NSG 533 — Advanced
2 MAXE · 335 GSN
NSG
533
Pharmacology
Exam 2 — Pain, Gout, Osteoporosis, Migraine, OA & Antibiotics
EXAM 2
EVIDENCE-BASED PRESCRIBING · CLINICAL EXCELLENCE
NSG 533 Advanced Pharmacology — Exam 2
CO M P L E T E Q U E ST I O N S & V E R I F I E D A N S W E RS | 8 9 Q U E ST I O N S | PA I N , I N F E CT I O US
DISEASE & MORE | 2026
INSTITUTION Graduate Nursing Program — NSG COURSE CODE NSG 533 — Advanced
533 Pharmacology
PROGRAM Master of Science in Nursing / DNP ACADEMIC YEAR
EXAM TITLE NSG 533 Advanced Pharmacology TOTAL QUESTIONS 89 Questions
Exam 2 | Verified Answers
COURSE TITLE Advanced Pharmacology — Pain FORMAT Multiple Choice — Select the
Management & Infectious Disease Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover pain management, WHO ladder, NSAIDs, opioids, migraine, OA, gout, osteoporosis,
antibiotics, UTI/pneumonia/cellulitis treatment.
▸ Correct answers and detailed clinical rationales appear below each question.
▸ Content aligned with NSG 533 Advanced Pharmacology curriculum and evidence-based prescribing
guidelines.
, SECTION I — ADVANCED PHARMACOLOGY EXAM 2
Questions 1 – 89
COMPREHENSIVE REVIEW
1. The WHO Three-Step Ladder Approach for pain management recommends ______.
A. Step 1: Non-opioid ± adjuvant; Step 2: Weak opioid + non-opioid + adjuvant; Step 3:
Strong opioid + non-opioid + adjuvant
B. Step 1: Strong opioid; Step 2: Weak opioid; Step 3: Non-opioid
C. Step 1: Adjuvant only; Step 2: Non-opioid; Step 3: Opioid
D. All steps use identical medications at different doses
CORRECT ANSWER A — Step 1: Non-opioid ± adjuvant; Step 2: Weak opioid + non-opioid +
adjuvant; Step 3: Strong opioid + non-opioid + adjuvant
RATIONALE The WHO analgesic ladder provides a stepwise framework: Step 1 (mild pain) —
non-opioid analgesics (acetaminophen, NSAIDs) with optional adjuvant
medications. Step 2 (moderate pain) — add a weak opioid (codeine, tramadol,
hydrocodone) while continuing non-opioid and adjuvant therapy. Step 3 (severe
pain) — switch to a strong opioid (morphine, oxycodone, hydromorphone,
fentanyl). Adjuvant analgesics (gabapentin, duloxetine, TCAs) are useful at all
steps, especially for neuropathic pain.
2. Nonselective NSAIDs inhibit ______. Key precautions include ______.
A. Both COX-1 and COX-2; increased GI and renal toxicity and peptic ulcers
B. Only COX-2; minimal GI risk
C. Only COX-1; no anti-inflammatory effect
D. Neither COX enzyme; works through opioid receptors
CORRECT ANSWER A — Both COX-1 and COX-2; increased GI/renal toxicity, peptic ulcers
RATIONALE Nonselective NSAIDs inhibit both COX-1 and COX-2. COX-2 inhibition produces
anti-inflammatory and analgesic effects. COX-1 inhibition causes adverse
effects: decreased gastric mucosal protection, reduced renal blood flow, and
impaired platelet aggregation. All NSAIDs provide equal analgesia. COX-2
selective inhibitors (celecoxib) spare COX-1 → lower GI risk but higher
cardiovascular thrombotic risk.
,3. The maximum daily dose of acetaminophen for elderly patients is ______.
A. 3000 mg
B. 4000 mg
C. 2000 mg
D. 1000 mg
CORRECT ANSWER A — 3000 mg
RATIONALE The maximum daily acetaminophen dose for elderly patients is 3000 mg,
reduced from 4000 mg due to age-related decreased hepatic function.
Acetaminophen inhibits prostaglandin synthesis centrally. Overdose causes
fatal liver necrosis — acetylcysteine is the antidote, most effective within 8
hours. It is preferred first-line for mild-moderate pain in elderly due to safety
profile compared to NSAIDs.
