pg. 1
,Wilkes NSG 533 Exam 1 — Advanced Pharmacology (2026/2027)
Course: NSG 533 Advanced Pharmacology, Wilkes University
Content basis: Pharmacodynamics, pharmacokinetics, pharmacotherapeutics, autonomic
pharmacology, cardiovascular agents, endocrine pharmacology, anti-infectives, GI pharmacology,
CNS agents, and clinical prescribing/medication safety
Q1. A drug achieves its therapeutic effect by binding to a receptor and producing a maximal
response greater than that of another drug occupying the same receptor. This property is best
described as:
A. Potency
B. Efficacy
C. Affinity
D. Bioavailability
Correct Answer: B. Efficacy
Rationale: Efficacy refers to the maximal response a drug can produce once bound to its receptor.
Potency refers to the dose required to produce a given effect (often measured by EC50). Affinity
describes binding strength, and bioavailability describes the fraction of administered drug reaching
systemic circulation. The question describes the magnitude of maximal response, which is efficacy.
Q2. A 72-year-old patient is started on diazepam for muscle spasm. The prescriber notes that the
half-life of diazepam is significantly prolonged in older adults. Which age-related pharmacokinetic
change best explains this finding?
A. Decreased gastric pH
B. Increased hepatic blood flow
C. Increased body fat percentage
D. Increased renal clearance
Correct Answer: C. Increased body fat percentage
Rationale: Aging is associated with an increased proportion of body fat and decreased lean body
mass. Lipophilic drugs such as diazepam distribute extensively into adipose tissue, increasing volume
of distribution and prolonging half-life. Hepatic blood flow and renal clearance generally decline with
age, not increase, and decreased gastric pH does not explain prolonged half-life of a lipophilic drug.
Q3. A patient taking an ACE inhibitor develops a persistent dry cough several weeks after initiation.
Which mechanism best explains this adverse effect?
A. Accumulation of bradykinin
B. Increased aldosterone secretion
C. Direct beta-2 receptor stimulation
D. Excess sodium retention
Correct Answer: A. Accumulation of bradykinin
pg. 2
,Rationale: ACE is responsible for degrading bradykinin in addition to converting angiotensin I to
angiotensin II. Inhibition of ACE leads to bradykinin accumulation in the respiratory tract, producing
the characteristic dry cough. Aldosterone secretion decreases (not increases) with ACE inhibition,
and sodium retention would not produce cough.
Q4. A patient with heart failure taking spironolactone asks which dietary change requires the
greatest caution. The nurse practitioner should advise the patient to avoid:
A. Excessive potassium intake
B. Foods containing tyramine
C. Grapefruit juice
D. High-fiber foods
Correct Answer: A. Excessive potassium intake
Rationale: Spironolactone is a potassium-sparing diuretic that blocks aldosterone receptors in the
distal tubule. Concurrent excessive potassium intake (including salt substitutes) increases the risk of
clinically significant hyperkalemia, particularly in patients with renal impairment or those taking ACE
inhibitors/ARBs.
Q5. A patient taking furosemide reports generalized weakness and palpitations. Which electrolyte
disturbance should be suspected first?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Correct Answer: B. Hypokalemia
Rationale: Loop diuretics such as furosemide inhibit sodium-potassium-chloride reabsorption in the
thick ascending limb, increasing urinary potassium excretion. Hypokalemia can produce weakness,
fatigue, and cardiac dysrhythmias. Furosemide does not typically cause hyperkalemia.
Q6. A patient with asthma is prescribed propranolol for migraine prophylaxis. Which pharmacologic
concern is most important?
A. Propranolol directly stimulates bronchial smooth muscle
B. Propranolol can cause significant bronchoconstriction
C. Propranolol increases pulmonary surfactant production
D. Propranolol suppresses respiratory drive centrally
Correct Answer: B. Propranolol can cause significant bronchoconstriction
Rationale: Propranolol is a nonselective beta-adrenergic antagonist that blocks both beta-1 and
beta-2 receptors. Blockade of pulmonary beta-2 receptors prevents bronchodilation and can
precipitate bronchospasm, making it relatively contraindicated in asthma. It does not directly
stimulate bronchial muscle or suppress central respiratory drive.
pg. 3
, Q7. A patient with type 2 diabetes has an A1C of 7.8% on metformin monotherapy at maximally
tolerated dose. Which action is most consistent with evidence-based guidelines?
