NURS 6521 Midterm Exam 2026 Update: Advanced Pharmacology Practice Questions with Complete
Solutions and Rationales for Nurse Practitioners Mastering Drug Therapy, Safety, and Prescriptive
Reasoning.
Combined Edition – Questions 1–150 (Multiple Choice, Answers +
Explanations)
1. A patient with heart failure is prescribed digoxin. Which finding suggests toxicity?
A) Heart rate 72 bpm
B) Serum potassium 4.0 mEq/L
C) Yellow vision and nausea
D) Blood pressure 120/80 mmHg
Correct Answer: C – Yellow vision (xanthopsia), nausea, vomiting, and bradycardia are classic signs of
digoxin toxicity.
2. Which drug class is first-line for stable angina?
A) Calcium channel blockers
B) Beta-blockers
C) Nitrates
D) ACE inhibitors
Correct Answer: B – Beta-blockers reduce myocardial oxygen demand by decreasing heart rate and
contractility.
3. A patient on warfarin has an INR of 4.5 with bleeding. What should be given?
A) Vitamin K
B) Protamine sulfate
C) Fresh frozen plasma
D) Aminocaproic acid
Correct Answer: A – Vitamin K reverses warfarin’s anticoagulant effect. For life-threatening bleeding,
fresh frozen plasma is added.
,4. Which medication is used to reverse heparin overdose?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Flumazenil
Correct Answer: B – Protamine sulfate binds heparin, neutralizing its anticoagulant effect.
5. A patient on lithium reports tremor, nausea, and confusion. Lithium level is 2.0 mEq/L. What is
the priority?
A) Increase fluids
B) Hold lithium and assess renal function
C) Add haloperidol
D) Give sodium bicarbonate
Correct Answer: B – Lithium levels >1.5 mEq/L indicate toxicity. Hold the drug and assess renal
function.
6. Which antibiotic is contraindicated in children under 8 years old?
A) Amoxicillin
B) Azithromycin
C) Tetracycline
D) Cephalexin
Correct Answer: C – Tetracycline causes permanent tooth discoloration and enamel hypoplasia in
children under 8.
7. A patient starts sertraline. When is the maximal therapeutic effect expected?
A) 24 hours
B) 3 days
C) 2–4 weeks
D) 12 hours
Correct Answer: C – SSRIs require 2–4 weeks of daily dosing to achieve full antidepressant effect.
8. A nurse administers furosemide IV push too quickly. What complication may occur?
A) Hyperkalemia
B) Ototoxicity
,C) Hypertension
D) Hypoglycemia
Correct Answer: B – Rapid IV furosemide (>4 mg/min) can cause irreversible ototoxicity.
9. Which drug is most likely to cause QTc prolongation?
A) Metformin
B) Ciprofloxacin
C) Lisinopril
D) Acetaminophen
Correct Answer: B – Fluoroquinolones (ciprofloxacin, levofloxacin) prolong the QTc interval.
10. A patient with asthma is prescribed propranolol. What is the risk?
A) Bronchospasm
B) Tachycardia
C) Hypoglycemia
D) Diarrhea
Correct Answer: A – Non-selective beta-blockers (propranolol) block beta-2 receptors in the lungs,
causing bronchospasm.
11. Which medication is used for opioid-induced constipation?
A) Naloxone
B) Methylnaltrexone
C) Buprenorphine
D) Methadone
Correct Answer: B – Methylnaltrexone is a peripheral opioid antagonist that does not cross the blood-
brain barrier.
12. A patient takes levodopa/carbidopa. Adding which drug can worsen Parkinson’s symptoms?
A) Vitamin B6
B) Anticholinergics
C) Antipsychotics (haloperidol)
D) MAO-B inhibitors
Correct Answer: C – Antipsychotics block dopamine D2 receptors, counteracting levodopa’s effects.
, 13. A pregnant patient needs an ACE inhibitor. What is true?
A) Safe in all trimesters
B) Contraindicated in second and third trimesters
C) First-line for pregnancy hypertension
D) No risk to fetus
Correct Answer: B – ACE inhibitors cause fetal renal agenesis, oligohydramnios, and neonatal death in
the second and third trimesters.
14. Which drug requires a low-tyramine diet?
A) Fluoxetine
B) Phenelzine
C) Bupropion
D) Trazodone
Correct Answer: B – Phenelzine (MAOI) with tyramine-rich foods causes hypertensive crisis.
15. A patient on amiodarone develops cough and dyspnea. What is most likely?
A) Heart failure
B) Pulmonary fibrosis
C) Asthma exacerbation
D) Pneumonia
Correct Answer: B – Amiodarone causes pulmonary toxicity (interstitial pneumonitis, pulmonary
fibrosis).
16. What is the antidote for benzodiazepine overdose?
A) Naloxone
B) Flumazenil
C) Activated charcoal
D) Atropine
Correct Answer: B – Flumazenil is a competitive benzodiazepine antagonist.
17. A patient on metformin is scheduled for IV contrast. What should be done?
A) Give metformin as usual
B) Hold metformin 48 hours before and after contrast
Solutions and Rationales for Nurse Practitioners Mastering Drug Therapy, Safety, and Prescriptive
Reasoning.
Combined Edition – Questions 1–150 (Multiple Choice, Answers +
Explanations)
1. A patient with heart failure is prescribed digoxin. Which finding suggests toxicity?
A) Heart rate 72 bpm
B) Serum potassium 4.0 mEq/L
C) Yellow vision and nausea
D) Blood pressure 120/80 mmHg
Correct Answer: C – Yellow vision (xanthopsia), nausea, vomiting, and bradycardia are classic signs of
digoxin toxicity.
2. Which drug class is first-line for stable angina?
A) Calcium channel blockers
B) Beta-blockers
C) Nitrates
D) ACE inhibitors
Correct Answer: B – Beta-blockers reduce myocardial oxygen demand by decreasing heart rate and
contractility.
3. A patient on warfarin has an INR of 4.5 with bleeding. What should be given?
A) Vitamin K
B) Protamine sulfate
C) Fresh frozen plasma
D) Aminocaproic acid
Correct Answer: A – Vitamin K reverses warfarin’s anticoagulant effect. For life-threatening bleeding,
fresh frozen plasma is added.
,4. Which medication is used to reverse heparin overdose?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Flumazenil
Correct Answer: B – Protamine sulfate binds heparin, neutralizing its anticoagulant effect.
5. A patient on lithium reports tremor, nausea, and confusion. Lithium level is 2.0 mEq/L. What is
the priority?
A) Increase fluids
B) Hold lithium and assess renal function
C) Add haloperidol
D) Give sodium bicarbonate
Correct Answer: B – Lithium levels >1.5 mEq/L indicate toxicity. Hold the drug and assess renal
function.
6. Which antibiotic is contraindicated in children under 8 years old?
A) Amoxicillin
B) Azithromycin
C) Tetracycline
D) Cephalexin
Correct Answer: C – Tetracycline causes permanent tooth discoloration and enamel hypoplasia in
children under 8.
7. A patient starts sertraline. When is the maximal therapeutic effect expected?
A) 24 hours
B) 3 days
C) 2–4 weeks
D) 12 hours
Correct Answer: C – SSRIs require 2–4 weeks of daily dosing to achieve full antidepressant effect.
8. A nurse administers furosemide IV push too quickly. What complication may occur?
A) Hyperkalemia
B) Ototoxicity
,C) Hypertension
D) Hypoglycemia
Correct Answer: B – Rapid IV furosemide (>4 mg/min) can cause irreversible ototoxicity.
9. Which drug is most likely to cause QTc prolongation?
A) Metformin
B) Ciprofloxacin
C) Lisinopril
D) Acetaminophen
Correct Answer: B – Fluoroquinolones (ciprofloxacin, levofloxacin) prolong the QTc interval.
10. A patient with asthma is prescribed propranolol. What is the risk?
A) Bronchospasm
B) Tachycardia
C) Hypoglycemia
D) Diarrhea
Correct Answer: A – Non-selective beta-blockers (propranolol) block beta-2 receptors in the lungs,
causing bronchospasm.
11. Which medication is used for opioid-induced constipation?
A) Naloxone
B) Methylnaltrexone
C) Buprenorphine
D) Methadone
Correct Answer: B – Methylnaltrexone is a peripheral opioid antagonist that does not cross the blood-
brain barrier.
12. A patient takes levodopa/carbidopa. Adding which drug can worsen Parkinson’s symptoms?
A) Vitamin B6
B) Anticholinergics
C) Antipsychotics (haloperidol)
D) MAO-B inhibitors
Correct Answer: C – Antipsychotics block dopamine D2 receptors, counteracting levodopa’s effects.
, 13. A pregnant patient needs an ACE inhibitor. What is true?
A) Safe in all trimesters
B) Contraindicated in second and third trimesters
C) First-line for pregnancy hypertension
D) No risk to fetus
Correct Answer: B – ACE inhibitors cause fetal renal agenesis, oligohydramnios, and neonatal death in
the second and third trimesters.
14. Which drug requires a low-tyramine diet?
A) Fluoxetine
B) Phenelzine
C) Bupropion
D) Trazodone
Correct Answer: B – Phenelzine (MAOI) with tyramine-rich foods causes hypertensive crisis.
15. A patient on amiodarone develops cough and dyspnea. What is most likely?
A) Heart failure
B) Pulmonary fibrosis
C) Asthma exacerbation
D) Pneumonia
Correct Answer: B – Amiodarone causes pulmonary toxicity (interstitial pneumonitis, pulmonary
fibrosis).
16. What is the antidote for benzodiazepine overdose?
A) Naloxone
B) Flumazenil
C) Activated charcoal
D) Atropine
Correct Answer: B – Flumazenil is a competitive benzodiazepine antagonist.
17. A patient on metformin is scheduled for IV contrast. What should be done?
A) Give metformin as usual
B) Hold metformin 48 hours before and after contrast
