NU 578 UNITS 1–5 EXAM –
PHARMACOLOGY FOR ADVANCED
PRACTICE NURSES – UNIVERSITY OF
SOUTH ALABAMA QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF
Core Domains:
1. Pharmacokinetics and Pharmacodynamics
2. Autonomic Nervous System Pharmacology
3. Central Nervous System Pharmacology
4. Cardiovascular Pharmacology
5. Renal and Endocrine Pharmacology
6. Antimicrobial and Antiviral Therapy
7. Pharmacogenomics and Individualized Therapy
8. Polypharmacy, Drug Interactions, and Adverse Effects
9. Prescriptive Authority and Legal/Ethical Considerations
10. Clinical Application in Primary Care and Acute Care Settings
Introduction
This comprehensive examination is designed to evaluate the advanced
practice nursing student's knowledge of pharmacology principles essential
for safe and effective prescribing. It assesses understanding of
pharmacokinetics, pharmacodynamics, autonomic and central nervous
system agents, cardiovascular drugs, antimicrobials, and endocrine
therapies. The exam utilizes a multiple-choice format with clinical
scenario-based questions that reflect real-world primary and acute care
prescribing decisions. Emphasis is placed on medication selection, dosing
considerations, adverse effect monitoring, drug-drug interactions, and the
application of pharmacogenomic principles to optimize patient outcomes.
,This assessment aligns with APRN core competencies and state
prescriptive authority requirements.
SECTION ONE: QUESTIONS 1 - 100
1. A 72-year-old patient with heart failure is prescribed digoxin.
Which of the following age-related changes in pharmacokinetics
places this patient at increased risk for digoxin toxicity?
A. Increased hepatic metabolism
B. Decreased glomerular filtration rate
C. Increased volume of distribution
D. Decreased protein binding
B. Decreased glomerular filtration rate
RATIONALE: Digoxin is primarily renally excreted. Age-related
decline in glomerular filtration rate (GFR) reduces drug clearance,
increasing the risk of toxicity. Dosing must be adjusted based on renal
function in older adults.
2. A patient is prescribed a medication that is a weak acid with a
pKa of 4.4. In which of the following body compartments would this
drug be MOST extensively ionized?
A. Stomach (pH 1.5)
B. Urine (pH 6.0)
C. Blood (pH 7.4)
D. Small intestine (pH 8.0)
D. Small intestine (pH 8.0)
RATIONALE: Weak acids are more ionized in alkaline environments
(pH above pKa). At pH 8.0, the drug would be highly ionized and
therefore less able to cross lipid membranes. Ionization reduces passive
reabsorption and enhances elimination.
,3. A patient with hypertension is prescribed lisinopril. Which of the
following adverse effects is most common with this class of
medication and should be discussed with the patient?
A. Hyperkalemia
B. Angioedema
C. Dry cough
D. Hypotension
C. Dry cough
RATIONALE: A dry, nonproductive cough is the most common
adverse effect of ACE inhibitors (including lisinopril), occurring in up to
20% of patients. It is thought to be related to increased bradykinin levels
and often resolves upon discontinuation.
4. Which of the following medications is classified as a non-
dihydropyridine calcium channel blocker?
A. Amlodipine
B. Nifedipine
C. Verapamil
D. Felodipine
C. Verapamil
RATIONALE: Verapamil and diltiazem are non-dihydropyridine
calcium channel blockers that have greater cardiac effects (negative
inotropy and chronotropy) compared to dihydropyridines (amlodipine,
nifedipine, felodipine), which are more selective for vascular smooth
muscle.
5. A 55-year-old male patient with type 2 diabetes and chronic
kidney disease (stage 3) is prescribed metformin. Which of the
following is a significant contraindication or precaution for this
medication?
A. Use in patients with heart failure
B. Use in patients with eGFR <30 mL/min/1.73m²
, C. Use in patients with obesity
D. Use in patients with hypertension
B. Use in patients with eGFR <30 mL/min/1.73m²
RATIONALE: Metformin is contraindicated in patients with an eGFR
<30 mL/min/1.73m² due to the risk of lactic acidosis. It should be used
with caution and at reduced doses in patients with stage 3 CKD (eGFR
30-59).
6. A patient is prescribed warfarin for atrial fibrillation. Which of
the following genetic factors should the APRN consider when
initiating therapy?
A. CYP2D6 polymorphisms affecting drug metabolism
B. VKORC1 and CYP2C9 polymorphisms affecting warfarin sensitivity
C. HLA-B*5701 genotype affecting hypersensitivity reactions
D. TPMT polymorphisms affecting drug toxicity
B. VKORC1 and CYP2C9 polymorphisms affecting warfarin
sensitivity
RATIONALE: Warfarin dosing is influenced by genetic
polymorphisms in VKORC1 (affecting the target enzyme) and CYP2C9
(affecting metabolism). Patients with certain variants require lower
doses and are at increased risk of bleeding.
7. A patient with asthma is prescribed a long-acting beta-agonist
(LABA) in combination with an inhaled corticosteroid. Which of the
following is the MOST important teaching point regarding this
combination?
