LATEST NUR 635 FINAL REVIEW TYLER/SARHAN
EXAM BANK AND A NEW UPDATED STUDY GUIDE
2026/2027 — FULL REVISED PRACTICE EXAM (205
QUESTIONS)
SECTION 1 — PHARMACOKINETICS, PHARMACODYNAMICS & PRESCRIBING PRINCIPLES
An NP prescribes an oral drug with a high first‑pass effect. What does this mean?
A. Low oral bioavailability — Correct: hepatic metabolism inactivates much of the drug before it reaches
circulation.
B. High oral bioavailability — Incorrect: first‑pass metabolism reduces, not increases, active drug.
C. The drug must be given only orally — Incorrect: high first‑pass drugs often need IV or alternative
routes.
D. The drug avoids hepatic metabolism — Incorrect: first‑pass IS hepatic metabolism.
ANSWER: A
A patient asks how long until a new drug reaches steady state. The NP explains it takes about:
A. 4–5 half‑lives — Correct: steady state is reached after 4–5 elimination half‑lives.
B. 1 half‑life — Incorrect: only ~50% of steady state is achieved.
C. 2 half‑lives — Incorrect: only ~75% achieved.
D. 10 half‑lives — Incorrect: overestimates; unnecessary time.
ANSWER: A
Why is a loading dose given for drugs like azithromycin or digoxin?
A. To reach therapeutic levels rapidly — Correct: loading dose quickly achieves target concentration.
B. To reduce toxicity — Incorrect: loading doses increase, not reduce, early exposure.
C. To prolong duration of action — Incorrect: duration is set by half‑life, not loading.
D. To avoid maintenance dosing — Incorrect: maintenance dosing is still required.
ANSWER: A
,Before prescribing a renally cleared drug to an older adult, the NP should assess:
A. Creatinine clearance — Correct: renal function declines with age and alters dosing.
B. Serum albumin only — Incorrect: albumin affects binding, not clearance.
C. Liver enzymes only — Incorrect: relevant for hepatic drugs, not renally cleared ones.
D. Body temperature — Incorrect: irrelevant to drug clearance.
ANSWER: A
A patient on warfarin starts rifampin and the INR drops. The mechanism is:
A. CYP450 induction — Correct: rifampin induces enzymes, increasing warfarin metabolism.
B. CYP450 inhibition — Incorrect: inhibition would raise INR/bleeding risk.
C. Protein binding displacement — Incorrect: not rifampin's main interaction.
D. Decreased absorption — Incorrect: rifampin acts via enzyme induction.
ANSWER: A
Which substance should a patient on simvastatin avoid because it inhibits CYP3A4?
A. Grapefruit juice — Correct: inhibits CYP3A4, raising statin levels and myopathy risk.
B. Milk — Incorrect: no CYP interaction.
C. Green tea — Incorrect: clinically insignificant here.
D. Calcium carbonate — Incorrect: affects absorption of other drugs, not CYP3A4.
ANSWER: A
A malnourished patient with low albumin receives a highly protein‑bound drug. The NP expects:
A. Increased free (active) drug — Correct: less albumin means more unbound, active fraction.
B. Decreased free drug — Incorrect: low binding raises free drug.
C. No change in effect — Incorrect: free fraction increases effect/toxicity.
D. Faster renal excretion of bound drug — Incorrect: only free drug is filtered; binding is reduced.
ANSWER: A
Which drug has a NARROW therapeutic index requiring level monitoring?
