NR 508 ADVANCED PHARMACOLOGY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with chronic kidney disease requires an antibiotic that is primarily excreted
renally. If the patient’s creatinine clearance is significantly reduced, what adjustment must
the prescriber make to prevent toxicity?
A. Increase the dose frequency to maintain steady state.
B. Decrease the dose or increase the dosing interval.
C. Switch to a medication with a shorter half-life.
D. Administer the drug with a high-protein meal to increase binding.
Answer: B
Conceptual Explanation: Renal impairment slows the elimination of drugs excreted by the
kidneys, leading to accumulation. To maintain therapeutic levels without toxicity, the total
daily dose must be reduced or the time between doses extended.
,2. Which of the following is a classic example of a ‘prodrug’ that requires hepatic conversion
to its active metabolite to exert its antiplatelet effect?
A. Aspirin
B. Warfarin
C. Ticagrelor
D. Clopidogrel
Answer: D
Conceptual Explanation: Clopidogrel is a prodrug that must be metabolized by the
CYP2C19 enzyme in the liver to become an active antiplatelet agent.
3. An elderly patient is prescribed a highly protein-bound medication. Due to age-related
physiological changes, the patient has low serum albumin. How does this affect the drug’s
pharmacokinetics?
A. The drug will be absorbed more slowly from the GI tract.
B. There will be a decrease in the volume of distribution.
C. There will be a higher fraction of free (active) drug in the bloodstream.
D. The liver will metabolize the drug faster due to lack of binding.
Answer: C
Conceptual Explanation: Lower albumin levels mean fewer binding sites for highly
protein-bound drugs, resulting in more ‘free’ drug, which increases the risk of toxicity.
, 4. A patient is taking Phenobarbital, a known CYP450 inducer. If the patient is also prescribed
Warfarin, what clinical outcome should the nurse practitioner anticipate?
A. Decreased effect of Warfarin, requiring a dose increase.
B. Increased effect of Warfarin, increasing the risk of bleeding.
C. No change in Warfarin levels as they use different pathways.
D. Immediate toxic reaction due to competitive inhibition.
Answer: A
Conceptual Explanation: CYP450 inducers speed up the metabolism of substrate drugs
(like Warfarin), leading to lower serum concentrations and reduced therapeutic efficacy.
5. Which of the following antihypertensive medications is contraindicated in a pregnant
patient due to the risk of fetal renal dysgenesis?
A. Lisinopril
B. Labetalol
C. Methyldopa
D. Nifedipine
Answer: A
Conceptual Explanation: ACE inhibitors (like Lisinopril) and ARBs are teratogenic,
specifically associated with fetal skull hypoplasia and renal failure; they should be avoided
in pregnancy.
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with chronic kidney disease requires an antibiotic that is primarily excreted
renally. If the patient’s creatinine clearance is significantly reduced, what adjustment must
the prescriber make to prevent toxicity?
A. Increase the dose frequency to maintain steady state.
B. Decrease the dose or increase the dosing interval.
C. Switch to a medication with a shorter half-life.
D. Administer the drug with a high-protein meal to increase binding.
Answer: B
Conceptual Explanation: Renal impairment slows the elimination of drugs excreted by the
kidneys, leading to accumulation. To maintain therapeutic levels without toxicity, the total
daily dose must be reduced or the time between doses extended.
,2. Which of the following is a classic example of a ‘prodrug’ that requires hepatic conversion
to its active metabolite to exert its antiplatelet effect?
A. Aspirin
B. Warfarin
C. Ticagrelor
D. Clopidogrel
Answer: D
Conceptual Explanation: Clopidogrel is a prodrug that must be metabolized by the
CYP2C19 enzyme in the liver to become an active antiplatelet agent.
3. An elderly patient is prescribed a highly protein-bound medication. Due to age-related
physiological changes, the patient has low serum albumin. How does this affect the drug’s
pharmacokinetics?
A. The drug will be absorbed more slowly from the GI tract.
B. There will be a decrease in the volume of distribution.
C. There will be a higher fraction of free (active) drug in the bloodstream.
D. The liver will metabolize the drug faster due to lack of binding.
Answer: C
Conceptual Explanation: Lower albumin levels mean fewer binding sites for highly
protein-bound drugs, resulting in more ‘free’ drug, which increases the risk of toxicity.
, 4. A patient is taking Phenobarbital, a known CYP450 inducer. If the patient is also prescribed
Warfarin, what clinical outcome should the nurse practitioner anticipate?
A. Decreased effect of Warfarin, requiring a dose increase.
B. Increased effect of Warfarin, increasing the risk of bleeding.
C. No change in Warfarin levels as they use different pathways.
D. Immediate toxic reaction due to competitive inhibition.
Answer: A
Conceptual Explanation: CYP450 inducers speed up the metabolism of substrate drugs
(like Warfarin), leading to lower serum concentrations and reduced therapeutic efficacy.
5. Which of the following antihypertensive medications is contraindicated in a pregnant
patient due to the risk of fetal renal dysgenesis?
A. Lisinopril
B. Labetalol
C. Methyldopa
D. Nifedipine
Answer: A
Conceptual Explanation: ACE inhibitors (like Lisinopril) and ARBs are teratogenic,
specifically associated with fetal skull hypoplasia and renal failure; they should be avoided
in pregnancy.
