NURS 5334 Advanced Pharmacology Final
Examination 2 versions Questions and Answers |
2026 Update | 100% Correct – UTA.
1. A drug with a high volume of distribution (Vd) is most likely to:
A. Remain mostly in the plasma
B. Require dialysis for overdose removal
C. Accumulate in tissues
D. Have a short half-life
Answer: C. Accumulate in tissues
Rationale: A high Vd indicates that the drug is extensively distributed into tissues
outside of the vascular space, rather than remaining in the plasma. Dialysis is
typically ineffective for these drugs because they are not confined to the blood. A
large Vd does not necessarily correlate with a short half-life; in fact, it often
prolongs elimination as the drug is slowly released from tissue stores .
2. A patient with hypoalbuminemia is prescribed a highly protein-bound drug.
What effect would this have on the drug's pharmacodynamics?
A. Decreased drug effect due to reduced protein binding
B. Increased free drug concentration and potential toxicity
C. No change in drug effect
D. Decreased drug half-life
Answer: B. Increased free drug concentration and potential toxicity
Rationale: Hypoalbuminemia reduces the number of protein binding sites
available. This leads to a higher concentration of free (unbound, active) drug,
which can precipitate toxicity at standard therapeutic doses .
3. A drug that demonstrates zero-order kinetics will be eliminated at what rate?
A. A constant rate regardless of concentration
B. A rate proportional to the drug concentration
,C. An exponential rate
D. A rate dependent on renal function only
Answer: A. A constant rate regardless of concentration
Rationale: Zero-order kinetics describes elimination at a constant rate, regardless
of drug concentration. Drugs demonstrating this include phenytoin, salicylates,
ethanol, and theophylline. In first-order kinetics, elimination is proportional to
concentration .
4. 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 all marketed drugs,
including statins, calcium channel blockers, and benzodiazepines. It is highly
susceptible to inhibition (e.g., by grapefruit juice, ketoconazole) and induction
(e.g., by rifampin, carbamazepine), making it the most common source of clinically
significant drug interactions .
5. A drug with a narrow therapeutic index requires:
A. Less frequent monitoring
B. Close therapeutic drug monitoring
C. Administration with food only
D. Use only in pediatric patients
Answer: B. Close therapeutic drug monitoring
Rationale: Drugs with a narrow therapeutic index have a small margin between
therapeutic and toxic doses. Examples include warfarin, digoxin, lithium, and
phenytoin. These drugs require close monitoring of serum levels to ensure safety
and efficacy .
,6. The half-life of Drug X is 24 hours. Approximately how long will it take 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 after approximately 4-5 half-lives of continuous
dosing. For a drug with a 24-hour half-life: 24 hours × 5 = 120 hours = 5 days .
7. Grapefruit juice inhibits CYP3A4. What effect would this have on felodipine (a
calcium channel blocker)?
A. Decreased effect
B. Increased toxicity
C. No change
D. Faster elimination
Answer: B. Increased toxicity
Rationale: Grapefruit juice inhibits CYP3A4 in the intestinal wall and liver,
decreasing the metabolism of drugs like felodipine. This leads to increased drug
levels and potential toxicity, including hypotension and bradycardia .
8. A drug with a 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 and avoid this extensive metabolism .
9. A loading dose primarily depends on:
A. Clearance
B. Half-life
C. Volume of distribution
D. Bioavailability
Answer: C. Volume of distribution
Rationale: The loading dose is calculated as: Loading Dose = (Desired
Concentration × Vd) / Bioavailability. Vd determines the amount of drug needed to
reach the target plasma concentration. Clearance and half-life determine
maintenance dosing .
10. Pharmacodynamics is the study of:
A. What the body does to the drug
B. What the drug does to the body
C. How a drug is absorbed
D. How a drug is excreted
Answer: B. What the drug does to the body
Rationale: Pharmacodynamics is the study of the biochemical and physiological
effects of drugs and their mechanisms of action. It describes "what the drug does
to the body." Pharmacokinetics is "what the body does to the drug" .
