1
NR 566 MIDTERM 2026/2027 Complete
Midterm Exam | Actual Questions &
Verified Answers | Advanced
Pharmacology for Nurse Practitioners |
Pass Guarantee
Section 1: Pharmacokinetics & Pharmacodynamics in Special Populations
Q1: In a frail 88-year-old with CKD stage 4, which factor most alters vancomycin
pharmacokinetics?
A. Increased volume of distribution
B. Decreased renal clearance
C. Enhanced hepatic first-pass
D. Increased protein binding
Answer: B
Verified Rationale: Age- and disease-related drop in GFR prolongs vancomycin half-life, raising
trough levels and nephrotoxicity risk.
Q2: A 3-week-old premature infant needs caffeine citrate for apnea; which pharmacodynamic
consideration is paramount?
A. Immature blood–brain barrier increases CNS sensitivity.
B. Faster gastric emptying speeds absorption.
C. Larger muscle mass increases IM bioavailability.
D. Higher albumin decreases free drug.
Answer: A
Verified Rationale: CNS sensitivity is heightened because the immature barrier allows greater
caffeine entry, lowering seizure threshold.
Q3: Child-Pugh C cirrhosis patient requires morphine; which adjustment best prevents toxicity?
A. Double the usual dose
B. Reduce dose by 50–75 % and lengthen interval
C. Switch to IM route only
D. Avoid morphine; use NSAIDs
,2
Answer: B
Verified Rationale: Severe hepatic impairment markedly reduces glucuronidation, so smaller,
less frequent doses prevent accumulation.
Q4: A 400 g极低出生体重 infant is prescribed ceftazidime; which pharmacokinetic parameter is
most altered?
A. Increased protein binding
B. Decreased volume of distribution
C. Prolonged half-life due to renal immaturity
D. Enhanced biliary excretion
Answer: C
Verified Rationale: Nephrogenesis incomplete, so glomerular filtration is low, extending β-
lactam half-life and requiring longer dosing intervals.
Q5: In hemodialysis, which drug characteristic best predicts dialyzability?
A. High protein binding
B. Large volume of distribution
C. Low molecular weight & low protein binding
D. High lipid solubility
Answer: C
Verified Rationale: Small, unbound water-soluble drugs readily cross the dialyzer membrane and
are removed.
Q6: A 78-year-old starts amiodarone; which age-related change exaggerates bradycardia?
A. Increased β-receptor density
B. Prolonged half-life from decreased hepatic blood flow
C. Increased creatinine clearance
D. Enhanced first-pass
Answer: B
Verified Rationale: Reduced hepatic perfusion slows amiodarone metabolism, raising plasma
levels and sinus-node suppression.
Q7: Pediatric codeine use is discouraged primarily because:
A. Rapid CYP2D6 ultra-rapid metabolizers convert codeine to lethal morphine levels.
B. Children have low opioid receptor density.
C. Codeine is not absorbed orally in neonates.
D. Hepatic clearance is faster in toddlers.
Answer: A
Verified Rationale: Up to 10 % of children are ultra-rapid CYP2D6 metabolizers, causing rapid
morphine accumulation and respiratory arrest.
, 3
Q8: In pregnancy, which statement about pharmacokinetics is correct?
A. Increased GFR raises lithium levels.
B. Higher albumin increases free warfarin.
C. Expanded volume of distribution lowers peak digoxin.
D. Delayed gastric emptying speeds acetaminophen onset.
Answer: C
Verified Rationale: Maternal blood volume expands 40 %, increasing Vd and reducing peak
concentrations of hydrophilic drugs like digoxin.
Q9: A patient with ascites receives a highly protein-bound drug; what is expected?
A. Increased free fraction due to hypoalbuminemia
B. Decreased free fraction due to α1-acid glycoprotein rise
C. No change in clearance
D. Enhanced renal excretion
Answer: A
Verified Rationale: Cirrhotic hypoalbuminemia leaves fewer binding sites, raising free drug
concentration and pharmacologic effect.
Q10: Which tool best estimates renal function for drug dosing in morbidly obese 65-year-old?
A. Cockcroft-Gault using actual body weight
B. MDRD using ideal body weight
C. CKD-EPI using adjusted body weight
D. 24-hour urine creatinine clearance
Answer: C
Verified Rationale: Adjusted body weight in CKD-EPI minimizes overestimation seen with
extreme obesity and preserves accuracy.
Section 2: Antimicrobial Therapy & Stewardship
Q11: Per IDSA, first-line oral therapy for uncomplicated MSSA cellulitis in a non-penicillin-
allergic adult is:
A. Doxycycline 100 mg BID
B. Clindamycin 300 mg TID
C. Cephalexin 500 mg QID
D. Linezolid 600 mg BID
Answer: C
Verified Rationale: Cephalexin covers MSSA, is inexpensive, and has low resistance rates in
uncomplicated skin infections.
