NURS 6521 - Advanced Pharmacology Exam Questions & Verified
Answers 2026/2027 -Edition 100% Pass
Overview
NURS 6521 covers advanced pharmacology for NPs: pharmacokinetics,
pharmacodynamics, autonomic/ CNS/ CV/ endocrine/ antimicrobials, prescribing
principles, and special populations. Questions are ANCC/3P exam style. Correct
answer in bold Green.
1. A patient with hepatic impairment needs a drug that undergoes extensive first-
pass metabolism. The NP should expect:
A. Decreased bioavailability
B. Increased bioavailability
C. No change in bioavailability
D. Increased protein binding
Rationale: First-pass metabolism occurs in the liver. Hepatic impairment ↓ metabolism
→ ↑ bioavailability and risk of toxicity.
2. Which CYP450 enzyme is responsible for metabolism of ∼50% of drugs and is
induced by rifampin?
A. CYP2D6
B. CYP2C19
C. CYP3A4
D. CYP1A2
Rationale: CYP3A4 metabolizes most drugs. Rifampin, carbamazepine, St. John’s wort
are strong inducers.
3. A patient on warfarin starts amiodarone. The NP anticipates:
A. Decreased INR, increase warfarin dose
B. Increased INR, decrease warfarin dose
C. No interaction
D. Switch to heparin
Rationale: Amiodarone inhibits CYP2C9 → ↓ warfarin metabolism → ↑ INR. Reduce
warfarin 30-50%.
4. Phase I metabolism primarily involves:
A. Conjugation
B. Oxidation, reduction, hydrolysis
C. Glucuronidation
D. Acetylation
Rationale: Phase I = oxidation/reduction/hydrolysis via CYP450. Phase II =
conjugation.
5. A drug with a half-life of 6 hours reaches steady state in:
A. 6 hours
B. 12 hours
C. 18 hours
D. 24-30 hours
Rationale: Steady state = 4-5 half-lives. 6h x 4-5 = 24-30h.
, 6. Which beta-blocker is cardioselective and safe in asthma?
A. Propranolol
B. Nadolol
C. Metoprolol
D. Carvedilol
Rationale: Metoprolol, atenolol, bisoprolol are B1 selective. Non-selective like
propranolol can trigger bronchospasm.
7. A patient taking lisinopril develops a dry cough. Mechanism?
A. Angiotensin II blockade
B. Bradykinin accumulation
C. Histamine release
D. Direct airway irritation
Rationale: ACE inhibitors prevent bradykinin breakdown → cough/angioedema. ARBs
don’t affect bradykinin.
8. First-line drug for uncomplicated UTI in non-pregnant adult female?
A. Ciprofloxacin
B. Amoxicillin
C. Nitrofurantoin x5 days
D. TMP-SMX x14 days
Rationale: IDSA: Nitrofurantoin 100mg BID x5d or TMP-SMX x3d if local resistance
<20%. Avoid fluoroquinolones.
9. A patient on sertraline starts St. John’s wort. Risk?
A. Hypertensive crisis
B. Serotonin syndrome
C. Bleeding
D. QT prolongation
Rationale: Both ↑ serotonin. Combo can cause serotonin syndrome: agitation,
hyperreflexia, fever.
10. Black box warning for fluoroquinolones includes:
A. Hepatotoxicity
B. Tendinopathy/tendon rupture
C. Bone marrow suppression
D. Stevens-Johnson syndrome
Rationale: FDA BBW: tendinitis/rupture, peripheral neuropathy, CNS effects,
myasthenia gravis exacerbation.
11. Drug of choice for anaphylaxis?
A. Diphenhydramine IV
B. Epinephrine 0.3mg IM
C. Methylprednisolone IV
D. Albuterol neb
Rationale: Epi IM 1:1000, 0.3-0.5mg adult, is first-line. Antihistamines/steroids are
adjuncts.
