NR 566 ADVANCED PHARMACOLOGY
MIDTERM EXAM COMPREHENSIVE
STUDY QUESTIONS AND VERIFIED
ANSWERS | 100% CORRECT | GRADE A+
1. A patient is prescribed a drug that is known to be a potent CYP3A4 inhibitor. How should
the nurse practitioner adjust the dosage of a co-administered drug that is a substrate of
CYP3A4?
A. Decrease the dose of the substrate drug to avoid toxicity.
B. Increase the dose of the substrate drug to maintain efficacy.
C. Keep the dose the same but monitor for decreased effect.
D. Administer the inhibitor 4 hours after the substrate.
Answer: A
Conceptual Explanation: Inhibitors slow down the metabolism of substrates, leading to
higher serum levels. To prevent toxicity, the substrate dose must be reduced.
2. Which pharmacokinetic process is most significantly affected by the first-pass effect?
A. Distribution
,B. Excretion
C. Bioavailability
D. Protein binding
Answer: C
Conceptual Explanation: The first-pass effect occurs when an oral drug is metabolized by
the liver before reaching systemic circulation, significantly reducing its bioavailability.
3. When assessing a patient for digoxin toxicity, which electrolyte imbalance is the most
critical risk factor?
A. Hypernatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypokalemia
Answer: D
Conceptual Explanation: Hypokalemia enhances the action of digoxin because digoxin
competes with potassium for the Na+/K+ ATPase pump, increasing the risk of toxicity.
4. A patient with a history of asthma is diagnosed with hypertension. Which class of
antihypertensives should be avoided?
A. Calcium Channel Blockers
B. ACE Inhibitors
, C. Thiazide Diuretics
D. Non-selective Beta-blockers
Answer: D
Conceptual Explanation: Non-selective beta-blockers (like Propranolol) block Beta-2
receptors in the lungs, potentially causing bronchoconstriction in asthma patients.
5. What is the primary mechanism of action of Angiotensin II Receptor Blockers (ARBs)?
A. Inhibiting the conversion of Angiotensin I to Angiotensin II
B. Blocking the binding of Angiotensin II to AT1 receptors
C. Inhibiting the release of Renin
D. Promoting the excretion of Potassium
Answer: B
Conceptual Explanation: ARBs directly block the receptor sites where Angiotensin II acts,
preventing vasoconstriction and aldosterone secretion.
6. Which side effect is uniquely associated with ACE inhibitors compared to ARBs?
A. Hyperkalemia
B. Orthostatic hypotension
C. Dry, hacking cough
D. Renal impairment
MIDTERM EXAM COMPREHENSIVE
STUDY QUESTIONS AND VERIFIED
ANSWERS | 100% CORRECT | GRADE A+
1. A patient is prescribed a drug that is known to be a potent CYP3A4 inhibitor. How should
the nurse practitioner adjust the dosage of a co-administered drug that is a substrate of
CYP3A4?
A. Decrease the dose of the substrate drug to avoid toxicity.
B. Increase the dose of the substrate drug to maintain efficacy.
C. Keep the dose the same but monitor for decreased effect.
D. Administer the inhibitor 4 hours after the substrate.
Answer: A
Conceptual Explanation: Inhibitors slow down the metabolism of substrates, leading to
higher serum levels. To prevent toxicity, the substrate dose must be reduced.
2. Which pharmacokinetic process is most significantly affected by the first-pass effect?
A. Distribution
,B. Excretion
C. Bioavailability
D. Protein binding
Answer: C
Conceptual Explanation: The first-pass effect occurs when an oral drug is metabolized by
the liver before reaching systemic circulation, significantly reducing its bioavailability.
3. When assessing a patient for digoxin toxicity, which electrolyte imbalance is the most
critical risk factor?
A. Hypernatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypokalemia
Answer: D
Conceptual Explanation: Hypokalemia enhances the action of digoxin because digoxin
competes with potassium for the Na+/K+ ATPase pump, increasing the risk of toxicity.
4. A patient with a history of asthma is diagnosed with hypertension. Which class of
antihypertensives should be avoided?
A. Calcium Channel Blockers
B. ACE Inhibitors
, C. Thiazide Diuretics
D. Non-selective Beta-blockers
Answer: D
Conceptual Explanation: Non-selective beta-blockers (like Propranolol) block Beta-2
receptors in the lungs, potentially causing bronchoconstriction in asthma patients.
5. What is the primary mechanism of action of Angiotensin II Receptor Blockers (ARBs)?
A. Inhibiting the conversion of Angiotensin I to Angiotensin II
B. Blocking the binding of Angiotensin II to AT1 receptors
C. Inhibiting the release of Renin
D. Promoting the excretion of Potassium
Answer: B
Conceptual Explanation: ARBs directly block the receptor sites where Angiotensin II acts,
preventing vasoconstriction and aldosterone secretion.
6. Which side effect is uniquely associated with ACE inhibitors compared to ARBs?
A. Hyperkalemia
B. Orthostatic hypotension
C. Dry, hacking cough
D. Renal impairment
