Q: A patient with chronic opioid use has developed tolerance. Which of the following effects are
the patient least likely to become tolerant to?
A. Respiratory depression
B. Euphoria
C. Nausea
D. Constipation
Correct Answer: D – Constipation does not develop tolerance.
Q: A patient is tolerant to oxycodone. The provider is considering a switch to hydromorphone.
What principle allows the provider to assume similar tolerance to the new opioid?
A. Receptor desensitization
B. Cross-dependence
C. Cross-tolerance
D. Opioid-sparing effect
Correct Answer: C – Opioids show cross-tolerance due to shared μ-receptor activity.
Q: Which of the following statements is TRUE regarding opioids and other CNS depressants like
benzodiazepines?
A. They share full cross-tolerance.
B. They act on the same receptors.
C. They show no cross-tolerance.
D. They can be substituted for each other in withdrawal.
Correct Answer: C – There is no cross-tolerance between opioids and other CNS depressants.
Q: A patient on heroin receives buprenorphine too soon after last use. The patient suddenly
experiences sweating, agitation, and abdominal cramps. What likely occurred?
A. Cross-tolerance
B. Post-acute withdrawal
C. Precipitated withdrawal
D. Opioid overdose
Correct Answer: C – Buprenorphine can displace full agonists and cause precipitated
withdrawal if started too early.
Q: At high doses, buprenorphine can block opioid-induced euphoria by:
A. Stimulating dopamine release
B. Irreversibly binding to GABA receptors
C. Displacing full opioid agonists from μ-receptors
D. Acting as a serotonin reuptake inhibitor
,Correct Answer: C – It displaces full agonists at the μ-receptor, preventing euphoria.
Q: Which of the following best describes noncompetitive antagonists?
A. Their effects are easily reversed with higher doses of agonists.
B. They bind to receptors reversibly.
C. They reduce the maximal effect an agonist can produce.
D. They are commonly used due to short duration.
Correct Answer: C – Noncompetitive antagonists reduce max response and cannot be
overcome by adding more agonist.
Q: Which of the following medications is most likely to prolong the QT interval?
A. Lisinopril
B. Metformin
C. Haloperidol
D. Acetaminophen
Correct Answer: C – Haloperidol is a known QT-prolonging antipsychotic.
Q: A patient is taking fluconazole and citalopram. What additional factor would further increase
the risk of torsades de pointes?
A. Hyperkalemia
B. Hypomagnesemia
C. Beta-blocker use
D. Opioid tolerance
Correct Answer: B – Low magnesium increases the risk of QT-related arrhythmias.
Q: Who determines whether a nurse practitioner can prescribe controlled substances in a given
state?
A. FDA
B. DEA
C. State Board of Nursing or Medicine
D. Centers for Medicare & Medicaid Services (CMS)
Correct Answer: C – Prescriptive authority is determined by state boards.
Q: A hospital uses a closed formulary system. What does this imply for prescribing providers?
A. They can prescribe any FDA-approved drug.
B. Drugs not on the formulary require justification or prior approval.
,C. All brand-name drugs are preferred.
D. Controlled substances are excluded.
Correct Answer: B – Closed formularies limit prescribing to approved drugs, with exceptions
needing special approval.
Q: Why do albumin-bound drugs stay in the bloodstream during renal filtration?
A. They are actively reabsorbed by the tubules
B. Albumin neutralizes the drug’s activity
C. Albumin-drug complexes are too large to pass through glomerular pores
D. They are rapidly metabolized before reaching the kidneys
Answer: C
Q: What best describes the action of noncompetitive antagonists?
A. They bind reversibly and reduce drug half-life
B. They bind irreversibly and reduce the total number of available receptors
C. They compete directly with agonists
D. Their effect increases with higher doses of agonists
Answer: B
Q: How does drug metabolism in children compare to adults?
A. Children metabolize drugs more slowly
B. Metabolism is the same after age 1
C. Children metabolize drugs faster than adults
D. Drug metabolism is independent of age
Answer: C
Q: What causes increased drug sensitivity in neonates?
A. Increased enzyme activity
B. Decreased protein binding
C. Organ immaturity
D. Overactive renal clearance
Answer: C
Q: What is the most important cause of adverse drug reactions in older adults?
A. Polypharmacy
B. Decreased liver function
, C. Drug accumulation due to reduced renal excretion
D. Increased receptor sensitivity
Answer: C
Q: Which diuretic class is associated with ototoxicity?
A. Thiazides
B. Potassium-sparing
C. Loop diuretics
D. Carbonic anhydrase inhibitors
Answer: C
Q: Which benefit is common to ACE inhibitors and ARBs in heart failure treatment?
A. Increase LDL
B. Prevent arrhythmias
C. Prolong survival
D. Decrease potassium levels
Answer: C
Q: What effect does losartan have on diabetic retinopathy?
A. Reverses retinopathy
B. Slows development, but not effective for existing retinopathy
C. No effect on any stage
D. Cures microvascular damage
Answer: B
Q: What is the mechanism of action of digoxin?
A. Calcium channel blockade
B. Sympathetic stimulation
C. Inhibits sodium-potassium ATPase
D. Direct β1 receptor activation
Answer: C
Q: Why is potassium level important in digoxin therapy?
