NURS 6521 ADVANCED
PHARMACOLOGY FINAL EXAM
(VERIFIED ANSWERS) QUESTIONS
WITH ANSWERS: WALDEN
UNIVERSITY
1. A patient is taking a drug that is a potent inducer of the CYP3A4 enzyme system. What is
the most likely effect on a co-administered drug that is a substrate of the same enzyme?
A. Increased metabolism and reduced therapeutic effect of the substrate drug
B. Decreased metabolism and increased risk of toxicity of the substrate drug
C. Decreased renal excretion of the substrate drug
D. Increased protein binding of the substrate drug
Answer: A
Conceptual Explanation: Enzyme inducers stimulate the synthesis of metabolic enzymes,
leading to faster clearance and lower plasma levels of drugs metabolized by those enzymes.
2. Which physiological change in the elderly significantly impacts the volume of distribution
(Vd) of fat-soluble drugs like diazepam?
A. Increased proportion of body fat
B. Decreased hepatic blood flow
,C. Increased total body water
D. Increased serum albumin levels
Answer: A
Conceptual Explanation: Aging is associated with an increase in body fat percentage,
which increases the volume of distribution for lipophilic drugs, potentially extending their
half-life.
3. A patient with a history of asthma is diagnosed with hypertension. Which of the following
antihypertensive agents is strictly contraindicated?
A. Amlodipine
B. Lisinopril
C. Propranolol
D. Hydrochlorothiazide
Answer: C
Conceptual Explanation: Propranolol is a non-selective beta-blocker that can block beta-2
receptors in the lungs, causing bronchoconstriction in patients with asthma.
4. When initiating Warfarin therapy, why is it common practice to overlap with Heparin for
the first few days?
A. Heparin increases the absorption of Warfarin
B. Heparin acts as a chemical buffer against Warfarin-induced GI upset
, C. To prevent a transient hypercoagulable state due to rapid depletion of Protein C and S
D. Warfarin requires Heparin as a cofactor to bind to Vitamin K
Answer: C
Conceptual Explanation: Warfarin inhibits Protein C and S (anticoagulant proteins) faster
than it inhibits clotting factors II, IX, and X, creating a temporary prothrombotic state.
5. A patient on Lithium therapy presents with tremors, ataxia, and confusion. What is the
most appropriate immediate action by the NP?
A. Increase the Lithium dose to stabilize mood
B. Prescribe a benzodiazepine for the tremors
C. Order a serum Lithium level and hold the next dose
D. Encourage a low-sodium diet to increase Lithium excretion
Answer: C
Conceptual Explanation: These symptoms are classic signs of lithium toxicity, which has a
narrow therapeutic range (0.6-1.2 mEq/L). Serum levels must be checked immediately.
6. Which mechanism best describes the action of Proton Pump Inhibitors (PPIs) like
Omeprazole?
A. Competitive inhibition of H2 receptors
B. Neutralization of gastric acid via a chemical buffer
C. Irreversible inhibition of the H+/K+ ATPase enzyme system
PHARMACOLOGY FINAL EXAM
(VERIFIED ANSWERS) QUESTIONS
WITH ANSWERS: WALDEN
UNIVERSITY
1. A patient is taking a drug that is a potent inducer of the CYP3A4 enzyme system. What is
the most likely effect on a co-administered drug that is a substrate of the same enzyme?
A. Increased metabolism and reduced therapeutic effect of the substrate drug
B. Decreased metabolism and increased risk of toxicity of the substrate drug
C. Decreased renal excretion of the substrate drug
D. Increased protein binding of the substrate drug
Answer: A
Conceptual Explanation: Enzyme inducers stimulate the synthesis of metabolic enzymes,
leading to faster clearance and lower plasma levels of drugs metabolized by those enzymes.
2. Which physiological change in the elderly significantly impacts the volume of distribution
(Vd) of fat-soluble drugs like diazepam?
A. Increased proportion of body fat
B. Decreased hepatic blood flow
,C. Increased total body water
D. Increased serum albumin levels
Answer: A
Conceptual Explanation: Aging is associated with an increase in body fat percentage,
which increases the volume of distribution for lipophilic drugs, potentially extending their
half-life.
3. A patient with a history of asthma is diagnosed with hypertension. Which of the following
antihypertensive agents is strictly contraindicated?
A. Amlodipine
B. Lisinopril
C. Propranolol
D. Hydrochlorothiazide
Answer: C
Conceptual Explanation: Propranolol is a non-selective beta-blocker that can block beta-2
receptors in the lungs, causing bronchoconstriction in patients with asthma.
4. When initiating Warfarin therapy, why is it common practice to overlap with Heparin for
the first few days?
A. Heparin increases the absorption of Warfarin
B. Heparin acts as a chemical buffer against Warfarin-induced GI upset
, C. To prevent a transient hypercoagulable state due to rapid depletion of Protein C and S
D. Warfarin requires Heparin as a cofactor to bind to Vitamin K
Answer: C
Conceptual Explanation: Warfarin inhibits Protein C and S (anticoagulant proteins) faster
than it inhibits clotting factors II, IX, and X, creating a temporary prothrombotic state.
5. A patient on Lithium therapy presents with tremors, ataxia, and confusion. What is the
most appropriate immediate action by the NP?
A. Increase the Lithium dose to stabilize mood
B. Prescribe a benzodiazepine for the tremors
C. Order a serum Lithium level and hold the next dose
D. Encourage a low-sodium diet to increase Lithium excretion
Answer: C
Conceptual Explanation: These symptoms are classic signs of lithium toxicity, which has a
narrow therapeutic range (0.6-1.2 mEq/L). Serum levels must be checked immediately.
6. Which mechanism best describes the action of Proton Pump Inhibitors (PPIs) like
Omeprazole?
A. Competitive inhibition of H2 receptors
B. Neutralization of gastric acid via a chemical buffer
C. Irreversible inhibition of the H+/K+ ATPase enzyme system
