NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | 2026-2027
NSG 533 / NSG533 Exam 2
Advanced Pharmacology | Questions and Verified Answers | 100% Correct | Grade A
Wilkes University Passan School of Nursing | 2026-2027 Curriculum
75 Questions | 6 Sections | Multiple Choice (A-D)
Section 1: Pain Management & Analgesic Pharmacology (Q1-25)
Q1: A 58-year-old patient with osteoarthritis describes his knee pain as a deep, aching throbbing that worsens with weight
bearing. Which pain classification best fits this presentation, and what is the first-line pharmacological approach?
A. Neuropathic pain; first-line gabapentin
B. Nociceptive pain; first-line NSAIDs [CORRECT]
C. Central sensitization pain; first-line duloxetine
D. Malignant pain; first-line morphine
Correct Answer: B
Rationale: Nociceptive pain results from tissue injury activating peripheral nociceptors through inflammatory mediators (prostaglandins,
bradykinin) and is described as aching, throbbing, sharp, and localized. First-line treatment includes NSAIDs, which target COX enzymes to
reduce prostaglandin synthesis. Neuropathic pain is described as burning or electric and requires different agents. Central sensitization pain
lacks clear tissue damage. This distinction is fundamental to the WHO analgesic ladder per Wilkes NSG 533.
Q2: A patient with diabetic neuropathy describes burning, shooting, electric-like pain in both feet that worsens at night.
NSAIDs have provided no relief. Which pain type and appropriate first-line treatment?
A. Nociceptive pain; increase NSAID dose
B. Inflammatory pain; add corticosteroids
C. Neuropathic pain from nerve injury and abnormal sodium channel firing; first-line duloxetine, gabapentin, or
pregabalin [CORRECT]
D. Central sensitization; first-line opioids
Correct Answer: C
Rationale: Neuropathic pain results from nerve injury causing abnormal sodium channel firing and central sensitization, described as
burning, electric, shooting, or tingling. NSAIDs are usually ineffective because the pain mechanism is not prostaglandin-mediated. First-line
treatments include duloxetine (SNRI), amitriptyline (TCA), and gabapentin/pregabalin (calcium channel modulators). This is a core NSG 533
competency for pain type differentiation.
Q3: A patient with fibromyalgia reports widespread chronic body pain, fatigue, and sleep disturbance. Physical examination
reveals multiple tender points but no joint inflammation. Which pharmacological approach is most appropriate?
A. High-dose NSAIDs for anti-inflammatory effect
B. Opioid analgesics for severe pain
C. Duloxetine, milnacipran, pregabalin, or amitriptyline targeting central sensitization [CORRECT]
D. Corticosteroids for autoimmune inflammation
Correct Answer: C
Rationale: Fibromyalgia is a classic example of central sensitization/nociplastic pain with amplified CNS pain signaling without clear tissue
damage. Best pharmacological choices are duloxetine, milnacipran, pregabalin, or amitriptyline. NSAIDs and opioids have limited role
because there is no peripheral inflammatory or nociceptive driver. This distinction is critical for NSG 533 exam preparation per 2026-2027
Wilkes curriculum.
Q4: A patient with metastatic breast cancer and bone metastases reports severe pain (8/10). She is currently on ibuprofen
800 mg TID with inadequate relief. According to the WHO analgesic ladder, what is the most appropriate next step?
A. Continue NSAIDs at maximum dose
B. Add acetaminophen for multimodal analgesia
Page 1
, NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | 2026-2027
C. Advance to Step 3 with morphine plus adjuvant bisphosphonates for bone metastases [CORRECT]
D. Switch to a different NSAID
Correct Answer: C
Rationale: Malignant (cancer) pain is often mixed (inflammatory plus neuropathic) and frequently starts at WHO Step 3 with morphine,
hydromorphone, or fentanyl. Adjuvants are essential: corticosteroids for spinal cord compression and bisphosphonates for bone metastases.
This patient has inadequate relief on Step 1 (NSAIDs), so advancing to an opioid plus adjuvant is indicated per the WHO ladder, a core NSG
533 pharmacotherapy principle.
Q5: A nurse is converting a patient from oral morphine 30 mg every 4 hours to IV hydromorphone for acute pain
management. Using equianalgesic dosing principles, what is the approximate equivalent IV hydromorphone dose?
