NSG 3160 Advanced Pharmacology Exam 1 | Galen College| 2026/2027 Edition (PDF)
,1. A patient with a history of heart failure is prescribed spironolactone. Which laboratory finding most
necessitates withholding the next dose and notifying the provider?
A) Serum potassium 5.8 mEq/L
B) Serum sodium 132 mEq/L
C) BUN 22 mg/dL
D) Creatinine 1.1 mg/dL
Correct Answer: Serum potassium 5.8 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic; hyperkalemia greater than 5.0 mEq/L is a
serious adverse effect that can cause cardiac arrhythmias. Withholding the dose and notifying the
provider is critical. Mild hyponatremia, slightly elevated BUN, and normal creatinine are not immediate
contraindications.
2. A patient with type 2 diabetes is started on metformin. Which mechanism best explains its
antihyperglycemic effect?
A) Stimulates pancreatic beta cells to release more insulin
B) Increases insulin sensitivity and decreases hepatic glucose production
C) Slows carbohydrate absorption in the small intestine
D) Enhances glucose uptake by skeletal muscle via GLUT4 translocation
Correct Answer: Increases insulin sensitivity and decreases hepatic glucose production
Rationale: Metformin primarily reduces hepatic glucose production and improves peripheral insulin
sensitivity. It does not stimulate insulin secretion (sulfonylureas do). While it may have minor effects on
intestinal glucose absorption and muscle glucose uptake, the main mechanism is hepatic and sensitivity.
3. An advanced practice nurse is reviewing the concept of bioavailability. Which statement accurately
defines this term?
A) The time it takes for a drug to reach its maximum concentration in the blood
B) The percentage of an administered drug that reaches the systemic circulation
C) The rate at which a drug is removed from the body
,D) The amount of drug that is bound to plasma proteins
Correct Answer: The percentage of an administered drug that reaches the systemic circulation
Rationale: Bioavailability refers to the fraction of an administered dose of a drug that reaches the
systemic circulation unchanged. It is a key factor in determining drug dosing, especially for drugs with a
narrow therapeutic range.
4. A patient is prescribed an oral medication with a significant first-pass effect. What is the most
important implication for the advanced practice nurse?
A) The drug will have increased bioavailability
B) A higher oral dose is required compared to the IV dose
C) The drug will be excreted more rapidly
D) The drug will have fewer side effects
Correct Answer: A higher oral dose is required compared to the IV dose
Rationale: Drugs with a high first-pass effect are significantly metabolized in the liver before reaching
systemic circulation, reducing their bioavailability. Therefore, a higher oral dose is required to achieve
therapeutic levels compared to the intravenous route.
5. Which route of drug administration completely bypasses the first-pass effect?
A) Oral
B) Sublingual
C) Intravenous
D) Rectal
Correct Answer: Intravenous
, Rationale: Intravenous administration delivers the drug directly into the systemic circulation, completely
bypassing first-pass metabolism in the liver. Sublingual and rectal routes partially bypass first-pass
metabolism, while oral administration is subject to the full first-pass effect.
6. A patient with hypoalbuminemia is prescribed a highly protein-bound drug. What is the advanced
practice nurse's primary concern?
A) Decreased drug efficacy
B) Increased risk of drug toxicity
C) Faster drug excretion
D) Reduced drug absorption
Correct Answer: Increased risk of drug toxicity
Rationale: Hypoalbuminemia results in fewer protein-binding sites, leading to higher levels of free
(active) drug in the bloodstream, which increases the risk of toxicity. Only unbound drug is
pharmacologically active.
7. A patient is taking warfarin and is prescribed a course of fluconazole. Which potential drug interaction
is most clinically significant?
A) Decreased warfarin metabolism, increasing bleeding risk
B) Increased warfarin metabolism, decreasing anticoagulant effect
C) Decreased warfarin absorption from the gastrointestinal tract
D) Increased renal elimination of warfarin
Correct Answer: Decreased warfarin metabolism, increasing bleeding risk
Rationale: Fluconazole inhibits CYP2C9, the enzyme responsible for warfarin metabolism. This inhibition
reduces warfarin clearance, leading to elevated INR and an increased risk of bleeding. Close monitoring
of INR is essential.
