NURS 676 Advanced Pharmacology Exam 1
Test Bank Questions and Answers Updated
2026 | Verified A+ Study Guide with
Complete Rationales for Exam Success
• This 200-question test bank covers the full scope of NURS 676 Advanced
Pharmacology, featuring verified answers with detailed EXPERT RATIONALE to
reinforce clinical reasoning and exam readiness.
• Work through each question independently before checking the highlighted
correct answer and EXPERT RATIONALE below it — spaced repetition across
multiple sessions yields the strongest retention.
1. A nurse practitioner is prescribing a drug that inhibits COX-1 and COX-2
enzymes. Which of the following best describes the primary mechanism of
this drug class?
A. Blocking opioid receptors in the CNS
B. Inhibiting prostaglandin synthesis by blocking cyclooxygenase enzymes
C. Activating adrenergic receptors to reduce inflammation
D. Blocking histamine H1 receptors
E. Stimulating serotonin reuptake inhibition
B. Inhibiting prostaglandin synthesis by blocking cyclooxygenase enzymes
EXPERT RATIONALE: NSAIDs work by inhibiting COX-1 and COX-2 enzymes, thereby
reducing the synthesis of prostaglandins, which mediate pain, fever, and
inflammation. This is their primary pharmacodynamic mechanism.
2. A patient taking warfarin is started on aspirin. Which of the following is the
most important concern?
A. Decreased warfarin absorption
B. Reduced anticoagulant effect of warfarin
,C. Increased risk of bleeding due to additive anticoagulant effects
D. Decreased platelet production
E. Aspirin displaces warfarin from protein-binding sites reducing efficacy
C. Increased risk of bleeding due to additive anticoagulant effects
EXPERT RATIONALE: Aspirin inhibits platelet aggregation and can irritate the GI
mucosa, while warfarin inhibits clotting factor synthesis. Together, they significantly
increase bleeding risk, particularly GI bleeding.
3. Which of the following beta-blockers is considered cardioselective at low
doses?
A. Propranolol
B. Carvedilol
C. Labetalol
D. Metoprolol
E. Nadolol
D. Metoprolol
EXPERT RATIONALE: Metoprolol is a beta-1 selective (cardioselective) blocker at
low doses, primarily affecting the heart with minimal effects on beta-2 receptors in
the lungs. This makes it preferred in patients with asthma or COPD when a beta-
blocker is necessary.
4. A patient with type 2 diabetes is started on metformin. What is the primary
mechanism of action?
A. Stimulating insulin secretion from beta cells
B. Blocking glucagon receptors in the liver
C. Decreasing hepatic glucose production and improving insulin sensitivity
,D. Inhibiting alpha-glucosidase enzymes in the intestine
E. Increasing renal glucose excretion
C. Decreasing hepatic glucose production and improving insulin sensitivity
EXPERT RATIONALE: Metformin primarily works by activating AMPK, which
decreases hepatic gluconeogenesis and glycogenolysis, and improves peripheral
insulin sensitivity without causing hypoglycemia.
5. Which of the following is the most serious adverse effect associated with
metformin?
A. Hypoglycemia
B. Weight gain
C. Lactic acidosis
D. Pancreatitis
E. Hepatotoxicity
C. Lactic acidosis
EXPERT RATIONALE: Although rare, lactic acidosis is the most serious adverse
effect of metformin. It is more likely in patients with renal impairment, hepatic
failure, or conditions causing hypoxia, which impair lactate clearance.
6. A nurse practitioner prescribes an ACE inhibitor for a patient with
hypertension. Which electrolyte imbalance should be monitored?
A. Hyponatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia
E. Hypomagnesemia
, B. Hyperkalemia
EXPERT RATIONALE: ACE inhibitors block the conversion of angiotensin I to
angiotensin II, which reduces aldosterone secretion. Since aldosterone promotes
potassium excretion, its reduction leads to potassium retention and the risk of
hyperkalemia.
7. A patient develops a dry, persistent cough after starting lisinopril. What is
the recommended action?
A. Reduce the dose by half
B. Add an antihistamine to manage the cough
C. Switch to an angiotensin receptor blocker (ARB)
D. Discontinue all antihypertensive therapy
E. Add a mucolytic agent to the regimen
C. Switch to an angiotensin receptor blocker (ARB)
EXPERT RATIONALE: ACE inhibitor-induced cough is caused by bradykinin
accumulation. ARBs block angiotensin II receptors without affecting bradykinin
levels, making them the appropriate alternative class when ACE inhibitor-induced
cough occurs.
8. Which of the following diuretics works by inhibiting the Na-K-2Cl
cotransporter in the thick ascending loop of Henle?
