NURS 6521 - Advanced Pharmacology Final Exam 2026/2027 -
Edition 100 Questions & Verified Answers
Overview
NURS 6521: Advanced Pharmacology examines pharmacokinetics, pharmacodynamics,
pharmacogenomics, and clinical application across drug classes. Emphasizes safe
prescribing, drug interactions, adverse effects, and therapeutic decision-making for diverse
populations across the lifespan in advanced nursing practice. Correct answer in bold
Green.
1. A patient is a CYP2D6 poor metabolizer. Which drug will have reduced
efficacy?
A. Metoprolol
B. Codeine
C. Fluoxetine
D. Amlodipine
Rationale: Codeine is a prodrug activated to morphine via CYP2D6. Poor metabolizers
→ ↓ analgesia. Metoprolol has ↑ levels in PMs.
2. Which medication requires HLA-B*5801 testing before initiation in patients of
Han Chinese descent?
A. Carbamazepine
B. Allopurinol
C. Abacavir
D. Phenytoin
Rationale: HLA-B5801 → risk SJS/TEN with allopurinol. HLA-B1502 for
carbamazepine. HLA-B*5701 for abacavir.
3. A 70kg patient needs dopamine at 5 mcg/kg/min. Concentration is
400mg/250mL. Rate in mL/hr?
A. 5.3 mL/hr
B. 13.1 mL/hr
C. 21 mL/hr
D. 52.5 mL/hr
Rationale: 5 mcg/kg/min x 70kg = 350 mcg/min = 21,000 mcg/hr = 21 mg/hr.
400mg/250mL = 1.6 mg/mL. 21 ÷ 1.6 = 13.1 mL/hr.
4. Which drug has a narrow therapeutic index and requires TDM?
A. Lisinopril
B. Metformin
C. Digoxin
D. Atorvastatin
Rationale: NTI drugs: digoxin, lithium, warfarin, phenytoin, theophylline, cyclosporine.
Need drug level monitoring.
5. A patient on warfarin with INR 8.0, no bleeding. Best action?
A. Give vitamin K 10mg IV
, B. Hold warfarin, give oral vitamin K 2.5-5mg
C. FFP transfusion
D. Continue warfarin
Rationale: CHEST guidelines: INR >5 <9 no bleed = hold + low-dose oral Vit K. IV Vit K
if serious bleed.
6. Which statin + fibrate combo has highest rhabdomyolysis risk?
A. Atorvastatin + fenofibrate
B. Simvastatin + gemfibrozil
C. Rosuvastatin + fenofibrate
D. Pravastatin + gemfibrozil
Rationale: Gemfibrozil inhibits glucuronidation of statins, esp simvastatin. Fenofibrate
safer.
7. A patient with CrCl 15 mL/min needs antibiotic for pneumonia. Which requires
dose adjustment?
A. Azithromycin
B. Doxycycline
C. Levofloxacin
D. Moxifloxacin
Rationale: Levofloxacin renally cleared. Azithro, doxy, moxi safe in renal failure.
8. First-line for hypertension in African American patient without CKD?
A. Lisinopril
B. Losartan
C. Amlodipine or HCTZ
D. Metoprolol
Rationale: JNC8/ACC: Black patients respond better to CCB or thiazide. ACE/ARB less
effective monotherapy.
9. A patient on escitalopram develops agitation, hyperreflexia, temp 102F after
adding tramadol. Diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Hypertensive crisis
D. Anticholinergic toxicity
Rationale: SSRI + tramadol = serotonin syndrome: mental status change, autonomic
instability, neuromuscular hyperactivity.
10. Which antidiabetic is contraindicated with history of medullary thyroid
cancer?
A. Metformin
B. Empagliflozin
C. Liraglutide
D. Sitagliptin
Rationale: GLP-1 RAs black box: risk thyroid C-cell tumors. Contraindicated in MTC or
MEN2.
11. A 30yo female with epilepsy wants to start OCPs. Which AED decreases OCP
efficacy?
A. Levetiracetam
B. Lamotrigine
Edition 100 Questions & Verified Answers
Overview
NURS 6521: Advanced Pharmacology examines pharmacokinetics, pharmacodynamics,
pharmacogenomics, and clinical application across drug classes. Emphasizes safe
prescribing, drug interactions, adverse effects, and therapeutic decision-making for diverse
populations across the lifespan in advanced nursing practice. Correct answer in bold
Green.
1. A patient is a CYP2D6 poor metabolizer. Which drug will have reduced
efficacy?
A. Metoprolol
B. Codeine
C. Fluoxetine
D. Amlodipine
Rationale: Codeine is a prodrug activated to morphine via CYP2D6. Poor metabolizers
→ ↓ analgesia. Metoprolol has ↑ levels in PMs.
2. Which medication requires HLA-B*5801 testing before initiation in patients of
Han Chinese descent?
A. Carbamazepine
B. Allopurinol
C. Abacavir
D. Phenytoin
Rationale: HLA-B5801 → risk SJS/TEN with allopurinol. HLA-B1502 for
carbamazepine. HLA-B*5701 for abacavir.
3. A 70kg patient needs dopamine at 5 mcg/kg/min. Concentration is
400mg/250mL. Rate in mL/hr?
A. 5.3 mL/hr
B. 13.1 mL/hr
C. 21 mL/hr
D. 52.5 mL/hr
Rationale: 5 mcg/kg/min x 70kg = 350 mcg/min = 21,000 mcg/hr = 21 mg/hr.
400mg/250mL = 1.6 mg/mL. 21 ÷ 1.6 = 13.1 mL/hr.
4. Which drug has a narrow therapeutic index and requires TDM?
A. Lisinopril
B. Metformin
C. Digoxin
D. Atorvastatin
Rationale: NTI drugs: digoxin, lithium, warfarin, phenytoin, theophylline, cyclosporine.
Need drug level monitoring.
5. A patient on warfarin with INR 8.0, no bleeding. Best action?
A. Give vitamin K 10mg IV
, B. Hold warfarin, give oral vitamin K 2.5-5mg
C. FFP transfusion
D. Continue warfarin
Rationale: CHEST guidelines: INR >5 <9 no bleed = hold + low-dose oral Vit K. IV Vit K
if serious bleed.
6. Which statin + fibrate combo has highest rhabdomyolysis risk?
A. Atorvastatin + fenofibrate
B. Simvastatin + gemfibrozil
C. Rosuvastatin + fenofibrate
D. Pravastatin + gemfibrozil
Rationale: Gemfibrozil inhibits glucuronidation of statins, esp simvastatin. Fenofibrate
safer.
7. A patient with CrCl 15 mL/min needs antibiotic for pneumonia. Which requires
dose adjustment?
A. Azithromycin
B. Doxycycline
C. Levofloxacin
D. Moxifloxacin
Rationale: Levofloxacin renally cleared. Azithro, doxy, moxi safe in renal failure.
8. First-line for hypertension in African American patient without CKD?
A. Lisinopril
B. Losartan
C. Amlodipine or HCTZ
D. Metoprolol
Rationale: JNC8/ACC: Black patients respond better to CCB or thiazide. ACE/ARB less
effective monotherapy.
9. A patient on escitalopram develops agitation, hyperreflexia, temp 102F after
adding tramadol. Diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Hypertensive crisis
D. Anticholinergic toxicity
Rationale: SSRI + tramadol = serotonin syndrome: mental status change, autonomic
instability, neuromuscular hyperactivity.
10. Which antidiabetic is contraindicated with history of medullary thyroid
cancer?
A. Metformin
B. Empagliflozin
C. Liraglutide
D. Sitagliptin
Rationale: GLP-1 RAs black box: risk thyroid C-cell tumors. Contraindicated in MTC or
MEN2.
11. A 30yo female with epilepsy wants to start OCPs. Which AED decreases OCP
efficacy?
A. Levetiracetam
B. Lamotrigine
