1
NURS 5334 EXAM 2 2026/2027 | Advanced
Pharmacology Guide | UTA | 100% Verified Q&A |
Grade A | Pass Guaranteed - A+ Graded
Section 1: Pharmacokinetics & Pharmacodynamics (15 Questions)
Q1: A 68-year-old male with creatinine clearance (CrCl) of 25 mL/min is prescribed
gentamicin. The desired peak concentration is 8 mcg/mL, volume of distribution (Vd)
is 0.25 L/kg, and the patient weighs 70 kg. Using the formula Loading Dose = Desired
Concentration × Vd, what is the appropriate loading dose?
A. 100 mg
B. 120 mg
C. 140 mg [CORRECT]
D. 160 mg
Correct Answer: C
Rationale: Formula: Loading Dose = Cp × Vd. Calculation: Vd = 0.25 L/kg × 70 kg =
17.5 L. Loading Dose = 8 mcg/mL × 17.5 L = 8 mg/L × 17.5 L = 140 mg. A represents
a Vd calculation error using 0.20 L/kg. B reflects an arithmetic error in unit
conversion. D uses an incorrect desired peak of 10 mcg/mL. Clinical significance:
Accurate loading dose calculation prevents subtherapeutic peaks in sepsis while
avoiding nephrotoxicity in renal impairment.
UTA NURS 5334 Competency: Apply pharmacokinetic principles to calculate
individualized drug dosing.
AACN DNP Essential: Essential III – Clinical Scholarship and Analytical Methods for
Evidence-Based Practice.
Q2: A patient on warfarin has a CYP2C9*2/*3 genotype and VKORC1 -1639A/A
genotype. Which pharmacogenomic-guided dosing adjustment is most appropriate
for initiating therapy?
A. Use standard 5 mg daily dosing
B. Reduce initial dose by 50% and monitor INR closely [CORRECT]
C. Switch to dabigatran due to guaranteed warfarin resistance
D. Increase dose to 10 mg daily to overcome genetic slow metabolism
Correct Answer: B
Rationale: The CYP2C9*2/*3 genotype indicates reduced enzyme activity (poor
metabolizer), and VKORC1 -1639A/A confers increased warfarin sensitivity.
,2
Combined, these polymorphisms significantly increase bleeding risk at standard
doses. A is incorrect because standard dosing ignores pharmacogenomic risk. C is
incorrect because warfarin remains effective with genotype-guided dosing; switching
is unnecessary. D is dangerously incorrect as it would precipitate hemorrhage.
Clinical significance: FDA labeling and CPIC guidelines recommend 50% dose
reduction with close INR monitoring for this genotype combination.
UTA NURS 5334 Competency: Integrate pharmacogenomic data into therapeutic
decision-making.
AACN DNP Essential: Essential I – Scientific Underpinnings for Practice.
Q3: A 45-year-old patient with normal hepatic function receives a drug with a half-
life of 8 hours. How long will it take to reach approximately 94% of steady-state
concentration with continuous infusion?
A. 16 hours
B. 24 hours
C. 32 hours [CORRECT]
D. 40 hours
Correct Answer: C
Rationale: Steady-state is reached after approximately 4 to 5 half-lives. At 4 half-lives
(32 hours), 94% of steady-state is achieved (1 - 0.5^4 = 0.9375). A represents only 2
half-lives (75% steady-state). B represents 3 half-lives (87.5% steady-state). D
represents 5 half-lives (97% steady-state). Clinical significance: Understanding time to
steady-state prevents premature dose adjustments and therapeutic failure.
UTA NURS 5334 Competency: Apply pharmacokinetic principles to predict drug
accumulation and steady-state.
AACN DNP Essential: Essential III – Clinical Scholarship and Analytical Methods for
Evidence-Based Practice.
Q4: A patient with a TPMT*3A/*3A genotype is prescribed azathioprine for
autoimmune disease. Which prescribing action is most appropriate?
