NURS 629 EXAM 1 QUESTIONS AND ANSWERS LATEST
2026/2027 | Maryville University | Graduate Nursing Program |
Complete Solution with Detailed Rationales | Advanced
Pharmacology | Pass Guaranteed - A+ Graded
Domain 1: Principles of Pharmacokinetics and Pharmacodynamics (15
Questions)
Q1: A 68-year-old male with heart failure is prescribed lisinopril 10 mg daily. He has a
history of chronic kidney disease (CKD Stage 3, eGFR 45 mL/min). Which
pharmacokinetic parameter is most significantly altered in this patient, requiring dose
adjustment consideration?
A. Absorption due to decreased gastrointestinal motility
B. Distribution due to increased body fat percentage
C. Elimination due to reduced renal clearance [CORRECT]
D. Metabolism due to decreased hepatic blood flow
Correct Answer: C
Rationale: Lisinopril is a renally eliminated ACE inhibitor (approximately 100%
unchanged in urine). In CKD Stage 3 (eGFR 30-59), drug accumulation risk increases
significantly. The FDA recommends dose reduction or extended intervals when CrCl <30
mL/min, with careful monitoring at eGFR 45 due to potential progression. Option A is
incorrect because age-related absorption changes are minimal for lisinopril (oral
bioavailability ~25% but consistent). Option B is incorrect because lisinopril is
water-soluble with minimal tissue distribution (Vd ~0.25 L/kg), making body
composition changes less relevant. Option D is incorrect because lisinopril undergoes
,minimal hepatic metabolism (<10%). This aligns with Maryville NURS 629 emphasis on
renal dosing and geriatric pharmacokinetics.
Q2: A nurse practitioner is prescribing warfarin for a patient with atrial fibrillation. The
patient is also started on amiodarone for ventricular arrhythmias. Which
pharmacodynamic interaction occurs between these medications?
A. Amiodarone induces CYP2C9, decreasing warfarin effect
B. Amiodarone inhibits CYP2C9 and CYP3A4, increasing warfarin plasma levels and
bleeding risk [CORRECT]
C. Amiodarone displaces warfarin from albumin binding sites
D. Amiodarone enhances vitamin K absorption, antagonizing warfarin
Correct Answer: B
Rationale: Amiodarone is a potent CYP2C9 and CYP3A4 inhibitor. Warfarin (S-warfarin
primarily metabolized by CYP2C9) metabolism is significantly reduced, leading to
30-50% increased INR and bleeding risk. The interaction requires 33-50% warfarin dose
reduction and weekly INR monitoring for 4 weeks. Option A is incorrect because
amiodarone inhibits, not induces, these enzymes. Option C is incorrect because
amiodarone is highly protein-bound but doesn't significantly displace warfarin clinically.
Option D is pharmacologically false—amiodarone doesn't affect vitamin K absorption.
This exemplifies Maryville's focus on CYP450 interactions in anticoagulation
management.
Q3: Which of the following factors increase the volume of distribution (Vd) for
lipophilic drugs in elderly patients? (Select all that apply)
A. Increased total body water
B. Increased adipose tissue percentage [CORRECT]
C. Decreased lean body mass
,D. Decreased albumin production
E. Increased alpha-1 acid glycoprotein
F. Decreased plasma protein binding
Correct Answer: B, C, D, F
Rationale: Lipophilic drugs distribute into fat tissue. Elderly patients show: increased
adipose (B, increases Vd for lipophilic drugs), decreased lean body mass/water (C,
concentrates hydrophilic drugs but lipophilic redistribute to fat), decreased albumin (D,
increases free fraction and apparent Vd for highly protein-bound drugs), and decreased
protein binding overall (F). Option A is incorrect (total body water decreases 10-15%
with aging). Option E is incorrect because while acute phase reactants may increase,
this primarily affects basic drug binding, not lipophilic Vd. Maryville NURS 629
emphasizes geriatric pharmacokinetic changes affecting drug dosing.
Q4: A patient receives IV furosemide 40 mg. The drug has a half-life of 2 hours and
reaches steady state with continuous infusion. If the infusion is stopped,
approximately how long until 94% of the drug is eliminated?
