NURS 6521 Advanced Pharmacology
Final Exam: Questions with Answers| Updated| Pass Guaranteed|
Walden University
1. Which statement about bioavailability is correct?
A. Intravenous administration has 100% bioavailability because it
bypasses absorption
B. Sublingual drugs undergo extensive first-pass metabolism
C. Oral drugs always have 100% bioavailability
D. Bioavailability depends only on dose
Answer: A. Intravenous administration has 100% bioavailability
because it bypasses absorption
Rationale: Bioavailability is the fraction of an administered dose that
reaches the systemic circulation unchanged. IV drugs enter the blood
directly. Oral bioavailability is reduced by incomplete absorption, gut wall
metabolism, and hepatic first-pass extraction.
2. Which drug characteristic favors passive diffusion across cell
membranes and rapid absorption?
A. Highly protein bound only
B. Water-soluble, highly ionized, large molecule
C. Lipid-soluble, nonionized, low molecular weight
D. Positively charged at all pH values
Answer: C. Lipid-soluble, nonionized, low molecular weight
Rationale: Most drugs cross membranes by passive diffusion in their
nonionized, lipophilic form. Weak acids such as aspirin are more
nonionized (and better absorbed) in the acidic stomach, while weak bases
are more absorbed in the alkaline intestine.
NURS 6521 Final | Page 1
,3. A drug has a very large volume of distribution (e.g., amiodarone).
Which conclusion is correct?
A. It is not protein bound
B. The drug is rapidly eliminated
C. The drug is confined to plasma
D. The drug is extensively distributed into tissues, so plasma levels are
low and hemodialysis is ineffective for overdose
Answer: D. The drug is extensively distributed into tissues, so plasma
levels are low and hemodialysis is ineffective for overdose
Rationale: A large Vd implies extensive tissue binding or lipid storage,
which prolongs half-life and requires a loading dose. Drugs with a small Vd
(warfarin, aminoglycosides) stay mostly in the plasma or extracellular fluid.
4. A patient on warfarin is started on another highly protein-bound
drug. What is the potential effect?
A. Decreased anticoagulation
B. Displacement increases the free (active) warfarin fraction, raising the
risk of bleeding
C. Warfarin is cleared more slowly because of decreased free drug
D. No effect, ever
Answer: B. Displacement increases the free (active) warfarin fraction,
raising the risk of bleeding
Rationale: Only unbound drug is active. Displacement matters most for
highly protein-bound drugs with a narrow therapeutic index, although the
effect is often transient because more free drug is eliminated. Concomitant
enzyme inhibition (e.g., TMP-SMX) usually makes the interaction more
significant.
NURS 6521 Final | Page 2
,5. Which statement correctly differentiates Phase I and Phase II drug
metabolism?
A. Phase I conjugates drugs with glucuronic acid
B. Only Phase II is affected by age
C. Phase I (oxidation by CYP450) modifies drugs, and Phase II
(conjugation such as glucuronidation) makes them more water-soluble
for excretion
D. Phase II always precedes Phase I
Answer: C. Phase I (oxidation by CYP450) modifies drugs, and Phase
II (conjugation such as glucuronidation) makes them more water-
soluble for excretion
Rationale: Phase I reactions (oxidation, reduction, hydrolysis) often
produce active or toxic metabolites, and Phase II attaches polar groups.
Phase I declines with age and liver disease, whereas glucuronidation is
relatively preserved.
6. A patient on carbamazepine has subtherapeutic levels several
weeks after reaching a stable dose. What is the explanation?
A. Autoinduction: carbamazepine induces its own CYP3A4 metabolism
B. Protein binding increases
C. Decreased absorption from age
D. Renal failure
Answer: A. Autoinduction: carbamazepine induces its own CYP3A4
metabolism
Rationale: Carbamazepine induces CYP3A4, increasing its own clearance
within 2-4 weeks, so doses often need to be increased. It also lowers levels
of warfarin, oral contraceptives, and many other drugs.
NURS 6521 Final | Page 3
, 7. A woman taking tamoxifen for breast cancer is started on
paroxetine for hot flashes. Why is this a concern?
A. No interaction exists
B. Paroxetine is a strong CYP2D6 inhibitor and reduces the conversion of
tamoxifen to its active metabolite, endoxifen
C. Paroxetine induces tamoxifen metabolism
D. Both drugs cause serotonin syndrome only
Answer: B. Paroxetine is a strong CYP2D6 inhibitor and reduces the
conversion of tamoxifen to its active metabolite, endoxifen
Rationale: Tamoxifen is a prodrug that depends on CYP2D6 for activation.
Strong inhibitors (paroxetine, fluoxetine, bupropion) may reduce efficacy.
Venlafaxine or other weaker inhibitors are preferable.
8. A patient who smokes is stable on clozapine. After quitting
smoking, he develops sedation, hypersalivation, and seizures. What
is the cause?
A. Nicotine increases protein binding
B. Increased clozapine clearance
C. Decreased absorption
D. Loss of CYP1A2 induction from tobacco smoke, which increases
clozapine levels
Answer: D. Loss of CYP1A2 induction from tobacco smoke, which
increases clozapine levels
Rationale: Polycyclic aromatic hydrocarbons in smoke (not nicotine)
induce CYP1A2. Stopping smoking raises levels of clozapine, olanzapine,
theophylline, and caffeine, which can lead to toxicity unless doses are
reduced.
NURS 6521 Final | Page 4
Final Exam: Questions with Answers| Updated| Pass Guaranteed|
Walden University
1. Which statement about bioavailability is correct?
A. Intravenous administration has 100% bioavailability because it
bypasses absorption
B. Sublingual drugs undergo extensive first-pass metabolism
C. Oral drugs always have 100% bioavailability
D. Bioavailability depends only on dose
Answer: A. Intravenous administration has 100% bioavailability
because it bypasses absorption
Rationale: Bioavailability is the fraction of an administered dose that
reaches the systemic circulation unchanged. IV drugs enter the blood
directly. Oral bioavailability is reduced by incomplete absorption, gut wall
metabolism, and hepatic first-pass extraction.
2. Which drug characteristic favors passive diffusion across cell
membranes and rapid absorption?
A. Highly protein bound only
B. Water-soluble, highly ionized, large molecule
C. Lipid-soluble, nonionized, low molecular weight
D. Positively charged at all pH values
Answer: C. Lipid-soluble, nonionized, low molecular weight
Rationale: Most drugs cross membranes by passive diffusion in their
nonionized, lipophilic form. Weak acids such as aspirin are more
nonionized (and better absorbed) in the acidic stomach, while weak bases
are more absorbed in the alkaline intestine.
NURS 6521 Final | Page 1
,3. A drug has a very large volume of distribution (e.g., amiodarone).
Which conclusion is correct?
A. It is not protein bound
B. The drug is rapidly eliminated
C. The drug is confined to plasma
D. The drug is extensively distributed into tissues, so plasma levels are
low and hemodialysis is ineffective for overdose
Answer: D. The drug is extensively distributed into tissues, so plasma
levels are low and hemodialysis is ineffective for overdose
Rationale: A large Vd implies extensive tissue binding or lipid storage,
which prolongs half-life and requires a loading dose. Drugs with a small Vd
(warfarin, aminoglycosides) stay mostly in the plasma or extracellular fluid.
4. A patient on warfarin is started on another highly protein-bound
drug. What is the potential effect?
A. Decreased anticoagulation
B. Displacement increases the free (active) warfarin fraction, raising the
risk of bleeding
C. Warfarin is cleared more slowly because of decreased free drug
D. No effect, ever
Answer: B. Displacement increases the free (active) warfarin fraction,
raising the risk of bleeding
Rationale: Only unbound drug is active. Displacement matters most for
highly protein-bound drugs with a narrow therapeutic index, although the
effect is often transient because more free drug is eliminated. Concomitant
enzyme inhibition (e.g., TMP-SMX) usually makes the interaction more
significant.
NURS 6521 Final | Page 2
,5. Which statement correctly differentiates Phase I and Phase II drug
metabolism?
A. Phase I conjugates drugs with glucuronic acid
B. Only Phase II is affected by age
C. Phase I (oxidation by CYP450) modifies drugs, and Phase II
(conjugation such as glucuronidation) makes them more water-soluble
for excretion
D. Phase II always precedes Phase I
Answer: C. Phase I (oxidation by CYP450) modifies drugs, and Phase
II (conjugation such as glucuronidation) makes them more water-
soluble for excretion
Rationale: Phase I reactions (oxidation, reduction, hydrolysis) often
produce active or toxic metabolites, and Phase II attaches polar groups.
Phase I declines with age and liver disease, whereas glucuronidation is
relatively preserved.
6. A patient on carbamazepine has subtherapeutic levels several
weeks after reaching a stable dose. What is the explanation?
A. Autoinduction: carbamazepine induces its own CYP3A4 metabolism
B. Protein binding increases
C. Decreased absorption from age
D. Renal failure
Answer: A. Autoinduction: carbamazepine induces its own CYP3A4
metabolism
Rationale: Carbamazepine induces CYP3A4, increasing its own clearance
within 2-4 weeks, so doses often need to be increased. It also lowers levels
of warfarin, oral contraceptives, and many other drugs.
NURS 6521 Final | Page 3
, 7. A woman taking tamoxifen for breast cancer is started on
paroxetine for hot flashes. Why is this a concern?
A. No interaction exists
B. Paroxetine is a strong CYP2D6 inhibitor and reduces the conversion of
tamoxifen to its active metabolite, endoxifen
C. Paroxetine induces tamoxifen metabolism
D. Both drugs cause serotonin syndrome only
Answer: B. Paroxetine is a strong CYP2D6 inhibitor and reduces the
conversion of tamoxifen to its active metabolite, endoxifen
Rationale: Tamoxifen is a prodrug that depends on CYP2D6 for activation.
Strong inhibitors (paroxetine, fluoxetine, bupropion) may reduce efficacy.
Venlafaxine or other weaker inhibitors are preferable.
8. A patient who smokes is stable on clozapine. After quitting
smoking, he develops sedation, hypersalivation, and seizures. What
is the cause?
A. Nicotine increases protein binding
B. Increased clozapine clearance
C. Decreased absorption
D. Loss of CYP1A2 induction from tobacco smoke, which increases
clozapine levels
Answer: D. Loss of CYP1A2 induction from tobacco smoke, which
increases clozapine levels
Rationale: Polycyclic aromatic hydrocarbons in smoke (not nicotine)
induce CYP1A2. Stopping smoking raises levels of clozapine, olanzapine,
theophylline, and caffeine, which can lead to toxicity unless doses are
reduced.
NURS 6521 Final | Page 4
