MARYVILLE UNIVERSITY NURS 615 —
COMPREHENSIVE EXAM
Advanced Pharmacology for Advanced Practice Nursing
200 MCQs (Advanced Level)
📋 EXAM COVERAGE DESCRIPTION
This exam covers the following core domains as assessed in NURS 615 at Maryville University:
Pharmacokinetics: Absorption, distribution, metabolism, excretion, bioavailability, half-
life, steady state
Pharmacodynamics: Receptor theory, agonists/antagonists, dose-response relationships,
therapeutic index
Autonomic Pharmacology: Cholinergic, adrenergic, sympathomimetic, and
parasympathomimetic agents
Cardiovascular Pharmacology: Antihypertensives, antiarrhythmics, heart failure drugs,
anticoagulants, lipid-lowering agents
Pulmonary Pharmacology: Bronchodilators, corticosteroids, leukotriene modifiers,
biologics
CNS Pharmacology: Antidepressants, antipsychotics, anxiolytics, mood stabilizers,
analgesics, anesthetics
Endocrine & Metabolic Pharmacology: Diabetes medications, thyroid drugs,
corticosteroids, HRT
Anti-infective Pharmacology: Antibiotics, antivirals, antifungals, antiparasitic agents
GI Pharmacology: Acid suppression, motility agents, IBD therapy, antiemetics
Musculoskeletal Pharmacology: NSAIDs, DMARDs, gout therapy, muscle relaxants
Hematologic Pharmacology: Anticoagulants, antiplatelets, thrombolytics, colony-
stimulating factors
Special Populations: Pediatric, geriatric, pregnancy, renal/hepatic impairment dosing
Drug Interactions & Adverse Effects: CYP450 system, pharmacogenomics, black box
warnings
NP Prescribing: DEA scheduling, evidence-based prescribing, patient education
Summary of Topics Covered:
Questions 1–10: Pharmacokinetics
Questions 11–15: Pharmacodynamics
Questions 16–20: Autonomic Pharmacology
Questions 21–30: Cardiovascular Pharmacology
, Questions 31–35: Pulmonary Pharmacology
Questions 36–45: CNS Pharmacology
Questions 46–50: Endocrine Pharmacology
Questions 51–58: Anti-infective Pharmacology
Questions 59–62: GI Pharmacology
Questions 63–65: Musculoskeletal Pharmacology
Questions 66–68: Hematologic Pharmacology
Questions 69–72: Special Populations
Questions 73–76: Drug Interactions & Adverse Effects
Questions 77–80: NP Prescribing Authority
Questions 81–200: Advanced Mixed Clinical Pharmacology
SECTION 1: PHARMACOKINETICS
1. A 68-year-old man with cirrhosis requires analgesia. Which pharmacokinetic parameter is
MOST affected by his liver disease, and what dosing adjustment is most appropriate?
A. Decreased renal clearance; reduce dose by 50% B. Decreased first-pass metabolism; reduce
dose and extend dosing interval ✅ (correct answer) C. Increased volume of distribution;
increase loading dose D. Decreased protein binding; decrease total daily dose only E. Increased
gastric emptying; administer drug with food only
Rationale: The liver is the primary site of first-pass metabolism. In cirrhosis, hepatic blood flow
and enzymatic function are both reduced, causing decreased first-pass metabolism and increased
bioavailability of orally administered drugs. This means more drug reaches systemic circulation
than intended, requiring dose reduction AND extended dosing intervals to prevent drug
accumulation. Opioids, benzodiazepines, and other highly metabolized drugs require careful
dose reduction in hepatic impairment.
2. A drug has a volume of distribution (Vd) of 600 L. Which of the following best characterizes
this drug?
A. It is primarily confined to the plasma compartment B. It is highly protein-bound in plasma C.
It is extensively distributed into peripheral tissues ✅ (correct answer) D. It has poor lipid
solubility E. It is renally eliminated without metabolism
Rationale: Volume of distribution (Vd) is a theoretical volume, not a real anatomical space. A
Vd of 600 L far exceeds total body water (~42 L), indicating the drug is extensively distributed
,into tissues (peripheral compartments — fat, muscle, organs). High Vd drugs are lipophilic,
protein-bound in tissues, and have low plasma concentrations relative to total body drug. Small
Vd (~5 L) = confined to plasma; ~15 L = extracellular fluid; ~42 L = total body water; >100 L =
extensive tissue distribution.