A. Add a second glucose-lowering agent with a complementary mechanism
B. Discontinue metformin and begin basal insulin
C. Increase metformin beyond the maximum tolerated dose
D. Add a sulfonylurea while discontinuing metformin
Correct Answer: A. Add a second glucose-lowering agent with a complementary mechanism
Rationale: When A1C remains above goal on metformin monotherapy at maximally tolerated doses,
guidelines recommend adding an agent from another class rather than discontinuing metformin.
Metformin should generally be continued because of its efficacy, safety profile, and cardiovascular
benefits. Increasing beyond the maximum tolerated dose is inappropriate, and switching to insulin is
premature without evidence of severe hyperglycemia or catabolism.
Q8. A patient with hypothyroidism is started on levothyroxine. Which monitoring parameter best
reflects adequate replacement over time?
A. Serum free T4 level only
B. Serum TSH level
C. Serum T3 level
D. Thyroid peroxidase antibodies
Correct Answer: B. Serum TSH level
Rationale: TSH is the most sensitive marker of thyroid hormone adequacy in primary hypothyroidism
because it reflects pituitary feedback from circulating thyroid hormone. TSH should be checked
approximately 6–8 weeks after initiation or dose changes to allow steady state. Free T4 alone does
not capture tissue-level adequacy, and T3 is not routinely used for monitoring replacement.
Q9. A patient is prescribed warfarin and subsequently receives a course of sulfamethoxazole-
trimethoprim. Which interaction mechanism is most clinically significant?
A. Displacement of warfarin from plasma protein binding sites and inhibition of its metabolism
B. Increased renal clearance of warfarin
C. Induction of warfarin metabolism
D. Decreased warfarin absorption
Correct Answer: A. Displacement of warfarin from plasma protein binding sites and inhibition of its
metabolism
Rationale: Sulfamethoxazole-trimethoprim can potentiate warfarin through two mechanisms:
displacement from albumin binding sites (increasing free warfarin) and inhibition of CYP2C9-
mediated metabolism. Both effects increase INR and bleeding risk. It does not increase renal
clearance or induce metabolism.
pg. 4
,Wilkes NSG 533 Exam 1 — Advanced Pharmacology (2026/2027)
Course: NSG 533 Advanced Pharmacology, Wilkes University
Content basis: Pharmacodynamics, pharmacokinetics, pharmacotherapeutics, autonomic
pharmacology, cardiovascular agents, endocrine pharmacology, anti-infectives, GI pharmacology,
CNS agents, and clinical prescribing/medication safety
Q1. A drug achieves its therapeutic effect by binding to a receptor and producing a maximal
response greater than that of another drug occupying the same receptor. This property is best
described as:
A. Potency
B. Efficacy
C. Affinity
D. Bioavailability
Correct Answer: B. Efficacy
Rationale: Efficacy refers to the maximal response a drug can produce once bound to its receptor.
Potency refers to the dose required to produce a given effect (often measured by EC50). Affinity
describes binding strength, and bioavailability describes the fraction of administered drug reaching
systemic circulation. The question describes the magnitude of maximal response, which is efficacy.
Q2. A 72-year-old patient is started on diazepam for muscle spasm. The prescriber notes that the
half-life of diazepam is significantly prolonged in older adults. Which age-related pharmacokinetic
change best explains this finding?
A. Decreased gastric pH
B. Increased hepatic blood flow
C. Increased body fat percentage
D. Increased renal clearance
Correct Answer: C. Increased body fat percentage
Rationale: Aging is associated with an increased proportion of body fat and decreased lean body
mass. Lipophilic drugs such as diazepam distribute extensively into adipose tissue, increasing volume
of distribution and prolonging half-life. Hepatic blood flow and renal clearance generally decline with
age, not increase, and decreased gastric pH does not explain prolonged half-life of a lipophilic drug.
Q3. A patient taking an ACE inhibitor develops a persistent dry cough several weeks after initiation.
Which mechanism best explains this adverse effect?
A. Accumulation of bradykinin
B. Increased aldosterone secretion
C. Direct beta-2 receptor stimulation
D. Excess sodium retention
Correct Answer: A. Accumulation of bradykinin
pg. 2
,Rationale: ACE is responsible for degrading bradykinin in addition to converting angiotensin I to
angiotensin II. Inhibition of ACE leads to bradykinin accumulation in the respiratory tract, producing
the characteristic dry cough. Aldosterone secretion decreases (not increases) with ACE inhibition,
and sodium retention would not produce cough.
