NURS 5334: Advanced Pharmacology –
Quiz 2 Exam Bank| 2026 latest verified
answers
1. A patient with heart failure is prescribed a drug that is a weak base. Which
change in physiology would most significantly decrease the excretion of this
drug?
a) Increased glomerular filtration rate
b) Alkaline urine pH
c) Acidic urine pH
d) Decreased hepatic blood flow
Correct Answer: b) Alkaline urine pH
Rationale: Weak bases are ionized (trapped) in acidic environments and are more
readily excreted in acidic urine. In alkaline urine, a weak base remains non-
ionized, which promotes passive reabsorption back into the bloodstream,
decreasing excretion. This principle is crucial in managing overdoses (e.g.,
alkalinizing urine for aspirin (acid) overdose).
2. A drug has a half-life of 12 hours. Approximately how long will it take to reach
steady-state if administered at a consistent dosing interval?
a) 24 hours
b) 36 hours
,c) 60 hours
d) 72 hours
Correct Answer: c) 60 hours
Rationale: Steady-state is achieved after approximately 4-5 half-lives. 5 half-lives
x 12 hours = 60 hours. This principle is essential for understanding when a drug’s
full therapeutic effect (and steady-state concentration) will be reached.
3. Which phase of biotransformation typically involves conjugation reactions
that increase a drug’s water solubility for excretion?
a) Phase I
b) Phase II
c) Phase 0
d) Absorption phase
Correct Answer: b) Phase II
Rationale: Phase I reactions (oxidation, reduction, hydrolysis) often introduce a
functional group. Phase II reactions (conjugation) attach an endogenous substrate
(e.g., glucuronide, sulfate) to the drug or Phase I metabolite, significantly
increasing water solubility for renal or biliary excretion.
4. The therapeutic index of a drug is defined as:
a) The ratio of the dose required to produce a therapeutic effect in 50% of the
population (ED50) to the dose that is lethal in 50% of the population (LD50)
b) The ratio of the toxic dose to the therapeutic dose (TD50/ED50)
c) The time it takes for the drug concentration to reach steady-state
d) The volume of plasma cleared of the drug per unit of time
,Correct Answer: b) The ratio of the toxic dose to the therapeutic dose
(TD50/ED50)
Rationale: The therapeutic index (TI) is a measure of drug safety. A high TI (e.g.,
penicillin) indicates a wide margin of safety. A low TI (e.g., warfarin, digoxin,
lithium) indicates a narrow margin where toxic levels are close to therapeutic
levels, requiring close monitoring.
5. A drug that acts as an agonist at a receptor will:
a) Bind to the receptor and block the endogenous ligand
b) Bind to the receptor and produce a response that mimics the endogenous
ligand
c) Bind to an allosteric site and decrease the receptor’s response
d) Bind to the receptor and produce an opposite effect of the endogenous ligand
Correct Answer: b) Bind to the receptor and produce a response that
mimics the endogenous ligand
Rationale: Agonists have both affinity (ability to bind) and intrinsic activity (ability
to activate the receptor). Antagonists have affinity but no intrinsic activity.
6. A patient is prescribed a drug that is a CYP3A4 inducer. The nurse practitioner
should anticipate that this drug may:
a) Increase the toxicity of a second drug metabolized by CYP3A4
b) Decrease the therapeutic effect of a second drug metabolized by CYP3A4
c) Have no effect on other medications
d) Increase the half-life of a second drug metabolized by CYP3A4
, Correct Answer: b) Decrease the therapeutic effect of a second drug
metabolized by CYP3A4
Rationale: CYP450 inducers (e.g., carbamazepine, rifampin, St. John’s Wort)
increase the synthesis of the enzyme, leading to faster metabolism of drugs that
are substrates. This results in lower plasma concentrations and potentially
reduced efficacy of the second drug.
Section 2: Autonomic Nervous System (ANS) Pharmacology
7. A patient receiving albuterol for asthma complains of tremors and
tachycardia. This is due to the activation of which receptor?
a) Alpha-1
b) Beta-1
c) Beta-2
d) Muscarinic M3
Correct Answer: b) Beta-1
Rationale: Albuterol is a selective beta-2 agonist, targeting bronchial smooth
muscle. However, at therapeutic or higher doses, it can have some beta-1
agonistic effects in the heart (chronotropy, inotropy), leading to tachycardia.
Beta-2 stimulation in skeletal muscle can cause tremor.
