NSG 533 Exam 2 Practice | Advanced Pharmacology | 2026/2027 Edition Page 1
, NSG 533 EXAM 2
Advanced Pharmacology
Wilkes University
100-Question Practice Examination | 2026/2027 Edition
This original exam-style practice assessment is designed for study and review. It is not an official, leaked, or confidential Wilkes
University examination.
1. An older adult takes hydrocodone/acetaminophen several times daily and also uses an over-the-
counter cold product. Which safety issue deserves the highest priority?
A) Total daily acetaminophen exposure
B) Serotonin syndrome from hydrocodone
C) Loss of opioid analgesia from acetaminophen
D) Hyperkalemia from combination therapy
Correct Answer: Total daily acetaminophen exposure
Rationale: Combination products can unintentionally raise the total acetaminophen dose. Older adults and
patients with liver disease have less margin for dosing error, so all prescription and nonprescription sources
should be counted before recommending additional acetaminophen.
2. For mild nociceptive pain without contraindications, the first pharmacologic step in a stepwise
analgesic strategy is best represented by which option?
A) A long-acting strong opioid
B) Immediate use of methadone
C) Dual-opioid therapy
D) A nonopioid analgesic with or without an adjuvant
Correct Answer: A nonopioid analgesic with or without an adjuvant
Rationale: Stepwise pain therapy generally begins with nonopioid options such as acetaminophen or an
NSAID, with adjuvant therapy when appropriate. Opioids are reserved for situations in which pain severity,
diagnosis, and prior response justify their additional risks.
3. A patient with painful diabetic peripheral neuropathy also has major depressive symptoms. Which
medication can reasonably target both problems?
A) Acetaminophen
NSG 533 Exam 2 Practice | Advanced Pharmacology | 2026/2027 Edition Page 2
,B) Celecoxib
C) Duloxetine
D) Naloxone
Correct Answer: Duloxetine
Rationale: Duloxetine is an SNRI with evidence for diabetic neuropathic pain and depressive disorders.
Acetaminophen and celecoxib do not treat the neuropathic mechanism or depression, while naloxone is an
opioid antagonist used for opioid toxicity rather than chronic neuropathic pain.
4. When an NSAID dose has reached its analgesic ceiling, increasing the dose further is most likely to
produce what result?
A) Linear improvement in analgesia
B) Elimination of gastrointestinal risk
C) More toxicity with little additional analgesia
D) Conversion to opioid-level analgesia
Correct Answer: More toxicity with little additional analgesia
Rationale: NSAIDs have a ceiling effect for analgesia. Beyond an effective dose, greater exposure tends to
increase gastrointestinal, renal, and cardiovascular adverse effects more than it improves pain relief, so
escalation should be guided by risk and response rather than by dose alone.
5. A patient with stage 4 chronic kidney disease asks about regular ibuprofen for osteoarthritis pain.
Which concern is most important?
A) Severe hypoglycemia from COX inhibition
B) Irreversible bone marrow stimulation
C) Further reduction in renal perfusion and kidney function
D) Loss of all antihypertensive activity
Correct Answer: Further reduction in renal perfusion and kidney function
Rationale: NSAIDs reduce prostaglandin-mediated afferent arteriolar vasodilation and can worsen renal
perfusion, especially in advanced kidney disease, dehydration, heart failure, or concomitant renin-angiotensin
system blockade. This risk often makes chronic NSAID therapy inappropriate in severe renal impairment.
6. A patient with prior peptic ulcer bleeding requires anti-inflammatory therapy. Which strategy most
directly reduces gastrointestinal risk?
A) Use the lowest effective NSAID dose and consider gastroprotection
B) Add a second NSAID from another class
NSG 533 Exam 2 Practice | Advanced Pharmacology | 2026/2027 Edition Page 3
, C) Take the NSAID only with grapefruit juice
D) Combine aspirin with ketorolac
Correct Answer: Use the lowest effective NSAID dose and consider gastroprotection
Rationale: Prior ulcer bleeding markedly increases NSAID-related GI risk. Minimizing NSAID exposure and
using appropriate gastroprotection, such as a proton-pump inhibitor in high-risk patients, is safer than
combining NSAIDs or adding aspirin, which would increase bleeding risk.
7. A patient receiving chronic opioid therapy develops persistent constipation without evidence of
obstruction. Which management principle is most appropriate?
A) Wait for tolerance to eliminate the problem
B) Begin a proactive bowel regimen
C) Use naloxone orally at full overdose-reversal doses
D) Stop all fluid intake
Correct Answer: Begin a proactive bowel regimen
Rationale: Constipation is a predictable opioid adverse effect and tolerance develops poorly. Preventive
management commonly includes stimulant and/or osmotic laxative strategies, hydration when appropriate,
activity, and escalation to peripherally acting opioid antagonists for refractory opioid-induced constipation.
8. After an opioid dose increase, a patient becomes difficult to arouse and has slow, shallow
respirations. What pharmacologic intervention is most urgent?
A) Naltrexone depot injection
B) Duloxetine
C) Naloxone
D) Celecoxib
Correct Answer: Naloxone
Rationale: Naloxone is a short-acting opioid antagonist used to reverse life-threatening opioid-induced
respiratory depression. Because its duration can be shorter than that of the opioid, repeated dosing and
continued respiratory monitoring may be necessary after initial improvement.