12. Which statin has lowest risk of CYP3A4 interaction?
A. Simvastatin
B. Atorvastatin
C. Lovastatin
Answers 2026/2027 -Edition 100% Pass
Overview
NURS 6521 covers advanced pharmacology for NPs: pharmacokinetics,
pharmacodynamics, autonomic/ CNS/ CV/ endocrine/ antimicrobials, prescribing
principles, and special populations. Questions are ANCC/3P exam style. Correct
answer in bold Green.
1. A patient with hepatic impairment needs a drug that undergoes extensive first-
pass metabolism. The NP should expect:
A. Decreased bioavailability
B. Increased bioavailability
C. No change in bioavailability
D. Increased protein binding
Rationale: First-pass metabolism occurs in the liver. Hepatic impairment ↓ metabolism
→ ↑ bioavailability and risk of toxicity.
2. Which CYP450 enzyme is responsible for metabolism of ∼50% of drugs and is
induced by rifampin?
A. CYP2D6
B. CYP2C19
C. CYP3A4
D. CYP1A2
Rationale: CYP3A4 metabolizes most drugs. Rifampin, carbamazepine, St. John’s wort
are strong inducers.
3. A patient on warfarin starts amiodarone. The NP anticipates:
A. Decreased INR, increase warfarin dose
B. Increased INR, decrease warfarin dose
C. No interaction
D. Switch to heparin
Rationale: Amiodarone inhibits CYP2C9 → ↓ warfarin metabolism → ↑ INR. Reduce
warfarin 30-50%.
4. Phase I metabolism primarily involves:
A. Conjugation
B. Oxidation, reduction, hydrolysis
C. Glucuronidation
D. Acetylation
Rationale: Phase I = oxidation/reduction/hydrolysis via CYP450. Phase II =
conjugation.
5. A drug with a half-life of 6 hours reaches steady state in:
A. 6 hours
B. 12 hours
C. 18 hours
D. 24-30 hours
Rationale: Steady state = 4-5 half-lives. 6h x 4-5 = 24-30h.
, 6. Which beta-blocker is cardioselective and safe in asthma?
A. Propranolol
B. Nadolol
C. Metoprolol
D. Carvedilol
Rationale: Metoprolol, atenolol, bisoprolol are B1 selective. Non-selective like
propranolol can trigger bronchospasm.
7. A patient taking lisinopril develops a dry cough. Mechanism?
A. Angiotensin II blockade
B. Bradykinin accumulation
C. Histamine release
D. Direct airway irritation
Rationale: ACE inhibitors prevent bradykinin breakdown → cough/angioedema. ARBs
don’t affect bradykinin.
8. First-line drug for uncomplicated UTI in non-pregnant adult female?
A. Ciprofloxacin
B. Amoxicillin
C. Nitrofurantoin x5 days
D. TMP-SMX x14 days
Rationale: IDSA: Nitrofurantoin 100mg BID x5d or TMP-SMX x3d if local resistance
<20%. Avoid fluoroquinolones.
9. A patient on sertraline starts St. John’s wort. Risk?
A. Hypertensive crisis
B. Serotonin syndrome
C. Bleeding
D. QT prolongation
Rationale: Both ↑ serotonin. Combo can cause serotonin syndrome: agitation,
hyperreflexia, fever.
10. Black box warning for fluoroquinolones includes:
A. Hepatotoxicity
B. Tendinopathy/tendon rupture
C. Bone marrow suppression
D. Stevens-Johnson syndrome
Rationale: FDA BBW: tendinitis/rupture, peripheral neuropathy, CNS effects,
myasthenia gravis exacerbation.
11. Drug of choice for anaphylaxis?
A. Diphenhydramine IV
B. Epinephrine 0.3mg IM
C. Methylprednisolone IV
D. Albuterol neb
Rationale: Epi IM 1:1000, 0.3-0.5mg adult, is first-line. Antihistamines/steroids are
adjuncts.
12. Which statin has lowest risk of CYP3A4 interaction?
A. Simvastatin
B. Atorvastatin
C. Lovastatin
