NR 508 ADVANCED PHARMACOLOGY
MIDTERM AND FINAL EXAM BANK
2026/2027
1. Which phase of pharmacokinetics is most significantly impacted by a patient’s genetic
polymorphism of the CYP2D6 enzyme?
A. Absorption
B. Distribution
C. Excretion
D. Metabolism
Answer: D
Conceptual Explanation: Metabolism is the primary phase affected by cytochrome P450
enzymes. Polymorphisms in CYP2D6 can lead to ultra-rapid, extensive, intermediate, or
poor metabolism of drugs like codeine and SSRIs.
2. When prescribing an ACE inhibitor, the nurse practitioner must monitor for which life-
threatening adverse effect associated with increased bradykinin levels?
A. Hypokalemia
B. Nephrotoxicity
,C. Angioedema
D. Tachycardia
Answer: C
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin, which can
lead to angioedema, a medical emergency characterized by swelling of the face, lips, and
airway.
3. A patient with a history of heart failure is prescribed Digoxin. Which electrolyte imbalance
increases the risk of Digoxin toxicity?
A. Hypokalemia
B. Hyperkalemia
C. Hypomagnesemia
D. Hypercalcemia
Answer: A
Conceptual Explanation: Hypokalemia increases the risk of digoxin toxicity because
potassium and digoxin compete for binding sites on the Na+/K+ ATPase pump.
4. Which of the following is a primary contraindication for the use of Metformin in a patient
with Type 2 Diabetes?
A. Body Mass Index (BMI) greater than 30
B. Glomerular Filtration Rate (GFR) less than 30 mL/min
, C. History of hypertension
D. Age over 65
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with severe renal
impairment (GFR < 30 mL/min) due to the increased risk of lactic acidosis.
5. According to the DEA, which schedule of controlled substances has the highest potential
for abuse while still having a currently accepted medical use?
A. Schedule II
B. Schedule I
C. Schedule III
D. Schedule IV
Answer: A
Conceptual Explanation: Schedule II drugs have a high potential for abuse and
physical/psychological dependence but are accepted for medical use, unlike Schedule I
drugs.
6. When initiating statin therapy, which laboratory value is most important to assess at
baseline and if the patient reports muscle pain?
A. Serum creatinine
B. Creatine Kinase (CK)
MIDTERM AND FINAL EXAM BANK
2026/2027
1. Which phase of pharmacokinetics is most significantly impacted by a patient’s genetic
polymorphism of the CYP2D6 enzyme?
A. Absorption
B. Distribution
C. Excretion
D. Metabolism
Answer: D
Conceptual Explanation: Metabolism is the primary phase affected by cytochrome P450
enzymes. Polymorphisms in CYP2D6 can lead to ultra-rapid, extensive, intermediate, or
poor metabolism of drugs like codeine and SSRIs.
2. When prescribing an ACE inhibitor, the nurse practitioner must monitor for which life-
threatening adverse effect associated with increased bradykinin levels?
A. Hypokalemia
B. Nephrotoxicity
,C. Angioedema
D. Tachycardia
Answer: C
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin, which can
lead to angioedema, a medical emergency characterized by swelling of the face, lips, and
airway.
3. A patient with a history of heart failure is prescribed Digoxin. Which electrolyte imbalance
increases the risk of Digoxin toxicity?
A. Hypokalemia
B. Hyperkalemia
C. Hypomagnesemia
D. Hypercalcemia
Answer: A
Conceptual Explanation: Hypokalemia increases the risk of digoxin toxicity because
potassium and digoxin compete for binding sites on the Na+/K+ ATPase pump.
4. Which of the following is a primary contraindication for the use of Metformin in a patient
with Type 2 Diabetes?
A. Body Mass Index (BMI) greater than 30
B. Glomerular Filtration Rate (GFR) less than 30 mL/min
, C. History of hypertension
D. Age over 65
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with severe renal
impairment (GFR < 30 mL/min) due to the increased risk of lactic acidosis.
5. According to the DEA, which schedule of controlled substances has the highest potential
for abuse while still having a currently accepted medical use?
A. Schedule II
B. Schedule I
C. Schedule III
D. Schedule IV
Answer: A
Conceptual Explanation: Schedule II drugs have a high potential for abuse and
physical/psychological dependence but are accepted for medical use, unlike Schedule I
drugs.
6. When initiating statin therapy, which laboratory value is most important to assess at
baseline and if the patient reports muscle pain?
A. Serum creatinine
B. Creatine Kinase (CK)
