NURS 5334 Advanced Pharmacology Quiz 2 | Questions and
Answers + Rationales | 2026/27 Updates | 100% Correct | UTA
Which of the following physiological changes associated with aging would most likely increase
the risk of digoxin toxicity?
A) Increased glomerular filtration rate
B) Decreased lean body mass
C) Increased hepatic blood flow
D) Decreased serum albumin
Correct Answer: Decreased serum albumin
Rationale: Aging is associated with decreased serum albumin levels. Digoxin is moderately
protein-bound; lower albumin levels increase the free, active fraction of the drug, leading to a
greater pharmacological effect and higher toxicity risk . Decreased lean body mass affects
volume of distribution, but hypoalbuminemia more directly impacts active drug levels for
protein-bound drugs.
A drug has a half-life of 24 hours. Approximately how many hours will it take for the drug to
reach steady state?
A) 24 hours
B) 48 hours
C) 120 hours
D) 240 hours
Correct Answer: 120 hours
,Rationale: Steady state is achieved after approximately 4-5 half-lives . With a half-life of 24
hours, 4-5 half-lives equal 96-120 hours. This principle determines dosing intervals and the time
to therapeutic effect, making it crucial for clinical prescribing.
A patient is prescribed a drug that is a weak acid (pKa 4.4). In which part of the gastrointestinal
tract will absorption be most rapid?
A) Mouth (pH 7.0)
B) Stomach (pH 1.5)
C) Duodenum (pH 6.0)
D) Colon (pH 7.5)
Correct Answer: Stomach (pH 1.5)
Rationale: Weak acids are best absorbed in acidic environments where they remain non-ionized
(lipid-soluble) . In the stomach's acidic pH, the drug is predominantly non-ionized, allowing for
passive diffusion across the gastric mucosa. In basic pH, weak acids become ionized, reducing
passive diffusion .
A patient with chronic kidney disease (Stage 4) is prescribed a medication that is primarily
renally excreted. The nurse anticipates that the patient will require which of the following?
A) A higher dose to achieve a therapeutic effect
B) A lower dose or longer dosing interval to prevent toxicity
C) The same dose as a patient with normal renal function
D) An increased frequency of administration
Correct Answer: A lower dose or longer dosing interval to prevent toxicity
,Rationale: In chronic kidney disease, renal clearance of drugs is significantly reduced, which
leads to drug accumulation and increased toxicity risk with standard doses . Therefore, the dose
must be reduced or the dosing interval extended to maintain therapeutic levels without toxicity.
A patient with liver failure is prescribed a drug with high hepatic extraction. What change in
bioavailability should the nurse anticipate?
A) Decreased bioavailability
B) Increased bioavailability
C) No change in bioavailability
D) Variable, depends on renal function
Correct Answer: Increased bioavailability
Rationale: High hepatic extraction drugs undergo extensive first-pass metabolism . Liver failure
reduces this first-pass effect, increasing the fraction of drug reaching systemic circulation and
thus increasing bioavailability and risk of toxicity . This requires dose adjustment.
Which pharmacokinetic process is primarily affected by a patient's decreased serum albumin?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Correct Answer: Distribution
Rationale: Albumin binds acidic drugs. Hypoalbuminemia results in more unbound (free) drug,
increasing the risk of adverse effects . This is a key pharmacodynamic consideration, especially
for highly protein-bound medications like warfarin and phenytoin .
, What is the primary mechanism by which angiotensin II contributes to hypertension?
A) Acts as a potent vasodilator to reduce peripheral resistance
B) Stimulates aldosterone release, promoting sodium and water retention
C) Blocks the release of antidiuretic hormone (ADH)
D) Directly stimulates the parasympathetic nervous system
Correct Answer: Stimulates aldosterone release, promoting sodium and water retention
Rationale: Angiotensin II is a potent vasoconstrictor and key RAAS component. It contributes to
hypertension by causing vasoconstriction and by stimulating adrenal aldosterone release .
Aldosterone promotes sodium and water reabsorption in the kidneys, increasing blood volume
and pressure.
Which antihypertensive drug class is most effective in reducing proteinuria in patients with
diabetic nephropathy?
A) Beta-blockers
B) Calcium channel blockers
C) ACE inhibitors
D) Alpha-blockers
Correct Answer: ACE inhibitors
Rationale: ACE inhibitors and ARBs are preferred for diabetic nephropathy due to
renoprotective effects, including significant reduction in proteinuria . They lower
intraglomerular pressure by dilating the efferent arteriole, reducing glomerular hyperfiltration
and slowing kidney disease progression .