A. Digoxin — Correct: small margin between therapeutic and toxic levels.
B. Penicillin — Incorrect: wide safety margin.
C. Acetaminophen — Incorrect: wide therapeutic window at normal doses.
D. Cetirizine — Incorrect: very wide safety margin.
,ANSWER: A
A drug that binds a receptor and produces a maximal response is a:
A. Full agonist — Correct: full agonists produce maximal receptor response.
B. Antagonist — Incorrect: antagonists block response.
C. Partial agonist — Incorrect: produces submaximal response.
D. Inverse agonist — Incorrect: produces opposite effect to agonist.
ANSWER: A
A patient on chronic opioids needs higher doses for the same pain relief. This is:
A. Tolerance from receptor down‑regulation — Correct: chronic stimulation reduces receptor response.
B. Allergy — Incorrect: allergy is immune‑mediated, not dose‑related.
C. Addiction — Incorrect: addiction is behavioral compulsion, not pharmacologic tolerance.
D. Idiosyncratic reaction — Incorrect: idiosyncratic = genetically unusual response.
ANSWER: A
A CYP2D6 poor metabolizer takes codeine and gets no pain relief because:
A. Codeine is not converted to morphine — Correct: CYP2D6 activates codeine; poor metabolizers get no
effect.
B. Codeine is excreted too slowly — Incorrect: activation, not excretion, is the issue.
C. Codeine binds too tightly — Incorrect: binding is unchanged.
D. Morphine is overproduced — Incorrect: that occurs in ultrarapid metabolizers (toxicity).
ANSWER: A
A "black box warning" indicates:
A. The most serious FDA safety warning — Correct: boxed warnings flag life‑threatening risks.
B. The drug is contraindicated in all patients — Incorrect: it warns, not universally bans.
C. The drug is unapproved — Incorrect: it is approved with serious risk labeling.
D. A manufacturing defect — Incorrect: unrelated to manufacturing.
ANSWER: A
Which controlled substance is Schedule II (high abuse potential with accepted medical use)?
A. Oxycodone — Correct: Schedule II opioid.
B. Diazepam — Incorrect: Schedule IV.
, C. Loperamide — Incorrect: not scheduled at OTC doses.
D. Pseudoephedrine — Incorrect: behind‑counter but not a controlled schedule.
ANSWER: A
Which drug is a known teratogen the NP must avoid in pregnancy?
A. Warfarin — Correct: causes fetal warfarin syndrome/CNS defects.
B. Penicillin — Incorrect: category‑safe in pregnancy.
C. Levothyroxine — Incorrect: safe and necessary in pregnancy.
D. Insulin — Incorrect: preferred glucose‑lowering agent in pregnancy.
ANSWER: A
SECTION 2 — ANTI‑INFECTIVES (ANTIBIOTICS, ANTIVIRALS, ANTIFUNGALS, ANTIPARASITICS)
A 34‑year‑old female has dysuria, frequency, urgency; lower UTI, no predisposing factors, UTI 6 months
ago. Which TX plan does the NP choose?
A. Short‑course or single‑dose therapy — Correct: uncomplicated lower UTI responds to short course.
B. 14‑day IV antibiotics — Incorrect: excessive; reserved for complicated infection.
C. Observation only — Incorrect: symptomatic UTI needs treatment.
D. Long‑term suppressive therapy — Incorrect: not indicated for a single recurrence.
ANSWER: A
What short‑course therapy would you prescribe for a 34‑year‑old non‑pregnant female with a UTI?
A. Trimethoprim/sulfamethoxazole (Bactrim) for 3 days — Correct: standard 3‑day regimen.
B. Vancomycin IV for 3 days — Incorrect: wrong spectrum/route for uncomplicated UTI.
C. Azithromycin 1 g once — Incorrect: treats chlamydia, not typical UTI pathogens.
D. Nitrofurantoin for 14 days — Incorrect: nitrofurantoin course is 5 days, not 14.
ANSWER: A
Which aminoglycoside would the NP prescribe for conjunctivitis?
