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NURS 676 Advanced
Pharmacology Actual 2025
Midterm Exam Questions
and Answers (WCU) -
Guaranteed Pass
Question 1
A nurse practitioner is prescribing a medication with a high first-pass effect. Which
administration route bypasses this effect?
A. Oral
B. Intravenous
C. Sublingual
D. Rectal
Correct Answer: B. Intravenous
Rationale: Intravenous administration delivers the drug directly into systemic circulation,
bypassing the liver’s first-pass metabolism, which reduces bioavailability for oral medications.
Question 2
A patient has been taking an opioid agonist for 3 weeks. What should the nurse anticipate?
A. Increased drug effectiveness
B. Decreased drug effectiveness
C. No change in effectiveness
D. Increased risk of overdose
Correct Answer: B. Decreased drug effectiveness
Rationale: Prolonged use of opioid agonists leads to tolerance, reducing the drug’s effectiveness
due to receptor desensitization, per pharmacodynamic principles.
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Question 3
A nurse is reviewing a patient’s medication list. Which factor most affects drug distribution?
A. Plasma protein binding
B. Hepatic metabolism
C. Renal clearance
D. Gastric pH
Correct Answer: A. Plasma protein binding
Rationale: Plasma protein binding determines the amount of free drug available for distribution
to tissues, a key pharmacokinetic process.
Question 4
A patient with renal impairment is prescribed a renally cleared drug. What adjustment is
necessary?
A. Increase the dose
B. Decrease the dose
C. Change to an oral route
D. Maintain the standard dose
Correct Answer: B. Decrease the dose
Rationale: Renal impairment reduces drug clearance, requiring a decreased dose to prevent
accumulation and toxicity, per pharmacokinetic principles.
Question 5
A nurse is educating a patient about warfarin therapy. Which dietary consideration is critical?
A. Increase vitamin C intake
B. Maintain consistent vitamin K intake
C. Avoid carbohydrates
D. Limit protein intake
Correct Answer: B. Maintain consistent vitamin K intake
Rationale: Vitamin K antagonizes warfarin’s anticoagulant effect, so consistent intake is
essential to maintain therapeutic INR levels.
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Question 6
A patient is prescribed a beta-blocker for hypertension. Which adverse effect should the nurse
monitor?
A. Hyperglycemia
B. Bradycardia
C. Hyperkalemia
D. Hypertension
Correct Answer: B. Bradycardia
Rationale: Beta-blockers block sympathetic stimulation, slowing heart rate and potentially
causing bradycardia, per pharmacodynamic effects.
Question 7
A nurse is caring for a patient receiving an IV antibiotic with a short half-life. How does this
affect dosing?
A. Frequent dosing intervals
B. Once-daily dosing
C. No change in dosing
D. Reduced total daily dose
Correct Answer: A. Frequent dosing intervals
Rationale: A short half-life means the drug is eliminated quickly, requiring more frequent
dosing to maintain therapeutic levels, per pharmacokinetics.
Question 8
A patient with asthma is prescribed montelukast. Which laboratory test should the nurse
monitor?
A. Alanine transaminase (ALT)
B. Serum creatinine
C. Blood glucose
D. Platelet count
Correct Answer: A. Alanine transaminase (ALT)
Rationale: Montelukast can cause hepatotoxicity, necessitating monitoring of liver function tests
like ALT.
NURS 676 Advanced
Pharmacology Actual 2025
Midterm Exam Questions
and Answers (WCU) -
Guaranteed Pass
Question 1
A nurse practitioner is prescribing a medication with a high first-pass effect. Which
administration route bypasses this effect?
A. Oral
B. Intravenous
C. Sublingual
D. Rectal
Correct Answer: B. Intravenous
Rationale: Intravenous administration delivers the drug directly into systemic circulation,
bypassing the liver’s first-pass metabolism, which reduces bioavailability for oral medications.
Question 2
A patient has been taking an opioid agonist for 3 weeks. What should the nurse anticipate?
A. Increased drug effectiveness
B. Decreased drug effectiveness
C. No change in effectiveness
D. Increased risk of overdose
Correct Answer: B. Decreased drug effectiveness
Rationale: Prolonged use of opioid agonists leads to tolerance, reducing the drug’s effectiveness
due to receptor desensitization, per pharmacodynamic principles.
, 2
Question 3
A nurse is reviewing a patient’s medication list. Which factor most affects drug distribution?
A. Plasma protein binding
B. Hepatic metabolism
C. Renal clearance
D. Gastric pH
Correct Answer: A. Plasma protein binding
Rationale: Plasma protein binding determines the amount of free drug available for distribution
to tissues, a key pharmacokinetic process.
Question 4
A patient with renal impairment is prescribed a renally cleared drug. What adjustment is
necessary?
A. Increase the dose
B. Decrease the dose
C. Change to an oral route
D. Maintain the standard dose
Correct Answer: B. Decrease the dose
Rationale: Renal impairment reduces drug clearance, requiring a decreased dose to prevent
accumulation and toxicity, per pharmacokinetic principles.
Question 5
A nurse is educating a patient about warfarin therapy. Which dietary consideration is critical?
A. Increase vitamin C intake
B. Maintain consistent vitamin K intake
C. Avoid carbohydrates
D. Limit protein intake
Correct Answer: B. Maintain consistent vitamin K intake
Rationale: Vitamin K antagonizes warfarin’s anticoagulant effect, so consistent intake is
essential to maintain therapeutic INR levels.
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Question 6
A patient is prescribed a beta-blocker for hypertension. Which adverse effect should the nurse
monitor?
A. Hyperglycemia
B. Bradycardia
C. Hyperkalemia
D. Hypertension
Correct Answer: B. Bradycardia
Rationale: Beta-blockers block sympathetic stimulation, slowing heart rate and potentially
causing bradycardia, per pharmacodynamic effects.
Question 7
A nurse is caring for a patient receiving an IV antibiotic with a short half-life. How does this
affect dosing?
A. Frequent dosing intervals
B. Once-daily dosing
C. No change in dosing
D. Reduced total daily dose
Correct Answer: A. Frequent dosing intervals
Rationale: A short half-life means the drug is eliminated quickly, requiring more frequent
dosing to maintain therapeutic levels, per pharmacokinetics.
Question 8
A patient with asthma is prescribed montelukast. Which laboratory test should the nurse
monitor?
A. Alanine transaminase (ALT)
B. Serum creatinine
C. Blood glucose
D. Platelet count
Correct Answer: A. Alanine transaminase (ALT)
Rationale: Montelukast can cause hepatotoxicity, necessitating monitoring of liver function tests
like ALT.