Answers + Rationales | 2026/27 Updates | 100% Correct | UTA
Which of the following physiological changes associated with aging would most likely increase
the risk of digoxin toxicity?
A) Increased glomerular filtration rate
B) Decreased lean body mass
C) Increased hepatic blood flow
D) Decreased serum albumin
Correct Answer: Decreased serum albumin
Rationale: Aging is associated with decreased serum albumin levels. Digoxin is moderately
protein-bound; lower albumin levels increase the free, active fraction of the drug, leading to a
greater pharmacological effect and higher toxicity risk . Decreased lean body mass affects
volume of distribution, but hypoalbuminemia more directly impacts active drug levels for
protein-bound drugs.
A drug has a half-life of 24 hours. Approximately how many hours will it take for the drug to
reach steady state?
A) 24 hours
B) 48 hours
C) 120 hours
D) 240 hours
Correct Answer: 120 hours
,Rationale: Steady state is achieved after approximately 4-5 half-lives . With a half-life of 24
hours, 4-5 half-lives equal 96-120 hours. This principle determines dosing intervals and the time
to therapeutic effect, making it crucial for clinical prescribing.
A patient is prescribed a drug that is a weak acid (pKa 4.4). In which part of the gastrointestinal
tract will absorption be most rapid?
A) Mouth (pH 7.0)
B) Stomach (pH 1.5)
C) Duodenum (pH 6.0)
D) Colon (pH 7.5)
Correct Answer: Stomach (pH 1.5)
Rationale: Weak acids are best absorbed in acidic environments where they remain non-ionized
(lipid-soluble) . In the stomach's acidic pH, the drug is predominantly non-ionized, allowing for
passive diffusion across the gastric mucosa. In basic pH, weak acids become ionized, reducing
passive diffusion .
A patient with chronic kidney disease (Stage 4) is prescribed a medication that is primarily
renally excreted. The nurse anticipates that the patient will require which of the following?
A) A higher dose to achieve a therapeutic effect
B) A lower dose or longer dosing interval to prevent toxicity
C) The same dose as a patient with normal renal function
D) An increased frequency of administration
Correct Answer: A lower dose or longer dosing interval to prevent toxicity
,Rationale: In chronic kidney disease, renal clearance of drugs is significantly reduced, which
leads to drug accumulation and increased toxicity risk with standard doses . Therefore, the dose
must be reduced or the dosing interval extended to maintain therapeutic levels without toxicity.
A patient with liver failure is prescribed a drug with high hepatic extraction. What change in
bioavailability should the nurse anticipate?
A) Decreased bioavailability
B) Increased bioavailability
C) No change in bioavailability
D) Variable, depends on renal function
Correct Answer: Increased bioavailability
Rationale: High hepatic extraction drugs undergo extensive first-pass metabolism . Liver failure
reduces this first-pass effect, increasing the fraction of drug reaching systemic circulation and
thus increasing bioavailability and risk of toxicity . This requires dose adjustment.
Which pharmacokinetic process is primarily affected by a patient's decreased serum albumin?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Correct Answer: Distribution
Rationale: Albumin binds acidic drugs. Hypoalbuminemia results in more unbound (free) drug,
increasing the risk of adverse effects . This is a key pharmacodynamic consideration, especially
for highly protein-bound medications like warfarin and phenytoin .
, What is the primary mechanism by which angiotensin II contributes to hypertension?
A) Acts as a potent vasodilator to reduce peripheral resistance
B) Stimulates aldosterone release, promoting sodium and water retention
C) Blocks the release of antidiuretic hormone (ADH)
D) Directly stimulates the parasympathetic nervous system
Correct Answer: Stimulates aldosterone release, promoting sodium and water retention
Rationale: Angiotensin II is a potent vasoconstrictor and key RAAS component. It contributes to
hypertension by causing vasoconstriction and by stimulating adrenal aldosterone release .
Aldosterone promotes sodium and water reabsorption in the kidneys, increasing blood volume
and pressure.
Which antihypertensive drug class is most effective in reducing proteinuria in patients with
diabetic nephropathy?
A) Beta-blockers
B) Calcium channel blockers
C) ACE inhibitors
D) Alpha-blockers
Correct Answer: ACE inhibitors
Rationale: ACE inhibitors and ARBs are preferred for diabetic nephropathy due to
renoprotective effects, including significant reduction in proteinuria . They lower
intraglomerular pressure by dilating the efferent arteriole, reducing glomerular hyperfiltration
and slowing kidney disease progression .
