NR 508 – Advanced Pharmacology for
Nurse Practitioners | 2025/2026 Verified
Questions and Detailed Rationales
Question 1: Mechanism of Action - Beta-Blockers
A patient with hypertension is prescribed metoprolol. What is the primary mechanism of
action of metoprolol in reducing blood pressure?
A. Vasodilation via nitric oxide release.
B. Selective beta-1 adrenergic receptor blockade, decreasing cardiac output and renin
release.
C. Inhibition of angiotensin-converting enzyme.
D. Calcium channel antagonism in vascular smooth muscle.
Rationale: Per 2025 AANP Guidelines, metoprolol's cardioselectivity targets beta-1
receptors in the heart, reducing sympathetic stimulation and aligning with precision
prescribing for patients with comorbid asthma, minimizing beta-2 effects (AANP, 2025).
Question 2: Prescriptive Safety - Opioids
When prescribing oxycodone for acute pain, which safety measure aligns with 2026 CDC
Opioid Prescribing Recommendations?
A. Unlimited refills to ensure adherence.
B. Initiate at lowest effective dose with urine drug screening and naloxone co-prescription.
C. Combine with benzodiazepines for synergy.
D. Prescribe for >7 days without reassessment.
Rationale: The 2026 CDC updates emphasize risk mitigation through low-dose starts,
monitoring, and harm reduction via naloxone, reducing overdose risk by 50% in high-risk
populations (CDC, 2026).
,Question 3: Pharmacokinetics - Warfarin
A 65-year-old on warfarin develops gastrointestinal bleeding. What pharmacokinetic factor
most influences warfarin's variable response?
A. Rapid renal clearance.
B. Hepatic metabolism via CYP2C9 with extensive protein binding, affected by diet and
drugs.
C. Biliary excretion dominance.
D. Active tubular secretion.
Rationale: Warfarin's narrow therapeutic index is exacerbated by CYP2C9
polymorphisms and vitamin K interactions, per 2025 ASHP Pharmacogenomics Standards,
necessitating INR monitoring (ASHP, 2025).
Question 4: Case-Based - Diabetes Management
A 52-year-old T2DM patient with CKD stage 3 starts semaglutide. What is the key
consideration for this GLP-1 agonist?
A. Risk of lactic acidosis.
B. Renal-independent clearance, reducing hypoglycemia risk while promoting weight loss.
C. Hepatotoxicity.
D. QT prolongation.
Rationale: Semaglutide's non-renal elimination supports use in CKD per 2025 ADA
Standards, improving glycemic control without dose adjustment (ADA, 2025).
Question 5: Mechanism of Action - Statins
Atorvastatin lowers LDL cholesterol primarily through:
A. Bile acid sequestration.
B. HMG-CoA reductase inhibition in the liver, upregulating LDL receptors.
C. Cholesterol absorption blockade.
D. PPAR-alpha activation.
, Rationale: This mevalonate pathway inhibition is foundational in 2025 ACC Lipid
Guidelines, reducing ASCVD events by 20-30% (ACC, 2025).
Question 6: Prescriptive Safety - Antidepressants
Prescribing sertraline for MDD in a patient on tamoxifen requires:
A. No adjustment needed.
B. Avoiding strong CYP2D6 inhibitors; consider alternatives like citalopram.
C. Doubling tamoxifen dose.
D. Adding St. John's Wort.
Rationale: Sertraline's mild CYP2D6 inhibition can reduce tamoxifen efficacy; 2026 NCCN
Oncology Guidelines recommend pharmacogenomic testing (NCCN, 2026).
Question 7: Pharmacokinetics - Levothyroxine
In hypothyroidism, levothyroxine's absorption is best optimized by:
A. Taking with high-fiber meals.
B. Empty stomach administration, as food delays T4 to T3 conversion.
C. Evening dosing only.
D. Concurrent iron supplementation.
Rationale: Gastric pH and motility affect bioavailability; 2025 ATA Guidelines stress
fasting to maintain steady TSH levels (ATA, 2025).
