300-question practice exam for NURS 5334
Advanced Pharmacology — Quiz 2.
Section 1: Pharmacokinetics & Pharmacodynamics (Q1–Q50)
1. A patient with chronic kidney disease (Stage 4) is prescribed a medication that is primarily
renally excreted. The nurse anticipates that the patient will require:
A) A higher dose to achieve a therapeutic effect
B) A lower dose or longer dosing interval to prevent toxicity
C) The same dose as a patient with normal renal function
D) An increased frequency of administration
Answer: B. Rationale: In renal impairment, drug clearance is reduced, leading to drug
accumulation and increased risk of toxicity. Dose reduction or extended dosing intervals are
required to maintain therapeutic levels while avoiding adverse effects.
2. A patient with heart failure is prescribed digoxin. Which physiological change associated with
aging would most likely increase the risk of digoxin toxicity?
A) Increased glomerular filtration rate
B) Decreased lean body mass
C) Increased hepatic blood flow
D) Decreased serum albumin
Answer: D. Rationale: Aging is associated with decreased serum albumin. Digoxin is moderately
protein-bound. Lower albumin levels increase the free (active) fraction of the drug, leading to a
greater pharmacological effect and higher risk of toxicity.
3. A drug has a half-life of 24 hours. Approximately how many hours will it take for the drug to
reach steady state?
A) 24 hours
B) 48 hours
C) 120 hours
D) 240 hours
Answer: C. Rationale: Steady state is achieved after approximately 4–5 half-lives. With a
half-life of 24 hours, 4–5 half-lives equal 96–120 hours.
4. A patient is prescribed a drug that is a weak acid (pKa 4.4). In which part of the
gastrointestinal tract will absorption be most rapid?
A) Mouth (pH 7.0)
B) Stomach (pH 1.5)
C) Duodenum (pH 6.0)
D) Colon (pH 7.5)
,Answer: B. Rationale: Weak acids are best absorbed in acidic environments where they remain
non-ionized (lipid-soluble). In the stomach's acidic pH, the drug is predominantly non-ionized,
allowing for passive diffusion across the gastric mucosa.
5. What are the four phases of pharmacokinetics?
A) Absorption, Distribution, Metabolism, Excretion
B) Ingestion, Digestion, Absorption, Elimination
C) Uptake, Binding, Breakdown, Clearance
D) Diffusion, Transport, Activation, Removal
Answer: A. Rationale: These four phases (ADME) describe how the body processes a drug from
administration to elimination.
6. Bioavailability is defined as:
A) The extent of drug that becomes available to the body after absorption
B) The rate of drug excretion
C) The amount of drug bound to protein
D) The volume of distribution
Answer: A. Rationale: Bioavailability refers to the fraction of an administered dose that reaches
systemic circulation in an unchanged form.
7. "Free drug" refers to:
A) The drug that is not bound to protein and is free to exert a therapeutic effect
B) The drug that is bound to albumin
C) The drug that has been metabolized
D) The drug that is excreted unchanged
Answer: A. Rationale: Only unbound (free) drug can cross membranes and interact with target
receptors to produce a pharmacological effect.
8. Nicotine is a CYP450 inducer. What are its effects?
A) Increases metabolism of drugs metabolized by CYP450 enzymes
B) Decreases metabolism of drugs metabolized by CYP450 enzymes
C) Has no effect on CYP450 enzymes
D) Inhibits CYP450 enzymes
Answer: A. Rationale: CYP450 inducers increase the metabolism of drugs that are substrates of
those enzymes, potentially reducing their efficacy.
9. A drug with a narrow therapeutic index requires:
A) Routine monitoring of serum drug levels
B) No monitoring
C) Only clinical monitoring
D) Monitoring only after adverse effects occur
Answer: A. Rationale: Narrow therapeutic index drugs require therapeutic drug monitoring to
ensure levels remain within the therapeutic range.
,10. The volume of distribution (Vd) is:
A) The theoretical volume into which a drug distributes in the body
B) The volume of blood in the body
C) The volume of drug excreted
D) The volume of drug absorbed
Answer: A. Rationale: Vd relates the amount of drug in the body to its concentration in the
blood.
11. First-pass metabolism occurs:
A) In the liver after oral absorption before reaching systemic circulation
B) In the stomach
C) In the kidneys
D) In the lungs
Answer: A. Rationale: Orally administered drugs pass through the portal circulation and liver
before entering systemic circulation.
12. A drug that is highly protein-bound will have:
A) A small free fraction and potentially reduced efficacy
B) A large free fraction
C) No free fraction
D) Increased renal excretion
Answer: A. Rationale: Highly protein-bound drugs have less free drug available for
pharmacological action.
