NUR 641E MIDTERM EXAM AND STUDY
GUIDE (GCU) NEWEST 2026 TEST BANK|
ADVANCED PATHOPHYSIOLOGY
Question 1
What does pharmacokinetics involve?
A) The study of drug-receptor interactions and mechanisms of action
B) The process of ADME (absorption, distribution, metabolism, and elimination)
C) The study of drug toxicity and adverse effects
D) The process of drug manufacturing and formulation
Answer: B) The process of ADME (absorption, distribution, metabolism, and
elimination)
Rationale: Pharmacokinetics is what the body does to the drug, involving
Absorption (administration site to blood/plasma), Distribution (bloodstream to
interstitial/intracellular fluid), Metabolism (biotransformation via hepatic
metabolism or other tissues), and Elimination (drug and metabolites removed
from the body) .
Question 2
Which route of administration has the highest bioavailability?
A) Oral
B) Intramuscular
C) Intravenous
D) Sublingual
Answer: C) Intravenous
Rationale: The intravenous route places the entire dose directly into a patient's
vein, bypassing absorption entirely. It also avoids first-pass metabolism in the
,liver, which can destroy a significant portion of orally administered drugs before
they reach systemic circulation .
Question 3
A patient with cirrhosis receives a medication with extensive first-pass
metabolism. What pharmacokinetic change is expected?
A) Lower absorption
B) Higher bioavailability
C) Faster excretion
D) Reduced distribution
Answer: B) Higher bioavailability
Rationale: Hepatic impairment reduces first-pass metabolism, allowing more drug
to enter systemic circulation unchanged. This can lead to increased drug effects
and potential toxicity at standard doses .
Question 4
A patient receives an intravenous medication with a half-life of 8 hours.
Approximately how long will it take to reach steady state?
A) 8 hours
B) 16 hours
C) 40 hours
D) 80 hours
Answer: C) 40 hours
Rationale: Most drugs reach steady state after approximately 4-5 half-lives. Five
half-lives × 8 hours = 40 hours. Steady state is achieved when drug elimination
equals drug administration .
Question 5
What is a prodrug?
,A) An active drug that requires no metabolism
B) An inactive drug dosage form converted to an active metabolite inside the
body
C) A drug that is always administered intravenously
D) A drug that cannot be absorbed orally
Answer: B) An inactive drug dosage form converted to an active metabolite
inside the body
Rationale: A prodrug is an inactive drug dosage form that is converted to an
active metabolite by various biochemical reactions once inside the body.
Examples include aspirin, codeine, and enalapril. Many prodrugs are activated by
cytochrome P450 enzymes .
Question 6
A 72-year-old woman with chronic pain is prescribed codeine. She reports little
pain relief despite adherence. Genetic testing reveals significantly increased
CYP2D6 activity. Which outcome is most likely?
A) Toxicity
B) Tolerance
C) Resistance
D) Dependence
Answer: A) Toxicity
Rationale: Ultra-rapid CYP2D6 metabolizers convert prodrugs such as codeine
into active metabolites (morphine) more rapidly and extensively, increasing
serum concentrations and risk of opioid toxicity. This can be life-threatening,
especially in children .
Question 7
A patient taking warfarin starts trimethoprim-sulfamethoxazole for a urinary
infection. Three days later the INR is 5.8. Which concept best explains this result?
, A) Enzyme induction
B) Additive beta blockade
C) Inhibition of warfarin metabolism and vitamin K-producing flora
D) Reduced renal filtration of warfarin
Answer: C) Inhibition of warfarin metabolism and vitamin K-producing flora
Rationale: TMP-SMX can inhibit warfarin metabolism (CYP2C9) and reduce
intestinal vitamin K production by gut flora. The combined effect increases
anticoagulation and bleeding risk. INR should be monitored closely when these
drugs are used together .
Question 8
A patient with chronic grapefruit intake develops profound bradycardia and
hypotension after a dose increase of a calcium channel blocker. Which interaction
is most likely?
A) Renal alkalinization delaying excretion
B) CYP2D6 induction decreasing drug exposure
C) P-glycoprotein induction in the gut
D) CYP3A4 inhibition increasing drug exposure
Answer: D) CYP3A4 inhibition increasing drug exposure
Rationale: Grapefruit juice can inhibit intestinal CYP3A4, increasing exposure to
susceptible drugs such as some calcium channel blockers (felodipine, nifedipine)
and statins. Higher exposure increases dose-related toxicity. Patients should avoid
grapefruit while taking these medications .
Question 9
What is the key difference between an agonist and an antagonist?
