NURS 6521 Midterm Exam Review
2026/2027
PHARMACOKINETICS & PHARMACODYNAMICS
Question 1
A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the
following measures has the potential to increase the amount of the free drug that is available to body
cells?
A. Administering the drug with a high-fat meal
B. Administering the drug intravenously rather than orally
C. Administering the drug with an antacid
D. Crushing the tablet before administration
ANSWER: B. Administering the drug intravenously rather than orally
Rationale: First-pass metabolism occurs when drugs are absorbed from the GI tract and transported via
the portal vein to the liver, where they are extensively metabolized before reaching systemic circulation.
Intravenous administration bypasses the first-pass effect entirely, allowing 100% of the drug to reach
systemic circulation. This significantly increases the bioavailability of drugs that undergo extensive
hepatic metabolism.
Question 2
First-pass metabolism occurs primarily in which organ?
A. Kidneys
,B. Lungs
C. Liver
D. Small intestine
ANSWER: C. Liver
Rationale: The liver is the primary site of first-pass metabolism. When orally administered drugs are
absorbed from the gastrointestinal tract, they are carried via the portal venous system to the liver
before reaching systemic circulation. Hepatic enzymes, particularly the cytochrome P450 system,
metabolize many drugs during this first pass, significantly reducing their bioavailability.
Question 3
A patient is prescribed a drug with a half-life of 12 hours. Approximately how long will it take for the
drug to reach steady-state concentration?
A. 12 hours
B. 24 hours
C. 48 hours
D. 60 hours
ANSWER: D. 60 hours
Rationale: Steady-state concentration is achieved after approximately 4–5 half-lives of drug
administration. With a half-life of 12 hours, steady state would be reached in approximately 48–60
hours (4–5 × 12 hours). At steady state, the rate of drug administration equals the rate of drug
elimination, and plasma concentrations remain relatively constant with repeated dosing.
Question 4
Which of the following factors would most significantly decrease drug protein binding and potentially
increase the risk of drug toxicity?
A. Increased renal function
,B. Hypoalbuminemia
C. Increased hepatic blood flow
D. Decreased gastric pH
ANSWER: B. Hypoalbuminemia
Rationale: Many drugs bind to plasma proteins, primarily albumin. Hypoalbuminemia (low serum
albumin) reduces available protein-binding sites, resulting in a higher proportion of unbound (free) drug.
Only free drug is pharmacologically active and can be distributed to tissues. Increased free drug levels
can lead to enhanced therapeutic effects and increased risk of toxicity, particularly for highly protein-
bound drugs with narrow therapeutic indices.
Question 5
Which route of administration has the fastest rate of drug absorption?
A. Oral
B. Subcutaneous
C. Intramuscular
D. Intravenous
ANSWER: D. Intravenous
Rationale: Intravenous administration delivers the drug directly into the bloodstream, resulting in
immediate and complete absorption. There is no absorption phase with IV administration; the drug is
immediately available for distribution to target tissues. This route provides the fastest onset of action
and 100% bioavailability.
Question 6
A patient with cirrhosis is prescribed a medication that is extensively metabolized by the liver. What
adjustment is most likely needed?
A. Increase the dose
, B. Decrease the dose or increase the dosing interval
C. No adjustment is needed
D. Administer the drug with food
ANSWER: B. Decrease the dose or increase the dosing interval
Rationale: Cirrhosis impairs hepatic function, reducing the liver's ability to metabolize drugs. This leads
to drug accumulation and increased risk of toxicity. Dose reduction or extended dosing intervals are
typically required to maintain therapeutic drug levels while avoiding toxicity. Drug levels should be
monitored closely in patients with hepatic impairment.
Question 7
What is the definition of drug tolerance?
A. A physical and psychological dependence on a drug
B. A need for increasing doses of a drug to achieve the same effect
C. An unusual or unexpected response to a drug
D. The movement of drugs within the body
ANSWER: B. A need for increasing doses of a drug to achieve the same effect
Rationale: Drug tolerance is defined as a diminished response to a drug over time, requiring
progressively larger doses to achieve the same therapeutic effect. Tolerance can develop to both
therapeutic and adverse effects of medications. It is important to distinguish tolerance from addiction,
which involves compulsive drug-seeking behavior despite harmful consequences.