3. A patient takes Drug A, a CYP3A4 substrate, along with Drug B, a potent CYP3A4 inhibitor.
The expected pharmacokinetic outcome is:
A. Decreased plasma concentration of Drug A B. Increased metabolism of Drug A C. Increased
plasma concentration of Drug A with potential toxicity ✅ (correct answer) D. Increased renal
clearance of Drug A E. No significant interaction since metabolism and excretion are separate
processes
Rationale: CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, grapefruit juice, erythromycin)
reduce the metabolism of CYP3A4 substrates, causing accumulation of the substrate drug in
plasma. The result is elevated drug levels, prolonged drug effect, and potential dose-dependent
toxicity. This is one of the most clinically important drug interactions in pharmacology. The
opposite occurs with CYP3A4 inducers (e.g., rifampin, carbamazepine), which increase
metabolism and decrease drug levels.
4. The half-life (t½) of a drug is 8 hours. Approximately how long will it take to reach steady-
state plasma concentration with regular dosing?
A. 8 hours (1 half-life) B. 16 hours (2 half-lives) C. 24 hours (3 half-lives) D. 40 hours (5 half-
lives) ✅ (correct answer) E. 64 hours (8 half-lives)
Rationale: Steady state is reached after approximately 4–5 half-lives of regular dosing,
regardless of dose size. At 5 half-lives: ~97% of steady-state concentration is achieved. At 8-
hour half-life: 5 × 8 = 40 hours. The dose size affects the plateau concentration (higher dose =
higher steady state) but NOT the time to reach steady state. This principle applies to all drugs
following first-order kinetics and is essential for understanding loading doses, dosing intervals,
and accumulation.
5. A patient with a creatinine clearance of 20 mL/min is prescribed a renally cleared antibiotic
with a therapeutic index of 1.5. The MOST appropriate adjustment is:
A. Administer the standard dose since antibiotics don't require renal adjustments B. Increase the
dose to overcome reduced clearance C. Extend the dosing interval and/or reduce the dose based
on the degree of renal impairment ✅ (correct answer) D. Switch to the IV formulation, which
bypasses renal excretion E. Add a nephroprotective agent and continue the standard dose
, Rationale: For renally cleared drugs with narrow therapeutic indices (TI), renal impairment
significantly reduces drug elimination, causing accumulation and potential toxicity. With a CrCl
of 20 mL/min (severe impairment), the dosing interval must be extended, the dose reduced, or
both, based on the degree of renal function impairment (often using the Cockcroft-Gault or
CKD-EPI equation). A narrow TI (toxic dose close to therapeutic dose) makes this adjustment
critical to prevent toxicity.
6. Which route of drug administration has 100% bioavailability by definition?
A. Oral (PO) B. Sublingual (SL) C. Intramuscular (IM) D. Intravenous (IV) ✅ (correct
answer) E. Transdermal (TD)
Rationale: Intravenous (IV) administration delivers the drug directly into the systemic
circulation, bypassing all absorption barriers and the first-pass effect. By definition,
bioavailability = 100% (F = 1.0). All other routes have bioavailability less than 100% due to
incomplete absorption, first-pass metabolism, or both. This is why IV dosing is used as the
reference standard when calculating bioavailability of other formulations and why IV doses are
typically lower than oral doses.
7. A patient is prescribed a drug with zero-order kinetics. Which statement about this drug is
MOST accurate?
A. A constant fraction of the drug is eliminated per unit time B. Doubling the dose doubles the
elimination rate C. A constant amount of drug is eliminated per unit time, regardless of
concentration ✅ (correct answer) D. Elimination rate is proportional to plasma concentration
E. The drug reaches steady state after 5 half-lives
Rationale: Zero-order kinetics (saturation kinetics): a fixed amount of drug is eliminated per
unit time (not a fixed fraction). This occurs when metabolic pathways are saturated. Examples:
alcohol, phenytoin, aspirin (at high doses). Clinical implications: small dose increases can cause
disproportionate (non-linear) increases in plasma concentration, making toxicity unpredictable.
The concept of "half-life" does not apply. First-order kinetics (most drugs) = constant fraction
eliminated per unit time, linear relationship.
8. An NP prescribes a loading dose of a medication. The PRIMARY rationale for giving a
loading dose is:
A. To test the patient's drug tolerance before starting maintenance dosing B. To rapidly achieve
therapeutic plasma concentrations without waiting 4–5 half-lives ✅ (correct answer) C. To
COMPREHENSIVE EXAM
Advanced Pharmacology for Advanced Practice Nursing
200 MCQs (Advanced Level)
📋 EXAM COVERAGE DESCRIPTION
This exam covers the following core domains as assessed in NURS 615 at Maryville University:
Pharmacokinetics: Absorption, distribution, metabolism, excretion, bioavailability, half-
life, steady state
Pharmacodynamics: Receptor theory, agonists/antagonists, dose-response relationships,
therapeutic index
Autonomic Pharmacology: Cholinergic, adrenergic, sympathomimetic, and
parasympathomimetic agents
Cardiovascular Pharmacology: Antihypertensives, antiarrhythmics, heart failure drugs,
anticoagulants, lipid-lowering agents
Pulmonary Pharmacology: Bronchodilators, corticosteroids, leukotriene modifiers,
biologics
CNS Pharmacology: Antidepressants, antipsychotics, anxiolytics, mood stabilizers,
analgesics, anesthetics
Endocrine & Metabolic Pharmacology: Diabetes medications, thyroid drugs,
corticosteroids, HRT
Anti-infective Pharmacology: Antibiotics, antivirals, antifungals, antiparasitic agents
GI Pharmacology: Acid suppression, motility agents, IBD therapy, antiemetics
Musculoskeletal Pharmacology: NSAIDs, DMARDs, gout therapy, muscle relaxants
Hematologic Pharmacology: Anticoagulants, antiplatelets, thrombolytics, colony-
stimulating factors
Special Populations: Pediatric, geriatric, pregnancy, renal/hepatic impairment dosing
Drug Interactions & Adverse Effects: CYP450 system, pharmacogenomics, black box
warnings
NP Prescribing: DEA scheduling, evidence-based prescribing, patient education
Summary of Topics Covered:
Questions 1–10: Pharmacokinetics
Questions 11–15: Pharmacodynamics
Questions 16–20: Autonomic Pharmacology
Questions 21–30: Cardiovascular Pharmacology
, Questions 31–35: Pulmonary Pharmacology
Questions 36–45: CNS Pharmacology
Questions 46–50: Endocrine Pharmacology
Questions 51–58: Anti-infective Pharmacology
Questions 59–62: GI Pharmacology
Questions 63–65: Musculoskeletal Pharmacology
Questions 66–68: Hematologic Pharmacology
Questions 69–72: Special Populations
Questions 73–76: Drug Interactions & Adverse Effects
Questions 77–80: NP Prescribing Authority
Questions 81–200: Advanced Mixed Clinical Pharmacology
SECTION 1: PHARMACOKINETICS
1. A 68-year-old man with cirrhosis requires analgesia. Which pharmacokinetic parameter is
MOST affected by his liver disease, and what dosing adjustment is most appropriate?
A. Decreased renal clearance; reduce dose by 50% B. Decreased first-pass metabolism; reduce
dose and extend dosing interval ✅ (correct answer) C. Increased volume of distribution;
increase loading dose D. Decreased protein binding; decrease total daily dose only E. Increased
gastric emptying; administer drug with food only
Rationale: The liver is the primary site of first-pass metabolism. In cirrhosis, hepatic blood flow
and enzymatic function are both reduced, causing decreased first-pass metabolism and increased
bioavailability of orally administered drugs. This means more drug reaches systemic circulation
than intended, requiring dose reduction AND extended dosing intervals to prevent drug
accumulation. Opioids, benzodiazepines, and other highly metabolized drugs require careful
dose reduction in hepatic impairment.
2. A drug has a volume of distribution (Vd) of 600 L. Which of the following best characterizes
this drug?
A. It is primarily confined to the plasma compartment B. It is highly protein-bound in plasma C.
It is extensively distributed into peripheral tissues ✅ (correct answer) D. It has poor lipid
solubility E. It is renally eliminated without metabolism
Rationale: Volume of distribution (Vd) is a theoretical volume, not a real anatomical space. A
Vd of 600 L far exceeds total body water (~42 L), indicating the drug is extensively distributed
,into tissues (peripheral compartments — fat, muscle, organs). High Vd drugs are lipophilic,
protein-bound in tissues, and have low plasma concentrations relative to total body drug. Small
Vd (~5 L) = confined to plasma; ~15 L = extracellular fluid; ~42 L = total body water; >100 L =
extensive tissue distribution.
3. A patient takes Drug A, a CYP3A4 substrate, along with Drug B, a potent CYP3A4 inhibitor.
The expected pharmacokinetic outcome is:
A. Decreased plasma concentration of Drug A B. Increased metabolism of Drug A C. Increased
plasma concentration of Drug A with potential toxicity ✅ (correct answer) D. Increased renal
clearance of Drug A E. No significant interaction since metabolism and excretion are separate
processes
Rationale: CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, grapefruit juice, erythromycin)
reduce the metabolism of CYP3A4 substrates, causing accumulation of the substrate drug in
plasma. The result is elevated drug levels, prolonged drug effect, and potential dose-dependent
toxicity. This is one of the most clinically important drug interactions in pharmacology. The
opposite occurs with CYP3A4 inducers (e.g., rifampin, carbamazepine), which increase
metabolism and decrease drug levels.
4. The half-life (t½) of a drug is 8 hours. Approximately how long will it take to reach steady-
state plasma concentration with regular dosing?
A. 8 hours (1 half-life) B. 16 hours (2 half-lives) C. 24 hours (3 half-lives) D. 40 hours (5 half-
lives) ✅ (correct answer) E. 64 hours (8 half-lives)
Rationale: Steady state is reached after approximately 4–5 half-lives of regular dosing,
regardless of dose size. At 5 half-lives: ~97% of steady-state concentration is achieved. At 8-
hour half-life: 5 × 8 = 40 hours. The dose size affects the plateau concentration (higher dose =
higher steady state) but NOT the time to reach steady state. This principle applies to all drugs
following first-order kinetics and is essential for understanding loading doses, dosing intervals,
and accumulation.
5. A patient with a creatinine clearance of 20 mL/min is prescribed a renally cleared antibiotic
with a therapeutic index of 1.5. The MOST appropriate adjustment is:
A. Administer the standard dose since antibiotics don't require renal adjustments B. Increase the
dose to overcome reduced clearance C. Extend the dosing interval and/or reduce the dose based
on the degree of renal impairment ✅ (correct answer) D. Switch to the IV formulation, which
bypasses renal excretion E. Add a nephroprotective agent and continue the standard dose
, Rationale: For renally cleared drugs with narrow therapeutic indices (TI), renal impairment
significantly reduces drug elimination, causing accumulation and potential toxicity. With a CrCl
of 20 mL/min (severe impairment), the dosing interval must be extended, the dose reduced, or
both, based on the degree of renal function impairment (often using the Cockcroft-Gault or
CKD-EPI equation). A narrow TI (toxic dose close to therapeutic dose) makes this adjustment
critical to prevent toxicity.
6. Which route of drug administration has 100% bioavailability by definition?
A. Oral (PO) B. Sublingual (SL) C. Intramuscular (IM) D. Intravenous (IV) ✅ (correct
answer) E. Transdermal (TD)
Rationale: Intravenous (IV) administration delivers the drug directly into the systemic
circulation, bypassing all absorption barriers and the first-pass effect. By definition,
bioavailability = 100% (F = 1.0). All other routes have bioavailability less than 100% due to
incomplete absorption, first-pass metabolism, or both. This is why IV dosing is used as the
reference standard when calculating bioavailability of other formulations and why IV doses are
typically lower than oral doses.
7. A patient is prescribed a drug with zero-order kinetics. Which statement about this drug is
MOST accurate?
A. A constant fraction of the drug is eliminated per unit time B. Doubling the dose doubles the
elimination rate C. A constant amount of drug is eliminated per unit time, regardless of
concentration ✅ (correct answer) D. Elimination rate is proportional to plasma concentration
E. The drug reaches steady state after 5 half-lives
Rationale: Zero-order kinetics (saturation kinetics): a fixed amount of drug is eliminated per
unit time (not a fixed fraction). This occurs when metabolic pathways are saturated. Examples:
alcohol, phenytoin, aspirin (at high doses). Clinical implications: small dose increases can cause
disproportionate (non-linear) increases in plasma concentration, making toxicity unpredictable.
The concept of "half-life" does not apply. First-order kinetics (most drugs) = constant fraction
eliminated per unit time, linear relationship.
8. An NP prescribes a loading dose of a medication. The PRIMARY rationale for giving a
loading dose is:
A. To test the patient's drug tolerance before starting maintenance dosing B. To rapidly achieve
therapeutic plasma concentrations without waiting 4–5 half-lives ✅ (correct answer) C. To
