NURS 5334 Advanced Pharmacology Quiz 2 Actual
2026/2027 with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
EXAM INFORMATION
Total Questions: 67
Recommended Time: 100 Minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs)
Question Style: Scenario-Based, Applied, and Clinical Decision-Making Questions
Difficulty Level: Advanced
==============================
SECTION 1: Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics
Question 1
A 68-year-old male with atrial fibrillation on warfarin is started on rifampin for
tuberculosis. The nurse practitioner anticipates which change in warfarin dosing
requirements?
A. Decreased dose requirements due to inhibition of CYP2C9
B. Increased dose requirements due to induction of CYP1A2
C. Increased dose requirements due to induction of CYP2C9 and CYP3A4
D. No change in dose requirements because warfarin metabolism is unaffected by
rifampin
,Correct Answer: C
Rationale: Rifampin is a potent inducer of multiple cytochrome P450 enzymes, including
CYP2C9 and CYP3A4, which metabolize the S- and R-enantiomers of warfarin. This
increases warfarin clearance and reduces anticoagulant effect, necessitating dose
increases to maintain therapeutic INR. Options A and B misidentify the mechanism.
Option D is incorrect because rifampin significantly affects warfarin metabolism.
Question 2
A 55-year-old female with chronic kidney disease (eGFR 28 mL/min) is prescribed
gabapentin for neuropathic pain. Which adjustment is most appropriate?
A. No adjustment needed; gabapentin is hepatically metabolized
B. Reduce the dose and extend the dosing interval due to renal elimination
C. Increase the dose to compensate for decreased bioavailability in CKD
D. Switch to pregabalin because it does not require renal adjustment
Correct Answer: B
Rationale: Gabapentin is renally eliminated unchanged. In CKD stage 4, dose reduction
and/or extended dosing intervals are required to prevent accumulation and
neurotoxicity. It is not hepatically metabolized. Pregabalin also requires renal dose
adjustment and is not an automatic substitute.
,Question 3
A patient with major depressive disorder is found to be a CYP2D6 poor metabolizer
based on pharmacogenomic testing. Which antidepressant would require the most
significant dose reduction to avoid toxicity?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Citalopram
Correct Answer: C
Rationale: Venlafaxine is primarily metabolized by CYP2D6 to its active metabolite
O-desmethylvenlafaxine. CYP2D6 poor metabolizers have significantly reduced
clearance and increased parent drug exposure, increasing the risk of adverse effects.
While fluoxetine is a CYP2D6 substrate and inhibitor, venlafaxine pharmacokinetics are
most dramatically altered by CYP2D6 poor metabolizer status.
Question 4
A patient taking levothyroxine 125 mcg daily begins consuming soy milk with breakfast
and dinner. At the 8-week follow-up, the TSH is elevated to 9.2 mIU/L despite adherence.
Which mechanism explains this finding?
A. Increased levothyroxine absorption due to phytoestrogen enhancement
B. Decreased levothyroxine absorption due to binding in the gastrointestinal tract
, C. Increased T4 to T3 conversion in peripheral tissues
D. No effect because soy products do not interact with thyroid hormone
Correct Answer: B
Rationale: Soy products contain compounds that bind levothyroxine in the
gastrointestinal tract, reducing absorption. Levothyroxine should be taken on an empty
stomach and separated from soy products, calcium, and iron by at least 4 hours. The
elevated TSH indicates inadequate thyroid hormone replacement.
Question 5
A patient on a highly protein-bound drug (greater than 90%) has albumin levels of 2.6
g/dL. The total drug concentration is within the therapeutic range, but the patient
exhibits signs of toxicity. Which pharmacokinetic principle explains this?
