NR 565 Advanced Pharmacology Test Bank 2026/2027 Latest
Version Questions, Rationales / GRADED A+ Complete
VERSIONS/ Correct Questions Tested 100% Verified
1. A 58-year-old man with type 2 diabetes and hypertension is prescribed lisinopril. After
two weeks, his potassium level rises to 5.8 mEq/L. What is the best next step?
A. Continue lisinopril and recheck potassium in 6 months
B. Discontinue lisinopril and evaluate for alternative antihypertensive therapy
C. Add a potassium supplement
D. Switch to spironolactone
Rationale: ACE inhibitors inhibit angiotensin II formation, reducing aldosterone-mediated
potassium excretion. Hyperkalemia >5.5 mEq/L warrants discontinuation. Alternative agents
such as calcium channel blockers or beta blockers should be considered.
2. A 40-year-old woman with asthma is prescribed propranolol for anxiety. She returns with
wheezing and dyspnea. What is the most likely cause?
A. Non-selective beta blockade causing bronchoconstriction
B. Anxiety exacerbation
C. Allergic reaction to propranolol
D. Pulmonary embolism
Rationale: Non-selective beta-blockers inhibit β2 receptors in bronchial smooth muscle,
provoking bronchospasm. Cardioselective agents like atenolol or metoprolol are safer in
asthmatics.
3. A patient started on warfarin develops a nosebleed. His INR is 4.2. What is the best
management?
A. Continue current dose
B. Hold warfarin and recheck INR
C. Give vitamin K 10 mg IM immediately
D. Start heparin bridge therapy
Rationale: An INR >4 with bleeding indicates excessive anticoagulation. Holding warfarin
allows INR to return to therapeutic range. Vitamin K is reserved for serious bleeding or very
high INR.
,4. Which drug requires genetic screening for HLA-B1502 in Asian patients due to risk of
Stevens–Johnson syndrome?
A. Lamotrigine
B. Carbamazepine
C. Phenytoin
D. Valproate
Rationale: Carbamazepine hypersensitivity reactions correlate with HLA-B1502 allele,
prevalent in patients of Asian descent. Screening reduces life-threatening cutaneous
reactions.
5. A patient taking digoxin reports nausea, blurred vision, and seeing yellow halos. Which
electrolyte imbalance increases digoxin toxicity risk?
A. Hypokalemia
B. Hypernatremia
C. Hypercalcemia
D. Hyponatremia
Rationale: Low potassium enhances digoxin binding to Na⁺/K⁺ ATPase, increasing toxicity.
Monitoring K⁺ and renal function is essential, especially with diuretic therapy.
6. Which antibiotic is contraindicated in children under 8 years due to risk of permanent teeth
discoloration?
A. Doxycycline
B. Amoxicillin
C. Azithromycin
D. Cephalexin
Rationale: Tetracyclines bind calcium in developing teeth and bone, leading to discoloration
and enamel hypoplasia.
7. A 32-year-old woman on oral contraceptives starts rifampin for latent TB. What
counseling is essential?
A. Rifampin reduces contraceptive efficacy; use backup contraception
B. Continue usual contraceptive dosing
C. Rifampin increases estrogen levels
D. Switch to estrogen patch
Rationale: Rifampin induces hepatic CYP450 enzymes, increasing metabolism of
estrogen/progestin, reducing oral contraceptive effectiveness.
8. Which insulin has the longest duration of action?
A. Regular insulin
B. NPH insulin
C. Insulin glargine
D. Insulin lispro
Rationale: Glargine is a long-acting basal insulin with a 24-hour steady release, minimizing
peaks and hypoglycemia risk.
, 9. A 45-year-old man taking atorvastatin reports severe muscle pain. CK is elevated to 1200
U/L. Next step?
A. Discontinue atorvastatin and assess for rhabdomyolysis
B. Continue therapy and add niacin
C. Lower dose and recheck CK
D. Add ezetimibe
Rationale: Statin-induced myopathy can progress to rhabdomyolysis. Discontinue
immediately and evaluate renal function.
10. Which of the following antibiotics inhibits bacterial cell wall synthesis by binding
penicillin-binding proteins?
A. Amoxicillin
B. Azithromycin
C. Gentamicin
D. Ciprofloxacin
Rationale: Beta-lactams (penicillins, cephalosporins) inhibit transpeptidase, preventing
peptidoglycan crosslinking in bacterial cell walls.
11. A patient is prescribed metformin. Which condition is a contraindication?
A. Hypertension
B. Chronic kidney disease with eGFR <30 mL/min
C. Hyperlipidemia
D. Obesity
Rationale: Metformin accumulation in renal impairment can lead to lactic acidosis. Always
assess eGFR before initiation.
12. Which antihypertensive is most effective in African American adults as monotherapy?
A. ACE inhibitors
B. Calcium channel blockers
C. Beta blockers
D. ARBs
Rationale: African Americans respond better to CCBs or thiazide diuretics due to lower
renin activity.
13. A 24-year-old woman is prescribed isotretinoin. What must be verified before starting
therapy?
A. Negative pregnancy test
B. Normal liver enzymes
C. Cholesterol levels
D. WBC count
Rationale: Isotretinoin is teratogenic. Enrollment in iPLEDGE and confirmed negative
pregnancy tests are mandatory.
Version Questions, Rationales / GRADED A+ Complete
VERSIONS/ Correct Questions Tested 100% Verified
1. A 58-year-old man with type 2 diabetes and hypertension is prescribed lisinopril. After
two weeks, his potassium level rises to 5.8 mEq/L. What is the best next step?
A. Continue lisinopril and recheck potassium in 6 months
B. Discontinue lisinopril and evaluate for alternative antihypertensive therapy
C. Add a potassium supplement
D. Switch to spironolactone
Rationale: ACE inhibitors inhibit angiotensin II formation, reducing aldosterone-mediated
potassium excretion. Hyperkalemia >5.5 mEq/L warrants discontinuation. Alternative agents
such as calcium channel blockers or beta blockers should be considered.
2. A 40-year-old woman with asthma is prescribed propranolol for anxiety. She returns with
wheezing and dyspnea. What is the most likely cause?
A. Non-selective beta blockade causing bronchoconstriction
B. Anxiety exacerbation
C. Allergic reaction to propranolol
D. Pulmonary embolism
Rationale: Non-selective beta-blockers inhibit β2 receptors in bronchial smooth muscle,
provoking bronchospasm. Cardioselective agents like atenolol or metoprolol are safer in
asthmatics.
3. A patient started on warfarin develops a nosebleed. His INR is 4.2. What is the best
management?
A. Continue current dose
B. Hold warfarin and recheck INR
C. Give vitamin K 10 mg IM immediately
D. Start heparin bridge therapy
Rationale: An INR >4 with bleeding indicates excessive anticoagulation. Holding warfarin
allows INR to return to therapeutic range. Vitamin K is reserved for serious bleeding or very
high INR.
,4. Which drug requires genetic screening for HLA-B1502 in Asian patients due to risk of
Stevens–Johnson syndrome?
A. Lamotrigine
B. Carbamazepine
C. Phenytoin
D. Valproate
Rationale: Carbamazepine hypersensitivity reactions correlate with HLA-B1502 allele,
prevalent in patients of Asian descent. Screening reduces life-threatening cutaneous
reactions.
5. A patient taking digoxin reports nausea, blurred vision, and seeing yellow halos. Which
electrolyte imbalance increases digoxin toxicity risk?
A. Hypokalemia
B. Hypernatremia
C. Hypercalcemia
D. Hyponatremia
Rationale: Low potassium enhances digoxin binding to Na⁺/K⁺ ATPase, increasing toxicity.
Monitoring K⁺ and renal function is essential, especially with diuretic therapy.
6. Which antibiotic is contraindicated in children under 8 years due to risk of permanent teeth
discoloration?
A. Doxycycline
B. Amoxicillin
C. Azithromycin
D. Cephalexin
Rationale: Tetracyclines bind calcium in developing teeth and bone, leading to discoloration
and enamel hypoplasia.
7. A 32-year-old woman on oral contraceptives starts rifampin for latent TB. What
counseling is essential?
A. Rifampin reduces contraceptive efficacy; use backup contraception
B. Continue usual contraceptive dosing
C. Rifampin increases estrogen levels
D. Switch to estrogen patch
Rationale: Rifampin induces hepatic CYP450 enzymes, increasing metabolism of
estrogen/progestin, reducing oral contraceptive effectiveness.
8. Which insulin has the longest duration of action?
A. Regular insulin
B. NPH insulin
C. Insulin glargine
D. Insulin lispro
Rationale: Glargine is a long-acting basal insulin with a 24-hour steady release, minimizing
peaks and hypoglycemia risk.
, 9. A 45-year-old man taking atorvastatin reports severe muscle pain. CK is elevated to 1200
U/L. Next step?
A. Discontinue atorvastatin and assess for rhabdomyolysis
B. Continue therapy and add niacin
C. Lower dose and recheck CK
D. Add ezetimibe
Rationale: Statin-induced myopathy can progress to rhabdomyolysis. Discontinue
immediately and evaluate renal function.
10. Which of the following antibiotics inhibits bacterial cell wall synthesis by binding
penicillin-binding proteins?
A. Amoxicillin
B. Azithromycin
C. Gentamicin
D. Ciprofloxacin
Rationale: Beta-lactams (penicillins, cephalosporins) inhibit transpeptidase, preventing
peptidoglycan crosslinking in bacterial cell walls.
11. A patient is prescribed metformin. Which condition is a contraindication?
A. Hypertension
B. Chronic kidney disease with eGFR <30 mL/min
C. Hyperlipidemia
D. Obesity
Rationale: Metformin accumulation in renal impairment can lead to lactic acidosis. Always
assess eGFR before initiation.
12. Which antihypertensive is most effective in African American adults as monotherapy?
A. ACE inhibitors
B. Calcium channel blockers
C. Beta blockers
D. ARBs
Rationale: African Americans respond better to CCBs or thiazide diuretics due to lower
renin activity.
13. A 24-year-old woman is prescribed isotretinoin. What must be verified before starting
therapy?
A. Negative pregnancy test
B. Normal liver enzymes
C. Cholesterol levels
D. WBC count
Rationale: Isotretinoin is teratogenic. Enrollment in iPLEDGE and confirmed negative
pregnancy tests are mandatory.