A. Prescribe standard 2.5 mg/kg daily dosing
B. Reduce dose to 25-33% of standard and monitor CBC closely [CORRECT]
C. Avoid azathioprine entirely and select methotrexate instead
D. Prescribe allopurinol concurrently to enhance metabolism
Correct Answer: B
Rationale: TPMT*3A/*3A indicates deficient thiopurine methyltransferase activity,
causing toxic accumulation of 6-thioguanine nucleotides and severe
,3
myelosuppression at standard doses. A is incorrect and dangerous due to high
pancytopenia risk. C is unnecessary because azathioprine remains effective at
reduced doses per CPIC guidelines. D is incorrect because allopurinol inhibits
xanthine oxidase, further increasing 6-MP toxicity rather than enhancing metabolism.
Clinical significance: Pharmacogenomic testing prevents life-threatening bone
marrow suppression.
UTA NURS 5334 Competency: Apply pharmacogenomic principles to prevent adverse
drug reactions.
AACN DNP Essential: Essential I – Scientific Underpinnings for Practice.
Q5: Which pharmacodynamic principle best explains why a partial agonist produces
a lower maximum effect than a full agonist at the same receptor?
A. Reduced receptor affinity
B. Lower intrinsic activity [CORRECT]
C. Competitive antagonism
D. Increased receptor downregulation
Correct Answer: B
Rationale: Intrinsic activity (efficacy) determines the magnitude of response a drug
produces when bound to a receptor. Partial agonists have lower intrinsic activity than
full agonists, resulting in a lower Emax despite similar receptor affinity. A is incorrect
because partial agonists may have high affinity. C describes antagonist behavior, not
partial agonism. D refers to a chronic adaptive response, not the fundamental
pharmacodynamic property. Clinical significance: Understanding intrinsic activity
explains why buprenorphine (partial mu agonist) has ceiling effects for respiratory
depression compared to full agonists.
UTA NURS 5334 Competency: Analyze pharmacodynamic principles governing drug-
receptor interactions.
AACN DNP Essential: Essential I – Scientific Underpinnings for Practice.
Q6: A 78-year-old patient with CrCl 30 mL/min requires dosing adjustment for a
renally eliminated drug with normal maintenance dose of 200 mg every 12 hours.
Using the Cockcroft-Gault adjustment formula (Adjusted Dose = Normal Dose ×
[Patient CrCl / Normal CrCl]), what is the appropriate adjusted dose if normal CrCl is
assumed at 100 mL/min?
A. 50 mg every 12 hours
B. 60 mg every 12 hours [CORRECT]
, 4
C. 100 mg every 12 hours
D. 150 mg every 12 hours
Correct Answer: B
Rationale: Formula: Adjusted Dose = 200 mg × (30/100) = 60 mg every 12 hours. A
represents an error using 25 mL/min. C represents failure to adjust dose, risking drug
accumulation. D represents an incorrect calculation using 75% of normal dose.
Clinical significance: Accurate renal dose adjustment prevents toxicity in elderly
patients with declining renal function.
UTA NURS 5334 Competency: Apply pharmacokinetic principles to adjust dosing in
renal impairment.
AACN DNP Essential: Essential VIII – Advanced Nursing Practice.
Q7: A patient with a CYP2D6 poor metabolizer phenotype is prescribed tramadol for
postoperative pain. Which clinical outcome is most likely?
A. Enhanced analgesic effect due to increased parent drug levels
B. Reduced analgesia due to impaired conversion to active O-desmethyltramadol
[CORRECT]
C. Increased risk of serotonin syndrome only
D. No change in therapeutic effect
Correct Answer: B
Rationale: Tramadol requires CYP2D6-mediated O-demethylation to form the active
metabolite O-desmethyltramadol (M1), which has 200-fold greater mu-opioid
affinity. Poor metabolizers cannot efficiently convert tramadol, resulting in
inadequate analgesia. A is incorrect because parent drug alone provides minimal
opioid effect. C is partially true but secondary to the primary therapeutic failure. D is
incorrect because CYP2D6 polymorphism significantly alters tramadol efficacy.
Clinical significance: Alternative analgesics (morphine, oxycodone) should be
considered for CYP2D6 poor metabolizers.
UTA NURS 5334 Competency: Apply pharmacogenomic principles to optimize
analgesic therapy.
AACN DNP Essential: Essential I – Scientific Underpinnings for Practice.
Q8: Which statement correctly differentiates potency from efficacy in
pharmacodynamics?
