NURS 5334 Final Exam V3 | NURS 5334
Advanced Pharmacology Guide
2026/2027 | Actual Q&A with Rationale
(NURS5334 Final Exam) | The University
of Texas at Arlington
Question 1
A patient with end-stage renal disease (eGFR <15 mL/min) is prescribed a medication
that is 70% renally excreted. The nurse practitioner should anticipate:
A) Increasing the dose by 50%
B) Decreasing the dosing frequency
C) Changing to a prodrug
D) Adding a diuretic to enhance excretion
Answer: B) Decreasing the dosing frequency
Rationale: Reduced renal clearance leads to drug accumulation. Decreasing frequency
maintains therapeutic levels without toxicity. Increasing dose would worsen toxicity.
Prodrug conversion may be impaired in renal failure .
Question 2
Which cytochrome P450 enzyme is most commonly involved in clinically significant
drug-drug interactions?
A) CYP1A2
B) CYP2D6
C) CYP3A4
D) CYP2C9
Answer: C) CYP3A4
,Rationale: CYP3A4 metabolizes approximately 50% of marketed drugs (e.g., statins,
calcium channel blockers, benzodiazepines). It is highly susceptible to inhibition
(grapefruit juice, ketoconazole) and induction (rifampin, carbamazepine) .
Question 3
A drug with high first-pass effect is given orally. The NP understands that:
A) The drug will have increased bioavailability
B) The drug must be given via a non-oral route to avoid extensive hepatic metabolism
C) Gastric pH will alter absorption significantly
D) Protein binding will be decreased
Answer: B) The drug must be given via a non-oral route to avoid extensive hepatic
metabolism
Rationale: High first-pass effect means the liver metabolizes much of the drug before it
reaches systemic circulation. IV, IM, or sublingual routes bypass portal circulation .
Question 4
A patient develops tolerance to morphine. This is most likely due to:
A) Increased renal excretion
B) Downregulation of opioid receptors
C) Upregulation of P-glycoprotein in the gut
D) Decreased liver blood flow
Answer: B) Downregulation of opioid receptors
Rationale: Chronic opioid use leads to receptor desensitization and downregulation,
requiring higher doses for same effect. Tolerance is pharmacodynamic, not
pharmacokinetic .
Question 5
,Which medication exhibits nonlinear (zero-order) pharmacokinetics at therapeutic
doses?
A) Lisinopril
B) Phenytoin
C) Metformin
D) Amoxicillin
Answer: B) Phenytoin
Rationale: Phenytoin saturates hepatic enzymes at therapeutic levels, leading to
disproportionate increases in serum concentration with dose adjustments. Others
exhibit first-order kinetics .
Question 6
A patient takes warfarin. Starting rifampin (a potent CYP inducer) will likely:
A) Increase INR and bleeding risk
B) Decrease INR and reduce anticoagulant effect
C) Have no effect on INR
D) Cause warfarin toxicity
Answer: B) Decrease INR and reduce anticoagulant effect
Rationale: Rifampin induces CYP2C9 (warfarin metabolism), lowering warfarin levels and
INR. Dose adjustment upward may be needed. Patients should be monitored closely .
Question 7
The half-life of Drug X is 24 hours. Approximately how long to reach steady state?
A) 24 hours
B) 48 hours
C) 5 days
D) 10 days
Answer: C) 5 days
, Rationale: Steady state is reached in 4–5 half-lives. 24h × 5 = 120 hours = 5 days .
Question 8
Define pharmacokinetics and list its four primary processes.
A) What the drug does to the body; Absorption, Distribution, Metabolism, Excretion
B) What the body does to the drug; Absorption, Distribution, Metabolism, Excretion
C) What the drug does to the body; Receptor binding, Signal transduction, Efficacy,
Potency
D) What the body does to the drug; Receptor binding, Signal transduction, Efficacy,
Potency
Answer: B) What the body does to the drug; Absorption, Distribution, Metabolism,
Excretion
Rationale: Pharmacokinetics is what the body does to the drug, encompassing the four
primary processes of Absorption, Distribution, Metabolism, and Excretion (ADME).
Pharmacodynamics is what the drug does to the body .
Question 9
Differentiate between a drug's potency and its efficacy.
A) Potency is the maximum effect; efficacy is the dose needed for effect
B) Potency is the dose needed for effect; efficacy is the maximum effect
C) Both describe the same property
D) Potency is measured in milligrams; efficacy is measured in percentage
Answer: B) Potency is the dose needed for effect; efficacy is the maximum effect
Rationale: Potency refers to the amount of drug needed to produce a given effect (e.g.,
a lower ED50 means higher potency). Efficacy refers to the maximum therapeutic
response a drug can produce, regardless of dose .
