NURS 5338 - Module 2 Pretest | University of Texas at Arlington 2026/2027 Edition
NURS 5338 - Module 2 Pretest Examination
University of Texas at Arlington - College of Nursing and Health Innovation
Advanced Pharmacology & Family Clinical Practice | 100-Question Comprehensive Pretest with Complete Solutions
2026/2027 Edition | Aligned with FNP Competencies and Advanced Pharmacology Standards
Total Questions Cognitive Mix Format Sections
20% Recall / 50% Application / 30% 75% Scenario-based / 25%
100 (Exact) 7 Subject Areas
Analysis Direct Knowledge
Instructions: Each question has ONE best answer. The correct answer is marked with *[CORRECT]* and a complete
rationale is provided below each question. This pretest is designed to assess mastery across seven core domains of
advanced pharmacology and family nurse practitioner practice. Use this examination for self-assessment, content review,
and identification of knowledge gaps requiring further study prior to the Module 2 examination.
Section 1: Pharmacokinetics & Pharmacodynamics
Q1: A 68-year-old male with hepatic cirrhosis is prescribed a medication that undergoes extensive
first-pass metabolism. Which pharmacokinetic change is MOST expected when switching from oral to
sublingual administration?
A. Decreased bioavailability due to bypass of gut metabolism
B. Increased bioavailability due to bypass of hepatic first-pass metabolism *[CORRECT]*
C. No change in bioavailability because sublingual absorption is identical to oral
D. Decreased onset of action due to delayed gastric emptying
Correct Answer: B
Rationale:
Sublingual administration bypasses both intestinal and hepatic first-pass metabolism, directly entering
systemic circulation and increasing bioavailability. This is clinically relevant in patients with cirrhosis or for
drugs like nitroglycerin. UTA NURS 5338 emphasizes route selection based on first-pass effect.
Q2: A patient taking warfarin (highly protein-bound, 99%) is started on sulfamethoxazole/trimethoprim
(also highly protein-bound). What pharmacokinetic consequence is MOST likely?
A. Warfarin metabolism increases, requiring dose escalation
B. Free warfarin levels rise, increasing bleeding risk *[CORRECT]*
C. Warfarin absorption decreases, reducing anticoagulation
D. No clinically significant interaction occurs
Correct Answer: B
Rationale:
Both drugs compete for albumin binding sites; sulfamethoxazole displaces warfarin, raising the free (active)
fraction and INR. This is a classic protein-binding displacement interaction taught in advanced
pharmacology. Monitoring INR within 3-7 days is essential.
Page 1 | 100-Question Comprehensive Examination | Family Nurse Practitioner Advanced Pharmacology
,NURS 5338 - Module 2 Pretest | University of Texas at Arlington 2026/2027 Edition
Q3: A drug has a half-life of 12 hours. Approximately how long will it take to reach steady state when
administered at consistent dosing intervals?
A. 12 hours (1 half-life)
B. 24 hours (2 half-lives)
C. 48 hours (4 half-lives)
D. 60 hours (5 half-lives) *[CORRECT]*
Correct Answer: D
Rationale:
Steady state is reached after approximately 4-5 half-lives. With a 12-hour half-life, steady state is achieved
in 48-60 hours. This principle guides clinicians on when to assess therapeutic drug levels and adjust dosing,
especially for drugs like digoxin or phenytoin.
Q4: A patient is a CYP2D6 poor metabolizer. Which medication requires dose reduction or alternative
selection due to reduced metabolism?
A. Codeine (prodrug requiring activation) *[CORRECT]*
B. Phenytoin (CYP2C9 metabolized)
C. Warfarin (CYP2C9 metabolized)
D. Omeprazole (CYP2C19 metabolized)
Correct Answer: A
Rationale:
Codeine is converted to morphine via CYP2D6. Poor metabolizers produce little morphine, resulting in
inadequate analgesia; ultrarapid metabolizers risk toxicity. Pharmacogenomic testing before prescribing
opioids aligns with precision medicine in advanced pharmacology practice.
Q5: Which statement BEST describes the difference between potency and efficacy?
A. Potency refers to the maximum effect a drug can produce; efficacy refers to the dose required
B. Potency refers to the dose required to produce an effect; efficacy refers to the maximum effect
achievable *[CORRECT]*
C. Potency and efficacy are interchangeable terms
D. Potency is determined by receptor affinity only; efficacy is determined by absorption only
Correct Answer: B
Rationale:
Potency is the concentration or dose needed to produce a defined effect (EC50), while efficacy is the
maximal response (Emax). A drug can be potent but have low efficacy (e.g., partial agonists).
Understanding both is essential for therapeutic drug selection.
Q6: A drug has a therapeutic index (TI) of 2. Which interpretation is MOST accurate?
A. The drug is very safe; large doses are tolerated
B. The drug has a narrow safety margin; close monitoring is required *[CORRECT]*
Page 2 | 100-Question Comprehensive Examination | Family Nurse Practitioner Advanced Pharmacology
,NURS 5338 - Module 2 Pretest | University of Texas at Arlington 2026/2027 Edition
C. The drug has no toxic effects at any dose
D. The drug requires no serum level monitoring
Correct Answer: B
Rationale:
Therapeutic index = TD50/ED50. A TI of 2 means the toxic dose is only twice the effective dose, indicating a
narrow safety margin. Drugs like digoxin, lithium, and warfarin require serum monitoring and individualized
dosing.
Q7: A patient on phenytoin therapy is started on carbamazepine. Both drugs are metabolized by
CYP3A4. What is the expected interaction?
A. Increased phenytoin levels due to enzyme inhibition
B. Decreased phenytoin levels due to enzyme induction by carbamazepine *[CORRECT]*
C. No change in phenytoin levels
D. Increased carbamazepine toxicity due to phenytoin inhibition
Correct Answer: B
Rationale:
Carbamazepine is a CYP3A4 inducer, increasing phenytoin metabolism and lowering its levels.
Autoinduction of carbamazepine's own metabolism also occurs. FNP standards require monitoring
antiepileptic levels when combining enzyme inducers.
Q8: Which route of administration is associated with 100% bioavailability by definition?
A. Intramuscular (IM)
B. Subcutaneous (SC)
C. Intravenous (IV) *[CORRECT]*
D. Oral (PO)
Correct Answer: C
Rationale:
IV administration delivers drug directly into systemic circulation, defining 100% bioavailability (F=1.0). Other
routes have variable bioavailability due to absorption barriers and first-pass metabolism. This concept is
foundational to pharmacokinetic dosing calculations.
Q9: A patient with chronic kidney disease has a creatinine clearance of 25 mL/min. Which
pharmacokinetic parameter is MOST affected, requiring dose adjustment?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion *[CORRECT]*
Correct Answer: D
Rationale:
Page 3 | 100-Question Comprehensive Examination | Family Nurse Practitioner Advanced Pharmacology
, NURS 5338 - Module 2 Pretest | University of Texas at Arlington 2026/2027 Edition
Renal excretion is the primary route of elimination for many drugs (e.g., vancomycin, digoxin, metformin,
gabapentin). Reduced creatinine clearance prolongs half-life and increases drug accumulation. Dose
adjustment based on eGFR or CrCl is a core FNP competency.
Q10: A patient presents with signs of digoxin toxicity (nausea, visual disturbances, confusion). Serum
digoxin level is 3.2 ng/mL (therapeutic 0.5-2.0). Which electrolyte abnormality MOST commonly
precipitates digoxin toxicity?
A. Hypernatremia
B. Hypokalemia *[CORRECT]*
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale:
Hypokalemia enhances digoxin binding to the Na+/K+ ATPase, potentiating toxicity even at therapeutic
levels. Loop diuretics commonly cause hypokalemia in heart failure patients on digoxin. Potassium
monitoring and supplementation are mandatory.
Q11: Which pharmacodynamic concept describes a drug that binds to a receptor without producing a
maximal response, even at full receptor occupancy?
A. Full agonist
B. Partial agonist *[CORRECT]*
C. Competitive antagonist
D. Inverse agonist
Correct Answer: B
Rationale:
Partial agonists (e.g., buprenorphine, pindolol) bind receptors but produce submaximal efficacy, acting as
agonists in absence of full agonist and antagonists in presence of full agonist. This dual property is exploited
in opioid replacement therapy.
Q12: A patient is prescribed a beta-1 selective antagonist (metoprolol). Which receptor theory explains
the selectivity that allows safer use in patients with mild reactive airway disease?
A. Absolute receptor specificity with no off-target binding
B. Relative selectivity that is dose-dependent and lost at higher doses *[CORRECT]*
C. Receptor downregulation with chronic use
D. Receptor upregulation with acute dosing
Correct Answer: B
Rationale:
Beta-1 selectivity is relative, not absolute; at higher doses, metoprolol also blocks beta-2 receptors,
potentially causing bronchospasm. Cardioselective beta-blockers should be used cautiously in
asthma/COPD. This principle is critical for cardiovascular pharmacology.
