NR565 ADVANCED PHARMACOLOGY
FUNDAMENTALS 250-Question Practice Exam |
Answers & Rationales 2026/2027
1. A patient with hypertension is prescribed lisinopril. Which adverse effect is most characteristic
of ACE inhibitors?
A) Hyperkalemia and dry cough
B) Hyperkalemia and dry cough
C) Bradycardia
D) Weight gain
Answer A: Hyperkalemia and dry cough
Rationale: ACE inhibitors cause cough (bradykinin) and hyperkalemia (reduced aldosterone).
Angioedema is also possible.
2. A patient is started on metformin for type 2 diabetes. Which serious adverse effect requires
immediate discontinuation?
A) Nausea and diarrhea
B) Weight gain
C) Lactic acidosis (muscle pain, weakness, hyperventilation)
D) Hypoglycemia
Answer C: Lactic acidosis (muscle pain, weakness, hyperventilation)
Rationale: Metformin can cause lactic acidosis, especially in renal impairment or hypoxic states.
3. A patient with heart failure is prescribed digoxin. Which electrolyte abnormality increases the
risk of digoxin toxicity?
A) Hyperkalemia
B) Hypokalemia
,C) Hypercalcemia
D) Hypermagnesemia
Answer B: Hypokalemia
Rationale: Hypokalemia increases digoxin binding to Na/K-ATPase, increasing toxicity.
4. A patient with bipolar disorder is prescribed lithium. Which baseline tests are essential before
starting therapy?
A) Liver function tests
B) Thyroid function, renal function, and pregnancy test
C) Complete blood count
D) Cardiac enzymes
Answer B: Thyroid function, renal function, and pregnancy test
Rationale: Lithium affects thyroid and kidneys; it is teratogenic (Ebstein's anomaly).
5. A patient is prescribed warfarin. Which drug interaction would potentiate the anticoagulant
effect?
A) Rifampin
B) Vitamin K
C) Amiodarone
D) Oral contraceptives
Answer C: Amiodarone
Rationale: Amiodarone inhibits CYP2C9, increasing INR and bleeding risk. Rifampin decreases warfarin
effect.
6. A patient with asthma is prescribed albuterol. Which receptor mediates its bronchodilator
effect?
A) Beta-1 adrenergic
B) Beta-2 adrenergic
,C) Muscarinic M3
D) Alpha-1 adrenergic
Answer B: Beta-2 adrenergic
Rationale: Albuterol is a selective beta-2 agonist, relaxing bronchial smooth muscle.
7. A patient with glaucoma is prescribed timolol eye drops. Which systemic effect should be
monitored?
A) Tachycardia
B) Bradycardia and bronchospasm
C) Hyperglycemia
D) Diarrhea
Answer B: Bradycardia and bronchospasm
Rationale: Timolol (non-selective beta-blocker) can cause bradycardia and exacerbate asthma/COPD.
8. A patient with a urinary tract infection is prescribed nitrofurantoin. Which condition is a
contraindication?
A) Pregnancy
B) Renal impairment (CrCl <60 mL/min)
C) G6PD deficiency
D) Liver disease
Answer B: Renal impairment (CrCl <60 mL/min)
Rationale: Nitrofurantoin requires adequate renal excretion to reach therapeutic levels; ineffective and
accumulates in renal failure.
9. A patient with schizophrenia is prescribed clozapine. Which laboratory monitoring is required
weekly for the first 6 months?
A) Liver function tests
B) Absolute neutrophil count (ANC)
, C) Thyroid function tests
D) Blood glucose
Answer B: Absolute neutrophil count (ANC)
Rationale: Clozapine causes agranulocytosis; ANC must be monitored regularly (REMS program).
10. A patient with opioid use disorder is prescribed buprenorphine/naloxone (Suboxone). Why is
naloxone included?
A) To enhance buprenorphine absorption
B) To deter intravenous misuse (precipitated withdrawal)
C) To reverse opioid overdose
D) To increase the half-life
Answer B: To deter intravenous misuse (precipitated withdrawal)
Rationale: Naloxone is poorly absorbed sublingually but causes withdrawal if injected.
11. A patient with heart failure is prescribed spironolactone. Which electrolyte imbalance is most
concerning?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypocalcemia
Answer B: Hyperkalemia
Rationale: Spironolactone is potassium-sparing; hyperkalemia risk increases with renal impairment.
12. A patient with status epilepticus receives IV lorazepam. Which is the mechanism of
benzodiazepines?
