NR547 Nursing Exam – Advanced
Pharmacology Practice Exam 2026/2027 |
Practice Questions & Study Guide | Complete
Exam-Style Questions with Correct Detailed
Answers & Rationales (Reliable Answers) |
Latest Updated Version | Instant Download
PDf
Question 1
A patient is prescribed a medication that has a half-life of 12
hours and follows linear pharmacokinetics. Approximately how
long should it take for the medication to reach near steady-state
concentrations with repeated dosing?
A. 12 hours
B. 24 hours
C. 48–60 hours
D. 120 hours
Rationale: With linear pharmacokinetics, most medications
reach approximately 94–97% of steady state after about four to
five half-lives. A medication with a 12-hour half-life therefore
,requires approximately 48–60 hours to approach steady state.
The dose and dosing interval influence the concentration
achieved but do not substantially change the time required to
reach steady state. One half-life represents only about 50% of
eventual steady state, while two half-lives represent
approximately 75%. Five half-lives provide approximately 97%
of steady-state concentration.
Question 2
A patient with chronic kidney disease is prescribed a medication
that is primarily eliminated unchanged through the kidneys.
Which pharmacokinetic change is most likely to occur as renal
function declines?
A. Increased renal clearance
B. Prolonged elimination half-life
C. Increased hepatic first-pass metabolism
D. Decreased volume of distribution in every patient
Rationale: Reduced renal function decreases the clearance of
medications that depend substantially on renal excretion. When
clearance decreases, the elimination half-life generally
increases, allowing the medication to remain in the body longer
and potentially accumulate with repeated dosing. This may
require a lower maintenance dose, a longer dosing interval, or
both, depending on the medication. Renal impairment does not
,automatically reduce volume of distribution, and hepatic first-
pass metabolism is a separate pharmacokinetic process.
Question 3
A patient taking an ACE inhibitor develops facial swelling,
tongue enlargement, and difficulty breathing. Which action has
the highest priority?
A. Administer the next scheduled ACE inhibitor dose
B. Place the patient supine and reassess in 30 minutes
C. Discontinue the medication and initiate emergency
management of angioedema
D. Administer an antacid because the symptoms are likely
gastrointestinal
Rationale: ACE inhibitor–associated angioedema can rapidly
compromise the upper airway and is a potentially life-
threatening adverse reaction. The medication should be
discontinued, and immediate assessment and management of
airway, breathing, and circulation are priorities. Depending on
severity and local protocols, emergency airway intervention and
medications used for acute angioedema may be required.
Waiting for symptoms to resolve or administering another dose
can worsen the reaction.
, Question 4
A patient taking warfarin has an INR of 8.2 but has no evidence
of active bleeding. Which general management principle is most
appropriate?
A. Automatically administer a full dose of protamine
B. Hold warfarin and assess the need for vitamin K based on
bleeding risk and clinical circumstances
C. Administer aspirin to prevent thrombosis
D. Give an additional dose of warfarin to stabilize the INR
Rationale: A markedly elevated INR without bleeding requires
withholding warfarin and individualized assessment of bleeding
risk, the degree of INR elevation, indication for anticoagulation,
and other patient-specific factors. Vitamin K may be appropriate
in selected patients at sufficiently high INR or bleeding risk, but
management should follow current anticoagulation protocols.
Protamine reverses heparin rather than warfarin. Aspirin would
increase bleeding risk, and additional warfarin would further
increase anticoagulation.
Question 5
A patient taking digoxin reports nausea, anorexia, and yellow-
green visual disturbances. Which additional finding would
increase concern for digoxin toxicity?
Pharmacology Practice Exam 2026/2027 |
Practice Questions & Study Guide | Complete
Exam-Style Questions with Correct Detailed
Answers & Rationales (Reliable Answers) |
Latest Updated Version | Instant Download
Question 1
A patient is prescribed a medication that has a half-life of 12
hours and follows linear pharmacokinetics. Approximately how
long should it take for the medication to reach near steady-state
concentrations with repeated dosing?
A. 12 hours
B. 24 hours
C. 48–60 hours
D. 120 hours
Rationale: With linear pharmacokinetics, most medications
reach approximately 94–97% of steady state after about four to
five half-lives. A medication with a 12-hour half-life therefore
,requires approximately 48–60 hours to approach steady state.
The dose and dosing interval influence the concentration
achieved but do not substantially change the time required to
reach steady state. One half-life represents only about 50% of
eventual steady state, while two half-lives represent
approximately 75%. Five half-lives provide approximately 97%
of steady-state concentration.
Question 2
A patient with chronic kidney disease is prescribed a medication
that is primarily eliminated unchanged through the kidneys.
Which pharmacokinetic change is most likely to occur as renal
function declines?
A. Increased renal clearance
B. Prolonged elimination half-life
C. Increased hepatic first-pass metabolism
D. Decreased volume of distribution in every patient
Rationale: Reduced renal function decreases the clearance of
medications that depend substantially on renal excretion. When
clearance decreases, the elimination half-life generally
increases, allowing the medication to remain in the body longer
and potentially accumulate with repeated dosing. This may
require a lower maintenance dose, a longer dosing interval, or
both, depending on the medication. Renal impairment does not
,automatically reduce volume of distribution, and hepatic first-
pass metabolism is a separate pharmacokinetic process.
Question 3
A patient taking an ACE inhibitor develops facial swelling,
tongue enlargement, and difficulty breathing. Which action has
the highest priority?
A. Administer the next scheduled ACE inhibitor dose
B. Place the patient supine and reassess in 30 minutes
C. Discontinue the medication and initiate emergency
management of angioedema
D. Administer an antacid because the symptoms are likely
gastrointestinal
Rationale: ACE inhibitor–associated angioedema can rapidly
compromise the upper airway and is a potentially life-
threatening adverse reaction. The medication should be
discontinued, and immediate assessment and management of
airway, breathing, and circulation are priorities. Depending on
severity and local protocols, emergency airway intervention and
medications used for acute angioedema may be required.
Waiting for symptoms to resolve or administering another dose
can worsen the reaction.
, Question 4
A patient taking warfarin has an INR of 8.2 but has no evidence
of active bleeding. Which general management principle is most
appropriate?
A. Automatically administer a full dose of protamine
B. Hold warfarin and assess the need for vitamin K based on
bleeding risk and clinical circumstances
C. Administer aspirin to prevent thrombosis
D. Give an additional dose of warfarin to stabilize the INR
Rationale: A markedly elevated INR without bleeding requires
withholding warfarin and individualized assessment of bleeding
risk, the degree of INR elevation, indication for anticoagulation,
and other patient-specific factors. Vitamin K may be appropriate
in selected patients at sufficiently high INR or bleeding risk, but
management should follow current anticoagulation protocols.
Protamine reverses heparin rather than warfarin. Aspirin would
increase bleeding risk, and additional warfarin would further
increase anticoagulation.
Question 5
A patient taking digoxin reports nausea, anorexia, and yellow-
green visual disturbances. Which additional finding would
increase concern for digoxin toxicity?
