NSG 6001 – Advanced Pharmacology – Week 1 Quiz
2026/2027 – Graduate Nursing Program – 100% Correct
Foundational Concepts
[INSTRUCTIONS: This quiz contains 50 questions covering foundational pharmacology
principles. Select the single best answer unless otherwise indicated. Questions include
multiple choice, select all that apply, fill-in-the-blank calculations, and matching items. ]
SECTION 1: PHARMACOKINETICS – ABSORPTION, DISTRIBUTION,
METABOLISM, EXCRETION
(Questions 1-15)
Q1: A 72-year-old male with chronic kidney disease (eGFR 28 mL/min/1.73m²) is
prescribed a medication that is primarily eliminated renally. Which pharmacokinetic
parameter will be most significantly altered in this patient?
A. Absorption rate
B. Volume of distribution
C. Half-life
D. Bioavailability
Correct Answer: C
Client Need Category: Pharmacological and Parenteral Therapies
Nursing Process: Assessment
,Clinical Judgment Skill: Analyze Cues – Pharmacokinetic Alterations in Renal
Impairment
Rationale: [CORRECT] C: Half-life (t½) is the time required for plasma concentration to
decrease by 50%. In renal impairment, drugs primarily eliminated renally have reduced
clearance, leading to prolonged half-life and accumulation. This requires dose
adjustment (reduced dose or extended interval). A: Absorption may be altered but is not
the primary concern. B: Volume of distribution may change with fluid shifts but is not
the most significantly altered parameter. D: Bioavailability is primarily affected by
hepatic first-pass metabolism, not renal excretion. Common NP error: Focusing on dose
reduction without understanding that half-life prolongation dictates dosing interval.
Q2: A patient is prescribed propranolol 40 mg orally for hypertension. The oral
bioavailability of propranolol is 26% due to extensive hepatic first-pass metabolism. If
the patient were to receive the same dose intravenously, what would be the expected
relative bioavailability?
A. 26%
B. 50%
C. 74%
D. 100%
Correct Answer: D
Client Need Category: Pharmacological and Parenteral Therapies
Clinical Judgment Skill: Recall – Bioavailability Principles
,Rationale: [CORRECT] D: By definition, intravenous (IV) administration delivers drug
directly into systemic circulation, bypassing absorption barriers and first-pass
metabolism. Therefore, IV bioavailability is always 100%. The 26% oral bioavailability
means only 26% of the oral dose reaches systemic circulation unchanged. A: This is oral
bioavailability. B/C: Incorrect values. Clinical pearl: High first-pass drugs (propranolol,
nitroglycerin, morphine) have large differences between oral and IV dosing.
Q3: A patient on warfarin therapy is started on rifampin for tuberculosis prophylaxis.
Which effect will rifampin have on warfarin metabolism?
A. Inhibit CYP2C9, increasing warfarin levels
B. Induce CYP2C9, decreasing warfarin levels
C. Inhibit CYP3A4, increasing warfarin levels
D. Induce CYP3A4, decreasing warfarin levels
Correct Answer: B
Client Need Category: Pharmacological and Parenteral Therapies
Clinical Judgment Skill: Analyze Cues – CYP450 Drug Interactions
Rationale: [CORRECT] B: Rifampin is a potent broad-spectrum CYP450 inducer, including
CYP2C9 (primary warfarin metabolizing enzyme). Enzyme induction increases
metabolic clearance, decreasing warfarin levels and increasing INR (more rapid
metabolism = less anticoagulant effect). Warfarin dose typically needs to be increased
2-3x during rifampin therapy. A: Inhibition would increase levels. C/D: Warfarin is
primarily CYP2C9, not CYP3A4. Common NP error: Not recognizing that enzyme induction
takes 7-14 days to reach full effect and persists 7-14 days after stopping inducer.
, Q4: Which of the following medications is a potent CYP3A4 inhibitor that significantly
increases levels of simvastatin, leading to risk of rhabdomyolysis?
A. Phenytoin
B. Carbamazepine
C. Ketoconazole
D. Rifampin
Correct Answer: C
Client Need Category: Pharmacological and Parenteral Therapies
Clinical Judgment Skill: Recall – CYP3A4 Inhibitors
Rationale: [CORRECT] C: Ketoconazole (and other azole antifungals: itraconazole,
fluconazole, voriconazole) are potent CYP3A4 inhibitors. Simvastatin and atorvastatin
are CYP3A4 substrates; co-administration causes markedly increased statin levels and
risk of myopathy/rhabdomyolysis. A/B/D: These are CYP450 inducers, not inhibitors.
Clinical pearl: The FDA recommends avoiding simvastatin with strong CYP3A4 inhibitors
or limiting dose to 20 mg with moderate inhibitors.
Q5: A drug has a half-life of 6 hours. How many hours are required to reach
approximately 94% of steady-state concentration with repeated dosing?