Q12: A patient on renal-dose vancomycin develops rash, eosinophilia, and rising SCr; likely
diagnosis is:
NR 566 MIDTERM 2026/2027 Complete
Midterm Exam | Actual Questions &
Verified Answers | Advanced
Pharmacology for Nurse Practitioners |
Pass Guarantee
Section 1: Pharmacokinetics & Pharmacodynamics in Special Populations
Q1: In a frail 88-year-old with CKD stage 4, which factor most alters vancomycin
pharmacokinetics?
A. Increased volume of distribution
B. Decreased renal clearance
C. Enhanced hepatic first-pass
D. Increased protein binding
Answer: B
Verified Rationale: Age- and disease-related drop in GFR prolongs vancomycin half-life, raising
trough levels and nephrotoxicity risk.
Q2: A 3-week-old premature infant needs caffeine citrate for apnea; which pharmacodynamic
consideration is paramount?
A. Immature blood–brain barrier increases CNS sensitivity.
B. Faster gastric emptying speeds absorption.
C. Larger muscle mass increases IM bioavailability.
D. Higher albumin decreases free drug.
Answer: A
Verified Rationale: CNS sensitivity is heightened because the immature barrier allows greater
caffeine entry, lowering seizure threshold.
Q3: Child-Pugh C cirrhosis patient requires morphine; which adjustment best prevents toxicity?
A. Double the usual dose
B. Reduce dose by 50–75 % and lengthen interval
C. Switch to IM route only
D. Avoid morphine; use NSAIDs
,2
Answer: B
Verified Rationale: Severe hepatic impairment markedly reduces glucuronidation, so smaller,
less frequent doses prevent accumulation.
Q4: A 400 g极低出生体重 infant is prescribed ceftazidime; which pharmacokinetic parameter is
most altered?
A. Increased protein binding
B. Decreased volume of distribution
C. Prolonged half-life due to renal immaturity
D. Enhanced biliary excretion
Answer: C
Verified Rationale: Nephrogenesis incomplete, so glomerular filtration is low, extending β-
lactam half-life and requiring longer dosing intervals.
Q5: In hemodialysis, which drug characteristic best predicts dialyzability?
A. High protein binding
B. Large volume of distribution
C. Low molecular weight & low protein binding
D. High lipid solubility
Answer: C
Verified Rationale: Small, unbound water-soluble drugs readily cross the dialyzer membrane and
are removed.
Q6: A 78-year-old starts amiodarone; which age-related change exaggerates bradycardia?
A. Increased β-receptor density
B. Prolonged half-life from decreased hepatic blood flow
C. Increased creatinine clearance
D. Enhanced first-pass
Answer: B
Verified Rationale: Reduced hepatic perfusion slows amiodarone metabolism, raising plasma
levels and sinus-node suppression.
Q7: Pediatric codeine use is discouraged primarily because:
A. Rapid CYP2D6 ultra-rapid metabolizers convert codeine to lethal morphine levels.
B. Children have low opioid receptor density.
C. Codeine is not absorbed orally in neonates.
D. Hepatic clearance is faster in toddlers.
Answer: A
Verified Rationale: Up to 10 % of children are ultra-rapid CYP2D6 metabolizers, causing rapid
morphine accumulation and respiratory arrest.
, 3
Q8: In pregnancy, which statement about pharmacokinetics is correct?
A. Increased GFR raises lithium levels.
B. Higher albumin increases free warfarin.
C. Expanded volume of distribution lowers peak digoxin.
D. Delayed gastric emptying speeds acetaminophen onset.
Answer: C
Verified Rationale: Maternal blood volume expands 40 %, increasing Vd and reducing peak
concentrations of hydrophilic drugs like digoxin.
Q9: A patient with ascites receives a highly protein-bound drug; what is expected?
A. Increased free fraction due to hypoalbuminemia
B. Decreased free fraction due to α1-acid glycoprotein rise
C. No change in clearance
D. Enhanced renal excretion
Answer: A
Verified Rationale: Cirrhotic hypoalbuminemia leaves fewer binding sites, raising free drug
concentration and pharmacologic effect.
Q10: Which tool best estimates renal function for drug dosing in morbidly obese 65-year-old?
A. Cockcroft-Gault using actual body weight
B. MDRD using ideal body weight
C. CKD-EPI using adjusted body weight
D. 24-hour urine creatinine clearance
Answer: C
Verified Rationale: Adjusted body weight in CKD-EPI minimizes overestimation seen with
extreme obesity and preserves accuracy.
Section 2: Antimicrobial Therapy & Stewardship
Q11: Per IDSA, first-line oral therapy for uncomplicated MSSA cellulitis in a non-penicillin-
allergic adult is:
A. Doxycycline 100 mg BID
B. Clindamycin 300 mg TID
C. Cephalexin 500 mg QID
D. Linezolid 600 mg BID
Answer: C
Verified Rationale: Cephalexin covers MSSA, is inexpensive, and has low resistance rates in
uncomplicated skin infections.
Q12: A patient on renal-dose vancomycin develops rash, eosinophilia, and rising SCr; likely
diagnosis is:
