NR508 Advanced
Pharmacology for the Nurse
Practitioner 2025/2026
Practice Questions
General Principles (Questions 1–20)
1. A nurse practitioner prescribes a drug with first-order kinetics. What does this imply for
dosing adjustments? A. Dose proportionally to steady-state concentration B. Linear increase in
plasma levels with dose C. Saturation at low doses D. Zero-order elimination
Rationale: First-order kinetics follows linear PK, where plasma concentration doubles with dose
doubling, allowing predictable adjustments; safe prescribing requires monitoring for
accumulation in renal impairment, per 2025 AANP guidelines.
2. For a patient with a penicillin allergy reporting hives, which class alternative is safest for
beta-lactamase coverage? A. Macrolides B. Monobactams like aztreonam C. Fluoroquinolones
D. Tetracyclines
Rationale: Monobactams have no cross-reactivity with penicillins; PK involves renal excretion,
so adjust in CrCl <30 mL/min; safe prescribing avoids anaphylaxis risk via allergy history.
3. The volume of distribution (Vd) for a hydrophilic drug is typically: A. High (>1 L/kg) B.
Low (<0.6 L/kg) C. Variable with age D. Increased in obesity
Rationale: Hydrophilic drugs remain extracellular (low Vd); safe prescribing considers this for
loading doses in edema, aligning with 2025 FDA PK labeling.
4. A patient on warfarin starts amiodarone. What PK interaction occurs? A. Increased
absorption B. CYP2C9 inhibition, elevating INR C. Renal clearance D. Volume expansion
Rationale: Amiodarone inhibits warfarin metabolism; safe prescribing mandates INR
monitoring weekly initially, per 2025 ACC guidelines to prevent bleeding.
5. Zero-order kinetics is characteristic of: A. Most antibiotics B. Alcohol and phenytoin at
high doses C. Beta-blockers D. Statins
, Rationale: Constant elimination rate regardless of concentration; safe prescribing requires dose
capping to avoid toxicity, as PK saturation leads to nonlinear levels.
6. For elderly patients, which PK change most affects drug dosing? A. Increased absorption
B. Decreased renal clearance C. Higher Vd D. Faster metabolism
Rationale: Age-related GFR decline prolongs half-life; safe prescribing uses CrCl-adjusted
doses (e.g., Cockcroft-Gault), per 2025 Beers Criteria to reduce ADRs.
7. A drug with high hepatic first-pass effect has: A. Low oral bioavailability B. Low oral
bioavailability C. Rapid excretion D. Wide distribution
Rationale: Extensive metabolism reduces systemic exposure; safe prescribing favors IV for
emergencies, monitoring LFTs in liver disease.
8. Grapefruit juice interacts with drugs via: A. P-gp induction B. CYP3A4 inhibition C. Renal
uptake D. Albumin binding
Rationale: Inhibits intestinal CYP3A4, increasing bioavailability; safe prescribing counsels
avoidance with statins/calcium blockers, per 2025 FDA warnings.
9. Half-life (t1/2) determines: A. Onset time B. Dosing interval for steady state C. Peak
concentration D. Absorption rate
Rationale: t1/2 guides q dosing (e.g., 4–5 t1/2 to steady state); safe prescribing shortens
intervals in renal failure to prevent accumulation.
10. For a drug 90% protein-bound, displacement by warfarin affects: A. Total concentration
B. Free fraction, increasing effect C. Vd D. Metabolism
Rationale: Only free drug is active; safe prescribing monitors levels (e.g., phenytoin), avoiding
polypharmacy in hypoalbuminemia.
11. Enteric-coated aspirin should be given: A. Crushed B. Whole with water C. With milk D.
At bedtime
Rationale: Protects gastric mucosa (delayed absorption); safe prescribing prevents GI bleed, per
2025 AGA guidelines.
12. A prodrug like clopidogrel requires: A. Renal activation B. Hepatic CYP2C19 metabolism
C. Direct action D. Enteric coating
Rationale: Poor metabolizers (2–14%) have reduced efficacy; safe prescribing genotypes or uses
alternatives like prasugrel.
13. Bioavailability (F) of IV drugs is: A. Variable B. 100% C. 50% D. <10%
Pharmacology for the Nurse
Practitioner 2025/2026
Practice Questions
General Principles (Questions 1–20)
1. A nurse practitioner prescribes a drug with first-order kinetics. What does this imply for
dosing adjustments? A. Dose proportionally to steady-state concentration B. Linear increase in
plasma levels with dose C. Saturation at low doses D. Zero-order elimination
Rationale: First-order kinetics follows linear PK, where plasma concentration doubles with dose
doubling, allowing predictable adjustments; safe prescribing requires monitoring for
accumulation in renal impairment, per 2025 AANP guidelines.
2. For a patient with a penicillin allergy reporting hives, which class alternative is safest for
beta-lactamase coverage? A. Macrolides B. Monobactams like aztreonam C. Fluoroquinolones
D. Tetracyclines
Rationale: Monobactams have no cross-reactivity with penicillins; PK involves renal excretion,
so adjust in CrCl <30 mL/min; safe prescribing avoids anaphylaxis risk via allergy history.
3. The volume of distribution (Vd) for a hydrophilic drug is typically: A. High (>1 L/kg) B.
Low (<0.6 L/kg) C. Variable with age D. Increased in obesity
Rationale: Hydrophilic drugs remain extracellular (low Vd); safe prescribing considers this for
loading doses in edema, aligning with 2025 FDA PK labeling.
4. A patient on warfarin starts amiodarone. What PK interaction occurs? A. Increased
absorption B. CYP2C9 inhibition, elevating INR C. Renal clearance D. Volume expansion
Rationale: Amiodarone inhibits warfarin metabolism; safe prescribing mandates INR
monitoring weekly initially, per 2025 ACC guidelines to prevent bleeding.
5. Zero-order kinetics is characteristic of: A. Most antibiotics B. Alcohol and phenytoin at
high doses C. Beta-blockers D. Statins
, Rationale: Constant elimination rate regardless of concentration; safe prescribing requires dose
capping to avoid toxicity, as PK saturation leads to nonlinear levels.
6. For elderly patients, which PK change most affects drug dosing? A. Increased absorption
B. Decreased renal clearance C. Higher Vd D. Faster metabolism
Rationale: Age-related GFR decline prolongs half-life; safe prescribing uses CrCl-adjusted
doses (e.g., Cockcroft-Gault), per 2025 Beers Criteria to reduce ADRs.
7. A drug with high hepatic first-pass effect has: A. Low oral bioavailability B. Low oral
bioavailability C. Rapid excretion D. Wide distribution
Rationale: Extensive metabolism reduces systemic exposure; safe prescribing favors IV for
emergencies, monitoring LFTs in liver disease.
8. Grapefruit juice interacts with drugs via: A. P-gp induction B. CYP3A4 inhibition C. Renal
uptake D. Albumin binding
Rationale: Inhibits intestinal CYP3A4, increasing bioavailability; safe prescribing counsels
avoidance with statins/calcium blockers, per 2025 FDA warnings.
9. Half-life (t1/2) determines: A. Onset time B. Dosing interval for steady state C. Peak
concentration D. Absorption rate
Rationale: t1/2 guides q dosing (e.g., 4–5 t1/2 to steady state); safe prescribing shortens
intervals in renal failure to prevent accumulation.
10. For a drug 90% protein-bound, displacement by warfarin affects: A. Total concentration
B. Free fraction, increasing effect C. Vd D. Metabolism
Rationale: Only free drug is active; safe prescribing monitors levels (e.g., phenytoin), avoiding
polypharmacy in hypoalbuminemia.
11. Enteric-coated aspirin should be given: A. Crushed B. Whole with water C. With milk D.
At bedtime
Rationale: Protects gastric mucosa (delayed absorption); safe prescribing prevents GI bleed, per
2025 AGA guidelines.
12. A prodrug like clopidogrel requires: A. Renal activation B. Hepatic CYP2C19 metabolism
C. Direct action D. Enteric coating
Rationale: Poor metabolizers (2–14%) have reduced efficacy; safe prescribing genotypes or uses
alternatives like prasugrel.
13. Bioavailability (F) of IV drugs is: A. Variable B. 100% C. 50% D. <10%