A. 6 hours
B. 12 hours
C. 18 hours
2026/2027 – Graduate Nursing Program – 100% Correct
Foundational Concepts
[INSTRUCTIONS: This quiz contains 50 questions covering foundational pharmacology
principles. Select the single best answer unless otherwise indicated. Questions include
multiple choice, select all that apply, fill-in-the-blank calculations, and matching items. ]
SECTION 1: PHARMACOKINETICS – ABSORPTION, DISTRIBUTION,
METABOLISM, EXCRETION
(Questions 1-15)
Q1: A 72-year-old male with chronic kidney disease (eGFR 28 mL/min/1.73m²) is
prescribed a medication that is primarily eliminated renally. Which pharmacokinetic
parameter will be most significantly altered in this patient?
A. Absorption rate
B. Volume of distribution
C. Half-life
D. Bioavailability
Correct Answer: C
Client Need Category: Pharmacological and Parenteral Therapies
Nursing Process: Assessment
,Clinical Judgment Skill: Analyze Cues – Pharmacokinetic Alterations in Renal
Impairment
Rationale: [CORRECT] C: Half-life (t½) is the time required for plasma concentration to
decrease by 50%. In renal impairment, drugs primarily eliminated renally have reduced
clearance, leading to prolonged half-life and accumulation. This requires dose
adjustment (reduced dose or extended interval). A: Absorption may be altered but is not
the primary concern. B: Volume of distribution may change with fluid shifts but is not
the most significantly altered parameter. D: Bioavailability is primarily affected by
hepatic first-pass metabolism, not renal excretion. Common NP error: Focusing on dose
reduction without understanding that half-life prolongation dictates dosing interval.
Q2: A patient is prescribed propranolol 40 mg orally for hypertension. The oral
bioavailability of propranolol is 26% due to extensive hepatic first-pass metabolism. If
the patient were to receive the same dose intravenously, what would be the expected
relative bioavailability?
A. 26%
B. 50%
C. 74%
D. 100%
Correct Answer: D
Client Need Category: Pharmacological and Parenteral Therapies
Clinical Judgment Skill: Recall – Bioavailability Principles
,Rationale: [CORRECT] D: By definition, intravenous (IV) administration delivers drug
directly into systemic circulation, bypassing absorption barriers and first-pass
metabolism. Therefore, IV bioavailability is always 100%. The 26% oral bioavailability
means only 26% of the oral dose reaches systemic circulation unchanged. A: This is oral
bioavailability. B/C: Incorrect values. Clinical pearl: High first-pass drugs (propranolol,
nitroglycerin, morphine) have large differences between oral and IV dosing.
Q3: A patient on warfarin therapy is started on rifampin for tuberculosis prophylaxis.
Which effect will rifampin have on warfarin metabolism?
A. Inhibit CYP2C9, increasing warfarin levels
B. Induce CYP2C9, decreasing warfarin levels
C. Inhibit CYP3A4, increasing warfarin levels
D. Induce CYP3A4, decreasing warfarin levels
Correct Answer: B
Client Need Category: Pharmacological and Parenteral Therapies
Clinical Judgment Skill: Analyze Cues – CYP450 Drug Interactions
Rationale: [CORRECT] B: Rifampin is a potent broad-spectrum CYP450 inducer, including
CYP2C9 (primary warfarin metabolizing enzyme). Enzyme induction increases
metabolic clearance, decreasing warfarin levels and increasing INR (more rapid
metabolism = less anticoagulant effect). Warfarin dose typically needs to be increased
2-3x during rifampin therapy. A: Inhibition would increase levels. C/D: Warfarin is
primarily CYP2C9, not CYP3A4. Common NP error: Not recognizing that enzyme induction
takes 7-14 days to reach full effect and persists 7-14 days after stopping inducer.
, Q4: Which of the following medications is a potent CYP3A4 inhibitor that significantly
increases levels of simvastatin, leading to risk of rhabdomyolysis?
A. Phenytoin
B. Carbamazepine
C. Ketoconazole
D. Rifampin
Correct Answer: C
Client Need Category: Pharmacological and Parenteral Therapies
Clinical Judgment Skill: Recall – CYP3A4 Inhibitors
Rationale: [CORRECT] C: Ketoconazole (and other azole antifungals: itraconazole,
fluconazole, voriconazole) are potent CYP3A4 inhibitors. Simvastatin and atorvastatin
are CYP3A4 substrates; co-administration causes markedly increased statin levels and
risk of myopathy/rhabdomyolysis. A/B/D: These are CYP450 inducers, not inhibitors.
Clinical pearl: The FDA recommends avoiding simvastatin with strong CYP3A4 inhibitors
or limiting dose to 20 mg with moderate inhibitors.
Q5: A drug has a half-life of 6 hours. How many hours are required to reach
approximately 94% of steady-state concentration with repeated dosing?
A. 6 hours
B. 12 hours
C. 18 hours
