UNI VE RSI TY OF SOU TH CAROLI NA
C O L L E G E O F N U R S I N G · G R AD U AT E P R O G R AM U
E XAM 1 · VERI F I ED P RACTI CE SET
N U RS 71 1 · 2 0 2 6
Pharmacotherapies
Exam 1
70 Questions & Verified Answers
with Detailed RATIONALE:s
A comprehensive practice examination covering pharmacokinetics,
pharmacodynamics, drug safety and regulation, and autonomic nervous system
pharmacotherapies. Questions reflect NCLEX-style clinical judgment at the
application and analysis level, including dosage calculations, case vignettes, and
black box warning items.
UN I VE RSI TY O F SO UTH CARO LI N A · CO LLE GE O F N URSI N G N URS 71 1 · E XAM 1 · 2 02 6
,NURS 711 — Pharmacotherapies — Exam 1 (2026) University of South Carolina · College of Nursing
Exam 1 — Pharmacotherapies
University of South Carolina · College of Nursing · NURS 711 · 2026
1.
A 68-year-old patient is prescribed propranolol 80 mg PO daily. The nurse
understands that, due to first-pass hepatic metabolism, the bioavailability of
propranolol is approximately 30%. Which statement best explains the clinical
implication of this pharmacokinetic property?
A. The oral dose must be roughly three times the IV dose to achieve equivalent
systemic exposure.
B. The drug should only be administered intravenously to ensure therapeutic
effect.
C. Food in the stomach has no effect on drug absorption.
D. The drug has a half-life of less than 2 hours.
ANSWER
Correct Answer: A
RATIONALE:
First-pass (presystemic) metabolism occurs when a drug absorbed from the gut
passes through the liver via the portal circulation before reaching systemic
circulation. Propranolol is a high-extraction drug with bioavailability of about 30%
because roughly 70% is metabolized before reaching systemic circulation. To achieve
equivalent plasma concentrations, the oral dose must be substantially higher than the
IV dose — typically about three-fold for propranolol. Option B is incorrect because
propranolol is routinely given orally; the dose is simply adjusted. Option C is
incorrect because food and gut motility can still influence absorption rate. Option D
is unrelated; half-life is independent of first-pass effect and propranolol's half-life is
approximately 4 hours.
Practice Exam · 70 Items Page 2
,NURS 711 — Pharmacotherapies — Exam 1 (2026) University of South Carolina · College of Nursing
2.
A patient starting rifampin for tuberculosis asks why his urine and tears
have turned orange. The nurse explains that rifampin is a potent cytochrome
P450 inducer. Which laboratory finding best demonstrates the clinical effect
of CYP450 induction in this patient?
A. Elevated serum rifampin level at week 2 of therapy.
B. Subtherapeutic INR in a patient concurrently taking warfarin.
Practice Exam · 70 Items Page 3
, NURS 711 — Pharmacotherapies — Exam 1 (2026) University of South Carolina · College of Nursing
C. Increased phenytoin level in a patient concurrently taking phenytoin.
D. Acute liver injury with elevated ALT and AST.
ANSWER
Correct Answer: B
RATIONALE:
Rifampin is a potent inducer of CYP3A4 and CYP2C9. Induction increases the
synthesis of hepatic enzymes, which accelerates the metabolism of concurrently
administered drugs metabolized by those enzymes — including warfarin (CYP2C9).
Within 1–2 weeks, the patient's INR will drop below therapeutic range, requiring
warfarin dose escalation. Option A is incorrect because autoinduction accelerates
rifampin's own metabolism, lowering serum levels rather than raising them. Option
C is wrong because phenytoin levels would also decrease, not increase, with enzyme
induction. Option D describes hepatotoxicity, which is a separate adverse effect, not
a manifestation of enzyme induction.
3.
Grapefruit juice is known to inhibit the CYP3A4 enzyme in the intestinal
wall. A patient asks the nurse if she can continue drinking her morning
grapefruit juice while taking simvastatin. What is the nurse's best response
based on the mechanism of this interaction?
A. Yes — grapefruit juice has no interaction with simvastatin.
B. No — inhibition of intestinal CYP3A4 can increase simvastatin plasma
levels up to three-fold, raising the risk of myopathy and rhabdomyolysis.
C. Yes — but only on days when simvastatin is not taken.
D. No — grapefruit juice accelerates simvastatin metabolism and reduces its
cholesterol-lowering effect.
ANSWER
Correct Answer: B
RATIONALE:
Grapefruit juice irreversibly inhibits CYP3A4 in the small intestinal wall, decreasing
presystemic metabolism of CYP3A4 substrates such as simvastatin, lovastatin, and
atorvastatin. The resulting increase in bioavailability can raise plasma simvastatin
levels roughly three-fold and dramatically increase the risk of statin-associated
Practice Exam · 70 Items Page 4
C O L L E G E O F N U R S I N G · G R AD U AT E P R O G R AM U
E XAM 1 · VERI F I ED P RACTI CE SET
N U RS 71 1 · 2 0 2 6
Pharmacotherapies
Exam 1
70 Questions & Verified Answers
with Detailed RATIONALE:s
A comprehensive practice examination covering pharmacokinetics,
pharmacodynamics, drug safety and regulation, and autonomic nervous system
pharmacotherapies. Questions reflect NCLEX-style clinical judgment at the
application and analysis level, including dosage calculations, case vignettes, and
black box warning items.
UN I VE RSI TY O F SO UTH CARO LI N A · CO LLE GE O F N URSI N G N URS 71 1 · E XAM 1 · 2 02 6
,NURS 711 — Pharmacotherapies — Exam 1 (2026) University of South Carolina · College of Nursing
Exam 1 — Pharmacotherapies
University of South Carolina · College of Nursing · NURS 711 · 2026
1.
A 68-year-old patient is prescribed propranolol 80 mg PO daily. The nurse
understands that, due to first-pass hepatic metabolism, the bioavailability of
propranolol is approximately 30%. Which statement best explains the clinical
implication of this pharmacokinetic property?
A. The oral dose must be roughly three times the IV dose to achieve equivalent
systemic exposure.
B. The drug should only be administered intravenously to ensure therapeutic
effect.
C. Food in the stomach has no effect on drug absorption.
D. The drug has a half-life of less than 2 hours.
ANSWER
Correct Answer: A
RATIONALE:
First-pass (presystemic) metabolism occurs when a drug absorbed from the gut
passes through the liver via the portal circulation before reaching systemic
circulation. Propranolol is a high-extraction drug with bioavailability of about 30%
because roughly 70% is metabolized before reaching systemic circulation. To achieve
equivalent plasma concentrations, the oral dose must be substantially higher than the
IV dose — typically about three-fold for propranolol. Option B is incorrect because
propranolol is routinely given orally; the dose is simply adjusted. Option C is
incorrect because food and gut motility can still influence absorption rate. Option D
is unrelated; half-life is independent of first-pass effect and propranolol's half-life is
approximately 4 hours.
Practice Exam · 70 Items Page 2
,NURS 711 — Pharmacotherapies — Exam 1 (2026) University of South Carolina · College of Nursing
2.
A patient starting rifampin for tuberculosis asks why his urine and tears
have turned orange. The nurse explains that rifampin is a potent cytochrome
P450 inducer. Which laboratory finding best demonstrates the clinical effect
of CYP450 induction in this patient?
A. Elevated serum rifampin level at week 2 of therapy.
B. Subtherapeutic INR in a patient concurrently taking warfarin.
Practice Exam · 70 Items Page 3
, NURS 711 — Pharmacotherapies — Exam 1 (2026) University of South Carolina · College of Nursing
C. Increased phenytoin level in a patient concurrently taking phenytoin.
D. Acute liver injury with elevated ALT and AST.
ANSWER
Correct Answer: B
RATIONALE:
Rifampin is a potent inducer of CYP3A4 and CYP2C9. Induction increases the
synthesis of hepatic enzymes, which accelerates the metabolism of concurrently
administered drugs metabolized by those enzymes — including warfarin (CYP2C9).
Within 1–2 weeks, the patient's INR will drop below therapeutic range, requiring
warfarin dose escalation. Option A is incorrect because autoinduction accelerates
rifampin's own metabolism, lowering serum levels rather than raising them. Option
C is wrong because phenytoin levels would also decrease, not increase, with enzyme
induction. Option D describes hepatotoxicity, which is a separate adverse effect, not
a manifestation of enzyme induction.
3.
Grapefruit juice is known to inhibit the CYP3A4 enzyme in the intestinal
wall. A patient asks the nurse if she can continue drinking her morning
grapefruit juice while taking simvastatin. What is the nurse's best response
based on the mechanism of this interaction?
A. Yes — grapefruit juice has no interaction with simvastatin.
B. No — inhibition of intestinal CYP3A4 can increase simvastatin plasma
levels up to three-fold, raising the risk of myopathy and rhabdomyolysis.
C. Yes — but only on days when simvastatin is not taken.
D. No — grapefruit juice accelerates simvastatin metabolism and reduces its
cholesterol-lowering effect.
ANSWER
Correct Answer: B
RATIONALE:
Grapefruit juice irreversibly inhibits CYP3A4 in the small intestinal wall, decreasing
presystemic metabolism of CYP3A4 substrates such as simvastatin, lovastatin, and
atorvastatin. The resulting increase in bioavailability can raise plasma simvastatin
levels roughly three-fold and dramatically increase the risk of statin-associated
Practice Exam · 70 Items Page 4
