NU553 EXAM UNIT 1 AND UNIT 2 REVIEW
150 Multiple Choice Questions with Correct
Answers Italicized 2026
UNIT 1: PRINCIPLES OF THERAPEUTICS
1. A patient with acute heart failure is administered intravenous furosemide rather
than oral. This route is chosen primarily because:
• A. It has a slower onset of action, reducing adverse effects
• B. It requires a higher total dose to achieve therapeutic effect
• C. It distributes only to the intravascular space
• D. It avoids first-pass metabolism, ensuring 100% bioavailability
2. A drug has a high volume of distribution (Vd > 40 L). This suggests the drug:
• A. Is primarily confined to the plasma compartment
• B. Is highly bound to plasma albumin
• C. Is extensively distributed into peripheral tissues
• D. Has poor lipid solubility
3. A patient with hepatic cirrhosis has reduced cytochrome P450 enzyme activity. The
nurse expects the half-life of a drug metabolized by CYP3A4 to:
,• A. Decrease, requiring higher doses
• B. Remain unchanged due to renal compensation
• C. Increase, requiring lower doses or longer intervals
• D. Fluctuate unpredictably
4. A drug that binds to a receptor but stabilizes it in an inactive conformation,
reducing basal activity, is a(n):
• A. Neutral antagonist
• B. Partial agonist
• C. Inverse agonist
• D. Allosteric agonist
5. The law of mass action applied to drug-receptor binding implies that:
• A. All receptors must be occupied for a maximal response
• B. The response is linearly related to receptor occupancy
• C. The fraction of occupied receptors is a function of drug concentration and
dissociation constant (Kd)
• D. Spare receptors do not exist
6. Which of the following best describes the concept of "spare receptors"?
• A. Receptors that are not functional
• B. A condition where maximal response occurs without occupying all receptors
• C. Receptors that have been internalized
• D. Receptors that bind drug irreversibly
7. A patient on warfarin has an INR of 5.0 (target 2-3). Vitamin K is administered.
Vitamin K acts as:
,• A. A competitive antagonist at the vitamin K epoxide reductase enzyme
• B. An antidote that replaces the missing clotting factors
• C. A functional antagonist by providing substrate
• D. A partial agonist of the warfarin receptor
8. A drug that exhibits tachyphylaxis upon repeated administration is likely acting
via:
• A. Upregulation of receptors
• B. Downregulation of receptors or depletion of mediators
• C. Increased drug metabolism
• D. Improved renal excretion
9. An allosteric modulator differs from an orthosteric ligand in that it:
• A. Binds to the same site as the endogenous agonist
• B. Competes with the agonist for binding
• C. Binds to a different site, altering receptor conformation and potentially enhancing
or inhibiting agonist binding
• D. Is always an antagonist
10. First-pass metabolism refers to:
• A. Drug removal by the kidneys before absorption
• B. Drug metabolism by the liver after oral administration before reaching systemic
circulation
• C. Drug binding to receptors in the brain
• D. Drug storage in adipose tissue
11. Which route avoids first-pass metabolism most directly?
, • A. Oral
• B. Sublingual
• C. Enteric-coated oral tablet
• D. Extended-release oral capsule
12. Phase I metabolism commonly includes which reactions?
• A. Oxidation, reduction, and hydrolysis
• B. Filtration, secretion, and reabsorption
• C. Conjugation only
• D. Protein binding only
13. Phase II metabolism is also known as:
• A. Absorption
• B. Distribution
• C. Conjugation
• D. Receptor activation
14. The main goal of Phase I and Phase II metabolism is to:
• A. Make drugs more lipid soluble
• B. Make drugs more water soluble for elimination
• C. Increase drug toxicity
• D. Prevent renal excretion
15. The CYP450 enzyme system is mainly located in the:
• A. Skin
• B. Liver
150 Multiple Choice Questions with Correct
Answers Italicized 2026
UNIT 1: PRINCIPLES OF THERAPEUTICS
1. A patient with acute heart failure is administered intravenous furosemide rather
than oral. This route is chosen primarily because:
• A. It has a slower onset of action, reducing adverse effects
• B. It requires a higher total dose to achieve therapeutic effect
• C. It distributes only to the intravascular space
• D. It avoids first-pass metabolism, ensuring 100% bioavailability
2. A drug has a high volume of distribution (Vd > 40 L). This suggests the drug:
• A. Is primarily confined to the plasma compartment
• B. Is highly bound to plasma albumin
• C. Is extensively distributed into peripheral tissues
• D. Has poor lipid solubility
3. A patient with hepatic cirrhosis has reduced cytochrome P450 enzyme activity. The
nurse expects the half-life of a drug metabolized by CYP3A4 to:
,• A. Decrease, requiring higher doses
• B. Remain unchanged due to renal compensation
• C. Increase, requiring lower doses or longer intervals
• D. Fluctuate unpredictably
4. A drug that binds to a receptor but stabilizes it in an inactive conformation,
reducing basal activity, is a(n):
• A. Neutral antagonist
• B. Partial agonist
• C. Inverse agonist
• D. Allosteric agonist
5. The law of mass action applied to drug-receptor binding implies that:
• A. All receptors must be occupied for a maximal response
• B. The response is linearly related to receptor occupancy
• C. The fraction of occupied receptors is a function of drug concentration and
dissociation constant (Kd)
• D. Spare receptors do not exist
6. Which of the following best describes the concept of "spare receptors"?
• A. Receptors that are not functional
• B. A condition where maximal response occurs without occupying all receptors
• C. Receptors that have been internalized
• D. Receptors that bind drug irreversibly
7. A patient on warfarin has an INR of 5.0 (target 2-3). Vitamin K is administered.
Vitamin K acts as:
,• A. A competitive antagonist at the vitamin K epoxide reductase enzyme
• B. An antidote that replaces the missing clotting factors
• C. A functional antagonist by providing substrate
• D. A partial agonist of the warfarin receptor
8. A drug that exhibits tachyphylaxis upon repeated administration is likely acting
via:
• A. Upregulation of receptors
• B. Downregulation of receptors or depletion of mediators
• C. Increased drug metabolism
• D. Improved renal excretion
9. An allosteric modulator differs from an orthosteric ligand in that it:
• A. Binds to the same site as the endogenous agonist
• B. Competes with the agonist for binding
• C. Binds to a different site, altering receptor conformation and potentially enhancing
or inhibiting agonist binding
• D. Is always an antagonist
10. First-pass metabolism refers to:
• A. Drug removal by the kidneys before absorption
• B. Drug metabolism by the liver after oral administration before reaching systemic
circulation
• C. Drug binding to receptors in the brain
• D. Drug storage in adipose tissue
11. Which route avoids first-pass metabolism most directly?
, • A. Oral
• B. Sublingual
• C. Enteric-coated oral tablet
• D. Extended-release oral capsule
12. Phase I metabolism commonly includes which reactions?
• A. Oxidation, reduction, and hydrolysis
• B. Filtration, secretion, and reabsorption
• C. Conjugation only
• D. Protein binding only
13. Phase II metabolism is also known as:
• A. Absorption
• B. Distribution
• C. Conjugation
• D. Receptor activation
14. The main goal of Phase I and Phase II metabolism is to:
• A. Make drugs more lipid soluble
• B. Make drugs more water soluble for elimination
• C. Increase drug toxicity
• D. Prevent renal excretion
15. The CYP450 enzyme system is mainly located in the:
• A. Skin
• B. Liver
