NR 567 Midterm (Latest 2026/2027) – Advanced
Pharmacology | Grade A
Section 1: Principles of Pharmacology (Q1–Q10)
Q1. Which phase of pharmacokinetics involves the movement of a
drug from the site of administration into the bloodstream?
A. Metabolism
B. Absorption
C. Distribution
D. Excretion
Answer: B
Rationale: Absorption is the process by which a drug moves from its site of
administration into the systemic circulation. Metabolism (biotransformation)
occurs mainly in the liver; distribution is the movement of drug to tissues;
excretion is elimination.
Q2. A patient with severe liver cirrhosis is prescribed a drug that
undergoes extensive first-pass metabolism. The nurse practitioner
should anticipate:
A. Increased drug effect due to reduced first-pass metabolism
B. Decreased drug effect due to enhanced metabolism
C. No change in drug effect
D. Increased renal excretion
Answer: A
Rationale: In cirrhosis, hepatic metabolism is reduced, leading to
increased bioavailability and potential toxicity of drugs with high first-pass
metabolism.
,Q3. Which statement best describes a drug’s half-life?
A. Time required for the drug to reach peak plasma concentration
B. Time required for the body to eliminate half of the drug
C. Time required for the drug to become effective
D. Time required for the drug to be absorbed
Answer: B
Rationale: Half-life (t½) is the time required for the plasma concentration of
a drug to decrease by 50%. It determines dosing interval and time to
steady state.
Q4. A drug that binds to a receptor and produces a maximal response
is called a:
A. Partial agonist
B. Antagonist
C. Full agonist
D. Inverse agonist
Answer: C
Rationale: A full agonist binds to a receptor and produces a maximal
biological response. A partial agonist produces a submaximal response; an
antagonist blocks the receptor; an inverse agonist produces an opposite
effect.
Q5. Which of the following is a common cause of drug–drug
interactions involving cytochrome P450 enzymes?
A. Inhibition or induction of CYP450 enzymes
B. Increased renal blood flow
C. Decreased gastric pH
D. Increased plasma protein binding
Answer: A
Rationale: CYP450 inhibitors (e.g., ketoconazole, grapefruit juice) increase
,levels of substrate drugs; inducers (e.g., rifampin, carbamazepine)
decrease levels.
Q6. A patient is taking warfarin. Which medication would most likely
increase the INR and bleeding risk?
A. Rifampin
B. Vitamin K
C. Fluconazole
D. Phenytoin
Answer: C
Rationale: Fluconazole inhibits CYP2C9, which metabolizes warfarin,
leading to increased warfarin levels and INR. Rifampin induces
metabolism, decreasing INR. Vitamin K antagonizes warfarin.
Q7. The therapeutic index of a drug is:
A. The ratio of toxic dose to therapeutic dose
B. The ratio of effective dose to lethal dose
C. The time to peak effect
D. The time to half-life
Answer: A
Rationale: Therapeutic index (TI) = TD50/ED50. A narrow TI (e.g., digoxin,
lithium) requires careful monitoring.
Q8. Which route of administration bypasses first-pass metabolism?
A. Oral
B. Rectal (lower portion)
C. Sublingual
D. Enteral
Answer: C
Rationale: Sublingual absorption drains into the superior vena cava,
, bypassing the portal circulation and first-pass hepatic metabolism. Rectal
partially bypasses.
Q9. A patient with renal impairment is prescribed a drug that is
primarily renally excreted. The nurse practitioner should:
A. Increase the dose
B. Decrease the dose or extend the dosing interval
C. Administer with food
D. Change to oral route
Answer: B
Rationale: Reduced renal clearance leads to drug accumulation. Dose
reduction or increased interval prevents toxicity.
Q10. Which factor is most likely to increase drug distribution to
tissues?
A. High plasma protein binding
B. Low lipid solubility
C. High lipid solubility
D. Large molecular size
Answer: C
Rationale: Lipid-soluble drugs cross membranes easily and distribute
widely. High protein binding keeps drug in plasma; large molecules stay
intravascular.
Section 2: Autonomic Pharmacology (Q11–Q20)
Q11. A patient is prescribed metoprolol. The nurse practitioner
understands this drug works by:
A. Blocking beta-1 receptors
B. Blocking alpha-1 receptors
C. Stimulating beta-2 receptors
D. Blocking muscarinic receptors
Pharmacology | Grade A
Section 1: Principles of Pharmacology (Q1–Q10)
Q1. Which phase of pharmacokinetics involves the movement of a
drug from the site of administration into the bloodstream?
