UT Arlington NURS 5334 Exam 2 (pdf) | 2026/2027 | Advanced
Pharmacology for NPs Q&A | Pharmacology
1. A patient with chronic kidney disease (Stage 4) is prescribed a medication
that is primarily renally excreted. Which of the following dose adjustments is
most appropriate?
A) A higher dose to achieve a therapeutic effect
B) A lower dose or longer dosing interval to prevent toxicity
C) The same dose as a patient with normal renal function
D) An increased frequency of administration
Correct Answer: A lower dose or longer dosing interval to prevent toxicity
Rationale: In renal impairment, drug clearance is reduced, leading to drug
accumulation and increased risk of toxicity. Dose reduction or extended
dosing intervals are required to maintain safe therapeutic levels.
2. A drug has a half-life of 24 hours. Approximately how many hours will it
take for the drug to reach steady state?
A) 24 hours
B) 48 hours
C) 120 hours
D) 240 hours
Correct Answer: 120 hours
Rationale: Steady state is achieved after approximately 4-5 half-lives. With a
half-life of 24 hours, 4-5 half-lives equal 96-120 hours.
3. A patient with heart failure is prescribed digoxin. Which physiological
change associated with aging would most likely increase the risk of digoxin
toxicity?
A) Increased glomerular filtration rate
B) Decreased lean body mass
C) Increased hepatic blood flow
,D) Decreased serum albumin
Correct Answer: Decreased serum albumin
Rationale: Aging is associated with decreased serum albumin. Digoxin is
moderately protein-bound. Lower albumin levels increase the free (active)
fraction of the drug, leading to a greater pharmacological effect and higher
risk of toxicity.
4. A weak acid drug with a pKa of 4.4 is administered orally. In which part of
the gastrointestinal tract will absorption be most rapid?
A) Mouth (pH 7.0)
B) Stomach (pH 1.5)
C) Duodenum (pH 6.0)
D) Colon (pH 7.5)
Correct Answer: Stomach (pH 1.5)
Rationale: Weak acids are non-ionized (lipid-soluble) in acidic environments,
facilitating absorption across cell membranes. The stomach's acidic pH
promotes the non-ionized form of a weak acid, enhancing absorption.
5. A patient is prescribed a drug that is a weak base. Which change in urine
pH would most significantly decrease the excretion of this drug?
A) Acidic urine pH
B) Alkaline urine pH
C) Neutral urine pH
D) Fluctuating urine pH
Correct Answer: Alkaline urine pH
Rationale: Weak bases are ionized (trapped) in acidic environments and are
more readily excreted in acidic urine. In alkaline urine, a weak base remains
non-ionized, which promotes passive reabsorption back into the bloodstream,
decreasing excretion.
,6. A patient is prescribed a drug that is highly protein-bound. Which of the
following conditions would most likely increase the risk of toxicity from this
drug?
A) Hypoalbuminemia
B) Hyperalbuminemia
C) Decreased hepatic blood flow
D) Increased glomerular filtration rate
Correct Answer: Hypoalbuminemia
Rationale: Hypoalbuminemia results in fewer protein-binding sites, leading to
an increased free (active) fraction of highly protein-bound drugs. This can
precipitate toxicity even at standard doses.
7. A drug has a volume of distribution (Vd) of 50 L. This indicates that the
drug:
A) Is confined to the vascular space
B) Is extensively distributed into tissues
C) Is highly protein-bound
D) Has poor lipid solubility
Correct Answer: Is extensively distributed into tissues
Rationale: A large volume of distribution suggests the drug is extensively
distributed into tissues, often due to high lipid solubility and binding to tissue
proteins, rather than being confined to the plasma.
8. Which of the following drugs is a non-depolarizing neuromuscular blocker?
A) Succinylcholine
B) Rocuronium
C) Neostigmine
D) Atropine
Correct Answer: Rocuronium
, Rationale: Rocuronium is a non-depolarizing neuromuscular blocker that
competitively blocks acetylcholine at the neuromuscular junction.
Succinylcholine is a depolarizing blocker. Neostigmine is a cholinesterase
inhibitor, and atropine is a muscarinic antagonist.
9. A patient is receiving succinylcholine for procedural sedation. Which
adverse effect is most concerning with this drug?
A) Tachycardia
B) Hyperkalemia
C) Hypotension
D) Bronchospasm
Correct Answer: Hyperkalemia
Rationale: Succinylcholine can cause a rapid release of potassium from
muscle cells, leading to life-threatening hyperkalemia, especially in patients
with burns, crush injuries, or neuromuscular disorders.
10. A patient is prescribed a drug that acts as a direct-acting cholinergic
agonist. Which of the following effects is expected?
A) Mydriasis
B) Tachycardia
C) Increased gastrointestinal motility
D) Bronchodilation
Correct Answer: Increased gastrointestinal motility
Rationale: Cholinergic agonists stimulate the parasympathetic nervous
system, leading to effects such as increased gastrointestinal motility, miosis,
bradycardia, and bronchoconstriction.
11. A patient with glaucoma is prescribed pilocarpine eye drops. What is the
mechanism of action of this drug?
