NUR 635 ADVANCED PHARMACOLOGY
MIDTERM EXAM PRACTICE QUESTIONS &
ANSWERS 2026 | COMPREHENSIVE
NURSING PHARMACOLOGY STUDY GUIDE
WITH VERIFIED RATIONALES
• This 200-question practice exam mirrors the rigor and breadth of a real NUR 635
Advanced Pharmacology Midterm — each question is paired with a bolded correct
answer and a clear EXPERT RATIONALE to reinforce the "why" behind every choice.
• Work through questions one block at a time, cover the answer, commit to a
choice, then check — active recall like this builds the pharmacology reasoning you'll
need under real exam pressure.
Question 1 A nurse is preparing to administer metformin to a patient with
type 2 diabetes. Which of the following conditions is an absolute
contraindication for metformin use?
A. Mild hypertension
B. Obesity with BMI of 32
C. History of seasonal allergies
D. Age over 65 years
E. Renal impairment with eGFR below 30 mL/min
Correct Answer: E. Renal impairment with eGFR below 30 mL/min
EXPERT RATIONALE: Metformin is contraindicated when eGFR falls below 30
mL/min because impaired renal clearance causes metformin accumulation,
significantly increasing the risk of life-threatening lactic acidosis.
Question 2 Which mechanism of action best describes how beta-1 selective
adrenergic blockers reduce blood pressure?
A. Blocking alpha-1 receptors in peripheral vasculature
,B. Inhibiting angiotensin-converting enzyme
C. Decreasing heart rate and cardiac output by blocking beta-1 receptors
D. Stimulating central alpha-2 receptors to reduce sympathetic outflow
E. Blocking calcium channels in vascular smooth muscle
Correct Answer: C. Decreasing heart rate and cardiac output by blocking
beta-1 receptors
EXPERT RATIONALE: Beta-1 selective blockers such as metoprolol competitively
antagonize catecholamines at beta-1 receptors in the heart, reducing heart rate and
myocardial contractility, which lowers cardiac output and ultimately blood pressure.
Question 3 A patient taking warfarin begins a course of fluconazole. What
pharmacokinetic interaction should the nurse anticipate?
A. Decreased warfarin absorption from the GI tract
B. Increased renal excretion of warfarin
C. Inhibition of CYP2C9 leading to elevated warfarin levels
D. Induction of CYP3A4 reducing warfarin effectiveness
E. Displacement of warfarin from tissue binding sites
Correct Answer: C. Inhibition of CYP2C9 leading to elevated warfarin levels
EXPERT RATIONALE: Fluconazole is a potent inhibitor of CYP2C9, the primary
enzyme responsible for warfarin metabolism. Inhibition results in reduced warfarin
clearance, elevated plasma levels, and a significantly increased risk of bleeding.
Question 4 Which of the following opioid analgesics has the highest risk of
causing serotonin syndrome when combined with an SSRI?
A. Morphine
B. Hydromorphone
,C. Codeine
D. Tramadol
E. Oxycodone
Correct Answer: D. Tramadol
EXPERT RATIONALE: Tramadol inhibits serotonin and norepinephrine reuptake in
addition to its weak opioid agonist activity. When combined with SSRIs, this dual
serotonergic action significantly increases the risk of serotonin syndrome,
characterized by agitation, hyperthermia, and neuromuscular abnormalities.
Question 5 A nurse is educating a patient newly prescribed lisinopril. Which
side effect is most directly related to the drug's mechanism of action?
A. Hyperglycemia
B. Peripheral edema
C. Dry persistent cough
D. Bradycardia
E. Constipation
Correct Answer: C. Dry persistent cough
EXPERT RATIONALE: ACE inhibitors like lisinopril prevent the breakdown of
bradykinin by inhibiting ACE. Bradykinin accumulation in the respiratory tract
causes irritation of airway mucosa, producing a characteristic dry persistent cough
in up to 15–20% of patients.
Question 6 A patient with heart failure is prescribed digoxin. Hypokalemia
increases the risk of digoxin toxicity through which mechanism?
A. Increasing digoxin absorption from the intestine
B. Decreasing renal excretion of digoxin
, C. Potassium and digoxin compete for the same binding site on Na+/K+ ATPase
D. Hypokalemia causes increased protein binding of digoxin
E. Low potassium increases hepatic metabolism of digoxin
Correct Answer: C. Potassium and digoxin compete for the same binding
site on Na+/K+ ATPase
EXPERT RATIONALE: Digoxin exerts its effect by binding to and inhibiting Na+/K+
ATPase. Potassium normally competes with digoxin for this binding site. When
potassium levels are low, digoxin binds more readily, increasing toxicity risk even at
therapeutic serum digoxin concentrations.
Question 7 A nurse administers vancomycin too rapidly. Which adverse effect
is most likely to occur?
A. Nephrotoxicity
B. Ototoxicity
C. Red man syndrome
D. Stevens-Johnson syndrome
E. Anaphylactic shock
Correct Answer: C. Red man syndrome
EXPERT RATIONALE: Rapid infusion of vancomycin causes non-immune-mediated
mast cell degranulation and histamine release, resulting in red man syndrome —
characterized by flushing, erythema, and pruritus predominantly over the face,
neck, and upper torso. Slowing the infusion rate prevents this reaction.
Question 8 Which of the following insulins is classified as a rapid-acting
analog appropriate for mealtime dosing?
