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NR 566 Advanced Pharmacology – Original Midterm Practice
Exam Questions with Answers & Rationales
Section 1: Pharmacokinetics & Pharmacodynamics Review
1. A nurse practitioner is prescribing a medication that
undergoes extensive first-pass metabolism. Which route of
administration would provide the highest bioavailability?
A. Oral
B. Rectal
C. Intravenous
D. Subcutaneous
Answer: C
Rationale: IV administration bypasses the first-pass effect
entirely, providing 100% bioavailability. Oral drugs
undergo hepatic first-pass metabolism, reducing
bioavailability. Rectal partially bypasses; subcutaneous
does not undergo first-pass but absorption is slower than
IV.
2. A patient with liver cirrhosis is prescribed a drug
metabolized by CYP450 enzymes. The nurse practitioner
should:
A. Increase the dose due to faster metabolism
B. Decrease the dose due to impaired metabolism
C. Maintain the standard dose
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D. Discontinue all medications
Answer: B
Rationale: Liver disease impairs drug metabolism, leading
to drug accumulation and increased risk of toxicity. Doses
often need to be reduced or intervals extended.
3. Which of the following best describes a drug with a narrow
therapeutic index?
A. Large margin between effective and toxic doses
B. Small margin between effective and toxic doses
C. No toxic effects
D. Only effective at toxic doses
Answer: B
Rationale: Narrow therapeutic index drugs (e.g., digoxin,
warfarin, lithium) have a small range between
therapeutic and toxic levels, requiring close monitoring.
4. A drug that binds to a receptor and produces a maximal
response is called:
A. Antagonist
B. Partial agonist
C. Full agonist
D. Inverse agonist
Answer: C
Rationale: A full agonist binds and activates the receptor,
,https://www.stuvia.com/user/performance
producing the maximum tissue response. Partial agonists
produce less than maximal response; antagonists block.
5. Which enzyme system is responsible for the metabolism of
the majority of drugs?
A. Cyclooxygenase
B. Cytochrome P450
C. Renin-angiotensin system
D. Monoamine oxidase
Answer: B
Rationale: The cytochrome P450 (CYP450) system,
located primarily in the liver, metabolizes most drugs.
CYP3A4 is the most common isoenzyme.
6. A patient's serum albumin is 2.0 g/dL (low). The nurse
practitioner should anticipate what effect on a highly
protein-bound drug?
A. Decreased free drug concentration
B. Increased free drug concentration and potential toxicity
C. No change in drug effect
D. Decreased drug absorption
Answer: B
Rationale: Low albumin means fewer binding sites, so
more drug remains unbound (free). Free drug is
pharmacologically active, increasing the risk of toxicity.
, https://www.stuvia.com/user/performance
7. Which statement about drug half-life is correct?
A. It is the time for drug concentration to double
B. It determines the dosing interval
C. It is always 4 hours
D. It is unrelated to drug accumulation
Answer: B
Rationale: Half-life is the time for plasma drug
concentration to decrease by 50%. It helps determine
dosing frequency and time to steady state (4-5 half-lives).
8. A prescriber orders a loading dose of a medication. The
purpose of a loading dose is to:
A. Reduce side effects
B. Rapidly achieve therapeutic drug levels
C. Prolong the half-life
D. Decrease the need for monitoring
Answer: B
Rationale: Loading doses quickly raise plasma
concentrations to therapeutic range, especially for drugs
with long half-lives (e.g., digoxin, amiodarone).
9. Which route of administration has the slowest onset of
action?
A. Intravenous
B. Intramuscular
C. Sublingual
NR 566 Advanced Pharmacology – Original Midterm Practice
Exam Questions with Answers & Rationales
Section 1: Pharmacokinetics & Pharmacodynamics Review
1. A nurse practitioner is prescribing a medication that
undergoes extensive first-pass metabolism. Which route of
administration would provide the highest bioavailability?
A. Oral
B. Rectal
C. Intravenous
D. Subcutaneous
Answer: C
Rationale: IV administration bypasses the first-pass effect
entirely, providing 100% bioavailability. Oral drugs
undergo hepatic first-pass metabolism, reducing
bioavailability. Rectal partially bypasses; subcutaneous
does not undergo first-pass but absorption is slower than
IV.
2. A patient with liver cirrhosis is prescribed a drug
metabolized by CYP450 enzymes. The nurse practitioner
should:
A. Increase the dose due to faster metabolism
B. Decrease the dose due to impaired metabolism
C. Maintain the standard dose
,https://www.stuvia.com/user/performance
D. Discontinue all medications
Answer: B
Rationale: Liver disease impairs drug metabolism, leading
to drug accumulation and increased risk of toxicity. Doses
often need to be reduced or intervals extended.
3. Which of the following best describes a drug with a narrow
therapeutic index?
A. Large margin between effective and toxic doses
B. Small margin between effective and toxic doses
C. No toxic effects
D. Only effective at toxic doses
Answer: B
Rationale: Narrow therapeutic index drugs (e.g., digoxin,
warfarin, lithium) have a small range between
therapeutic and toxic levels, requiring close monitoring.
4. A drug that binds to a receptor and produces a maximal
response is called:
A. Antagonist
B. Partial agonist
C. Full agonist
D. Inverse agonist
Answer: C
Rationale: A full agonist binds and activates the receptor,
,https://www.stuvia.com/user/performance
producing the maximum tissue response. Partial agonists
produce less than maximal response; antagonists block.
5. Which enzyme system is responsible for the metabolism of
the majority of drugs?
A. Cyclooxygenase
B. Cytochrome P450
C. Renin-angiotensin system
D. Monoamine oxidase
Answer: B
Rationale: The cytochrome P450 (CYP450) system,
located primarily in the liver, metabolizes most drugs.
CYP3A4 is the most common isoenzyme.
6. A patient's serum albumin is 2.0 g/dL (low). The nurse
practitioner should anticipate what effect on a highly
protein-bound drug?
A. Decreased free drug concentration
B. Increased free drug concentration and potential toxicity
C. No change in drug effect
D. Decreased drug absorption
Answer: B
Rationale: Low albumin means fewer binding sites, so
more drug remains unbound (free). Free drug is
pharmacologically active, increasing the risk of toxicity.
, https://www.stuvia.com/user/performance
7. Which statement about drug half-life is correct?
A. It is the time for drug concentration to double
B. It determines the dosing interval
C. It is always 4 hours
D. It is unrelated to drug accumulation
Answer: B
Rationale: Half-life is the time for plasma drug
concentration to decrease by 50%. It helps determine
dosing frequency and time to steady state (4-5 half-lives).
8. A prescriber orders a loading dose of a medication. The
purpose of a loading dose is to:
A. Reduce side effects
B. Rapidly achieve therapeutic drug levels
C. Prolong the half-life
D. Decrease the need for monitoring
Answer: B
Rationale: Loading doses quickly raise plasma
concentrations to therapeutic range, especially for drugs
with long half-lives (e.g., digoxin, amiodarone).
9. Which route of administration has the slowest onset of
action?
A. Intravenous
B. Intramuscular
C. Sublingual
