Page 1 of 284
NU 578 UNITS 1-5 EXAM – COMPLETE
PRACTICE QUESTION BANK
PHARMACOLOGY FOR ADVANCED
PRACTICE NURSES
UNIVERSITY OF SOUTH ALABAMA | 2026-
2027 ACADEMIC YEAR
itsjereguides
---
# TABLE OF CONTENTS
| Unit | Topic | Question Numbers | Page |
|------|-------|------------------|------|
| **Unit 1** | Foundational Pharmacology: Pharmacokinetics, Pharmacodynamics, Drug
Interactions, & Medication Safety | 1–75 | 1 |
| **Unit 2** | Autonomic Nervous System Pharmacology & CNS Agents | 76–150 | 15 |
| **Unit 3** | Cardiovascular & Renal Pharmacology | 151–225 | 29 |
| **Unit 4** | Endocrine, GI, Anti-inflammatory, Bone & Joint Pharmacology | 226–300 | 43 |
| **Unit 5** | Anti-infectives, Chemotherapy, & Immunopharmacology | 301–375 | 57 |
---
,Page 2 of 284
# UNIT 1: FOUNDATIONAL PHARMACOLOGY
## Pharmacokinetics, Pharmacodynamics, Drug Interactions, & Medication Safety
### Question 1
A patient asks the nurse practitioner why a medication that is rapidly metabolized by the liver is
given intravenously rather than orally. Which response is most accurate?
A. "Oral administration would cause the drug to be destroyed by stomach acid before it could be
absorbed."
B. "Intravenous administration allows the drug to bypass the liver's first-pass effect, ensuring
more of the active drug reaches systemic circulation."
C. "Intravenous administration is preferred because it is less expensive than oral formulations."
D. "The liver cannot metabolize drugs that are given intravenously, so this route is always safer."
**Correct Answer: B**
**Rationale:** Drugs that undergo rapid hepatic metabolism are typically administered
intravenously to bypass the liver and avoid the first-pass effect. The first-pass effect refers to the
extensive metabolism of an orally administered drug by the liver before it reaches systemic
circulation. When a drug is given IV, it enters systemic circulation directly, bypassing the liver's
initial metabolic processing. This ensures higher bioavailability and more predictable therapeutic
effects.
**Distractor Analysis:**
- **A:** While some drugs are degraded by gastric acid, this is not the primary reason for IV
administration of hepatically metabolized drugs. Enteric coatings or parenteral routes other than
IV can address acid degradation.
- **C:** IV administration is generally more expensive and invasive than oral administration,
making this statement factually incorrect.
- **D:** The liver can and does metabolize IV drugs; they simply bypass the first-pass effect. IV
drugs still undergo hepatic metabolism during subsequent passes through the liver.
,Page 3 of 284
### Question 2
A patient reports drinking grapefruit juice daily. The nurse practitioner should be most concerned
about this habit when the patient is prescribed which medication?
A. Amoxicillin
B. Furosemide
C. Simvastatin
D. Metformin
**Correct Answer: C**
**Rationale:** Grapefruit juice inhibits CYP3A4 metabolism in the liver and intestinal wall,
which can raise blood levels of certain drugs. Simvastatin is a statin that is extensively
metabolized by CYP3A4. Grapefruit juice can significantly increase simvastatin levels, leading
to an increased risk of myopathy and rhabdomyolysis. The inhibition of gut cells can last up to 3
days after consuming grapefruit juice.
**Distractor Analysis:**
- **A:** Amoxicillin is primarily excreted renally and is not significantly metabolized by
CYP3A4. Grapefruit juice does not pose a significant interaction risk.
- **B:** Furosemide is primarily eliminated renally and is not a major CYP3A4 substrate.
Grapefruit juice does not significantly affect its metabolism.
- **D:** Metformin is excreted unchanged in the urine and does not undergo significant hepatic
metabolism via CYP3A4. Grapefruit juice does not meaningfully interact with metformin.
---
### Question 3
, Page 4 of 284
The nurse practitioner is reviewing a patient's medication list and notes that the patient is taking
a drug that is a known inhibitor of cytochrome P-450 enzymes and P-glycoprotein. What effect
would this drug likely have on other medications?
A. It will decrease the absorption of other medications from the gastrointestinal tract.
B. It will increase the serum concentrations of other medications that are substrates for these
systems.
C. It will have no effect on other medications because these systems are drug-specific.
D. It will accelerate the renal excretion of other medications.
**Correct Answer: B**
**Rationale:** When a drug inhibits cytochrome P-450 enzymes and P-glycoprotein, it reduces
the metabolism and efflux of other drugs that are substrates for these systems. This results in
increased serum concentrations of the affected medications, potentially leading to toxicity. P-
glycoprotein is an efflux transporter that pumps drugs out of cells; inhibiting it increases drug
absorption and decreases elimination.
**Distractor Analysis:**
- **A:** Inhibition of P-glycoprotein actually increases absorption of substrate drugs from the
GI tract, not decreases it.
- **C:** These transport and metabolic systems are not drug-specific; many drugs share these
pathways, leading to clinically significant drug interactions.
- **D:** Inhibition of these systems would decrease metabolism and elimination, not accelerate
renal excretion.
---
### Question 4
A patient with hypertension is prescribed methyldopa. The nurse practitioner knows that a
Coombs' test should be performed at which times?
