Walden University Nurs 6521 Advanced
Pharmacology Midterm Exam with 100 Questions
from Actual Past Exams, 100% Correct Answers and
Rationale
1. What is the primary process by which the liver metabolizes most drugs?
A. Hydrolysis
B. Oxidation
C. Glucuronidation
D. Acetylation
Correct Answer: B
Rationale: The liver primarily uses oxidation via cytochrome P450 enzymes to metabolize drugs,
converting them into water-soluble compounds for excretion.
2. A patient is prescribed warfarin. Which vitamin is antagonized by this drug?
A. Vitamin A
B. Vitamin D
C. Vitamin K
D. Vitamin B12
Correct Answer: C
Rationale: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X), reducing
coagulation.
3. What is the definition of bioavailability?
A. Rate of drug elimination
B. Fraction of administered drug reaching systemic circulation
C. Time to peak plasma concentration
D. Drug binding to plasma proteins
Correct Answer: B
Rationale: Bioavailability measures the proportion of a drug that enters the bloodstream in its
active form.
4. A patient on phenytoin reports gingival hyperplasia. What action should the nurse take?
A. Increase the dose
B. Monitor for toxicity and educate on oral hygiene
C. Discontinue immediately
D. Switch to IV administration
Correct Answer: B
Rationale: Gingival hyperplasia is a common side effect of phenytoin; monitoring and oral
hygiene education are appropriate.
5. Which drug class is used to treat hypertension by blocking angiotensin II receptors?
A. ACE inhibitors
B. ARBs
C. Beta-blockers
D. Calcium channel blockers
Correct Answer: B
,Rationale: Angiotensin receptor blockers (ARBs) inhibit angiotensin II, reducing
vasoconstriction and blood pressure.
6. True or False: First-pass metabolism occurs primarily in the kidneys.
A. True
B. False
Correct Answer: B
Rationale: First-pass metabolism occurs in the liver, reducing bioavailability of orally
administered drugs.
7. Select all that apply: Which factors affect drug absorption?
A. Gastrointestinal pH
B. Food in the stomach
C. Drug formulation
D. Body temperature
E. Blood pressure
Correct Answers: A, B, C
Rationale: GI pH, food, and drug formulation (e.g., tablet vs. liquid) influence absorption; body
temperature and blood pressure have minimal direct impact.
8. A patient is prescribed digoxin. What electrolyte imbalance increases the risk of toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Correct Answer: B
Rationale: Hypokalemia enhances digoxin binding to cardiac Na+/K+-ATPase, increasing
toxicity risk.
9. What is the mechanism of action of metformin?
A. Increases insulin secretion
B. Decreases hepatic glucose production
C. Inhibits glucagon release
D. Enhances peripheral glucose uptake only
Correct Answer: B
Rationale: Metformin reduces hepatic gluconeogenesis and improves insulin sensitivity in type 2
diabetes.
10. A patient with asthma is prescribed albuterol. What is its primary action?
A. Anti-inflammatory
B. Bronchodilation
C. Mucolytic
D. Anticholinergic
Correct Answer: B
Rationale: Albuterol, a beta-2 agonist, relaxes bronchial smooth muscle, promoting
bronchodilation.
11. What is the therapeutic index of a drug?
A. Ratio of effective dose to toxic dose
B. Time to peak effect
C. Drug half-life
D. Plasma protein binding
, Correct Answer: A
Rationale: The therapeutic index measures the safety margin between the effective dose (ED50)
and toxic dose (TD50).
12. A patient on a statin reports muscle pain. What should the nurse assess for?
A. Rhabdomyolysis
B. Hypoglycemia
C. Hyperkalemia
D. Hypertension
Correct Answer: A
Rationale: Statins can cause myopathy, potentially progressing to rhabdomyolysis, a serious side
effect.
13. Which anticoagulant requires monitoring with aPTT?
A. Warfarin
B. Heparin
C. Apixaban
D. Dabigatran
Correct Answer: B
Rationale: Heparin’s anticoagulant effect is monitored via aPTT to ensure therapeutic dosing.
14. A patient is prescribed fluoxetine. What class of drug is this?
A. SSRI
B. SNRI
C. Tricyclic antidepressant
D. MAOI
Correct Answer: A
Rationale: Fluoxetine is a selective serotonin reuptake inhibitor used for depression and anxiety.
15. What is the primary route of excretion for most drugs?
A. Lungs
B. Kidneys
C. Skin
D. Intestines
Correct Answer: B
Rationale: The kidneys excrete most drugs and their metabolites via urine.
16. True or False: Grapefruit juice inhibits cytochrome P450 enzymes.
A. True
B. False
Correct Answer: A
Rationale: Grapefruit juice inhibits CYP3A4, increasing plasma levels of drugs metabolized by
this enzyme.