A. Potassium enhances digoxin absorption
B. Potassium competes with digoxin for receptor binding
the patient least likely to become tolerant to?
A. Respiratory depression
B. Euphoria
C. Nausea
D. Constipation
Correct Answer: D – Constipation does not develop tolerance.
Q: A patient is tolerant to oxycodone. The provider is considering a switch to hydromorphone.
What principle allows the provider to assume similar tolerance to the new opioid?
A. Receptor desensitization
B. Cross-dependence
C. Cross-tolerance
D. Opioid-sparing effect
Correct Answer: C – Opioids show cross-tolerance due to shared μ-receptor activity.
Q: Which of the following statements is TRUE regarding opioids and other CNS depressants like
benzodiazepines?
A. They share full cross-tolerance.
B. They act on the same receptors.
C. They show no cross-tolerance.
D. They can be substituted for each other in withdrawal.
Correct Answer: C – There is no cross-tolerance between opioids and other CNS depressants.
Q: A patient on heroin receives buprenorphine too soon after last use. The patient suddenly
experiences sweating, agitation, and abdominal cramps. What likely occurred?
A. Cross-tolerance
B. Post-acute withdrawal
C. Precipitated withdrawal
D. Opioid overdose
Correct Answer: C – Buprenorphine can displace full agonists and cause precipitated
withdrawal if started too early.
Q: At high doses, buprenorphine can block opioid-induced euphoria by:
A. Stimulating dopamine release
B. Irreversibly binding to GABA receptors
C. Displacing full opioid agonists from μ-receptors
D. Acting as a serotonin reuptake inhibitor
,Correct Answer: C – It displaces full agonists at the μ-receptor, preventing euphoria.
Q: Which of the following best describes noncompetitive antagonists?
A. Their effects are easily reversed with higher doses of agonists.
B. They bind to receptors reversibly.
C. They reduce the maximal effect an agonist can produce.
D. They are commonly used due to short duration.
Correct Answer: C – Noncompetitive antagonists reduce max response and cannot be
overcome by adding more agonist.
Q: Which of the following medications is most likely to prolong the QT interval?
A. Lisinopril
B. Metformin
C. Haloperidol
D. Acetaminophen
Correct Answer: C – Haloperidol is a known QT-prolonging antipsychotic.
Q: A patient is taking fluconazole and citalopram. What additional factor would further increase
the risk of torsades de pointes?
A. Hyperkalemia
B. Hypomagnesemia
C. Beta-blocker use
D. Opioid tolerance
Correct Answer: B – Low magnesium increases the risk of QT-related arrhythmias.
Q: Who determines whether a nurse practitioner can prescribe controlled substances in a given
state?
A. FDA
B. DEA
C. State Board of Nursing or Medicine
D. Centers for Medicare & Medicaid Services (CMS)
Correct Answer: C – Prescriptive authority is determined by state boards.
Q: A hospital uses a closed formulary system. What does this imply for prescribing providers?
A. They can prescribe any FDA-approved drug.
B. Drugs not on the formulary require justification or prior approval.
,C. All brand-name drugs are preferred.
D. Controlled substances are excluded.
Correct Answer: B – Closed formularies limit prescribing to approved drugs, with exceptions
needing special approval.
Q: Why do albumin-bound drugs stay in the bloodstream during renal filtration?
A. They are actively reabsorbed by the tubules
B. Albumin neutralizes the drug’s activity
C. Albumin-drug complexes are too large to pass through glomerular pores
D. They are rapidly metabolized before reaching the kidneys
Answer: C
Q: What best describes the action of noncompetitive antagonists?
A. They bind reversibly and reduce drug half-life
B. They bind irreversibly and reduce the total number of available receptors
C. They compete directly with agonists
D. Their effect increases with higher doses of agonists
Answer: B
Q: How does drug metabolism in children compare to adults?
A. Children metabolize drugs more slowly
B. Metabolism is the same after age 1
C. Children metabolize drugs faster than adults
D. Drug metabolism is independent of age
Answer: C
Q: What causes increased drug sensitivity in neonates?
A. Increased enzyme activity
B. Decreased protein binding
C. Organ immaturity
D. Overactive renal clearance
Answer: C
Q: What is the most important cause of adverse drug reactions in older adults?
A. Polypharmacy
B. Decreased liver function
, C. Drug accumulation due to reduced renal excretion
D. Increased receptor sensitivity
Answer: C
Q: Which diuretic class is associated with ototoxicity?
A. Thiazides
B. Potassium-sparing
C. Loop diuretics
D. Carbonic anhydrase inhibitors
Answer: C
Q: Which benefit is common to ACE inhibitors and ARBs in heart failure treatment?
A. Increase LDL
B. Prevent arrhythmias
C. Prolong survival
D. Decrease potassium levels
Answer: C
Q: What effect does losartan have on diabetic retinopathy?
A. Reverses retinopathy
B. Slows development, but not effective for existing retinopathy
C. No effect on any stage
D. Cures microvascular damage
Answer: B
Q: What is the mechanism of action of digoxin?
A. Calcium channel blockade
B. Sympathetic stimulation
C. Inhibits sodium-potassium ATPase
D. Direct β1 receptor activation
Answer: C
Q: Why is potassium level important in digoxin therapy?
A. Potassium enhances digoxin absorption
B. Potassium competes with digoxin for receptor binding
