NP Advanced Pharmacology Review: 150
Practice Questions for Clinical Mastery
2025/2026
1. A 55-year-old patient with chronic heart failure is prescribed
digoxin. Which of the following symptoms indicates digoxin
toxicity?
A. Bradycardia and nausea
B. Tachycardia and polyuria
C. Hypertension and dry mouth
D. Hyperreflexia and tremors
A. Bradycardia and nausea
Rationale: Digoxin toxicity commonly presents with
gastrointestinal symptoms (nausea, vomiting, anorexia) and
cardiac manifestations such as bradycardia or arrhythmias.
2. Which class of antihypertensive drugs works by inhibiting the
conversion of angiotensin I to angiotensin II?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. Thiazide diuretics
B. ACE inhibitors
Rationale: ACE inhibitors block the angiotensin-converting
enzyme, preventing the formation of angiotensin II, thereby
reducing vasoconstriction and aldosterone-mediated sodium
retention.
,3. A patient is taking warfarin. Which lab value is most important to
monitor?
A. Platelet count
B. aPTT
C. INR
D. Serum creatinine
C. INR
Rationale: INR (International Normalized Ratio) is the primary
laboratory test to monitor the effectiveness and safety of
warfarin therapy.
4. Which medication is first-line therapy for type 2 diabetes
mellitus?
A. Insulin glargine
B. Metformin
C. Glipizide
D. Pioglitazone
B. Metformin
Rationale: Metformin is the first-line oral hypoglycemic agent
due to its effectiveness, low risk of hypoglycemia, and
cardiovascular benefits.
5. Which adverse effect is most concerning for a patient on long-
term corticosteroid therapy?
A. Hyperpigmentation
B. Osteoporosis
C. Alopecia
D. Constipation
B. Osteoporosis
Rationale: Long-term corticosteroid use can lead to bone
demineralization, increasing the risk for osteoporosis and
fractures.
,6. A patient with asthma is prescribed a LABA (long-acting beta-
agonist). What is the primary counseling point?
A. Use only as needed for acute symptoms
B. Should be used with an inhaled corticosteroid
C. Can replace the daily steroid inhaler
D. Take orally on an empty stomach
B. Should be used with an inhaled corticosteroid
Rationale: LABAs should not be used as monotherapy in asthma;
they must be combined with an inhaled corticosteroid to reduce
the risk of severe asthma exacerbations.
7. Which antibiotic is contraindicated in pregnancy due to potential
teratogenic effects?
A. Amoxicillin
B. Ciprofloxacin
C. Cephalexin
D. Azithromycin
B. Ciprofloxacin
Rationale: Fluoroquinolones, such as ciprofloxacin, are
contraindicated in pregnancy because they can affect fetal
cartilage development.
8. A patient on lithium presents with tremors, polyuria, and nausea.
What should the nurse practitioner do first?
A. Increase the dose of lithium
B. Assess serum lithium levels
C. Discontinue all medications
D. Encourage high protein intake
B. Assess serum lithium levels
Rationale: Lithium has a narrow therapeutic index; symptoms of
toxicity require immediate assessment of serum levels before
adjusting therapy.
, 9. Which of the following drugs is most appropriate for a patient
with both hypertension and chronic kidney disease?
A. Furosemide
B. Losartan
C. Verapamil
D. Hydralazine
B. Losartan
Rationale: ARBs (angiotensin receptor blockers) like losartan
reduce proteinuria and slow the progression of chronic kidney
disease while controlling blood pressure.
10. A patient with atrial fibrillation is prescribed dabigatran.
Which teaching point is essential?
A. Take with vitamin K
B. Regular INR monitoring is required
C. Do not stop abruptly without consulting the provider
D. Can be used to treat acute bacterial infections
C. Do not stop abruptly without consulting the provider
Rationale: Abrupt discontinuation of dabigatran increases the
risk of thromboembolism; patient adherence and monitoring for
bleeding are crucial.
11. Which drug class is first-line for treating neuropathic pain?
A. NSAIDs
B. Opioids
C. Antidepressants (e.g., SNRIs, TCAs)
D. Corticosteroids
C. Antidepressants (e.g., SNRIs, TCAs)
Rationale: Neuropathic pain responds better to certain
antidepressants and anticonvulsants rather than conventional
analgesics like NSAIDs or opioids.