13. The therapeutic index is:
A) The ratio of toxic dose to therapeutic dose
B) The ratio of therapeutic dose to toxic dose
C) The dose required for therapeutic effect
D) The dose required for toxicity
Answer: A. Rationale: A higher therapeutic index indicates a safer drug.
14. Which route of administration bypasses first-pass metabolism?
A) Oral
B) Intravenous
C) Rectal
D) Enteral
Answer: B. Rationale: IV administration delivers drug directly into systemic circulation.
15. Enzyme inhibition by a drug will:
A) Increase levels of drugs metabolized by that enzyme
B) Decrease levels of drugs metabolized by that enzyme
C) Have no effect
D) Increase renal excretion
Answer: A. Rationale: Inhibition slows metabolism, leading to accumulation of substrate drugs.
, 16. A loading dose is given to:
A) Rapidly achieve therapeutic drug levels
B) Maintain therapeutic levels
C) Prevent toxicity
D) Reduce side effects
Answer: A. Rationale: Loading doses quickly bring drug levels into therapeutic range.
17. A maintenance dose is given to:
A) Maintain therapeutic drug levels
B) Rapidly achieve therapeutic levels
C) Prevent absorption
D) Increase toxicity
Answer: A. Rationale: Maintenance doses replace drug eliminated since the last dose.
18. Zero-order elimination means:
A) A constant amount of drug is eliminated per unit time
B) A constant fraction of drug is eliminated per unit time
C) Drug elimination is unpredictable
D) Drug is not eliminated
Answer: A. Rationale: Zero-order kinetics involves a fixed amount eliminated regardless of
concentration.
19. First-order elimination means:
A) A constant fraction of drug is eliminated per unit time
B) A constant amount is eliminated per unit time
C) Drug is not eliminated
D) Elimination is unpredictable
Answer: A. Rationale: First-order kinetics involves a constant fraction eliminated per unit time.
20. A drug's half-life is:
A) The time required for the drug concentration to decrease by half
B) The time required for the drug to reach steady state
C) The time required for the drug to be absorbed
D) The time required for the drug to be excreted
Answer: A. Rationale: Half-life determines dosing frequency and time to steady state.
21. Which factor least affects drug distribution?
A) Blood flow to tissues
B) Protein binding
C) Lipid solubility
D) Tablet color
Answer: D. Rationale: Tablet color does not affect pharmacokinetics.
Advanced Pharmacology — Quiz 2.
Section 1: Pharmacokinetics & Pharmacodynamics (Q1–Q50)
1. A patient with chronic kidney disease (Stage 4) is prescribed a medication that is primarily
renally excreted. The nurse anticipates that the patient will require:
A) A higher dose to achieve a therapeutic effect
B) A lower dose or longer dosing interval to prevent toxicity
C) The same dose as a patient with normal renal function
D) An increased frequency of administration
Answer: B. Rationale: In renal impairment, drug clearance is reduced, leading to drug
accumulation and increased risk of toxicity. Dose reduction or extended dosing intervals are
required to maintain therapeutic levels while avoiding adverse effects.
2. A patient with heart failure is prescribed digoxin. Which physiological change associated with
aging would most likely increase the risk of digoxin toxicity?
A) Increased glomerular filtration rate
B) Decreased lean body mass
C) Increased hepatic blood flow
D) Decreased serum albumin
Answer: D. Rationale: Aging is associated with decreased serum albumin. Digoxin is moderately
protein-bound. Lower albumin levels increase the free (active) fraction of the drug, leading to a
greater pharmacological effect and higher risk of toxicity.
3. A drug has a half-life of 24 hours. Approximately how many hours will it take for the drug to
reach steady state?
A) 24 hours
B) 48 hours
C) 120 hours
D) 240 hours
Answer: C. Rationale: Steady state is achieved after approximately 4–5 half-lives. With a
half-life of 24 hours, 4–5 half-lives equal 96–120 hours.
4. A patient is prescribed a drug that is a weak acid (pKa 4.4). In which part of the
gastrointestinal tract will absorption be most rapid?
A) Mouth (pH 7.0)
B) Stomach (pH 1.5)
C) Duodenum (pH 6.0)
D) Colon (pH 7.5)
,Answer: B. Rationale: Weak acids are best absorbed in acidic environments where they remain
non-ionized (lipid-soluble). In the stomach's acidic pH, the drug is predominantly non-ionized,
allowing for passive diffusion across the gastric mucosa.
5. What are the four phases of pharmacokinetics?
A) Absorption, Distribution, Metabolism, Excretion
B) Ingestion, Digestion, Absorption, Elimination
C) Uptake, Binding, Breakdown, Clearance
D) Diffusion, Transport, Activation, Removal
Answer: A. Rationale: These four phases (ADME) describe how the body processes a drug from
administration to elimination.
