NU 578 - Unit 2 EXAM 2026 | ACTUAL REAL EXAM ACCURATE
QUESTIONS AND ANSWERS WITH RATIONALES | VERIFIED AND
LATEST UPDATED |GUARANTEED PASS
Question 1. A patient taking warfarin has an INR of 5.8 without active
bleeding. Which finding is most important when assessing the patient's
medication history?
A. Recent use of an antacid
B. Recent use of an antibiotic
C. Increased intake of potassium
D. Increased intake of dietary fiber
Correct Answer: B. Recent use of an antibiotic
Rationale: Many antibiotics can increase warfarin's anticoagulant effect by
altering vitamin K production in the gut or inhibiting warfarin metabolism.
This can raise the INR and increase bleeding risk. Medication reconciliation is
therefore essential when an unexpectedly high INR occurs.
Question 2. Which pharmacokinetic change is most likely to occur in an older
adult?
A. Increased renal clearance
B. Increased hepatic blood flow
C. Reduced renal elimination
D. Increased total body water
Correct Answer: C. Reduced renal elimination
Rationale: Aging commonly decreases renal blood flow and glomerular
filtration, reducing clearance of renally eliminated medications. This can
increase drug concentrations and toxicity risk, particularly for drugs with
narrow therapeutic ranges.
Question 3. A patient with a CYP2D6 poor-metabolizer phenotype receives a
medication primarily activated by CYP2D6. What effect is most likely?
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,A. Increased formation of the active metabolite
B. Reduced therapeutic effect
C. Increased renal elimination
D. Complete prevention of adverse effects
Correct Answer: B. Reduced therapeutic effect
Rationale: Some medications are prodrugs that require CYP enzymes for
conversion to their active forms. A poor metabolizer has reduced enzymatic
activity, resulting in less active metabolite formation and potentially
inadequate therapeutic response.
Question 4. Which genetic phenotype may result in unusually rapid
conversion of a drug to its active metabolite?
A. Poor metabolizer
B. Intermediate metabolizer
C. Normal metabolizer
D. Ultrarapid metabolizer
Correct Answer: D. Ultrarapid metabolizer
Rationale: Ultrarapid metabolizers have unusually high metabolic activity for
certain CYP pathways. With some prodrugs, this can produce excessive active
metabolite concentrations and increase adverse-effect risk.
Question 5. A patient taking simvastatin is advised to avoid large amounts of
grapefruit juice. What is the primary pharmacologic concern?
A. Increased CYP3A4-mediated metabolism
B. Inhibition of intestinal CYP3A4
C. Increased renal filtration
D. Increased protein binding
Correct Answer: B. Inhibition of intestinal CYP3A4
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,Rationale: Grapefruit components can inhibit intestinal CYP3A4, reducing
first-pass metabolism of susceptible drugs. This may increase systemic drug
concentrations and increase the risk of dose-related toxicity.
Question 6. Which medication effect is most likely in a patient who abruptly
stops long-term clonidine therapy?
A. Severe hypoglycemia
B. Rebound hypertension
C. Profound bradycardia
D. Acute renal failure
Correct Answer: B. Rebound hypertension
Rationale: Clonidine suppresses sympathetic outflow from the central
nervous system. Abrupt withdrawal can produce excessive sympathetic
activity, resulting in rebound hypertension, tachycardia, anxiety, and other
withdrawal symptoms. Gradual tapering is generally used.
Question 7. Which adverse drug reaction is considered a predictable, dose-
related reaction?
A. Type A reaction
B. Type B reaction
C. Idiosyncratic reaction
D. Delayed hypersensitivity reaction
Correct Answer: A. Type A reaction
Rationale: Type A adverse drug reactions are predictable from the known
pharmacologic action of a medication and are generally dose dependent.
Examples include hypoglycemia from insulin and bleeding from excessive
anticoagulation.
3|Page
, Question 8. Which characteristic best describes a Type B adverse drug
reaction?
A. Predictable and dose dependent
B. Related directly to therapeutic action
C. Unpredictable and often immune or idiosyncratic
D. Always caused by medication overdose
Correct Answer: C. Unpredictable and often immune or idiosyncratic
Rationale: Type B reactions are generally not predictable from the drug's
normal pharmacologic effects. They may result from unusual individual
responses, genetic factors, or immune-mediated reactions and can occur at
therapeutic doses.
Question 9. Which medication is considered a high-alert medication because
an error can cause serious patient harm?
A. Multivitamin
B. Insulin
C. Topical moisturizer
D. Calcium carbonate antacid
Correct Answer: B. Insulin
Rationale: Insulin is classified as a high-alert medication because dosing
errors can produce severe hypoglycemia, neurologic injury, or death. Accurate
prescribing, preparation, administration, and monitoring are essential.
Question 10. Which intervention is most appropriate during medication
reconciliation?
A. Review only prescription medications
B. Review only medications prescribed by the current provider
C. Compare the patient's complete medication list with current orders
D. Ask only about medications taken during hospitalization
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QUESTIONS AND ANSWERS WITH RATIONALES | VERIFIED AND
LATEST UPDATED |GUARANTEED PASS
Question 1. A patient taking warfarin has an INR of 5.8 without active
bleeding. Which finding is most important when assessing the patient's
medication history?
A. Recent use of an antacid
B. Recent use of an antibiotic
C. Increased intake of potassium
D. Increased intake of dietary fiber
Correct Answer: B. Recent use of an antibiotic
Rationale: Many antibiotics can increase warfarin's anticoagulant effect by
altering vitamin K production in the gut or inhibiting warfarin metabolism.
This can raise the INR and increase bleeding risk. Medication reconciliation is
therefore essential when an unexpectedly high INR occurs.
Question 2. Which pharmacokinetic change is most likely to occur in an older
adult?
A. Increased renal clearance
B. Increased hepatic blood flow
C. Reduced renal elimination
D. Increased total body water
Correct Answer: C. Reduced renal elimination
Rationale: Aging commonly decreases renal blood flow and glomerular
filtration, reducing clearance of renally eliminated medications. This can
increase drug concentrations and toxicity risk, particularly for drugs with
narrow therapeutic ranges.
Question 3. A patient with a CYP2D6 poor-metabolizer phenotype receives a
medication primarily activated by CYP2D6. What effect is most likely?
1|Page
,A. Increased formation of the active metabolite
B. Reduced therapeutic effect
C. Increased renal elimination
D. Complete prevention of adverse effects
Correct Answer: B. Reduced therapeutic effect
Rationale: Some medications are prodrugs that require CYP enzymes for
conversion to their active forms. A poor metabolizer has reduced enzymatic
activity, resulting in less active metabolite formation and potentially
inadequate therapeutic response.
Question 4. Which genetic phenotype may result in unusually rapid
conversion of a drug to its active metabolite?
A. Poor metabolizer
B. Intermediate metabolizer
C. Normal metabolizer
D. Ultrarapid metabolizer
Correct Answer: D. Ultrarapid metabolizer
Rationale: Ultrarapid metabolizers have unusually high metabolic activity for
certain CYP pathways. With some prodrugs, this can produce excessive active
metabolite concentrations and increase adverse-effect risk.
Question 5. A patient taking simvastatin is advised to avoid large amounts of
grapefruit juice. What is the primary pharmacologic concern?
A. Increased CYP3A4-mediated metabolism
B. Inhibition of intestinal CYP3A4
C. Increased renal filtration
D. Increased protein binding
Correct Answer: B. Inhibition of intestinal CYP3A4
2|Page
,Rationale: Grapefruit components can inhibit intestinal CYP3A4, reducing
first-pass metabolism of susceptible drugs. This may increase systemic drug
concentrations and increase the risk of dose-related toxicity.
Question 6. Which medication effect is most likely in a patient who abruptly
stops long-term clonidine therapy?
A. Severe hypoglycemia
B. Rebound hypertension
C. Profound bradycardia
D. Acute renal failure
Correct Answer: B. Rebound hypertension
Rationale: Clonidine suppresses sympathetic outflow from the central
nervous system. Abrupt withdrawal can produce excessive sympathetic
activity, resulting in rebound hypertension, tachycardia, anxiety, and other
withdrawal symptoms. Gradual tapering is generally used.
Question 7. Which adverse drug reaction is considered a predictable, dose-
related reaction?
A. Type A reaction
B. Type B reaction
C. Idiosyncratic reaction
D. Delayed hypersensitivity reaction
Correct Answer: A. Type A reaction
Rationale: Type A adverse drug reactions are predictable from the known
pharmacologic action of a medication and are generally dose dependent.
Examples include hypoglycemia from insulin and bleeding from excessive
anticoagulation.
3|Page
, Question 8. Which characteristic best describes a Type B adverse drug
reaction?
A. Predictable and dose dependent
B. Related directly to therapeutic action
C. Unpredictable and often immune or idiosyncratic
D. Always caused by medication overdose
Correct Answer: C. Unpredictable and often immune or idiosyncratic
Rationale: Type B reactions are generally not predictable from the drug's
normal pharmacologic effects. They may result from unusual individual
responses, genetic factors, or immune-mediated reactions and can occur at
therapeutic doses.
Question 9. Which medication is considered a high-alert medication because
an error can cause serious patient harm?
A. Multivitamin
B. Insulin
C. Topical moisturizer
D. Calcium carbonate antacid
Correct Answer: B. Insulin
Rationale: Insulin is classified as a high-alert medication because dosing
errors can produce severe hypoglycemia, neurologic injury, or death. Accurate
prescribing, preparation, administration, and monitoring are essential.
Question 10. Which intervention is most appropriate during medication
reconciliation?
A. Review only prescription medications
B. Review only medications prescribed by the current provider
C. Compare the patient's complete medication list with current orders
D. Ask only about medications taken during hospitalization
4|Page