Page 4 | 100-Question Comprehensive Examination | Family Nurse Practitioner Advanced Pharmacology
NURS 5338 - Module 2 Pretest Examination
University of Texas at Arlington - College of Nursing and Health Innovation
Advanced Pharmacology & Family Clinical Practice | 100-Question Comprehensive Pretest with Complete Solutions
2026/2027 Edition | Aligned with FNP Competencies and Advanced Pharmacology Standards
Total Questions Cognitive Mix Format Sections
20% Recall / 50% Application / 30% 75% Scenario-based / 25%
100 (Exact) 7 Subject Areas
Analysis Direct Knowledge
Instructions: Each question has ONE best answer. The correct answer is marked with *[CORRECT]* and a complete
rationale is provided below each question. This pretest is designed to assess mastery across seven core domains of
advanced pharmacology and family nurse practitioner practice. Use this examination for self-assessment, content review,
and identification of knowledge gaps requiring further study prior to the Module 2 examination.
Section 1: Pharmacokinetics & Pharmacodynamics
Q1: A 68-year-old male with hepatic cirrhosis is prescribed a medication that undergoes extensive
first-pass metabolism. Which pharmacokinetic change is MOST expected when switching from oral to
sublingual administration?
A. Decreased bioavailability due to bypass of gut metabolism
B. Increased bioavailability due to bypass of hepatic first-pass metabolism *[CORRECT]*
C. No change in bioavailability because sublingual absorption is identical to oral
D. Decreased onset of action due to delayed gastric emptying
Correct Answer: B
Rationale:
Sublingual administration bypasses both intestinal and hepatic first-pass metabolism, directly entering
systemic circulation and increasing bioavailability. This is clinically relevant in patients with cirrhosis or for
drugs like nitroglycerin. UTA NURS 5338 emphasizes route selection based on first-pass effect.
Q2: A patient taking warfarin (highly protein-bound, 99%) is started on sulfamethoxazole/trimethoprim
(also highly protein-bound). What pharmacokinetic consequence is MOST likely?
A. Warfarin metabolism increases, requiring dose escalation
B. Free warfarin levels rise, increasing bleeding risk *[CORRECT]*
C. Warfarin absorption decreases, reducing anticoagulation
D. No clinically significant interaction occurs
Correct Answer: B
Rationale:
Both drugs compete for albumin binding sites; sulfamethoxazole displaces warfarin, raising the free (active)
fraction and INR. This is a classic protein-binding displacement interaction taught in advanced
pharmacology. Monitoring INR within 3-7 days is essential.
Page 1 | 100-Question Comprehensive Examination | Family Nurse Practitioner Advanced Pharmacology
,NURS 5338 - Module 2 Pretest | University of Texas at Arlington 2026/2027 Edition
Q3: A drug has a half-life of 12 hours. Approximately how long will it take to reach steady state when
administered at consistent dosing intervals?
A. 12 hours (1 half-life)
B. 24 hours (2 half-lives)
C. 48 hours (4 half-lives)
D. 60 hours (5 half-lives) *[CORRECT]*
Correct Answer: D
Rationale:
Steady state is reached after approximately 4-5 half-lives. With a 12-hour half-life, steady state is achieved
in 48-60 hours. This principle guides clinicians on when to assess therapeutic drug levels and adjust dosing,
especially for drugs like digoxin or phenytoin.
Q4: A patient is a CYP2D6 poor metabolizer. Which medication requires dose reduction or alternative
selection due to reduced metabolism?
A. Codeine (prodrug requiring activation) *[CORRECT]*
B. Phenytoin (CYP2C9 metabolized)
C. Warfarin (CYP2C9 metabolized)
D. Omeprazole (CYP2C19 metabolized)
Correct Answer: A
Rationale:
Codeine is converted to morphine via CYP2D6. Poor metabolizers produce little morphine, resulting in
inadequate analgesia; ultrarapid metabolizers risk toxicity. Pharmacogenomic testing before prescribing
opioids aligns with precision medicine in advanced pharmacology practice.
Q5: Which statement BEST describes the difference between potency and efficacy?
A. Potency refers to the maximum effect a drug can produce; efficacy refers to the dose required
B. Potency refers to the dose required to produce an effect; efficacy refers to the maximum effect
achievable *[CORRECT]*
C. Potency and efficacy are interchangeable terms
D. Potency is determined by receptor affinity only; efficacy is determined by absorption only
Correct Answer: B
Rationale:
Potency is the concentration or dose needed to produce a defined effect (EC50), while efficacy is the
maximal response (Emax). A drug can be potent but have low efficacy (e.g., partial agonists).
