Page 1 of 101
NR 565 Midterm Exam – Advanced Pharmacology
Fundamentals QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
NR 565 Midterm Exam – Advanced Pharmacology Fundamentals
SUMMARIZED EXAM TOPIC COVERAGE (Point Form)
• Pharmacodynamics – What the drug does to the body: receptor interactions, enzyme
inhibition/catalysis, nonselective interactions (chemotherapy); mechanisms of drug action
• Pharmacokinetics – What the body does to the drug: absorption, distribution, metabolism,
excretion; factors affecting drug movement (ADME)
• Drug Interactions – Drug-drug, food-drug, additive, synergistic, antagonistic, incompatibility;
grapefruit juice effects; vitamin K antagonism with warfarin
• Adverse Reactions – Pharmacologic (extension of effects), allergic/hypersensitivity (immune-
mediated), idiosyncratic (patient-specific), drug interactions; teratogenic, mutagenic,
carcinogenic effects
• Special Populations – Pregnancy (increased GFR, teratogens, asthma risk vs medication);
neonates (immature organs); older adults (polypharmacy, declining renal/hepatic function, body
fat changes); children over 1 year (increased hepatic metabolism)
• Prescribing Considerations – State-specific prescriptive authority; PDMP use; black box
warnings; Beers Criteria; narrow therapeutic index drugs; methadone QT monitoring
• Major Drug Classes – Cardiovascular (digoxin, diuretics, antihypertensives); CNS (opioids,
antidepressants, anticonvulsants); antimicrobials; endocrine (insulin, thyroid); respiratory
• Medication Safety – 8 Rights of Medication Administration; patient-specific treatment goals;
drug scheduling and controlled substances
1. A patient on digoxin and furosemide develops nausea, vomiting, and confusion. Which electrolyte
imbalance is most likely contributing to this presentation?
A) Hypercalcemia
B) Hypokalemia
, Page 2 of 101
C) Hypermagnesemia
D) Hypernatremia
Answer: B – Hypokalemia increases digoxin binding to Na⁺/K⁺-ATPase, enhancing toxicity. Furosemide
causes potassium loss, making this a classic precipitant of digoxin toxicity.
2. An APRN is considering prescribing methadone for chronic pain. Which specific monitoring parameter
should be obtained at baseline, at 30 days, and annually?
A) Serum creatinine
B) Liver function tests
C) ECG to monitor QT interval
D) Complete blood count
Answer: C – Methadone can significantly prolong the QT interval, increasing torsades de pointes risk;
ECG monitoring is specifically recommended.
3. A pregnant patient in her first trimester asks about a medication with known teratogenic risk. What
teaching is most accurate?
A) The embryo is least sensitive to teratogens during weeks 3–8
B) Teratogen exposure during weeks 3–8 can cause major structural malformations
C) Teratogenic drugs only affect fetal growth in the third trimester
D) Teratogenesis is primarily a concern during labor and delivery
, Page 3 of 101
Answer: B – Weeks 3–8 are the period of organogenesis; teratogen exposure during this window can
cause major structural birth defects.
4. A 72-year-old patient is starting antihypertensive therapy. Which strategy best reduces the risk of
orthostatic hypotension?
A) Initiate with standard adult doses
B) Start with half the usual adult dose and titrate slowly
C) Use only short-acting agents
D) Avoid monitoring blood pressure to reduce anxiety
Answer: B – Older adults have blunted baroreceptor responses; starting with lower doses and slow
titration minimizes orthostatic hypotension risk.
5. An APRN is deciding whether to prescribe a medication with a narrow therapeutic index. What is the
most appropriate approach?
A) Use standard dosing without monitoring
B) Avoid documenting potential risks to reduce patient anxiety
C) Monitor drug levels and clinical response closely
D) Use over-the-counter alternatives concurrently
Answer: C – Narrow therapeutic index drugs require close monitoring of serum levels and clinical
response to prevent toxicity or subtherapeutic effects.
, Page 4 of 101
6. Which physiologic change during pregnancy is most likely to require increased dosing of drugs
eliminated by the kidneys?
A) Decreased renal blood flow
B) Increased renal blood flow and glomerular filtration
C) Increased plasma albumin
D) Decreased hepatic metabolism
Answer: B – Pregnancy enhances renal perfusion and GFR, accelerating excretion of renally cleared
medications and often necessitating upward dose adjustment.
7. A patient on long-term phenytoin therapy develops nystagmus, ataxia, and confusion. Which
pharmacokinetic parameter best explains these symptoms?
A) Increased protein binding leading to higher free drug concentration
B) Saturable metabolism at therapeutic doses causing nonlinear kinetics
C) Enhanced hepatic clearance due to enzyme induction
D) Decreased volume of distribution
Answer: B – Phenytoin exhibits saturable (Michaelis-Menten) metabolism; at therapeutic doses, small
dose increases can cause disproportionate rises in serum levels, leading to toxicity.
8. A patient is prescribed buprenorphine/naloxone (Suboxone) for opioid use disorder. What is the
rationale for including naloxone?
