NSG 5240 – Advanced Pharmacology Midterm Practice Examination
Graduate Nursing | MSN/NP Program | Comprehensive Midterm Review
Version 1 | South College Practice Questions | Clinical Application |
Answers in Bold with Rationales
Exam Overview
This comprehensive Advanced Pharmacology Midterm Practice Examination is designed for graduate
nursing students preparing for the NSG 5240 Advanced Pharmacology Midterm. The exam emphasizes
application of pharmacologic principles, evidence-based prescribing, patient safety, pharmacokinetics,
pharmacodynamics, drug interactions, adverse effects, and therapeutic decision-making commonly
covered in graduate-level advanced pharmacology courses.
Question 1
A 72-year-old woman with chronic kidney disease (eGFR 28 mL/min/1.73 m²) is prescribed
an antibiotic that is primarily eliminated unchanged by the kidneys. Before initiating therapy,
the nurse practitioner reviews the patient's renal function to determine whether dosage
adjustment is necessary. Which pharmacokinetic process is most directly affected by this
patient's decreased renal function?
A. Absorption
B. Distribution
C. Metabolism
,D. Excretion
Rationale: Renal impairment primarily affects drug excretion, leading to decreased
clearance, prolonged half-life, increased plasma drug concentrations, and a greater risk for
toxicity. Dosage adjustments are commonly required for medications eliminated by the
kidneys.
Question 2
A patient with severe liver cirrhosis is prescribed a medication that undergoes extensive
first-pass metabolism. Which pharmacokinetic change should the clinician anticipate when
determining the initial dose?
A. Decreased bioavailability
B. Increased renal elimination
C. Increased bioavailability because hepatic metabolism is reduced
D. Increased protein binding
Rationale: Reduced hepatic metabolism decreases the first-pass effect, increasing the
amount of active drug reaching systemic circulation.
Question 3
An advanced practice nurse explains that drug absorption is influenced by several
physiologic factors. Which condition would most likely delay oral medication absorption?
A. Increased gastric blood flow
B. Empty stomach
,C. Delayed gastric emptying
D. Increased intestinal motility
Rationale: Delayed gastric emptying prolongs the time medications remain in the stomach
before reaching the small intestine, where most absorption occurs.
Question 4
A medication is described as being highly protein bound. Which patient condition would
most likely increase the concentration of free (active) drug available in circulation?
A. Hyperalbuminemia
B. Polycythemia
C. Hypoalbuminemia
D. Increased body fat
Rationale: Low serum albumin decreases available binding sites, increasing the amount of
pharmacologically active free drug and the risk for adverse effects.
Question 5
A nurse practitioner prescribes propranolol for hypertension. Which receptor is primarily
blocked by this medication?
A. Alpha-1
B. Alpha-2
C. Beta-2 only
, D. Beta-1 and Beta-2 adrenergic receptors
Rationale: Propranolol is a nonselective beta blocker that inhibits both β1 and β2 receptors.
Question 6
A patient asks why two medications in the same drug class produce similar therapeutic
effects. Which pharmacologic principle best explains this observation?
A. Drug antagonism
B. First-pass metabolism
C. Shared receptor affinity and mechanism of action
D. Zero-order elimination
Rationale: Drugs within the same therapeutic class often act on the same receptors or
physiologic pathways.
Question 7
A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. Which outcome is the
greatest concern?
A. Reduced INR
B. Increased vitamin K production
C. Increased bleeding risk due to elevated warfarin levels
D. Accelerated warfarin metabolism
Rationale: TMP-SMX inhibits warfarin metabolism, increasing INR and bleeding risk.
Graduate Nursing | MSN/NP Program | Comprehensive Midterm Review
Version 1 | South College Practice Questions | Clinical Application |
Answers in Bold with Rationales
Exam Overview
This comprehensive Advanced Pharmacology Midterm Practice Examination is designed for graduate
nursing students preparing for the NSG 5240 Advanced Pharmacology Midterm. The exam emphasizes
application of pharmacologic principles, evidence-based prescribing, patient safety, pharmacokinetics,
pharmacodynamics, drug interactions, adverse effects, and therapeutic decision-making commonly
covered in graduate-level advanced pharmacology courses.
Question 1
A 72-year-old woman with chronic kidney disease (eGFR 28 mL/min/1.73 m²) is prescribed
an antibiotic that is primarily eliminated unchanged by the kidneys. Before initiating therapy,
the nurse practitioner reviews the patient's renal function to determine whether dosage
adjustment is necessary. Which pharmacokinetic process is most directly affected by this
patient's decreased renal function?
A. Absorption
B. Distribution
C. Metabolism
,D. Excretion
Rationale: Renal impairment primarily affects drug excretion, leading to decreased
clearance, prolonged half-life, increased plasma drug concentrations, and a greater risk for
toxicity. Dosage adjustments are commonly required for medications eliminated by the
kidneys.
Question 2
A patient with severe liver cirrhosis is prescribed a medication that undergoes extensive
first-pass metabolism. Which pharmacokinetic change should the clinician anticipate when
determining the initial dose?
A. Decreased bioavailability
B. Increased renal elimination
C. Increased bioavailability because hepatic metabolism is reduced
D. Increased protein binding
Rationale: Reduced hepatic metabolism decreases the first-pass effect, increasing the
amount of active drug reaching systemic circulation.
Question 3
An advanced practice nurse explains that drug absorption is influenced by several
physiologic factors. Which condition would most likely delay oral medication absorption?
A. Increased gastric blood flow
B. Empty stomach
,C. Delayed gastric emptying
D. Increased intestinal motility
Rationale: Delayed gastric emptying prolongs the time medications remain in the stomach
before reaching the small intestine, where most absorption occurs.
Question 4
A medication is described as being highly protein bound. Which patient condition would
most likely increase the concentration of free (active) drug available in circulation?
A. Hyperalbuminemia
B. Polycythemia
C. Hypoalbuminemia
D. Increased body fat
Rationale: Low serum albumin decreases available binding sites, increasing the amount of
pharmacologically active free drug and the risk for adverse effects.
Question 5
A nurse practitioner prescribes propranolol for hypertension. Which receptor is primarily
blocked by this medication?
A. Alpha-1
B. Alpha-2
C. Beta-2 only
, D. Beta-1 and Beta-2 adrenergic receptors
Rationale: Propranolol is a nonselective beta blocker that inhibits both β1 and β2 receptors.
Question 6
A patient asks why two medications in the same drug class produce similar therapeutic
effects. Which pharmacologic principle best explains this observation?
A. Drug antagonism
B. First-pass metabolism
C. Shared receptor affinity and mechanism of action
D. Zero-order elimination
Rationale: Drugs within the same therapeutic class often act on the same receptors or
physiologic pathways.
Question 7
A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. Which outcome is the
greatest concern?
A. Reduced INR
B. Increased vitamin K production
C. Increased bleeding risk due to elevated warfarin levels
D. Accelerated warfarin metabolism
Rationale: TMP-SMX inhibits warfarin metabolism, increasing INR and bleeding risk.
