Page 1 of 142
NR 565 Midterm Exam – Advanced Pharmacology
Fundamentals QUESTIONS AND DETAILED
SOLUTIONS JUST RELEASED
NR 565 Midterm Exam – Advanced Pharmacology Fundamentals
10 Most Tested Coverage Areas
1. Pharmacokinetics and Pharmacodynamics - Absorption, distribution, metabolism, excretion;
receptor theory; first-pass effect; therapeutic index; drug half-life; onset of action for drug
classes
2. CYP450 Enzyme System - Drug metabolism; CYP450 inducers vs. inhibitors; mnemonics for
identifying common inducers and inhibitors; drug-drug interactions from enzyme modulation
3. Prescribing in Special Populations - Pregnancy (first trimester teratogenic risk); pediatric
patients (immature organ systems, weight-based dosing); geriatric patients (BEERS criteria,
altered pharmacokinetics, start low and go slow)
4. Geriatric Pharmacology & BEERS Criteria - BEERS Criteria list of potentially inappropriate
medications for adults 65+; age-related changes (↓ renal clearance, ↓ hepatic metabolism, ↑
body fat, ↓ serum albumin); medication safety in older adults
5. Cardiovascular Pharmacology - Nitroglycerin (vasodilation, reflex tachycardia, beta-blocker
combination); beta-blockers (mechanism, agents ending in -lol); diuretics (thiazide, loop,
monitoring considerations); statins and cholesterol management
6. Pain Management and Opioid Pharmacology - CDC opioid prescribing guidelines; pure opioid
agonists (morphine, fentanyl, oxycodone); methadone (QT prolongation, respiratory
depression); buprenorphine/naloxone combination; opioid use disorder management
7. Pediatric Pharmacokinetics - Immature hepatic and renal function; variable half-life; weight-
based dosing; drugs potentially inappropriate in pediatrics (codeine, tramadol, promethazine,
aspirin)
8. CNS Pharmacology - SSRIs (4-6 week onset of action); lithium monitoring (renal, thyroid);
clozapine (agranulocytosis, ANC monitoring); buspirone (2-4 week onset, non-benzodiazepine);
MAOI drug/food interactions (hypertensive crisis)
9. Endocrine and Metabolic Pharmacology - Metformin (GI side effects, lactic acidosis risk);
thiazide diuretics (hyperglycemia monitoring, hypokalemia); gout treatment (NSAIDs first-line
for acute attack, colchicine, glucocorticoids)
10. Drug Interactions and Safety Monitoring - Boxed warnings (promethazine in pediatrics,
methadone QT prolongation, codeine in children); FDA QT interval monitoring; pregnancy risk
categories and prescribing principles
, Page 2 of 142
1. An APRN is reviewing a patient's medication list and notes the patient is taking both digoxin and
furosemide. What is the most important assessment for the nurse to perform?
A) Monitor for signs of hyperkalemia
B) Assess for signs of digoxin toxicity
C) Check the patient's blood pressure
D) Evaluate the patient's renal function
Answer: B
Rationale: Loop diuretics can cause hypokalemia, which increases the risk of digoxin toxicity. The nurse
should monitor for symptoms such as nausea, vomiting, and visual disturbances.
2. A patient with major depressive disorder is started on escitalopram. Which statement regarding
SSRI onset of action is correct?
A) Therapeutic effects typically begin within 24-48 hours
B) Full therapeutic effect may take 4-6 weeks
C) Immediate improvement is expected
D) The drug must be taken with food
Answer: B
, Page 3 of 142
Rationale: SSRIs take 4-6 weeks to achieve full therapeutic effect, though some improvement may be
seen earlier.
3. A patient with bipolar disorder is prescribed lithium. Which baseline laboratory tests are required
before initiation?
A) Renal function, thyroid function, and pregnancy test if applicable
B) Liver function tests
C) Complete blood count
D) Electrocardiogram
Answer: A
Rationale: Lithium affects renal and thyroid function; baseline creatinine, TSH, and pregnancy status are
essential. ECG is recommended for patients with cardiac risk factors.
4. What is the cytochrome P450 (CYP450) system?
A) A renal filtration system for drug elimination
B) A liver enzyme system where medications are metabolized; inducers or inhibitors create drug-drug
interactions
, Page 4 of 142
C) A transport protein in the blood-brain barrier
D) A receptor system in the GI tract
Answer: B
Rationale: The CYP450 enzyme system, located primarily in the liver, is responsible for metabolizing
approximately 75% of all medications. CYP450 inducers speed up metabolism (decreasing drug levels),
while inhibitors slow down metabolism (increasing drug levels and toxicity risk).
5. What do CYP450 inducers do?
A) Inhibit metabolism, increasing blood levels of medications
B) Speed up metabolism of drugs; drug is cleared faster with lesser effect; elevate CYP enzymes
C) Have no effect on drug metabolism
D) Block drug absorption in the GI tract
Answer: B
Rationale: CYP450 inducers increase the metabolism of drugs, leading to faster clearance and reduced
drug effects.