A. Hydromorphone 1.5 mg IV
B. Hydromorphone 4.5 mg IV [CORRECT]
C. Hydromorphone 7.5 mg IV
D. Hydromorphone 15 mg IV
Correct Answer: B
Rationale: Equianalgesic dosing: morphine 10 mg IV equals hydromorphone 1.5 mg IV. For 30 mg oral morphine, the IV morphine
equivalent is approximately 10 mg (oral to IV conversion is roughly 3:1 for morphine). Ten mg IV morphine equals approximately 1.5 mg IV
hydromorphone. However, when converting from oral morphine 30 mg to IV hydromorphone directly, the equianalgesic ratio is
approximately 20:1 (oral morphine to IV hydromorphone), giving 1.5 mg IV hydromorphone. Accurate equianalgesic conversion is essential
for NSG 533.
Q6: A patient receiving morphine PCA post-operatively becomes difficult to arouse with a respiratory rate of 8 breaths/min
and pinpoint pupils. Which medication should the nurse administer immediately?
A. Flumazenil (Romazicon)
B. Naloxone (Narcan) [CORRECT]
C. N-acetylcysteine (NAC)
D. Protamine sulfate
Correct Answer: B
Rationale: Naloxone (Narcan) is the specific opioid antidote for opioid overdose causing respiratory depression, sedation, and pinpoint
pupils. It competitively antagonizes mu opioid receptors, reversing respiratory depression and CNS depression. Flumazenil reverses
benzodiazepines, NAC treats acetaminophen toxicity, and protamine reverses heparin. Recognizing opioid toxicity and naloxone as the
antidote is fundamental to NSG 533 opioid pharmacology.
Q7: A 72-year-old patient with chronic pain asks about acetaminophen for pain relief. What is the maximum recommended
daily dose of acetaminophen in elderly patients, and what is its primary mechanism?
A. 4000 mg/day; inhibits peripheral COX enzymes reducing inflammation
B. 3000 mg/day; works centrally inhibiting central COX and decreasing prostaglandin synthesis in the CNS
[CORRECT]
C. 2000 mg/day; inhibits COX-2 selectively in peripheral tissues
D. 5000 mg/day; blocks sodium channels in peripheral nerves
Correct Answer: B
Rationale: The maximum acetaminophen dose in elderly patients is 3000 mg/day (reduced from 4000 mg in younger adults). Acetaminophen
works centrally in the CNS by inhibiting central COX, decreasing prostaglandin synthesis in the CNS, reducing pain perception and fever. It
does NOT inhibit peripheral COX, does not reduce inflammation, does not affect platelets, and causes no gastric irritation. These
pharmacological distinctions are essential per NSG 533.
Q8: A patient with chronic liver disease asks which analgesic is safest for his condition. The nurse correctly recommends
acetaminophen (at reduced dose) over NSAIDs. Which property of acetaminophen makes it preferred?
A. Acetaminophen has no hepatotoxic potential
B. Acetaminophen does not affect platelets, has no gastric irritation, and does not reduce renal blood flow
[CORRECT]
C. Acetaminophen provides superior anti-inflammatory action
D. Acetaminophen is metabolized exclusively by the lungs
Correct Answer: B
Page 2
, NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | 2026-2027
Rationale: Acetaminophen does not affect platelets, causes no gastric irritation, and does not reduce renal blood flow, making it safer than
NSAIDs in patients with liver disease (at reduced doses), hypertension, heart failure, or bleeding risk. While acetaminophen has hepatotoxic
potential at high doses, it remains preferred over NSAIDs in many comorbid conditions. Understanding these comparative safety profiles is a
key NSG 533 pharmacology competency.
Q9: A patient is prescribed methadone for chronic pain. Which statement about methadone is most important for the nurse
to understand?
A. Methadone has a short, predictable half-life of 4-6 hours
B. Methadone has a long and variable half-life (15-60 hours) requiring slow titration and monitoring for delayed
accumulation, QT prolongation, and sedation [CORRECT]
C. Methadone has no risk of respiratory depression
D. Methadone is a partial mu opioid agonist
Correct Answer: B
Rationale: Methadone has a long and variable half-life (15-60 hours), which can lead to delayed accumulation and toxicity. It requires slow
titration with monitoring for QT prolongation and sedation. Unlike short-acting opioids, methadone's pharmacokinetics make it challenging to
dose safely. It is a full mu agonist with respiratory depression risk. These pharmacokinetic properties are critical safety concepts for NSG
533.
Q10: A nurse is providing education about adjuvant analgesics. Which statement best describes adjuvant analgesics?