Practice Questions for Clinical Mastery
2025/2026
1. A 55-year-old patient with chronic heart failure is prescribed
digoxin. Which of the following symptoms indicates digoxin
toxicity?
A. Bradycardia and nausea
B. Tachycardia and polyuria
C. Hypertension and dry mouth
D. Hyperreflexia and tremors
A. Bradycardia and nausea
Rationale: Digoxin toxicity commonly presents with
gastrointestinal symptoms (nausea, vomiting, anorexia) and
cardiac manifestations such as bradycardia or arrhythmias.
2. Which class of antihypertensive drugs works by inhibiting the
conversion of angiotensin I to angiotensin II?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. Thiazide diuretics
B. ACE inhibitors
Rationale: ACE inhibitors block the angiotensin-converting
enzyme, preventing the formation of angiotensin II, thereby
reducing vasoconstriction and aldosterone-mediated sodium
retention.
,3. A patient is taking warfarin. Which lab value is most important to
monitor?
A. Platelet count
B. aPTT
C. INR
D. Serum creatinine
C. INR
Rationale: INR (International Normalized Ratio) is the primary
laboratory test to monitor the effectiveness and safety of
warfarin therapy.
4. Which medication is first-line therapy for type 2 diabetes
mellitus?
A. Insulin glargine
B. Metformin
C. Glipizide
D. Pioglitazone
B. Metformin
Rationale: Metformin is the first-line oral hypoglycemic agent
due to its effectiveness, low risk of hypoglycemia, and
cardiovascular benefits.
5. Which adverse effect is most concerning for a patient on long-
term corticosteroid therapy?
A. Hyperpigmentation
B. Osteoporosis
C. Alopecia
D. Constipation
B. Osteoporosis
Rationale: Long-term corticosteroid use can lead to bone
demineralization, increasing the risk for osteoporosis and
fractures.
,6. A patient with asthma is prescribed a LABA (long-acting beta-
agonist). What is the primary counseling point?
A. Use only as needed for acute symptoms
B. Should be used with an inhaled corticosteroid
C. Can replace the daily steroid inhaler
D. Take orally on an empty stomach
B. Should be used with an inhaled corticosteroid
Rationale: LABAs should not be used as monotherapy in asthma;
they must be combined with an inhaled corticosteroid to reduce
the risk of severe asthma exacerbations.
7. Which antibiotic is contraindicated in pregnancy due to potential
teratogenic effects?
A. Amoxicillin
B. Ciprofloxacin
C. Cephalexin
D. Azithromycin
B. Ciprofloxacin
Rationale: Fluoroquinolones, such as ciprofloxacin, are
contraindicated in pregnancy because they can affect fetal
cartilage development.
8. A patient on lithium presents with tremors, polyuria, and nausea.
What should the nurse practitioner do first?
A. Increase the dose of lithium
B. Assess serum lithium levels
C. Discontinue all medications
D. Encourage high protein intake
B. Assess serum lithium levels
Rationale: Lithium has a narrow therapeutic index; symptoms of
toxicity require immediate assessment of serum levels before
adjusting therapy.
, 9. Which of the following drugs is most appropriate for a patient
with both hypertension and chronic kidney disease?
A. Furosemide
B. Losartan
C. Verapamil
D. Hydralazine
B. Losartan
Rationale: ARBs (angiotensin receptor blockers) like losartan
reduce proteinuria and slow the progression of chronic kidney
disease while controlling blood pressure.
10. A patient with atrial fibrillation is prescribed dabigatran.
Which teaching point is essential?
A. Take with vitamin K
B. Regular INR monitoring is required
C. Do not stop abruptly without consulting the provider
D. Can be used to treat acute bacterial infections
C. Do not stop abruptly without consulting the provider
Rationale: Abrupt discontinuation of dabigatran increases the
risk of thromboembolism; patient adherence and monitoring for
bleeding are crucial.
11. Which drug class is first-line for treating neuropathic pain?
A. NSAIDs
B. Opioids
C. Antidepressants (e.g., SNRIs, TCAs)
D. Corticosteroids
C. Antidepressants (e.g., SNRIs, TCAs)
Rationale: Neuropathic pain responds better to certain
antidepressants and anticonvulsants rather than conventional
analgesics like NSAIDs or opioids.
