NSG 533 / NSG533
Exam 2 (Latest 2026/2027)
Advanced Pharmacology Quiz Bank
Questions and Verified Answers with Rationales
100% Correct | Grade A
Wilkes University
Passan School of Nursing
75 Questions | Aligned with 2026-2027 Curriculum Standards
NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | Page 1
,Section 1: Pain Management
Q1: A nurse is educating a patient about the World Health Organization (WHO) analgesic ladder for
cancer pain management. Which statement by the nurse best describes the guiding principle of
the WHO analgesic ladder?
A. A. Start with the strongest opioid available and taper down as pain improves
B. B. Begin with non-opioid analgesics and progress to stronger agents based on pain severity
[CORRECT]
C. C. Use adjuvant medications exclusively before introducing any analgesics
D. D. Reserve all pharmacologic interventions until nonpharmacologic measures have been exhausted
Correct Answer: B
Rationale: The WHO analgesic ladder is a stepwise approach to pain management that recommends starting with
non-opioid analgesics (Step 1: acetaminophen, NSAIDs) for mild pain, progressing to weak opioids with or without
non-opioids for moderate pain (Step 2), and escalating to strong opioids for severe pain (Step 3). Adjuvant
medications (antidepressants, anticonvulsants, corticosteroids) can be used at any step. Option A is incorrect
because treatment escalates, not de-escalates. Option C is incorrect because adjuvants supplement, not replace,
analgesics. Option D is incorrect because pharmacologic and nonpharmacologic approaches should be used
concurrently.
Q2: A patient with chronic cancer pain has been on oral morphine 30 mg every 4 hours. The nurse
is converting the patient to an equivalent dose of transdermal fentanyl. Which principle of opioid
equianalgesic dosing is most critical for the nurse to apply?
A. A. Apply the equianalgesic conversion ratio directly without adjustment
B. B. Reduce the calculated equianalgesic dose by 25-50% when switching from one opioid to another
due to incomplete cross-tolerance [CORRECT]
C. C. Increase the calculated dose by 25% to ensure adequate pain relief during the transition
D. D. Maintain the exact same milligram dose when switching formulations
Correct Answer: B
Rationale: When converting between opioids, the calculated equianalgesic dose should be reduced by 25-50% due to
incomplete cross-tolerance. Patients who have been on one opioid develop tolerance to its specific effects, but this
tolerance does not fully transfer to a different opioid. Administering the full calculated equianalgesic dose of a new
opioid risks overdose and respiratory depression. This safety principle is fundamental to safe opioid rotation. Option A
risks overdose. Option C would further increase the risk. Option D ignores both the different potencies of opioids and
the cross-tolerance issue.
Q3: A patient receiving morphine via patient-controlled analgesia (PCA) reports difficulty breathing
and has a respiratory rate of 8 breaths per minute. Which medication should the nurse prepare to
administer as the reversal agent?
A. A. Flumazenil (Romazicon)
B. B. Naloxone (Narcan) [CORRECT]
C. C. Naltrexone (Vivitrol)
D. D. Methylnaltrexone (Relistor)
Correct Answer: B
Rationale: Naloxone is the opioid reversal agent of choice for acute opioid-induced respiratory depression. It is a
competitive antagonist at mu-opioid receptors and rapidly reverses respiratory depression, sedation, and hypotension
caused by opioid agonists. It has a short duration of action (30-90 minutes), so patients must be monitored for
NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | Page 2
, re-sedation. Option A (flumazenil) reverses benzodiazepines. Option C (naltrexone) is used for opioid and alcohol
dependence management, not acute reversal. Option D (methylnaltrexone) is a peripherally acting mu-opioid
receptor antagonist used for opioid-induced constipation; it does not cross the blood-brain barrier and will not reverse
respiratory depression.
Q4: A nurse is assessing a patient who has been taking ibuprofen 800 mg three times daily for
chronic musculoskeletal pain for the past 6 months. Which adverse effect should the nurse
prioritize in the assessment?