A. Potency is the maximum effect; efficacy is the dose required
B. Efficacy is the maximum effect; potency is the dose required to produce a given
effect [CORRECT]
NURS 5334 EXAM 2 2026/2027 | Advanced
Pharmacology Guide | UTA | 100% Verified Q&A |
Grade A | Pass Guaranteed - A+ Graded
Section 1: Pharmacokinetics & Pharmacodynamics (15 Questions)
Q1: A 68-year-old male with creatinine clearance (CrCl) of 25 mL/min is prescribed
gentamicin. The desired peak concentration is 8 mcg/mL, volume of distribution (Vd)
is 0.25 L/kg, and the patient weighs 70 kg. Using the formula Loading Dose = Desired
Concentration × Vd, what is the appropriate loading dose?
A. 100 mg
B. 120 mg
C. 140 mg [CORRECT]
D. 160 mg
Correct Answer: C
Rationale: Formula: Loading Dose = Cp × Vd. Calculation: Vd = 0.25 L/kg × 70 kg =
17.5 L. Loading Dose = 8 mcg/mL × 17.5 L = 8 mg/L × 17.5 L = 140 mg. A represents
a Vd calculation error using 0.20 L/kg. B reflects an arithmetic error in unit
conversion. D uses an incorrect desired peak of 10 mcg/mL. Clinical significance:
Accurate loading dose calculation prevents subtherapeutic peaks in sepsis while
avoiding nephrotoxicity in renal impairment.
UTA NURS 5334 Competency: Apply pharmacokinetic principles to calculate
individualized drug dosing.
AACN DNP Essential: Essential III – Clinical Scholarship and Analytical Methods for
Evidence-Based Practice.
Q2: A patient on warfarin has a CYP2C9*2/*3 genotype and VKORC1 -1639A/A
genotype. Which pharmacogenomic-guided dosing adjustment is most appropriate
for initiating therapy?
A. Use standard 5 mg daily dosing
B. Reduce initial dose by 50% and monitor INR closely [CORRECT]
C. Switch to dabigatran due to guaranteed warfarin resistance
D. Increase dose to 10 mg daily to overcome genetic slow metabolism
Correct Answer: B
Rationale: The CYP2C9*2/*3 genotype indicates reduced enzyme activity (poor
metabolizer), and VKORC1 -1639A/A confers increased warfarin sensitivity.
,2
Combined, these polymorphisms significantly increase bleeding risk at standard
doses. A is incorrect because standard dosing ignores pharmacogenomic risk. C is
incorrect because warfarin remains effective with genotype-guided dosing; switching
is unnecessary. D is dangerously incorrect as it would precipitate hemorrhage.
Clinical significance: FDA labeling and CPIC guidelines recommend 50% dose
reduction with close INR monitoring for this genotype combination.
UTA NURS 5334 Competency: Integrate pharmacogenomic data into therapeutic
decision-making.
AACN DNP Essential: Essential I – Scientific Underpinnings for Practice.
Q3: A 45-year-old patient with normal hepatic function receives a drug with a half-
life of 8 hours. How long will it take to reach approximately 94% of steady-state
concentration with continuous infusion?
A. 16 hours
B. 24 hours
C. 32 hours [CORRECT]
D. 40 hours
Correct Answer: C
Rationale: Steady-state is reached after approximately 4 to 5 half-lives. At 4 half-lives
(32 hours), 94% of steady-state is achieved (1 - 0.5^4 = 0.9375). A represents only 2
half-lives (75% steady-state). B represents 3 half-lives (87.5% steady-state). D
represents 5 half-lives (97% steady-state). Clinical significance: Understanding time to
steady-state prevents premature dose adjustments and therapeutic failure.
UTA NURS 5334 Competency: Apply pharmacokinetic principles to predict drug
accumulation and steady-state.
AACN DNP Essential: Essential III – Clinical Scholarship and Analytical Methods for
Evidence-Based Practice.
Q4: A patient with a TPMT*3A/*3A genotype is prescribed azathioprine for
autoimmune disease. Which prescribing action is most appropriate?
