1 | Page
NSG 533 FINAL EXAM 2026 – ADVANCED PHARMACOLOGY
QUESTIONS & VERIFIED ANSWERS WITH RATIONALES ALREADY
GRADED A+, GUARANTEED PASS
1.
A 60-year-old patient with a history of GERD is started on omeprazole for
persistent symptoms. The provider explains that the drug works at the final
common pathway of gastric acid secretion. Which mechanism best describes how
omeprazole reduces gastric acidity?
Answer: It irreversibly inhibits the gastric H⁺/K⁺ ATPase (proton pump) in
parietal cells.
Rationale: PPIs covalently bind the proton pump, leading to prolonged
suppression of acid secretion until new pumps are synthesized.
2.
A 72-year-old man stabilized on warfarin is prescribed trimethoprim-
sulfamethoxazole for a urinary tract infection. A week later, he presents with
gingival bleeding and an elevated INR. Which pharmacokinetic interaction best
explains this finding?
Answer: TMP-SMX inhibits warfarin metabolism, leading to increased
anticoagulant effect and bleeding risk.
Rationale: Sulfonamides inhibit CYP450 and displace warfarin from protein
binding sites, increasing INR.
3.
,2 | Page
A pregnant woman with group B strep bacteriuria needs antibiotic therapy. Which
antibiotic class is both effective and considered safe during pregnancy compared to
alternatives like tetracyclines or fluoroquinolones?
Answer: Penicillins are safe in pregnancy and act by inhibiting bacterial cell
wall synthesis.
Rationale: Beta-lactams are bactericidal and safe in pregnancy; tetracyclines
cause teeth discoloration, fluoroquinolones damage cartilage.
4.
A patient with mild hypertension is prescribed a beta-blocker. The clinician
chooses pindolol because it provides partial agonist activity at beta-receptors,
thereby reducing bradycardia risk. What is this property called?
Answer: Intrinsic sympathomimetic activity (ISA).
Rationale: ISA means the drug partially stimulates receptors while blocking
stronger endogenous agonists.
5.
A 25-year-old male presents after ingesting 20 grams of acetaminophen. Liver
enzymes are elevated, but treatment is started within 8 hours of ingestion. Which
antidote prevents hepatic injury by replenishing glutathione stores?
Answer: N-acetylcysteine.
Rationale: NAC restores glutathione, which detoxifies the harmful metabolite
NAPQI.
6.
A patient receiving unfractionated heparin for DVT develops a sudden platelet
count drop and new DVTs. The team suspects heparin-induced thrombocytopenia
(HIT). Which is the most appropriate next therapeutic step?
,3 | Page
Answer: Discontinue heparin and initiate a direct thrombin inhibitor such as
argatroban.
Rationale: Warfarin is avoided initially because it may worsen hypercoagulability;
platelet transfusion is contraindicated.
7.
A 45-year-old man with cirrhosis is prescribed spironolactone for ascites. The drug
improves his condition by acting at the collecting duct of the nephron. What is its
primary mechanism?
Answer: Aldosterone receptor antagonism, leading to potassium retention and
sodium/water excretion.
Rationale: Unlike loop or thiazide diuretics, spironolactone spares potassium.
8.
A patient with major depression on sertraline complains of decreased libido and
anorgasmia. The psychiatrist considers switching therapy to an antidepressant with
lower sexual side-effect risk. Which drug is most appropriate?
Answer: Bupropion.
Rationale: As an NDRI, bupropion enhances norepinephrine and dopamine but
has minimal serotonin activity, avoiding sexual side effects.
9.
A 52-year-old man with bipolar disorder is stable on lithium but later develops
tremor and confusion after being prescribed hydrochlorothiazide. What is the
mechanism for this adverse drug interaction?
Answer: Thiazides increase lithium reabsorption in the proximal tubule,
raising serum lithium levels and toxicity risk.
Rationale: Sodium loss enhances lithium retention since the kidney treats lithium
like sodium.
, 4 | Page
10.
A patient with generalized tonic-clonic seizures is prescribed phenytoin. The
provider explains the importance of therapeutic drug monitoring. Which
pharmacokinetic property justifies frequent monitoring of this drug?
Answer: Phenytoin exhibits zero-order kinetics at higher concentrations.
Rationale: Once enzymes are saturated, small dose increases cause
disproportionate rises in plasma levels, risking toxicity.
11.
A 65-year-old post-MI patient is started on lisinopril in addition to beta-blockers
and aspirin. What is the main reason ACE inhibitors improve outcomes after
myocardial infarction?
Answer: They reduce cardiac remodeling and improve survival by decreasing
afterload and aldosterone-mediated volume expansion.
Rationale: Beyond blood pressure lowering, ACE inhibitors prevent maladaptive
cardiac remodeling.
12.
A 70-year-old woman with atrial fibrillation on digoxin presents with nausea,
visual disturbances, and bradyarrhythmia. Laboratory results show hyperkalemia.
Which interpretation is most accurate?
Answer: Hyperkalemia indicates severe digoxin toxicity.
Rationale: Digoxin inhibits Na⁺/K⁺-ATPase, leading to increased extracellular
K⁺; the presence of hyperkalemia signals life-threatening poisoning.