A. A. Hepatotoxicity and elevated liver enzymes
B. B. Gastrointestinal ulceration, bleeding, and renal impairment [CORRECT]
C. C. Rebound hypertension and reflex tachycardia
D. D. Weight gain and hyperglycemia
Correct Answer: B
Rationale: Chronic NSAID use (including ibuprofen) carries significant risk for gastrointestinal complications
(ulceration, bleeding, perforation) due to inhibition of COX-1, which reduces protective gastric prostaglandin (PGE2,
PGI2) production. NSAIDs also impair renal blood flow by inhibiting prostaglandin-mediated vasodilation of the
afferent arteriole, potentially causing acute kidney injury, especially in volume-depleted patients or those with
preexisting renal disease. Option A is more associated with acetaminophen overdose or chronic high-dose
acetaminophen use. Option C is not characteristic of NSAIDs. Option D is associated with corticosteroids.
Q5: A postoperative patient is ordered to receive ketorolac (Toradol) 30 mg IV every 6 hours for
pain management. The nurse understands that ketorolac differs from other NSAIDs in which
critical way?
A. A. It has no effect on platelet function
B. B. It is available in both parenteral and oral formulations and is indicated only for short-term use (up to 5
days) [CORRECT]
C. C. It selectively inhibits COX-2 without affecting COX-1
D. D. It has a longer half-life than other NSAIDs, allowing once-daily dosing
Correct Answer: B
Rationale: Ketorolac is unique among NSAIDs in that it is available in parenteral (IM, IV) and oral formulations,
making it useful for acute pain management when oral intake is not feasible. However, it is approved only for
short-term use (up to 5 days) due to the risk of serious adverse effects, including GI bleeding, renal impairment, and
bleeding. It nonselectively inhibits both COX-1 and COX-2, does affect platelet function (contraindicated as a
bleeding risk), and has a relatively short half-life of about 5 hours. Option A is incorrect because ketorolac inhibits
platelet aggregation. Option C describes celecoxib. Option D is incorrect given its 5-hour half-life.
Q6: A patient with severe chronic pain is prescribed methadone for pain management. The nurse
recognizes that methadone has unique pharmacokinetic properties that distinguish it from other
opioids. Which statement about methadone is correct?
A. A. Methadone has a very short half-life requiring dosing every 2-3 hours
B. B. Methadone has a prolonged and variable half-life (8-59 hours) with risk of accumulation and delayed
toxicity [CORRECT]
C. C. Methadone does not cause respiratory depression even at high doses
D. D. Methadone has no NMDA receptor antagonist activity
Correct Answer: B
NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | Page 3
Exam 2 (Latest 2026/2027)
Advanced Pharmacology Quiz Bank
Questions and Verified Answers with Rationales
100% Correct | Grade A
Wilkes University
Passan School of Nursing
75 Questions | Aligned with 2026-2027 Curriculum Standards
NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | Page 1
,Section 1: Pain Management
Q1: A nurse is educating a patient about the World Health Organization (WHO) analgesic ladder for
cancer pain management. Which statement by the nurse best describes the guiding principle of
the WHO analgesic ladder?
A. A. Start with the strongest opioid available and taper down as pain improves
B. B. Begin with non-opioid analgesics and progress to stronger agents based on pain severity
[CORRECT]
C. C. Use adjuvant medications exclusively before introducing any analgesics
D. D. Reserve all pharmacologic interventions until nonpharmacologic measures have been exhausted
Correct Answer: B
Rationale: The WHO analgesic ladder is a stepwise approach to pain management that recommends starting with
non-opioid analgesics (Step 1: acetaminophen, NSAIDs) for mild pain, progressing to weak opioids with or without
non-opioids for moderate pain (Step 2), and escalating to strong opioids for severe pain (Step 3). Adjuvant
medications (antidepressants, anticonvulsants, corticosteroids) can be used at any step. Option A is incorrect
because treatment escalates, not de-escalates. Option C is incorrect because adjuvants supplement, not replace,
analgesics. Option D is incorrect because pharmacologic and nonpharmacologic approaches should be used
concurrently.
Q2: A patient with chronic cancer pain has been on oral morphine 30 mg every 4 hours. The nurse
is converting the patient to an equivalent dose of transdermal fentanyl. Which principle of opioid
equianalgesic dosing is most critical for the nurse to apply?
