,NUR 521 Advanced Pharmacology Exam 1
| University of Alabama | 26/27
Guaranteed PDF)
1. An APRN in a restricted state is evaluating a patient with uncontrolled hypertension. The patient's
insurance plan does not cover any of the medications on the APRN's preferred formulary. Which
action best demonstrates safe and ethical prescribing practice in this context?
A) Prescribe a medication not on the formulary and instruct the patient to use a discount card
B) Consult with a collaborating physician to select an alternative covered medication
C) Prescribe a higher-cost medication and document medical necessity for the insurer
D) Defer prescribing and refer the patient to a primary care physician for management
Correct Answer: Consult with a collaborating physician to select an alternative covered medication
Rationale: In restricted-practice states, APRNs must collaborate with or be supervised by a physician.
Consulting with the collaborating physician to select an appropriate, covered alternative respects both
legal requirements and the patient's financial constraints. Prescribing without addressing formulary
barriers or deferring care does not fulfill the APRN's duty to provide accessible, patient-centered care.
2. A patient with chronic pain is prescribed oxycodone. According to the Controlled Substances Act,
which schedule does this medication belong to, and what is the defining characteristic of that
schedule?
A) Schedule II; high potential for abuse with severe psychological or physical dependence
B) Schedule III; moderate to low potential for physical and psychological dependence
C) Schedule IV; low potential for abuse relative to Schedule III substances
D) Schedule I; no currently accepted medical use and a high potential for abuse
Correct Answer: Schedule II; high potential for abuse with severe psychological or physical
dependence
Rationale: Oxycodone is a Schedule II controlled substance, defined as having a high potential for
abuse which may lead to severe psychological or physical dependence. Schedule I drugs have no
accepted medical use, Schedule III have moderate dependence potential, and Schedule IV have lower
abuse potential.
,3. An APRN is writing a prescription for amoxicillin for a pediatric patient. Which element is legally
required on the prescription to ensure safe dispensing?
A) The patient's insurance policy number
B) The indication for the medication
C) The patient's height and weight
D) The APRN's National Provider Identifier (NPI) number
Correct Answer: The APRN's National Provider Identifier (NPI) number
Rationale: A valid prescription must include the prescriber's NPI number, along with the patient's
name and date of birth, medication name, strength, dose, route, frequency, quantity, and refills. The
indication, while good practice, is not legally required. Insurance information and height/weight are
not mandatory elements for a legal prescription.
4. An APRN is reviewing a patient's home medication list and notes that the patient takes warfarin
and amiodarone. Which pharmacokinetic interaction is most concerning for this combination?
A) Amiodarone increases the absorption of warfarin from the GI tract
B) Amiodarone inhibits the hepatic metabolism of warfarin, increasing its effect
C) Amiodarone displaces warfarin from plasma protein binding sites
D) Amiodarone decreases the renal excretion of warfarin
Correct Answer: Amiodarone inhibits the hepatic metabolism of warfarin, increasing its effect
Rationale: Amiodarone is a potent inhibitor of the CYP450 enzyme system, particularly CYP2C9, which
metabolizes the more active S-enantiomer of warfarin. This inhibition reduces warfarin clearance,
leading to elevated INR and an increased risk of bleeding. Displacement from protein binding is a less
significant mechanism.
5. A patient with a history of chronic liver disease is started on a medication that undergoes extensive
first-pass metabolism. Which adjustment to the dosing regimen is most appropriate based on this
patient's condition?
A) Increase the dose to overcome reduced first-pass effect
B) Decrease the dose to prevent drug accumulation and toxicity
, C) Administer the drug via a route that avoids first-pass metabolism
D) No adjustment is needed; first-pass metabolism is unaffected by liver disease
Correct Answer: Decrease the dose to prevent drug accumulation and toxicity
Rationale: In chronic liver disease, hepatic function is impaired, reducing first-pass metabolism and
drug clearance. This leads to higher systemic drug levels. Decreasing the dose is necessary to prevent
accumulation and toxicity. Increasing the dose would be dangerous. While altering the route may
help, dose reduction is the most direct and appropriate adjustment.
6. A patient is receiving a drug with a half-life of 12 hours. Approximately how long will it take to
reach steady-state concentration with regular dosing?
A) 24 to 36 hours
B) 36 to 48 hours
C) 60 to 72 hours
D) 84 to 96 hours
Correct Answer: 60 to 72 hours
Rationale: Steady-state is achieved after approximately 3 to 5 half-lives. With a half-life of 12 hours, 5
half-lives equal 60 hours (2.5 days). Therefore, steady-state is reached between 60 and 72 hours. This
is a critical pharmacokinetic principle for understanding drug accumulation and dosing intervals.
7. An APRN is interpreting a dose-response curve for a new analgesic. The curve shows that Drug A
produces 80% of maximal pain relief at a dose of 50 mg, while Drug B produces the same effect at a
dose of 10 mg. Which statement accurately compares these two drugs?