NU 578 UNITS 1-5 EXAM – COMPLETE
PRACTICE QUESTION BANK
PHARMACOLOGY FOR ADVANCED
PRACTICE NURSES
UNIVERSITY OF SOUTH ALABAMA | 2026-
2027 ACADEMIC YEAR
itsjereguides
---
# TABLE OF CONTENTS
| Unit | Topic | Question Numbers | Page |
|------|-------|------------------|------|
| **Unit 1** | Foundational Pharmacology: Pharmacokinetics, Pharmacodynamics, Drug
Interactions, & Medication Safety | 1–75 | 1 |
| **Unit 2** | Autonomic Nervous System Pharmacology & CNS Agents | 76–150 | 15 |
| **Unit 3** | Cardiovascular & Renal Pharmacology | 151–225 | 29 |
| **Unit 4** | Endocrine, GI, Anti-inflammatory, Bone & Joint Pharmacology | 226–300 | 43 |
| **Unit 5** | Anti-infectives, Chemotherapy, & Immunopharmacology | 301–375 | 57 |
---
,Page 2 of 284
# UNIT 1: FOUNDATIONAL PHARMACOLOGY
## Pharmacokinetics, Pharmacodynamics, Drug Interactions, & Medication Safety
### Question 1
A patient asks the nurse practitioner why a medication that is rapidly metabolized by the liver is
given intravenously rather than orally. Which response is most accurate?
A. "Oral administration would cause the drug to be destroyed by stomach acid before it could be
absorbed."
B. "Intravenous administration allows the drug to bypass the liver's first-pass effect, ensuring
more of the active drug reaches systemic circulation."
C. "Intravenous administration is preferred because it is less expensive than oral formulations."
D. "The liver cannot metabolize drugs that are given intravenously, so this route is always safer."
**Correct Answer: B**
**Rationale:** Drugs that undergo rapid hepatic metabolism are typically administered
intravenously to bypass the liver and avoid the first-pass effect. The first-pass effect refers to the
extensive metabolism of an orally administered drug by the liver before it reaches systemic
circulation. When a drug is given IV, it enters systemic circulation directly, bypassing the liver's
initial metabolic processing. This ensures higher bioavailability and more predictable therapeutic
effects.
**Distractor Analysis:**
- **A:** While some drugs are degraded by gastric acid, this is not the primary reason for IV
administration of hepatically metabolized drugs. Enteric coatings or parenteral routes other than
IV can address acid degradation.
- **C:** IV administration is generally more expensive and invasive than oral administration,
making this statement factually incorrect.
- **D:** The liver can and does metabolize IV drugs; they simply bypass the first-pass effect. IV
drugs still undergo hepatic metabolism during subsequent passes through the liver.
,Page 3 of 284
### Question 2
A patient reports drinking grapefruit juice daily. The nurse practitioner should be most concerned
about this habit when the patient is prescribed which medication?
A. Amoxicillin
B. Furosemide
C. Simvastatin
D. Metformin
**Correct Answer: C**
**Rationale:** Grapefruit juice inhibits CYP3A4 metabolism in the liver and intestinal wall,
which can raise blood levels of certain drugs. Simvastatin is a statin that is extensively
metabolized by CYP3A4. Grapefruit juice can significantly increase simvastatin levels, leading
to an increased risk of myopathy and rhabdomyolysis. The inhibition of gut cells can last up to 3
days after consuming grapefruit juice.
**Distractor Analysis:**
- **A:** Amoxicillin is primarily excreted renally and is not significantly metabolized by
CYP3A4. Grapefruit juice does not pose a significant interaction risk.
- **B:** Furosemide is primarily eliminated renally and is not a major CYP3A4 substrate.
Grapefruit juice does not significantly affect its metabolism.
- **D:** Metformin is excreted unchanged in the urine and does not undergo significant hepatic
metabolism via CYP3A4. Grapefruit juice does not meaningfully interact with metformin.
---
### Question 3
, Page 4 of 284
The nurse practitioner is reviewing a patient's medication list and notes that the patient is taking
a drug that is a known inhibitor of cytochrome P-450 enzymes and P-glycoprotein. What effect
would this drug likely have on other medications?
A. It will decrease the absorption of other medications from the gastrointestinal tract.
B. It will increase the serum concentrations of other medications that are substrates for these
systems.
C. It will have no effect on other medications because these systems are drug-specific.
D. It will accelerate the renal excretion of other medications.
**Correct Answer: B**
**Rationale:** When a drug inhibits cytochrome P-450 enzymes and P-glycoprotein, it reduces
the metabolism and efflux of other drugs that are substrates for these systems. This results in
increased serum concentrations of the affected medications, potentially leading to toxicity. P-
glycoprotein is an efflux transporter that pumps drugs out of cells; inhibiting it increases drug
absorption and decreases elimination.
**Distractor Analysis:**
- **A:** Inhibition of P-glycoprotein actually increases absorption of substrate drugs from the
GI tract, not decreases it.
- **C:** These transport and metabolic systems are not drug-specific; many drugs share these
pathways, leading to clinically significant drug interactions.
- **D:** Inhibition of these systems would decrease metabolism and elimination, not accelerate
renal excretion.
---
### Question 4
A patient with hypertension is prescribed methyldopa. The nurse practitioner knows that a
Coombs' test should be performed at which times?
