NU 578 Units 1–5 Exam (2026/2027) (PDF) |
Advanced Nursing | University of South Alabama
1. A patient with severe liver cirrhosis is prescribed a medication that
undergoes extensive first-pass metabolism. The prescriber should anticipate
which of the following?
A) Decreased oral bioavailability
B) Increased oral bioavailability
C) No change in bioavailability
D) Increased renal excretion
Answer B: Increased oral bioavailability
Rationale: First-pass metabolism occurs in the liver; in severe liver disease, hepatic
extraction is reduced, allowing more drug to reach systemic circulation, increasing
bioavailability and requiring dose reduction to prevent toxicity .
2. A Clinical Nurse Specialist (CNS) implements a new CAUTI prevention
protocol across three units. Two units show significant improvement while
the third shows no change. Applying Benner’s Novice-to-Expert framework
and Rogers’ Diffusion of Innovations theory, what is the most appropriate
initial action?
A) Implement a punishment system for non-compliant staff
,B) Conduct a focused needs assessment on the underperforming unit to identify
barriers and staff expertise levels
C) Immediately replace the nurse manager
D) Discontinue the protocol on the underperforming unit
Answer B: Conduct a focused needs assessment on the underperforming unit
to identify barriers and staff expertise levels
Rationale: Implementation failures often stem from contextual barriers rather
than individual resistance. The CNS role encompasses consultation and
collaboration, recognizing that staff at different developmental stages require
different support .
3. An NP with 15 years of cardiology experience transitions to a Federally
Qualified Health Center (FQHC). The NP experiences significant anxiety about
managing diverse conditions outside their specialty. Which concept best
explains this phenomenon?
A) Role ambiguity
B) Role transition
C) Horizontal violence
D) Burnout syndrome
Answer B: Role transition
Rationale: Role transition involves moving from one phase or role to another,
characterized by disruption and disconnectedness. Advanced practice nursing role
transitions are complex due to paradigm shifts in accountability, autonomy, and
scope. Deliberate reflection and mentorship are evidence-based strategies .
,4. A drug has a volume of distribution (Vd) of 0.2 L/kg. This suggests the
drug is primarily:
A) Confined to plasma
B) Distributed into total body water
C) Accumulated in fat tissue
D) Bound extensively to tissues
Answer A: Confined to plasma
Rationale: A Vd of 0.05–0.2 L/kg indicates the drug remains primarily in the
plasma compartment. Total body water Vd is approximately 0.5 L/kg. High tissue
binding or lipid solubility would increase Vd significantly .
5. Which CYP450 enzyme is most commonly involved in clinically significant
drug-drug interactions?
A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C9
Answer B: CYP3A4
Rationale: CYP3A4 is the most abundant hepatic enzyme and metabolizes
approximately 50% of all medications. It is involved in numerous clinically
significant interactions due to its broad substrate specificity and susceptibility to
inhibition/induction .
, 6. When two drugs that use the same active tubular transport system are
administered together, what effect occurs?
A) Increased excretion of both drugs
B) Delayed excretion of both drugs
C) No change in excretion
D) Increased metabolism of both drugs
Answer B: Delayed excretion of both drugs
Rationale: When two drugs use the same active tubular transport system, they
compete for transport sites, delaying the renal excretion of both drugs and
prolonging their effects .
7. Probenecid is administered with penicillin to:
A) Increase penicillin absorption
B) Decrease penicillin side effects
C) Prolong penicillin's effects
D) Reduce penicillin's effectiveness
Answer C: Prolong penicillin's effects
Rationale: Probenecid competes with penicillin for active tubular transport,
delaying penicillin's renal excretion and prolonging its effects in the body .
8. The phenomenon of pH in urine affects drug excretion by:
Advanced Nursing | University of South Alabama
1. A patient with severe liver cirrhosis is prescribed a medication that
undergoes extensive first-pass metabolism. The prescriber should anticipate
which of the following?
A) Decreased oral bioavailability
B) Increased oral bioavailability
C) No change in bioavailability
D) Increased renal excretion
Answer B: Increased oral bioavailability
Rationale: First-pass metabolism occurs in the liver; in severe liver disease, hepatic
extraction is reduced, allowing more drug to reach systemic circulation, increasing
bioavailability and requiring dose reduction to prevent toxicity .
2. A Clinical Nurse Specialist (CNS) implements a new CAUTI prevention
protocol across three units. Two units show significant improvement while
the third shows no change. Applying Benner’s Novice-to-Expert framework
and Rogers’ Diffusion of Innovations theory, what is the most appropriate
initial action?
A) Implement a punishment system for non-compliant staff
,B) Conduct a focused needs assessment on the underperforming unit to identify
barriers and staff expertise levels
C) Immediately replace the nurse manager
D) Discontinue the protocol on the underperforming unit
Answer B: Conduct a focused needs assessment on the underperforming unit
to identify barriers and staff expertise levels
Rationale: Implementation failures often stem from contextual barriers rather
than individual resistance. The CNS role encompasses consultation and
collaboration, recognizing that staff at different developmental stages require
different support .
3. An NP with 15 years of cardiology experience transitions to a Federally
Qualified Health Center (FQHC). The NP experiences significant anxiety about
managing diverse conditions outside their specialty. Which concept best
explains this phenomenon?
A) Role ambiguity
B) Role transition
C) Horizontal violence
D) Burnout syndrome
Answer B: Role transition
Rationale: Role transition involves moving from one phase or role to another,
characterized by disruption and disconnectedness. Advanced practice nursing role
transitions are complex due to paradigm shifts in accountability, autonomy, and
scope. Deliberate reflection and mentorship are evidence-based strategies .
,4. A drug has a volume of distribution (Vd) of 0.2 L/kg. This suggests the
drug is primarily:
A) Confined to plasma
B) Distributed into total body water
C) Accumulated in fat tissue
D) Bound extensively to tissues
Answer A: Confined to plasma
Rationale: A Vd of 0.05–0.2 L/kg indicates the drug remains primarily in the
plasma compartment. Total body water Vd is approximately 0.5 L/kg. High tissue
binding or lipid solubility would increase Vd significantly .
5. Which CYP450 enzyme is most commonly involved in clinically significant
drug-drug interactions?
A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C9
Answer B: CYP3A4
Rationale: CYP3A4 is the most abundant hepatic enzyme and metabolizes
approximately 50% of all medications. It is involved in numerous clinically
significant interactions due to its broad substrate specificity and susceptibility to
inhibition/induction .
, 6. When two drugs that use the same active tubular transport system are
administered together, what effect occurs?
A) Increased excretion of both drugs
B) Delayed excretion of both drugs
C) No change in excretion
D) Increased metabolism of both drugs
Answer B: Delayed excretion of both drugs
Rationale: When two drugs use the same active tubular transport system, they
compete for transport sites, delaying the renal excretion of both drugs and
prolonging their effects .
7. Probenecid is administered with penicillin to:
A) Increase penicillin absorption
B) Decrease penicillin side effects
C) Prolong penicillin's effects
D) Reduce penicillin's effectiveness
Answer C: Prolong penicillin's effects
Rationale: Probenecid competes with penicillin for active tubular transport,
delaying penicillin's renal excretion and prolonging its effects in the body .
8. The phenomenon of pH in urine affects drug excretion by:
