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NURS 5334 Advanced Pharmacology Final Exam
Actual Exam 2026/2027 | UTA Graduate Nursing
Complete Test Bank with Verified Questions &
Correct Answers | Updated & Verified | A+ Graded
SECTION 1: FOUNDATIONS OF ADVANCED PHARMACOLOGY
Q1: A 65-year-old patient with atrial fibrillation is started on warfarin. The nurse practitioner
knows that warfarin's anticoagulant effect is monitored using which laboratory value, and what is
the therapeutic range for most indications?
A. aPTT; 1.5-2.5 times control
B. INR; 2.0-3.0. [CORRECT]
C. Anti-Xa; 0.5-1.0 IU/mL
D. Bleeding time; 3-9 minutes
Correct Answer: B
Rationale: Warfarin's anticoagulant effect is monitored using the International Normalized Ratio
(INR). For most indications, including atrial fibrillation and venous thromboembolism, the
therapeutic target INR is 2.0-3.0 (B). aPTT (A) is used to monitor unfractionated heparin. Anti-
Xa (C) is used to monitor LMWH and occasionally unfractionated heparin. Bleeding time (D) is
not used to monitor warfarin therapy.
Q2: A nurse practitioner is prescribing a medication that is a substrate of the CYP2D6 enzyme
system. The patient is a poor metabolizer (PM) for CYP2D6. What effect will this have on the
drug's plasma concentration and clinical effect?
A. Decreased plasma concentration, requiring higher doses for therapeutic effect
B. Increased plasma concentration, increasing risk of toxicity. [CORRECT]
C. No change in plasma concentration or clinical effect
D. Rapid metabolism leading to therapeutic failure
Correct Answer: B
Rationale: Poor metabolizers (PMs) lack functional CYP2D6 enzyme activity, resulting in
reduced metabolism of CYP2D6 substrates. This leads to increased plasma concentrations and
prolonged half-life, increasing the risk of adverse effects and toxicity (B). Ultra-rapid
,2
metabolizers (UMs) would experience decreased plasma concentrations (A). The genetic
polymorphism directly affects drug metabolism (C is incorrect).
Q3: A 45-year-old patient with depression is prescribed fluoxetine. The NP knows that fluoxetine
is a potent inhibitor of which CYP enzyme, requiring careful monitoring when co-prescribing
drugs metabolized by this system?
A. CYP3A4
B. CYP2C9
C. CYP2D6. [CORRECT]
D. CYP1A2
Correct Answer: C
Rationale: Fluoxetine and its active metabolite norfluoxetine are potent inhibitors of CYP2D6
(C), which can significantly increase plasma concentrations of concurrent medications
metabolized by this enzyme (e.g., metoprolol, tramadol, codeine, TCAs). While fluoxetine has
some effect on CYP3A4, its CYP2D6 inhibition is clinically most significant. This interaction
can convert codeine (a prodrug requiring CYP2D6 activation) into an ineffective analgesic.
Q4: A patient has been taking phenytoin for seizure control for 3 weeks. The NP adds a new
medication that is metabolized by CYP3A4. What is the most likely effect of phenytoin on the
new medication's pharmacokinetics?
A. Increased plasma concentration due to CYP3A4 inhibition
B. Decreased plasma concentration due to CYP3A4 induction. [CORRECT]
C. No effect on the new medication's metabolism
D. Increased protein binding and reduced free drug concentration
Correct Answer: B
Rationale: Phenytoin is a potent CYP450 enzyme inducer, particularly affecting CYP3A4,
CYP2C9, and CYP2C19. Chronic administration (>1-2 weeks) increases enzyme synthesis,
accelerating metabolism of substrates and decreasing their plasma concentrations (B). This can
lead to therapeutic failure of drugs like oral contraceptives, warfarin, and many antiretrovirals.
Option A describes enzyme inhibition (e.g., ketoconazole).
Q5: A nurse practitioner is calculating a loading dose for digoxin in a patient with normal renal
function. Which pharmacokinetic parameter primarily determines the loading dose calculation?
A. Clearance (Cl)
B. Volume of distribution (Vd). [CORRECT]
,3
C. Half-life (t½)
D. Bioavailability (F)
Correct Answer: B
Rationale: The loading dose (LD) is calculated using the formula: LD = (Target Concentration ×
Vd) / Bioavailability. Volume of distribution (Vd) (B) represents the theoretical volume into
which the drug distributes and is the primary determinant of loading dose. Clearance (A) and
half-life (C) determine maintenance dosing intervals. While bioavailability (D) is included in the
calculation, Vd is the critical variable for determining the initial amount needed to achieve
therapeutic concentrations quickly.
Q6: A patient with chronic kidney disease (CrCl 30 mL/min) requires dosing adjustment for a
drug that is 80% renally eliminated. The normal dose is 500 mg every 12 hours. What principle
guides the dosing adjustment in renal impairment?
A. Increase the dose and lengthen the interval to maintain therapeutic levels
B. Decrease the dose or lengthen the interval to prevent drug accumulation. [CORRECT]
C. Maintain normal dosing because hepatic metabolism will compensate
D. Discontinue the drug entirely as it is contraindicated in renal impairment
Correct Answer: B
Rationale: For drugs primarily eliminated by the kidneys, reduced renal function leads to
decreased clearance and prolonged half-life, causing drug accumulation and toxicity risk. The
dosing adjustment principle involves either reducing the dose while maintaining the interval, or
lengthening the interval while maintaining the dose, or both (B). This maintains average steady-
state concentrations within therapeutic range. Option A would worsen toxicity.
Q7: A nurse practitioner is prescribing carbamazepine for a patient with bipolar disorder. Which
pharmacogenomic consideration is most important regarding HLA-B*1502 allele testing?
A. Risk of Stevens-Johnson syndrome/toxic epidermal necrolysis in Asian patients.
[CORRECT]
B. Risk of agranulocytosis in all ethnic populations
C. Prediction of therapeutic response in Caucasian patients
D. Metabolism rate and dosing requirements
Correct Answer: A
Rationale: The FDA requires HLA-B1502 genetic screening before initiating carbamazepine in
patients of Asian ancestry due to significantly increased risk of severe, potentially fatal
cutaneous adverse reactions including Stevens-Johnson syndrome (SJS) and toxic epidermal
necrolysis (TEN) (A). This allele is present in 10-15% of some Asian populations. The
, 4
association with agranulocytosis (B) is not HLA-B1502 related. CYP2C19 polymorphisms affect
metabolism (D).
Q8: A patient is taking warfarin (highly protein-bound, 99%) and is prescribed
sulfamethoxazole-trimethoprim (TMP-SMX), which is also highly protein-bound. What is the
primary mechanism of the potential drug-drug interaction?
A. CYP2C9 inhibition reducing warfarin metabolism
B. Displacement from protein binding sites increasing free warfarin. [CORRECT]
C. Increased absorption of warfarin from the GI tract
D. Induction of warfarin metabolism
Correct Answer: B
Rationale: Both warfarin and TMP-SMX are highly protein-bound drugs. When administered
concurrently, TMP-SMX can displace warfarin from albumin binding sites, transiently increasing
free (active) warfarin concentration (B), potentially causing bleeding. Additionally, TMP-SMX
inhibits CYP2C9 (A), further complicating the interaction. The protein binding displacement is
immediate, while enzyme inhibition develops over days.
Q9: A nurse practitioner is writing a prescription for a Schedule II controlled substance.
According to DEA regulations, which requirement is mandatory for the prescription to be valid?
A. The prescription may be transmitted electronically, orally, or by fax at the prescriber's
discretion
B. The prescription must include the patient's phone number and diagnosis code
C. The prescription must be written with ink or indelible pencil, manually signed by the
prescriber, and include the DEA number. [CORRECT]
D. The prescription may be refilled up to 5 times within 6 months
Correct Answer: C
Rationale: Schedule II controlled substances require strict prescription requirements: must be
written (not phoned, except emergencies), signed manually by the prescriber, written in ink or
indelible pencil, and include the prescriber's DEA registration number (C). While electronic
prescribing for Schedule II drugs is now permitted under specific DEA regulations, traditional
written prescriptions must meet these standards. Schedule II prescriptions cannot be refilled (D is
incorrect).
NURS 5334 Advanced Pharmacology Final Exam
Actual Exam 2026/2027 | UTA Graduate Nursing
Complete Test Bank with Verified Questions &
Correct Answers | Updated & Verified | A+ Graded
SECTION 1: FOUNDATIONS OF ADVANCED PHARMACOLOGY
Q1: A 65-year-old patient with atrial fibrillation is started on warfarin. The nurse practitioner
knows that warfarin's anticoagulant effect is monitored using which laboratory value, and what is
the therapeutic range for most indications?
A. aPTT; 1.5-2.5 times control
B. INR; 2.0-3.0. [CORRECT]
C. Anti-Xa; 0.5-1.0 IU/mL
D. Bleeding time; 3-9 minutes
Correct Answer: B
Rationale: Warfarin's anticoagulant effect is monitored using the International Normalized Ratio
(INR). For most indications, including atrial fibrillation and venous thromboembolism, the
therapeutic target INR is 2.0-3.0 (B). aPTT (A) is used to monitor unfractionated heparin. Anti-
Xa (C) is used to monitor LMWH and occasionally unfractionated heparin. Bleeding time (D) is
not used to monitor warfarin therapy.
Q2: A nurse practitioner is prescribing a medication that is a substrate of the CYP2D6 enzyme
system. The patient is a poor metabolizer (PM) for CYP2D6. What effect will this have on the
drug's plasma concentration and clinical effect?
A. Decreased plasma concentration, requiring higher doses for therapeutic effect
B. Increased plasma concentration, increasing risk of toxicity. [CORRECT]
C. No change in plasma concentration or clinical effect
D. Rapid metabolism leading to therapeutic failure
Correct Answer: B
Rationale: Poor metabolizers (PMs) lack functional CYP2D6 enzyme activity, resulting in
reduced metabolism of CYP2D6 substrates. This leads to increased plasma concentrations and
prolonged half-life, increasing the risk of adverse effects and toxicity (B). Ultra-rapid
,2
metabolizers (UMs) would experience decreased plasma concentrations (A). The genetic
polymorphism directly affects drug metabolism (C is incorrect).
Q3: A 45-year-old patient with depression is prescribed fluoxetine. The NP knows that fluoxetine
is a potent inhibitor of which CYP enzyme, requiring careful monitoring when co-prescribing
drugs metabolized by this system?
A. CYP3A4
B. CYP2C9
C. CYP2D6. [CORRECT]
D. CYP1A2
Correct Answer: C
Rationale: Fluoxetine and its active metabolite norfluoxetine are potent inhibitors of CYP2D6
(C), which can significantly increase plasma concentrations of concurrent medications
metabolized by this enzyme (e.g., metoprolol, tramadol, codeine, TCAs). While fluoxetine has
some effect on CYP3A4, its CYP2D6 inhibition is clinically most significant. This interaction
can convert codeine (a prodrug requiring CYP2D6 activation) into an ineffective analgesic.
Q4: A patient has been taking phenytoin for seizure control for 3 weeks. The NP adds a new
medication that is metabolized by CYP3A4. What is the most likely effect of phenytoin on the
new medication's pharmacokinetics?
A. Increased plasma concentration due to CYP3A4 inhibition
B. Decreased plasma concentration due to CYP3A4 induction. [CORRECT]
C. No effect on the new medication's metabolism
D. Increased protein binding and reduced free drug concentration
Correct Answer: B
Rationale: Phenytoin is a potent CYP450 enzyme inducer, particularly affecting CYP3A4,
CYP2C9, and CYP2C19. Chronic administration (>1-2 weeks) increases enzyme synthesis,
accelerating metabolism of substrates and decreasing their plasma concentrations (B). This can
lead to therapeutic failure of drugs like oral contraceptives, warfarin, and many antiretrovirals.
Option A describes enzyme inhibition (e.g., ketoconazole).
Q5: A nurse practitioner is calculating a loading dose for digoxin in a patient with normal renal
function. Which pharmacokinetic parameter primarily determines the loading dose calculation?