A. Drugs whose primary indication IS pain, used as second-line agents
B. Drugs whose primary indication is NOT pain but are useful as monotherapy or in combination for pain,
particularly neuropathic pain [CORRECT]
C. Drugs that replace opioids in the WHO analgesic ladder
D. Drugs used exclusively for cancer pain management
Correct Answer: B
Rationale: Adjuvant analgesics are drugs whose primary indication is not pain but are useful as monotherapy or in combination for pain
control. Examples include antiepileptics (gabapentin, pregabalin), antidepressants (TCAs, SNRIs), local anesthetics (lidocaine), capsaicin, and
muscle relaxants. They are particularly useful for neuropathic pain conditions such as diabetic neuropathy, postherpetic neuralgia, and
fibromyalgia per NSG 533 curriculum.
Q11: Which of the following is NOT a common side effect of mu opioid receptor agonists such as morphine?
A. Constipation
B. Respiratory depression
C. Bronchodilation [CORRECT]
D. Sedation and nausea
Correct Answer: C
Rationale: Common side effects of mu opioid agonists include constipation, respiratory depression, sedation, nausea, dependence, and
tolerance. Opioids cause bronchoconstriction (not bronchodilation) through histamine release and direct effects on airway smooth muscle.
Constipation and respiratory depression are the most clinically significant and do not develop tolerance with long-term use, making them
persistent concerns in opioid therapy per NSG 533.
Q12: A patient presents to the ED with acetaminophen overdose (ingested approximately 15 grams 4 hours ago). AST is
350 U/L, ALT is 380 U/L, and INR is 1.6. Which antidote should be administered?
A. Naloxone (Narcan)
B. N-acetylcysteine (NAC) [CORRECT]
C. Flumazenil (Romazicon)
D. Protamine sulfate
Correct Answer: B
Rationale: N-acetylcysteine (NAC) is the specific antidote for acetaminophen hepatotoxicity. NAC serves as a glutathione precursor,
replenishing hepatic glutathione stores to detoxify the toxic metabolite NAPQI. It is most effective when administered within 8-10 hours of
overdose. The elevated liver enzymes and INR indicate hepatic injury has begun. Naloxone reverses opioids, flumazenil reverses
benzodiazepines, and protamine reverses heparin per NSG 533.
Q13: A patient with inflammatory pain from rheumatoid arthritis asks why NSAIDs are more effective for her condition
than acetaminophen. Which response is most accurate?
Page 3
NSG 533 / NSG533 Exam 2
Advanced Pharmacology | Questions and Verified Answers | 100% Correct | Grade A
Wilkes University Passan School of Nursing | 2026-2027 Curriculum
75 Questions | 6 Sections | Multiple Choice (A-D)
Section 1: Pain Management & Analgesic Pharmacology (Q1-25)
Q1: A 58-year-old patient with osteoarthritis describes his knee pain as a deep, aching throbbing that worsens with weight
bearing. Which pain classification best fits this presentation, and what is the first-line pharmacological approach?
A. Neuropathic pain; first-line gabapentin
B. Nociceptive pain; first-line NSAIDs [CORRECT]
C. Central sensitization pain; first-line duloxetine
D. Malignant pain; first-line morphine
Correct Answer: B
Rationale: Nociceptive pain results from tissue injury activating peripheral nociceptors through inflammatory mediators (prostaglandins,
bradykinin) and is described as aching, throbbing, sharp, and localized. First-line treatment includes NSAIDs, which target COX enzymes to
reduce prostaglandin synthesis. Neuropathic pain is described as burning or electric and requires different agents. Central sensitization pain
lacks clear tissue damage. This distinction is fundamental to the WHO analgesic ladder per Wilkes NSG 533.
Q2: A patient with diabetic neuropathy describes burning, shooting, electric-like pain in both feet that worsens at night.
NSAIDs have provided no relief. Which pain type and appropriate first-line treatment?
A. Nociceptive pain; increase NSAID dose
B. Inflammatory pain; add corticosteroids
C. Neuropathic pain from nerve injury and abnormal sodium channel firing; first-line duloxetine, gabapentin, or
pregabalin [CORRECT]
D. Central sensitization; first-line opioids
Correct Answer: C
Rationale: Neuropathic pain results from nerve injury causing abnormal sodium channel firing and central sensitization, described as
burning, electric, shooting, or tingling. NSAIDs are usually ineffective because the pain mechanism is not prostaglandin-mediated. First-line
treatments include duloxetine (SNRI), amitriptyline (TCA), and gabapentin/pregabalin (calcium channel modulators). This is a core NSG 533
competency for pain type differentiation.
Q3: A patient with fibromyalgia reports widespread chronic body pain, fatigue, and sleep disturbance. Physical examination
reveals multiple tender points but no joint inflammation. Which pharmacological approach is most appropriate?