6. The BEERS criteria are best described as which of the following?
NR 565 Midterm Exam – Advanced Pharmacology
Fundamentals QUESTIONS AND DETAILED
SOLUTIONS JUST RELEASED
NR 565 Midterm Exam – Advanced Pharmacology Fundamentals
10 Most Tested Coverage Areas
1. Pharmacokinetics and Pharmacodynamics - Absorption, distribution, metabolism, excretion;
receptor theory; first-pass effect; therapeutic index; drug half-life; onset of action for drug
classes
2. CYP450 Enzyme System - Drug metabolism; CYP450 inducers vs. inhibitors; mnemonics for
identifying common inducers and inhibitors; drug-drug interactions from enzyme modulation
3. Prescribing in Special Populations - Pregnancy (first trimester teratogenic risk); pediatric
patients (immature organ systems, weight-based dosing); geriatric patients (BEERS criteria,
altered pharmacokinetics, start low and go slow)
4. Geriatric Pharmacology & BEERS Criteria - BEERS Criteria list of potentially inappropriate
medications for adults 65+; age-related changes (↓ renal clearance, ↓ hepatic metabolism, ↑
body fat, ↓ serum albumin); medication safety in older adults
5. Cardiovascular Pharmacology - Nitroglycerin (vasodilation, reflex tachycardia, beta-blocker
combination); beta-blockers (mechanism, agents ending in -lol); diuretics (thiazide, loop,
monitoring considerations); statins and cholesterol management
6. Pain Management and Opioid Pharmacology - CDC opioid prescribing guidelines; pure opioid
agonists (morphine, fentanyl, oxycodone); methadone (QT prolongation, respiratory
depression); buprenorphine/naloxone combination; opioid use disorder management
7. Pediatric Pharmacokinetics - Immature hepatic and renal function; variable half-life; weight-
based dosing; drugs potentially inappropriate in pediatrics (codeine, tramadol, promethazine,
aspirin)
8. CNS Pharmacology - SSRIs (4-6 week onset of action); lithium monitoring (renal, thyroid);
clozapine (agranulocytosis, ANC monitoring); buspirone (2-4 week onset, non-benzodiazepine);
MAOI drug/food interactions (hypertensive crisis)
9. Endocrine and Metabolic Pharmacology - Metformin (GI side effects, lactic acidosis risk);
thiazide diuretics (hyperglycemia monitoring, hypokalemia); gout treatment (NSAIDs first-line
for acute attack, colchicine, glucocorticoids)
10. Drug Interactions and Safety Monitoring - Boxed warnings (promethazine in pediatrics,
methadone QT prolongation, codeine in children); FDA QT interval monitoring; pregnancy risk
categories and prescribing principles
, Page 2 of 142
1. An APRN is reviewing a patient's medication list and notes the patient is taking both digoxin and
furosemide. What is the most important assessment for the nurse to perform?
A) Monitor for signs of hyperkalemia
B) Assess for signs of digoxin toxicity
C) Check the patient's blood pressure
D) Evaluate the patient's renal function
Answer: B
Rationale: Loop diuretics can cause hypokalemia, which increases the risk of digoxin toxicity. The nurse
should monitor for symptoms such as nausea, vomiting, and visual disturbances.
2. A patient with major depressive disorder is started on escitalopram. Which statement regarding
SSRI onset of action is correct?
A) Therapeutic effects typically begin within 24-48 hours
B) Full therapeutic effect may take 4-6 weeks
C) Immediate improvement is expected
D) The drug must be taken with food
Answer: B
, Page 3 of 142
Rationale: SSRIs take 4-6 weeks to achieve full therapeutic effect, though some improvement may be
seen earlier.
3. A patient with bipolar disorder is prescribed lithium. Which baseline laboratory tests are required
before initiation?
A) Renal function, thyroid function, and pregnancy test if applicable
B) Liver function tests
C) Complete blood count
D) Electrocardiogram
Answer: A
Rationale: Lithium affects renal and thyroid function; baseline creatinine, TSH, and pregnancy status are
essential. ECG is recommended for patients with cardiac risk factors.
4. What is the cytochrome P450 (CYP450) system?
A) A renal filtration system for drug elimination
B) A liver enzyme system where medications are metabolized; inducers or inhibitors create drug-drug
interactions
, Page 4 of 142
C) A transport protein in the blood-brain barrier
D) A receptor system in the GI tract
Answer: B
Rationale: The CYP450 enzyme system, located primarily in the liver, is responsible for metabolizing
approximately 75% of all medications. CYP450 inducers speed up metabolism (decreasing drug levels),
while inhibitors slow down metabolism (increasing drug levels and toxicity risk).
5. What do CYP450 inducers do?
A) Inhibit metabolism, increasing blood levels of medications
B) Speed up metabolism of drugs; drug is cleared faster with lesser effect; elevate CYP enzymes
C) Have no effect on drug metabolism
D) Block drug absorption in the GI tract
Answer: B
Rationale: CYP450 inducers increase the metabolism of drugs, leading to faster clearance and reduced
drug effects.
6. The BEERS criteria are best described as which of the following?