17. Select all that apply: Which are side effects of ACE inhibitors?
A. Dry cough
B. Hyperkalemia
C. Hypotension
D. Bradycardia
E. Angioedema
Correct Answers: A, B, C, E
Rationale: ACE inhibitors cause cough, hyperkalemia, hypotension, and angioedema;
Pharmacology Midterm Exam with 100 Questions
from Actual Past Exams, 100% Correct Answers and
Rationale
1. What is the primary process by which the liver metabolizes most drugs?
A. Hydrolysis
B. Oxidation
C. Glucuronidation
D. Acetylation
Correct Answer: B
Rationale: The liver primarily uses oxidation via cytochrome P450 enzymes to metabolize drugs,
converting them into water-soluble compounds for excretion.
2. A patient is prescribed warfarin. Which vitamin is antagonized by this drug?
A. Vitamin A
B. Vitamin D
C. Vitamin K
D. Vitamin B12
Correct Answer: C
Rationale: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X), reducing
coagulation.
3. What is the definition of bioavailability?
A. Rate of drug elimination
B. Fraction of administered drug reaching systemic circulation
C. Time to peak plasma concentration
D. Drug binding to plasma proteins
Correct Answer: B
Rationale: Bioavailability measures the proportion of a drug that enters the bloodstream in its
active form.
4. A patient on phenytoin reports gingival hyperplasia. What action should the nurse take?
A. Increase the dose
B. Monitor for toxicity and educate on oral hygiene
C. Discontinue immediately
D. Switch to IV administration
Correct Answer: B
Rationale: Gingival hyperplasia is a common side effect of phenytoin; monitoring and oral
hygiene education are appropriate.
5. Which drug class is used to treat hypertension by blocking angiotensin II receptors?
A. ACE inhibitors
B. ARBs
C. Beta-blockers
D. Calcium channel blockers
Correct Answer: B
,Rationale: Angiotensin receptor blockers (ARBs) inhibit angiotensin II, reducing
vasoconstriction and blood pressure.
6. True or False: First-pass metabolism occurs primarily in the kidneys.
A. True
B. False
Correct Answer: B
Rationale: First-pass metabolism occurs in the liver, reducing bioavailability of orally
administered drugs.
7. Select all that apply: Which factors affect drug absorption?
A. Gastrointestinal pH
B. Food in the stomach
C. Drug formulation
D. Body temperature
E. Blood pressure
Correct Answers: A, B, C
Rationale: GI pH, food, and drug formulation (e.g., tablet vs. liquid) influence absorption; body
temperature and blood pressure have minimal direct impact.
8. A patient is prescribed digoxin. What electrolyte imbalance increases the risk of toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Correct Answer: B
Rationale: Hypokalemia enhances digoxin binding to cardiac Na+/K+-ATPase, increasing
toxicity risk.
9. What is the mechanism of action of metformin?
A. Increases insulin secretion
B. Decreases hepatic glucose production
C. Inhibits glucagon release
D. Enhances peripheral glucose uptake only
Correct Answer: B
Rationale: Metformin reduces hepatic gluconeogenesis and improves insulin sensitivity in type 2
diabetes.
10. A patient with asthma is prescribed albuterol. What is its primary action?
A. Anti-inflammatory
B. Bronchodilation
C. Mucolytic
D. Anticholinergic
Correct Answer: B
Rationale: Albuterol, a beta-2 agonist, relaxes bronchial smooth muscle, promoting
bronchodilation.
11. What is the therapeutic index of a drug?
A. Ratio of effective dose to toxic dose
B. Time to peak effect
C. Drug half-life
D. Plasma protein binding
, Correct Answer: A
Rationale: The therapeutic index measures the safety margin between the effective dose (ED50)
and toxic dose (TD50).
12. A patient on a statin reports muscle pain. What should the nurse assess for?
A. Rhabdomyolysis
B. Hypoglycemia
C. Hyperkalemia
D. Hypertension
Correct Answer: A
Rationale: Statins can cause myopathy, potentially progressing to rhabdomyolysis, a serious side
effect.
13. Which anticoagulant requires monitoring with aPTT?
A. Warfarin
B. Heparin
C. Apixaban
D. Dabigatran
Correct Answer: B
Rationale: Heparin’s anticoagulant effect is monitored via aPTT to ensure therapeutic dosing.
14. A patient is prescribed fluoxetine. What class of drug is this?
A. SSRI
B. SNRI
C. Tricyclic antidepressant
D. MAOI
Correct Answer: A
Rationale: Fluoxetine is a selective serotonin reuptake inhibitor used for depression and anxiety.
15. What is the primary route of excretion for most drugs?
A. Lungs
B. Kidneys
C. Skin
D. Intestines
Correct Answer: B
Rationale: The kidneys excrete most drugs and their metabolites via urine.
16. True or False: Grapefruit juice inhibits cytochrome P450 enzymes.
A. True
B. False
Correct Answer: A
Rationale: Grapefruit juice inhibits CYP3A4, increasing plasma levels of drugs metabolized by
this enzyme.
17. Select all that apply: Which are side effects of ACE inhibitors?
A. Dry cough
B. Hyperkalemia
C. Hypotension
D. Bradycardia
E. Angioedema
Correct Answers: A, B, C, E
Rationale: ACE inhibitors cause cough, hyperkalemia, hypotension, and angioedema;