A) Block voltage-gated sodium channels
B) Enhance GABA-A receptor chloride channel opening
C) Inhibit T-type calcium channels
FUNDAMENTALS 250-Question Practice Exam |
Answers & Rationales 2026/2027
1. A patient with hypertension is prescribed lisinopril. Which adverse effect is most characteristic
of ACE inhibitors?
A) Hyperkalemia and dry cough
B) Hyperkalemia and dry cough
C) Bradycardia
D) Weight gain
Answer A: Hyperkalemia and dry cough
Rationale: ACE inhibitors cause cough (bradykinin) and hyperkalemia (reduced aldosterone).
Angioedema is also possible.
2. A patient is started on metformin for type 2 diabetes. Which serious adverse effect requires
immediate discontinuation?
A) Nausea and diarrhea
B) Weight gain
C) Lactic acidosis (muscle pain, weakness, hyperventilation)
D) Hypoglycemia
Answer C: Lactic acidosis (muscle pain, weakness, hyperventilation)
Rationale: Metformin can cause lactic acidosis, especially in renal impairment or hypoxic states.
3. A patient with heart failure is prescribed digoxin. Which electrolyte abnormality increases the
risk of digoxin toxicity?
A) Hyperkalemia
B) Hypokalemia
,C) Hypercalcemia
D) Hypermagnesemia
Answer B: Hypokalemia
Rationale: Hypokalemia increases digoxin binding to Na/K-ATPase, increasing toxicity.
4. A patient with bipolar disorder is prescribed lithium. Which baseline tests are essential before
starting therapy?
A) Liver function tests
B) Thyroid function, renal function, and pregnancy test
C) Complete blood count
D) Cardiac enzymes
Answer B: Thyroid function, renal function, and pregnancy test
Rationale: Lithium affects thyroid and kidneys; it is teratogenic (Ebstein's anomaly).
5. A patient is prescribed warfarin. Which drug interaction would potentiate the anticoagulant
effect?
A) Rifampin
B) Vitamin K
C) Amiodarone
D) Oral contraceptives
Answer C: Amiodarone
Rationale: Amiodarone inhibits CYP2C9, increasing INR and bleeding risk. Rifampin decreases warfarin
effect.
6. A patient with asthma is prescribed albuterol. Which receptor mediates its bronchodilator
effect?
A) Beta-1 adrenergic
B) Beta-2 adrenergic
,C) Muscarinic M3
D) Alpha-1 adrenergic
Answer B: Beta-2 adrenergic
Rationale: Albuterol is a selective beta-2 agonist, relaxing bronchial smooth muscle.
7. A patient with glaucoma is prescribed timolol eye drops. Which systemic effect should be
monitored?
A) Tachycardia
B) Bradycardia and bronchospasm
C) Hyperglycemia
D) Diarrhea
Answer B: Bradycardia and bronchospasm
Rationale: Timolol (non-selective beta-blocker) can cause bradycardia and exacerbate asthma/COPD.
8. A patient with a urinary tract infection is prescribed nitrofurantoin. Which condition is a
contraindication?
A) Pregnancy
B) Renal impairment (CrCl <60 mL/min)
C) G6PD deficiency
D) Liver disease
Answer B: Renal impairment (CrCl <60 mL/min)
Rationale: Nitrofurantoin requires adequate renal excretion to reach therapeutic levels; ineffective and
accumulates in renal failure.
9. A patient with schizophrenia is prescribed clozapine. Which laboratory monitoring is required
weekly for the first 6 months?
A) Liver function tests
B) Absolute neutrophil count (ANC)
, C) Thyroid function tests
D) Blood glucose
Answer B: Absolute neutrophil count (ANC)
Rationale: Clozapine causes agranulocytosis; ANC must be monitored regularly (REMS program).
10. A patient with opioid use disorder is prescribed buprenorphine/naloxone (Suboxone). Why is
naloxone included?
A) To enhance buprenorphine absorption
B) To deter intravenous misuse (precipitated withdrawal)
C) To reverse opioid overdose
D) To increase the half-life
Answer B: To deter intravenous misuse (precipitated withdrawal)
Rationale: Naloxone is poorly absorbed sublingually but causes withdrawal if injected.
11. A patient with heart failure is prescribed spironolactone. Which electrolyte imbalance is most
concerning?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypocalcemia
Answer B: Hyperkalemia
Rationale: Spironolactone is potassium-sparing; hyperkalemia risk increases with renal impairment.
12. A patient with status epilepticus receives IV lorazepam. Which is the mechanism of
benzodiazepines?
A) Block voltage-gated sodium channels
B) Enhance GABA-A receptor chloride channel opening
C) Inhibit T-type calcium channels