13.
NSG 533 FINAL EXAM 2026 – ADVANCED PHARMACOLOGY
QUESTIONS & VERIFIED ANSWERS WITH RATIONALES ALREADY
GRADED A+, GUARANTEED PASS
1.
A 60-year-old patient with a history of GERD is started on omeprazole for
persistent symptoms. The provider explains that the drug works at the final
common pathway of gastric acid secretion. Which mechanism best describes how
omeprazole reduces gastric acidity?
Answer: It irreversibly inhibits the gastric H⁺/K⁺ ATPase (proton pump) in
parietal cells.
Rationale: PPIs covalently bind the proton pump, leading to prolonged
suppression of acid secretion until new pumps are synthesized.
2.
A 72-year-old man stabilized on warfarin is prescribed trimethoprim-
sulfamethoxazole for a urinary tract infection. A week later, he presents with
gingival bleeding and an elevated INR. Which pharmacokinetic interaction best
explains this finding?
Answer: TMP-SMX inhibits warfarin metabolism, leading to increased
anticoagulant effect and bleeding risk.
Rationale: Sulfonamides inhibit CYP450 and displace warfarin from protein
binding sites, increasing INR.
3.
,2 | Page
A pregnant woman with group B strep bacteriuria needs antibiotic therapy. Which
antibiotic class is both effective and considered safe during pregnancy compared to
alternatives like tetracyclines or fluoroquinolones?
Answer: Penicillins are safe in pregnancy and act by inhibiting bacterial cell
wall synthesis.
Rationale: Beta-lactams are bactericidal and safe in pregnancy; tetracyclines
cause teeth discoloration, fluoroquinolones damage cartilage.
4.
A patient with mild hypertension is prescribed a beta-blocker. The clinician
chooses pindolol because it provides partial agonist activity at beta-receptors,
thereby reducing bradycardia risk. What is this property called?
Answer: Intrinsic sympathomimetic activity (ISA).
Rationale: ISA means the drug partially stimulates receptors while blocking
stronger endogenous agonists.
5.
A 25-year-old male presents after ingesting 20 grams of acetaminophen. Liver
enzymes are elevated, but treatment is started within 8 hours of ingestion. Which
antidote prevents hepatic injury by replenishing glutathione stores?
Answer: N-acetylcysteine.
Rationale: NAC restores glutathione, which detoxifies the harmful metabolite
NAPQI.
6.
A patient receiving unfractionated heparin for DVT develops a sudden platelet
count drop and new DVTs. The team suspects heparin-induced thrombocytopenia
(HIT). Which is the most appropriate next therapeutic step?
,3 | Page
Answer: Discontinue heparin and initiate a direct thrombin inhibitor such as
argatroban.
Rationale: Warfarin is avoided initially because it may worsen hypercoagulability;
platelet transfusion is contraindicated.
7.
A 45-year-old man with cirrhosis is prescribed spironolactone for ascites. The drug
improves his condition by acting at the collecting duct of the nephron. What is its
primary mechanism?
Answer: Aldosterone receptor antagonism, leading to potassium retention and
sodium/water excretion.
Rationale: Unlike loop or thiazide diuretics, spironolactone spares potassium.
8.
A patient with major depression on sertraline complains of decreased libido and
anorgasmia. The psychiatrist considers switching therapy to an antidepressant with
lower sexual side-effect risk. Which drug is most appropriate?
Answer: Bupropion.
Rationale: As an NDRI, bupropion enhances norepinephrine and dopamine but
has minimal serotonin activity, avoiding sexual side effects.
9.
A 52-year-old man with bipolar disorder is stable on lithium but later develops
tremor and confusion after being prescribed hydrochlorothiazide. What is the
mechanism for this adverse drug interaction?
Answer: Thiazides increase lithium reabsorption in the proximal tubule,
raising serum lithium levels and toxicity risk.
Rationale: Sodium loss enhances lithium retention since the kidney treats lithium
like sodium.
, 4 | Page
10.
A patient with generalized tonic-clonic seizures is prescribed phenytoin. The
provider explains the importance of therapeutic drug monitoring. Which
pharmacokinetic property justifies frequent monitoring of this drug?
Answer: Phenytoin exhibits zero-order kinetics at higher concentrations.
Rationale: Once enzymes are saturated, small dose increases cause
disproportionate rises in plasma levels, risking toxicity.
11.
A 65-year-old post-MI patient is started on lisinopril in addition to beta-blockers
and aspirin. What is the main reason ACE inhibitors improve outcomes after
myocardial infarction?
Answer: They reduce cardiac remodeling and improve survival by decreasing
afterload and aldosterone-mediated volume expansion.
Rationale: Beyond blood pressure lowering, ACE inhibitors prevent maladaptive
cardiac remodeling.
12.
A 70-year-old woman with atrial fibrillation on digoxin presents with nausea,
visual disturbances, and bradyarrhythmia. Laboratory results show hyperkalemia.
Which interpretation is most accurate?
Answer: Hyperkalemia indicates severe digoxin toxicity.
Rationale: Digoxin inhibits Na⁺/K⁺-ATPase, leading to increased extracellular
K⁺; the presence of hyperkalemia signals life-threatening poisoning.
13.