6. Bioavailability is defined as:
A) The extent of drug that becomes available to the body after absorption
B) The rate of drug excretion
C) The amount of drug bound to protein
D) The volume of distribution
Answer: A. Rationale: Bioavailability refers to the fraction of an administered dose that reaches
systemic circulation in an unchanged form.
7. "Free drug" refers to:
A) The drug that is not bound to protein and is free to exert a therapeutic effect
B) The drug that is bound to albumin
C) The drug that has been metabolized
D) The drug that is excreted unchanged
Answer: A. Rationale: Only unbound (free) drug can cross membranes and interact with target
receptors to produce a pharmacological effect.
8. Nicotine is a CYP450 inducer. What are its effects?
A) Increases metabolism of drugs metabolized by CYP450 enzymes
B) Decreases metabolism of drugs metabolized by CYP450 enzymes
C) Has no effect on CYP450 enzymes
D) Inhibits CYP450 enzymes
Answer: A. Rationale: CYP450 inducers increase the metabolism of drugs that are substrates of
those enzymes, potentially reducing their efficacy.
9. A drug with a narrow therapeutic index requires:
A) Routine monitoring of serum drug levels
B) No monitoring
C) Only clinical monitoring
D) Monitoring only after adverse effects occur
Answer: A. Rationale: Narrow therapeutic index drugs require therapeutic drug monitoring to
ensure levels remain within the therapeutic range.
,10. The volume of distribution (Vd) is:
A) The theoretical volume into which a drug distributes in the body
B) The volume of blood in the body
C) The volume of drug excreted
D) The volume of drug absorbed
Answer: A. Rationale: Vd relates the amount of drug in the body to its concentration in the
blood.
11. First-pass metabolism occurs:
A) In the liver after oral absorption before reaching systemic circulation
B) In the stomach
C) In the kidneys
D) In the lungs
Answer: A. Rationale: Orally administered drugs pass through the portal circulation and liver
before entering systemic circulation.
12. A drug that is highly protein-bound will have:
A) A small free fraction and potentially reduced efficacy
B) A large free fraction
C) No free fraction
D) Increased renal excretion
Answer: A. Rationale: Highly protein-bound drugs have less free drug available for
pharmacological action.
13. The therapeutic index is:
A) The ratio of toxic dose to therapeutic dose
B) The ratio of therapeutic dose to toxic dose
C) The dose required for therapeutic effect
D) The dose required for toxicity
Answer: A. Rationale: A higher therapeutic index indicates a safer drug.
14. Which route of administration bypasses first-pass metabolism?
A) Oral
B) Intravenous
C) Rectal
D) Enteral
Answer: B. Rationale: IV administration delivers drug directly into systemic circulation.
15. Enzyme inhibition by a drug will:
A) Increase levels of drugs metabolized by that enzyme
B) Decrease levels of drugs metabolized by that enzyme
C) Have no effect
D) Increase renal excretion
Answer: A. Rationale: Inhibition slows metabolism, leading to accumulation of substrate drugs.
, 16. A loading dose is given to:
A) Rapidly achieve therapeutic drug levels
B) Maintain therapeutic levels
C) Prevent toxicity
D) Reduce side effects
Answer: A. Rationale: Loading doses quickly bring drug levels into therapeutic range.
17. A maintenance dose is given to:
A) Maintain therapeutic drug levels
B) Rapidly achieve therapeutic levels
C) Prevent absorption
D) Increase toxicity
Answer: A. Rationale: Maintenance doses replace drug eliminated since the last dose.
18. Zero-order elimination means:
A) A constant amount of drug is eliminated per unit time
B) A constant fraction of drug is eliminated per unit time
C) Drug elimination is unpredictable
D) Drug is not eliminated
Answer: A. Rationale: Zero-order kinetics involves a fixed amount eliminated regardless of
concentration.
19. First-order elimination means:
A) A constant fraction of drug is eliminated per unit time
B) A constant amount is eliminated per unit time
C) Drug is not eliminated
D) Elimination is unpredictable
Answer: A. Rationale: First-order kinetics involves a constant fraction eliminated per unit time.
20. A drug's half-life is:
A) The time required for the drug concentration to decrease by half
B) The time required for the drug to reach steady state
C) The time required for the drug to be absorbed
D) The time required for the drug to be excreted
Answer: A. Rationale: Half-life determines dosing frequency and time to steady state.
21. Which factor least affects drug distribution?
A) Blood flow to tissues
B) Protein binding
C) Lipid solubility
D) Tablet color
Answer: D. Rationale: Tablet color does not affect pharmacokinetics.