A) Drug A has greater efficacy than Drug B
B) Drug B has greater potency than Drug A
C) Drug A has a wider therapeutic index than Drug B
D) Drug B has a steeper dose-response curve than Drug A
Correct Answer: Drug B has greater potency than Drug A
| University of Alabama | 26/27
Guaranteed PDF)
1. An APRN in a restricted state is evaluating a patient with uncontrolled hypertension. The patient's
insurance plan does not cover any of the medications on the APRN's preferred formulary. Which
action best demonstrates safe and ethical prescribing practice in this context?
A) Prescribe a medication not on the formulary and instruct the patient to use a discount card
B) Consult with a collaborating physician to select an alternative covered medication
C) Prescribe a higher-cost medication and document medical necessity for the insurer
D) Defer prescribing and refer the patient to a primary care physician for management
Correct Answer: Consult with a collaborating physician to select an alternative covered medication
Rationale: In restricted-practice states, APRNs must collaborate with or be supervised by a physician.
Consulting with the collaborating physician to select an appropriate, covered alternative respects both
legal requirements and the patient's financial constraints. Prescribing without addressing formulary
barriers or deferring care does not fulfill the APRN's duty to provide accessible, patient-centered care.
2. A patient with chronic pain is prescribed oxycodone. According to the Controlled Substances Act,
which schedule does this medication belong to, and what is the defining characteristic of that
schedule?
A) Schedule II; high potential for abuse with severe psychological or physical dependence
B) Schedule III; moderate to low potential for physical and psychological dependence
C) Schedule IV; low potential for abuse relative to Schedule III substances
D) Schedule I; no currently accepted medical use and a high potential for abuse
Correct Answer: Schedule II; high potential for abuse with severe psychological or physical
dependence
Rationale: Oxycodone is a Schedule II controlled substance, defined as having a high potential for
abuse which may lead to severe psychological or physical dependence. Schedule I drugs have no
accepted medical use, Schedule III have moderate dependence potential, and Schedule IV have lower
abuse potential.
,3. An APRN is writing a prescription for amoxicillin for a pediatric patient. Which element is legally
required on the prescription to ensure safe dispensing?
A) The patient's insurance policy number
B) The indication for the medication
C) The patient's height and weight
D) The APRN's National Provider Identifier (NPI) number
Correct Answer: The APRN's National Provider Identifier (NPI) number
Rationale: A valid prescription must include the prescriber's NPI number, along with the patient's
name and date of birth, medication name, strength, dose, route, frequency, quantity, and refills. The
indication, while good practice, is not legally required. Insurance information and height/weight are
not mandatory elements for a legal prescription.
4. An APRN is reviewing a patient's home medication list and notes that the patient takes warfarin
and amiodarone. Which pharmacokinetic interaction is most concerning for this combination?
A) Amiodarone increases the absorption of warfarin from the GI tract
B) Amiodarone inhibits the hepatic metabolism of warfarin, increasing its effect
C) Amiodarone displaces warfarin from plasma protein binding sites
D) Amiodarone decreases the renal excretion of warfarin
Correct Answer: Amiodarone inhibits the hepatic metabolism of warfarin, increasing its effect
Rationale: Amiodarone is a potent inhibitor of the CYP450 enzyme system, particularly CYP2C9, which
metabolizes the more active S-enantiomer of warfarin. This inhibition reduces warfarin clearance,
leading to elevated INR and an increased risk of bleeding. Displacement from protein binding is a less
significant mechanism.
5. A patient with a history of chronic liver disease is started on a medication that undergoes extensive
first-pass metabolism. Which adjustment to the dosing regimen is most appropriate based on this
patient's condition?
A) Increase the dose to overcome reduced first-pass effect
B) Decrease the dose to prevent drug accumulation and toxicity
, C) Administer the drug via a route that avoids first-pass metabolism
D) No adjustment is needed; first-pass metabolism is unaffected by liver disease
Correct Answer: Decrease the dose to prevent drug accumulation and toxicity
Rationale: In chronic liver disease, hepatic function is impaired, reducing first-pass metabolism and
drug clearance. This leads to higher systemic drug levels. Decreasing the dose is necessary to prevent
accumulation and toxicity. Increasing the dose would be dangerous. While altering the route may
help, dose reduction is the most direct and appropriate adjustment.
6. A patient is receiving a drug with a half-life of 12 hours. Approximately how long will it take to
reach steady-state concentration with regular dosing?
A) 24 to 36 hours
B) 36 to 48 hours
C) 60 to 72 hours
D) 84 to 96 hours
Correct Answer: 60 to 72 hours
Rationale: Steady-state is achieved after approximately 3 to 5 half-lives. With a half-life of 12 hours, 5
half-lives equal 60 hours (2.5 days). Therefore, steady-state is reached between 60 and 72 hours. This
is a critical pharmacokinetic principle for understanding drug accumulation and dosing intervals.
7. An APRN is interpreting a dose-response curve for a new analgesic. The curve shows that Drug A
produces 80% of maximal pain relief at a dose of 50 mg, while Drug B produces the same effect at a
dose of 10 mg. Which statement accurately compares these two drugs?
A) Drug A has greater efficacy than Drug B
B) Drug B has greater potency than Drug A
C) Drug A has a wider therapeutic index than Drug B
D) Drug B has a steeper dose-response curve than Drug A
Correct Answer: Drug B has greater potency than Drug A
