Page 1 of 76
NU 578 Unit 1 Exam (2026/2027) |
Advanced Practice Nurses | University of
South Alabama - PDF
Q1. A nurse is preparing to administer an oral medication that
undergoes extensive first-pass metabolism. Which route would
the nurse expect the prescriber to order to bypass this effect?
a) Oral
b) Sublingual
c) Rectal
d) Intravenous
Answer: d) Intravenous
Rationale: First-pass effect refers to rapid hepatic inactivation
of certain oral drugs as they pass through the gut wall and
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liver via the portal circulation. IV administration bypasses the
hepatic portal system entirely, allowing the drug to reach
systemic circulation before hepatic metabolism .
Q2. Scenario: A patient with liver cirrhosis is prescribed a
highly protein-bound medication. Due to decreased albumin
levels, the nurse expects:
a) Decreased free drug concentration
b) Increased free drug concentration
c) No change in drug concentration
d) Decreased drug absorption
Answer: b) Increased free drug concentration
Rationale: Decreased albumin levels result in fewer protein-
binding sites, leading to a higher proportion of unbound (free)
drug. Free drug is pharmacologically active and can lead to
increased drug effect and toxicity. This is particularly
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important for highly protein-bound drugs (>90%) such as
warfarin, phenytoin, and diazepam .
Q3. A drug that is a weak acid with a pKa of 4.5 is
administered orally. In the stomach (pH 2), the drug will be:
a) Mostly ionized
b) Mostly non-ionized
c) Equally ionized and non-ionized
d) Precipitated
Answer: b) Mostly non-ionized
Rationale: Weak acids are non-ionized (lipophilic) in acidic
environments and ionized (hydrophilic) in basic environments.
Non-ionized drugs are more readily absorbed across cell
membranes. The Henderson-Hasselbalch equation explains this
relationship: pH = pKa + log [ionized]/[non-ionized] .
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Q4. Which factor would the advanced practice nurse
recognize as having the GREATEST influence on drug
absorption from the gastrointestinal tract?
a) Renal function
b) Hepatic metabolism
c) Gastric emptying time
d) Protein binding
Answer: c) Gastric emptying time
Rationale: Gastric emptying time significantly affects the rate
at which drugs reach the small intestine, where most absorption
occurs. Factors that slow gastric emptying (e.g., food,
anticholinergics) delay drug absorption .
Q5. Scenario: An APRN is prescribing a medication that is a
substrate for P-glycoprotein (PGP). The nurse understands that
PGP functions to:
a) Enhance drug absorption from the gut
NU 578 Unit 1 Exam (2026/2027) |
Advanced Practice Nurses | University of
South Alabama - PDF
Q1. A nurse is preparing to administer an oral medication that
undergoes extensive first-pass metabolism. Which route would
the nurse expect the prescriber to order to bypass this effect?
a) Oral
b) Sublingual
c) Rectal
d) Intravenous
Answer: d) Intravenous
Rationale: First-pass effect refers to rapid hepatic inactivation
of certain oral drugs as they pass through the gut wall and
,Page 2 of 76
liver via the portal circulation. IV administration bypasses the
hepatic portal system entirely, allowing the drug to reach
systemic circulation before hepatic metabolism .
Q2. Scenario: A patient with liver cirrhosis is prescribed a
highly protein-bound medication. Due to decreased albumin
levels, the nurse expects:
a) Decreased free drug concentration
b) Increased free drug concentration
c) No change in drug concentration
d) Decreased drug absorption
Answer: b) Increased free drug concentration
Rationale: Decreased albumin levels result in fewer protein-
binding sites, leading to a higher proportion of unbound (free)
drug. Free drug is pharmacologically active and can lead to
increased drug effect and toxicity. This is particularly
,Page 3 of 76
important for highly protein-bound drugs (>90%) such as
warfarin, phenytoin, and diazepam .
Q3. A drug that is a weak acid with a pKa of 4.5 is
administered orally. In the stomach (pH 2), the drug will be:
a) Mostly ionized
b) Mostly non-ionized
c) Equally ionized and non-ionized
d) Precipitated
Answer: b) Mostly non-ionized
Rationale: Weak acids are non-ionized (lipophilic) in acidic
environments and ionized (hydrophilic) in basic environments.
Non-ionized drugs are more readily absorbed across cell
membranes. The Henderson-Hasselbalch equation explains this
relationship: pH = pKa + log [ionized]/[non-ionized] .
, Page 4 of 76
Q4. Which factor would the advanced practice nurse
recognize as having the GREATEST influence on drug
absorption from the gastrointestinal tract?
a) Renal function
b) Hepatic metabolism
c) Gastric emptying time
d) Protein binding
Answer: c) Gastric emptying time
Rationale: Gastric emptying time significantly affects the rate
at which drugs reach the small intestine, where most absorption
occurs. Factors that slow gastric emptying (e.g., food,
anticholinergics) delay drug absorption .
Q5. Scenario: An APRN is prescribing a medication that is a
substrate for P-glycoprotein (PGP). The nurse understands that
PGP functions to:
a) Enhance drug absorption from the gut
