2026/2027
Chamberlain College NR 565 Week 4
Midterm Exam Advanced
Pharmacology Fundamentals Study
Guide, Practice Questions, Test Bank
Review and Exam Preparation
2026/2027
Question 1
A nurse practitioner is reviewing controlled substance classifications. Which of the
following medications are correctly classified as Schedule II drugs?
A. Alprazolam (Xanax) and Tramadol
B. Fentanyl, Oxycodone, Methadone, and Ativan
C. Codeine and Tramadol
D. Diazepam and anabolic steroids
Correct Answer: B. Fentanyl, Oxycodone, Methadone, and Ativan
Rationale:
Schedule II drugs include medications with high abuse potential but accepted medical
use, such as fentanyl, oxycodone, methadone, and certain benzodiazepines like
lorazepam (Ativan). Option A and C contain Schedule III or IV drugs, while anabolic
steroids are Schedule III. Accurate classification is essential for safe prescribing and
regulatory compliance.
Question 2
Which of the following medications are classified as Schedule III controlled
substances?
A. Xanax, Tramadol, anabolic steroids, and codeine (<90 mg)
B. Fentanyl and oxycodone
C. Ativan and methadone
D. Morphine and hydromorphone
Correct Answer: A. Xanax, Tramadol, anabolic steroids, and codeine (<90 mg)
Rationale:
Schedule III drugs include medications with moderate to low physical dependence
,2026/2027
risk such as alprazolam, tramadol, anabolic steroids, and limited-dose codeine.
Schedule II drugs (like fentanyl and morphine) have higher abuse potential and
stricter prescribing rules.
Question 3
Which medications are classified as Schedule IV drugs?
A. Fentanyl and morphine
B. Xanax, Ativan, and Tramadol
C. Codeine and hydromorphone
D. Methadone and oxycodone
Correct Answer: B. Xanax, Ativan, and Tramadol
Rationale:
Schedule IV drugs have a lower abuse potential compared to Schedule II and III drugs.
Alprazolam (Xanax), lorazepam (Ativan), and tramadol fall into this category.
Schedule II opioids like fentanyl and oxycodone have significantly higher abuse
potential.
Question 4
Under current prescribing guidelines, advanced practice registered nurses (APRNs)
are typically authorized to prescribe:
A. Only Schedule I drugs
B. Schedule II through Schedule IV drugs
C. Only Schedule III drugs
D. All controlled substances without restriction
Correct Answer: B. Schedule II through Schedule IV drugs
Rationale:
APRNs are commonly granted prescriptive authority for Schedule II–IV medications
depending on state regulations. Schedule I drugs are not prescribed as they have no
accepted medical use.
Question 5
Which of the following is a common reason for medication non-adherence in older
adults?
A. Excessive physical activity
B. Too busy or forgetfulness
,2026/2027
C. Increased metabolism
D. Improved cognitive function
Correct Answer: B. Too busy or forgetfulness
Rationale:
Medication non-adherence is often due to forgetfulness, cost barriers, complex
regimens, or being busy. Cognitive and physical limitations in older adults also
contribute significantly.
Question 6
Age-related pharmacokinetic changes in elderly patients include:
A. Increased gastric acidity and faster absorption
B. Decreased lean body mass, albumin, and slower absorption
C. Increased liver enzyme activity
D. Increased renal clearance
Correct Answer: B. Decreased lean body mass, albumin, and slower absorption
Rationale:
Aging reduces lean body mass, albumin levels, and gastric motility, leading to slower
absorption and altered drug distribution. These changes increase risk of toxicity.
Question 7
Decreased albumin levels in elderly patients primarily affect drug therapy by:
A. Increasing drug excretion
B. Reducing protein binding and increasing free drug levels
C. Increasing gastric emptying
D. Reducing drug absorption only
Correct Answer: B. Reducing protein binding and increasing free drug levels
Rationale:
Many drugs bind to plasma proteins like albumin. Low albumin increases free (active)
drug concentration, increasing risk of toxicity.
Question 8
How does decreased body fat in elderly patients affect medication distribution?
, 2026/2027
A. Increases drug storage for lipid-soluble drugs
B. Has no effect on medications
C. Decreases metabolism only
D. Eliminates drug absorption variability
Correct Answer: A. Increases drug storage for lipid-soluble drugs
Rationale:
Body fat influences distribution of fat-soluble drugs. Changes in fat composition alter
drug storage and release, affecting duration and intensity of action.
Question 9
Age-related decline in liver function is primarily due to:
A. Increased hepatic blood flow
B. Decreased hepatic enzymes and reduced blood flow
C. Increased bile production
D. Increased metabolic rate
Correct Answer: B. Decreased hepatic enzymes and reduced blood flow
Rationale:
Reduced liver perfusion and enzyme activity slow drug metabolism, increasing drug
half-life and risk of toxicity in older adults.
Question 10
The most important cause of adverse drug reactions in older adults is:
A. Increased hydration
B. Polypharmacy and overprescribing
C. Increased exercise
D. High protein intake
Correct Answer: B. Polypharmacy and overprescribing
Rationale:
Using multiple medications increases drug interactions, duplication, and toxicity risk.
“Start low and go slow” is a key prescribing principle.