NR 565 Midterm Exam – Advanced Pharmacology
Fundamentals QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
NR 565 Midterm Exam – Advanced Pharmacology Fundamentals
SUMMARIZED EXAM TOPIC COVERAGE (Point Form)
• Pharmacodynamics – What the drug does to the body: receptor interactions, enzyme
inhibition/catalysis, nonselective interactions (chemotherapy); mechanisms of drug action
• Pharmacokinetics – What the body does to the drug: absorption, distribution, metabolism,
excretion; factors affecting drug movement (ADME)
• Drug Interactions – Drug-drug, food-drug, additive, synergistic, antagonistic, incompatibility;
grapefruit juice effects; vitamin K antagonism with warfarin
• Adverse Reactions – Pharmacologic (extension of effects), allergic/hypersensitivity (immune-
mediated), idiosyncratic (patient-specific), drug interactions; teratogenic, mutagenic,
carcinogenic effects
• Special Populations – Pregnancy (increased GFR, teratogens, asthma risk vs medication);
neonates (immature organs); older adults (polypharmacy, declining renal/hepatic function, body
fat changes); children over 1 year (increased hepatic metabolism)
• Prescribing Considerations – State-specific prescriptive authority; PDMP use; black box
warnings; Beers Criteria; narrow therapeutic index drugs; methadone QT monitoring
• Major Drug Classes – Cardiovascular (digoxin, diuretics, antihypertensives); CNS (opioids,
antidepressants, anticonvulsants); antimicrobials; endocrine (insulin, thyroid); respiratory
• Medication Safety – 8 Rights of Medication Administration; patient-specific treatment goals;
drug scheduling and controlled substances
1. A patient on digoxin and furosemide develops nausea, vomiting, and confusion. Which electrolyte
imbalance is most likely contributing to this presentation?
A) Hypercalcemia
B) Hypokalemia
, Page 2 of 101
C) Hypermagnesemia
D) Hypernatremia
Answer: B – Hypokalemia increases digoxin binding to Na⁺/K⁺-ATPase, enhancing toxicity. Furosemide
causes potassium loss, making this a classic precipitant of digoxin toxicity.
2. An APRN is considering prescribing methadone for chronic pain. Which specific monitoring parameter
should be obtained at baseline, at 30 days, and annually?
A) Serum creatinine
B) Liver function tests
C) ECG to monitor QT interval
D) Complete blood count
Answer: C – Methadone can significantly prolong the QT interval, increasing torsades de pointes risk;
ECG monitoring is specifically recommended.
3. A pregnant patient in her first trimester asks about a medication with known teratogenic risk. What
teaching is most accurate?
A) The embryo is least sensitive to teratogens during weeks 3–8
B) Teratogen exposure during weeks 3–8 can cause major structural malformations
C) Teratogenic drugs only affect fetal growth in the third trimester
D) Teratogenesis is primarily a concern during labor and delivery
, Page 3 of 101
Answer: B – Weeks 3–8 are the period of organogenesis; teratogen exposure during this window can
cause major structural birth defects.
4. A 72-year-old patient is starting antihypertensive therapy. Which strategy best reduces the risk of
orthostatic hypotension?
A) Initiate with standard adult doses
B) Start with half the usual adult dose and titrate slowly
C) Use only short-acting agents
D) Avoid monitoring blood pressure to reduce anxiety
Answer: B – Older adults have blunted baroreceptor responses; starting with lower doses and slow
titration minimizes orthostatic hypotension risk.
5. An APRN is deciding whether to prescribe a medication with a narrow therapeutic index. What is the
most appropriate approach?
A) Use standard dosing without monitoring
B) Avoid documenting potential risks to reduce patient anxiety
C) Monitor drug levels and clinical response closely
D) Use over-the-counter alternatives concurrently
Answer: C – Narrow therapeutic index drugs require close monitoring of serum levels and clinical
response to prevent toxicity or subtherapeutic effects.
, Page 4 of 101
6. Which physiologic change during pregnancy is most likely to require increased dosing of drugs
eliminated by the kidneys?
A) Decreased renal blood flow
B) Increased renal blood flow and glomerular filtration
C) Increased plasma albumin
D) Decreased hepatic metabolism
Answer: B – Pregnancy enhances renal perfusion and GFR, accelerating excretion of renally cleared
medications and often necessitating upward dose adjustment.
7. A patient on long-term phenytoin therapy develops nystagmus, ataxia, and confusion. Which
pharmacokinetic parameter best explains these symptoms?
A) Increased protein binding leading to higher free drug concentration
B) Saturable metabolism at therapeutic doses causing nonlinear kinetics
C) Enhanced hepatic clearance due to enzyme induction
D) Decreased volume of distribution
Answer: B – Phenytoin exhibits saturable (Michaelis-Menten) metabolism; at therapeutic doses, small
dose increases can cause disproportionate rises in serum levels, leading to toxicity.
8. A patient is prescribed buprenorphine/naloxone (Suboxone) for opioid use disorder. What is the
rationale for including naloxone?
