NURS 676
NURS 676 Advanced Pharmacology: Comprehensive 100-Question
Final Exam Review with Rationales
This Document Contains:
NURS 676 2025/2026 Exam
100 Multiple Choice Questions with Correct Answers
Detailed Professional Rationales
100% Guaranteed Pass
Complete A+ Guide
,NURS 676: Advanced Pharmacology
Section 1: Foundational Principles (Questions 1-15)
1. A 75-year-old patient with diminished renal function is prescribed a medication that
is primarily renally excreted. The nurse practitioner anticipates that the most
significant pharmacokinetic change will be:
a) Decreased volume of distribution
b) Increased drug metabolism
c) Decreased drug clearance
d) Enhanced protein binding
Correct Answer: c) Decreased drug clearance
Explanation: Renal excretion is a major component of drug clearance. Impaired renal
function directly reduces the clearance of drugs that are eliminated by the kidneys. This leads
to drug accumulation, a prolonged half-life, and an increased risk of toxicity. Volume of
distribution (a) is primarily affected by body composition and protein binding, not directly by
renal function. Metabolism (b) is primarily a hepatic function. Protein binding (d) can be
affected by age and disease but is not the primary direct consequence of renal impairment.
2. The "First-Pass Effect" is a phenomenon that significantly reduces the bioavailability
of orally administered drugs due to:
a) Metabolism by the liver and intestinal wall before reaching systemic circulation
b) Rapid renal excretion immediately after absorption
c) Degradation by stomach acid
d) Competition with food particles for absorption sites
Correct Answer: a) Metabolism by the liver and intestinal wall before reaching systemic
circulation
Explanation: After absorption from the GI tract, blood flows directly to the liver via the
portal vein. The liver and gut wall enzymes can extensively metabolize the drug before it ever
reaches the general bloodstream. This first-pass metabolism drastically reduces the fraction
,of the active drug that becomes systemically available. The other options are not the
definition of the first-pass effect.
3. When a drug is described as having high "protein binding," it implies that:
a) It is highly effective at producing its therapeutic response.
b) A large portion of the drug is bound to plasma proteins and is pharmacologically inactive.
c) It is rapidly metabolized by the cytochrome P450 system.
d) It has a very large volume of distribution, concentrating in tissues.
Correct Answer: b) A large portion of the drug is bound to plasma proteins and is
pharmacologically inactive.
Explanation: Only the free, unbound fraction of a drug is active and can interact with
receptors or diffuse into tissues. Protein binding acts as a circulating reservoir. Changes in
protein levels (e.g., in malnutrition or liver disease) or competition with other protein-bound
drugs can displace this bound fraction, suddenly increasing the free drug concentration and
potentially causing toxicity.
4. The primary reason for administering a "loading dose" of a medication is to:
a) Overcome first-pass metabolism in the liver.
b) Achieve the target steady-state plasma concentration rapidly.
c) Ensure complete absorption from the gastrointestinal tract.
d) Reduce the frequency of adverse effects.
Correct Answer: b) Achieve the target steady-state plasma concentration rapidly.
Explanation: Without a loading dose, it takes approximately 4-5 half-lives for a drug to reach
steady state with regular maintenance dosing. For drugs where a rapid therapeutic effect is
critical (e.g., antibiotics in sepsis, antiarrhythmics), a loading dose is used to "saturate" the
volume of distribution and bring plasma levels into the therapeutic range immediately.
5. Pharmacodynamics refers to the study of:
a) The body's effect on the drug, including absorption, distribution, metabolism, and
excretion.
, b) The drug's effect on the body, including mechanisms of action and therapeutic and adverse
effects.
c) The genetic factors influencing drug response.
d) The interaction between two or more drugs.
Correct Answer: b) The drug's effect on the body, including mechanisms of action and
therapeutic and adverse effects.
Explanation: This is a fundamental definition. Pharmacokinetics is "what the body does to
the drug" (ADME). Pharmacodynamics is "what the drug does to the body." Option (a)
describes pharmacokinetics. (c) describes pharmacogenomics, and (d) describes a specific
aspect of pharmacodynamics or pharmacokinetics.
6. A drug that acts as a "partial agonist" is best described as:
a) A drug that binds to a receptor and causes the opposite effect of an agonist.
b) A drug that binds to a receptor and produces a submaximal response even at full receptor
occupancy.
c) A drug that has no intrinsic activity but blocks agonists from binding.
d) A drug that enhances the effect of an endogenous agonist.
Correct Answer: b) A drug that binds to a receptor and produces a submaximal response
even at full receptor occupancy.
Explanation: A partial agonist has affinity for the receptor but lower intrinsic efficacy than a
full agonist. It can act as an agonist in the absence of a full agonist but can also act as a
competitive antagonist in the presence of a full agonist by blocking it from producing its
maximal effect. (a) describes an inverse agonist, (c) describes a neutral antagonist, and (d)
describes a positive allosteric modulator.
7. Drug A and Drug B are both highly protein-bound. When administered together, they
are likely to:
a) Have their metabolism induced.
b) Compete for protein-binding sites, increasing the free fraction of one or both drugs.
c) Form an inactive complex in the plasma.
