2026 NR 565 Final Exam
QUESTION 1
The APRN understands that the movement of a drug from the site of administration into
the bloodstream is referred to as:
A) Distribution
B) Absorption
C) Metabolism
D) Excretion
CORRECT ANSWER: B) Absorption
RATIONALE: Absorption is the process by which a drug moves from its site of
administration (e.g., GI tract, muscle, skin) into systemic circulation. Distribution is the
movement of drug from circulation to tissues. Metabolism is biotransformation, and
excretion is elimination from the body.
QUESTION 2
A patient with hepatic cirrhosis is prescribed a medication with high first-pass
metabolism. The NP anticipates:
A) Decreased bioavailability requiring higher doses
B) Increased bioavailability requiring lower doses
C) No change in dosing requirements
D) Faster drug elimination
,CORRECT ANSWER: B) Increased bioavailability requiring lower doses
RATIONALE: In cirrhosis, impaired hepatocyte function and portosystemic shunting
reduce first-pass metabolism, increasing oral bioavailability. The starting dose should be
reduced to avoid toxicity.
QUESTION 3
A patient is taking warfarin and is started on amiodarone. The NP should monitor for:
A) Decreased INR
B) Increased INR with bleeding risk
C) No change in INR
D) Reduced warfarin absorption
CORRECT ANSWER: B) Increased INR with bleeding risk
RATIONALE: Amiodarone inhibits CYP2C9, the enzyme that metabolizes warfarin,
leading to elevated INR and bleeding risk. Warfarin dose typically needs to be reduced by
30-50%.
QUESTION 4
A patient on digoxin has a serum potassium of 2.9 mEq/L. The NP recognizes that:
A) Digoxin is less effective in hypokalemia
B) Hypokalemia increases the risk of digoxin toxicity
C) Digoxin should be increased to compensate
D) Potassium replacement is not needed
,CORRECT ANSWER: B) Hypokalemia increases the risk of digoxin toxicity
RATIONALE: Hypokalemia enhances digoxin binding to the sodium-potassium ATPase
pump, increasing the risk of toxicity even at therapeutic levels. Potassium should be
repleted and digoxin held if toxicity is suspected.
QUESTION 5
The APRN understands that a CYP450 enzyme inducer will cause which effect on a co-
administered drug metabolized by that enzyme?
A) Increased serum levels and toxicity
B) Decreased serum levels and reduced efficacy
C) No change in serum levels
D) Increased protein binding
CORRECT ANSWER: B) Decreased serum levels and reduced efficacy
RATIONALE: Inducers increase enzyme activity, accelerating metabolism of co-
administered drugs, leading to lower serum concentrations and potential therapeutic
failure. Common inducers include rifampin, carbamazepine, and phenytoin.
QUESTION 6
A patient with renal impairment is prescribed a drug that is primarily renally excreted.
The NP should:
A) Increase the dose
B) Decrease the dose or extend the dosing interval
C) No dose adjustment needed
D) Switch to a hepatically cleared drug
, CORRECT ANSWER: B) Decrease the dose or extend the dosing interval
RATIONALE: Renal impairment reduces drug clearance, prolonging half-life. Dose
reduction or extended intervals prevent accumulation and toxicity while maintaining
therapeutic levels.
QUESTION 7
A patient with a narrow therapeutic index drug requires serum level monitoring
primarily to:
A) Confirm adherence
B) Avoid toxicity while ensuring efficacy
C) Reduce healthcare costs
D) Satisfy legal requirements
CORRECT ANSWER: B) Avoid toxicity while ensuring efficacy
RATIONALE: Narrow therapeutic index drugs have a small window between therapeutic
and toxic levels. Monitoring ensures levels remain in this range to maximize benefit and
minimize harm.
