NURS 6521 Advanced pharmacology Final
Exam- (6 Versions, 600QA), Walden, Latest
2021
1. A patient asks why the oral dose of a medication is significantly higher than the intravenous
dose of the same drug. The NP explains this is primarily due to:
A. Increased renal excretion of oral drugs
B. First-pass hepatic metabolism reducing bioavailability
C. Poor dissolution of oral formulations
D. Protein binding differences between routes
Correct Answer: B
Rationale: Orally administered drugs are absorbed through the GI tract and transported via
the portal vein to the liver before entering systemic circulation. The liver metabolizes a portion
of the drug, reducing the fraction that reaches the target site (bioavailability). This is why oral
doses are often higher than parenteral doses of the same medication.
2. A patient with chronic kidney disease (eGFR 28 mL/min) is prescribed a drug primarily
eliminated by glomerular filtration. The NP should anticipate which change?
A. Increased volume of distribution
B. Prolonged half-life requiring dose adjustment
C. Enhanced drug efficacy due to accumulation
D. Decreased absorption from the GI tract
Correct Answer: B
Rationale: Renal impairment reduces clearance of renally eliminated drugs, prolonging the
elimination half-life and increasing the risk of accumulation and toxicity. Dosage reduction or
extended dosing intervals are typically required.
3. Grapefruit juice interacts with many medications by:
A. Inducing CYP3A4 activity
B. Inhibiting intestinal CYP3A4, increasing drug levels
,C. Enhancing renal excretion of drugs
D. Increasing protein binding of drugs
Correct Answer: B
Rationale: Grapefruit juice inhibits CYP3A4 in the intestinal wall, reducing first-pass
metabolism of CYP3A4 substrate drugs. This leads to increased bioavailability and potential
toxicity. Common affected drugs include statins, calcium channel blockers, and benzodiazepines.
4. A patient with a CYP2D6 poor metabolizer phenotype is prescribed codeine for pain. The NP
should anticipate:
A. Enhanced analgesic effect due to drug accumulation
B. Little to no pain relief because codeine cannot be activated
C. Increased risk of serotonin syndrome
D. Rapid clearance requiring higher doses
Correct Answer: B
Rationale: Codeine is a prodrug requiring CYP2D6-mediated conversion to morphine for
analgesic effect. Poor metabolizers cannot efficiently perform this conversion, resulting in
inadequate pain relief. Ultra-rapid metabolizers face the opposite risk—excessive morphine
production and toxicity.
5. Which drug requires routine serum level monitoring due to a narrow therapeutic index?
A. Amoxicillin
B. Metformin
C. Lithium
D. Lisinopril
Correct Answer: C
Rationale: Lithium has a narrow therapeutic index (0.6–1.2 mEq/L). Serum levels must be
monitored regularly to maintain efficacy for bipolar disorder while preventing toxicity (tremor,
confusion, seizures, coma). Other narrow therapeutic index drugs include digoxin, warfarin,
phenytoin, and theophylline.
,6. A drug that binds to a receptor and produces the maximum possible biological response is
classified as:
A. Partial agonist
B. Full agonist
C. Competitive antagonist
D. Inverse agonist
Correct Answer: B
Rationale: A full agonist has both high affinity for the receptor and full intrinsic activity,
producing the maximum possible response. A partial agonist produces a submaximal response
even at full receptor occupancy. Antagonists have affinity but no intrinsic activity (or negative
intrinsic activity for inverse agonists).
7. Approximately how many half-lives are required to reach steady-state plasma concentration
with continuous dosing?
A. 1–2
B. 2–3
C. 4–5
D. 7–8
Correct Answer: C
Rationale: With first-order kinetics, approximately 4–5 half-lives are needed to reach steady
state. This principle guides timing of serum level monitoring and assessment of full therapeutic
effect after initiating or adjusting a drug dose.
8. Which pharmacokinetic parameter describes the volume of fluid from which a drug is
completely removed per unit time?
A. Volume of distribution
B. Bioavailability
C. Clearance
D. Half-life
Correct Answer: C
, Rationale: Clearance is the volume of plasma cleared of drug per unit time (mL/min or
L/hr). It reflects the efficiency of drug elimination by all routes (hepatic, renal, etc.). Volume of
distribution describes the apparent space into which a drug distributes, not the rate of
elimination.
9. A patient taking warfarin is prescribed a drug that displaces warfarin from plasma albumin.
The NP should monitor for:
A. Decreased warfarin effect
B. Increased free warfarin fraction and bleeding risk
C. No change in anticoagulant effect
D. Reduced warfarin absorption
Correct Answer: B
Rationale: Displacement from plasma proteins increases the free (unbound) fraction of
warfarin, which is pharmacologically active. This can transiently increase anticoagulant effect
and bleeding risk. However, the free drug is also available for metabolism and excretion, so the
net effect depends on the displacing drug's other properties.
10. Which statement accurately describes zero-order elimination kinetics?
A. A constant fraction of drug is eliminated per unit time
B. A constant amount of drug is eliminated per unit time
C. The elimination rate is proportional to plasma concentration
D. Half-life remains constant regardless of dose
Correct Answer: B
Rationale: Zero-order (saturation) kinetics occurs when elimination pathways are saturated.
A constant amount of drug is eliminated per unit time, regardless of plasma concentration. Half-
life increases with higher doses. Ethanol, phenytoin, and high-dose aspirin exhibit zero-order
kinetics.
