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NURS 5663 FINAL EXAM QUESTIONS LATEST 2026 – 2027 VERSION
SOLVED QUESTIONS & ANSWERS
NURS 5663 FINAL EXAM
NURS 5663 FINAL EXAM
PART 1 — QUESTIONS 1–15
1. A patient with severe benzodiazepine overdose presents with respiratory
depression. Which medication is the appropriate antidote?
A) Naloxone
B) Flumazenil
C) Atropine
D) Protamine sulfate
Answer: B
Rationale: Flumazenil is a benzodiazepine receptor antagonist that reverses
benzodiazepine-induced sedation and respiratory depression.
2. Which statement best explains why only the unbound fraction of a highly
protein-bound drug is pharmacologically active?
A) Bound drug is rapidly excreted by the kidneys
B) Bound drug cannot cross membranes or bind to receptors
C) Bound drug is always toxic to tissues
D) Bound drug is metabolized faster than free drug
Answer: B
Rationale: Protein-bound drug is inactive because it cannot cross capillary
membranes or interact with target receptors until it becomes unbound.
3. A patient with hepatic cirrhosis is prescribed a drug with extensive first-pass
metabolism. What dosage adjustment is usually required?
A) Increase the oral dose
B) Decrease the oral dose
C) Give the drug intravenously only
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D) No adjustment is needed
Answer: B
Rationale: Cirrhosis reduces first-pass metabolism, increasing oral bioavailability and
the risk of toxicity, so a lower dose is often needed.
4. Which CYP450 enzyme is responsible for metabolizing approximately 50% of
all drugs?
A) CYP1A2
B) CYP2D6
C) CYP3A4
D) CYP2C9
Answer: C
Rationale: CYP3A4 is the most abundant hepatic and intestinal CYP450 enzyme and
metabolizes about half of all clinically used drugs.
5. A patient taking warfarin is prescribed rifampin. What is the most likely
clinical consequence?
A) Increased warfarin effect and bleeding
B) Decreased warfarin effect and clot risk
C) No change in warfarin effect
D) Immediate warfarin toxicity
Answer: B
Rationale: Rifampin induces CYP450 enzymes, accelerating warfarin metabolism and
reducing its anticoagulant effect, increasing clot risk.
6. Which medication is a muscarinic agonist used to treat urinary retention?
A) Bethanechol
B) Atropine
C) Prazosin
D) Propranolol
Answer: A
Rationale: Bethanechol directly stimulates muscarinic receptors, causing detrusor
muscle contraction and promoting urination.
7. A patient taking atropine should be monitored for which common
anticholinergic adverse effect?
A) Diarrhea
B) Bradycardia
C) Dry mouth and urinary retention
D) Miosis
Answer: C
Rationale: Atropine blocks muscarinic receptors, causing dry mouth, urinary
retention, blurred vision, constipation, and tachycardia.
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8. Which medication is a beta-1 selective blocker commonly used for
hypertension and angina?
A) Propranolol
B) Metoprolol
C) Carvedilol
D) Labetalol
Answer: B
Rationale: Metoprolol is beta-1 selective, primarily reducing heart rate and cardiac
output at usual therapeutic doses.
9. A patient taking lisinopril develops a persistent dry cough. Which mechanism
best explains this adverse effect?
A) Accumulation of bradykinin and substance P
B) Direct irritation of the bronchial mucosa
C) Increased angiotensin II formation
D) Histamine release from mast cells
Answer: A
Rationale: ACE inhibitors block bradykinin breakdown, leading to bradykinin and
substance P accumulation, which causes dry cough.
10. Which electrolyte imbalance is most concerning in a patient taking
furosemide?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Answer: B
Rationale: Furosemide is a loop diuretic that increases potassium excretion, causing
hypokalemia and risk of arrhythmias.
11. A patient taking spironolactone should be monitored for which serious
electrolyte abnormality?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypocalcemia
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone
antagonist that can cause dangerous hyperkalemia.
12. Which medication is the antidote for opioid overdose?
A) Flumazenil
B) Naloxone
C) Atropine
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D) Thiamine
Answer: B
Rationale: Naloxone is an opioid receptor antagonist that rapidly reverses opioid-
induced respiratory depression and sedation.
13. A patient taking lithium for bipolar disorder should be monitored for which
long-term adverse effect?
A) Nephrotoxicity and hypothyroidism
B) Hyperkalemia
C) Hypertension
D) Weight loss
Answer: A
Rationale: Lithium has a narrow therapeutic index and can cause nephrogenic
diabetes insipidus, renal impairment, and hypothyroidism.
14. Which insulin has the most rapid onset of action?
A) Regular insulin
B) NPH insulin
C) Insulin lispro
D) Insulin glargine
Answer: C
Rationale: Insulin lispro is a rapid-acting analog with onset around 15 minutes, ideal
for mealtime glucose control.
15. A patient taking metformin should be counseled about which most
common adverse effect?
A) Gastrointestinal upset
B) Hypoglycemia
C) Weight gain
D) Hypertension
Answer: A
Rationale: Metformin commonly causes nausea, diarrhea, and abdominal
discomfort, which can be reduced by taking it with food.
Section 1: Pharmacokinetics & Pharmacodynamics (16–30)
16. A nurse practitioner is calculating a loading dose for a patient who requires
rapid therapeutic drug levels. Which pharmacokinetic parameter is most
essential?
