NURS 6521 ADVANCED
PHARMACOLOGY MIDTERM EXAM
QUESTIONS AND ANSWERS
1. A patient is prescribed a drug that is a known substrate of the CYP3A4 enzyme. If the
patient begins consuming grapefruit juice daily, what is the most likely pharmacological
outcome?
A. Decreased drug plasma levels due to enzyme induction
B. Increased drug plasma levels and risk of toxicity
C. Increased renal clearance of the drug
D. Reduced bioavailability due to intestinal competition
Answer: B
Conceptual Explanation: Grapefruit juice is a potent inhibitor of the CYP3A4 enzyme in
the intestinal wall. Inhibiting this enzyme reduces the first-pass metabolism of substrates,
leading to higher systemic concentrations and potential toxicity.
,2. When assessing the therapeutic index (TI) of a new medication, a narrow TI indicates which
of the following?
A. The drug is safe to administer without monitoring
B. The lethal dose is significantly higher than the effective dose
C. There is a small margin between the effective dose and the toxic dose
D. The drug has high potency but low efficacy
Answer: C
Conceptual Explanation: The therapeutic index is the ratio of the toxic dose to the
effective dose. A narrow TI means the therapeutic and toxic doses are close, requiring
precise dosing and frequent monitoring.
3. A patient with chronic kidney disease (CKD) is prescribed a drug that is primarily excreted
renally. How should the clinician adjust the dosage?
A. Increase the dose to compensate for poor absorption
B. Switch to an oral route to slow down distribution
C. Decrease the dose or increase the dosing interval
D. Maintain the standard dose as CKD only affects metabolism
Answer: C
, Conceptual Explanation: Reduced renal function leads to decreased excretion of drugs,
causing accumulation. To prevent toxicity, the dose must be lowered or the time between
doses must be extended.
4. Which physiological change in geriatric patients most significantly impacts the distribution
of lipid-soluble drugs?
A. Increased total body water
B. Decreased body fat percentage
C. Increased serum albumin levels
D. Increased proportion of adipose tissue
Answer: D
Conceptual Explanation: Aging is associated with an increase in body fat and a decrease
in lean body mass and water. This increases the volume of distribution for lipophilic drugs,
potentially prolonging their half-life.
5. A patient taking Digoxin presents with nausea, blurred vision, and halo effects around
lights. Which electrolyte imbalance increases the risk of this condition?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypermagnesemia
PHARMACOLOGY MIDTERM EXAM
QUESTIONS AND ANSWERS
1. A patient is prescribed a drug that is a known substrate of the CYP3A4 enzyme. If the
patient begins consuming grapefruit juice daily, what is the most likely pharmacological
outcome?
A. Decreased drug plasma levels due to enzyme induction
B. Increased drug plasma levels and risk of toxicity
C. Increased renal clearance of the drug
D. Reduced bioavailability due to intestinal competition
Answer: B
Conceptual Explanation: Grapefruit juice is a potent inhibitor of the CYP3A4 enzyme in
the intestinal wall. Inhibiting this enzyme reduces the first-pass metabolism of substrates,
leading to higher systemic concentrations and potential toxicity.
,2. When assessing the therapeutic index (TI) of a new medication, a narrow TI indicates which
of the following?
A. The drug is safe to administer without monitoring
B. The lethal dose is significantly higher than the effective dose
C. There is a small margin between the effective dose and the toxic dose
D. The drug has high potency but low efficacy
Answer: C
Conceptual Explanation: The therapeutic index is the ratio of the toxic dose to the
effective dose. A narrow TI means the therapeutic and toxic doses are close, requiring
precise dosing and frequent monitoring.
3. A patient with chronic kidney disease (CKD) is prescribed a drug that is primarily excreted
renally. How should the clinician adjust the dosage?
A. Increase the dose to compensate for poor absorption
B. Switch to an oral route to slow down distribution
C. Decrease the dose or increase the dosing interval
D. Maintain the standard dose as CKD only affects metabolism
Answer: C
, Conceptual Explanation: Reduced renal function leads to decreased excretion of drugs,
causing accumulation. To prevent toxicity, the dose must be lowered or the time between
doses must be extended.
4. Which physiological change in geriatric patients most significantly impacts the distribution
of lipid-soluble drugs?
A. Increased total body water
B. Decreased body fat percentage
C. Increased serum albumin levels
D. Increased proportion of adipose tissue
Answer: D
Conceptual Explanation: Aging is associated with an increase in body fat and a decrease
in lean body mass and water. This increases the volume of distribution for lipophilic drugs,
potentially prolonging their half-life.
5. A patient taking Digoxin presents with nausea, blurred vision, and halo effects around
lights. Which electrolyte imbalance increases the risk of this condition?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypermagnesemia
