NURS 6521 ADVANCED
PHARMACOLOGY FINAL EXAM
(VERIFIED ANSWERS) QUESTIONS
WITH ANSWERS: WALDEN
UNIVERSITY
1. A patient with chronic kidney disease (CKD) requires an increased dose of a drug that is
primarily excreted unchanged by the kidneys. What is the most likely physiological reason for
this adjustment?
A. Increased glomerular filtration rate
B. Decreased renal clearance requiring lower doses to avoid toxicity
C. Increased tubular secretion
D. Enhanced protein binding in the plasma
Answer: B
Conceptual Explanation: In CKD, renal clearance is reduced, which decreases the
excretion of drugs. To prevent toxicity, doses are typically decreased or intervals are
prolonged, though the question asks for the reason for adjustment, which is the decreased
clearance.
,2. Which of the following describes the first-pass effect?
A. The transport of a drug from the site of administration to the systemic circulation
B. The excretion of a drug through the bile into the feces
C. The metabolism of a drug by the liver before it reaches systemic circulation
D. The process of a drug crossing the blood-brain barrier
Answer: C
Conceptual Explanation: The first-pass effect refers to the metabolism of an orally
administered drug by the liver or GI tract before it enters the systemic circulation, often
significantly reducing the drug’s bioavailability.
3. A patient is prescribed a drug with a narrow therapeutic index. Which nursing action is
most critical?
A. Administering the drug with food to increase absorption
B. Encouraging high fluid intake to promote excretion
C. Monitoring serum drug levels frequently
D. Observing for general signs of allergy
Answer: C
Conceptual Explanation: Drugs with a narrow therapeutic index have a small margin
between effective and toxic doses; therefore, serum drug level monitoring is essential to
ensure safety and efficacy.
, 4. How does hypoalbuminemia affect the pharmacokinetics of highly protein-bound drugs?
A. It decreases the amount of free drug in the plasma
B. It increases the volume of distribution and the risk of toxicity
C. It accelerates the rate of drug metabolism by the liver
D. It has no significant effect on drug distribution
Answer: B
Conceptual Explanation: Lower albumin levels result in less drug binding and more free
(active) drug in the circulation, which can lead to increased pharmacological effects or
toxicity.
5. A patient is taking Warfarin and begins a course of Rifampin. What adjustment should the
provider anticipate?
A. Decrease the Warfarin dose
B. Maintain the same Warfarin dose
C. Increase the Warfarin dose
D. Discontinue Warfarin immediately
Answer: C
Conceptual Explanation: Rifampin is a potent inducer of hepatic CYP450 enzymes, which
increases the metabolism of Warfarin. To maintain therapeutic anticoagulation (INR), a
higher dose of Warfarin is usually required.
PHARMACOLOGY FINAL EXAM
(VERIFIED ANSWERS) QUESTIONS
WITH ANSWERS: WALDEN
UNIVERSITY
1. A patient with chronic kidney disease (CKD) requires an increased dose of a drug that is
primarily excreted unchanged by the kidneys. What is the most likely physiological reason for
this adjustment?
A. Increased glomerular filtration rate
B. Decreased renal clearance requiring lower doses to avoid toxicity
C. Increased tubular secretion
D. Enhanced protein binding in the plasma
Answer: B
Conceptual Explanation: In CKD, renal clearance is reduced, which decreases the
excretion of drugs. To prevent toxicity, doses are typically decreased or intervals are
prolonged, though the question asks for the reason for adjustment, which is the decreased
clearance.
,2. Which of the following describes the first-pass effect?
A. The transport of a drug from the site of administration to the systemic circulation
B. The excretion of a drug through the bile into the feces
C. The metabolism of a drug by the liver before it reaches systemic circulation
D. The process of a drug crossing the blood-brain barrier
Answer: C
Conceptual Explanation: The first-pass effect refers to the metabolism of an orally
administered drug by the liver or GI tract before it enters the systemic circulation, often
significantly reducing the drug’s bioavailability.
3. A patient is prescribed a drug with a narrow therapeutic index. Which nursing action is
most critical?
A. Administering the drug with food to increase absorption
B. Encouraging high fluid intake to promote excretion
C. Monitoring serum drug levels frequently
D. Observing for general signs of allergy
Answer: C
Conceptual Explanation: Drugs with a narrow therapeutic index have a small margin
between effective and toxic doses; therefore, serum drug level monitoring is essential to
ensure safety and efficacy.
, 4. How does hypoalbuminemia affect the pharmacokinetics of highly protein-bound drugs?
A. It decreases the amount of free drug in the plasma
B. It increases the volume of distribution and the risk of toxicity
C. It accelerates the rate of drug metabolism by the liver
D. It has no significant effect on drug distribution
Answer: B
Conceptual Explanation: Lower albumin levels result in less drug binding and more free
(active) drug in the circulation, which can lead to increased pharmacological effects or
toxicity.
5. A patient is taking Warfarin and begins a course of Rifampin. What adjustment should the
provider anticipate?
A. Decrease the Warfarin dose
B. Maintain the same Warfarin dose
C. Increase the Warfarin dose
D. Discontinue Warfarin immediately
Answer: C
Conceptual Explanation: Rifampin is a potent inducer of hepatic CYP450 enzymes, which
increases the metabolism of Warfarin. To maintain therapeutic anticoagulation (INR), a
higher dose of Warfarin is usually required.
