NURS 6521 ADVANCED
PHARMACOLOGY MIDTERM EXAM
QUESTIONS AND ANSWERS
1. Which phase of pharmacokinetics is most significantly affected by a patient with
decompensated liver cirrhosis?
A. Absorption
B. Distribution
C. Excretion
D. Metabolism
Answer: D
Conceptual Explanation: Metabolism occurs primarily in the liver via the CYP450 enzyme
system. Liver cirrhosis reduces enzymatic capacity and blood flow, significantly impairing
drug metabolism.
2. A patient is prescribed a drug with a narrow therapeutic index. Which action is most
important for the nurse practitioner?
A. Monitor serum drug levels frequently
,B. Encourage the patient to increase fluid intake
C. Instruct the patient to take the drug on an empty stomach
D. Administer the drug only via the intravenous route
Answer: A
Conceptual Explanation: Drugs with a narrow therapeutic index have a small margin of
safety between effective and toxic doses, requiring close monitoring of serum levels.
3. A 75-year-old patient has a reduced glomerular filtration rate (GFR). How should the NP
adjust a renally excreted drug?
A. Increase the dose
B. Decrease the dosing interval
C. Switch to an oral route for slower absorption
D. Increase the dosing interval
Answer: D
Conceptual Explanation: Reduced GFR means the drug is cleared more slowly. To avoid
toxicity, the NP should either decrease the dose or increase the time between doses
(interval).
4. What is the primary mechanism of action of a competitive antagonist?
A. Binding to a receptor to trigger a maximal response
B. Irreversibly binding to the active site to destroy the receptor
, C. Binding to an allosteric site to change receptor shape
D. Binding to a receptor to prevent agonist binding without activating it
Answer: D
Conceptual Explanation: Competitive antagonists compete with agonists for the same
receptor site, blocking the agonist’s effect without activating the receptor themselves.
5. Which pregnancy category indicates that the drug is contraindicated in women who are or
may become pregnant because of proven fetal risk?
A. Category B
B. Category C
C. Category X
D. Category D
Answer: C
Conceptual Explanation: Category X drugs have demonstrated human fetal abnormalities
and the risks clearly outweigh any potential benefits.
6. In the ‘first-pass effect’, what happens to a drug administered orally?
A. It is absorbed directly into the systemic circulation
B. It is excreted by the kidneys before it can be absorbed
C. It is metabolized by the liver before reaching systemic circulation
PHARMACOLOGY MIDTERM EXAM
QUESTIONS AND ANSWERS
1. Which phase of pharmacokinetics is most significantly affected by a patient with
decompensated liver cirrhosis?
A. Absorption
B. Distribution
C. Excretion
D. Metabolism
Answer: D
Conceptual Explanation: Metabolism occurs primarily in the liver via the CYP450 enzyme
system. Liver cirrhosis reduces enzymatic capacity and blood flow, significantly impairing
drug metabolism.
2. A patient is prescribed a drug with a narrow therapeutic index. Which action is most
important for the nurse practitioner?
A. Monitor serum drug levels frequently
,B. Encourage the patient to increase fluid intake
C. Instruct the patient to take the drug on an empty stomach
D. Administer the drug only via the intravenous route
Answer: A
Conceptual Explanation: Drugs with a narrow therapeutic index have a small margin of
safety between effective and toxic doses, requiring close monitoring of serum levels.
3. A 75-year-old patient has a reduced glomerular filtration rate (GFR). How should the NP
adjust a renally excreted drug?
A. Increase the dose
B. Decrease the dosing interval
C. Switch to an oral route for slower absorption
D. Increase the dosing interval
Answer: D
Conceptual Explanation: Reduced GFR means the drug is cleared more slowly. To avoid
toxicity, the NP should either decrease the dose or increase the time between doses
(interval).
4. What is the primary mechanism of action of a competitive antagonist?
A. Binding to a receptor to trigger a maximal response
B. Irreversibly binding to the active site to destroy the receptor
, C. Binding to an allosteric site to change receptor shape
D. Binding to a receptor to prevent agonist binding without activating it
Answer: D
Conceptual Explanation: Competitive antagonists compete with agonists for the same
receptor site, blocking the agonist’s effect without activating the receptor themselves.
5. Which pregnancy category indicates that the drug is contraindicated in women who are or
may become pregnant because of proven fetal risk?
A. Category B
B. Category C
C. Category X
D. Category D
Answer: C
Conceptual Explanation: Category X drugs have demonstrated human fetal abnormalities
and the risks clearly outweigh any potential benefits.
6. In the ‘first-pass effect’, what happens to a drug administered orally?
A. It is absorbed directly into the systemic circulation
B. It is excreted by the kidneys before it can be absorbed
C. It is metabolized by the liver before reaching systemic circulation