A. Metabolism
B. Absorption
C. Distribution
D. Excretion
Answer: B
Rationale: Absorption is the process by which a drug moves from its site of
administration into the systemic circulation. Metabolism (biotransformation)
occurs mainly in the liver; distribution is the movement of drug to tissues;
excretion is elimination.
Q2. A patient with severe liver cirrhosis is prescribed a drug that
undergoes extensive first-pass metabolism. The nurse practitioner
should anticipate:
A. Increased drug effect due to reduced first-pass metabolism
B. Decreased drug effect due to enhanced metabolism
C. No change in drug effect
D. Increased renal excretion
Answer: A
Rationale: In cirrhosis, hepatic metabolism is reduced, leading to
increased bioavailability and potential toxicity of drugs with high first-pass
metabolism.
,Q3. Which statement best describes a drug’s half-life?
A. Time required for the drug to reach peak plasma concentration
B. Time required for the body to eliminate half of the drug
C. Time required for the drug to become effective
D. Time required for the drug to be absorbed
Answer: B
Rationale: Half-life (t½) is the time required for the plasma concentration of
a drug to decrease by 50%. It determines dosing interval and time to
steady state.
Q4. A drug that binds to a receptor and produces a maximal response
is called a:
A. Partial agonist
B. Antagonist
C. Full agonist
D. Inverse agonist
Answer: C
Rationale: A full agonist binds to a receptor and produces a maximal
biological response. A partial agonist produces a submaximal response; an
antagonist blocks the receptor; an inverse agonist produces an opposite
effect.
Q5. Which of the following is a common cause of drug–drug
interactions involving cytochrome P450 enzymes?
A. Inhibition or induction of CYP450 enzymes
B. Increased renal blood flow
C. Decreased gastric pH
D. Increased plasma protein binding
Answer: A
Rationale: CYP450 inhibitors (e.g., ketoconazole, grapefruit juice) increase
,levels of substrate drugs; inducers (e.g., rifampin, carbamazepine)
decrease levels.
Q6. A patient is taking warfarin. Which medication would most likely
increase the INR and bleeding risk?
A. Rifampin
B. Vitamin K
C. Fluconazole
D. Phenytoin
Answer: C
Rationale: Fluconazole inhibits CYP2C9, which metabolizes warfarin,
leading to increased warfarin levels and INR. Rifampin induces
metabolism, decreasing INR. Vitamin K antagonizes warfarin.
Q7. The therapeutic index of a drug is:
A. The ratio of toxic dose to therapeutic dose
B. The ratio of effective dose to lethal dose
C. The time to peak effect
D. The time to half-life
Answer: A
Rationale: Therapeutic index (TI) = TD50/ED50. A narrow TI (e.g., digoxin,
lithium) requires careful monitoring.
Q8. Which route of administration bypasses first-pass metabolism?
A. Oral
B. Rectal (lower portion)
C. Sublingual
D. Enteral
Answer: C
Rationale: Sublingual absorption drains into the superior vena cava,
, bypassing the portal circulation and first-pass hepatic metabolism. Rectal
partially bypasses.
Q9. A patient with renal impairment is prescribed a drug that is
primarily renally excreted. The nurse practitioner should:
A. Increase the dose
B. Decrease the dose or extend the dosing interval
C. Administer with food
D. Change to oral route
Answer: B
Rationale: Reduced renal clearance leads to drug accumulation. Dose
reduction or increased interval prevents toxicity.
Q10. Which factor is most likely to increase drug distribution to
tissues?
A. High plasma protein binding
B. Low lipid solubility
C. High lipid solubility
D. Large molecular size
Answer: C
Rationale: Lipid-soluble drugs cross membranes easily and distribute
widely. High protein binding keeps drug in plasma; large molecules stay
intravascular.
Section 2: Autonomic Pharmacology (Q11–Q20)
Q11. A patient is prescribed metoprolol. The nurse practitioner
understands this drug works by:
A. Blocking beta-1 receptors
B. Blocking alpha-1 receptors
C. Stimulating beta-2 receptors
D. Blocking muscarinic receptors