A. Clearance (Cl)
B. Volume of distribution (Vd). [CORRECT]
,3
C. Half-life (t½)
D. Bioavailability (F)
Correct Answer: B
Rationale: The loading dose (LD) is calculated using the formula: LD = (Target Concentration ×
Vd) / Bioavailability. Volume of distribution (Vd) (B) represents the theoretical volume into
which the drug distributes and is the primary determinant of loading dose. Clearance (A) and
half-life (C) determine maintenance dosing intervals. While bioavailability (D) is included in the
calculation, Vd is the critical variable for determining the initial amount needed to achieve
therapeutic concentrations quickly.
Q6: A patient with chronic kidney disease (CrCl 30 mL/min) requires dosing adjustment for a
drug that is 80% renally eliminated. The normal dose is 500 mg every 12 hours. What principle
guides the dosing adjustment in renal impairment?
A. Increase the dose and lengthen the interval to maintain therapeutic levels
B. Decrease the dose or lengthen the interval to prevent drug accumulation. [CORRECT]
C. Maintain normal dosing because hepatic metabolism will compensate
D. Discontinue the drug entirely as it is contraindicated in renal impairment
Correct Answer: B
Rationale: For drugs primarily eliminated by the kidneys, reduced renal function leads to
decreased clearance and prolonged half-life, causing drug accumulation and toxicity risk. The
dosing adjustment principle involves either reducing the dose while maintaining the interval, or
lengthening the interval while maintaining the dose, or both (B). This maintains average steady-
state concentrations within therapeutic range. Option A would worsen toxicity.
Q7: A nurse practitioner is prescribing carbamazepine for a patient with bipolar disorder. Which
pharmacogenomic consideration is most important regarding HLA-B*1502 allele testing?
A. Risk of Stevens-Johnson syndrome/toxic epidermal necrolysis in Asian patients.
[CORRECT]
B. Risk of agranulocytosis in all ethnic populations
C. Prediction of therapeutic response in Caucasian patients
D. Metabolism rate and dosing requirements
Correct Answer: A
Rationale: The FDA requires HLA-B1502 genetic screening before initiating carbamazepine in
patients of Asian ancestry due to significantly increased risk of severe, potentially fatal
cutaneous adverse reactions including Stevens-Johnson syndrome (SJS) and toxic epidermal
necrolysis (TEN) (A). This allele is present in 10-15% of some Asian populations. The
, 4
association with agranulocytosis (B) is not HLA-B1502 related. CYP2C19 polymorphisms affect
metabolism (D).
Q8: A patient is taking warfarin (highly protein-bound, 99%) and is prescribed
sulfamethoxazole-trimethoprim (TMP-SMX), which is also highly protein-bound. What is the
primary mechanism of the potential drug-drug interaction?
A. CYP2C9 inhibition reducing warfarin metabolism
B. Displacement from protein binding sites increasing free warfarin. [CORRECT]
C. Increased absorption of warfarin from the GI tract
D. Induction of warfarin metabolism
Correct Answer: B
Rationale: Both warfarin and TMP-SMX are highly protein-bound drugs. When administered
concurrently, TMP-SMX can displace warfarin from albumin binding sites, transiently increasing
free (active) warfarin concentration (B), potentially causing bleeding. Additionally, TMP-SMX
inhibits CYP2C9 (A), further complicating the interaction. The protein binding displacement is
immediate, while enzyme inhibition develops over days.
Q9: A nurse practitioner is writing a prescription for a Schedule II controlled substance.
According to DEA regulations, which requirement is mandatory for the prescription to be valid?
A. The prescription may be transmitted electronically, orally, or by fax at the prescriber's
discretion
B. The prescription must include the patient's phone number and diagnosis code
C. The prescription must be written with ink or indelible pencil, manually signed by the
prescriber, and include the DEA number. [CORRECT]
D. The prescription may be refilled up to 5 times within 6 months
Correct Answer: C
Rationale: Schedule II controlled substances require strict prescription requirements: must be
written (not phoned, except emergencies), signed manually by the prescriber, written in ink or
indelible pencil, and include the prescriber's DEA registration number (C). While electronic
prescribing for Schedule II drugs is now permitted under specific DEA regulations, traditional
written prescriptions must meet these standards. Schedule II prescriptions cannot be refilled (D is
incorrect).
