NURS 6521 ADVANCED PHARMACOLOGY FINAL
EXAM 2025/2026 V3 WINTER QUARTER 350
MULTIPLECHOICE QUESTIONS WITH CORRECT
ANSWERS AND RATIONALES
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS (Questions 150)
Question 1
A 72yearold patient with hepatic cirrhosis is prescribed a medication that
undergoes extensive firstpass metabolism. The nurse practitioner should
anticipate:
A) Increasing the dose due to decreased bioavailability
B) Decreasing the dose due to reduced hepatic clearance
C) No dose adjustment is necessary
D) Administering the medication via the sublingual route to avoid firstpass
effect
Correct Answer: B
Rationale: Hepatic cirrhosis impairs liver function, reducing the liver's ability
to metabolize drugs. Medications that undergo extensive firstpass metabolism
will have increased bioavailability and prolonged halflife, requiring a lower
dose to prevent toxicity.
Question 2
,A patient with renal impairment (CrCl = 25 mL/min) is prescribed digoxin.
Which pharmacokinetic parameter is most significantly affected, requiring
dosage adjustment?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Correct Answer: D
Rationale: Digoxin is primarily eliminated unchanged by the kidneys. In renal
impairment, drug accumulation occurs, increasing the risk of digoxin toxicity.
The halflife of digoxin increases from 1.52 days in normal renal function to 46
days in anuric patients.
Question 3
A patient's serum drug level is 15 mcg/mL, and the drug has a halflife of 4
hours. Approximately how many hours will it take for the drug level to reach
3.75 mcg/mL?
A) 4 hours
B) 8 hours
C) 12 hours
D) 16 hours
Correct Answer: B
Rationale: Halflife is the time required for drug concentration to decrease by
50%. Starting at 15 mcg/mL: after 4 hours → 7.5 mcg/mL; after 8 hours →
3.75 mcg/mL. Therefore, it takes 8 hours (two halflives) to reach 3.75
mcg/mL.
,Question 4
Which of the following drug properties would result in the highest volume of
distribution (Vd)?
A) Highly proteinbound, hydrophilic
B) Highly lipidsoluble, low protein binding
C) Highly watersoluble, high protein binding
D) Ionized, polar compound
Correct Answer: B
Rationale: Highly lipidsoluble drugs with low protein binding readily cross
cell membranes and distribute extensively into tissues, resulting in a large
volume of distribution.
Question 5
A patient receiving atropine preoperatively develops blurred vision, dry
mouth, and urinary retention. These effects are due to:
A) Stimulation of alphaadrenergic receptors
B) Blockade of muscarinic cholinergic receptors
C) Stimulation of nicotinic receptors
D) Inhibition of acetylcholinesterase
Correct Answer: B
Rationale: Atropine is a muscarinic receptor antagonist. Blockade of these
receptors leads to classic anticholinergic effects including blurred vision
(cycloplegia and mydriasis), dry mouth (reduced salivation), and urinary
retention (relaxation of detrusor muscle).
, Question 6
A patient with renal impairment is prescribed a medication that is primarily
eliminated by the kidneys. The nurse expects which of the following changes
to occur?
A) Decreased halflife
B) Increased drug clearance
C) Increased halflife
D) Decreased volume of distribution
Correct Answer: C
Rationale: When a medication is primarily eliminated by the kidneys and
renal function is impaired, drug clearance decreases, leading to a prolonged
halflife and increased risk of accumulation and toxicity.
Question 7
Which of the following statements accurately describes the firstpass effect?
A) The metabolism of a drug in the liver before it reaches systemic circulation
B) The binding of a drug to plasma proteins
C) The excretion of a drug through the kidneys
D) The distribution of a drug to adipose tissue
Correct Answer: A
Rationale: The firstpass effect refers to the metabolism of a drug in the liver
before it reaches systemic circulation. Drugs absorbed from the GI tract pass
through the portal circulation to the liver where they may be extensively
metabolized before reaching systemic circulation.