A) Agonists activate receptors; antagonists block receptors
B) Agonists block receptors; antagonists activate receptors
C) Both activate receptors equally
D) Both block receptors equally
GUIDE (GCU) NEWEST 2026 TEST BANK|
ADVANCED PATHOPHYSIOLOGY
Question 1
What does pharmacokinetics involve?
A) The study of drug-receptor interactions and mechanisms of action
B) The process of ADME (absorption, distribution, metabolism, and elimination)
C) The study of drug toxicity and adverse effects
D) The process of drug manufacturing and formulation
Answer: B) The process of ADME (absorption, distribution, metabolism, and
elimination)
Rationale: Pharmacokinetics is what the body does to the drug, involving
Absorption (administration site to blood/plasma), Distribution (bloodstream to
interstitial/intracellular fluid), Metabolism (biotransformation via hepatic
metabolism or other tissues), and Elimination (drug and metabolites removed
from the body) .
Question 2
Which route of administration has the highest bioavailability?
A) Oral
B) Intramuscular
C) Intravenous
D) Sublingual
Answer: C) Intravenous
Rationale: The intravenous route places the entire dose directly into a patient's
vein, bypassing absorption entirely. It also avoids first-pass metabolism in the
,liver, which can destroy a significant portion of orally administered drugs before
they reach systemic circulation .
Question 3
A patient with cirrhosis receives a medication with extensive first-pass
metabolism. What pharmacokinetic change is expected?
A) Lower absorption
B) Higher bioavailability
C) Faster excretion
D) Reduced distribution
Answer: B) Higher bioavailability
Rationale: Hepatic impairment reduces first-pass metabolism, allowing more drug
to enter systemic circulation unchanged. This can lead to increased drug effects
and potential toxicity at standard doses .
Question 4
A patient receives an intravenous medication with a half-life of 8 hours.
Approximately how long will it take to reach steady state?
A) 8 hours
B) 16 hours
C) 40 hours
D) 80 hours
Answer: C) 40 hours
Rationale: Most drugs reach steady state after approximately 4-5 half-lives. Five
half-lives × 8 hours = 40 hours. Steady state is achieved when drug elimination
equals drug administration .
Question 5
What is a prodrug?
,A) An active drug that requires no metabolism
B) An inactive drug dosage form converted to an active metabolite inside the
body
C) A drug that is always administered intravenously
D) A drug that cannot be absorbed orally
Answer: B) An inactive drug dosage form converted to an active metabolite
inside the body
Rationale: A prodrug is an inactive drug dosage form that is converted to an
active metabolite by various biochemical reactions once inside the body.
Examples include aspirin, codeine, and enalapril. Many prodrugs are activated by
cytochrome P450 enzymes .
Question 6
A 72-year-old woman with chronic pain is prescribed codeine. She reports little
pain relief despite adherence. Genetic testing reveals significantly increased
CYP2D6 activity. Which outcome is most likely?
A) Toxicity
B) Tolerance
C) Resistance
D) Dependence
Answer: A) Toxicity
Rationale: Ultra-rapid CYP2D6 metabolizers convert prodrugs such as codeine
into active metabolites (morphine) more rapidly and extensively, increasing
serum concentrations and risk of opioid toxicity. This can be life-threatening,
especially in children .
Question 7
A patient taking warfarin starts trimethoprim-sulfamethoxazole for a urinary
infection. Three days later the INR is 5.8. Which concept best explains this result?
, A) Enzyme induction
B) Additive beta blockade
C) Inhibition of warfarin metabolism and vitamin K-producing flora
D) Reduced renal filtration of warfarin
Answer: C) Inhibition of warfarin metabolism and vitamin K-producing flora
Rationale: TMP-SMX can inhibit warfarin metabolism (CYP2C9) and reduce
intestinal vitamin K production by gut flora. The combined effect increases
anticoagulation and bleeding risk. INR should be monitored closely when these
drugs are used together .
Question 8
A patient with chronic grapefruit intake develops profound bradycardia and
hypotension after a dose increase of a calcium channel blocker. Which interaction
is most likely?
A) Renal alkalinization delaying excretion
B) CYP2D6 induction decreasing drug exposure
C) P-glycoprotein induction in the gut
D) CYP3A4 inhibition increasing drug exposure
Answer: D) CYP3A4 inhibition increasing drug exposure
Rationale: Grapefruit juice can inhibit intestinal CYP3A4, increasing exposure to
susceptible drugs such as some calcium channel blockers (felodipine, nifedipine)
and statins. Higher exposure increases dose-related toxicity. Patients should avoid
grapefruit while taking these medications .
Question 9
What is the key difference between an agonist and an antagonist?
A) Agonists activate receptors; antagonists block receptors
B) Agonists block receptors; antagonists activate receptors
C) Both activate receptors equally
D) Both block receptors equally