9. Why does methadone require special caution during dose initiation and titration?
A) It has a long, variable half-life and can prolong the QT interval
B) It has no clinically relevant drug interactions
C) It cannot cause respiratory depression
D) It is eliminated entirely by the lungs
NSG 533 Exam 2 Practice | Advanced Pharmacology | 2026/2027 Edition Page 4
, NSG 533 EXAM 2
Advanced Pharmacology
Wilkes University
100-Question Practice Examination | 2026/2027 Edition
This original exam-style practice assessment is designed for study and review. It is not an official, leaked, or confidential Wilkes
University examination.
1. An older adult takes hydrocodone/acetaminophen several times daily and also uses an over-the-
counter cold product. Which safety issue deserves the highest priority?
A) Total daily acetaminophen exposure
B) Serotonin syndrome from hydrocodone
C) Loss of opioid analgesia from acetaminophen
D) Hyperkalemia from combination therapy
Correct Answer: Total daily acetaminophen exposure
Rationale: Combination products can unintentionally raise the total acetaminophen dose. Older adults and
patients with liver disease have less margin for dosing error, so all prescription and nonprescription sources
should be counted before recommending additional acetaminophen.
2. For mild nociceptive pain without contraindications, the first pharmacologic step in a stepwise
analgesic strategy is best represented by which option?
A) A long-acting strong opioid
B) Immediate use of methadone
C) Dual-opioid therapy
D) A nonopioid analgesic with or without an adjuvant
Correct Answer: A nonopioid analgesic with or without an adjuvant
Rationale: Stepwise pain therapy generally begins with nonopioid options such as acetaminophen or an
NSAID, with adjuvant therapy when appropriate. Opioids are reserved for situations in which pain severity,
diagnosis, and prior response justify their additional risks.
3. A patient with painful diabetic peripheral neuropathy also has major depressive symptoms. Which
medication can reasonably target both problems?
A) Acetaminophen
NSG 533 Exam 2 Practice | Advanced Pharmacology | 2026/2027 Edition Page 2
,B) Celecoxib
C) Duloxetine
D) Naloxone
Correct Answer: Duloxetine
Rationale: Duloxetine is an SNRI with evidence for diabetic neuropathic pain and depressive disorders.
Acetaminophen and celecoxib do not treat the neuropathic mechanism or depression, while naloxone is an
opioid antagonist used for opioid toxicity rather than chronic neuropathic pain.
4. When an NSAID dose has reached its analgesic ceiling, increasing the dose further is most likely to
produce what result?
A) Linear improvement in analgesia
B) Elimination of gastrointestinal risk
C) More toxicity with little additional analgesia
D) Conversion to opioid-level analgesia
Correct Answer: More toxicity with little additional analgesia
Rationale: NSAIDs have a ceiling effect for analgesia. Beyond an effective dose, greater exposure tends to
increase gastrointestinal, renal, and cardiovascular adverse effects more than it improves pain relief, so
escalation should be guided by risk and response rather than by dose alone.
5. A patient with stage 4 chronic kidney disease asks about regular ibuprofen for osteoarthritis pain.
Which concern is most important?
A) Severe hypoglycemia from COX inhibition
B) Irreversible bone marrow stimulation
C) Further reduction in renal perfusion and kidney function
D) Loss of all antihypertensive activity
Correct Answer: Further reduction in renal perfusion and kidney function
Rationale: NSAIDs reduce prostaglandin-mediated afferent arteriolar vasodilation and can worsen renal
perfusion, especially in advanced kidney disease, dehydration, heart failure, or concomitant renin-angiotensin
system blockade. This risk often makes chronic NSAID therapy inappropriate in severe renal impairment.
6. A patient with prior peptic ulcer bleeding requires anti-inflammatory therapy. Which strategy most
directly reduces gastrointestinal risk?
A) Use the lowest effective NSAID dose and consider gastroprotection
B) Add a second NSAID from another class
NSG 533 Exam 2 Practice | Advanced Pharmacology | 2026/2027 Edition Page 3
, C) Take the NSAID only with grapefruit juice
D) Combine aspirin with ketorolac
Correct Answer: Use the lowest effective NSAID dose and consider gastroprotection
Rationale: Prior ulcer bleeding markedly increases NSAID-related GI risk. Minimizing NSAID exposure and
using appropriate gastroprotection, such as a proton-pump inhibitor in high-risk patients, is safer than
combining NSAIDs or adding aspirin, which would increase bleeding risk.
7. A patient receiving chronic opioid therapy develops persistent constipation without evidence of
obstruction. Which management principle is most appropriate?
A) Wait for tolerance to eliminate the problem
B) Begin a proactive bowel regimen
C) Use naloxone orally at full overdose-reversal doses
D) Stop all fluid intake
Correct Answer: Begin a proactive bowel regimen
Rationale: Constipation is a predictable opioid adverse effect and tolerance develops poorly. Preventive
management commonly includes stimulant and/or osmotic laxative strategies, hydration when appropriate,
activity, and escalation to peripherally acting opioid antagonists for refractory opioid-induced constipation.
8. After an opioid dose increase, a patient becomes difficult to arouse and has slow, shallow
respirations. What pharmacologic intervention is most urgent?
A) Naltrexone depot injection
B) Duloxetine
C) Naloxone
D) Celecoxib
Correct Answer: Naloxone
Rationale: Naloxone is a short-acting opioid antagonist used to reverse life-threatening opioid-induced
respiratory depression. Because its duration can be shorter than that of the opioid, repeated dosing and
continued respiratory monitoring may be necessary after initial improvement.
9. Why does methadone require special caution during dose initiation and titration?
A) It has a long, variable half-life and can prolong the QT interval
B) It has no clinically relevant drug interactions
C) It cannot cause respiratory depression
D) It is eliminated entirely by the lungs
NSG 533 Exam 2 Practice | Advanced Pharmacology | 2026/2027 Edition Page 4
