NR 566 Week 4 Midterm — Master
Review & Preparation Guide 2025/2026
<Latest Version>
Category 1: Foundational Principles & Pharmacokinetics/Pharmacodynamics
1. What is the first-pass effect?
A. The effect of a drug on its primary target organ
B. The metabolism of a drug in the liver before it reaches systemic circulation ✓
C. The initial allergic reaction to a new medication
D. The time it takes for a drug to be absorbed from the GI tract
2. A drug with a high hepatic extraction ratio is significantly affected by what?
A. Renal function
B. Changes in liver blood flow ✓
C. Stomach pH
D. Adipose tissue content
3. What does a narrow therapeutic index (NTI) indicate about a drug?
A. It is very safe with few side effects.
B. There is a small difference between a therapeutic and a toxic dose. ✓
C. It is only effective for a narrow range of diseases.
D. It requires frequent monitoring of serum levels to ensure efficacy.
4. The study of what the body does to the drug is known as:
A. Pharmacodynamics
B. Pharmacokinetics ✓
C. Pharmacogenomics
D. Pharmacotherapeutics
5. Which phase of pharmacokinetics is most affected by food interactions?
A. Distribution
B. Metabolism
C. Excretion
D. Absorption ✓
,6. The primary organ for drug excretion is the:
A. Liver
B. Kidney ✓
C. Lung
D. Skin
7. What is the primary goal of Phase I metabolism?
A. To make the drug more water-soluble for excretion ✓
B. To make the drug more active
C. To conjugate the drug with glucuronic acid
D. To transport the drug to its target site
8. A patient with renal impairment is at highest risk for which of the following?
A. Decreased drug absorption
B. Increased drug metabolism
C. Drug accumulation and toxicity ✓
D. Enhanced first-pass effect
9. The term "steady state" refers to:
A. The point when a drug is fully absorbed
B. When the rate of drug administration equals the rate of elimination ✓
C. The maximum tolerated dose of a drug
D. The time of peak drug effect
10. What does the Cytochrome P450 (CYP450) system do?
A. Synthesizes plasma proteins for drug binding
B. Metabolizes many medications in the liver ✓
C. Filters drugs from the blood in the kidneys
D. Absorbs drugs from the intestinal wall
Category 2: Guidelines, Safety, & Prescribing
11. The Beers Criteria is used to identify:
A. Safe medications for children
B. First-line antibiotics for adults
C. Potentially Inappropriate Medications (PIMs) in older adults ✓
D. Medications that require genetic testing
,12. What is the single most important action to prevent antibiotic resistance?
A. Prescribing the newest available antibiotic
B. Using broad-spectrum antibiotics for all infections
C. Ensuring appropriate antibiotic use and completing the full course ✓
D. Prescribing double the dose for severe infections
13. According to the CDC, what is the first-line pharmacologic treatment for acute pain in
most patients?
A. Opioids (e.g., oxycodone)
B. Muscle relaxants (e.g., cyclobenzaprine)
C. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) or Acetaminophen ✓
D. Benzodiazepines (e.g., lorazepam)
14. The Prescription Drug Monitoring Program (PDMP) is primarily used to:
A. Check a patient's entire medical history
B. Identify potential drug-drug interactions
C. Track controlled substance prescriptions to prevent misuse ✓
D. Determine insurance coverage for medications
15. Before prescribing any medication, the NP must do all EXCEPT:
A. Obtain a thorough history and medication list
B. Establish a diagnosis
C. Discuss the plan, including risks and benefits
D. Guarantee the patient will have no side effects ✓
16. What is a "black box warning" on a drug label?
A. A reminder to take with food
B. The strongest safety warning the FDA requires ✓
C. A notice that the drug is available over-the-counter
D. An indication that the drug is a generic
17. The "Five Rights" of medication administration do NOT include:
A. Right Patient
B. Right Dose
C. Right Time
D. Right Diagnosis ✓
18. A key principle of antimicrobial stewardship is:
A. Treating all upper respiratory infections with antibiotics
B. Using the broadest-spectrum antibiotic available
, C. Targeting the pathogen with the most narrow-spectrum antibiotic effective ✓
D. Continuing antibiotics until the patient feels completely better
19. When prescribing a medication with anticholinergic effects to an older adult, the NP
should be most concerned about increased risk for:
A. Hyperactivity
B. Confusion, dry mouth, and urinary retention ✓
C. Hypoglycemia
D. Hypertension
20. Teratogenic effects refer to:
A. Side effects in the mother
B. Birth defects caused by drug exposure in utero ✓
C. Allergic reactions in newborns
D. The carcinogenic potential of a drug
Category 3: Cardiovascular & Renal Pharmacology
21. What is the first-line drug class for uncomplicated hypertension in most patients?
A. Thiazide diuretics ✓
B. Beta-blockers
C. Alpha-blockers
D. Calcium Channel Blockers (Non-DHP)
22. A patient on Lisinopril (an ACE Inhibitor) develops a dry, persistent cough. What is the best
course of action?
A. Prescribe a cough suppressant.
B. Switch to an Angiotensin II Receptor Blocker (ARB). ✓
C. Increase the dose; the cough will subside.
D. Add a beta-blocker.
23. Which laboratory value is most critical to monitor when initiating a patient on an ACE
Inhibitor or ARB?