A. High-dose NSAIDs for anti-inflammatory effect
B. Opioid analgesics for severe pain
C. Duloxetine, milnacipran, pregabalin, or amitriptyline targeting central sensitization [CORRECT]
D. Corticosteroids for autoimmune inflammation
Correct Answer: C
Rationale: Fibromyalgia is a classic example of central sensitization/nociplastic pain with amplified CNS pain signaling without clear tissue
damage. Best pharmacological choices are duloxetine, milnacipran, pregabalin, or amitriptyline. NSAIDs and opioids have limited role
because there is no peripheral inflammatory or nociceptive driver. This distinction is critical for NSG 533 exam preparation per 2026-2027
Wilkes curriculum.
Q4: A patient with metastatic breast cancer and bone metastases reports severe pain (8/10). She is currently on ibuprofen
800 mg TID with inadequate relief. According to the WHO analgesic ladder, what is the most appropriate next step?
A. Continue NSAIDs at maximum dose
B. Add acetaminophen for multimodal analgesia
Page 1
, NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | 2026-2027
C. Advance to Step 3 with morphine plus adjuvant bisphosphonates for bone metastases [CORRECT]
D. Switch to a different NSAID
Correct Answer: C
Rationale: Malignant (cancer) pain is often mixed (inflammatory plus neuropathic) and frequently starts at WHO Step 3 with morphine,
hydromorphone, or fentanyl. Adjuvants are essential: corticosteroids for spinal cord compression and bisphosphonates for bone metastases.
This patient has inadequate relief on Step 1 (NSAIDs), so advancing to an opioid plus adjuvant is indicated per the WHO ladder, a core NSG
533 pharmacotherapy principle.
Q5: A nurse is converting a patient from oral morphine 30 mg every 4 hours to IV hydromorphone for acute pain
management. Using equianalgesic dosing principles, what is the approximate equivalent IV hydromorphone dose?
A. Hydromorphone 1.5 mg IV
B. Hydromorphone 4.5 mg IV [CORRECT]
C. Hydromorphone 7.5 mg IV
D. Hydromorphone 15 mg IV
Correct Answer: B
Rationale: Equianalgesic dosing: morphine 10 mg IV equals hydromorphone 1.5 mg IV. For 30 mg oral morphine, the IV morphine
equivalent is approximately 10 mg (oral to IV conversion is roughly 3:1 for morphine). Ten mg IV morphine equals approximately 1.5 mg IV
hydromorphone. However, when converting from oral morphine 30 mg to IV hydromorphone directly, the equianalgesic ratio is
approximately 20:1 (oral morphine to IV hydromorphone), giving 1.5 mg IV hydromorphone. Accurate equianalgesic conversion is essential
for NSG 533.
Q6: A patient receiving morphine PCA post-operatively becomes difficult to arouse with a respiratory rate of 8 breaths/min
and pinpoint pupils. Which medication should the nurse administer immediately?
A. Flumazenil (Romazicon)
B. Naloxone (Narcan) [CORRECT]
C. N-acetylcysteine (NAC)
D. Protamine sulfate
Correct Answer: B
Rationale: Naloxone (Narcan) is the specific opioid antidote for opioid overdose causing respiratory depression, sedation, and pinpoint
pupils. It competitively antagonizes mu opioid receptors, reversing respiratory depression and CNS depression. Flumazenil reverses
benzodiazepines, NAC treats acetaminophen toxicity, and protamine reverses heparin. Recognizing opioid toxicity and naloxone as the
antidote is fundamental to NSG 533 opioid pharmacology.
Q7: A 72-year-old patient with chronic pain asks about acetaminophen for pain relief. What is the maximum recommended
daily dose of acetaminophen in elderly patients, and what is its primary mechanism?
A. 4000 mg/day; inhibits peripheral COX enzymes reducing inflammation
B. 3000 mg/day; works centrally inhibiting central COX and decreasing prostaglandin synthesis in the CNS
[CORRECT]
C. 2000 mg/day; inhibits COX-2 selectively in peripheral tissues
D. 5000 mg/day; blocks sodium channels in peripheral nerves
Correct Answer: B
Rationale: The maximum acetaminophen dose in elderly patients is 3000 mg/day (reduced from 4000 mg in younger adults). Acetaminophen
works centrally in the CNS by inhibiting central COX, decreasing prostaglandin synthesis in the CNS, reducing pain perception and fever. It
does NOT inhibit peripheral COX, does not reduce inflammation, does not affect platelets, and causes no gastric irritation. These
pharmacological distinctions are essential per NSG 533.
