NURS 6521 ADVANCED PHARMACOLOGY FINAL
EXAM/NURS 6521N WEEK 11 LATEST 2023-2024
VERSION C(100 Q&a)
1. A patient with decompensated liver cirrhosis is prescribed a medication that undergoes
extensive first-pass metabolism. The nurse anticipates that the oral bioavailability of this drug
will be:
• A. Decreased due to reduced hepatic blood flow
• B. Increased due to impaired hepatic extraction
• C. Unchanged because renal excretion compensates
• D. Decreased due to hypoalbuminemia
Correct Answer: B
Rationale: In liver cirrhosis, hepatic extraction ratio decreases, allowing more unchanged
drug to reach systemic circulation. This significantly increases oral bioavailability, potentially
causing toxicity at standard doses. Option A is incorrect because while hepatic blood flow may
decrease, the net effect is increased bioavailability. Option C is incorrect because renal
compensation does not affect first-pass metabolism. Option D is incorrect because
hypoalbuminemia affects distribution, not first-pass extraction.
2. A drug has a half-life of 18 hours. Approximately how long will it take to reach steady-state
plasma concentrations with consistent dosing?
• A. 18 hours
• B. 36 hours
• C. 72-90 hours
• D. 7-10 days
Correct Answer: C
Rationale: Steady state is achieved after approximately 4-5 half-lives. With an 18-hour half-
life, 4-5 × 18 = 72-90 hours (3-4 days). Option A is one half-life (50% of steady state). Option B is
two half-lives (~75% of steady state). Option D is excessive and would only apply to drugs with
much longer half-lives (e.g., 30+ hours).
,3. A patient is receiving warfarin (narrow therapeutic index) and is prescribed a new
medication that is a potent CYP2C9 inhibitor. The nurse should anticipate:
• A. Decreased warfarin effect requiring dose increase
• B. Increased warfarin effect with elevated INR
• C. No interaction since warfarin is renally excreted
• D. Enhanced warfarin metabolism
Correct Answer: B
Rationale: Warfarin is metabolized primarily by CYP2C9. Inhibition of this enzyme decreases
warfarin metabolism, increasing plasma concentrations and anticoagulant effect, elevating INR
and bleeding risk. Option A is incorrect because inhibition increases effect, not decreases.
Option C is incorrect because warfarin is hepatically metabolized. Option D is incorrect because
inhibition slows metabolism, not enhances it.
4. Which of the following statements accurately describes the concept of "volume of
distribution" (Vd)?
• A. The volume of plasma cleared of drug per unit time
• B. A theoretical volume relating total drug amount to plasma concentration
• C. The rate at which drug crosses the blood-brain barrier
• D. The amount of drug bound to plasma proteins
Correct Answer: B
Rationale: Vd = amount of drug in body / plasma concentration. It is a theoretical volume,
not a real anatomical space. A large Vd indicates extensive tissue distribution. Option A
describes clearance, not Vd. Option C describes permeability characteristics. Option D describes
protein binding, which influences Vd but is not its definition.
5. A patient is prescribed a weak acid medication. The nurse understands that urinary
excretion of this drug would be enhanced by:
• A. Acidifying the urine
, • B. Alkalinizing the urine
• C. Decreasing urine flow
• D. Administering a CYP450 inducer
Correct Answer: B
Rationale: Weak acids are more ionized in alkaline urine, and ionized drugs are less
reabsorbed, increasing excretion. Option A would promote reabsorption of weak acids. Option C
would decrease excretion overall. Option D affects metabolism, not renal handling.
6. A 72-year-old patient has a creatinine clearance of 28 mL/min. For a drug that is 90%
renally excreted unchanged, the nurse should anticipate:
• A. No dosage adjustment needed
• B. Increased dose due to poor absorption
• C. Dose reduction to prevent accumulation and toxicity
• D. Decreased therapeutic effect at standard doses
Correct Answer: C
Rationale: With significantly reduced renal function and a drug highly dependent on renal
excretion, accumulation occurs, necessitating dose reduction. Option A is unsafe. Option B is
illogical. Option D is incorrect; the risk is toxicity, not subtherapeutic levels, if dosed normally.
7. Which statement best differentiates pharmacodynamics from pharmacokinetics?
• A. Pharmacodynamics is what the body does to the drug; pharmacokinetics is what the
drug does to the body
• B. Pharmacodynamics is what the drug does to the body; pharmacokinetics is what the
body does to the drug
• C. Pharmacodynamics involves ADME; pharmacokinetics involves receptor binding
• D. Pharmacodynamics only applies to IV drugs
Correct Answer: B
Rationale: Pharmacodynamics = drug effects on the body (receptor binding, signal
transduction). Pharmacokinetics = body's effect on the drug (absorption, distribution,
, metabolism, excretion). Option A reverses the definitions. Option C reverses the components.
Option D is false.
8. A patient is taking Drug A (highly protein-bound) and is started on Drug B (also highly
protein-bound). The nurse should monitor for:
• A. Decreased effect of Drug A
• B. Increased free fraction of Drug A and potential toxicity
• C. Decreased absorption of both drugs
• D. Enhanced renal excretion of Drug A
Correct Answer: B
Rationale: Competition for protein binding sites displaces Drug A, increasing its free (active)
fraction and potential toxicity. Option A is incorrect; effect increases, not decreases. Option C is
incorrect; protein binding occurs after absorption. Option D may eventually occur but the
immediate concern is toxicity from increased free drug.
9. A drug that binds to a receptor and produces a submaximal response even at full receptor
occupancy is best described as a:
• A. Full agonist
• B. Partial agonist
• C. Competitive antagonist
• D. Inverse agonist
Correct Answer: B
Rationale: Partial agonists have intrinsic activity greater than zero but less than a full
agonist. Option A produces maximal response. Option C produces no response and blocks
agonists. Option D produces effects opposite to the endogenous agonist.
10. Which of the following is the primary mechanism by which enzyme inducers affect co-
administered drugs?
• A. They increase plasma protein binding
EXAM/NURS 6521N WEEK 11 LATEST 2023-2024
VERSION C(100 Q&a)
1. A patient with decompensated liver cirrhosis is prescribed a medication that undergoes
extensive first-pass metabolism. The nurse anticipates that the oral bioavailability of this drug
will be:
• A. Decreased due to reduced hepatic blood flow
• B. Increased due to impaired hepatic extraction
• C. Unchanged because renal excretion compensates
• D. Decreased due to hypoalbuminemia
Correct Answer: B
Rationale: In liver cirrhosis, hepatic extraction ratio decreases, allowing more unchanged
drug to reach systemic circulation. This significantly increases oral bioavailability, potentially
causing toxicity at standard doses. Option A is incorrect because while hepatic blood flow may
decrease, the net effect is increased bioavailability. Option C is incorrect because renal
compensation does not affect first-pass metabolism. Option D is incorrect because
hypoalbuminemia affects distribution, not first-pass extraction.
2. A drug has a half-life of 18 hours. Approximately how long will it take to reach steady-state
plasma concentrations with consistent dosing?
• A. 18 hours
• B. 36 hours
• C. 72-90 hours
• D. 7-10 days
Correct Answer: C
Rationale: Steady state is achieved after approximately 4-5 half-lives. With an 18-hour half-
life, 4-5 × 18 = 72-90 hours (3-4 days). Option A is one half-life (50% of steady state). Option B is
two half-lives (~75% of steady state). Option D is excessive and would only apply to drugs with
much longer half-lives (e.g., 30+ hours).
,3. A patient is receiving warfarin (narrow therapeutic index) and is prescribed a new
medication that is a potent CYP2C9 inhibitor. The nurse should anticipate:
• A. Decreased warfarin effect requiring dose increase
• B. Increased warfarin effect with elevated INR
• C. No interaction since warfarin is renally excreted
• D. Enhanced warfarin metabolism
Correct Answer: B
Rationale: Warfarin is metabolized primarily by CYP2C9. Inhibition of this enzyme decreases
warfarin metabolism, increasing plasma concentrations and anticoagulant effect, elevating INR
and bleeding risk. Option A is incorrect because inhibition increases effect, not decreases.