A. Neomycin — Correct: topical aminoglycoside for bacterial conjunctivitis.
B. Gentamicin oral — Incorrect: gentamicin is not oral; neomycin is the ophthalmic classic.
C. Amikacin IV — Incorrect: IV reserved for systemic resistant infections.
D. Tobramycin oral — Incorrect: aminoglycosides are not given orally for eye infection.
ANSWER: A
EXAM BANK AND A NEW UPDATED STUDY GUIDE
2026/2027 — FULL REVISED PRACTICE EXAM (205
QUESTIONS)
SECTION 1 — PHARMACOKINETICS, PHARMACODYNAMICS & PRESCRIBING PRINCIPLES
An NP prescribes an oral drug with a high first‑pass effect. What does this mean?
A. Low oral bioavailability — Correct: hepatic metabolism inactivates much of the drug before it reaches
circulation.
B. High oral bioavailability — Incorrect: first‑pass metabolism reduces, not increases, active drug.
C. The drug must be given only orally — Incorrect: high first‑pass drugs often need IV or alternative
routes.
D. The drug avoids hepatic metabolism — Incorrect: first‑pass IS hepatic metabolism.
ANSWER: A
A patient asks how long until a new drug reaches steady state. The NP explains it takes about:
A. 4–5 half‑lives — Correct: steady state is reached after 4–5 elimination half‑lives.
B. 1 half‑life — Incorrect: only ~50% of steady state is achieved.
C. 2 half‑lives — Incorrect: only ~75% achieved.
D. 10 half‑lives — Incorrect: overestimates; unnecessary time.
ANSWER: A
Why is a loading dose given for drugs like azithromycin or digoxin?
A. To reach therapeutic levels rapidly — Correct: loading dose quickly achieves target concentration.
B. To reduce toxicity — Incorrect: loading doses increase, not reduce, early exposure.
C. To prolong duration of action — Incorrect: duration is set by half‑life, not loading.
D. To avoid maintenance dosing — Incorrect: maintenance dosing is still required.
ANSWER: A
,Before prescribing a renally cleared drug to an older adult, the NP should assess:
A. Creatinine clearance — Correct: renal function declines with age and alters dosing.
B. Serum albumin only — Incorrect: albumin affects binding, not clearance.
C. Liver enzymes only — Incorrect: relevant for hepatic drugs, not renally cleared ones.
D. Body temperature — Incorrect: irrelevant to drug clearance.
ANSWER: A
A patient on warfarin starts rifampin and the INR drops. The mechanism is:
A. CYP450 induction — Correct: rifampin induces enzymes, increasing warfarin metabolism.
B. CYP450 inhibition — Incorrect: inhibition would raise INR/bleeding risk.
C. Protein binding displacement — Incorrect: not rifampin's main interaction.
D. Decreased absorption — Incorrect: rifampin acts via enzyme induction.
ANSWER: A
Which substance should a patient on simvastatin avoid because it inhibits CYP3A4?
A. Grapefruit juice — Correct: inhibits CYP3A4, raising statin levels and myopathy risk.
B. Milk — Incorrect: no CYP interaction.
C. Green tea — Incorrect: clinically insignificant here.
D. Calcium carbonate — Incorrect: affects absorption of other drugs, not CYP3A4.
ANSWER: A
A malnourished patient with low albumin receives a highly protein‑bound drug. The NP expects:
A. Increased free (active) drug — Correct: less albumin means more unbound, active fraction.
B. Decreased free drug — Incorrect: low binding raises free drug.
C. No change in effect — Incorrect: free fraction increases effect/toxicity.
D. Faster renal excretion of bound drug — Incorrect: only free drug is filtered; binding is reduced.
ANSWER: A
Which drug has a NARROW therapeutic index requiring level monitoring?