Understanding both is essential for therapeutic drug selection.
Q6: A drug has a therapeutic index (TI) of 2. Which interpretation is MOST accurate?
A. The drug is very safe; large doses are tolerated
B. The drug has a narrow safety margin; close monitoring is required *[CORRECT]*
Page 2 | 100-Question Comprehensive Examination | Family Nurse Practitioner Advanced Pharmacology
,NURS 5338 - Module 2 Pretest | University of Texas at Arlington 2026/2027 Edition
C. The drug has no toxic effects at any dose
D. The drug requires no serum level monitoring
Correct Answer: B
Rationale:
Therapeutic index = TD50/ED50. A TI of 2 means the toxic dose is only twice the effective dose, indicating a
narrow safety margin. Drugs like digoxin, lithium, and warfarin require serum monitoring and individualized
dosing.
Q7: A patient on phenytoin therapy is started on carbamazepine. Both drugs are metabolized by
CYP3A4. What is the expected interaction?
A. Increased phenytoin levels due to enzyme inhibition
B. Decreased phenytoin levels due to enzyme induction by carbamazepine *[CORRECT]*
C. No change in phenytoin levels
D. Increased carbamazepine toxicity due to phenytoin inhibition
Correct Answer: B
Rationale:
Carbamazepine is a CYP3A4 inducer, increasing phenytoin metabolism and lowering its levels.
Autoinduction of carbamazepine's own metabolism also occurs. FNP standards require monitoring
antiepileptic levels when combining enzyme inducers.
Q8: Which route of administration is associated with 100% bioavailability by definition?
A. Intramuscular (IM)
B. Subcutaneous (SC)
C. Intravenous (IV) *[CORRECT]*
D. Oral (PO)
Correct Answer: C
Rationale:
IV administration delivers drug directly into systemic circulation, defining 100% bioavailability (F=1.0). Other
routes have variable bioavailability due to absorption barriers and first-pass metabolism. This concept is
foundational to pharmacokinetic dosing calculations.
Q9: A patient with chronic kidney disease has a creatinine clearance of 25 mL/min. Which
pharmacokinetic parameter is MOST affected, requiring dose adjustment?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion *[CORRECT]*
Correct Answer: D
Rationale:
Page 3 | 100-Question Comprehensive Examination | Family Nurse Practitioner Advanced Pharmacology
, NURS 5338 - Module 2 Pretest | University of Texas at Arlington 2026/2027 Edition
Renal excretion is the primary route of elimination for many drugs (e.g., vancomycin, digoxin, metformin,
gabapentin). Reduced creatinine clearance prolongs half-life and increases drug accumulation. Dose
adjustment based on eGFR or CrCl is a core FNP competency.
Q10: A patient presents with signs of digoxin toxicity (nausea, visual disturbances, confusion). Serum
digoxin level is 3.2 ng/mL (therapeutic 0.5-2.0). Which electrolyte abnormality MOST commonly
precipitates digoxin toxicity?
A. Hypernatremia
B. Hypokalemia *[CORRECT]*
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale:
Hypokalemia enhances digoxin binding to the Na+/K+ ATPase, potentiating toxicity even at therapeutic
levels. Loop diuretics commonly cause hypokalemia in heart failure patients on digoxin. Potassium
monitoring and supplementation are mandatory.
Q11: Which pharmacodynamic concept describes a drug that binds to a receptor without producing a
maximal response, even at full receptor occupancy?
A. Full agonist
B. Partial agonist *[CORRECT]*
C. Competitive antagonist
D. Inverse agonist
Correct Answer: B
Rationale:
Partial agonists (e.g., buprenorphine, pindolol) bind receptors but produce submaximal efficacy, acting as
agonists in absence of full agonist and antagonists in presence of full agonist. This dual property is exploited
in opioid replacement therapy.
Q12: A patient is prescribed a beta-1 selective antagonist (metoprolol). Which receptor theory explains
the selectivity that allows safer use in patients with mild reactive airway disease?
A. Absolute receptor specificity with no off-target binding
B. Relative selectivity that is dose-dependent and lost at higher doses *[CORRECT]*
C. Receptor downregulation with chronic use
D. Receptor upregulation with acute dosing
Correct Answer: B
Rationale:
Beta-1 selectivity is relative, not absolute; at higher doses, metoprolol also blocks beta-2 receptors,
potentially causing bronchospasm. Cardioselective beta-blockers should be used cautiously in
asthma/COPD. This principle is critical for cardiovascular pharmacology.
Page 4 | 100-Question Comprehensive Examination | Family Nurse Practitioner Advanced Pharmacology
