,NSG 533 Exam 2 | Advanced Pharmacology (2026)
Actual Q&A PDF | Wilkes
1. According to the WHO three‑step analgesic ladder, the initial pharmacologic
approach for mild pain is:
A) Non‑opioid analgesics such as acetaminophen or NSAIDs
B) Weak opioids such as codeine
C) Strong opioids such as morphine
D) Adjuvant analgesics such as gabapentin
Correct Answer: Non‑opioid analgesics such as acetaminophen or NSAIDs
Rationale: Step 1 of the WHO ladder recommends non‑opioids for mild pain.
Steps 2 and 3 add weak and strong opioids respectively. Adjuvants are used at
any step for specific pain types.
2. The maximum recommended daily dose of acetaminophen for an elderly
patient with normal liver function is:
A) 4000 mg per day
B) 3000 mg per day
C) 2000 mg per day
D) 1000 mg per day
Correct Answer: 3000 mg per day
,Rationale: In older adults, acetaminophen clearance may be reduced, increasing
the risk of hepatotoxicity. The maximum dose should be limited to 3000 mg
daily, or lower if liver disease is present.
3. Which medication is FDA‑approved for diabetic peripheral neuropathy and
also treats comorbid depression?
A) Gabapentin
B) Pregabalin
C) Duloxetine
D) Ibuprofen
Correct Answer: Duloxetine
Rationale: Duloxetine is a serotonin‑norepinephrine reuptake inhibitor (SNRI)
with proven efficacy for neuropathic pain and depression. Gabapentin and
pregabalin are used for neuropathic pain but do not treat depression.
4. Naloxone reverses opioid‑induced respiratory depression by acting as a:
A) Partial mu receptor agonist
B) Full mu receptor agonist
C) Kappa receptor agonist
D) Pure opioid antagonist that displaces opioids from receptor sites
Correct Answer: Pure opioid antagonist that displaces opioids from receptor
sites
, Rationale: Naloxone competitively binds to mu, kappa, and delta opioid
receptors, displacing opioid agonists and rapidly reversing their effects,
especially respiratory depression.
5. When a patient has a true immunoglobulin‑mediated allergy to morphine,
the safest alternative opioid is:
A) Fentanyl
B) Codeine
C) Oxycodone
D) Hydromorphone
Correct Answer: Fentanyl
Rationale: Fentanyl has a different chemical structure (phenylpiperidine) than
morphine and its congeners, so cross‑reactivity is extremely low. It is often used
in patients with a true morphine allergy.
6. Which adverse effect of NSAIDs is of greatest concern in patients with a
history of peptic ulcer disease?
A) Hepatotoxicity
B) Gastrointestinal bleeding
C) Nephrotoxicity
D) Tinnitus
Correct Answer: Gastrointestinal bleeding
Actual Q&A PDF | Wilkes
1. According to the WHO three‑step analgesic ladder, the initial pharmacologic
approach for mild pain is:
A) Non‑opioid analgesics such as acetaminophen or NSAIDs
B) Weak opioids such as codeine
C) Strong opioids such as morphine
D) Adjuvant analgesics such as gabapentin
Correct Answer: Non‑opioid analgesics such as acetaminophen or NSAIDs
Rationale: Step 1 of the WHO ladder recommends non‑opioids for mild pain.
Steps 2 and 3 add weak and strong opioids respectively. Adjuvants are used at
any step for specific pain types.
2. The maximum recommended daily dose of acetaminophen for an elderly
patient with normal liver function is:
A) 4000 mg per day
B) 3000 mg per day
C) 2000 mg per day
D) 1000 mg per day
Correct Answer: 3000 mg per day
,Rationale: In older adults, acetaminophen clearance may be reduced, increasing
the risk of hepatotoxicity. The maximum dose should be limited to 3000 mg
daily, or lower if liver disease is present.
3. Which medication is FDA‑approved for diabetic peripheral neuropathy and
also treats comorbid depression?
A) Gabapentin
B) Pregabalin
C) Duloxetine
D) Ibuprofen
Correct Answer: Duloxetine
Rationale: Duloxetine is a serotonin‑norepinephrine reuptake inhibitor (SNRI)
with proven efficacy for neuropathic pain and depression. Gabapentin and
pregabalin are used for neuropathic pain but do not treat depression.
4. Naloxone reverses opioid‑induced respiratory depression by acting as a:
A) Partial mu receptor agonist
B) Full mu receptor agonist
C) Kappa receptor agonist
D) Pure opioid antagonist that displaces opioids from receptor sites
Correct Answer: Pure opioid antagonist that displaces opioids from receptor
sites
, Rationale: Naloxone competitively binds to mu, kappa, and delta opioid
receptors, displacing opioid agonists and rapidly reversing their effects,
especially respiratory depression.
5. When a patient has a true immunoglobulin‑mediated allergy to morphine,
the safest alternative opioid is:
A) Fentanyl
B) Codeine
C) Oxycodone
D) Hydromorphone
Correct Answer: Fentanyl
Rationale: Fentanyl has a different chemical structure (phenylpiperidine) than
morphine and its congeners, so cross‑reactivity is extremely low. It is often used
in patients with a true morphine allergy.
6. Which adverse effect of NSAIDs is of greatest concern in patients with a
history of peptic ulcer disease?
A) Hepatotoxicity
B) Gastrointestinal bleeding
C) Nephrotoxicity
D) Tinnitus
Correct Answer: Gastrointestinal bleeding