EXAM 2025/2026 V3 WINTER QUARTER 350
MULTIPLECHOICE QUESTIONS WITH CORRECT
ANSWERS AND RATIONALES
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS (Questions 150)
Question 1
A 72yearold patient with hepatic cirrhosis is prescribed a medication that
undergoes extensive firstpass metabolism. The nurse practitioner should
anticipate:
A) Increasing the dose due to decreased bioavailability
B) Decreasing the dose due to reduced hepatic clearance
C) No dose adjustment is necessary
D) Administering the medication via the sublingual route to avoid firstpass
effect
Correct Answer: B
Rationale: Hepatic cirrhosis impairs liver function, reducing the liver's ability
to metabolize drugs. Medications that undergo extensive firstpass metabolism
will have increased bioavailability and prolonged halflife, requiring a lower
dose to prevent toxicity.
Question 2
,A patient with renal impairment (CrCl = 25 mL/min) is prescribed digoxin.
Which pharmacokinetic parameter is most significantly affected, requiring
dosage adjustment?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Correct Answer: D
Rationale: Digoxin is primarily eliminated unchanged by the kidneys. In renal
impairment, drug accumulation occurs, increasing the risk of digoxin toxicity.
The halflife of digoxin increases from 1.52 days in normal renal function to 46
days in anuric patients.
Question 3
A patient's serum drug level is 15 mcg/mL, and the drug has a halflife of 4
hours. Approximately how many hours will it take for the drug level to reach
3.75 mcg/mL?
A) 4 hours
B) 8 hours
C) 12 hours
D) 16 hours
Correct Answer: B
Rationale: Halflife is the time required for drug concentration to decrease by
50%. Starting at 15 mcg/mL: after 4 hours → 7.5 mcg/mL; after 8 hours →
3.75 mcg/mL. Therefore, it takes 8 hours (two halflives) to reach 3.75
mcg/mL.
,Question 4
Which of the following drug properties would result in the highest volume of
distribution (Vd)?
A) Highly proteinbound, hydrophilic
B) Highly lipidsoluble, low protein binding
C) Highly watersoluble, high protein binding
D) Ionized, polar compound
Correct Answer: B
Rationale: Highly lipidsoluble drugs with low protein binding readily cross
cell membranes and distribute extensively into tissues, resulting in a large
volume of distribution.
Question 5
A patient receiving atropine preoperatively develops blurred vision, dry
mouth, and urinary retention. These effects are due to:
A) Stimulation of alphaadrenergic receptors
B) Blockade of muscarinic cholinergic receptors
C) Stimulation of nicotinic receptors
D) Inhibition of acetylcholinesterase
Correct Answer: B
Rationale: Atropine is a muscarinic receptor antagonist. Blockade of these
receptors leads to classic anticholinergic effects including blurred vision
(cycloplegia and mydriasis), dry mouth (reduced salivation), and urinary
retention (relaxation of detrusor muscle).
, Question 6
A patient with renal impairment is prescribed a medication that is primarily
eliminated by the kidneys. The nurse expects which of the following changes
to occur?
A) Decreased halflife
B) Increased drug clearance
C) Increased halflife
D) Decreased volume of distribution
Correct Answer: C
Rationale: When a medication is primarily eliminated by the kidneys and
renal function is impaired, drug clearance decreases, leading to a prolonged
halflife and increased risk of accumulation and toxicity.
Question 7
Which of the following statements accurately describes the firstpass effect?
A) The metabolism of a drug in the liver before it reaches systemic circulation
B) The binding of a drug to plasma proteins
C) The excretion of a drug through the kidneys
D) The distribution of a drug to adipose tissue
Correct Answer: A
Rationale: The firstpass effect refers to the metabolism of a drug in the liver
before it reaches systemic circulation. Drugs absorbed from the GI tract pass
through the portal circulation to the liver where they may be extensively
metabolized before reaching systemic circulation.