Question 10
Advanced Pharmacology Guide
2026/2027 | Actual Q&A with Rationale
(NURS5334 Final Exam) | The University
of Texas at Arlington
Question 1
A patient with end-stage renal disease (eGFR <15 mL/min) is prescribed a medication
that is 70% renally excreted. The nurse practitioner should anticipate:
A) Increasing the dose by 50%
B) Decreasing the dosing frequency
C) Changing to a prodrug
D) Adding a diuretic to enhance excretion
Answer: B) Decreasing the dosing frequency
Rationale: Reduced renal clearance leads to drug accumulation. Decreasing frequency
maintains therapeutic levels without toxicity. Increasing dose would worsen toxicity.
Prodrug conversion may be impaired in renal failure .
Question 2
Which cytochrome P450 enzyme is most commonly involved in clinically significant
drug-drug interactions?
A) CYP1A2
B) CYP2D6
C) CYP3A4
D) CYP2C9
Answer: C) CYP3A4
,Rationale: CYP3A4 metabolizes approximately 50% of marketed drugs (e.g., statins,
calcium channel blockers, benzodiazepines). It is highly susceptible to inhibition
(grapefruit juice, ketoconazole) and induction (rifampin, carbamazepine) .
Question 3
A drug with high first-pass effect is given orally. The NP understands that:
A) The drug will have increased bioavailability
B) The drug must be given via a non-oral route to avoid extensive hepatic metabolism
C) Gastric pH will alter absorption significantly
D) Protein binding will be decreased
Answer: B) The drug must be given via a non-oral route to avoid extensive hepatic
metabolism
Rationale: High first-pass effect means the liver metabolizes much of the drug before it
reaches systemic circulation. IV, IM, or sublingual routes bypass portal circulation .
Question 4
A patient develops tolerance to morphine. This is most likely due to:
A) Increased renal excretion
B) Downregulation of opioid receptors
C) Upregulation of P-glycoprotein in the gut
D) Decreased liver blood flow
Answer: B) Downregulation of opioid receptors
Rationale: Chronic opioid use leads to receptor desensitization and downregulation,
requiring higher doses for same effect. Tolerance is pharmacodynamic, not
pharmacokinetic .
Question 5
,Which medication exhibits nonlinear (zero-order) pharmacokinetics at therapeutic
doses?
A) Lisinopril
B) Phenytoin
C) Metformin
D) Amoxicillin
Answer: B) Phenytoin
Rationale: Phenytoin saturates hepatic enzymes at therapeutic levels, leading to
disproportionate increases in serum concentration with dose adjustments. Others
exhibit first-order kinetics .
Question 6
A patient takes warfarin. Starting rifampin (a potent CYP inducer) will likely:
A) Increase INR and bleeding risk
B) Decrease INR and reduce anticoagulant effect
C) Have no effect on INR
D) Cause warfarin toxicity
Answer: B) Decrease INR and reduce anticoagulant effect
Rationale: Rifampin induces CYP2C9 (warfarin metabolism), lowering warfarin levels and
INR. Dose adjustment upward may be needed. Patients should be monitored closely .
Question 7
The half-life of Drug X is 24 hours. Approximately how long to reach steady state?
A) 24 hours
B) 48 hours
C) 5 days
D) 10 days
Answer: C) 5 days
, Rationale: Steady state is reached in 4–5 half-lives. 24h × 5 = 120 hours = 5 days .
Question 8
Define pharmacokinetics and list its four primary processes.
A) What the drug does to the body; Absorption, Distribution, Metabolism, Excretion
B) What the body does to the drug; Absorption, Distribution, Metabolism, Excretion
C) What the drug does to the body; Receptor binding, Signal transduction, Efficacy,
Potency
D) What the body does to the drug; Receptor binding, Signal transduction, Efficacy,
Potency
Answer: B) What the body does to the drug; Absorption, Distribution, Metabolism,
Excretion
Rationale: Pharmacokinetics is what the body does to the drug, encompassing the four
primary processes of Absorption, Distribution, Metabolism, and Excretion (ADME).
Pharmacodynamics is what the drug does to the body .
Question 9
Differentiate between a drug's potency and its efficacy.
A) Potency is the maximum effect; efficacy is the dose needed for effect
B) Potency is the dose needed for effect; efficacy is the maximum effect
C) Both describe the same property
D) Potency is measured in milligrams; efficacy is measured in percentage
Answer: B) Potency is the dose needed for effect; efficacy is the maximum effect
Rationale: Potency refers to the amount of drug needed to produce a given effect (e.g.,
a lower ED50 means higher potency). Efficacy refers to the maximum therapeutic
response a drug can produce, regardless of dose .
Question 10