Question 11
A patient with poor drug metabolism phenotype is most likely to experience:
Chamberlain College NR 565 Week 4
Midterm Exam Advanced
Pharmacology Fundamentals Study
Guide, Practice Questions, Test Bank
Review and Exam Preparation
2026/2027
Question 1
A nurse practitioner is reviewing controlled substance classifications. Which of the
following medications are correctly classified as Schedule II drugs?
A. Alprazolam (Xanax) and Tramadol
B. Fentanyl, Oxycodone, Methadone, and Ativan
C. Codeine and Tramadol
D. Diazepam and anabolic steroids
Correct Answer: B. Fentanyl, Oxycodone, Methadone, and Ativan
Rationale:
Schedule II drugs include medications with high abuse potential but accepted medical
use, such as fentanyl, oxycodone, methadone, and certain benzodiazepines like
lorazepam (Ativan). Option A and C contain Schedule III or IV drugs, while anabolic
steroids are Schedule III. Accurate classification is essential for safe prescribing and
regulatory compliance.
Question 2
Which of the following medications are classified as Schedule III controlled
substances?
A. Xanax, Tramadol, anabolic steroids, and codeine (<90 mg)
B. Fentanyl and oxycodone
C. Ativan and methadone
D. Morphine and hydromorphone
Correct Answer: A. Xanax, Tramadol, anabolic steroids, and codeine (<90 mg)
Rationale:
Schedule III drugs include medications with moderate to low physical dependence
,2026/2027
risk such as alprazolam, tramadol, anabolic steroids, and limited-dose codeine.
Schedule II drugs (like fentanyl and morphine) have higher abuse potential and
stricter prescribing rules.
Question 3
Which medications are classified as Schedule IV drugs?
A. Fentanyl and morphine
B. Xanax, Ativan, and Tramadol
C. Codeine and hydromorphone
D. Methadone and oxycodone
Correct Answer: B. Xanax, Ativan, and Tramadol
Rationale:
Schedule IV drugs have a lower abuse potential compared to Schedule II and III drugs.
Alprazolam (Xanax), lorazepam (Ativan), and tramadol fall into this category.
Schedule II opioids like fentanyl and oxycodone have significantly higher abuse
potential.
Question 4
Under current prescribing guidelines, advanced practice registered nurses (APRNs)
are typically authorized to prescribe:
A. Only Schedule I drugs
B. Schedule II through Schedule IV drugs
C. Only Schedule III drugs
D. All controlled substances without restriction
Correct Answer: B. Schedule II through Schedule IV drugs
Rationale:
APRNs are commonly granted prescriptive authority for Schedule II–IV medications
depending on state regulations. Schedule I drugs are not prescribed as they have no
accepted medical use.
Question 5
Which of the following is a common reason for medication non-adherence in older
adults?
A. Excessive physical activity
B. Too busy or forgetfulness
,2026/2027
C. Increased metabolism
D. Improved cognitive function
Correct Answer: B. Too busy or forgetfulness
Rationale:
Medication non-adherence is often due to forgetfulness, cost barriers, complex
regimens, or being busy. Cognitive and physical limitations in older adults also
contribute significantly.
Question 6
Age-related pharmacokinetic changes in elderly patients include:
A. Increased gastric acidity and faster absorption
B. Decreased lean body mass, albumin, and slower absorption
C. Increased liver enzyme activity
D. Increased renal clearance
Correct Answer: B. Decreased lean body mass, albumin, and slower absorption
Rationale:
Aging reduces lean body mass, albumin levels, and gastric motility, leading to slower
absorption and altered drug distribution. These changes increase risk of toxicity.
Question 7
Decreased albumin levels in elderly patients primarily affect drug therapy by:
A. Increasing drug excretion
B. Reducing protein binding and increasing free drug levels
C. Increasing gastric emptying
D. Reducing drug absorption only
Correct Answer: B. Reducing protein binding and increasing free drug levels
Rationale:
Many drugs bind to plasma proteins like albumin. Low albumin increases free (active)
drug concentration, increasing risk of toxicity.
Question 8
How does decreased body fat in elderly patients affect medication distribution?
, 2026/2027
A. Increases drug storage for lipid-soluble drugs
B. Has no effect on medications
C. Decreases metabolism only
D. Eliminates drug absorption variability
Correct Answer: A. Increases drug storage for lipid-soluble drugs
Rationale:
Body fat influences distribution of fat-soluble drugs. Changes in fat composition alter
drug storage and release, affecting duration and intensity of action.
Question 9
Age-related decline in liver function is primarily due to:
A. Increased hepatic blood flow
B. Decreased hepatic enzymes and reduced blood flow
C. Increased bile production
D. Increased metabolic rate
Correct Answer: B. Decreased hepatic enzymes and reduced blood flow
Rationale:
Reduced liver perfusion and enzyme activity slow drug metabolism, increasing drug
half-life and risk of toxicity in older adults.
Question 10
The most important cause of adverse drug reactions in older adults is:
A. Increased hydration
B. Polypharmacy and overprescribing
C. Increased exercise
D. High protein intake
Correct Answer: B. Polypharmacy and overprescribing
Rationale:
Using multiple medications increases drug interactions, duplication, and toxicity risk.
“Start low and go slow” is a key prescribing principle.
Question 11
A patient with poor drug metabolism phenotype is most likely to experience:
