Chamberlain NR 566 Midterm Exam Study Guide (2026) –
Pharmacology Chamberlain University College of Nursing
Complete A+ Guide with Rationales
Section 1: Advanced Pharmacology Principles (Questions 1-30)
1. A patient with chronic kidney disease (eGFR 25 mL/min) is
prescribed a medication that is 80% renally excreted. What
adjustment is most appropriate?
A. Increase the dose by 50%
B. Decrease the dose or extend the dosing interval
C. No adjustment is needed
D. Administer the medication intravenously instead of orally
Answer: B. Decrease the dose or extend the dosing interval
Rationale: For medications primarily eliminated by the
kidneys, dose reduction or extended dosing intervals are
necessary in patients with reduced eGFR to prevent drug
accumulation and toxicity. The degree of adjustment
depends on the eGFR and drug characteristics .
2. A patient is prescribed a drug that is a CYP3A4 inhibitor. Which
medication would the nurse expect to have increased levels when
co-administered?
A. Simvastatin (Zocor)
B. Acetaminophen (Tylenol)
C. Metformin (Glucophage)
D. Lisinopril (Prinivil)
,Answer: A. Simvastatin (Zocor)
Rationale: Simvastatin is a substrate of CYP3A4. When co-
administered with a CYP3A4 inhibitor, simvastatin levels
increase, raising the risk of myopathy and rhabdomyolysis.
Many statins have significant CYP3A4 interactions .
3. A patient taking warfarin (Coumadin) is started on amiodarone.
What effect does the nurse anticipate?
A. Decreased INR, increased warfarin metabolism
B. Increased INR, increased bleeding risk
C. No change in INR
D. Decreased warfarin absorption
Answer: B. Increased INR, increased bleeding risk
Rationale: Amiodarone inhibits CYP2C9 and CYP1A2, which
metabolize warfarin. This interaction leads to increased INR
and bleeding risk. Warfarin dose should be reduced by 30-
50% when amiodarone is initiated .
4. The nurse is educating a patient about the importance of
medication adherence. Which statement reflects the concept of
pharmacotherapeutic goals?
A. "You should take your medication only when you feel
symptoms."
B. "The goal is to achieve maximum benefit with minimal harm."
C. "All medications have the same therapeutic window."
D. "Side effects are not important to report."
Answer: B. "The goal is to achieve maximum benefit with
minimal harm."
Rationale: The objective of drug therapy is to achieve
,maximum therapeutic benefit while minimizing harm.
Because no drug is ideal, clinicians must balance efficacy with
safety for each individual patient .
5. A drug with a narrow therapeutic index requires:
A. Less frequent monitoring
B. Therapeutic drug monitoring to maintain levels within a narrow
range
C. Higher doses to achieve effect
D. No special monitoring
Answer: B. Therapeutic drug monitoring to maintain levels
within a narrow range
Rationale: Drugs with a narrow therapeutic index have a
small margin of safety between therapeutic and toxic doses.
Therapeutic drug monitoring is essential to maintain levels
within the therapeutic range and prevent toxicity. Examples
include lithium, digoxin, warfarin, and phenytoin .
6. Which factor would decrease the absorption of an orally
administered drug?
A. Increased blood flow to the gastrointestinal tract
B. Administration on an empty stomach
C. The presence of food that binds the drug
D. Administration of a liquid formulation
Answer: C. The presence of food that binds the drug
Rationale: Food can decrease drug absorption by binding to
the drug, delaying gastric emptying, or altering gastric pH.
Increased blood flow, empty stomach, and liquid
formulations typically enhance absorption .
, 7. A patient's serum albumin level is low. How will this affect the
distribution of a highly protein-bound drug?
A. Decreased free drug concentration
B. Increased free drug concentration
C. No change in drug distribution
D. Decreased volume of distribution
Answer: B. Increased free drug concentration
Rationale: Low albumin levels mean fewer binding sites for
protein-bound drugs. This results in a higher concentration
of free, pharmacologically active drug, increasing both
therapeutic effects and risk of toxicity .
8. The nurse explains to a patient that a loading dose is often used
for certain medications. What is the purpose of a loading dose?
A. To maintain therapeutic levels over a long period
B. To rapidly achieve therapeutic drug levels
C. To minimize side effects
D. To reduce the frequency of dosing
Answer: B. To rapidly achieve therapeutic drug levels
Rationale: A loading dose is a larger initial dose used to
achieve therapeutic levels quickly. Maintenance doses are
then given to sustain those levels. This is particularly
important for drugs with long half-lives .
9. A patient asks why they need to take a medication every 12
hours. The nurse explains that the dosing interval is based on
which pharmacokinetic principle?
A. Rate of absorption
B. Volume of distribution
Pharmacology Chamberlain University College of Nursing
Complete A+ Guide with Rationales
Section 1: Advanced Pharmacology Principles (Questions 1-30)
1. A patient with chronic kidney disease (eGFR 25 mL/min) is
prescribed a medication that is 80% renally excreted. What
adjustment is most appropriate?
A. Increase the dose by 50%
B. Decrease the dose or extend the dosing interval
C. No adjustment is needed
D. Administer the medication intravenously instead of orally
Answer: B. Decrease the dose or extend the dosing interval
Rationale: For medications primarily eliminated by the
kidneys, dose reduction or extended dosing intervals are
necessary in patients with reduced eGFR to prevent drug
accumulation and toxicity. The degree of adjustment
depends on the eGFR and drug characteristics .
2. A patient is prescribed a drug that is a CYP3A4 inhibitor. Which
medication would the nurse expect to have increased levels when
co-administered?
A. Simvastatin (Zocor)
B. Acetaminophen (Tylenol)
C. Metformin (Glucophage)
D. Lisinopril (Prinivil)
,Answer: A. Simvastatin (Zocor)
Rationale: Simvastatin is a substrate of CYP3A4. When co-
administered with a CYP3A4 inhibitor, simvastatin levels
increase, raising the risk of myopathy and rhabdomyolysis.
Many statins have significant CYP3A4 interactions .
3. A patient taking warfarin (Coumadin) is started on amiodarone.
What effect does the nurse anticipate?
A. Decreased INR, increased warfarin metabolism
B. Increased INR, increased bleeding risk
C. No change in INR
D. Decreased warfarin absorption
Answer: B. Increased INR, increased bleeding risk
Rationale: Amiodarone inhibits CYP2C9 and CYP1A2, which
metabolize warfarin. This interaction leads to increased INR
and bleeding risk. Warfarin dose should be reduced by 30-
50% when amiodarone is initiated .
4. The nurse is educating a patient about the importance of
medication adherence. Which statement reflects the concept of
pharmacotherapeutic goals?
A. "You should take your medication only when you feel
symptoms."
B. "The goal is to achieve maximum benefit with minimal harm."
C. "All medications have the same therapeutic window."
D. "Side effects are not important to report."
Answer: B. "The goal is to achieve maximum benefit with
minimal harm."
Rationale: The objective of drug therapy is to achieve
,maximum therapeutic benefit while minimizing harm.
Because no drug is ideal, clinicians must balance efficacy with
safety for each individual patient .
5. A drug with a narrow therapeutic index requires:
A. Less frequent monitoring
B. Therapeutic drug monitoring to maintain levels within a narrow
range
C. Higher doses to achieve effect
D. No special monitoring
Answer: B. Therapeutic drug monitoring to maintain levels
within a narrow range
Rationale: Drugs with a narrow therapeutic index have a
small margin of safety between therapeutic and toxic doses.
Therapeutic drug monitoring is essential to maintain levels
within the therapeutic range and prevent toxicity. Examples
include lithium, digoxin, warfarin, and phenytoin .
6. Which factor would decrease the absorption of an orally
administered drug?
A. Increased blood flow to the gastrointestinal tract
B. Administration on an empty stomach
C. The presence of food that binds the drug
D. Administration of a liquid formulation
Answer: C. The presence of food that binds the drug
Rationale: Food can decrease drug absorption by binding to
the drug, delaying gastric emptying, or altering gastric pH.
Increased blood flow, empty stomach, and liquid
formulations typically enhance absorption .
, 7. A patient's serum albumin level is low. How will this affect the
distribution of a highly protein-bound drug?
A. Decreased free drug concentration
B. Increased free drug concentration
C. No change in drug distribution
D. Decreased volume of distribution
Answer: B. Increased free drug concentration
Rationale: Low albumin levels mean fewer binding sites for
protein-bound drugs. This results in a higher concentration
of free, pharmacologically active drug, increasing both
therapeutic effects and risk of toxicity .
8. The nurse explains to a patient that a loading dose is often used
for certain medications. What is the purpose of a loading dose?
A. To maintain therapeutic levels over a long period
B. To rapidly achieve therapeutic drug levels
C. To minimize side effects
D. To reduce the frequency of dosing
Answer: B. To rapidly achieve therapeutic drug levels
Rationale: A loading dose is a larger initial dose used to
achieve therapeutic levels quickly. Maintenance doses are
then given to sustain those levels. This is particularly
important for drugs with long half-lives .
9. A patient asks why they need to take a medication every 12
hours. The nurse explains that the dosing interval is based on
which pharmacokinetic principle?
A. Rate of absorption
B. Volume of distribution