A. Prescribe standard 2.5 mg/kg daily dosing
B. Reduce dose to 25-33% of standard and monitor CBC closely [CORRECT]
C. Avoid azathioprine entirely and select methotrexate instead
D. Prescribe allopurinol concurrently to enhance metabolism
Correct Answer: B
Rationale: TPMT*3A/*3A indicates deficient thiopurine methyltransferase activity,
causing toxic accumulation of 6-thioguanine nucleotides and severe
,3
myelosuppression at standard doses. A is incorrect and dangerous due to high
pancytopenia risk. C is unnecessary because azathioprine remains effective at
reduced doses per CPIC guidelines. D is incorrect because allopurinol inhibits
xanthine oxidase, further increasing 6-MP toxicity rather than enhancing metabolism.
Clinical significance: Pharmacogenomic testing prevents life-threatening bone
marrow suppression.
UTA NURS 5334 Competency: Apply pharmacogenomic principles to prevent adverse
drug reactions.
AACN DNP Essential: Essential I – Scientific Underpinnings for Practice.
Q5: Which pharmacodynamic principle best explains why a partial agonist produces
a lower maximum effect than a full agonist at the same receptor?
A. Reduced receptor affinity
B. Lower intrinsic activity [CORRECT]
C. Competitive antagonism
D. Increased receptor downregulation
Correct Answer: B
Rationale: Intrinsic activity (efficacy) determines the magnitude of response a drug
produces when bound to a receptor. Partial agonists have lower intrinsic activity than
full agonists, resulting in a lower Emax despite similar receptor affinity. A is incorrect
because partial agonists may have high affinity. C describes antagonist behavior, not
partial agonism. D refers to a chronic adaptive response, not the fundamental
pharmacodynamic property. Clinical significance: Understanding intrinsic activity
explains why buprenorphine (partial mu agonist) has ceiling effects for respiratory
depression compared to full agonists.
UTA NURS 5334 Competency: Analyze pharmacodynamic principles governing drug-
receptor interactions.
AACN DNP Essential: Essential I – Scientific Underpinnings for Practice.
Q6: A 78-year-old patient with CrCl 30 mL/min requires dosing adjustment for a
renally eliminated drug with normal maintenance dose of 200 mg every 12 hours.
Using the Cockcroft-Gault adjustment formula (Adjusted Dose = Normal Dose ×
[Patient CrCl / Normal CrCl]), what is the appropriate adjusted dose if normal CrCl is
assumed at 100 mL/min?
A. 50 mg every 12 hours
B. 60 mg every 12 hours [CORRECT]
, 4
C. 100 mg every 12 hours
D. 150 mg every 12 hours
Correct Answer: B
Rationale: Formula: Adjusted Dose = 200 mg × (30/100) = 60 mg every 12 hours. A
represents an error using 25 mL/min. C represents failure to adjust dose, risking drug
accumulation. D represents an incorrect calculation using 75% of normal dose.
Clinical significance: Accurate renal dose adjustment prevents toxicity in elderly
patients with declining renal function.
UTA NURS 5334 Competency: Apply pharmacokinetic principles to adjust dosing in
renal impairment.
AACN DNP Essential: Essential VIII – Advanced Nursing Practice.
Q7: A patient with a CYP2D6 poor metabolizer phenotype is prescribed tramadol for
postoperative pain. Which clinical outcome is most likely?
A. Enhanced analgesic effect due to increased parent drug levels
B. Reduced analgesia due to impaired conversion to active O-desmethyltramadol
[CORRECT]
C. Increased risk of serotonin syndrome only
D. No change in therapeutic effect
Correct Answer: B
Rationale: Tramadol requires CYP2D6-mediated O-demethylation to form the active
metabolite O-desmethyltramadol (M1), which has 200-fold greater mu-opioid
affinity. Poor metabolizers cannot efficiently convert tramadol, resulting in
inadequate analgesia. A is incorrect because parent drug alone provides minimal
opioid effect. C is partially true but secondary to the primary therapeutic failure. D is
incorrect because CYP2D6 polymorphism significantly alters tramadol efficacy.
Clinical significance: Alternative analgesics (morphine, oxycodone) should be
considered for CYP2D6 poor metabolizers.
UTA NURS 5334 Competency: Apply pharmacogenomic principles to optimize
analgesic therapy.
AACN DNP Essential: Essential I – Scientific Underpinnings for Practice.
Q8: Which statement correctly differentiates potency from efficacy in
pharmacodynamics?
A. Potency is the maximum effect; efficacy is the dose required
B. Efficacy is the maximum effect; potency is the dose required to produce a given
effect [CORRECT]
