A+ GRADED 1
NSG 527 Final Exam –
Questions and Verified
Answers (Latest
2025/2026, Graded A)
Instructions
• This document contains 75 multiple-choice questions designed for the NSG 527 /
NSG527 Final Exam, aligned with 2025/2026 advanced pharmacology and
therapeutics standards.
• All questions are original, realistic, and reflect current evidence-based practices,
including updates from recent FDA approvals, clinical guidelines (e.g., JNC 9,
ADA 2026), and pharmacogenomic advancements.
• EachSecti
question includes four answer choices (A–D).
• The correct answer is highlighted in blue for easy identification.
• An expert rationale follows each question, explaining the correct choice and why
others are incorrect.
, 2
Question 1
In a patient with newly diagnosed type 2 diabetes mellitus (T2DM) and an eGFR
of 75 mL/min/1.73 m², which initial pharmacologic therapy is most appropriate per
ADA 2026 guidelines, assuming no history of atherosclerotic cardiovascular
disease (ASCVD)?
A. Metformin 500 mg BID B. GLP-1 receptor agonist (e.g., semaglutide) C.
SGLT2 inhibitor (e.g., empagliflozin) D. Insulin glargine
Expert Rationale: C is correct because ADA 2026 prioritizes SGLT2 inhibitors as
first-line add-on therapy to metformin in T2DM patients with CKD risk, due to
proven renoprotective effects (e.g., reducing albuminuria by 30-40%). Metformin
(A) remains foundational but requires dose adjustment if eGFR <60; GLP-1 RA
(B) is preferred for weight loss/ASCVD; insulin (D) is reserved for symptomatic
hyperglycemia.
Question 2
A 68-year-old male with hypertension and stage 3 CKD (eGFR 45 mL/min/1.73
m²) is initiated on sacubitril/valsartan. What is the primary mechanism contributing
to its superiority over enalapril in reducing heart failure hospitalizations per
PARADIGM-HF follow-up data through 2025?
A. Direct vasodilation via natriuretic peptides B. Inhibition of neprilysin leading to
increased natriuretic peptides C. Enhanced aldosterone antagonism D. Beta-1
receptor blockade
Expert Rationale: B is correct as sacubitril inhibits neprilysin, elevating
BNP/ANP levels to promote diuresis and vasodilation, reducing HF events by 20%
vs. ACEIs in long-term analyses. A is partial but incomplete; C/D describe
spironolactone or carvedilol effects.
Question 3
, 3
For a pediatric patient (age 8) with acute lymphoblastic leukemia (ALL) on
maintenance chemotherapy including 6-mercaptopurine, routine monitoring of
what genetic variant is essential to prevent severe myelosuppression per 2025
CPIC guidelines?
A. CYP2D6 poor metabolizer status B. TPMT3A allele C. TPMT2/3A variants D.
UGT1A128 polymorphism
Expert Rationale: C is correct; TPMT variants (e.g., *2/*3A) reduce enzyme
activity, leading to toxic 6-MP metabolites—CPIC 2025 recommends 30-70%
dose reduction for heterozygotes. A relates to codeine; D to irinotecan.
Question 4
In managing opioid-induced constipation (OIC) in a palliative care patient on
chronic oxycodone, which peripherally acting mu-opioid receptor antagonist
(PAMORA) is contraindicated if the patient has severe hepatic impairment (Child-
Pugh C)?
A. Naloxegol B. Methylnaltrexone C. Naldemedine D. Alvimopan
Expert Rationale: B is correct; methylnaltrexone is primarily renally cleared and
contraindicated in severe hepatic impairment due to limited data and risk of
accumulation. Others (A, C) have hepatic metabolism but are usable with caution;
D is surgical-only.
Question 5
A 45-year-old female with rheumatoid arthritis (RA) fails MTX monotherapy. Per
2026 ACR guidelines, what is the next preferred biologic DMARD if she has high
disease activity and no extra-articular manifestations?
A. TNF inhibitor (e.g., etanercept) B. JAK inhibitor (e.g., tofacitinib) C. IL-6
inhibitor (e.g., sarilumab) D. B-cell depleter (e.g., rituximab)
Expert Rationale: A is correct; ACR 2026 recommends TNFis as first biologic
for MTX-IR RA due to broad efficacy (ACR50 response ~50%) and safety profile.
NSG 527 Final Exam –
Questions and Verified
Answers (Latest
2025/2026, Graded A)
Instructions
• This document contains 75 multiple-choice questions designed for the NSG 527 /
NSG527 Final Exam, aligned with 2025/2026 advanced pharmacology and
therapeutics standards.
• All questions are original, realistic, and reflect current evidence-based practices,
including updates from recent FDA approvals, clinical guidelines (e.g., JNC 9,
ADA 2026), and pharmacogenomic advancements.
• EachSecti
question includes four answer choices (A–D).
• The correct answer is highlighted in blue for easy identification.
• An expert rationale follows each question, explaining the correct choice and why
others are incorrect.
, 2
Question 1
In a patient with newly diagnosed type 2 diabetes mellitus (T2DM) and an eGFR
of 75 mL/min/1.73 m², which initial pharmacologic therapy is most appropriate per
ADA 2026 guidelines, assuming no history of atherosclerotic cardiovascular
disease (ASCVD)?
A. Metformin 500 mg BID B. GLP-1 receptor agonist (e.g., semaglutide) C.
SGLT2 inhibitor (e.g., empagliflozin) D. Insulin glargine
Expert Rationale: C is correct because ADA 2026 prioritizes SGLT2 inhibitors as
first-line add-on therapy to metformin in T2DM patients with CKD risk, due to
proven renoprotective effects (e.g., reducing albuminuria by 30-40%). Metformin
(A) remains foundational but requires dose adjustment if eGFR <60; GLP-1 RA
(B) is preferred for weight loss/ASCVD; insulin (D) is reserved for symptomatic
hyperglycemia.
Question 2
A 68-year-old male with hypertension and stage 3 CKD (eGFR 45 mL/min/1.73
m²) is initiated on sacubitril/valsartan. What is the primary mechanism contributing
to its superiority over enalapril in reducing heart failure hospitalizations per
PARADIGM-HF follow-up data through 2025?
A. Direct vasodilation via natriuretic peptides B. Inhibition of neprilysin leading to
increased natriuretic peptides C. Enhanced aldosterone antagonism D. Beta-1
receptor blockade
Expert Rationale: B is correct as sacubitril inhibits neprilysin, elevating
BNP/ANP levels to promote diuresis and vasodilation, reducing HF events by 20%
vs. ACEIs in long-term analyses. A is partial but incomplete; C/D describe
spironolactone or carvedilol effects.
Question 3
, 3
For a pediatric patient (age 8) with acute lymphoblastic leukemia (ALL) on
maintenance chemotherapy including 6-mercaptopurine, routine monitoring of
what genetic variant is essential to prevent severe myelosuppression per 2025
CPIC guidelines?
A. CYP2D6 poor metabolizer status B. TPMT3A allele C. TPMT2/3A variants D.
UGT1A128 polymorphism
Expert Rationale: C is correct; TPMT variants (e.g., *2/*3A) reduce enzyme
activity, leading to toxic 6-MP metabolites—CPIC 2025 recommends 30-70%
dose reduction for heterozygotes. A relates to codeine; D to irinotecan.
Question 4
In managing opioid-induced constipation (OIC) in a palliative care patient on
chronic oxycodone, which peripherally acting mu-opioid receptor antagonist
(PAMORA) is contraindicated if the patient has severe hepatic impairment (Child-
Pugh C)?
A. Naloxegol B. Methylnaltrexone C. Naldemedine D. Alvimopan
Expert Rationale: B is correct; methylnaltrexone is primarily renally cleared and
contraindicated in severe hepatic impairment due to limited data and risk of
accumulation. Others (A, C) have hepatic metabolism but are usable with caution;
D is surgical-only.
Question 5
A 45-year-old female with rheumatoid arthritis (RA) fails MTX monotherapy. Per
2026 ACR guidelines, what is the next preferred biologic DMARD if she has high
disease activity and no extra-articular manifestations?
A. TNF inhibitor (e.g., etanercept) B. JAK inhibitor (e.g., tofacitinib) C. IL-6
inhibitor (e.g., sarilumab) D. B-cell depleter (e.g., rituximab)
Expert Rationale: A is correct; ACR 2026 recommends TNFis as first biologic
for MTX-IR RA due to broad efficacy (ACR50 response ~50%) and safety profile.
