NUR 635 Advanced Pharmacology Final Exam ACTUAL EXAM 2026/2027 Version 1 2 3 | Advanced Pharmacology | Verified Q&A | Pass Guaranteed - A+ Graded

NUR 635 Advanced Pharmacology Final Exam
ACTUAL EXAM 2026/2027 Version 1 2 3 |
Advanced Pharmacology | Verified Q&A | Pass
Guaranteed - A+ Graded


VERSION 1 (50 Questions)

Section 1: Pharmacokinetics & Pharmacodynamics (10 Questions)
Q1: A 65-year-old patient with liver cirrhosis is prescribed a drug metabolized by CYP3A4. Which
pharmacokinetic change is most likely to occur?

 A. Increased drug metabolism

 B. Decreased drug metabolism leading to increased drug levels. [CORRECT]

 C. No change in drug metabolism

 D. Increased renal excretion Correct Answer: B Rationale: Liver disease impairs CYP450 enzyme
function, reducing drug metabolism and potentially causing drug accumulation and toxicity;
dosage reduction or alternative agents may be necessary.

Q2: A drug with a half-life of 8 hours is administered every 8 hours. How long will it take to reach steady
state?

 A. 8 hours

 B. 24 hours

 C. 40 hours. [CORRECT]

 D. 80 hours Correct Answer: C Rationale: Steady state is typically reached in 4-5 half-lives; with
an 8-hour half-life, steady state occurs in approximately 32-40 hours of regular dosing.

Q3: A patient taking warfarin (highly protein-bound) is prescribed aspirin, which displaces warfarin from
albumin. What is the initial pharmacodynamic effect?

 A. Decreased INR

 B. Increased free warfarin and enhanced anticoagulation. [CORRECT]

,  C. No change in anticoagulation

 D. Decreased warfarin absorption Correct Answer: B Rationale: Displacement from protein
binding increases free (active) drug concentration, temporarily enhancing anticoagulant effect
until metabolism and distribution re-equilibrate.

Q4: Which receptor type is activated by albuterol producing bronchodilation?

 A. Alpha-1 adrenergic receptors

 B. Beta-1 adrenergic receptors

 C. Beta-2 adrenergic receptors. [CORRECT]

 D. Muscarinic receptors Correct Answer: C Rationale: Albuterol is a selective beta-2 agonist;
beta-2 receptor activation relaxes bronchial smooth muscle, producing rapid bronchodilation in
asthma and COPD.

Q5: A drug with a therapeutic index of 2 is considered:

 A. Very safe

 B. Relatively unsafe with a narrow margin between effective and toxic doses. [CORRECT]

 C. Ineffective

 D. Highly protein-bound Correct Answer: B Rationale: A low therapeutic index (close to 1-2)
indicates a narrow safety margin; small dose increases may produce toxicity, requiring careful
monitoring (e.g., digoxin, lithium, warfarin).

Q6: First-pass metabolism primarily occurs in the:

 A. Kidneys

 B. Liver. [CORRECT]

 C. Lungs

 D. Stomach Correct Answer: B Rationale: Oral drugs absorbed through the GI tract enter the
portal circulation and pass through the liver before systemic circulation, where extensive
metabolism may significantly reduce bioavailability.

Q7: A drug that acts as a non-competitive antagonist at a receptor will:

 A. Bind reversibly and can be overcome by increasing agonist concentration

 B. Bind irreversibly or allosterically, reducing maximal response regardless of agonist
concentration. [CORRECT]

,  C. Produce the same effect as an agonist

 D. Have no effect on receptor function Correct Answer: B Rationale: Non-competitive
antagonists reduce the number of available receptors or their function, decreasing maximal
response; this cannot be overcome by increasing agonist concentration.

Q8: The volume of distribution (Vd) for a drug that is highly lipophilic and tissue-bound is typically:

 A. Very low

 B. Very high. [CORRECT]

 C. Equal to plasma volume

 D. Zero Correct Answer: B Rationale: Lipophilic drugs distribute extensively into fat and tissues,
creating a large apparent volume of distribution; loading doses must account for this extensive
tissue distribution.

Q9: A patient with renal failure (CrCl 20 mL/min) requires dosing adjustment for a drug primarily
eliminated by the kidneys. The general principle is to:

 A. Increase the dose and frequency

 B. Decrease the dose and/or extend the dosing interval. [CORRECT]

 C. No adjustment needed

 D. Switch to the IV route only Correct Answer: B Rationale: Reduced renal elimination increases
drug half-life and risk of accumulation; dosing adjustments (lower doses, extended intervals, or
both) prevent toxicity while maintaining efficacy.

Q10: Which CYP450 enzyme is responsible for metabolizing the largest number of clinically used drugs?

 A. CYP1A2

 B. CYP2C9

 C. CYP2D6

 D. CYP3A4. [CORRECT] Correct Answer: D Rationale: CYP3A4 metabolizes approximately 50% of
clinically used drugs; inhibitors (ketoconazole, grapefruit) or inducers (rifampin, carbamazepine)
significantly affect many medications.



Section 2: Autonomic Nervous System Pharmacology (10 Questions)

, Q1: A patient with bradycardia and hypotension after a myocardial infarction would benefit most from
which medication?

 A. Propranolol

 B. Atropine. [CORRECT]

 C. Prazosin

 D. Metoprolol Correct Answer: B Rationale: Atropine is an anticholinergic that blocks
parasympathetic (vagal) stimulation, increasing heart rate and improving hemodynamics in
symptomatic bradycardia.

Q2: A patient with benign prostatic hyperplasia and hypertension is prescribed tamsulosin. The primary
mechanism of action is:

 A. Beta-1 blockade

 B. Alpha-1A selective blockade causing smooth muscle relaxation. [CORRECT]

 C. ACE inhibition

 D. Calcium channel blockade Correct Answer: B Rationale: Tamsulosin selectively blocks alpha-
1A receptors in the prostate and bladder neck, reducing smooth muscle tone and improving
urinary flow with minimal blood pressure effects.

Q3: Which medication is a direct-acting cholinergic agonist used for glaucoma?

 A. Atropine

 B. Pilocarpine. [CORRECT]

 C. Epinephrine

 D. Propranolol Correct Answer: B Rationale: Pilocarpine is a direct muscarinic agonist that
increases aqueous humor outflow through trabecular meshwork contraction, reducing
intraocular pressure in glaucoma.

Q4: A patient receiving beta-blocker therapy develops bronchospasm. Which beta-blocker property
contributed to this adverse effect?

 A. Beta-1 selectivity

 B. Non-selective beta blockade affecting beta-2 receptors. [CORRECT]

 C. Alpha blockade