Advanced Pharmacology Challenge for Nurse
Practitioners Test Bank– 150 Questions &
Answers
2025/2026
1. Which of the following drugs is a selective serotonin reuptake
inhibitor (SSRI)?
A. Amitriptyline
B. Fluoxetine
C. Phenelzine
D. Bupropion
Rationale: Fluoxetine is an SSRI that inhibits the reuptake of serotonin
in the CNS, enhancing serotonergic activity.
2. A patient on warfarin reports bruising and bleeding gums. The NP
should first:
A. Increase vitamin K intake
B. Check the INR
C. Discontinue warfarin immediately
D. Administer fresh frozen plasma
Rationale: Checking the INR is essential to assess the degree of
anticoagulation before making dosage adjustments or administering
reversal agents.
3. Which medication is contraindicated in pregnancy due to
teratogenicity?
A. Lisinopril
B. Metformin
C. Valproic acid
D. Levothyroxine
,Rationale: Valproic acid is highly teratogenic and can cause neural tube
defects; ACE inhibitors like lisinopril are also contraindicated in the
second and third trimesters.
4. The mechanism of action of albuterol involves:
A. Beta-1 receptor blockade
B. Beta-2 receptor stimulation
C. Alpha-1 receptor stimulation
D. Muscarinic receptor antagonism
Rationale: Albuterol is a selective beta-2 agonist that causes
bronchodilation by relaxing bronchial smooth muscle.
5. A patient taking digoxin presents with nausea, visual changes, and
arrhythmias. The NP recognizes these as:
A. Side effects
B. Signs of toxicity
C. Allergic reaction
D. Therapeutic effects
Rationale: Digoxin toxicity often presents with GI, visual, and cardiac
symptoms; serum levels should be checked.
6. Which statin is most likely to cause drug interactions via CYP3A4?
A. Pravastatin
B. Simvastatin
C. Rosuvastatin
D. Fluvastatin
Rationale: Simvastatin is metabolized by CYP3A4 and can interact with
drugs that inhibit this enzyme, increasing the risk of myopathy.
7. The antidote for acetaminophen overdose is:
A. Naloxone
B. Atropine
, C. N-acetylcysteine (NAC)
D. Flumazenil
Rationale: N-acetylcysteine replenishes hepatic glutathione and
prevents acetaminophen-induced hepatotoxicity.
8. A patient with chronic kidney disease requires antibiotic therapy.
Which is safest?
A. Aminoglycosides
B. Cephalosporins (dose-adjusted)
C. Vancomycin (standard dose)
D. Nitrofurantoin
Rationale: Cephalosporins are renally excreted but can be safely used
with dose adjustments; aminoglycosides and vancomycin carry higher
nephrotoxic risk.
9. Which of the following drugs is used for both depression and
neuropathic pain?
A. Paroxetine
B. Duloxetine
C. Sertraline
D. Fluoxetine
Rationale: Duloxetine is an SNRI approved for major depressive disorder
and neuropathic pain (diabetic neuropathy).
10. A patient on lithium develops tremors and polyuria. The NP
should:
A. Increase lithium dose
B. Check serum lithium level
C. Discontinue all fluids
D. Administer thiazide diuretic
, Rationale: Lithium has a narrow therapeutic index; tremor and polyuria
may indicate toxicity, requiring serum level evaluation.
11. Which anticoagulant directly inhibits thrombin?
A. Warfarin
B. Apixaban
C. Dabigatran
D. Heparin
Rationale: Dabigatran is a direct thrombin inhibitor, preventing fibrin
formation.
12. The preferred first-line therapy for type 2 diabetes is:
A. Insulin
B. Sulfonylurea
C. Thiazolidinedione
D. Metformin
Rationale: Metformin improves insulin sensitivity and decreases hepatic
glucose production, making it first-line therapy.
13. A patient presents with severe hypertension and
bradycardia. Which drug is most likely involved?
A. Lisinopril
B. Beta-blocker overdose
C. Furosemide
D. Hydrochlorothiazide
Rationale: Beta-blocker toxicity can lead to bradycardia, hypotension,
and conduction abnormalities.
14. Which drug class is associated with osteonecrosis of the
jaw?
A. SSRIs
B. Bisphosphonates
Practitioners Test Bank– 150 Questions &
Answers
2025/2026
1. Which of the following drugs is a selective serotonin reuptake
inhibitor (SSRI)?
A. Amitriptyline
B. Fluoxetine
C. Phenelzine
D. Bupropion
Rationale: Fluoxetine is an SSRI that inhibits the reuptake of serotonin
in the CNS, enhancing serotonergic activity.
2. A patient on warfarin reports bruising and bleeding gums. The NP
should first:
A. Increase vitamin K intake
B. Check the INR
C. Discontinue warfarin immediately
D. Administer fresh frozen plasma
Rationale: Checking the INR is essential to assess the degree of
anticoagulation before making dosage adjustments or administering
reversal agents.
3. Which medication is contraindicated in pregnancy due to
teratogenicity?
A. Lisinopril
B. Metformin
C. Valproic acid
D. Levothyroxine
,Rationale: Valproic acid is highly teratogenic and can cause neural tube
defects; ACE inhibitors like lisinopril are also contraindicated in the
second and third trimesters.
4. The mechanism of action of albuterol involves:
A. Beta-1 receptor blockade
B. Beta-2 receptor stimulation
C. Alpha-1 receptor stimulation
D. Muscarinic receptor antagonism
Rationale: Albuterol is a selective beta-2 agonist that causes
bronchodilation by relaxing bronchial smooth muscle.
5. A patient taking digoxin presents with nausea, visual changes, and
arrhythmias. The NP recognizes these as:
A. Side effects
B. Signs of toxicity
C. Allergic reaction
D. Therapeutic effects
Rationale: Digoxin toxicity often presents with GI, visual, and cardiac
symptoms; serum levels should be checked.
6. Which statin is most likely to cause drug interactions via CYP3A4?
A. Pravastatin
B. Simvastatin
C. Rosuvastatin
D. Fluvastatin
Rationale: Simvastatin is metabolized by CYP3A4 and can interact with
drugs that inhibit this enzyme, increasing the risk of myopathy.
7. The antidote for acetaminophen overdose is:
A. Naloxone
B. Atropine
, C. N-acetylcysteine (NAC)
D. Flumazenil
Rationale: N-acetylcysteine replenishes hepatic glutathione and
prevents acetaminophen-induced hepatotoxicity.
8. A patient with chronic kidney disease requires antibiotic therapy.
Which is safest?
A. Aminoglycosides
B. Cephalosporins (dose-adjusted)
C. Vancomycin (standard dose)
D. Nitrofurantoin
Rationale: Cephalosporins are renally excreted but can be safely used
with dose adjustments; aminoglycosides and vancomycin carry higher
nephrotoxic risk.
9. Which of the following drugs is used for both depression and
neuropathic pain?
A. Paroxetine
B. Duloxetine
C. Sertraline
D. Fluoxetine
Rationale: Duloxetine is an SNRI approved for major depressive disorder
and neuropathic pain (diabetic neuropathy).
10. A patient on lithium develops tremors and polyuria. The NP
should:
A. Increase lithium dose
B. Check serum lithium level
C. Discontinue all fluids
D. Administer thiazide diuretic
, Rationale: Lithium has a narrow therapeutic index; tremor and polyuria
may indicate toxicity, requiring serum level evaluation.
11. Which anticoagulant directly inhibits thrombin?
A. Warfarin
B. Apixaban
C. Dabigatran
D. Heparin
Rationale: Dabigatran is a direct thrombin inhibitor, preventing fibrin
formation.
12. The preferred first-line therapy for type 2 diabetes is:
A. Insulin
B. Sulfonylurea
C. Thiazolidinedione
D. Metformin
Rationale: Metformin improves insulin sensitivity and decreases hepatic
glucose production, making it first-line therapy.
13. A patient presents with severe hypertension and
bradycardia. Which drug is most likely involved?
A. Lisinopril
B. Beta-blocker overdose
C. Furosemide
D. Hydrochlorothiazide
Rationale: Beta-blocker toxicity can lead to bradycardia, hypotension,
and conduction abnormalities.
14. Which drug class is associated with osteonecrosis of the
jaw?
A. SSRIs
B. Bisphosphonates
