NR 567 Advanced Pharmacology for the
AGACNP: Comprehensive Midterm Practice Exam
(200 Questions with Answers & Explanations)
Content Area Key Focus
Pharmacokinetics & Absorption, distribution, metabolism, excretion; drug-receptor interaction
Pharmacodynamics
Cardiovascular Pharmacology Antihypertensives, antiplatelets, anticoagulants, heart failure medications
Antimicrobial Therapy Antibiotics, antifungals, antivirals; resistance mechanisms; stewardship
Endocrine Pharmacology Insulins, thyroid medications, adrenal disorders, diabetes emergencies
Neuropharmacology Antiepileptics, sedatives, neuromuscular blockers, pain management
Critical Care Pharmacology Vasopressors, sedation, electrolyte management, reversal agents
Hematology & Oncology Anticoagulation reversal, growth factors, chemotherapy agents
Special Populations Geriatrics, pregnancy, renal/hepatic impairment, pharmacogenomics
, Section 1: Pharmacokinetics & Pharmacodynamics
Q1. Which parameter primarily determines a drug's volume of distribution (Vd)? A)
Renal clearance
Pharmacokinetics & Pharmacodynamics
A 72-year-old patient with heart failure (EF 35%) is started on metoprolol succinate.
Which statement best describes the initiation of beta-blockers in this population?
A) Start at a high dose to achieve rapid heart rate control
B) Avoid in all patients with EF <40%
C) Start low, go slow, and titrate to target dose if tolerated
D) Use only if the patient has atrial fibrillation
Correct Answer: C
*Explanation: In chronic heart failure with reduced EF, beta-blockers (carvedilol,
metoprolol succinate, bisoprolol) reduce mortality and hospitalizations. Therapy must
start at very low doses and be up-titrated slowly every 2 weeks to avoid
decompensation.*
2. A patient with septic shock requires norepinephrine. What is the primary receptor
responsible for its vasopressor effect?
A) Beta-1 receptors
B) Beta-2 receptors
C) Alpha-1 receptors
D) Dopamine-1 receptors
,Correct Answer: C
*Explanation: Norepinephrine is a potent alpha-1 agonist causing vasoconstriction and
increased SVR. Beta-1 effects increase heart rate and contractility, but alpha-1 drives the
pressor response.*
3. Which antibiotic requires therapeutic drug monitoring to avoid ototoxicity and
nephrotoxicity?
A) Ceftriaxone
B) Vancomycin
C) Azithromycin
D) Doxycycline
Correct Answer: B
*Explanation: Vancomycin has a narrow therapeutic index. Trough levels (10–20 mcg/mL
for routine infections, 15–20 for MRSA pneumonia) guide dosing to minimize
nephrotoxicity and ototoxicity.*
4. A patient with acute kidney injury (AKI) has a creatinine clearance of 25 mL/min.
Which medication requires no dose adjustment?
A) Metformin
B) Apixaban
C) Levetiracetam
D) Ceftriaxone
Correct Answer: D
Explanation: Ceftriaxone is primarily hepatically excreted (40–50% unchanged in bile) and
does not require renal dose adjustment. Metformin, apixaban, and levetiracetam require
renal adjustment.
5. Which drug is the preferred initial agent for rate control in new-onset atrial fibrillation
with rapid ventricular response in a hemodynamically stable patient?
A) Metoprolol tartrate IV
, B) Amiodarone IV
C) Digoxin IV
D) Diltiazem bolus + infusion
Correct Answer: A
Explanation: For stable rapid AF, IV beta-blockers (metoprolol) or non-dihydropyridine
CCBs (diltiazem, verapamil) are first-line. Metoprolol is often preferred in HF or CAD.
Amiodarone is not first-line for rate control.
6. A patient on warfarin for mechanical mitral valve presents with INR 4.5 and minor
epistaxis. What is the best next step?
A) Vitamin K 10 mg IV
B) Fresh frozen plasma (FFP)
C) Hold warfarin and recheck INR tomorrow
D) Prothrombin complex concentrate (PCC)
Correct Answer: C
*Explanation: INR 4.5 without major bleeding → withhold warfarin, monitor INR. Vitamin
K is for major bleeding or very high INR (>10). FFP/PCC for life-threatening bleeding.*
7. Which medication is contraindicated within 48 hours of tPA administration for acute
ischemic stroke?
A) Enoxaparin
B) Aspirin
C) Clopidogrel
D) All of the above
Correct Answer: D
Explanation: Antithrombotics (antiplatelets, anticoagulants) are avoided for 24–48 hours
after IV tPA to reduce intracranial hemorrhage risk.
AGACNP: Comprehensive Midterm Practice Exam
(200 Questions with Answers & Explanations)
Content Area Key Focus
Pharmacokinetics & Absorption, distribution, metabolism, excretion; drug-receptor interaction
Pharmacodynamics
Cardiovascular Pharmacology Antihypertensives, antiplatelets, anticoagulants, heart failure medications
Antimicrobial Therapy Antibiotics, antifungals, antivirals; resistance mechanisms; stewardship
Endocrine Pharmacology Insulins, thyroid medications, adrenal disorders, diabetes emergencies
Neuropharmacology Antiepileptics, sedatives, neuromuscular blockers, pain management
Critical Care Pharmacology Vasopressors, sedation, electrolyte management, reversal agents
Hematology & Oncology Anticoagulation reversal, growth factors, chemotherapy agents
Special Populations Geriatrics, pregnancy, renal/hepatic impairment, pharmacogenomics
, Section 1: Pharmacokinetics & Pharmacodynamics
Q1. Which parameter primarily determines a drug's volume of distribution (Vd)? A)
Renal clearance
Pharmacokinetics & Pharmacodynamics
A 72-year-old patient with heart failure (EF 35%) is started on metoprolol succinate.
Which statement best describes the initiation of beta-blockers in this population?
A) Start at a high dose to achieve rapid heart rate control
B) Avoid in all patients with EF <40%
C) Start low, go slow, and titrate to target dose if tolerated
D) Use only if the patient has atrial fibrillation
Correct Answer: C
*Explanation: In chronic heart failure with reduced EF, beta-blockers (carvedilol,
metoprolol succinate, bisoprolol) reduce mortality and hospitalizations. Therapy must
start at very low doses and be up-titrated slowly every 2 weeks to avoid
decompensation.*
2. A patient with septic shock requires norepinephrine. What is the primary receptor
responsible for its vasopressor effect?
A) Beta-1 receptors
B) Beta-2 receptors
C) Alpha-1 receptors
D) Dopamine-1 receptors
,Correct Answer: C
*Explanation: Norepinephrine is a potent alpha-1 agonist causing vasoconstriction and
increased SVR. Beta-1 effects increase heart rate and contractility, but alpha-1 drives the
pressor response.*
3. Which antibiotic requires therapeutic drug monitoring to avoid ototoxicity and
nephrotoxicity?
A) Ceftriaxone
B) Vancomycin
C) Azithromycin
D) Doxycycline
Correct Answer: B
*Explanation: Vancomycin has a narrow therapeutic index. Trough levels (10–20 mcg/mL
for routine infections, 15–20 for MRSA pneumonia) guide dosing to minimize
nephrotoxicity and ototoxicity.*
4. A patient with acute kidney injury (AKI) has a creatinine clearance of 25 mL/min.
Which medication requires no dose adjustment?
A) Metformin
B) Apixaban
C) Levetiracetam
D) Ceftriaxone
Correct Answer: D
Explanation: Ceftriaxone is primarily hepatically excreted (40–50% unchanged in bile) and
does not require renal dose adjustment. Metformin, apixaban, and levetiracetam require
renal adjustment.
5. Which drug is the preferred initial agent for rate control in new-onset atrial fibrillation
with rapid ventricular response in a hemodynamically stable patient?
A) Metoprolol tartrate IV
, B) Amiodarone IV
C) Digoxin IV
D) Diltiazem bolus + infusion
Correct Answer: A
Explanation: For stable rapid AF, IV beta-blockers (metoprolol) or non-dihydropyridine
CCBs (diltiazem, verapamil) are first-line. Metoprolol is often preferred in HF or CAD.
Amiodarone is not first-line for rate control.
6. A patient on warfarin for mechanical mitral valve presents with INR 4.5 and minor
epistaxis. What is the best next step?
A) Vitamin K 10 mg IV
B) Fresh frozen plasma (FFP)
C) Hold warfarin and recheck INR tomorrow
D) Prothrombin complex concentrate (PCC)
Correct Answer: C
*Explanation: INR 4.5 without major bleeding → withhold warfarin, monitor INR. Vitamin
K is for major bleeding or very high INR (>10). FFP/PCC for life-threatening bleeding.*
7. Which medication is contraindicated within 48 hours of tPA administration for acute
ischemic stroke?
A) Enoxaparin
B) Aspirin
C) Clopidogrel
D) All of the above
Correct Answer: D
Explanation: Antithrombotics (antiplatelets, anticoagulants) are avoided for 24–48 hours
after IV tPA to reduce intracranial hemorrhage risk.
