NSG 533 ADVANCED PHARMACOLOGY EXAM 2 & FINAL
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Section 1: Pharmacokinetics & Pharmacodynamics - Advanced Concepts (Q1-15)
Q1. A 3-year-old child weighs 15 kg. The provider orders amoxicillin 50 mg/kg/day
divided BID for otitis media. How many milligrams should be administered per dose?
A. 187.5 mg
B. 375 mg
C. 750 mg
D. 1,500 mg
Correct Answer: B. 375 mg [CORRECT]
Rationale: 50 mg/kg/day × 15 kg = 750 mg/day; divided BID yields 375 mg per dose.
Option A represents a QID division, C is the total daily dose, and D is a tenfold
overdose.
Q2. A provider orders nitroglycerin 0.4 mg sublingual for acute angina rather than an
oral tablet. The primary pharmacokinetic rationale for this route selection is:
A. Avoidance of hepatic first-pass metabolism
B. Increased renal excretion
C. Enhanced plasma protein binding
D. Slower absorption for prolonged effect
Correct Answer: A. Avoidance of hepatic first-pass metabolism [CORRECT]
Rationale: Nitroglycerin undergoes extensive hepatic first-pass metabolism, yielding
near-zero oral bioavailability; sublingual administration bypasses the portal
circulation. Options B, C, and D describe irrelevant or opposite pharmacokinetic
effects.
,Q3. A patient stabilized on warfarin is started on fluconazole for esophageal
candidiasis. The APRN should anticipate which clinically significant interaction?
A. Decreased INR due to CYP2C9 induction
B. Increased INR and bleeding risk due to CYP2C9 inhibition
C. No interaction because warfarin is renally cleared
D. Decreased warfarin absorption due to fluconazole chelation
Correct Answer: B. Increased INR and bleeding risk due to CYP2C9 inhibition
[CORRECT]
Rationale: Fluconazole inhibits CYP2C9, reducing warfarin metabolism and increasing
anticoagulant effect. Warfarin is hepatically metabolized, not renally cleared (C), and
fluconazole does not chelate warfarin (D).
Q4. A 68-year-old male with type 2 diabetes has an eGFR of 25 mL/min/1.73m².
Which adjustment is required for metformin prescribing?
A. No dose adjustment is necessary
B. Reduce the dose by 50% and monitor quarterly
C. Avoid metformin use due to contraindication and lactic acidosis risk
D. Switch to metformin extended-release 2,000 mg daily
Correct Answer: C. Avoid metformin use due to contraindication and lactic acidosis
risk [CORRECT]
Rationale: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m²
due to accumulation and lactic acidosis risk. No dose reduction (B) or formulation
change (D) is safe at this level of renal impairment.
Q5. Buprenorphine is classified as a partial agonist at mu-opioid receptors because it:
,A. Binds without producing any receptor response
B. Produces a submaximal response even at full receptor occupancy and can
antagonize full agonists
C. Stabilizes the inactive receptor conformation, reducing basal activity
D. Requires 100% receptor occupancy to produce any analgesic effect
Correct Answer: B. Produces a submaximal response even at full receptor occupancy
and can antagonize full agonists [CORRECT]
Rationale: Partial agonists have intermediate intrinsic activity; they activate receptors
but cannot produce the maximal effect of full agonists and may block full agonist
binding. Option A describes an antagonist, C an inverse agonist, and D
mischaracterizes receptor theory.
Q6. A patient taking combined oral contraceptives (ethinyl estradiol/norgestimate) is
started on carbamazepine for seizure control. The APRN counsels the patient that
contraceptive efficacy may decrease because carbamazepine is a:
A. CYP3A4 inhibitor that increases estrogen levels
B. CYP3A4 inducer that increases metabolism of the progestin and estrogen
C. CYP2D6 substrate with no interaction risk
D. P-glycoprotein inhibitor that reduces gut absorption
Correct Answer: B. CYP3A4 inducer that increases metabolism of the progestin and
estrogen [CORRECT]
Rationale: Carbamazepine induces CYP3A4, accelerating metabolism of oral
contraceptive steroids and reducing efficacy. It is not an inhibitor (A) or a CYP2D6
substrate without interaction (C).
Q7. A type 1 diabetic patient’s bedtime blood glucose is 280 mg/dL. The sliding scale
orders: 150–200 mg/dL: 2 units; 201–250 mg/dL: 4 units; 251–300 mg/dL: 6 units;
301–350 mg/dL: 8 units; >350 mg/dL: 10 units and call provider. How many units of
rapid-acting insulin should be administered?
, A. 2 units
B. 4 units
C. 6 units
D. 8 units
Correct Answer: C. 6 units [CORRECT]
Rationale: A blood glucose of 280 mg/dL falls within the 251–300 mg/dL range,
indicating 6 units. Option A corresponds to 150–200, B to 201–250, and D to 301–
350.
Q8. Which medication pair is correctly identified as having a narrow therapeutic
index, requiring routine drug level monitoring?
A. Amoxicillin and azithromycin
B. Digoxin and lithium
C. Metformin and lisinopril
D. Sertraline and buspirone
Correct Answer: B. Digoxin and lithium [CORRECT]
Rationale: Digoxin and lithium both have narrow therapeutic indices where small
concentration changes produce toxicity or therapeutic failure. The other options
include drugs with wide safety margins that do not require routine serum level
monitoring.
Q9. A patient asks why the pharmacy label on atorvastatin warns against consuming
grapefruit juice. The APRN explains that grapefruit inhibits which metabolic pathway,
increasing the risk of rhabdomyolysis?
A. CYP2D6
B. CYP3A4
C. CYP2C9
D. CYP1A2
GUIDE 2026/2027 | Complete Solution 100% Verified |
Pass Guaranteed - A+ Graded
Section 1: Pharmacokinetics & Pharmacodynamics - Advanced Concepts (Q1-15)
Q1. A 3-year-old child weighs 15 kg. The provider orders amoxicillin 50 mg/kg/day
divided BID for otitis media. How many milligrams should be administered per dose?
A. 187.5 mg
B. 375 mg
C. 750 mg
D. 1,500 mg
Correct Answer: B. 375 mg [CORRECT]
Rationale: 50 mg/kg/day × 15 kg = 750 mg/day; divided BID yields 375 mg per dose.
Option A represents a QID division, C is the total daily dose, and D is a tenfold
overdose.
Q2. A provider orders nitroglycerin 0.4 mg sublingual for acute angina rather than an
oral tablet. The primary pharmacokinetic rationale for this route selection is:
A. Avoidance of hepatic first-pass metabolism
B. Increased renal excretion
C. Enhanced plasma protein binding
D. Slower absorption for prolonged effect
Correct Answer: A. Avoidance of hepatic first-pass metabolism [CORRECT]
Rationale: Nitroglycerin undergoes extensive hepatic first-pass metabolism, yielding
near-zero oral bioavailability; sublingual administration bypasses the portal
circulation. Options B, C, and D describe irrelevant or opposite pharmacokinetic
effects.
,Q3. A patient stabilized on warfarin is started on fluconazole for esophageal
candidiasis. The APRN should anticipate which clinically significant interaction?
A. Decreased INR due to CYP2C9 induction
B. Increased INR and bleeding risk due to CYP2C9 inhibition
C. No interaction because warfarin is renally cleared
D. Decreased warfarin absorption due to fluconazole chelation
Correct Answer: B. Increased INR and bleeding risk due to CYP2C9 inhibition
[CORRECT]
Rationale: Fluconazole inhibits CYP2C9, reducing warfarin metabolism and increasing
anticoagulant effect. Warfarin is hepatically metabolized, not renally cleared (C), and
fluconazole does not chelate warfarin (D).
Q4. A 68-year-old male with type 2 diabetes has an eGFR of 25 mL/min/1.73m².
Which adjustment is required for metformin prescribing?
A. No dose adjustment is necessary
B. Reduce the dose by 50% and monitor quarterly
C. Avoid metformin use due to contraindication and lactic acidosis risk
D. Switch to metformin extended-release 2,000 mg daily
Correct Answer: C. Avoid metformin use due to contraindication and lactic acidosis
risk [CORRECT]
Rationale: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m²
due to accumulation and lactic acidosis risk. No dose reduction (B) or formulation
change (D) is safe at this level of renal impairment.
Q5. Buprenorphine is classified as a partial agonist at mu-opioid receptors because it:
,A. Binds without producing any receptor response
B. Produces a submaximal response even at full receptor occupancy and can
antagonize full agonists
C. Stabilizes the inactive receptor conformation, reducing basal activity
D. Requires 100% receptor occupancy to produce any analgesic effect
Correct Answer: B. Produces a submaximal response even at full receptor occupancy
and can antagonize full agonists [CORRECT]
Rationale: Partial agonists have intermediate intrinsic activity; they activate receptors
but cannot produce the maximal effect of full agonists and may block full agonist
binding. Option A describes an antagonist, C an inverse agonist, and D
mischaracterizes receptor theory.
Q6. A patient taking combined oral contraceptives (ethinyl estradiol/norgestimate) is
started on carbamazepine for seizure control. The APRN counsels the patient that
contraceptive efficacy may decrease because carbamazepine is a:
A. CYP3A4 inhibitor that increases estrogen levels
B. CYP3A4 inducer that increases metabolism of the progestin and estrogen
C. CYP2D6 substrate with no interaction risk
D. P-glycoprotein inhibitor that reduces gut absorption
Correct Answer: B. CYP3A4 inducer that increases metabolism of the progestin and
estrogen [CORRECT]
Rationale: Carbamazepine induces CYP3A4, accelerating metabolism of oral
contraceptive steroids and reducing efficacy. It is not an inhibitor (A) or a CYP2D6
substrate without interaction (C).
Q7. A type 1 diabetic patient’s bedtime blood glucose is 280 mg/dL. The sliding scale
orders: 150–200 mg/dL: 2 units; 201–250 mg/dL: 4 units; 251–300 mg/dL: 6 units;
301–350 mg/dL: 8 units; >350 mg/dL: 10 units and call provider. How many units of
rapid-acting insulin should be administered?
, A. 2 units
B. 4 units
C. 6 units
D. 8 units
Correct Answer: C. 6 units [CORRECT]
Rationale: A blood glucose of 280 mg/dL falls within the 251–300 mg/dL range,
indicating 6 units. Option A corresponds to 150–200, B to 201–250, and D to 301–
350.
Q8. Which medication pair is correctly identified as having a narrow therapeutic
index, requiring routine drug level monitoring?
A. Amoxicillin and azithromycin
B. Digoxin and lithium
C. Metformin and lisinopril
D. Sertraline and buspirone
Correct Answer: B. Digoxin and lithium [CORRECT]
Rationale: Digoxin and lithium both have narrow therapeutic indices where small
concentration changes produce toxicity or therapeutic failure. The other options
include drugs with wide safety margins that do not require routine serum level
monitoring.
Q9. A patient asks why the pharmacy label on atorvastatin warns against consuming
grapefruit juice. The APRN explains that grapefruit inhibits which metabolic pathway,
increasing the risk of rhabdomyolysis?
A. CYP2D6
B. CYP3A4
C. CYP2C9
D. CYP1A2