NURS 676 Advanced Pharmacology: Comprehensive 100-Question
Final Exam Review with Rationales
This Document Contains:
NURS 676 2025/2026 Exam
100 Multiple Choice Questions with Correct Answers
Detailed Professional Rationales
100% Guaranteed Pass
Complete A+ Guide
,NURS 676: Advanced Pharmacology
Section 1: Foundational Principles (Questions 1-15)
1. A 75-year-old patient with diminished renal function is prescribed a medication that
is primarily renally excreted. The nurse practitioner anticipates that the most
significant pharmacokinetic change will be:
a) Decreased volume of distribution
b) Increased drug metabolism
c) Decreased drug clearance
d) Enhanced protein binding
Correct Answer: c) Decreased drug clearance
Explanation: Renal excretion is a major component of drug clearance. Impaired renal
function directly reduces the clearance of drugs that are eliminated by the kidneys. This leads
to drug accumulation, a prolonged half-life, and an increased risk of toxicity. Volume of
distribution (a) is primarily affected by body composition and protein binding, not directly by
renal function. Metabolism (b) is primarily a hepatic function. Protein binding (d) can be
affected by age and disease but is not the primary direct consequence of renal impairment.
2. The "First-Pass Effect" is a phenomenon that significantly reduces the bioavailability
of orally administered drugs due to:
a) Metabolism by the liver and intestinal wall before reaching systemic circulation
b) Rapid renal excretion immediately after absorption
c) Degradation by stomach acid
d) Competition with food particles for absorption sites
Correct Answer: a) Metabolism by the liver and intestinal wall before reaching systemic
circulation
Explanation: After absorption from the GI tract, blood flows directly to the liver via the
portal vein. The liver and gut wall enzymes can extensively metabolize the drug before it ever
reaches the general bloodstream. This first-pass metabolism drastically reduces the fraction
,of the active drug that becomes systemically available. The other options are not the
definition of the first-pass effect.
3. When a drug is described as having high "protein binding," it implies that:
a) It is highly effective at producing its therapeutic response.
b) A large portion of the drug is bound to plasma proteins and is pharmacologically inactive.
c) It is rapidly metabolized by the cytochrome P450 system.
d) It has a very large volume of distribution, concentrating in tissues.
Correct Answer: b) A large portion of the drug is bound to plasma proteins and is
pharmacologically inactive.
Explanation: Only the free, unbound fraction of a drug is active and can interact with
receptors or diffuse into tissues. Protein binding acts as a circulating reservoir. Changes in
protein levels (e.g., in malnutrition or liver disease) or competition with other protein-bound
drugs can displace this bound fraction, suddenly increasing the free drug concentration and
potentially causing toxicity.
4. The primary reason for administering a "loading dose" of a medication is to:
a) Overcome first-pass metabolism in the liver.
b) Achieve the target steady-state plasma concentration rapidly.
c) Ensure complete absorption from the gastrointestinal tract.
d) Reduce the frequency of adverse effects.
Correct Answer: b) Achieve the target steady-state plasma concentration rapidly.
Explanation: Without a loading dose, it takes approximately 4-5 half-lives for a drug to reach
steady state with regular maintenance dosing. For drugs where a rapid therapeutic effect is
critical (e.g., antibiotics in sepsis, antiarrhythmics), a loading dose is used to "saturate" the
volume of distribution and bring plasma levels into the therapeutic range immediately.
5. Pharmacodynamics refers to the study of:
a) The body's effect on the drug, including absorption, distribution, metabolism, and
excretion.
, b) The drug's effect on the body, including mechanisms of action and therapeutic and adverse
effects.
c) The genetic factors influencing drug response.
d) The interaction between two or more drugs.
Correct Answer: b) The drug's effect on the body, including mechanisms of action and
therapeutic and adverse effects.
Explanation: This is a fundamental definition. Pharmacokinetics is "what the body does to
the drug" (ADME). Pharmacodynamics is "what the drug does to the body." Option (a)
describes pharmacokinetics. (c) describes pharmacogenomics, and (d) describes a specific
aspect of pharmacodynamics or pharmacokinetics.
6. A drug that acts as a "partial agonist" is best described as:
a) A drug that binds to a receptor and causes the opposite effect of an agonist.
b) A drug that binds to a receptor and produces a submaximal response even at full receptor
occupancy.
c) A drug that has no intrinsic activity but blocks agonists from binding.
d) A drug that enhances the effect of an endogenous agonist.
Correct Answer: b) A drug that binds to a receptor and produces a submaximal response
even at full receptor occupancy.
Explanation: A partial agonist has affinity for the receptor but lower intrinsic efficacy than a
full agonist. It can act as an agonist in the absence of a full agonist but can also act as a
competitive antagonist in the presence of a full agonist by blocking it from producing its
maximal effect. (a) describes an inverse agonist, (c) describes a neutral antagonist, and (d)
describes a positive allosteric modulator.
7. Drug A and Drug B are both highly protein-bound. When administered together, they
are likely to:
a) Have their metabolism induced.
b) Compete for protein-binding sites, increasing the free fraction of one or both drugs.
c) Form an inactive complex in the plasma.
