NursiNg 527 Wilkes exam QuesTiONs aND aNsWers WiTH
raTiONales/graDeD a+/2026 uPDaTe/100% COrreCT
/iNsTaNT DOWNlOaD
Section 1: Advanced Pharmacology – Pharmacokinetics and Pharmacodynamics
Questions 1 to 20
**Question 1**
A patient with liver cirrhosis is prescribed a medication that is extensively metabolized
by the liver. The nurse practitioner anticipates that the prescriber will:
A. Increase the dose to achieve therapeutic effect
B. Decrease the dose or prolong the dosing interval ✓
C. Change the route to intramuscular
D. Add a second drug to enhance metabolism
**Correct Answer: B ✓**
Rationale: Liver disease reduces hepatic metabolism, leading to drug accumulation and
toxicity. Dose reduction or extended dosing intervals are required to prevent adverse
effects. Increasing the dose (A) would worsen toxicity. Changing the route (C) does not
address reduced metabolism. Adding another drug (D) would increase the risk of drug
interactions.
---
**Question 2**
A drug with a narrow therapeutic index requires:
A. No special monitoring
, B. Regular monitoring of serum drug levels to maintain therapeutic range and avoid
toxicity ✓
C. Only once-daily dosing
D. Administration with food only
**Correct Answer: B ✓**
Rationale: Drugs with a narrow therapeutic index (e.g., warfarin, digoxin, phenytoin,
lithium, vancomycin) have a small margin between therapeutic and toxic doses. Regular
monitoring of serum drug levels (peak and trough) is essential to ensure efficacy and
prevent toxicity. