NURS 5334 ADVANCED PHARMACOLOGY FOR NPS
— FINAL EXAM Actual Exam Complete Questions
and Detailed Rationales Graded A+ Pass
Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Pharmacokinetics & Pharmacodynamics | Q1 – Q10
Section 2 | Autonomic & Cardiovascular Pharmacology | Q11 – Q20
Section 3 | CNS & Psychopharmacology | Q21 – Q30
Section 4 | Endocrine, Anti-Infective & Immunologic | Q31 – Q40
Section 5 | Special Populations & Pain Management | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old patient with chronic kidney disease (eGFR 28 mL/min) is prescribed
cephalexin 500 mg every 6 hours for a skin infection. The nurse practitioner reviews the
pharmacokinetic profile and notes the drug is primarily renally excreted unchanged.
Which adjustment is most appropriate?
A. Reduce the dose to 250 mg every 6 hours and monitor renal function
B. Extend the interval to 500 mg every 12 hours ✓ CORRECT
C. Switch to amoxicillin-clavulanate 875/125 mg every 12 hours
D. Continue the current dose and increase fluid intake to 3 liters daily
,Correct Answer: B
Rationale: Cephalexin is excreted unchanged by the kidneys, and reducing the dosing
interval preserves peak concentrations while allowing adequate drug clearance in
impaired renal function. Option A reduces the dose but maintains frequent
administration, which may lead to accumulation. Amoxicillin-clavulanate is also renally
cleared and would require similar adjustment.
Question 2 of 50
A 45-year-old patient on long-term phenytoin therapy for seizure control presents with
worsening osteopenia. The patient's total phenytoin level is 18 mcg/mL, but the free
phenytoin level is elevated at 3.2 mcg/mL. Which pharmacokinetic principle explains
this finding?
A. Phenytoin displaces albumin-bound calcium, increasing free drug concentration
B. Phenytoin induces its own metabolism, reducing protein synthesis over time ✓
CORRECT
C. Phenytoin has nonlinear pharmacokinetics, causing unpredictable free fractions
D. The patient has developed hypoalbuminemia, reducing binding sites for phenytoin
Correct Answer: B
Rationale: Chronic phenytoin use induces hepatic enzyme production, including those
involved in protein synthesis, leading to reduced albumin and increased free drug
fraction despite normal total levels. Option A confuses calcium metabolism with drug
binding. Nonlinear kinetics refers to dose-dependent clearance, not protein binding
changes.
Question 3 of 50
A 58-year-old patient with atrial fibrillation on warfarin 5 mg daily presents with an INR
of 4.2 after starting a 5-day course of ciprofloxacin for a urinary tract infection. The
, patient denies bleeding and has no dietary changes. Which mechanism best explains
this interaction?
A. Ciprofloxacin inhibits CYP2C9, reducing warfarin metabolism ✓ CORRECT
B. Ciprofloxacin displaces warfarin from albumin binding sites
C. Ciprofloxacin induces vitamin K synthesis by gut flora
D. Ciprofloxacin enhances warfarin absorption from the gastrointestinal tract
Correct Answer: A
Rationale: Fluoroquinolones inhibit CYP2C9, the primary enzyme metabolizing
S-warfarin, leading to increased warfarin levels and elevated INR. Option B is incorrect
because warfarin is highly protein-bound but not significantly displaced by ciprofloxacin.
Ciprofloxacin actually suppresses gut flora that produce vitamin K, which would
increase INR rather than decrease it.
Question 4 of 50
A 34-year-old patient with HIV is starting efavirenz-based antiretroviral therapy. The
pharmacist warns that this medication has a long half-life and can accumulate. Which
clinical consequence is most likely during the first 2 weeks of therapy?
A. Early virologic failure due to subtherapeutic peak concentrations
B. Central nervous system side effects including vivid dreams and dizziness ✓
CORRECT
C. Nephrotoxicity from delayed renal clearance of the drug
D. Hypersensitivity reaction from rapid immune reconstitution
Correct Answer: B
Rationale: Efavirenz crosses the blood-brain barrier and causes neuropsychiatric effects
that are dose- and concentration-dependent, often peaking during the accumulation
phase. Option A is unlikely with appropriate dosing. Efavirenz is not nephrotoxic, and
immune reconstitution inflammatory syndrome occurs later with viral suppression.
Question 5 of 50
— FINAL EXAM Actual Exam Complete Questions
and Detailed Rationales Graded A+ Pass
Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Pharmacokinetics & Pharmacodynamics | Q1 – Q10
Section 2 | Autonomic & Cardiovascular Pharmacology | Q11 – Q20
Section 3 | CNS & Psychopharmacology | Q21 – Q30
Section 4 | Endocrine, Anti-Infective & Immunologic | Q31 – Q40
Section 5 | Special Populations & Pain Management | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old patient with chronic kidney disease (eGFR 28 mL/min) is prescribed
cephalexin 500 mg every 6 hours for a skin infection. The nurse practitioner reviews the
pharmacokinetic profile and notes the drug is primarily renally excreted unchanged.
Which adjustment is most appropriate?
A. Reduce the dose to 250 mg every 6 hours and monitor renal function
B. Extend the interval to 500 mg every 12 hours ✓ CORRECT
C. Switch to amoxicillin-clavulanate 875/125 mg every 12 hours
D. Continue the current dose and increase fluid intake to 3 liters daily
,Correct Answer: B
Rationale: Cephalexin is excreted unchanged by the kidneys, and reducing the dosing
interval preserves peak concentrations while allowing adequate drug clearance in
impaired renal function. Option A reduces the dose but maintains frequent
administration, which may lead to accumulation. Amoxicillin-clavulanate is also renally
cleared and would require similar adjustment.
Question 2 of 50
A 45-year-old patient on long-term phenytoin therapy for seizure control presents with
worsening osteopenia. The patient's total phenytoin level is 18 mcg/mL, but the free
phenytoin level is elevated at 3.2 mcg/mL. Which pharmacokinetic principle explains
this finding?
A. Phenytoin displaces albumin-bound calcium, increasing free drug concentration
B. Phenytoin induces its own metabolism, reducing protein synthesis over time ✓
CORRECT
C. Phenytoin has nonlinear pharmacokinetics, causing unpredictable free fractions
D. The patient has developed hypoalbuminemia, reducing binding sites for phenytoin
Correct Answer: B
Rationale: Chronic phenytoin use induces hepatic enzyme production, including those
involved in protein synthesis, leading to reduced albumin and increased free drug
fraction despite normal total levels. Option A confuses calcium metabolism with drug
binding. Nonlinear kinetics refers to dose-dependent clearance, not protein binding
changes.
Question 3 of 50
A 58-year-old patient with atrial fibrillation on warfarin 5 mg daily presents with an INR
of 4.2 after starting a 5-day course of ciprofloxacin for a urinary tract infection. The
, patient denies bleeding and has no dietary changes. Which mechanism best explains
this interaction?
A. Ciprofloxacin inhibits CYP2C9, reducing warfarin metabolism ✓ CORRECT
B. Ciprofloxacin displaces warfarin from albumin binding sites
C. Ciprofloxacin induces vitamin K synthesis by gut flora
D. Ciprofloxacin enhances warfarin absorption from the gastrointestinal tract
Correct Answer: A
Rationale: Fluoroquinolones inhibit CYP2C9, the primary enzyme metabolizing
S-warfarin, leading to increased warfarin levels and elevated INR. Option B is incorrect
because warfarin is highly protein-bound but not significantly displaced by ciprofloxacin.
Ciprofloxacin actually suppresses gut flora that produce vitamin K, which would
increase INR rather than decrease it.
Question 4 of 50
A 34-year-old patient with HIV is starting efavirenz-based antiretroviral therapy. The
pharmacist warns that this medication has a long half-life and can accumulate. Which
clinical consequence is most likely during the first 2 weeks of therapy?
A. Early virologic failure due to subtherapeutic peak concentrations
B. Central nervous system side effects including vivid dreams and dizziness ✓
CORRECT
C. Nephrotoxicity from delayed renal clearance of the drug
D. Hypersensitivity reaction from rapid immune reconstitution
Correct Answer: B
Rationale: Efavirenz crosses the blood-brain barrier and causes neuropsychiatric effects
that are dose- and concentration-dependent, often peaking during the accumulation
phase. Option A is unlikely with appropriate dosing. Efavirenz is not nephrotoxic, and
immune reconstitution inflammatory syndrome occurs later with viral suppression.
Question 5 of 50