A) Clearance
B) Volume of distribution
C) Half-life
D) Bioavailability
NURS 5663 FINAL EXAM QUESTIONS LATEST 2026 – 2027 VERSION
SOLVED QUESTIONS & ANSWERS
NURS 5663 FINAL EXAM
NURS 5663 FINAL EXAM
PART 1 — QUESTIONS 1–15
1. A patient with severe benzodiazepine overdose presents with respiratory
depression. Which medication is the appropriate antidote?
A) Naloxone
B) Flumazenil
C) Atropine
D) Protamine sulfate
Answer: B
Rationale: Flumazenil is a benzodiazepine receptor antagonist that reverses
benzodiazepine-induced sedation and respiratory depression.
2. Which statement best explains why only the unbound fraction of a highly
protein-bound drug is pharmacologically active?
A) Bound drug is rapidly excreted by the kidneys
B) Bound drug cannot cross membranes or bind to receptors
C) Bound drug is always toxic to tissues
D) Bound drug is metabolized faster than free drug
Answer: B
Rationale: Protein-bound drug is inactive because it cannot cross capillary
membranes or interact with target receptors until it becomes unbound.
3. A patient with hepatic cirrhosis is prescribed a drug with extensive first-pass
metabolism. What dosage adjustment is usually required?
A) Increase the oral dose
B) Decrease the oral dose
C) Give the drug intravenously only
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D) No adjustment is needed
Answer: B
Rationale: Cirrhosis reduces first-pass metabolism, increasing oral bioavailability and
the risk of toxicity, so a lower dose is often needed.
4. Which CYP450 enzyme is responsible for metabolizing approximately 50% of
all drugs?
A) CYP1A2
B) CYP2D6
C) CYP3A4
D) CYP2C9
Answer: C
Rationale: CYP3A4 is the most abundant hepatic and intestinal CYP450 enzyme and
metabolizes about half of all clinically used drugs.
5. A patient taking warfarin is prescribed rifampin. What is the most likely
clinical consequence?
A) Increased warfarin effect and bleeding
B) Decreased warfarin effect and clot risk
C) No change in warfarin effect
D) Immediate warfarin toxicity
Answer: B
Rationale: Rifampin induces CYP450 enzymes, accelerating warfarin metabolism and
reducing its anticoagulant effect, increasing clot risk.
6. Which medication is a muscarinic agonist used to treat urinary retention?
A) Bethanechol
B) Atropine
C) Prazosin
D) Propranolol
Answer: A
Rationale: Bethanechol directly stimulates muscarinic receptors, causing detrusor
muscle contraction and promoting urination.
7. A patient taking atropine should be monitored for which common
anticholinergic adverse effect?
A) Diarrhea
B) Bradycardia
C) Dry mouth and urinary retention
D) Miosis
Answer: C
Rationale: Atropine blocks muscarinic receptors, causing dry mouth, urinary
retention, blurred vision, constipation, and tachycardia.
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8. Which medication is a beta-1 selective blocker commonly used for
hypertension and angina?
A) Propranolol
B) Metoprolol
C) Carvedilol
D) Labetalol
Answer: B
Rationale: Metoprolol is beta-1 selective, primarily reducing heart rate and cardiac
output at usual therapeutic doses.
9. A patient taking lisinopril develops a persistent dry cough. Which mechanism
best explains this adverse effect?
A) Accumulation of bradykinin and substance P
B) Direct irritation of the bronchial mucosa
C) Increased angiotensin II formation
D) Histamine release from mast cells
Answer: A
Rationale: ACE inhibitors block bradykinin breakdown, leading to bradykinin and
substance P accumulation, which causes dry cough.
10. Which electrolyte imbalance is most concerning in a patient taking
furosemide?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Answer: B
Rationale: Furosemide is a loop diuretic that increases potassium excretion, causing
hypokalemia and risk of arrhythmias.
11. A patient taking spironolactone should be monitored for which serious
electrolyte abnormality?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypocalcemia
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone
antagonist that can cause dangerous hyperkalemia.
12. Which medication is the antidote for opioid overdose?
A) Flumazenil
B) Naloxone
C) Atropine
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D) Thiamine
Answer: B
Rationale: Naloxone is an opioid receptor antagonist that rapidly reverses opioid-
induced respiratory depression and sedation.
13. A patient taking lithium for bipolar disorder should be monitored for which
long-term adverse effect?
A) Nephrotoxicity and hypothyroidism
B) Hyperkalemia
C) Hypertension
D) Weight loss
Answer: A
Rationale: Lithium has a narrow therapeutic index and can cause nephrogenic
diabetes insipidus, renal impairment, and hypothyroidism.
14. Which insulin has the most rapid onset of action?
A) Regular insulin
B) NPH insulin
C) Insulin lispro
D) Insulin glargine
Answer: C
Rationale: Insulin lispro is a rapid-acting analog with onset around 15 minutes, ideal
for mealtime glucose control.
15. A patient taking metformin should be counseled about which most
common adverse effect?
A) Gastrointestinal upset
B) Hypoglycemia
C) Weight gain
D) Hypertension
Answer: A
Rationale: Metformin commonly causes nausea, diarrhea, and abdominal
discomfort, which can be reduced by taking it with food.
Section 1: Pharmacokinetics & Pharmacodynamics (16–30)
16. A nurse practitioner is calculating a loading dose for a patient who requires
rapid therapeutic drug levels. Which pharmacokinetic parameter is most
essential?
A) Clearance
B) Volume of distribution
C) Half-life
D) Bioavailability