A. LABA should be used as a rescue medication
B. LABA should not be used as monotherapy in asthma
C. Inhaled corticosteroids are not effective in asthma
D. The combination increases the risk of pneumonia
B. LABA should not be used as monotherapy in asthma
PHARMACOLOGY FOR ADVANCED
PRACTICE NURSES – UNIVERSITY OF
SOUTH ALABAMA QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF
Core Domains:
1. Pharmacokinetics and Pharmacodynamics
2. Autonomic Nervous System Pharmacology
3. Central Nervous System Pharmacology
4. Cardiovascular Pharmacology
5. Renal and Endocrine Pharmacology
6. Antimicrobial and Antiviral Therapy
7. Pharmacogenomics and Individualized Therapy
8. Polypharmacy, Drug Interactions, and Adverse Effects
9. Prescriptive Authority and Legal/Ethical Considerations
10. Clinical Application in Primary Care and Acute Care Settings
Introduction
This comprehensive examination is designed to evaluate the advanced
practice nursing student's knowledge of pharmacology principles essential
for safe and effective prescribing. It assesses understanding of
pharmacokinetics, pharmacodynamics, autonomic and central nervous
system agents, cardiovascular drugs, antimicrobials, and endocrine
therapies. The exam utilizes a multiple-choice format with clinical
scenario-based questions that reflect real-world primary and acute care
prescribing decisions. Emphasis is placed on medication selection, dosing
considerations, adverse effect monitoring, drug-drug interactions, and the
application of pharmacogenomic principles to optimize patient outcomes.
,This assessment aligns with APRN core competencies and state
prescriptive authority requirements.
SECTION ONE: QUESTIONS 1 - 100
1. A 72-year-old patient with heart failure is prescribed digoxin.
Which of the following age-related changes in pharmacokinetics
places this patient at increased risk for digoxin toxicity?
A. Increased hepatic metabolism
B. Decreased glomerular filtration rate
C. Increased volume of distribution
D. Decreased protein binding
B. Decreased glomerular filtration rate
RATIONALE: Digoxin is primarily renally excreted. Age-related
decline in glomerular filtration rate (GFR) reduces drug clearance,
increasing the risk of toxicity. Dosing must be adjusted based on renal
function in older adults.
2. A patient is prescribed a medication that is a weak acid with a
pKa of 4.4. In which of the following body compartments would this
drug be MOST extensively ionized?
A. Stomach (pH 1.5)
B. Urine (pH 6.0)
C. Blood (pH 7.4)
D. Small intestine (pH 8.0)
D. Small intestine (pH 8.0)
RATIONALE: Weak acids are more ionized in alkaline environments
(pH above pKa). At pH 8.0, the drug would be highly ionized and
therefore less able to cross lipid membranes. Ionization reduces passive
reabsorption and enhances elimination.
,3. A patient with hypertension is prescribed lisinopril. Which of the
following adverse effects is most common with this class of
medication and should be discussed with the patient?
A. Hyperkalemia
B. Angioedema
C. Dry cough
D. Hypotension
C. Dry cough
RATIONALE: A dry, nonproductive cough is the most common
adverse effect of ACE inhibitors (including lisinopril), occurring in up to
20% of patients. It is thought to be related to increased bradykinin levels
and often resolves upon discontinuation.
4. Which of the following medications is classified as a non-
dihydropyridine calcium channel blocker?
A. Amlodipine
B. Nifedipine
C. Verapamil
D. Felodipine
C. Verapamil
RATIONALE: Verapamil and diltiazem are non-dihydropyridine
calcium channel blockers that have greater cardiac effects (negative
inotropy and chronotropy) compared to dihydropyridines (amlodipine,
nifedipine, felodipine), which are more selective for vascular smooth
muscle.
5. A 55-year-old male patient with type 2 diabetes and chronic
kidney disease (stage 3) is prescribed metformin. Which of the
following is a significant contraindication or precaution for this
medication?
A. Use in patients with heart failure
B. Use in patients with eGFR <30 mL/min/1.73m²
, C. Use in patients with obesity
D. Use in patients with hypertension
B. Use in patients with eGFR <30 mL/min/1.73m²
RATIONALE: Metformin is contraindicated in patients with an eGFR
<30 mL/min/1.73m² due to the risk of lactic acidosis. It should be used
with caution and at reduced doses in patients with stage 3 CKD (eGFR
30-59).
6. A patient is prescribed warfarin for atrial fibrillation. Which of
the following genetic factors should the APRN consider when
initiating therapy?
A. CYP2D6 polymorphisms affecting drug metabolism
B. VKORC1 and CYP2C9 polymorphisms affecting warfarin sensitivity
C. HLA-B*5701 genotype affecting hypersensitivity reactions
D. TPMT polymorphisms affecting drug toxicity
B. VKORC1 and CYP2C9 polymorphisms affecting warfarin
sensitivity
RATIONALE: Warfarin dosing is influenced by genetic
polymorphisms in VKORC1 (affecting the target enzyme) and CYP2C9
(affecting metabolism). Patients with certain variants require lower
doses and are at increased risk of bleeding.
7. A patient with asthma is prescribed a long-acting beta-agonist
(LABA) in combination with an inhaled corticosteroid. Which of the
following is the MOST important teaching point regarding this
combination?
A. LABA should be used as a rescue medication
B. LABA should not be used as monotherapy in asthma
C. Inhaled corticosteroids are not effective in asthma
D. The combination increases the risk of pneumonia
B. LABA should not be used as monotherapy in asthma