A. Hydrochlorothiazide
B. Spironolactone
C. Acetazolamide
D. Furosemide
E. Amiloride
Test Bank Questions and Answers Updated
2026 | Verified A+ Study Guide with
Complete Rationales for Exam Success
• This 200-question test bank covers the full scope of NURS 676 Advanced
Pharmacology, featuring verified answers with detailed EXPERT RATIONALE to
reinforce clinical reasoning and exam readiness.
• Work through each question independently before checking the highlighted
correct answer and EXPERT RATIONALE below it — spaced repetition across
multiple sessions yields the strongest retention.
1. A nurse practitioner is prescribing a drug that inhibits COX-1 and COX-2
enzymes. Which of the following best describes the primary mechanism of
this drug class?
A. Blocking opioid receptors in the CNS
B. Inhibiting prostaglandin synthesis by blocking cyclooxygenase enzymes
C. Activating adrenergic receptors to reduce inflammation
D. Blocking histamine H1 receptors
E. Stimulating serotonin reuptake inhibition
B. Inhibiting prostaglandin synthesis by blocking cyclooxygenase enzymes
EXPERT RATIONALE: NSAIDs work by inhibiting COX-1 and COX-2 enzymes, thereby
reducing the synthesis of prostaglandins, which mediate pain, fever, and
inflammation. This is their primary pharmacodynamic mechanism.
2. A patient taking warfarin is started on aspirin. Which of the following is the
most important concern?
A. Decreased warfarin absorption
B. Reduced anticoagulant effect of warfarin
,C. Increased risk of bleeding due to additive anticoagulant effects
D. Decreased platelet production
E. Aspirin displaces warfarin from protein-binding sites reducing efficacy
C. Increased risk of bleeding due to additive anticoagulant effects
EXPERT RATIONALE: Aspirin inhibits platelet aggregation and can irritate the GI
mucosa, while warfarin inhibits clotting factor synthesis. Together, they significantly
increase bleeding risk, particularly GI bleeding.
3. Which of the following beta-blockers is considered cardioselective at low
doses?
A. Propranolol
B. Carvedilol
C. Labetalol
D. Metoprolol
E. Nadolol
D. Metoprolol
EXPERT RATIONALE: Metoprolol is a beta-1 selective (cardioselective) blocker at
low doses, primarily affecting the heart with minimal effects on beta-2 receptors in
the lungs. This makes it preferred in patients with asthma or COPD when a beta-
blocker is necessary.
4. A patient with type 2 diabetes is started on metformin. What is the primary
mechanism of action?
A. Stimulating insulin secretion from beta cells
B. Blocking glucagon receptors in the liver
C. Decreasing hepatic glucose production and improving insulin sensitivity
,D. Inhibiting alpha-glucosidase enzymes in the intestine
E. Increasing renal glucose excretion
C. Decreasing hepatic glucose production and improving insulin sensitivity
EXPERT RATIONALE: Metformin primarily works by activating AMPK, which
decreases hepatic gluconeogenesis and glycogenolysis, and improves peripheral
insulin sensitivity without causing hypoglycemia.
5. Which of the following is the most serious adverse effect associated with
metformin?
A. Hypoglycemia
B. Weight gain
C. Lactic acidosis
D. Pancreatitis
E. Hepatotoxicity
C. Lactic acidosis
EXPERT RATIONALE: Although rare, lactic acidosis is the most serious adverse
effect of metformin. It is more likely in patients with renal impairment, hepatic
failure, or conditions causing hypoxia, which impair lactate clearance.
6. A nurse practitioner prescribes an ACE inhibitor for a patient with
hypertension. Which electrolyte imbalance should be monitored?
A. Hyponatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia
E. Hypomagnesemia
, B. Hyperkalemia
EXPERT RATIONALE: ACE inhibitors block the conversion of angiotensin I to
angiotensin II, which reduces aldosterone secretion. Since aldosterone promotes
potassium excretion, its reduction leads to potassium retention and the risk of
hyperkalemia.
7. A patient develops a dry, persistent cough after starting lisinopril. What is
the recommended action?
A. Reduce the dose by half
B. Add an antihistamine to manage the cough
C. Switch to an angiotensin receptor blocker (ARB)
D. Discontinue all antihypertensive therapy
E. Add a mucolytic agent to the regimen
C. Switch to an angiotensin receptor blocker (ARB)
EXPERT RATIONALE: ACE inhibitor-induced cough is caused by bradykinin
accumulation. ARBs block angiotensin II receptors without affecting bradykinin
levels, making them the appropriate alternative class when ACE inhibitor-induced
cough occurs.
8. Which of the following diuretics works by inhibiting the Na-K-2Cl
cotransporter in the thick ascending loop of Henle?
A. Hydrochlorothiazide
B. Spironolactone
C. Acetazolamide
D. Furosemide
E. Amiloride