A. Serum Sodium
B. Liver Function Tests (LFTs)
C. Serum Creatinine and Potassium ✓
D. White Blood Cell Count (WBC)
Review & Preparation Guide 2025/2026
<Latest Version>
Category 1: Foundational Principles & Pharmacokinetics/Pharmacodynamics
1. What is the first-pass effect?
A. The effect of a drug on its primary target organ
B. The metabolism of a drug in the liver before it reaches systemic circulation ✓
C. The initial allergic reaction to a new medication
D. The time it takes for a drug to be absorbed from the GI tract
2. A drug with a high hepatic extraction ratio is significantly affected by what?
A. Renal function
B. Changes in liver blood flow ✓
C. Stomach pH
D. Adipose tissue content
3. What does a narrow therapeutic index (NTI) indicate about a drug?
A. It is very safe with few side effects.
B. There is a small difference between a therapeutic and a toxic dose. ✓
C. It is only effective for a narrow range of diseases.
D. It requires frequent monitoring of serum levels to ensure efficacy.
4. The study of what the body does to the drug is known as:
A. Pharmacodynamics
B. Pharmacokinetics ✓
C. Pharmacogenomics
D. Pharmacotherapeutics
5. Which phase of pharmacokinetics is most affected by food interactions?
A. Distribution
B. Metabolism
C. Excretion
D. Absorption ✓
,6. The primary organ for drug excretion is the:
A. Liver
B. Kidney ✓
C. Lung
D. Skin
7. What is the primary goal of Phase I metabolism?
A. To make the drug more water-soluble for excretion ✓
B. To make the drug more active
C. To conjugate the drug with glucuronic acid
D. To transport the drug to its target site
8. A patient with renal impairment is at highest risk for which of the following?
A. Decreased drug absorption
B. Increased drug metabolism
C. Drug accumulation and toxicity ✓
D. Enhanced first-pass effect
9. The term "steady state" refers to:
A. The point when a drug is fully absorbed
B. When the rate of drug administration equals the rate of elimination ✓
C. The maximum tolerated dose of a drug
D. The time of peak drug effect
10. What does the Cytochrome P450 (CYP450) system do?
A. Synthesizes plasma proteins for drug binding
B. Metabolizes many medications in the liver ✓
C. Filters drugs from the blood in the kidneys
D. Absorbs drugs from the intestinal wall
Category 2: Guidelines, Safety, & Prescribing
11. The Beers Criteria is used to identify:
A. Safe medications for children
B. First-line antibiotics for adults
C. Potentially Inappropriate Medications (PIMs) in older adults ✓
D. Medications that require genetic testing
,12. What is the single most important action to prevent antibiotic resistance?
A. Prescribing the newest available antibiotic
B. Using broad-spectrum antibiotics for all infections
C. Ensuring appropriate antibiotic use and completing the full course ✓
D. Prescribing double the dose for severe infections
13. According to the CDC, what is the first-line pharmacologic treatment for acute pain in
most patients?
A. Opioids (e.g., oxycodone)
B. Muscle relaxants (e.g., cyclobenzaprine)
C. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) or Acetaminophen ✓
D. Benzodiazepines (e.g., lorazepam)
14. The Prescription Drug Monitoring Program (PDMP) is primarily used to:
A. Check a patient's entire medical history
B. Identify potential drug-drug interactions
C. Track controlled substance prescriptions to prevent misuse ✓
D. Determine insurance coverage for medications
15. Before prescribing any medication, the NP must do all EXCEPT:
A. Obtain a thorough history and medication list
B. Establish a diagnosis
C. Discuss the plan, including risks and benefits
D. Guarantee the patient will have no side effects ✓
16. What is a "black box warning" on a drug label?
A. A reminder to take with food
B. The strongest safety warning the FDA requires ✓
C. A notice that the drug is available over-the-counter
D. An indication that the drug is a generic
17. The "Five Rights" of medication administration do NOT include:
A. Right Patient
B. Right Dose
C. Right Time
D. Right Diagnosis ✓
18. A key principle of antimicrobial stewardship is:
A. Treating all upper respiratory infections with antibiotics
B. Using the broadest-spectrum antibiotic available
, C. Targeting the pathogen with the most narrow-spectrum antibiotic effective ✓
D. Continuing antibiotics until the patient feels completely better
19. When prescribing a medication with anticholinergic effects to an older adult, the NP
should be most concerned about increased risk for:
A. Hyperactivity
B. Confusion, dry mouth, and urinary retention ✓
C. Hypoglycemia
D. Hypertension
20. Teratogenic effects refer to:
A. Side effects in the mother
B. Birth defects caused by drug exposure in utero ✓
C. Allergic reactions in newborns
D. The carcinogenic potential of a drug
Category 3: Cardiovascular & Renal Pharmacology
21. What is the first-line drug class for uncomplicated hypertension in most patients?
A. Thiazide diuretics ✓
B. Beta-blockers
C. Alpha-blockers
D. Calcium Channel Blockers (Non-DHP)
22. A patient on Lisinopril (an ACE Inhibitor) develops a dry, persistent cough. What is the best
course of action?
A. Prescribe a cough suppressant.
B. Switch to an Angiotensin II Receptor Blocker (ARB). ✓
C. Increase the dose; the cough will subside.
D. Add a beta-blocker.
23. Which laboratory value is most critical to monitor when initiating a patient on an ACE
Inhibitor or ARB?
A. Serum Sodium
B. Liver Function Tests (LFTs)
C. Serum Creatinine and Potassium ✓
D. White Blood Cell Count (WBC)