11. Which route of administration has 100% bioavailability?
A. Oral
B. Sublingual
C. Intramuscular
D. Intravenous
Answer: D. Intravenous
Examination 2 versions Questions and Answers |
2026 Update | 100% Correct – UTA.
1. A drug with a high volume of distribution (Vd) is most likely to:
A. Remain mostly in the plasma
B. Require dialysis for overdose removal
C. Accumulate in tissues
D. Have a short half-life
Answer: C. Accumulate in tissues
Rationale: A high Vd indicates that the drug is extensively distributed into tissues
outside of the vascular space, rather than remaining in the plasma. Dialysis is
typically ineffective for these drugs because they are not confined to the blood. A
large Vd does not necessarily correlate with a short half-life; in fact, it often
prolongs elimination as the drug is slowly released from tissue stores .
2. A patient with hypoalbuminemia is prescribed a highly protein-bound drug.
What effect would this have on the drug's pharmacodynamics?
A. Decreased drug effect due to reduced protein binding
B. Increased free drug concentration and potential toxicity
C. No change in drug effect
D. Decreased drug half-life
Answer: B. Increased free drug concentration and potential toxicity
Rationale: Hypoalbuminemia reduces the number of protein binding sites
available. This leads to a higher concentration of free (unbound, active) drug,
which can precipitate toxicity at standard therapeutic doses .
3. A drug that demonstrates zero-order kinetics will be eliminated at what rate?
A. A constant rate regardless of concentration
B. A rate proportional to the drug concentration
,C. An exponential rate
D. A rate dependent on renal function only
Answer: A. A constant rate regardless of concentration
Rationale: Zero-order kinetics describes elimination at a constant rate, regardless
of drug concentration. Drugs demonstrating this include phenytoin, salicylates,
ethanol, and theophylline. In first-order kinetics, elimination is proportional to
concentration .
4. 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 all marketed drugs,
including statins, calcium channel blockers, and benzodiazepines. It is highly
susceptible to inhibition (e.g., by grapefruit juice, ketoconazole) and induction
(e.g., by rifampin, carbamazepine), making it the most common source of clinically
significant drug interactions .
5. A drug with a narrow therapeutic index requires:
A. Less frequent monitoring
B. Close therapeutic drug monitoring
C. Administration with food only
D. Use only in pediatric patients
Answer: B. Close therapeutic drug monitoring
Rationale: Drugs with a narrow therapeutic index have a small margin between
therapeutic and toxic doses. Examples include warfarin, digoxin, lithium, and
phenytoin. These drugs require close monitoring of serum levels to ensure safety
and efficacy .
,6. The half-life of Drug X is 24 hours. Approximately how long will it take 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 after approximately 4-5 half-lives of continuous
dosing. For a drug with a 24-hour half-life: 24 hours × 5 = 120 hours = 5 days .
7. Grapefruit juice inhibits CYP3A4. What effect would this have on felodipine (a
calcium channel blocker)?
A. Decreased effect
B. Increased toxicity
C. No change
D. Faster elimination
Answer: B. Increased toxicity
Rationale: Grapefruit juice inhibits CYP3A4 in the intestinal wall and liver,
decreasing the metabolism of drugs like felodipine. This leads to increased drug
levels and potential toxicity, including hypotension and bradycardia .
8. A drug with a 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 and avoid this extensive metabolism .
9. A loading dose primarily depends on:
A. Clearance
B. Half-life
C. Volume of distribution
D. Bioavailability
Answer: C. Volume of distribution
Rationale: The loading dose is calculated as: Loading Dose = (Desired
Concentration × Vd) / Bioavailability. Vd determines the amount of drug needed to
reach the target plasma concentration. Clearance and half-life determine
maintenance dosing .
10. Pharmacodynamics is the study of:
A. What the body does to the drug
B. What the drug does to the body
C. How a drug is absorbed
D. How a drug is excreted
Answer: B. What the drug does to the body
Rationale: Pharmacodynamics is the study of the biochemical and physiological
effects of drugs and their mechanisms of action. It describes "what the drug does
to the body." Pharmacokinetics is "what the body does to the drug" .
11. Which route of administration has 100% bioavailability?
A. Oral
B. Sublingual
C. Intramuscular
D. Intravenous
Answer: D. Intravenous