A. Digoxin — Correct: small margin between therapeutic and toxic levels.
B. Penicillin — Incorrect: wide safety margin.
C. Acetaminophen — Incorrect: wide therapeutic window at normal doses.
D. Cetirizine — Incorrect: very wide safety margin.
,ANSWER: A
A drug that binds a receptor and produces a maximal response is a:
A. Full agonist — Correct: full agonists produce maximal receptor response.
B. Antagonist — Incorrect: antagonists block response.
C. Partial agonist — Incorrect: produces submaximal response.
D. Inverse agonist — Incorrect: produces opposite effect to agonist.
ANSWER: A
A patient on chronic opioids needs higher doses for the same pain relief. This is:
A. Tolerance from receptor down‑regulation — Correct: chronic stimulation reduces receptor response.
B. Allergy — Incorrect: allergy is immune‑mediated, not dose‑related.
C. Addiction — Incorrect: addiction is behavioral compulsion, not pharmacologic tolerance.
D. Idiosyncratic reaction — Incorrect: idiosyncratic = genetically unusual response.
ANSWER: A
A CYP2D6 poor metabolizer takes codeine and gets no pain relief because:
A. Codeine is not converted to morphine — Correct: CYP2D6 activates codeine; poor metabolizers get no
effect.
B. Codeine is excreted too slowly — Incorrect: activation, not excretion, is the issue.
C. Codeine binds too tightly — Incorrect: binding is unchanged.
D. Morphine is overproduced — Incorrect: that occurs in ultrarapid metabolizers (toxicity).
ANSWER: A
A "black box warning" indicates:
A. The most serious FDA safety warning — Correct: boxed warnings flag life‑threatening risks.
B. The drug is contraindicated in all patients — Incorrect: it warns, not universally bans.
C. The drug is unapproved — Incorrect: it is approved with serious risk labeling.
D. A manufacturing defect — Incorrect: unrelated to manufacturing.
ANSWER: A
Which controlled substance is Schedule II (high abuse potential with accepted medical use)?
A. Oxycodone — Correct: Schedule II opioid.
B. Diazepam — Incorrect: Schedule IV.
, C. Loperamide — Incorrect: not scheduled at OTC doses.
D. Pseudoephedrine — Incorrect: behind‑counter but not a controlled schedule.
ANSWER: A
Which drug is a known teratogen the NP must avoid in pregnancy?
A. Warfarin — Correct: causes fetal warfarin syndrome/CNS defects.
B. Penicillin — Incorrect: category‑safe in pregnancy.
C. Levothyroxine — Incorrect: safe and necessary in pregnancy.
D. Insulin — Incorrect: preferred glucose‑lowering agent in pregnancy.
ANSWER: A
SECTION 2 — ANTI‑INFECTIVES (ANTIBIOTICS, ANTIVIRALS, ANTIFUNGALS, ANTIPARASITICS)
A 34‑year‑old female has dysuria, frequency, urgency; lower UTI, no predisposing factors, UTI 6 months
ago. Which TX plan does the NP choose?
A. Short‑course or single‑dose therapy — Correct: uncomplicated lower UTI responds to short course.
B. 14‑day IV antibiotics — Incorrect: excessive; reserved for complicated infection.
C. Observation only — Incorrect: symptomatic UTI needs treatment.
D. Long‑term suppressive therapy — Incorrect: not indicated for a single recurrence.
ANSWER: A
What short‑course therapy would you prescribe for a 34‑year‑old non‑pregnant female with a UTI?
A. Trimethoprim/sulfamethoxazole (Bactrim) for 3 days — Correct: standard 3‑day regimen.
B. Vancomycin IV for 3 days — Incorrect: wrong spectrum/route for uncomplicated UTI.
C. Azithromycin 1 g once — Incorrect: treats chlamydia, not typical UTI pathogens.
D. Nitrofurantoin for 14 days — Incorrect: nitrofurantoin course is 5 days, not 14.
ANSWER: A
Which aminoglycoside would the NP prescribe for conjunctivitis?
A. Neomycin — Correct: topical aminoglycoside for bacterial conjunctivitis.
B. Gentamicin oral — Incorrect: gentamicin is not oral; neomycin is the ophthalmic classic.
C. Amikacin IV — Incorrect: IV reserved for systemic resistant infections.
D. Tobramycin oral — Incorrect: aminoglycosides are not given orally for eye infection.
ANSWER: A