A. A. Apply the equianalgesic conversion ratio directly without adjustment
B. B. Reduce the calculated equianalgesic dose by 25-50% when switching from one opioid to another
due to incomplete cross-tolerance [CORRECT]
C. C. Increase the calculated dose by 25% to ensure adequate pain relief during the transition
D. D. Maintain the exact same milligram dose when switching formulations
Correct Answer: B
Rationale: When converting between opioids, the calculated equianalgesic dose should be reduced by 25-50% due to
incomplete cross-tolerance. Patients who have been on one opioid develop tolerance to its specific effects, but this
tolerance does not fully transfer to a different opioid. Administering the full calculated equianalgesic dose of a new
opioid risks overdose and respiratory depression. This safety principle is fundamental to safe opioid rotation. Option A
risks overdose. Option C would further increase the risk. Option D ignores both the different potencies of opioids and
the cross-tolerance issue.
Q3: A patient receiving morphine via patient-controlled analgesia (PCA) reports difficulty breathing
and has a respiratory rate of 8 breaths per minute. Which medication should the nurse prepare to
administer as the reversal agent?
A. A. Flumazenil (Romazicon)
B. B. Naloxone (Narcan) [CORRECT]
C. C. Naltrexone (Vivitrol)
D. D. Methylnaltrexone (Relistor)
Correct Answer: B
Rationale: Naloxone is the opioid reversal agent of choice for acute opioid-induced respiratory depression. It is a
competitive antagonist at mu-opioid receptors and rapidly reverses respiratory depression, sedation, and hypotension
caused by opioid agonists. It has a short duration of action (30-90 minutes), so patients must be monitored for
NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | Page 2
, re-sedation. Option A (flumazenil) reverses benzodiazepines. Option C (naltrexone) is used for opioid and alcohol
dependence management, not acute reversal. Option D (methylnaltrexone) is a peripherally acting mu-opioid
receptor antagonist used for opioid-induced constipation; it does not cross the blood-brain barrier and will not reverse
respiratory depression.
Q4: A nurse is assessing a patient who has been taking ibuprofen 800 mg three times daily for
chronic musculoskeletal pain for the past 6 months. Which adverse effect should the nurse
prioritize in the assessment?
A. A. Hepatotoxicity and elevated liver enzymes
B. B. Gastrointestinal ulceration, bleeding, and renal impairment [CORRECT]
C. C. Rebound hypertension and reflex tachycardia
D. D. Weight gain and hyperglycemia
Correct Answer: B
Rationale: Chronic NSAID use (including ibuprofen) carries significant risk for gastrointestinal complications
(ulceration, bleeding, perforation) due to inhibition of COX-1, which reduces protective gastric prostaglandin (PGE2,
PGI2) production. NSAIDs also impair renal blood flow by inhibiting prostaglandin-mediated vasodilation of the
afferent arteriole, potentially causing acute kidney injury, especially in volume-depleted patients or those with
preexisting renal disease. Option A is more associated with acetaminophen overdose or chronic high-dose
acetaminophen use. Option C is not characteristic of NSAIDs. Option D is associated with corticosteroids.
Q5: A postoperative patient is ordered to receive ketorolac (Toradol) 30 mg IV every 6 hours for
pain management. The nurse understands that ketorolac differs from other NSAIDs in which
critical way?
A. A. It has no effect on platelet function
B. B. It is available in both parenteral and oral formulations and is indicated only for short-term use (up to 5
days) [CORRECT]
C. C. It selectively inhibits COX-2 without affecting COX-1
D. D. It has a longer half-life than other NSAIDs, allowing once-daily dosing
Correct Answer: B
Rationale: Ketorolac is unique among NSAIDs in that it is available in parenteral (IM, IV) and oral formulations,
making it useful for acute pain management when oral intake is not feasible. However, it is approved only for
short-term use (up to 5 days) due to the risk of serious adverse effects, including GI bleeding, renal impairment, and
bleeding. It nonselectively inhibits both COX-1 and COX-2, does affect platelet function (contraindicated as a
bleeding risk), and has a relatively short half-life of about 5 hours. Option A is incorrect because ketorolac inhibits
platelet aggregation. Option C describes celecoxib. Option D is incorrect given its 5-hour half-life.
Q6: A patient with severe chronic pain is prescribed methadone for pain management. The nurse
recognizes that methadone has unique pharmacokinetic properties that distinguish it from other
opioids. Which statement about methadone is correct?
A. A. Methadone has a very short half-life requiring dosing every 2-3 hours
B. B. Methadone has a prolonged and variable half-life (8-59 hours) with risk of accumulation and delayed
toxicity [CORRECT]
C. C. Methadone does not cause respiratory depression even at high doses
D. D. Methadone has no NMDA receptor antagonist activity
Correct Answer: B
NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | Page 3
