NURS 6521 ADVANCED
PHARMACOLOGY FINAL EXAM
(VERIFIED ANSWERS) QUESTIONS
WITH ANSWERS: WALDEN
UNIVERSITY
1. Which pharmacokinetic process is most significantly affected by a drug’s high affinity for
plasma albumin?
A. Absorption
B. Excretion
C. Metabolism
D. Distribution
Answer: D
Conceptual Explanation: Distribution is the process affected by protein binding. Drugs
bound to albumin stay in the vascular space and are pharmacologically inactive, while the
free drug moves into tissues.
2. An elderly patient is prescribed a new medication with a narrow therapeutic index. Which
physiological change in aging most concerns the NP regarding drug toxicity?
A. Increased gastric pH
,B. Decreased glomerular filtration rate (GFR)
C. Decreased total body fat
D. Increased serum albumin levels
Answer: B
Conceptual Explanation: Decreased GFR is the most common cause of adverse drug
reactions in older adults due to reduced renal clearance, leading to drug accumulation and
toxicity.
3. Which mechanism describes how ACE inhibitors, such as Lisinopril, contribute to the
development of hyperkalemia?
A. Increased potassium absorption in the GI tract
B. Induction of metabolic acidosis
C. Direct stimulation of the potassium-sparing receptors
D. Blockade of aldosterone, leading to potassium retention
Answer: D
Conceptual Explanation: ACE inhibitors reduce angiotensin II, which in turn reduces
aldosterone secretion. Since aldosterone promotes potassium excretion, its inhibition leads
to potassium retention.
, 4. A patient taking Warfarin (Coumadin) is diagnosed with a urinary tract infection and
prescribed Trimethoprim-sulfamethoxazole (Bactrim). What is the expected drug interaction?
A. Decreased anticoagulant effect of Warfarin
B. Increased risk of treatment failure for the UTI
C. Increased INR and higher risk of bleeding
D. Precipitation of acute renal failure
Answer: C
Conceptual Explanation: Bactrim inhibits the metabolism of Warfarin and displaces it
from protein binding sites, leading to an increased INR and significant bleeding risk.
5. When prescribing Metformin for Type 2 Diabetes, which laboratory value is the most
critical contraindication if significantly abnormal?
A. Estimated GFR (eGFR) < 30 mL/min/1.73m²
B. Hemoglobin A1c of 9.5%
C. ALT/AST > 2x upper limit of normal
D. Serum sodium < 135 mEq/L
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min due to the high risk of lactic acidosis, a rare but life-threatening side effect.
PHARMACOLOGY FINAL EXAM
(VERIFIED ANSWERS) QUESTIONS
WITH ANSWERS: WALDEN
UNIVERSITY
1. Which pharmacokinetic process is most significantly affected by a drug’s high affinity for
plasma albumin?
A. Absorption
B. Excretion
C. Metabolism
D. Distribution
Answer: D
Conceptual Explanation: Distribution is the process affected by protein binding. Drugs
bound to albumin stay in the vascular space and are pharmacologically inactive, while the
free drug moves into tissues.
2. An elderly patient is prescribed a new medication with a narrow therapeutic index. Which
physiological change in aging most concerns the NP regarding drug toxicity?
A. Increased gastric pH
,B. Decreased glomerular filtration rate (GFR)
C. Decreased total body fat
D. Increased serum albumin levels
Answer: B
Conceptual Explanation: Decreased GFR is the most common cause of adverse drug
reactions in older adults due to reduced renal clearance, leading to drug accumulation and
toxicity.
3. Which mechanism describes how ACE inhibitors, such as Lisinopril, contribute to the
development of hyperkalemia?
A. Increased potassium absorption in the GI tract
B. Induction of metabolic acidosis
C. Direct stimulation of the potassium-sparing receptors
D. Blockade of aldosterone, leading to potassium retention
Answer: D
Conceptual Explanation: ACE inhibitors reduce angiotensin II, which in turn reduces
aldosterone secretion. Since aldosterone promotes potassium excretion, its inhibition leads
to potassium retention.
, 4. A patient taking Warfarin (Coumadin) is diagnosed with a urinary tract infection and
prescribed Trimethoprim-sulfamethoxazole (Bactrim). What is the expected drug interaction?
A. Decreased anticoagulant effect of Warfarin
B. Increased risk of treatment failure for the UTI
C. Increased INR and higher risk of bleeding
D. Precipitation of acute renal failure
Answer: C
Conceptual Explanation: Bactrim inhibits the metabolism of Warfarin and displaces it
from protein binding sites, leading to an increased INR and significant bleeding risk.
5. When prescribing Metformin for Type 2 Diabetes, which laboratory value is the most
critical contraindication if significantly abnormal?
A. Estimated GFR (eGFR) < 30 mL/min/1.73m²
B. Hemoglobin A1c of 9.5%
C. ALT/AST > 2x upper limit of normal
D. Serum sodium < 135 mEq/L
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min due to the high risk of lactic acidosis, a rare but life-threatening side effect.