A. NPH insulin
B. Insulin glargine
MIDTERM EXAM PRACTICE QUESTIONS &
ANSWERS 2026 | COMPREHENSIVE
NURSING PHARMACOLOGY STUDY GUIDE
WITH VERIFIED RATIONALES
• This 200-question practice exam mirrors the rigor and breadth of a real NUR 635
Advanced Pharmacology Midterm — each question is paired with a bolded correct
answer and a clear EXPERT RATIONALE to reinforce the "why" behind every choice.
• Work through questions one block at a time, cover the answer, commit to a
choice, then check — active recall like this builds the pharmacology reasoning you'll
need under real exam pressure.
Question 1 A nurse is preparing to administer metformin to a patient with
type 2 diabetes. Which of the following conditions is an absolute
contraindication for metformin use?
A. Mild hypertension
B. Obesity with BMI of 32
C. History of seasonal allergies
D. Age over 65 years
E. Renal impairment with eGFR below 30 mL/min
Correct Answer: E. Renal impairment with eGFR below 30 mL/min
EXPERT RATIONALE: Metformin is contraindicated when eGFR falls below 30
mL/min because impaired renal clearance causes metformin accumulation,
significantly increasing the risk of life-threatening lactic acidosis.
Question 2 Which mechanism of action best describes how beta-1 selective
adrenergic blockers reduce blood pressure?
A. Blocking alpha-1 receptors in peripheral vasculature
,B. Inhibiting angiotensin-converting enzyme
C. Decreasing heart rate and cardiac output by blocking beta-1 receptors
D. Stimulating central alpha-2 receptors to reduce sympathetic outflow
E. Blocking calcium channels in vascular smooth muscle
Correct Answer: C. Decreasing heart rate and cardiac output by blocking
beta-1 receptors
EXPERT RATIONALE: Beta-1 selective blockers such as metoprolol competitively
antagonize catecholamines at beta-1 receptors in the heart, reducing heart rate and
myocardial contractility, which lowers cardiac output and ultimately blood pressure.
Question 3 A patient taking warfarin begins a course of fluconazole. What
pharmacokinetic interaction should the nurse anticipate?
A. Decreased warfarin absorption from the GI tract
B. Increased renal excretion of warfarin
C. Inhibition of CYP2C9 leading to elevated warfarin levels
D. Induction of CYP3A4 reducing warfarin effectiveness
E. Displacement of warfarin from tissue binding sites
Correct Answer: C. Inhibition of CYP2C9 leading to elevated warfarin levels
EXPERT RATIONALE: Fluconazole is a potent inhibitor of CYP2C9, the primary
enzyme responsible for warfarin metabolism. Inhibition results in reduced warfarin
clearance, elevated plasma levels, and a significantly increased risk of bleeding.
Question 4 Which of the following opioid analgesics has the highest risk of
causing serotonin syndrome when combined with an SSRI?
A. Morphine
B. Hydromorphone
,C. Codeine
D. Tramadol
E. Oxycodone
Correct Answer: D. Tramadol
EXPERT RATIONALE: Tramadol inhibits serotonin and norepinephrine reuptake in
addition to its weak opioid agonist activity. When combined with SSRIs, this dual
serotonergic action significantly increases the risk of serotonin syndrome,
characterized by agitation, hyperthermia, and neuromuscular abnormalities.
Question 5 A nurse is educating a patient newly prescribed lisinopril. Which
side effect is most directly related to the drug's mechanism of action?
A. Hyperglycemia
B. Peripheral edema
C. Dry persistent cough
D. Bradycardia
E. Constipation
Correct Answer: C. Dry persistent cough
EXPERT RATIONALE: ACE inhibitors like lisinopril prevent the breakdown of
bradykinin by inhibiting ACE. Bradykinin accumulation in the respiratory tract
causes irritation of airway mucosa, producing a characteristic dry persistent cough
in up to 15–20% of patients.
Question 6 A patient with heart failure is prescribed digoxin. Hypokalemia
increases the risk of digoxin toxicity through which mechanism?
A. Increasing digoxin absorption from the intestine
B. Decreasing renal excretion of digoxin
, C. Potassium and digoxin compete for the same binding site on Na+/K+ ATPase
D. Hypokalemia causes increased protein binding of digoxin
E. Low potassium increases hepatic metabolism of digoxin
Correct Answer: C. Potassium and digoxin compete for the same binding
site on Na+/K+ ATPase
EXPERT RATIONALE: Digoxin exerts its effect by binding to and inhibiting Na+/K+
ATPase. Potassium normally competes with digoxin for this binding site. When
potassium levels are low, digoxin binds more readily, increasing toxicity risk even at
therapeutic serum digoxin concentrations.
Question 7 A nurse administers vancomycin too rapidly. Which adverse effect
is most likely to occur?
A. Nephrotoxicity
B. Ototoxicity
C. Red man syndrome
D. Stevens-Johnson syndrome
E. Anaphylactic shock
Correct Answer: C. Red man syndrome
EXPERT RATIONALE: Rapid infusion of vancomycin causes non-immune-mediated
mast cell degranulation and histamine release, resulting in red man syndrome —
characterized by flushing, erythema, and pruritus predominantly over the face,
neck, and upper torso. Slowing the infusion rate prevents this reaction.
Question 8 Which of the following insulins is classified as a rapid-acting
analog appropriate for mealtime dosing?
A. NPH insulin
B. Insulin glargine