Question 8: Case-Based - Heart Failure
A 70-year-old HFpEF patient is titrated on sacubitril/valsartan. Monitor for:
A. Hyperkalemia.
B. Angioedema risk due to neprilysin inhibition enhancing bradykinin.
C. Thrombocytopenia.
D. Osteoporosis.
Nurse Practitioners | 2025/2026 Verified
Questions and Detailed Rationales
Question 1: Mechanism of Action - Beta-Blockers
A patient with hypertension is prescribed metoprolol. What is the primary mechanism of
action of metoprolol in reducing blood pressure?
A. Vasodilation via nitric oxide release.
B. Selective beta-1 adrenergic receptor blockade, decreasing cardiac output and renin
release.
C. Inhibition of angiotensin-converting enzyme.
D. Calcium channel antagonism in vascular smooth muscle.
Rationale: Per 2025 AANP Guidelines, metoprolol's cardioselectivity targets beta-1
receptors in the heart, reducing sympathetic stimulation and aligning with precision
prescribing for patients with comorbid asthma, minimizing beta-2 effects (AANP, 2025).
Question 2: Prescriptive Safety - Opioids
When prescribing oxycodone for acute pain, which safety measure aligns with 2026 CDC
Opioid Prescribing Recommendations?
A. Unlimited refills to ensure adherence.
B. Initiate at lowest effective dose with urine drug screening and naloxone co-prescription.
C. Combine with benzodiazepines for synergy.
D. Prescribe for >7 days without reassessment.
Rationale: The 2026 CDC updates emphasize risk mitigation through low-dose starts,
monitoring, and harm reduction via naloxone, reducing overdose risk by 50% in high-risk
populations (CDC, 2026).
,Question 3: Pharmacokinetics - Warfarin
A 65-year-old on warfarin develops gastrointestinal bleeding. What pharmacokinetic factor
most influences warfarin's variable response?
A. Rapid renal clearance.
B. Hepatic metabolism via CYP2C9 with extensive protein binding, affected by diet and
drugs.
C. Biliary excretion dominance.
D. Active tubular secretion.
Rationale: Warfarin's narrow therapeutic index is exacerbated by CYP2C9
polymorphisms and vitamin K interactions, per 2025 ASHP Pharmacogenomics Standards,
necessitating INR monitoring (ASHP, 2025).
Question 4: Case-Based - Diabetes Management
A 52-year-old T2DM patient with CKD stage 3 starts semaglutide. What is the key
consideration for this GLP-1 agonist?
A. Risk of lactic acidosis.
B. Renal-independent clearance, reducing hypoglycemia risk while promoting weight loss.
C. Hepatotoxicity.
D. QT prolongation.
Rationale: Semaglutide's non-renal elimination supports use in CKD per 2025 ADA
Standards, improving glycemic control without dose adjustment (ADA, 2025).
Question 5: Mechanism of Action - Statins
Atorvastatin lowers LDL cholesterol primarily through:
A. Bile acid sequestration.
B. HMG-CoA reductase inhibition in the liver, upregulating LDL receptors.
C. Cholesterol absorption blockade.
D. PPAR-alpha activation.
, Rationale: This mevalonate pathway inhibition is foundational in 2025 ACC Lipid
Guidelines, reducing ASCVD events by 20-30% (ACC, 2025).
Question 6: Prescriptive Safety - Antidepressants
Prescribing sertraline for MDD in a patient on tamoxifen requires:
A. No adjustment needed.
B. Avoiding strong CYP2D6 inhibitors; consider alternatives like citalopram.
C. Doubling tamoxifen dose.
D. Adding St. John's Wort.
Rationale: Sertraline's mild CYP2D6 inhibition can reduce tamoxifen efficacy; 2026 NCCN
Oncology Guidelines recommend pharmacogenomic testing (NCCN, 2026).
Question 7: Pharmacokinetics - Levothyroxine
In hypothyroidism, levothyroxine's absorption is best optimized by:
A. Taking with high-fiber meals.
B. Empty stomach administration, as food delays T4 to T3 conversion.
C. Evening dosing only.
D. Concurrent iron supplementation.
Rationale: Gastric pH and motility affect bioavailability; 2025 ATA Guidelines stress
fasting to maintain steady TSH levels (ATA, 2025).
Question 8: Case-Based - Heart Failure
A 70-year-old HFpEF patient is titrated on sacubitril/valsartan. Monitor for:
A. Hyperkalemia.
B. Angioedema risk due to neprilysin inhibition enhancing bradykinin.
C. Thrombocytopenia.
D. Osteoporosis.