QUESTION 8
Highly lipid-soluble drugs are absorbed more rapidly because they:
A) Require active transport
B) Cross cell membranes by passive diffusion
C) Are ionized in the GI tract
D) Are excreted faster
QUESTION 1
The APRN understands that the movement of a drug from the site of administration into
the bloodstream is referred to as:
A) Distribution
B) Absorption
C) Metabolism
D) Excretion
CORRECT ANSWER: B) Absorption
RATIONALE: Absorption is the process by which a drug moves from its site of
administration (e.g., GI tract, muscle, skin) into systemic circulation. Distribution is the
movement of drug from circulation to tissues. Metabolism is biotransformation, and
excretion is elimination from the body.
QUESTION 2
A patient with hepatic cirrhosis is prescribed a medication with high first-pass
metabolism. The NP anticipates:
A) Decreased bioavailability requiring higher doses
B) Increased bioavailability requiring lower doses
C) No change in dosing requirements
D) Faster drug elimination
,CORRECT ANSWER: B) Increased bioavailability requiring lower doses
RATIONALE: In cirrhosis, impaired hepatocyte function and portosystemic shunting
reduce first-pass metabolism, increasing oral bioavailability. The starting dose should be
reduced to avoid toxicity.
QUESTION 3
A patient is taking warfarin and is started on amiodarone. The NP should monitor for:
A) Decreased INR
B) Increased INR with bleeding risk
C) No change in INR
D) Reduced warfarin absorption
CORRECT ANSWER: B) Increased INR with bleeding risk
RATIONALE: Amiodarone inhibits CYP2C9, the enzyme that metabolizes warfarin,
leading to elevated INR and bleeding risk. Warfarin dose typically needs to be reduced by
30-50%.
QUESTION 4
A patient on digoxin has a serum potassium of 2.9 mEq/L. The NP recognizes that:
A) Digoxin is less effective in hypokalemia
B) Hypokalemia increases the risk of digoxin toxicity
C) Digoxin should be increased to compensate
D) Potassium replacement is not needed
,CORRECT ANSWER: B) Hypokalemia increases the risk of digoxin toxicity
RATIONALE: Hypokalemia enhances digoxin binding to the sodium-potassium ATPase
pump, increasing the risk of toxicity even at therapeutic levels. Potassium should be
repleted and digoxin held if toxicity is suspected.
QUESTION 5
The APRN understands that a CYP450 enzyme inducer will cause which effect on a co-
administered drug metabolized by that enzyme?
A) Increased serum levels and toxicity
B) Decreased serum levels and reduced efficacy
C) No change in serum levels
D) Increased protein binding
CORRECT ANSWER: B) Decreased serum levels and reduced efficacy
RATIONALE: Inducers increase enzyme activity, accelerating metabolism of co-
administered drugs, leading to lower serum concentrations and potential therapeutic
failure. Common inducers include rifampin, carbamazepine, and phenytoin.
QUESTION 6
A patient with renal impairment is prescribed a drug that is primarily renally excreted.
The NP should:
A) Increase the dose
B) Decrease the dose or extend the dosing interval
C) No dose adjustment needed
D) Switch to a hepatically cleared drug
, CORRECT ANSWER: B) Decrease the dose or extend the dosing interval
RATIONALE: Renal impairment reduces drug clearance, prolonging half-life. Dose
reduction or extended intervals prevent accumulation and toxicity while maintaining
therapeutic levels.
QUESTION 7
A patient with a narrow therapeutic index drug requires serum level monitoring
primarily to:
A) Confirm adherence
B) Avoid toxicity while ensuring efficacy
C) Reduce healthcare costs
D) Satisfy legal requirements
CORRECT ANSWER: B) Avoid toxicity while ensuring efficacy
RATIONALE: Narrow therapeutic index drugs have a small window between therapeutic
and toxic levels. Monitoring ensures levels remain in this range to maximize benefit and
minimize harm.
QUESTION 8
Highly lipid-soluble drugs are absorbed more rapidly because they:
A) Require active transport
B) Cross cell membranes by passive diffusion
C) Are ionized in the GI tract
D) Are excreted faster