A. Increased free drug concentration due to decreased protein binding
B. Decreased free drug concentration due to increased protein binding
C. Increased drug metabolism due to hepatic enzyme induction
D. Decreased drug volume of distribution due to hypoalbuminemia
Correct Answer: A
Rationale: Hypoalbuminemia reduces protein binding, increasing the free (unbound)
fraction of highly protein-bound drugs. Since only free drug is pharmacologically active
2026/2027 with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
EXAM INFORMATION
Total Questions: 67
Recommended Time: 100 Minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs)
Question Style: Scenario-Based, Applied, and Clinical Decision-Making Questions
Difficulty Level: Advanced
==============================
SECTION 1: Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics
Question 1
A 68-year-old male with atrial fibrillation on warfarin is started on rifampin for
tuberculosis. The nurse practitioner anticipates which change in warfarin dosing
requirements?
A. Decreased dose requirements due to inhibition of CYP2C9
B. Increased dose requirements due to induction of CYP1A2
C. Increased dose requirements due to induction of CYP2C9 and CYP3A4
D. No change in dose requirements because warfarin metabolism is unaffected by
rifampin
,Correct Answer: C
Rationale: Rifampin is a potent inducer of multiple cytochrome P450 enzymes, including
CYP2C9 and CYP3A4, which metabolize the S- and R-enantiomers of warfarin. This
increases warfarin clearance and reduces anticoagulant effect, necessitating dose
increases to maintain therapeutic INR. Options A and B misidentify the mechanism.
Option D is incorrect because rifampin significantly affects warfarin metabolism.
Question 2
A 55-year-old female with chronic kidney disease (eGFR 28 mL/min) is prescribed
gabapentin for neuropathic pain. Which adjustment is most appropriate?
A. No adjustment needed; gabapentin is hepatically metabolized
B. Reduce the dose and extend the dosing interval due to renal elimination
C. Increase the dose to compensate for decreased bioavailability in CKD
D. Switch to pregabalin because it does not require renal adjustment
Correct Answer: B
Rationale: Gabapentin is renally eliminated unchanged. In CKD stage 4, dose reduction
and/or extended dosing intervals are required to prevent accumulation and
neurotoxicity. It is not hepatically metabolized. Pregabalin also requires renal dose
adjustment and is not an automatic substitute.
,Question 3
A patient with major depressive disorder is found to be a CYP2D6 poor metabolizer
based on pharmacogenomic testing. Which antidepressant would require the most
significant dose reduction to avoid toxicity?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Citalopram
Correct Answer: C
Rationale: Venlafaxine is primarily metabolized by CYP2D6 to its active metabolite
O-desmethylvenlafaxine. CYP2D6 poor metabolizers have significantly reduced
clearance and increased parent drug exposure, increasing the risk of adverse effects.
While fluoxetine is a CYP2D6 substrate and inhibitor, venlafaxine pharmacokinetics are
most dramatically altered by CYP2D6 poor metabolizer status.
Question 4
A patient taking levothyroxine 125 mcg daily begins consuming soy milk with breakfast
and dinner. At the 8-week follow-up, the TSH is elevated to 9.2 mIU/L despite adherence.
Which mechanism explains this finding?
A. Increased levothyroxine absorption due to phytoestrogen enhancement
B. Decreased levothyroxine absorption due to binding in the gastrointestinal tract
, C. Increased T4 to T3 conversion in peripheral tissues
D. No effect because soy products do not interact with thyroid hormone
Correct Answer: B
Rationale: Soy products contain compounds that bind levothyroxine in the
gastrointestinal tract, reducing absorption. Levothyroxine should be taken on an empty
stomach and separated from soy products, calcium, and iron by at least 4 hours. The
elevated TSH indicates inadequate thyroid hormone replacement.
Question 5
A patient on a highly protein-bound drug (greater than 90%) has albumin levels of 2.6
g/dL. The total drug concentration is within the therapeutic range, but the patient
exhibits signs of toxicity. Which pharmacokinetic principle explains this?
A. Increased free drug concentration due to decreased protein binding
B. Decreased free drug concentration due to increased protein binding
C. Increased drug metabolism due to hepatic enzyme induction
D. Decreased drug volume of distribution due to hypoalbuminemia
Correct Answer: A
Rationale: Hypoalbuminemia reduces protein binding, increasing the free (unbound)
fraction of highly protein-bound drugs. Since only free drug is pharmacologically active