Option C is incorrect because warfarin is hepatically metabolized. Option D is incorrect because
inhibition slows metabolism, not enhances it.
4. Which of the following statements accurately describes the concept of "volume of
distribution" (Vd)?
• A. The volume of plasma cleared of drug per unit time
• B. A theoretical volume relating total drug amount to plasma concentration
• C. The rate at which drug crosses the blood-brain barrier
• D. The amount of drug bound to plasma proteins
Correct Answer: B
Rationale: Vd = amount of drug in body / plasma concentration. It is a theoretical volume,
not a real anatomical space. A large Vd indicates extensive tissue distribution. Option A
describes clearance, not Vd. Option C describes permeability characteristics. Option D describes
protein binding, which influences Vd but is not its definition.
5. A patient is prescribed a weak acid medication. The nurse understands that urinary
excretion of this drug would be enhanced by:
• A. Acidifying the urine
, • B. Alkalinizing the urine
• C. Decreasing urine flow
• D. Administering a CYP450 inducer
Correct Answer: B
Rationale: Weak acids are more ionized in alkaline urine, and ionized drugs are less
reabsorbed, increasing excretion. Option A would promote reabsorption of weak acids. Option C
would decrease excretion overall. Option D affects metabolism, not renal handling.
6. A 72-year-old patient has a creatinine clearance of 28 mL/min. For a drug that is 90%
renally excreted unchanged, the nurse should anticipate:
• A. No dosage adjustment needed
• B. Increased dose due to poor absorption
• C. Dose reduction to prevent accumulation and toxicity
• D. Decreased therapeutic effect at standard doses
Correct Answer: C
Rationale: With significantly reduced renal function and a drug highly dependent on renal
excretion, accumulation occurs, necessitating dose reduction. Option A is unsafe. Option B is
illogical. Option D is incorrect; the risk is toxicity, not subtherapeutic levels, if dosed normally.
7. Which statement best differentiates pharmacodynamics from pharmacokinetics?
• A. Pharmacodynamics is what the body does to the drug; pharmacokinetics is what the
drug does to the body
• B. Pharmacodynamics is what the drug does to the body; pharmacokinetics is what the
body does to the drug
• C. Pharmacodynamics involves ADME; pharmacokinetics involves receptor binding
• D. Pharmacodynamics only applies to IV drugs
Correct Answer: B
Rationale: Pharmacodynamics = drug effects on the body (receptor binding, signal
transduction). Pharmacokinetics = body's effect on the drug (absorption, distribution,
, metabolism, excretion). Option A reverses the definitions. Option C reverses the components.
Option D is false.
8. A patient is taking Drug A (highly protein-bound) and is started on Drug B (also highly
protein-bound). The nurse should monitor for:
• A. Decreased effect of Drug A
• B. Increased free fraction of Drug A and potential toxicity
• C. Decreased absorption of both drugs
• D. Enhanced renal excretion of Drug A
Correct Answer: B
Rationale: Competition for protein binding sites displaces Drug A, increasing its free (active)
fraction and potential toxicity. Option A is incorrect; effect increases, not decreases. Option C is
incorrect; protein binding occurs after absorption. Option D may eventually occur but the
immediate concern is toxicity from increased free drug.
9. A drug that binds to a receptor and produces a submaximal response even at full receptor
occupancy is best described as a:
• A. Full agonist
• B. Partial agonist
• C. Competitive antagonist
• D. Inverse agonist
Correct Answer: B
Rationale: Partial agonists have intrinsic activity greater than zero but less than a full
agonist. Option A produces maximal response. Option C produces no response and blocks
agonists. Option D produces effects opposite to the endogenous agonist.
10. Which of the following is the primary mechanism by which enzyme inducers affect co-
administered drugs?
• A. They increase plasma protein binding
