University of Alabama NUR 529 Exams 1–4
Blueprint | Verified Questions & Answers |
Complete Study Guide 2026
UNIVERSITY OF ALABAMA — NUR 529
EXAMS 1–4 | VERIFIED QUESTIONS & ANSWERS
Complete Study Guide
QUESTION 1
Which pharmacokinetic process refers to the movement of a drug from its site of
administration into the bloodstream?
A. Distribution
B. Metabolism
C. Absorption
D. Excretion
E. Elimination
CORRECT ANSWER: C. Absorption
RATIONALE: Absorption is the process by which a drug moves from its site of
administration (e.g., GI tract, muscle, skin) into the systemic circulation. It precedes
distribution, metabolism, and excretion in the pharmacokinetic sequence.
QUESTION 2
Which of the following factors most significantly affects the bioavailability of an
orally administered drug?
A. Renal clearance rate
B. Protein binding in plasma
C. First-pass hepatic metabolism
D. Volume of distribution
E. Half-life of the drug
CORRECT ANSWER: C. First-pass hepatic metabolism
, RATIONALE: First-pass metabolism occurs in the liver before the drug reaches
systemic circulation, significantly reducing bioavailability. Drugs with high first-pass
effects (e.g., morphine, nitroglycerin) may require alternative routes or higher oral
doses.
QUESTION 3
A patient is prescribed a drug with a narrow therapeutic index. What is the MOST
important nursing consideration?
A. Administer the drug with food to enhance absorption
B. Monitor drug levels and patient response closely
C. Encourage increased fluid intake to speed excretion
D. Switch to an equivalent generic brand
E. Administer at the same time as antacids
CORRECT ANSWER: B. Monitor drug levels and patient response closely
RATIONALE: Drugs with a narrow therapeutic index (e.g., digoxin, warfarin,
lithium) have a small difference between therapeutic and toxic concentrations. Frequent
monitoring of serum drug levels and clinical response is essential to avoid toxicity or
subtherapeutic dosing.
QUESTION 4
Which of the following best describes the volume of distribution (Vd) of a drug?
A. The rate at which a drug is eliminated from the body
B. The fraction of drug that reaches systemic circulation unchanged
C. A measure of how widely a drug is distributed throughout body tissues
D. The concentration of drug in plasma at steady state
E. The time it takes for a drug to reach peak plasma concentration
CORRECT ANSWER: C. A measure of how widely a drug is distributed
throughout body tissues
, RATIONALE: Volume of distribution (Vd) reflects the extent to which a drug
distributes into body compartments versus remaining in the plasma. A large Vd indicates
extensive tissue distribution; a small Vd suggests the drug remains primarily in the
plasma.
QUESTION 5
A nurse practitioner is prescribing a medication that is highly protein-bound.
Which patient condition would MOST likely increase free drug concentration and
risk of toxicity?
A. Hypertension
B. Hyperglycemia
C. Hypoalbuminemia
D. Hyperkalemia
E. Hypercalcemia
CORRECT ANSWER: C. Hypoalbuminemia
RATIONALE: Highly protein-bound drugs bind primarily to albumin. In
hypoalbuminemia (e.g., liver disease, malnutrition, nephrotic syndrome), fewer binding
sites are available, resulting in increased free (active) drug in circulation, raising the risk
of toxicity.
QUESTION 6
Which cytochrome P450 enzyme is responsible for metabolizing the largest
number of drugs currently in clinical use?
A. CYP1A2
B. CYP2C9
C. CYP2D6
D. CYP3A4
E. CYP2E1
CORRECT ANSWER: D. CYP3A4
, RATIONALE: CYP3A4 is the most abundantly expressed CYP enzyme in the liver
and small intestine and is responsible for metabolizing approximately 50% of all
clinically used drugs. It is a key site for drug–drug interactions.
QUESTION 7
A patient taking warfarin is started on rifampin. What pharmacokinetic interaction
should the nurse anticipate?
A. Decreased metabolism of warfarin leading to bleeding risk
B. Increased metabolism of warfarin leading to reduced anticoagulant effect
C. Decreased renal excretion of warfarin increasing INR
D. Enhanced protein binding of warfarin reducing free drug
E. No clinically significant interaction expected
CORRECT ANSWER: B. Increased metabolism of warfarin leading to reduced
anticoagulant effect
RATIONALE: Rifampin is a potent inducer of CYP enzymes, particularly CYP2C9,
which metabolizes warfarin. Enzyme induction increases warfarin breakdown,
decreasing its plasma concentration and anticoagulant effect, potentially increasing
clotting risk.
QUESTION 8
Which route of administration bypasses the first-pass effect entirely?
A. Oral
B. Sublingual
C. Rectal
D. Buccal
E. Both B and D
CORRECT ANSWER: E. Both B and D
RATIONALE: Sublingual and buccal routes deliver drugs directly into the highly
vascularized oral mucosa, allowing direct entry into systemic circulation and completely
Blueprint | Verified Questions & Answers |
Complete Study Guide 2026
UNIVERSITY OF ALABAMA — NUR 529
EXAMS 1–4 | VERIFIED QUESTIONS & ANSWERS
Complete Study Guide
QUESTION 1
Which pharmacokinetic process refers to the movement of a drug from its site of
administration into the bloodstream?
A. Distribution
B. Metabolism
C. Absorption
D. Excretion
E. Elimination
CORRECT ANSWER: C. Absorption
RATIONALE: Absorption is the process by which a drug moves from its site of
administration (e.g., GI tract, muscle, skin) into the systemic circulation. It precedes
distribution, metabolism, and excretion in the pharmacokinetic sequence.
QUESTION 2
Which of the following factors most significantly affects the bioavailability of an
orally administered drug?
A. Renal clearance rate
B. Protein binding in plasma
C. First-pass hepatic metabolism
D. Volume of distribution
E. Half-life of the drug
CORRECT ANSWER: C. First-pass hepatic metabolism
, RATIONALE: First-pass metabolism occurs in the liver before the drug reaches
systemic circulation, significantly reducing bioavailability. Drugs with high first-pass
effects (e.g., morphine, nitroglycerin) may require alternative routes or higher oral
doses.
QUESTION 3
A patient is prescribed a drug with a narrow therapeutic index. What is the MOST
important nursing consideration?
A. Administer the drug with food to enhance absorption
B. Monitor drug levels and patient response closely
C. Encourage increased fluid intake to speed excretion
D. Switch to an equivalent generic brand
E. Administer at the same time as antacids
CORRECT ANSWER: B. Monitor drug levels and patient response closely
RATIONALE: Drugs with a narrow therapeutic index (e.g., digoxin, warfarin,
lithium) have a small difference between therapeutic and toxic concentrations. Frequent
monitoring of serum drug levels and clinical response is essential to avoid toxicity or
subtherapeutic dosing.
QUESTION 4
Which of the following best describes the volume of distribution (Vd) of a drug?
A. The rate at which a drug is eliminated from the body
B. The fraction of drug that reaches systemic circulation unchanged
C. A measure of how widely a drug is distributed throughout body tissues
D. The concentration of drug in plasma at steady state
E. The time it takes for a drug to reach peak plasma concentration
CORRECT ANSWER: C. A measure of how widely a drug is distributed
throughout body tissues
, RATIONALE: Volume of distribution (Vd) reflects the extent to which a drug
distributes into body compartments versus remaining in the plasma. A large Vd indicates
extensive tissue distribution; a small Vd suggests the drug remains primarily in the
plasma.
QUESTION 5
A nurse practitioner is prescribing a medication that is highly protein-bound.
Which patient condition would MOST likely increase free drug concentration and
risk of toxicity?
A. Hypertension
B. Hyperglycemia
C. Hypoalbuminemia
D. Hyperkalemia
E. Hypercalcemia
CORRECT ANSWER: C. Hypoalbuminemia
RATIONALE: Highly protein-bound drugs bind primarily to albumin. In
hypoalbuminemia (e.g., liver disease, malnutrition, nephrotic syndrome), fewer binding
sites are available, resulting in increased free (active) drug in circulation, raising the risk
of toxicity.
QUESTION 6
Which cytochrome P450 enzyme is responsible for metabolizing the largest
number of drugs currently in clinical use?
A. CYP1A2
B. CYP2C9
C. CYP2D6
D. CYP3A4
E. CYP2E1
CORRECT ANSWER: D. CYP3A4
, RATIONALE: CYP3A4 is the most abundantly expressed CYP enzyme in the liver
and small intestine and is responsible for metabolizing approximately 50% of all
clinically used drugs. It is a key site for drug–drug interactions.
QUESTION 7
A patient taking warfarin is started on rifampin. What pharmacokinetic interaction
should the nurse anticipate?
A. Decreased metabolism of warfarin leading to bleeding risk
B. Increased metabolism of warfarin leading to reduced anticoagulant effect
C. Decreased renal excretion of warfarin increasing INR
D. Enhanced protein binding of warfarin reducing free drug
E. No clinically significant interaction expected
CORRECT ANSWER: B. Increased metabolism of warfarin leading to reduced
anticoagulant effect
RATIONALE: Rifampin is a potent inducer of CYP enzymes, particularly CYP2C9,
which metabolizes warfarin. Enzyme induction increases warfarin breakdown,
decreasing its plasma concentration and anticoagulant effect, potentially increasing
clotting risk.
QUESTION 8
Which route of administration bypasses the first-pass effect entirely?
A. Oral
B. Sublingual
C. Rectal
D. Buccal
E. Both B and D
CORRECT ANSWER: E. Both B and D
RATIONALE: Sublingual and buccal routes deliver drugs directly into the highly
vascularized oral mucosa, allowing direct entry into systemic circulation and completely