A. 2 hours
B. 4 hours
C. 6 hours
D. 8 hours [CORRECT]
Correct Answer: D
Rationale: Drug elimination follows first-order kinetics: 50% eliminated per half-life. After
4 half-lives, 94% elimination occurs (50% → 75% → 87.5% → 93.75%). With 2-hour
half-life: 4 × 2 = 8 hours. Option A represents 1 half-life (50% eliminated). Option B
represents 2 half-lives (75%). Option C represents 3 half-lives (87.5%). This calculation
is fundamental to Maryville's pharmacokinetics module and clinical dosing intervals.
, Q5: The therapeutic index of a drug is defined as:
A. The ratio of minimum effective concentration to maximum safe concentration
B. The ratio of LD50 (lethal dose for 50% of population) to ED50 (effective dose for 50%
of population) [CORRECT]
C. The difference between toxic dose and effective dose
D. The time between drug administration and peak effect
Correct Answer: B
Rationale: Therapeutic index (TI) = LD50/ED50, quantifying drug safety margin. Narrow
TI drugs (warfarin, digoxin, lithium, aminoglycosides, phenytoin) require therapeutic
drug monitoring (TDM). A TI <2 indicates narrow therapeutic window. Option A reverses
the ratio. Option C describes therapeutic range, not index. Option D describes onset or
time to peak. Maryville NURS 629 emphasizes TI in selecting monitoring protocols for
high-risk medications.
Q6: A patient with liver cirrhosis (Child-Pugh Class C) is prescribed lorazepam for
anxiety. Which pharmacokinetic consideration is most important?
A. Lorazepam requires dose reduction due to decreased phase I metabolism (oxidation)
[CORRECT]
B. Lorazepam requires dose reduction due to decreased phase II metabolism
(glucuronidation)
C. Lorazepam is safe because it undergoes renal elimination only
D. Lorazepam clearance is unaffected by liver disease
Correct Answer: A
Rationale: Lorazepam undergoes hepatic phase I oxidation (CYP3A4) and phase II
glucuronidation. In severe liver disease, phase I metabolism is significantly impaired
(reduced CYP450 activity, decreased hepatic blood flow), leading to prolonged half-life
2026/2027 | Maryville University | Graduate Nursing Program |
Complete Solution with Detailed Rationales | Advanced
Pharmacology | Pass Guaranteed - A+ Graded
Domain 1: Principles of Pharmacokinetics and Pharmacodynamics (15
Questions)
Q1: A 68-year-old male with heart failure is prescribed lisinopril 10 mg daily. He has a
history of chronic kidney disease (CKD Stage 3, eGFR 45 mL/min). Which
pharmacokinetic parameter is most significantly altered in this patient, requiring dose
adjustment consideration?
A. Absorption due to decreased gastrointestinal motility
B. Distribution due to increased body fat percentage
C. Elimination due to reduced renal clearance [CORRECT]
D. Metabolism due to decreased hepatic blood flow
Correct Answer: C
Rationale: Lisinopril is a renally eliminated ACE inhibitor (approximately 100%
unchanged in urine). In CKD Stage 3 (eGFR 30-59), drug accumulation risk increases
significantly. The FDA recommends dose reduction or extended intervals when CrCl <30
mL/min, with careful monitoring at eGFR 45 due to potential progression. Option A is
incorrect because age-related absorption changes are minimal for lisinopril (oral
bioavailability ~25% but consistent). Option B is incorrect because lisinopril is
water-soluble with minimal tissue distribution (Vd ~0.25 L/kg), making body
composition changes less relevant. Option D is incorrect because lisinopril undergoes
,minimal hepatic metabolism (<10%). This aligns with Maryville NURS 629 emphasis on
renal dosing and geriatric pharmacokinetics.
Q2: A nurse practitioner is prescribing warfarin for a patient with atrial fibrillation. The
patient is also started on amiodarone for ventricular arrhythmias. Which
pharmacodynamic interaction occurs between these medications?
