NR 565 Advanced Pharmacology – High-Yield
Exam Review Notes (Chamberlain MSN | 2025)
Question 1
A nurse practitioner is reviewing a medication that undergoes extensive
first-pass metabolism. Which effect should the nurse anticipate?
A. Increased oral bioavailability
B. Reduced oral bioavailability
C. Faster renal elimination
D. Increased protein binding
Correct Answer: B
Rationale:
First-pass metabolism occurs in the liver after oral administration,
reducing the amount of active drug that reaches systemic circulation,
thereby decreasing oral bioavailability.
,Question 2
Which factor most significantly increases the risk of drug toxicity in older adults?
A. Increased hepatic blood flow
B. Decreased renal clearance
C. Increased gastric acidity
D. Increased muscle mass
✅ Correct Answer: B
Rationale:
Aging reduces renal function, decreasing drug clearance and increasing the risk of
accumulation and toxicity.
Question 3
A CYP3A4 inhibitor would most likely cause which effect?
A. Decreased serum drug levels
B. Increased drug metabolism
C. Increased serum drug levels
D. Reduced drug absorption
✅ Correct Answer: C
Rationale:
CYP3A4 inhibitors slow drug metabolism, leading to increased serum
concentrations and higher risk of adverse effects.
,Question 4
Which medication carries a black box warning for increased risk of suicidal
ideation?
A. Benzodiazepines
B. Selective serotonin reuptake inhibitors (SSRIs)
C. Beta blockers
D. Proton pump inhibitors
✅ Correct Answer: B
Rationale:
SSRIs carry a black box warning for increased risk of suicidal thoughts, especially
in children, adolescents, and young adults.
Question 5
Which pharmacokinetic process describes drug movement from the bloodstream
into tissues?
A. Absorption
B. Distribution
C. Metabolism
D. Elimination
✅ Correct Answer: B
Rationale:
, Distribution refers to how a drug moves from systemic circulation into body
tissues and organs.
Question 6
A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. What is
the primary concern?
A. Reduced anticoagulation
B. Increased bleeding risk
C. Reduced absorption of warfarin
D. Decreased INR
✅ Correct Answer: B
Rationale:
TMP-SMX inhibits warfarin metabolism, increasing INR and bleeding risk.
Question 7
Which drug characteristic increases the ability to cross the blood–brain barrier?
A. High protein binding
B. Ionized form
C. Lipid solubility
D. Large molecular size
✅ Correct Answer: C
Exam Review Notes (Chamberlain MSN | 2025)
Question 1
A nurse practitioner is reviewing a medication that undergoes extensive
first-pass metabolism. Which effect should the nurse anticipate?
A. Increased oral bioavailability
B. Reduced oral bioavailability
C. Faster renal elimination
D. Increased protein binding
Correct Answer: B
Rationale:
First-pass metabolism occurs in the liver after oral administration,
reducing the amount of active drug that reaches systemic circulation,
thereby decreasing oral bioavailability.
,Question 2
Which factor most significantly increases the risk of drug toxicity in older adults?
A. Increased hepatic blood flow
B. Decreased renal clearance
C. Increased gastric acidity
D. Increased muscle mass
✅ Correct Answer: B
Rationale:
Aging reduces renal function, decreasing drug clearance and increasing the risk of
accumulation and toxicity.
Question 3
A CYP3A4 inhibitor would most likely cause which effect?
A. Decreased serum drug levels
B. Increased drug metabolism
C. Increased serum drug levels
D. Reduced drug absorption
✅ Correct Answer: C
Rationale:
CYP3A4 inhibitors slow drug metabolism, leading to increased serum
concentrations and higher risk of adverse effects.
,Question 4
Which medication carries a black box warning for increased risk of suicidal
ideation?
A. Benzodiazepines
B. Selective serotonin reuptake inhibitors (SSRIs)
C. Beta blockers
D. Proton pump inhibitors
✅ Correct Answer: B
Rationale:
SSRIs carry a black box warning for increased risk of suicidal thoughts, especially
in children, adolescents, and young adults.
Question 5
Which pharmacokinetic process describes drug movement from the bloodstream
into tissues?
A. Absorption
B. Distribution
C. Metabolism
D. Elimination
✅ Correct Answer: B
Rationale:
, Distribution refers to how a drug moves from systemic circulation into body
tissues and organs.
Question 6
A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. What is
the primary concern?
A. Reduced anticoagulation
B. Increased bleeding risk
C. Reduced absorption of warfarin
D. Decreased INR
✅ Correct Answer: B
Rationale:
TMP-SMX inhibits warfarin metabolism, increasing INR and bleeding risk.
Question 7
Which drug characteristic increases the ability to cross the blood–brain barrier?
A. High protein binding
B. Ionized form
C. Lipid solubility
D. Large molecular size
✅ Correct Answer: C