8. A patient is given atropine pre-operatively. Which of the following effects is
the intended therapeutic goal?
a) Increased heart rate to prevent bradycardia
b) Bronchoconstriction to prevent aspiration
Quiz 2 Exam Bank| 2026 latest verified
answers
1. A patient with heart failure is prescribed a drug that is a weak base. Which
change in physiology would most significantly decrease the excretion of this
drug?
a) Increased glomerular filtration rate
b) Alkaline urine pH
c) Acidic urine pH
d) Decreased hepatic blood flow
Correct Answer: b) Alkaline urine pH
Rationale: Weak bases are ionized (trapped) in acidic environments and are more
readily excreted in acidic urine. In alkaline urine, a weak base remains non-
ionized, which promotes passive reabsorption back into the bloodstream,
decreasing excretion. This principle is crucial in managing overdoses (e.g.,
alkalinizing urine for aspirin (acid) overdose).
2. A drug has a half-life of 12 hours. Approximately how long will it take to reach
steady-state if administered at a consistent dosing interval?
a) 24 hours
b) 36 hours
,c) 60 hours
d) 72 hours
Correct Answer: c) 60 hours
Rationale: Steady-state is achieved after approximately 4-5 half-lives. 5 half-lives
x 12 hours = 60 hours. This principle is essential for understanding when a drug’s
full therapeutic effect (and steady-state concentration) will be reached.
3. Which phase of biotransformation typically involves conjugation reactions
that increase a drug’s water solubility for excretion?
a) Phase I
b) Phase II
c) Phase 0
d) Absorption phase
Correct Answer: b) Phase II
Rationale: Phase I reactions (oxidation, reduction, hydrolysis) often introduce a
functional group. Phase II reactions (conjugation) attach an endogenous substrate
(e.g., glucuronide, sulfate) to the drug or Phase I metabolite, significantly
increasing water solubility for renal or biliary excretion.
4. The therapeutic index of a drug is defined as:
a) The ratio of the dose required to produce a therapeutic effect in 50% of the
population (ED50) to the dose that is lethal in 50% of the population (LD50)
b) The ratio of the toxic dose to the therapeutic dose (TD50/ED50)
c) The time it takes for the drug concentration to reach steady-state
d) The volume of plasma cleared of the drug per unit of time
,Correct Answer: b) The ratio of the toxic dose to the therapeutic dose
(TD50/ED50)
Rationale: The therapeutic index (TI) is a measure of drug safety. A high TI (e.g.,
penicillin) indicates a wide margin of safety. A low TI (e.g., warfarin, digoxin,
lithium) indicates a narrow margin where toxic levels are close to therapeutic
levels, requiring close monitoring.
5. A drug that acts as an agonist at a receptor will:
a) Bind to the receptor and block the endogenous ligand
b) Bind to the receptor and produce a response that mimics the endogenous
ligand
c) Bind to an allosteric site and decrease the receptor’s response
d) Bind to the receptor and produce an opposite effect of the endogenous ligand
Correct Answer: b) Bind to the receptor and produce a response that
mimics the endogenous ligand
Rationale: Agonists have both affinity (ability to bind) and intrinsic activity (ability
to activate the receptor). Antagonists have affinity but no intrinsic activity.
6. A patient is prescribed a drug that is a CYP3A4 inducer. The nurse practitioner
should anticipate that this drug may:
a) Increase the toxicity of a second drug metabolized by CYP3A4
b) Decrease the therapeutic effect of a second drug metabolized by CYP3A4
c) Have no effect on other medications
d) Increase the half-life of a second drug metabolized by CYP3A4
, Correct Answer: b) Decrease the therapeutic effect of a second drug
metabolized by CYP3A4
Rationale: CYP450 inducers (e.g., carbamazepine, rifampin, St. John’s Wort)
increase the synthesis of the enzyme, leading to faster metabolism of drugs that
are substrates. This results in lower plasma concentrations and potentially
reduced efficacy of the second drug.
Section 2: Autonomic Nervous System (ANS) Pharmacology
7. A patient receiving albuterol for asthma complains of tremors and
tachycardia. This is due to the activation of which receptor?
a) Alpha-1
b) Beta-1
c) Beta-2
d) Muscarinic M3
Correct Answer: b) Beta-1
Rationale: Albuterol is a selective beta-2 agonist, targeting bronchial smooth
muscle. However, at therapeutic or higher doses, it can have some beta-1
agonistic effects in the heart (chronotropy, inotropy), leading to tachycardia.
Beta-2 stimulation in skeletal muscle can cause tremor.
8. A patient is given atropine pre-operatively. Which of the following effects is
the intended therapeutic goal?
a) Increased heart rate to prevent bradycardia
b) Bronchoconstriction to prevent aspiration