Question 8
The study of the movement of drugs within the body is known as:
A. Pharmacodynamics
B. Pharmacokinetics
2026/2027
PHARMACOKINETICS & PHARMACODYNAMICS
Question 1
A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the
following measures has the potential to increase the amount of the free drug that is available to body
cells?
A. Administering the drug with a high-fat meal
B. Administering the drug intravenously rather than orally
C. Administering the drug with an antacid
D. Crushing the tablet before administration
ANSWER: B. Administering the drug intravenously rather than orally
Rationale: First-pass metabolism occurs when drugs are absorbed from the GI tract and transported via
the portal vein to the liver, where they are extensively metabolized before reaching systemic circulation.
Intravenous administration bypasses the first-pass effect entirely, allowing 100% of the drug to reach
systemic circulation. This significantly increases the bioavailability of drugs that undergo extensive
hepatic metabolism.
Question 2
First-pass metabolism occurs primarily in which organ?
A. Kidneys
,B. Lungs
C. Liver
D. Small intestine
ANSWER: C. Liver
Rationale: The liver is the primary site of first-pass metabolism. When orally administered drugs are
absorbed from the gastrointestinal tract, they are carried via the portal venous system to the liver
before reaching systemic circulation. Hepatic enzymes, particularly the cytochrome P450 system,
metabolize many drugs during this first pass, significantly reducing their bioavailability.
Question 3
A patient is prescribed a drug with a half-life of 12 hours. Approximately how long will it take for the
drug to reach steady-state concentration?
A. 12 hours
B. 24 hours
C. 48 hours
D. 60 hours
ANSWER: D. 60 hours
Rationale: Steady-state concentration is achieved after approximately 4–5 half-lives of drug
administration. With a half-life of 12 hours, steady state would be reached in approximately 48–60
hours (4–5 × 12 hours). At steady state, the rate of drug administration equals the rate of drug
elimination, and plasma concentrations remain relatively constant with repeated dosing.
Question 4
Which of the following factors would most significantly decrease drug protein binding and potentially
increase the risk of drug toxicity?
A. Increased renal function
,B. Hypoalbuminemia
C. Increased hepatic blood flow
D. Decreased gastric pH
ANSWER: B. Hypoalbuminemia
Rationale: Many drugs bind to plasma proteins, primarily albumin. Hypoalbuminemia (low serum
albumin) reduces available protein-binding sites, resulting in a higher proportion of unbound (free) drug.
Only free drug is pharmacologically active and can be distributed to tissues. Increased free drug levels
can lead to enhanced therapeutic effects and increased risk of toxicity, particularly for highly protein-
bound drugs with narrow therapeutic indices.
Question 5
Which route of administration has the fastest rate of drug absorption?
A. Oral
B. Subcutaneous
C. Intramuscular
D. Intravenous
ANSWER: D. Intravenous
Rationale: Intravenous administration delivers the drug directly into the bloodstream, resulting in
immediate and complete absorption. There is no absorption phase with IV administration; the drug is
immediately available for distribution to target tissues. This route provides the fastest onset of action
and 100% bioavailability.
Question 6
A patient with cirrhosis is prescribed a medication that is extensively metabolized by the liver. What
adjustment is most likely needed?
A. Increase the dose
, B. Decrease the dose or increase the dosing interval
C. No adjustment is needed
D. Administer the drug with food
ANSWER: B. Decrease the dose or increase the dosing interval
Rationale: Cirrhosis impairs hepatic function, reducing the liver's ability to metabolize drugs. This leads
to drug accumulation and increased risk of toxicity. Dose reduction or extended dosing intervals are
typically required to maintain therapeutic drug levels while avoiding toxicity. Drug levels should be
monitored closely in patients with hepatic impairment.
Question 7
What is the definition of drug tolerance?
A. A physical and psychological dependence on a drug
B. A need for increasing doses of a drug to achieve the same effect
C. An unusual or unexpected response to a drug
D. The movement of drugs within the body
ANSWER: B. A need for increasing doses of a drug to achieve the same effect
Rationale: Drug tolerance is defined as a diminished response to a drug over time, requiring
progressively larger doses to achieve the same therapeutic effect. Tolerance can develop to both
therapeutic and adverse effects of medications. It is important to distinguish tolerance from addiction,
which involves compulsive drug-seeking behavior despite harmful consequences.
Question 8
The study of the movement of drugs within the body is known as:
A. Pharmacodynamics
B. Pharmacokinetics