A) Alpha-1 adrenergic receptor blockade
Pharmacology for NPs Q&A | Pharmacology
1. A patient with chronic kidney disease (Stage 4) is prescribed a medication
that is primarily renally excreted. Which of the following dose adjustments is
most appropriate?
A) A higher dose to achieve a therapeutic effect
B) A lower dose or longer dosing interval to prevent toxicity
C) The same dose as a patient with normal renal function
D) An increased frequency of administration
Correct Answer: A lower dose or longer dosing interval to prevent toxicity
Rationale: In renal impairment, drug clearance is reduced, leading to drug
accumulation and increased risk of toxicity. Dose reduction or extended
dosing intervals are required to maintain safe therapeutic levels.
2. A drug has a half-life of 24 hours. Approximately how many hours will it
take for the drug to reach steady state?
A) 24 hours
B) 48 hours
C) 120 hours
D) 240 hours
Correct Answer: 120 hours
Rationale: Steady state is achieved after approximately 4-5 half-lives. With a
half-life of 24 hours, 4-5 half-lives equal 96-120 hours.
3. A patient with heart failure is prescribed digoxin. Which physiological
change associated with aging would most likely increase the risk of digoxin
toxicity?
A) Increased glomerular filtration rate
B) Decreased lean body mass
C) Increased hepatic blood flow
,D) Decreased serum albumin
Correct Answer: Decreased serum albumin
Rationale: Aging is associated with decreased serum albumin. Digoxin is
moderately protein-bound. Lower albumin levels increase the free (active)
fraction of the drug, leading to a greater pharmacological effect and higher
risk of toxicity.
4. A weak acid drug with a pKa of 4.4 is administered orally. In which part of
the gastrointestinal tract will absorption be most rapid?
A) Mouth (pH 7.0)
B) Stomach (pH 1.5)
C) Duodenum (pH 6.0)
D) Colon (pH 7.5)
Correct Answer: Stomach (pH 1.5)
Rationale: Weak acids are non-ionized (lipid-soluble) in acidic environments,
facilitating absorption across cell membranes. The stomach's acidic pH
promotes the non-ionized form of a weak acid, enhancing absorption.
5. A patient is prescribed a drug that is a weak base. Which change in urine
pH would most significantly decrease the excretion of this drug?
A) Acidic urine pH
B) Alkaline urine pH
C) Neutral urine pH
D) Fluctuating urine pH
Correct Answer: Alkaline urine pH
Rationale: Weak bases are ionized (trapped) in acidic environments and are
more readily excreted in acidic urine. In alkaline urine, a weak base remains
non-ionized, which promotes passive reabsorption back into the bloodstream,
decreasing excretion.
,6. A patient is prescribed a drug that is highly protein-bound. Which of the
following conditions would most likely increase the risk of toxicity from this
drug?
A) Hypoalbuminemia
B) Hyperalbuminemia
C) Decreased hepatic blood flow
D) Increased glomerular filtration rate
Correct Answer: Hypoalbuminemia
Rationale: Hypoalbuminemia results in fewer protein-binding sites, leading to
an increased free (active) fraction of highly protein-bound drugs. This can
precipitate toxicity even at standard doses.
7. A drug has a volume of distribution (Vd) of 50 L. This indicates that the
drug:
A) Is confined to the vascular space
B) Is extensively distributed into tissues
C) Is highly protein-bound
D) Has poor lipid solubility
Correct Answer: Is extensively distributed into tissues
Rationale: A large volume of distribution suggests the drug is extensively
distributed into tissues, often due to high lipid solubility and binding to tissue
proteins, rather than being confined to the plasma.
8. Which of the following drugs is a non-depolarizing neuromuscular blocker?
A) Succinylcholine
B) Rocuronium
C) Neostigmine
D) Atropine
Correct Answer: Rocuronium
, Rationale: Rocuronium is a non-depolarizing neuromuscular blocker that
competitively blocks acetylcholine at the neuromuscular junction.
Succinylcholine is a depolarizing blocker. Neostigmine is a cholinesterase
inhibitor, and atropine is a muscarinic antagonist.
9. A patient is receiving succinylcholine for procedural sedation. Which
adverse effect is most concerning with this drug?
A) Tachycardia
B) Hyperkalemia
C) Hypotension
D) Bronchospasm
Correct Answer: Hyperkalemia
Rationale: Succinylcholine can cause a rapid release of potassium from
muscle cells, leading to life-threatening hyperkalemia, especially in patients
with burns, crush injuries, or neuromuscular disorders.
10. A patient is prescribed a drug that acts as a direct-acting cholinergic
agonist. Which of the following effects is expected?
A) Mydriasis
B) Tachycardia
C) Increased gastrointestinal motility
D) Bronchodilation
Correct Answer: Increased gastrointestinal motility
Rationale: Cholinergic agonists stimulate the parasympathetic nervous
system, leading to effects such as increased gastrointestinal motility, miosis,
bradycardia, and bronchoconstriction.
11. A patient with glaucoma is prescribed pilocarpine eye drops. What is the
mechanism of action of this drug?
A) Alpha-1 adrenergic receptor blockade
