University of Texas, Arlington
NURS 5334: Advanced Pharmacology
2026
Quiz 2: Comprehensive Examination
Section 1: Pharmacokinetics & Pharmacodynamics
1. A patient with heart failure is prescribed digoxin. Which of the following
physiological changes 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
Correct Answer: d) Decreased serum albumin
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.
Decreased lean body mass affects volume of distribution, but hypoalbuminemia
has a more direct impact on active drug levels for protein-bound drugs.
,2. 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
Correct Answer: c) 120 hours
*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.*
3. 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)
Correct Answer: b) Stomach (pH 1.5)
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.
,4. A patient with hepatic cirrhosis is prescribed a medication with high first-pass
metabolism. The APRN anticipates that the patient’s bioavailability will be:
a) Decreased, requiring a higher dose
b) Unchanged, due to renal compensation
c) Increased, requiring a lower dose
d) Variable, requiring therapeutic drug monitoring only
Correct Answer: c) Increased, requiring a lower dose
Rationale: High first-pass metabolism occurs in the liver. In cirrhosis, hepatic
function is impaired, reducing the extent of first-pass metabolism. This leads to
significantly higher bioavailability, necessitating a lower initial dose to prevent
toxicity.
5. An APRN is explaining to a patient why a loading dose is being prescribed.
Which of the following statements is accurate regarding the purpose of a
loading dose?
a) To maintain drug levels within the therapeutic window for an extended period
b) To achieve steady state more rapidly than with maintenance doses alone
c) To decrease the frequency of adverse effects
d) To slow the rate of drug elimination
Correct Answer: b) To achieve steady state more rapidly than with
maintenance doses alone
Rationale: A loading dose is a single or few higher doses given at the onset of
therapy to rapidly achieve therapeutic drug levels, bypassing the time it would
take to reach steady state through maintenance dosing alone.
, Section 2: Autonomic Nervous System Pharmacology
6. A patient is receiving intravenous dopamine for cardiogenic shock. The APRN
notes that at a low dose (2 mcg/kg/min), the primary therapeutic effect is:
a) Increased heart rate (Beta-1 effect)
b) Vasoconstriction (Alpha-1 effect)
c) Renal and mesenteric vasodilation (Dopaminergic effect)
d) Bronchodilation (Beta-2 effect)
Correct Answer: c) Renal and mesenteric vasodilation (Dopaminergic
effect)
*Rationale: Dopamine has dose-dependent effects. At low doses, it acts primarily
on dopaminergic (D1) receptors in the renal, mesenteric, and coronary
vasculature, causing vasodilation and increased renal blood flow. Higher doses
stimulate beta-1 (inotropy) and then alpha-1 (vasoconstriction).*
7. A patient with asthma is prescribed a non-selective beta-blocker for migraine
prophylaxis. The APRN must monitor for which potential adverse effect?
a) Tachycardia
b) Bronchospasm
c) Hypotension
d) Urinary retention
Correct Answer: b) Bronchospasm
*Rationale: Non-selective beta-blockers (e.g., propranolol) block both beta-1
NURS 5334: Advanced Pharmacology
2026
Quiz 2: Comprehensive Examination
Section 1: Pharmacokinetics & Pharmacodynamics
1. A patient with heart failure is prescribed digoxin. Which of the following
physiological changes 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
Correct Answer: d) Decreased serum albumin
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.
Decreased lean body mass affects volume of distribution, but hypoalbuminemia
has a more direct impact on active drug levels for protein-bound drugs.
,2. 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
Correct Answer: c) 120 hours
*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.*
3. 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)
Correct Answer: b) Stomach (pH 1.5)
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.
,4. A patient with hepatic cirrhosis is prescribed a medication with high first-pass
metabolism. The APRN anticipates that the patient’s bioavailability will be:
a) Decreased, requiring a higher dose
b) Unchanged, due to renal compensation
c) Increased, requiring a lower dose
d) Variable, requiring therapeutic drug monitoring only
Correct Answer: c) Increased, requiring a lower dose
Rationale: High first-pass metabolism occurs in the liver. In cirrhosis, hepatic
function is impaired, reducing the extent of first-pass metabolism. This leads to
significantly higher bioavailability, necessitating a lower initial dose to prevent
toxicity.
5. An APRN is explaining to a patient why a loading dose is being prescribed.
Which of the following statements is accurate regarding the purpose of a
loading dose?
a) To maintain drug levels within the therapeutic window for an extended period
b) To achieve steady state more rapidly than with maintenance doses alone
c) To decrease the frequency of adverse effects
d) To slow the rate of drug elimination
Correct Answer: b) To achieve steady state more rapidly than with
maintenance doses alone
Rationale: A loading dose is a single or few higher doses given at the onset of
therapy to rapidly achieve therapeutic drug levels, bypassing the time it would
take to reach steady state through maintenance dosing alone.
, Section 2: Autonomic Nervous System Pharmacology
6. A patient is receiving intravenous dopamine for cardiogenic shock. The APRN
notes that at a low dose (2 mcg/kg/min), the primary therapeutic effect is:
a) Increased heart rate (Beta-1 effect)
b) Vasoconstriction (Alpha-1 effect)
c) Renal and mesenteric vasodilation (Dopaminergic effect)
d) Bronchodilation (Beta-2 effect)
Correct Answer: c) Renal and mesenteric vasodilation (Dopaminergic
effect)
*Rationale: Dopamine has dose-dependent effects. At low doses, it acts primarily
on dopaminergic (D1) receptors in the renal, mesenteric, and coronary
vasculature, causing vasodilation and increased renal blood flow. Higher doses
stimulate beta-1 (inotropy) and then alpha-1 (vasoconstriction).*
7. A patient with asthma is prescribed a non-selective beta-blocker for migraine
prophylaxis. The APRN must monitor for which potential adverse effect?
a) Tachycardia
b) Bronchospasm
c) Hypotension
d) Urinary retention
Correct Answer: b) Bronchospasm
*Rationale: Non-selective beta-blockers (e.g., propranolol) block both beta-1
