NR 565 ADVANCED PHARMACOLOGY MIDTERM EXAM 2026/2027 | VERIFIED PRACTICE QUESTIONS & DETAILED ANSWERS | COMPLETE STUDY GUIDE

NR 565 ADVANCED PHARMACOLOGY
MIDTERM EXAM 2026/2027 | VERIFIED
PRACTICE QUESTIONS & DETAILED
ANSWERS | COMPLETE STUDY GUIDE
NR 565 ADVANCED PHARMACOLOGY MIDTERM EXAM 2026/2027

VERIFIED PRACTICE QUESTIONS & DETAILED ANSWERS | COMPLETE STUDY
GUIDE



DOCUMENT OVERVIEW

• Comprehensive Exam Preparation: verified practice questions organized by
pharmacology topics with detailed rationales to reinforce clinical decision-making
and drug therapy knowledge.

• Study Strategy: Use these questions to test your knowledge, identify weak areas,
and build confidence before the midterm—review rationales carefully to
understand not just "what" but "why" for each answer.




QUESTION 1: A patient on warfarin comes to the clinic with an INR of 8.5 and
no signs of bleeding. Which action is most appropriate?

A) Continue current dose and recheck INR in 3 days

B) Administer fresh frozen plasma immediately

C) Hold one dose of warfarin and recheck INR in 2-3 days

D) Administer vitamin K subcutaneously

E) Double the next dose of warfarin

CORRECT ANSWER: C <

RATIONALE: An INR of 8.5 in a patient without bleeding indicates over-
anticoagulation. Holding one dose and rechecking in 2-3 days is the standard
protocol. Fresh frozen plasma and vitamin K are reserved for severe elevations (INR

,>20) with bleeding. Doubling the dose would worsen the situation. Continuing the
dose without intervention is unsafe.



QUESTION 2: Which cytochrome P450 enzyme is responsible for metabolizing
approximately 25% of all medications?

A) CYP1A2

B) CYP2D6

C) CYP3A4

D) CYP2C19

E) CYP2B6

CORRECT ANSWER: C <

RATIONALE: CYP3A4 is the most abundant hepatic microsomal enzyme and
metabolizes approximately 25-30% of all medications. This makes it highly
significant in drug interactions. CYP2D6 accounts for about 25% as well, but CYP3A4
is the primary metabolizer. The other enzymes metabolize smaller percentages of
drugs.



QUESTION 3: A patient taking fluoxetine is prescribed codeine for pain relief.
What is the primary concern with this combination?

A) Increased risk of hepatotoxicity

B) Risk of serotonin syndrome and poor pain control

C) Severe hypertension

D) Acute renal failure

E) Immediate hypersensitivity reaction

CORRECT ANSWER: B <

,RATIONALE: Fluoxetine is a strong CYP2D6 inhibitor that decreases codeine
metabolism to its active form (morphine). This results in poor pain control and
increased systemic codeine levels, raising serotonin syndrome risk. The
combination creates a dangerous scenario: inadequate analgesia and potential
toxicity. Hepatotoxicity, hypertension, renal failure, and hypersensitivity are not
primary concerns with this combination.



QUESTION 4: Which of the following drugs has a BLACK BOX WARNING for
increased risk of suicidality in pediatric patients?

A) Amitriptyline

B) Sertraline

C) Fluoxetine

D) Paroxetine

E) All selective serotonin reuptake inhibitors except fluoxetine

CORRECT ANSWER: D <

RATIONALE: Paroxetine carries a BLACK BOX WARNING for increased suicidal
thoughts and behaviors in pediatric and young adult patients. While all SSRIs carry
this warning, paroxetine has the strongest evidence for this risk, particularly in
adolescents. Fluoxetine is the only SSRI with FDA approval for pediatric depression
due to better safety data. Amitriptyline is a tricyclic antidepressant with different
warnings.



QUESTION 5: A patient develops angioedema after receiving lisinopril for
hypertension. What is the mechanism behind this adverse effect?

A) Direct mast cell degranulation

B) Inhibition of angiotensin II receptor type 1

C) Decreased bradykinin metabolism

D) Direct histamine release from basophils

, E) Allergic sensitization to the ACE inhibitor molecule

CORRECT ANSWER: C <

RATIONALE: ACE inhibitors block the enzyme that metabolizes bradykinin.
Bradykinin accumulates and increases vascular permeability, leading to
angioedema. This occurs in 0.1-0.2% of patients and is not truly an allergic reaction.
It can occur anytime during therapy, even after years of use. ARB angioedema is
much rarer and doesn't involve bradykinin accumulation.



QUESTION 6: Which drug is most appropriate for acute management of a
patient in atrial fibrillation with a rapid ventricular response and
hemodynamic instability?

A) Diltiazem IV

B) Amiodarone IV

C) Digoxin IV

D) Synchronized DC cardioversion

E) Metoprolol oral

CORRECT ANSWER: D <

RATIONALE: In hemodynamically unstable atrial fibrillation with rapid ventricular
response, synchronized DC cardioversion is the treatment of choice. IV medications
like diltiazem, amiodarone, or digoxin take time to work and are inappropriate
when the patient is unstable. Oral medications are ineffective in acute settings.
Cardioversion is immediate and restores perfusion pressure quickly.



QUESTION 7: A 65-year-old patient on metformin is scheduled for a CT scan
with contrast. What action should the nurse recommend?

A) Continue metformin; there is no interaction with contrast

B) Hold metformin 24 hours before and 48 hours after the procedure