8. Which statement best describes the concept of a drug's therapeutic index?
A) The ratio of the median lethal dose to the median effective dose
,1. A patient with a history of heart failure is prescribed spironolactone. Which laboratory finding most
necessitates withholding the next dose and notifying the provider?
A) Serum potassium 5.8 mEq/L
B) Serum sodium 132 mEq/L
C) BUN 22 mg/dL
D) Creatinine 1.1 mg/dL
Correct Answer: Serum potassium 5.8 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic; hyperkalemia greater than 5.0 mEq/L is a
serious adverse effect that can cause cardiac arrhythmias. Withholding the dose and notifying the
provider is critical. Mild hyponatremia, slightly elevated BUN, and normal creatinine are not immediate
contraindications.
2. A patient with type 2 diabetes is started on metformin. Which mechanism best explains its
antihyperglycemic effect?
A) Stimulates pancreatic beta cells to release more insulin
B) Increases insulin sensitivity and decreases hepatic glucose production
C) Slows carbohydrate absorption in the small intestine
D) Enhances glucose uptake by skeletal muscle via GLUT4 translocation
Correct Answer: Increases insulin sensitivity and decreases hepatic glucose production
Rationale: Metformin primarily reduces hepatic glucose production and improves peripheral insulin
sensitivity. It does not stimulate insulin secretion (sulfonylureas do). While it may have minor effects on
intestinal glucose absorption and muscle glucose uptake, the main mechanism is hepatic and sensitivity.
3. An advanced practice nurse is reviewing the concept of bioavailability. Which statement accurately
defines this term?
A) The time it takes for a drug to reach its maximum concentration in the blood
B) The percentage of an administered drug that reaches the systemic circulation
C) The rate at which a drug is removed from the body
,D) The amount of drug that is bound to plasma proteins
Correct Answer: The percentage of an administered drug that reaches the systemic circulation
Rationale: Bioavailability refers to the fraction of an administered dose of a drug that reaches the
systemic circulation unchanged. It is a key factor in determining drug dosing, especially for drugs with a
narrow therapeutic range.
4. A patient is prescribed an oral medication with a significant first-pass effect. What is the most
important implication for the advanced practice nurse?
A) The drug will have increased bioavailability
B) A higher oral dose is required compared to the IV dose
C) The drug will be excreted more rapidly
D) The drug will have fewer side effects
Correct Answer: A higher oral dose is required compared to the IV dose
Rationale: Drugs with a high first-pass effect are significantly metabolized in the liver before reaching
systemic circulation, reducing their bioavailability. Therefore, a higher oral dose is required to achieve
therapeutic levels compared to the intravenous route.
5. Which route of drug administration completely bypasses the first-pass effect?
A) Oral
B) Sublingual
C) Intravenous
D) Rectal
Correct Answer: Intravenous
, Rationale: Intravenous administration delivers the drug directly into the systemic circulation, completely
bypassing first-pass metabolism in the liver. Sublingual and rectal routes partially bypass first-pass
metabolism, while oral administration is subject to the full first-pass effect.
6. A patient with hypoalbuminemia is prescribed a highly protein-bound drug. What is the advanced
practice nurse's primary concern?
A) Decreased drug efficacy
B) Increased risk of drug toxicity
C) Faster drug excretion
D) Reduced drug absorption
Correct Answer: Increased risk of drug toxicity
Rationale: Hypoalbuminemia results in fewer protein-binding sites, leading to higher levels of free
(active) drug in the bloodstream, which increases the risk of toxicity. Only unbound drug is
pharmacologically active.
7. A patient is taking warfarin and is prescribed a course of fluconazole. Which potential drug interaction
is most clinically significant?
A) Decreased warfarin metabolism, increasing bleeding risk
B) Increased warfarin metabolism, decreasing anticoagulant effect
C) Decreased warfarin absorption from the gastrointestinal tract
D) Increased renal elimination of warfarin
Correct Answer: Decreased warfarin metabolism, increasing bleeding risk
Rationale: Fluconazole inhibits CYP2C9, the enzyme responsible for warfarin metabolism. This inhibition
reduces warfarin clearance, leading to elevated INR and an increased risk of bleeding. Close monitoring
of INR is essential.
8. Which statement best describes the concept of a drug's therapeutic index?
A) The ratio of the median lethal dose to the median effective dose
