NURS 180 | Pharmacology Exam 1 Study Guide | 2026 Update WCU
1. A patient with liver cirrhosis has low albumin levels. When administering a
drug that is 98% protein-bound, the nurse should monitor for which effect?
A. Decreased drug metabolism in the kidneys
B. Faster excretion of the drug via the biliary system
C. Reduced therapeutic effect of the drug
D. Increased risk of drug toxicity due to more free drug
Answer: D
Rationale: Low albumin levels result in fewer binding sites for protein-bound drugs. This
leads to an increase in the ‘free’ or active fraction of the drug, significantly increasing the
risk of toxicity.
2. Which process of pharmacokinetics is most directly affected by the ‘First-Pass
Effect’?
A. Distribution
B. Excretion
C. Absorption
D. Metabolism
Answer: D
Rationale: The first-pass effect refers to the rapid hepatic metabolism of a drug after it is
absorbed from the GI tract and carried to the liver via the portal vein, reducing its
bioavailability.
,3. A drug has a half-life of 4 hours. If a patient receives a dose of 400 mg at
0800, how much of the drug will remain in the body at 2000?
A. 100 mg
B. 50 mg
C. 25 mg
D. 12.5 mg
Answer: B
Rationale: From 0800 to 2000 is 12 hours (3 half-lives). After 4 hours: 200mg; after 8
hours: 100mg; after 12 hours: 50mg.
4. When a drug acts as an ‘agonist’ at a receptor site, what is its primary
function?
A. To block the endogenous ligand from binding
B. To permanently deactivate the receptor
C. To bind to the receptor and stimulate a biological response
D. To decrease the sensitivity of the receptor to other drugs
Answer: C
Rationale: An agonist mimics the action of endogenous substances by binding to a
receptor and triggering a physiological response.
5. Which pharmacokinetic change is expected in a geriatric patient due to age-
related physiological changes?
A. Increased glomerular filtration rate (GFR)
B. Decreased hepatic blood flow and enzyme activity
C. Decreased percentage of body fat
D. Increased serum albumin levels
Answer: B
, Rationale: Aging typically leads to reduced hepatic blood flow and a decline in microsomal
enzyme activity, which slows down drug metabolism and increases the half-life of many
medications.
6. The nurse is monitoring a patient for ‘Tachyphylaxis.’ Which scenario best
describes this phenomenon?
A. The accumulation of a drug leading to organ damage
B. An allergic reaction occurring after the first dose
C. A gradual need for higher doses over months of therapy
D. A rapid decrease in response to a drug after repeated doses
Answer: D
Rationale: Tachyphylaxis is an acute, sudden decrease in response to a drug after its
administration, essentially a rapid form of tolerance.
7. A patient is taking a drug that is a known ‘Enzyme Inducer’ of the Cytochrome
P450 system. What is the most likely clinical outcome for a second drug
metabolized by the same system?
A. The second drug will have a decreased therapeutic effect
B. The second drug will reach toxic levels faster
C. The second drug will have its metabolism inhibited
D. The second drug’s half-life will be significantly prolonged
Answer: A
Rationale: Enzyme inducers speed up the metabolism of other drugs, leading to lower
plasma concentrations and reduced therapeutic effectiveness.
1. A patient with liver cirrhosis has low albumin levels. When administering a
drug that is 98% protein-bound, the nurse should monitor for which effect?
A. Decreased drug metabolism in the kidneys
B. Faster excretion of the drug via the biliary system
C. Reduced therapeutic effect of the drug
D. Increased risk of drug toxicity due to more free drug
Answer: D
Rationale: Low albumin levels result in fewer binding sites for protein-bound drugs. This
leads to an increase in the ‘free’ or active fraction of the drug, significantly increasing the
risk of toxicity.
2. Which process of pharmacokinetics is most directly affected by the ‘First-Pass
Effect’?
A. Distribution
B. Excretion
C. Absorption
D. Metabolism
Answer: D
Rationale: The first-pass effect refers to the rapid hepatic metabolism of a drug after it is
absorbed from the GI tract and carried to the liver via the portal vein, reducing its
bioavailability.
,3. A drug has a half-life of 4 hours. If a patient receives a dose of 400 mg at
0800, how much of the drug will remain in the body at 2000?
A. 100 mg
B. 50 mg
C. 25 mg
D. 12.5 mg
Answer: B
Rationale: From 0800 to 2000 is 12 hours (3 half-lives). After 4 hours: 200mg; after 8
hours: 100mg; after 12 hours: 50mg.
4. When a drug acts as an ‘agonist’ at a receptor site, what is its primary
function?
A. To block the endogenous ligand from binding
B. To permanently deactivate the receptor
C. To bind to the receptor and stimulate a biological response
D. To decrease the sensitivity of the receptor to other drugs
Answer: C
Rationale: An agonist mimics the action of endogenous substances by binding to a
receptor and triggering a physiological response.
5. Which pharmacokinetic change is expected in a geriatric patient due to age-
related physiological changes?
A. Increased glomerular filtration rate (GFR)
B. Decreased hepatic blood flow and enzyme activity
C. Decreased percentage of body fat
D. Increased serum albumin levels
Answer: B
, Rationale: Aging typically leads to reduced hepatic blood flow and a decline in microsomal
enzyme activity, which slows down drug metabolism and increases the half-life of many
medications.
6. The nurse is monitoring a patient for ‘Tachyphylaxis.’ Which scenario best
describes this phenomenon?
A. The accumulation of a drug leading to organ damage
B. An allergic reaction occurring after the first dose
C. A gradual need for higher doses over months of therapy
D. A rapid decrease in response to a drug after repeated doses
Answer: D
Rationale: Tachyphylaxis is an acute, sudden decrease in response to a drug after its
administration, essentially a rapid form of tolerance.
7. A patient is taking a drug that is a known ‘Enzyme Inducer’ of the Cytochrome
P450 system. What is the most likely clinical outcome for a second drug
metabolized by the same system?
A. The second drug will have a decreased therapeutic effect
B. The second drug will reach toxic levels faster
C. The second drug will have its metabolism inhibited
D. The second drug’s half-life will be significantly prolonged
Answer: A
Rationale: Enzyme inducers speed up the metabolism of other drugs, leading to lower
plasma concentrations and reduced therapeutic effectiveness.