Q8: A patient with chronic liver disease asks which analgesic is safest for his condition. The nurse correctly recommends
acetaminophen (at reduced dose) over NSAIDs. Which property of acetaminophen makes it preferred?
A. Acetaminophen has no hepatotoxic potential
B. Acetaminophen does not affect platelets, has no gastric irritation, and does not reduce renal blood flow
[CORRECT]
C. Acetaminophen provides superior anti-inflammatory action
D. Acetaminophen is metabolized exclusively by the lungs
Correct Answer: B
Page 2
, NSG 533 Advanced Pharmacology Exam 2 | Wilkes University | 2026-2027
Rationale: Acetaminophen does not affect platelets, causes no gastric irritation, and does not reduce renal blood flow, making it safer than
NSAIDs in patients with liver disease (at reduced doses), hypertension, heart failure, or bleeding risk. While acetaminophen has hepatotoxic
potential at high doses, it remains preferred over NSAIDs in many comorbid conditions. Understanding these comparative safety profiles is a
key NSG 533 pharmacology competency.
Q9: A patient is prescribed methadone for chronic pain. Which statement about methadone is most important for the nurse
to understand?
A. Methadone has a short, predictable half-life of 4-6 hours
B. Methadone has a long and variable half-life (15-60 hours) requiring slow titration and monitoring for delayed
accumulation, QT prolongation, and sedation [CORRECT]
C. Methadone has no risk of respiratory depression
D. Methadone is a partial mu opioid agonist
Correct Answer: B
Rationale: Methadone has a long and variable half-life (15-60 hours), which can lead to delayed accumulation and toxicity. It requires slow
titration with monitoring for QT prolongation and sedation. Unlike short-acting opioids, methadone's pharmacokinetics make it challenging to
dose safely. It is a full mu agonist with respiratory depression risk. These pharmacokinetic properties are critical safety concepts for NSG
533.
Q10: A nurse is providing education about adjuvant analgesics. Which statement best describes adjuvant analgesics?
A. Drugs whose primary indication IS pain, used as second-line agents
B. Drugs whose primary indication is NOT pain but are useful as monotherapy or in combination for pain,
particularly neuropathic pain [CORRECT]
C. Drugs that replace opioids in the WHO analgesic ladder
D. Drugs used exclusively for cancer pain management
Correct Answer: B
Rationale: Adjuvant analgesics are drugs whose primary indication is not pain but are useful as monotherapy or in combination for pain
control. Examples include antiepileptics (gabapentin, pregabalin), antidepressants (TCAs, SNRIs), local anesthetics (lidocaine), capsaicin, and
muscle relaxants. They are particularly useful for neuropathic pain conditions such as diabetic neuropathy, postherpetic neuralgia, and
fibromyalgia per NSG 533 curriculum.
Q11: Which of the following is NOT a common side effect of mu opioid receptor agonists such as morphine?
A. Constipation
B. Respiratory depression
C. Bronchodilation [CORRECT]
D. Sedation and nausea
Correct Answer: C
Rationale: Common side effects of mu opioid agonists include constipation, respiratory depression, sedation, nausea, dependence, and
tolerance. Opioids cause bronchoconstriction (not bronchodilation) through histamine release and direct effects on airway smooth muscle.
Constipation and respiratory depression are the most clinically significant and do not develop tolerance with long-term use, making them
persistent concerns in opioid therapy per NSG 533.
Q12: A patient presents to the ED with acetaminophen overdose (ingested approximately 15 grams 4 hours ago). AST is
350 U/L, ALT is 380 U/L, and INR is 1.6. Which antidote should be administered?
A. Naloxone (Narcan)
B. N-acetylcysteine (NAC) [CORRECT]
C. Flumazenil (Romazicon)
D. Protamine sulfate
Correct Answer: B
Rationale: N-acetylcysteine (NAC) is the specific antidote for acetaminophen hepatotoxicity. NAC serves as a glutathione precursor,
replenishing hepatic glutathione stores to detoxify the toxic metabolite NAPQI. It is most effective when administered within 8-10 hours of
overdose. The elevated liver enzymes and INR indicate hepatic injury has begun. Naloxone reverses opioids, flumazenil reverses
benzodiazepines, and protamine reverses heparin per NSG 533.
Q13: A patient with inflammatory pain from rheumatoid arthritis asks why NSAIDs are more effective for her condition
than acetaminophen. Which response is most accurate?
Page 3
