URS 676 Advanced Pharmacology
N
Midterm Exam – West Coast University
(WCU), complete exam material with
accurate questions and answers
2025-2026
Exam overview:
This NURS 676 midterm exam features 75 graduate-level questions testing advanced
pharmacology. It covers PK/PD, autonomic, antimicrobial, endocrine, and
cardiovascular systems. The focus is on APRN-level prescribing, drug interactions,
genetics, and clinical decision-making for safe and effective pharmacotherapeutic
management.
Pharmacokinetics (PK)
1. A patient with chronic kidney disease (CKD) stage 4 has been prescribed a
medication that is primarily eliminated unchanged through renal excretion.
Which of the following pharmacokinetic parameters would be most
significantly affected in this patient?
A. Absorption rate constant (ka)
,B. Volume of distribution (Vd)
C. Clearance (Cl)
D. First-pass metabolism
Correct Answer: C
Rationale: In patients with CKD stage 4, renal clearance is significantly impaired,
which directly affects the total clearance of renally excreted drugs. This requires
dosage adjustments to prevent drug accumulation and toxicity. The absorption rate
constant, volume of distribution, and first-pass metabolism are not directly affected
by renal function to the same extent as clearance.
2. A 68-year-old patient with hepatic cirrhosis requires medication with a high
first-pass effect. Which pharmacokinetic alteration is most likely to occur?
A. Decreased oral bioavailability
B. Increased volume of distribution
C. Enhanced renal excretion
D. Accelerated metabolism
,Correct Answer: A
Rationale: In hepatic cirrhosis, the functional capacity of the liver is compromised,
leading to reduced first-pass metabolism. This results in increased bioavailability
of drugs that undergo extensive first-pass metabolism, potentially requiring dose
reductions to avoid toxicity. Volume of distribution, renal excretion, and metabolic
rate are not directly related to first-pass effects.
3. A medication follows nonlinear (Michaelis-Menten) kinetics. At
concentrations near the Vmax, which statement best describes the relationship
between dose and plasma concentration?
A. Linear relationship where doubling the dose doubles the concentration
B. Supra-proportional increase where small dose changes cause large concentration
changes
C. Sub-proportional increase where large dose changes cause minimal
concentration changes
D. No predictable relationship between dose and concentration
Correct Answer: B
, Rationale: In Michaelis-Menten kinetics, as drug concentrations approach Vmax,
the metabolic pathways become saturated. This results in a supra-proportional
relationship where small increases in dose lead to disproportionately large
increases in plasma concentration. This is clinically significant for drugs like
phenytoin where therapeutic monitoring is essential to avoid toxicity.
4. Which factor most significantly contributes to the high volume of
distribution observed for lipophilic drugs like diazepam?
A. High plasma protein binding
B. Extensive tissue binding, particularly to adipose tissue
C. Rapid renal clearance
D. Low molecular weight
Correct Answer: B
Rationale: Lipophilic drugs like diazepam have a high affinity for tissues,
particularly adipose tissue, leading to extensive distribution beyond the vascular
compartment. This results in a high volume of distribution. While plasma protein
binding affects distribution, it's the tissue binding that primarily contributes to the
N
Midterm Exam – West Coast University
(WCU), complete exam material with
accurate questions and answers
2025-2026
Exam overview:
This NURS 676 midterm exam features 75 graduate-level questions testing advanced
pharmacology. It covers PK/PD, autonomic, antimicrobial, endocrine, and
cardiovascular systems. The focus is on APRN-level prescribing, drug interactions,
genetics, and clinical decision-making for safe and effective pharmacotherapeutic
management.
Pharmacokinetics (PK)
1. A patient with chronic kidney disease (CKD) stage 4 has been prescribed a
medication that is primarily eliminated unchanged through renal excretion.
Which of the following pharmacokinetic parameters would be most
significantly affected in this patient?
A. Absorption rate constant (ka)
,B. Volume of distribution (Vd)
C. Clearance (Cl)
D. First-pass metabolism
Correct Answer: C
Rationale: In patients with CKD stage 4, renal clearance is significantly impaired,
which directly affects the total clearance of renally excreted drugs. This requires
dosage adjustments to prevent drug accumulation and toxicity. The absorption rate
constant, volume of distribution, and first-pass metabolism are not directly affected
by renal function to the same extent as clearance.
2. A 68-year-old patient with hepatic cirrhosis requires medication with a high
first-pass effect. Which pharmacokinetic alteration is most likely to occur?
A. Decreased oral bioavailability
B. Increased volume of distribution
C. Enhanced renal excretion
D. Accelerated metabolism
,Correct Answer: A
Rationale: In hepatic cirrhosis, the functional capacity of the liver is compromised,
leading to reduced first-pass metabolism. This results in increased bioavailability
of drugs that undergo extensive first-pass metabolism, potentially requiring dose
reductions to avoid toxicity. Volume of distribution, renal excretion, and metabolic
rate are not directly related to first-pass effects.
3. A medication follows nonlinear (Michaelis-Menten) kinetics. At
concentrations near the Vmax, which statement best describes the relationship
between dose and plasma concentration?
A. Linear relationship where doubling the dose doubles the concentration
B. Supra-proportional increase where small dose changes cause large concentration
changes
C. Sub-proportional increase where large dose changes cause minimal
concentration changes
D. No predictable relationship between dose and concentration
Correct Answer: B
, Rationale: In Michaelis-Menten kinetics, as drug concentrations approach Vmax,
the metabolic pathways become saturated. This results in a supra-proportional
relationship where small increases in dose lead to disproportionately large
increases in plasma concentration. This is clinically significant for drugs like
phenytoin where therapeutic monitoring is essential to avoid toxicity.
4. Which factor most significantly contributes to the high volume of
distribution observed for lipophilic drugs like diazepam?
A. High plasma protein binding
B. Extensive tissue binding, particularly to adipose tissue
C. Rapid renal clearance
D. Low molecular weight
Correct Answer: B
Rationale: Lipophilic drugs like diazepam have a high affinity for tissues,
particularly adipose tissue, leading to extensive distribution beyond the vascular
compartment. This results in a high volume of distribution. While plasma protein
binding affects distribution, it's the tissue binding that primarily contributes to the