Q4. A patient with heart failure taking spironolactone asks which dietary change requires the
greatest caution. The nurse practitioner should advise the patient to avoid:
A. Excessive potassium intake
B. Foods containing tyramine
C. Grapefruit juice
D. High-fiber foods
Correct Answer: A. Excessive potassium intake
Rationale: Spironolactone is a potassium-sparing diuretic that blocks aldosterone receptors in the
distal tubule. Concurrent excessive potassium intake (including salt substitutes) increases the risk of
clinically significant hyperkalemia, particularly in patients with renal impairment or those taking ACE
inhibitors/ARBs.
Q5. A patient taking furosemide reports generalized weakness and palpitations. Which electrolyte
disturbance should be suspected first?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Correct Answer: B. Hypokalemia
Rationale: Loop diuretics such as furosemide inhibit sodium-potassium-chloride reabsorption in the
thick ascending limb, increasing urinary potassium excretion. Hypokalemia can produce weakness,
fatigue, and cardiac dysrhythmias. Furosemide does not typically cause hyperkalemia.
Q6. A patient with asthma is prescribed propranolol for migraine prophylaxis. Which pharmacologic
concern is most important?
A. Propranolol directly stimulates bronchial smooth muscle
B. Propranolol can cause significant bronchoconstriction
C. Propranolol increases pulmonary surfactant production
D. Propranolol suppresses respiratory drive centrally
Correct Answer: B. Propranolol can cause significant bronchoconstriction
Rationale: Propranolol is a nonselective beta-adrenergic antagonist that blocks both beta-1 and
beta-2 receptors. Blockade of pulmonary beta-2 receptors prevents bronchodilation and can
precipitate bronchospasm, making it relatively contraindicated in asthma. It does not directly
stimulate bronchial muscle or suppress central respiratory drive.
pg. 3
, Q7. A patient with type 2 diabetes has an A1C of 7.8% on metformin monotherapy at maximally
tolerated dose. Which action is most consistent with evidence-based guidelines?
A. Add a second glucose-lowering agent with a complementary mechanism
B. Discontinue metformin and begin basal insulin
C. Increase metformin beyond the maximum tolerated dose
D. Add a sulfonylurea while discontinuing metformin
Correct Answer: A. Add a second glucose-lowering agent with a complementary mechanism
Rationale: When A1C remains above goal on metformin monotherapy at maximally tolerated doses,
guidelines recommend adding an agent from another class rather than discontinuing metformin.
Metformin should generally be continued because of its efficacy, safety profile, and cardiovascular
benefits. Increasing beyond the maximum tolerated dose is inappropriate, and switching to insulin is
premature without evidence of severe hyperglycemia or catabolism.
Q8. A patient with hypothyroidism is started on levothyroxine. Which monitoring parameter best
reflects adequate replacement over time?
A. Serum free T4 level only
B. Serum TSH level
C. Serum T3 level
D. Thyroid peroxidase antibodies
Correct Answer: B. Serum TSH level
Rationale: TSH is the most sensitive marker of thyroid hormone adequacy in primary hypothyroidism
because it reflects pituitary feedback from circulating thyroid hormone. TSH should be checked
approximately 6–8 weeks after initiation or dose changes to allow steady state. Free T4 alone does
not capture tissue-level adequacy, and T3 is not routinely used for monitoring replacement.
Q9. A patient is prescribed warfarin and subsequently receives a course of sulfamethoxazole-
trimethoprim. Which interaction mechanism is most clinically significant?
A. Displacement of warfarin from plasma protein binding sites and inhibition of its metabolism
B. Increased renal clearance of warfarin
C. Induction of warfarin metabolism
D. Decreased warfarin absorption
Correct Answer: A. Displacement of warfarin from plasma protein binding sites and inhibition of its
metabolism
Rationale: Sulfamethoxazole-trimethoprim can potentiate warfarin through two mechanisms:
displacement from albumin binding sites (increasing free warfarin) and inhibition of CYP2C9-
mediated metabolism. Both effects increase INR and bleeding risk. It does not increase renal
clearance or induce metabolism.
pg. 4
