D116 NURS 6800
Advanced Pharmacology for the Advanced
Practice Nurse
Final Assessments
2025 Versions
(With Solutions)
1. Which pharmacokinetic parameter best describes the efficiency of a drug’s
removal from plasma?
a) Volume of distribution
b) Clearance
c) Half-life
d) Bioavailability
Answer: b) Clearance
Rationale: Clearance is the volume of plasma completely cleared of the drug per
unit time and indicates the efficiency of elimination.
2. A patient taking warfarin is prescribed amiodarone. Which effect is most likely?
a) Increased warfarin metabolism leading to decreased INR
b) Decreased warfarin metabolism leading to increased INR
c) No significant interaction
d) Amiodarone reduces warfarin absorption
Answer: b) Decreased warfarin metabolism leading to increased INR
Rationale: Amiodarone inhibits CYP2C9, which metabolizes warfarin, causing
elevated plasma warfarin levels and increased bleeding risk.
3. Which receptor subtype is primarily responsible for bronchodilation in asthma
treatment?
a) Beta-1 adrenergic receptors
b) Beta-2 adrenergic receptors
c) Alpha-1 adrenergic receptors
d) Muscarinic M3 receptors
Answer: b) Beta-2 adrenergic receptors
Rationale: Beta-2 adrenergic receptor activation causes smooth muscle relaxation
in the bronchial tree, resulting in bronchodilation.
4. When starting an ACE inhibitor in patients with heart failure, monitoring of which
, lab value is essential during the first week?
a) Serum potassium
b) Serum sodium
c) Blood glucose
d) Liver enzymes
Answer: a) Serum potassium
Rationale: ACE inhibitors may reduce aldosterone leading to hyperkalemia; close
monitoring is critical to avoid life-threatening arrhythmias.
5. A narrow therapeutic window drug that is primarily renally cleared will require
dose adjustment in:
a) Hepatic impairment
b) Renal impairment
c) Both hepatic and renal impairment
d) Neither, clearance is not affected by organ function
Answer: b) Renal impairment
Rationale: Renal clearance affects drugs eliminated by the kidneys, requiring
dosing adjustments when renal function declines.
6. Which phase of drug metabolism primarily involves cytochrome P450 enzymes?
a) Phase 1
b) Phase 2
c) Phase 3
d) Renal excretion
Answer: a) Phase 1
Rationale: Phase 1 metabolism involves oxidation, reduction, hydrolysis, often
through CYP450 enzymes, preparing the drug for further conjugation.
7. In opioid therapy, which receptor subtype is primarily responsible for analgesia?
a) Mu (μ) receptors
b) Kappa (κ) receptors
c) Delta (δ) receptors
d) Sigma receptors
Answer: a) Mu (μ) receptors
Rationale: Activation of mu-opioid receptors provides most of the analgesic effects
of opioids.
8. Which of the following drugs is an example of a selective serotonin reuptake
inhibitor (SSRI)?
,a) Amitriptyline
b) Fluoxetine
c) Phenelzine
d) Bupropion
Answer: b) Fluoxetine
Rationale: Fluoxetine selectively inhibits the reuptake of serotonin, increasing its
availability in the CNS.
9. What is the primary mechanism of action of loop diuretics like furosemide?
a) Inhibiting sodium-potassium exchange in the distal tubule
b) Blocking sodium-chloride symporter in the proximal tubule
c) Inhibiting the Na-K-2Cl symporter in the thick ascending loop of Henle
d) Increasing aldosterone secretion
Answer: c) Inhibiting the Na-K-2Cl symporter in the thick ascending loop of Henle
Rationale: This inhibition reduces sodium and chloride reabsorption, causing
diuresis.
10. Which clinical feature is most suggestive of digoxin toxicity?
a) Bradycardia with visual disturbances
b) Hypertension
c) Hypoglycemia
d) Hyperactive deep tendon reflexes
Answer: a) Bradycardia with visual disturbances
Rationale: Digoxin toxicity commonly presents with bradyarrhythmias and
characteristic yellow-green visual halos.
11. The mechanism of action of beta blockers in reducing blood pressure is
primarily through:
a) Vasodilation of peripheral vessels
b) Decreasing heart rate and myocardial contractility
c) Increasing renal excretion of sodium
d) Direct relaxation of smooth muscle
Answer: b) Decreasing heart rate and myocardial contractility
Rationale: Beta blockers reduce cardiac output by slowing heart rate and
weakening contraction.
12. Which antibiotic class is known for the risk of tendon rupture as a side effect?
a) Macrolides
b) Fluoroquinolones
, c) Penicillins
d) Aminoglycosides
Answer: b) Fluoroquinolones
Rationale: Fluoroquinolones can cause tendonitis and tendon rupture, especially in
elderly and those on corticosteroids.
13. Which pharmacodynamic term refers to the drug concentration required to
achieve 50% of its maximal effect?
a) Potency
b) Efficacy
c) Half-life
d) Bioavailability
Answer: a) Potency
Rationale: Potency is the amount of drug needed to produce a given effect; lower
EC50 indicates higher potency.
14. What is the primary adverse effect to monitor in patients on long-term lithium
therapy?
a) Nephrotoxicity and hypothyroidism
b) Hepatotoxicity
c) Pulmonary fibrosis
d) Bone marrow suppression
Answer: a) Nephrotoxicity and hypothyroidism
Rationale: Lithium can impair renal function and thyroid hormone production over
time, requiring regular monitoring.
15. The term ‘first-pass effect’ refers to:
a) Rapid absorption of a drug through oral administration
b) Metabolic inactivation of a drug by the liver before it reaches systemic
circulation
c) The initial half-life elimination of the drug
d) The enhanced effect following first dose
Answer: b) Metabolic inactivation of a drug by the liver before it reaches systemic
circulation
Rationale: Many oral drugs undergo first-pass metabolism in the liver, reducing
bioavailability.
16. Which drug is the antidote for benzodiazepine overdose?
a) Flumazenil
Advanced Pharmacology for the Advanced
Practice Nurse
Final Assessments
2025 Versions
(With Solutions)
1. Which pharmacokinetic parameter best describes the efficiency of a drug’s
removal from plasma?
a) Volume of distribution
b) Clearance
c) Half-life
d) Bioavailability
Answer: b) Clearance
Rationale: Clearance is the volume of plasma completely cleared of the drug per
unit time and indicates the efficiency of elimination.
2. A patient taking warfarin is prescribed amiodarone. Which effect is most likely?
a) Increased warfarin metabolism leading to decreased INR
b) Decreased warfarin metabolism leading to increased INR
c) No significant interaction
d) Amiodarone reduces warfarin absorption
Answer: b) Decreased warfarin metabolism leading to increased INR
Rationale: Amiodarone inhibits CYP2C9, which metabolizes warfarin, causing
elevated plasma warfarin levels and increased bleeding risk.
3. Which receptor subtype is primarily responsible for bronchodilation in asthma
treatment?
a) Beta-1 adrenergic receptors
b) Beta-2 adrenergic receptors
c) Alpha-1 adrenergic receptors
d) Muscarinic M3 receptors
Answer: b) Beta-2 adrenergic receptors
Rationale: Beta-2 adrenergic receptor activation causes smooth muscle relaxation
in the bronchial tree, resulting in bronchodilation.
4. When starting an ACE inhibitor in patients with heart failure, monitoring of which
, lab value is essential during the first week?
a) Serum potassium
b) Serum sodium
c) Blood glucose
d) Liver enzymes
Answer: a) Serum potassium
Rationale: ACE inhibitors may reduce aldosterone leading to hyperkalemia; close
monitoring is critical to avoid life-threatening arrhythmias.
5. A narrow therapeutic window drug that is primarily renally cleared will require
dose adjustment in:
a) Hepatic impairment
b) Renal impairment
c) Both hepatic and renal impairment
d) Neither, clearance is not affected by organ function
Answer: b) Renal impairment
Rationale: Renal clearance affects drugs eliminated by the kidneys, requiring
dosing adjustments when renal function declines.
6. Which phase of drug metabolism primarily involves cytochrome P450 enzymes?
a) Phase 1
b) Phase 2
c) Phase 3
d) Renal excretion
Answer: a) Phase 1
Rationale: Phase 1 metabolism involves oxidation, reduction, hydrolysis, often
through CYP450 enzymes, preparing the drug for further conjugation.
7. In opioid therapy, which receptor subtype is primarily responsible for analgesia?
a) Mu (μ) receptors
b) Kappa (κ) receptors
c) Delta (δ) receptors
d) Sigma receptors
Answer: a) Mu (μ) receptors
Rationale: Activation of mu-opioid receptors provides most of the analgesic effects
of opioids.
8. Which of the following drugs is an example of a selective serotonin reuptake
inhibitor (SSRI)?
,a) Amitriptyline
b) Fluoxetine
c) Phenelzine
d) Bupropion
Answer: b) Fluoxetine
Rationale: Fluoxetine selectively inhibits the reuptake of serotonin, increasing its
availability in the CNS.
9. What is the primary mechanism of action of loop diuretics like furosemide?
a) Inhibiting sodium-potassium exchange in the distal tubule
b) Blocking sodium-chloride symporter in the proximal tubule
c) Inhibiting the Na-K-2Cl symporter in the thick ascending loop of Henle
d) Increasing aldosterone secretion
Answer: c) Inhibiting the Na-K-2Cl symporter in the thick ascending loop of Henle
Rationale: This inhibition reduces sodium and chloride reabsorption, causing
diuresis.
10. Which clinical feature is most suggestive of digoxin toxicity?
a) Bradycardia with visual disturbances
b) Hypertension
c) Hypoglycemia
d) Hyperactive deep tendon reflexes
Answer: a) Bradycardia with visual disturbances
Rationale: Digoxin toxicity commonly presents with bradyarrhythmias and
characteristic yellow-green visual halos.
11. The mechanism of action of beta blockers in reducing blood pressure is
primarily through:
a) Vasodilation of peripheral vessels
b) Decreasing heart rate and myocardial contractility
c) Increasing renal excretion of sodium
d) Direct relaxation of smooth muscle
Answer: b) Decreasing heart rate and myocardial contractility
Rationale: Beta blockers reduce cardiac output by slowing heart rate and
weakening contraction.
12. Which antibiotic class is known for the risk of tendon rupture as a side effect?
a) Macrolides
b) Fluoroquinolones
, c) Penicillins
d) Aminoglycosides
Answer: b) Fluoroquinolones
Rationale: Fluoroquinolones can cause tendonitis and tendon rupture, especially in
elderly and those on corticosteroids.
13. Which pharmacodynamic term refers to the drug concentration required to
achieve 50% of its maximal effect?
a) Potency
b) Efficacy
c) Half-life
d) Bioavailability
Answer: a) Potency
Rationale: Potency is the amount of drug needed to produce a given effect; lower
EC50 indicates higher potency.
14. What is the primary adverse effect to monitor in patients on long-term lithium
therapy?
a) Nephrotoxicity and hypothyroidism
b) Hepatotoxicity
c) Pulmonary fibrosis
d) Bone marrow suppression
Answer: a) Nephrotoxicity and hypothyroidism
Rationale: Lithium can impair renal function and thyroid hormone production over
time, requiring regular monitoring.
15. The term ‘first-pass effect’ refers to:
a) Rapid absorption of a drug through oral administration
b) Metabolic inactivation of a drug by the liver before it reaches systemic
circulation
c) The initial half-life elimination of the drug
d) The enhanced effect following first dose
Answer: b) Metabolic inactivation of a drug by the liver before it reaches systemic
circulation
Rationale: Many oral drugs undergo first-pass metabolism in the liver, reducing
bioavailability.
16. Which drug is the antidote for benzodiazepine overdose?
a) Flumazenil
