NURS 6521 Advanced Pharmacology –
Midterm & Final Comprehensive Exam
Review | 100-Question Practice Test with
Answers & Rationales (CNS, Cardiac,
Endocrine, Antimicrobials, Geriatrics,
Pregnancy-Safe Drugs)
1.
Which pharmacokinetic factor determines the onset of drug action?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Answer: A
Rationale: Absorption controls how quickly a drug enters systemic circulation and produces an
effect.
2.
A drug that binds to a receptor and produces a maximal effect is classified as:
A. Antagonist
B. Partial agonist
C. Full agonist
D. Inverse agonist
Answer: C
Rationale: Full agonists elicit the maximum biological response possible at the receptor.
3.
Which CYP450 enzyme metabolizes the majority of drugs?
A. CYP2D6
B. CYP3A4
,C. CYP1A2
D. CYP2C9
Answer: B
Rationale: CYP3A4 is responsible for ~50% of all drug metabolism.
4.
Which factor best explains why neonates are more sensitive to drugs?
A. Increased protein binding
B. Immature liver metabolism
C. Decreased gastric emptying
D. Larger renal clearance
Answer: B
Rationale: Infants have immature hepatic enzyme systems, prolonging drug half-life.
5.
Which drug is a selective beta-1 blocker used in hypertension?
A. Propranolol
B. Metoprolol
C. Carvedilol
D. Nadolol
Answer: B
Rationale: Metoprolol is cardioselective for β1 receptors, unlike propranolol.
6.
A patient on lisinopril develops a persistent dry cough. The nurse should suspect:
A. ACE inhibitor adverse effect
B. Beta-blocker intolerance
C. Calcium channel blocker toxicity
D. Electrolyte imbalance
Answer: A
Rationale: ACE inhibitors increase bradykinin → dry cough.
, 7.
Which drug is first-line for atrial fibrillation rate control?
A. Digoxin
B. Metoprolol
C. Amiodarone
D. Atropine
Answer: B
Rationale: Beta-blockers are first-line for controlling ventricular rate in AFib.
8.
Which antibiotic has the highest risk of C. difficile infection?
A. Vancomycin
B. Clindamycin
C. Ciprofloxacin
D. Azithromycin
Answer: B
Rationale: Clindamycin is strongly associated with pseudomembranous colitis.
9.
Which pharmacodynamic principle explains why increasing a drug dose beyond a certain point
produces no additional effect?
A. Potency
B. Affinity
C. Efficacy
D. Bioavailability
Answer: C
Rationale: Efficacy refers to the maximal drug effect; once reached, further dose increases add
only toxicity.
10.
A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. The nurse expects:
A. Increased INR and bleeding risk
B. Decreased INR and clotting risk
Midterm & Final Comprehensive Exam
Review | 100-Question Practice Test with
Answers & Rationales (CNS, Cardiac,
Endocrine, Antimicrobials, Geriatrics,
Pregnancy-Safe Drugs)
1.
Which pharmacokinetic factor determines the onset of drug action?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Answer: A
Rationale: Absorption controls how quickly a drug enters systemic circulation and produces an
effect.
2.
A drug that binds to a receptor and produces a maximal effect is classified as:
A. Antagonist
B. Partial agonist
C. Full agonist
D. Inverse agonist
Answer: C
Rationale: Full agonists elicit the maximum biological response possible at the receptor.
3.
Which CYP450 enzyme metabolizes the majority of drugs?
A. CYP2D6
B. CYP3A4
,C. CYP1A2
D. CYP2C9
Answer: B
Rationale: CYP3A4 is responsible for ~50% of all drug metabolism.
4.
Which factor best explains why neonates are more sensitive to drugs?
A. Increased protein binding
B. Immature liver metabolism
C. Decreased gastric emptying
D. Larger renal clearance
Answer: B
Rationale: Infants have immature hepatic enzyme systems, prolonging drug half-life.
5.
Which drug is a selective beta-1 blocker used in hypertension?
A. Propranolol
B. Metoprolol
C. Carvedilol
D. Nadolol
Answer: B
Rationale: Metoprolol is cardioselective for β1 receptors, unlike propranolol.
6.
A patient on lisinopril develops a persistent dry cough. The nurse should suspect:
A. ACE inhibitor adverse effect
B. Beta-blocker intolerance
C. Calcium channel blocker toxicity
D. Electrolyte imbalance
Answer: A
Rationale: ACE inhibitors increase bradykinin → dry cough.
, 7.
Which drug is first-line for atrial fibrillation rate control?
A. Digoxin
B. Metoprolol
C. Amiodarone
D. Atropine
Answer: B
Rationale: Beta-blockers are first-line for controlling ventricular rate in AFib.
8.
Which antibiotic has the highest risk of C. difficile infection?
A. Vancomycin
B. Clindamycin
C. Ciprofloxacin
D. Azithromycin
Answer: B
Rationale: Clindamycin is strongly associated with pseudomembranous colitis.
9.
Which pharmacodynamic principle explains why increasing a drug dose beyond a certain point
produces no additional effect?
A. Potency
B. Affinity
C. Efficacy
D. Bioavailability
Answer: C
Rationale: Efficacy refers to the maximal drug effect; once reached, further dose increases add
only toxicity.
10.
A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. The nurse expects:
A. Increased INR and bleeding risk
B. Decreased INR and clotting risk
