoid additional anticoagulant or antiplatelet agents
unless specifically prescribed and monitored. Taking aspirin for a headache
without provider approval is unsafe and indicates a need for further education.
, 4. A patient is receiving furosemide for heart failure. Which assessment finding
is most concerning for a potential adverse effect?
A. Serum potassium of 3.2 mEq/L
B. Blood pressure of 110/70 mmHg
C. Urine output of 500 mL over 8 hours
D. Serum sodium of 138 mEq/L
🟢 Correct Answer: A. Serum potassium of 3.2 mEq/L
🔴 Explanation: Furosemide is a loop diuretic that can cause significant
electrolyte imbalances, particularly hypokalemia. A serum potassium of 3.2 mEq/L
is below the normal range (3.5–5.0 mEq/L) and increases the risk of cardiac
arrhythmias, especially in patients with heart failure who may also be on digoxin.
This finding is more concerning than the other options, which are within
acceptable ranges or expected findings.
5. Which of the following medications is a non-selective beta-blocker that may
exacerbate asthma or COPD?
A. Metoprolol
B. Atenolol
C. Propranolol
D. Esmolol
🟢 Correct Answer: C. Propranolol
🔴 Explanation: Propranolol is a non-selective beta-blocker (blocks both β1 and
β2 receptors). Blockade of β2 receptors in the bronchial smooth muscle can lead
to bronchoconstriction, making it contraindicated in patients with asthma or
COPD. Metoprolol, atenolol, and esmolol are cardioselective (β1-blockers) and
have less effect on pulmonary function.