A. Amiodarone induces CYP2C9, decreasing warfarin effect
B. Amiodarone inhibits CYP2C9 and CYP3A4, increasing warfarin plasma levels and
bleeding risk [CORRECT]
C. Amiodarone displaces warfarin from albumin binding sites
D. Amiodarone enhances vitamin K absorption, antagonizing warfarin
Correct Answer: B
Rationale: Amiodarone is a potent CYP2C9 and CYP3A4 inhibitor. Warfarin (S-warfarin
primarily metabolized by CYP2C9) metabolism is significantly reduced, leading to
30-50% increased INR and bleeding risk. The interaction requires 33-50% warfarin dose
reduction and weekly INR monitoring for 4 weeks. Option A is incorrect because
amiodarone inhibits, not induces, these enzymes. Option C is incorrect because
amiodarone is highly protein-bound but doesn't significantly displace warfarin clinically.
Option D is pharmacologically false—amiodarone doesn't affect vitamin K absorption.
This exemplifies Maryville's focus on CYP450 interactions in anticoagulation
management.
Q3: Which of the following factors increase the volume of distribution (Vd) for
lipophilic drugs in elderly patients? (Select all that apply)
A. Increased total body water
B. Increased adipose tissue percentage [CORRECT]
C. Decreased lean body mass
,D. Decreased albumin production
E. Increased alpha-1 acid glycoprotein
F. Decreased plasma protein binding
Correct Answer: B, C, D, F
Rationale: Lipophilic drugs distribute into fat tissue. Elderly patients show: increased
adipose (B, increases Vd for lipophilic drugs), decreased lean body mass/water (C,
concentrates hydrophilic drugs but lipophilic redistribute to fat), decreased albumin (D,
increases free fraction and apparent Vd for highly protein-bound drugs), and decreased
protein binding overall (F). Option A is incorrect (total body water decreases 10-15%
with aging). Option E is incorrect because while acute phase reactants may increase,
this primarily affects basic drug binding, not lipophilic Vd. Maryville NURS 629
emphasizes geriatric pharmacokinetic changes affecting drug dosing.
Q4: A patient receives IV furosemide 40 mg. The drug has a half-life of 2 hours and
reaches steady state with continuous infusion. If the infusion is stopped,
approximately how long until 94% of the drug is eliminated?
A. 2 hours
B. 4 hours
C. 6 hours
D. 8 hours [CORRECT]
Correct Answer: D
Rationale: Drug elimination follows first-order kinetics: 50% eliminated per half-life. After
4 half-lives, 94% elimination occurs (50% → 75% → 87.5% → 93.75%). With 2-hour
half-life: 4 × 2 = 8 hours. Option A represents 1 half-life (50% eliminated). Option B
represents 2 half-lives (75%). Option C represents 3 half-lives (87.5%). This calculation
is fundamental to Maryville's pharmacokinetics module and clinical dosing intervals.
, Q5: The therapeutic index of a drug is defined as:
A. The ratio of minimum effective concentration to maximum safe concentration
B. The ratio of LD50 (lethal dose for 50% of population) to ED50 (effective dose for 50%
of population) [CORRECT]
C. The difference between toxic dose and effective dose
D. The time between drug administration and peak effect
Correct Answer: B
Rationale: Therapeutic index (TI) = LD50/ED50, quantifying drug safety margin. Narrow
TI drugs (warfarin, digoxin, lithium, aminoglycosides, phenytoin) require therapeutic
drug monitoring (TDM). A TI <2 indicates narrow therapeutic window. Option A reverses
the ratio. Option C describes therapeutic range, not index. Option D describes onset or
time to peak. Maryville NURS 629 emphasizes TI in selecting monitoring protocols for
high-risk medications.
Q6: A patient with liver cirrhosis (Child-Pugh Class C) is prescribed lorazepam for
anxiety. Which pharmacokinetic consideration is most important?
A. Lorazepam requires dose reduction due to decreased phase I metabolism (oxidation)
[CORRECT]
B. Lorazepam requires dose reduction due to decreased phase II metabolism
(glucuronidation)
C. Lorazepam is safe because it undergoes renal elimination only
D. Lorazepam clearance is unaffected by liver disease
Correct Answer: A
Rationale: Lorazepam undergoes hepatic phase I oxidation (CYP3A4) and phase II
glucuronidation. In severe liver disease, phase I metabolism is significantly impaired
(reduced CYP450 activity, decreased hepatic blood flow), leading to prolonged half-life