4. Pure opioid agonists (morphine) bind to ______ receptors and produce analgesia that
______.
A. Mu (μ) receptors; increases with dose and has no ceiling effect
B. Kappa receptors; decreases with dose
C. Delta receptors; has a strict ceiling effect
D. Sigma receptors; is independent of dose
CORRECT ANSWER A — Mu (μ) receptors; increases with dose, no ceiling effect
RATIONALE Pure opioid agonists bind mu-opioid receptors, producing analgesia
proportional to dose with no ceiling effect. Partial agonists (tramadol) produce
submaximal response with a ceiling effect. Adverse effects: sedation, respiratory
depression (naloxone), constipation (prophylaxis required), N/V. When rotating
opioids, reduce new dose by ≥50% of equianalgesic calculation due to
incomplete cross-tolerance.
, 5. When rotating from one opioid to another, the starting dose must be ______.
A. Reduced by at least 50% of the calculated equianalgesic dose to prevent overdose
B. The exact same as the calculated equianalgesic dose
C. Doubled to account for cross-tolerance
D. Started at the lowest available dose regardless of prior opioid use
CORRECT ANSWER A — Reduced by at least 50% to prevent overdose
RATIONALE Incomplete cross-tolerance means tolerance to one opioid does NOT fully
transfer to another. The new opioid starting dose must be reduced by ≥50% of
the equianalgesic calculation to prevent overdose. Failure to reduce the dose
during rotation is a leading cause of opioid overdose. Titrate to effect after the
initial reduced dose.
6. Absolute contraindications for triptans include ______.
A. CAD, history of stroke, PAD, uncontrolled HTN, pregnancy category C
B. Mild hypertension, diabetes, obesity
C. GERD, asthma, allergic rhinitis
D. Anxiety, depression, insomnia
CORRECT ANSWER A — CAD, stroke history, PAD, uncontrolled HTN, pregnancy category C
RATIONALE Triptans are 5-HT1B/1D agonists that constrict cranial vessels — and also
coronary/peripheral arteries. Absolute contraindications: CAD, history of MI,
Prinzmetal angina, stroke/TIA, PAD, uncontrolled hypertension. Most effective
triptan: rizatriptan. Alternatives for patients with CV risk: NSAIDs, antiemetics,
preventive therapy.
2 MAXE · 335 GSN
NSG
533
Pharmacology
Exam 2 — Pain, Gout, Osteoporosis, Migraine, OA & Antibiotics
EXAM 2
EVIDENCE-BASED PRESCRIBING · CLINICAL EXCELLENCE
NSG 533 Advanced Pharmacology — Exam 2
CO M P L E T E Q U E ST I O N S & V E R I F I E D A N S W E RS | 8 9 Q U E ST I O N S | PA I N , I N F E CT I O US
DISEASE & MORE | 2026
INSTITUTION Graduate Nursing Program — NSG COURSE CODE NSG 533 — Advanced
533 Pharmacology
PROGRAM Master of Science in Nursing / DNP ACADEMIC YEAR
EXAM TITLE NSG 533 Advanced Pharmacology TOTAL QUESTIONS 89 Questions
Exam 2 | Verified Answers
COURSE TITLE Advanced Pharmacology — Pain FORMAT Multiple Choice — Select the
Management & Infectious Disease Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover pain management, WHO ladder, NSAIDs, opioids, migraine, OA, gout, osteoporosis,
antibiotics, UTI/pneumonia/cellulitis treatment.
▸ Correct answers and detailed clinical rationales appear below each question.
▸ Content aligned with NSG 533 Advanced Pharmacology curriculum and evidence-based prescribing
guidelines.
, SECTION I — ADVANCED PHARMACOLOGY EXAM 2
Questions 1 – 89
COMPREHENSIVE REVIEW
1. The WHO Three-Step Ladder Approach for pain management recommends ______.
A. Step 1: Non-opioid ± adjuvant; Step 2: Weak opioid + non-opioid + adjuvant; Step 3:
Strong opioid + non-opioid + adjuvant
B. Step 1: Strong opioid; Step 2: Weak opioid; Step 3: Non-opioid
C. Step 1: Adjuvant only; Step 2: Non-opioid; Step 3: Opioid
D. All steps use identical medications at different doses
CORRECT ANSWER A — Step 1: Non-opioid ± adjuvant; Step 2: Weak opioid + non-opioid +
adjuvant; Step 3: Strong opioid + non-opioid + adjuvant
RATIONALE The WHO analgesic ladder provides a stepwise framework: Step 1 (mild pain) —
non-opioid analgesics (acetaminophen, NSAIDs) with optional adjuvant
medications. Step 2 (moderate pain) — add a weak opioid (codeine, tramadol,
hydrocodone) while continuing non-opioid and adjuvant therapy. Step 3 (severe
pain) — switch to a strong opioid (morphine, oxycodone, hydromorphone,
fentanyl). Adjuvant analgesics (gabapentin, duloxetine, TCAs) are useful at all
steps, especially for neuropathic pain.
2. Nonselective NSAIDs inhibit ______. Key precautions include ______.
A. Both COX-1 and COX-2; increased GI and renal toxicity and peptic ulcers
B. Only COX-2; minimal GI risk
C. Only COX-1; no anti-inflammatory effect
D. Neither COX enzyme; works through opioid receptors
CORRECT ANSWER A — Both COX-1 and COX-2; increased GI/renal toxicity, peptic ulcers
RATIONALE Nonselective NSAIDs inhibit both COX-1 and COX-2. COX-2 inhibition produces
anti-inflammatory and analgesic effects. COX-1 inhibition causes adverse
effects: decreased gastric mucosal protection, reduced renal blood flow, and
impaired platelet aggregation. All NSAIDs provide equal analgesia. COX-2
selective inhibitors (celecoxib) spare COX-1 → lower GI risk but higher
cardiovascular thrombotic risk.
,3. The maximum daily dose of acetaminophen for elderly patients is ______.
A. 3000 mg
B. 4000 mg
C. 2000 mg
D. 1000 mg
CORRECT ANSWER A — 3000 mg
RATIONALE The maximum daily acetaminophen dose for elderly patients is 3000 mg,
reduced from 4000 mg due to age-related decreased hepatic function.
Acetaminophen inhibits prostaglandin synthesis centrally. Overdose causes
fatal liver necrosis — acetylcysteine is the antidote, most effective within 8
hours. It is preferred first-line for mild-moderate pain in elderly due to safety
profile compared to NSAIDs.
4. Pure opioid agonists (morphine) bind to ______ receptors and produce analgesia that
______.
A. Mu (μ) receptors; increases with dose and has no ceiling effect
B. Kappa receptors; decreases with dose
C. Delta receptors; has a strict ceiling effect
D. Sigma receptors; is independent of dose
CORRECT ANSWER A — Mu (μ) receptors; increases with dose, no ceiling effect
RATIONALE Pure opioid agonists bind mu-opioid receptors, producing analgesia
proportional to dose with no ceiling effect. Partial agonists (tramadol) produce
submaximal response with a ceiling effect. Adverse effects: sedation, respiratory
depression (naloxone), constipation (prophylaxis required), N/V. When rotating
opioids, reduce new dose by ≥50% of equianalgesic calculation due to
incomplete cross-tolerance.
, 5. When rotating from one opioid to another, the starting dose must be ______.
A. Reduced by at least 50% of the calculated equianalgesic dose to prevent overdose
B. The exact same as the calculated equianalgesic dose
C. Doubled to account for cross-tolerance
D. Started at the lowest available dose regardless of prior opioid use
CORRECT ANSWER A — Reduced by at least 50% to prevent overdose
RATIONALE Incomplete cross-tolerance means tolerance to one opioid does NOT fully
transfer to another. The new opioid starting dose must be reduced by ≥50% of
the equianalgesic calculation to prevent overdose. Failure to reduce the dose
during rotation is a leading cause of opioid overdose. Titrate to effect after the
initial reduced dose.
6. Absolute contraindications for triptans include ______.
A. CAD, history of stroke, PAD, uncontrolled HTN, pregnancy category C
B. Mild hypertension, diabetes, obesity
C. GERD, asthma, allergic rhinitis
D. Anxiety, depression, insomnia
CORRECT ANSWER A — CAD, stroke history, PAD, uncontrolled HTN, pregnancy category C
RATIONALE Triptans are 5-HT1B/1D agonists that constrict cranial vessels — and also
coronary/peripheral arteries. Absolute contraindications: CAD, history of MI,
Prinzmetal angina, stroke/TIA, PAD, uncontrolled hypertension. Most effective
triptan: rizatriptan. Alternatives for patients with CV risk: NSAIDs, antiemetics,
preventive therapy.