11. A 78-year-old patient has decreased renal function and low serum albumin. The NP should
consider that:
Exam- (6 Versions, 600QA), Walden, Latest
2021
1. A patient asks why the oral dose of a medication is significantly higher than the intravenous
dose of the same drug. The NP explains this is primarily due to:
A. Increased renal excretion of oral drugs
B. First-pass hepatic metabolism reducing bioavailability
C. Poor dissolution of oral formulations
D. Protein binding differences between routes
Correct Answer: B
Rationale: Orally administered drugs are absorbed through the GI tract and transported via
the portal vein to the liver before entering systemic circulation. The liver metabolizes a portion
of the drug, reducing the fraction that reaches the target site (bioavailability). This is why oral
doses are often higher than parenteral doses of the same medication.
2. A patient with chronic kidney disease (eGFR 28 mL/min) is prescribed a drug primarily
eliminated by glomerular filtration. The NP should anticipate which change?
A. Increased volume of distribution
B. Prolonged half-life requiring dose adjustment
C. Enhanced drug efficacy due to accumulation
D. Decreased absorption from the GI tract
Correct Answer: B
Rationale: Renal impairment reduces clearance of renally eliminated drugs, prolonging the
elimination half-life and increasing the risk of accumulation and toxicity. Dosage reduction or
extended dosing intervals are typically required.
3. Grapefruit juice interacts with many medications by:
A. Inducing CYP3A4 activity
B. Inhibiting intestinal CYP3A4, increasing drug levels
,C. Enhancing renal excretion of drugs
D. Increasing protein binding of drugs
Correct Answer: B
Rationale: Grapefruit juice inhibits CYP3A4 in the intestinal wall, reducing first-pass
metabolism of CYP3A4 substrate drugs. This leads to increased bioavailability and potential
toxicity. Common affected drugs include statins, calcium channel blockers, and benzodiazepines.
4. A patient with a CYP2D6 poor metabolizer phenotype is prescribed codeine for pain. The NP
should anticipate:
A. Enhanced analgesic effect due to drug accumulation
B. Little to no pain relief because codeine cannot be activated
C. Increased risk of serotonin syndrome
D. Rapid clearance requiring higher doses
Correct Answer: B
Rationale: Codeine is a prodrug requiring CYP2D6-mediated conversion to morphine for
analgesic effect. Poor metabolizers cannot efficiently perform this conversion, resulting in
inadequate pain relief. Ultra-rapid metabolizers face the opposite risk—excessive morphine
production and toxicity.
5. Which drug requires routine serum level monitoring due to a narrow therapeutic index?
A. Amoxicillin
B. Metformin
C. Lithium
D. Lisinopril
Correct Answer: C
Rationale: Lithium has a narrow therapeutic index (0.6–1.2 mEq/L). Serum levels must be
monitored regularly to maintain efficacy for bipolar disorder while preventing toxicity (tremor,
confusion, seizures, coma). Other narrow therapeutic index drugs include digoxin, warfarin,
phenytoin, and theophylline.
,6. A drug that binds to a receptor and produces the maximum possible biological response is
classified as:
A. Partial agonist
B. Full agonist
C. Competitive antagonist
D. Inverse agonist
Correct Answer: B
Rationale: A full agonist has both high affinity for the receptor and full intrinsic activity,
producing the maximum possible response. A partial agonist produces a submaximal response
even at full receptor occupancy. Antagonists have affinity but no intrinsic activity (or negative
intrinsic activity for inverse agonists).
7. Approximately how many half-lives are required to reach steady-state plasma concentration
with continuous dosing?
A. 1–2
B. 2–3
C. 4–5
D. 7–8
Correct Answer: C
Rationale: With first-order kinetics, approximately 4–5 half-lives are needed to reach steady
state. This principle guides timing of serum level monitoring and assessment of full therapeutic
effect after initiating or adjusting a drug dose.
8. Which pharmacokinetic parameter describes the volume of fluid from which a drug is
completely removed per unit time?
A. Volume of distribution
B. Bioavailability
C. Clearance
D. Half-life
Correct Answer: C
, Rationale: Clearance is the volume of plasma cleared of drug per unit time (mL/min or
L/hr). It reflects the efficiency of drug elimination by all routes (hepatic, renal, etc.). Volume of
distribution describes the apparent space into which a drug distributes, not the rate of
elimination.
9. A patient taking warfarin is prescribed a drug that displaces warfarin from plasma albumin.
The NP should monitor for:
A. Decreased warfarin effect
B. Increased free warfarin fraction and bleeding risk
C. No change in anticoagulant effect
D. Reduced warfarin absorption
Correct Answer: B
Rationale: Displacement from plasma proteins increases the free (unbound) fraction of
warfarin, which is pharmacologically active. This can transiently increase anticoagulant effect
and bleeding risk. However, the free drug is also available for metabolism and excretion, so the
net effect depends on the displacing drug's other properties.
10. Which statement accurately describes zero-order elimination kinetics?
A. A constant fraction of drug is eliminated per unit time
B. A constant amount of drug is eliminated per unit time
C. The elimination rate is proportional to plasma concentration
D. Half-life remains constant regardless of dose
Correct Answer: B
Rationale: Zero-order (saturation) kinetics occurs when elimination pathways are saturated.
A constant amount of drug is eliminated per unit time, regardless of plasma concentration. Half-
life increases with higher doses. Ethanol, phenytoin, and high-dose aspirin exhibit zero-order
kinetics.
11. A 78-year-old patient has decreased renal function and low serum albumin. The NP should
consider that:
