NR 508 ADVANCED PHARMACOLOGY
COMPREHENSIVE EXAM BANK
2026/2027
1. Which pharmacokinetic parameter is primarily affected by a patient’s genetic
polymorphism of the CYP2D6 enzyme?
A. Metabolism
B. Distribution
C. Absorption
D. Excretion
Answer: A
Conceptual Explanation: Metabolism is the primary phase affected by cytochrome P450
enzyme polymorphisms, such as CYP2D6, which can lead to poor or ultra-rapid metabolism
of drugs like codeine.
2. A patient is prescribed a drug with a narrow therapeutic index. Which of the following
statements best describes the clinical implication of this?
A. The drug has a high margin of safety.
B. The drug is rapidly eliminated by the kidneys.
,C. The drug does not require serum level monitoring.
D. The toxic dose is very close to the therapeutic dose.
Answer: D
Conceptual Explanation: A narrow therapeutic index indicates that there is a small
difference between the dose that produces a therapeutic effect and the dose that produces
toxicity, requiring careful monitoring.
3. When prescribing an ACE inhibitor to a patient with chronic kidney disease (CKD), the nurse
practitioner should monitor for which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
Answer: A
Conceptual Explanation: ACE inhibitors decrease aldosterone secretion, which leads to
potassium retention, potentially resulting in hyperkalemia, especially in patients with
impaired renal function.
4. What is the mechanism of action of Metformin in the treatment of Type 2 Diabetes?
A. Decreases hepatic glucose production and improves insulin sensitivity.
B. Increases glucose uptake in the kidneys.
, C. Stimulates insulin secretion from pancreatic beta cells.
D. Slows the absorption of carbohydrates in the gut.
Answer: A
Conceptual Explanation: Metformin primarily works by decreasing gluconeogenesis in
the liver and increasing peripheral insulin sensitivity; it does not stimulate insulin
secretion.
5. A 65-year-old patient is prescribed Amiodarone for atrial fibrillation. Which baseline and
periodic screening is most critical due to potential organ toxicity?
A. Bone density scans.
B. Hearing tests and vision exams.
C. Pulmonary function tests and thyroid levels.
D. Complete blood count for agranulocytosis.
Answer: C
Conceptual Explanation: Amiodarone is associated with pulmonary fibrosis and thyroid
dysfunction (both hyper- and hypothyroidism) due to its high iodine content and tissue
accumulation.
6. Which of the following describes ‘First-Pass Metabolism’?
A. The initial metabolism of a drug in the gut wall before entering the liver.
B. The binding of a drug to albumin in the bloodstream.
COMPREHENSIVE EXAM BANK
2026/2027
1. Which pharmacokinetic parameter is primarily affected by a patient’s genetic
polymorphism of the CYP2D6 enzyme?
A. Metabolism
B. Distribution
C. Absorption
D. Excretion
Answer: A
Conceptual Explanation: Metabolism is the primary phase affected by cytochrome P450
enzyme polymorphisms, such as CYP2D6, which can lead to poor or ultra-rapid metabolism
of drugs like codeine.
2. A patient is prescribed a drug with a narrow therapeutic index. Which of the following
statements best describes the clinical implication of this?
A. The drug has a high margin of safety.
B. The drug is rapidly eliminated by the kidneys.
,C. The drug does not require serum level monitoring.
D. The toxic dose is very close to the therapeutic dose.
Answer: D
Conceptual Explanation: A narrow therapeutic index indicates that there is a small
difference between the dose that produces a therapeutic effect and the dose that produces
toxicity, requiring careful monitoring.
3. When prescribing an ACE inhibitor to a patient with chronic kidney disease (CKD), the nurse
practitioner should monitor for which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
Answer: A
Conceptual Explanation: ACE inhibitors decrease aldosterone secretion, which leads to
potassium retention, potentially resulting in hyperkalemia, especially in patients with
impaired renal function.
4. What is the mechanism of action of Metformin in the treatment of Type 2 Diabetes?
A. Decreases hepatic glucose production and improves insulin sensitivity.
B. Increases glucose uptake in the kidneys.
, C. Stimulates insulin secretion from pancreatic beta cells.
D. Slows the absorption of carbohydrates in the gut.
Answer: A
Conceptual Explanation: Metformin primarily works by decreasing gluconeogenesis in
the liver and increasing peripheral insulin sensitivity; it does not stimulate insulin
secretion.
5. A 65-year-old patient is prescribed Amiodarone for atrial fibrillation. Which baseline and
periodic screening is most critical due to potential organ toxicity?
A. Bone density scans.
B. Hearing tests and vision exams.
C. Pulmonary function tests and thyroid levels.
D. Complete blood count for agranulocytosis.
Answer: C
Conceptual Explanation: Amiodarone is associated with pulmonary fibrosis and thyroid
dysfunction (both hyper- and hypothyroidism) due to its high iodine content and tissue
accumulation.
6. Which of the following describes ‘First-Pass Metabolism’?
A. The initial metabolism of a drug in the gut wall before entering the liver.
B. The binding of a drug to albumin in the bloodstream.
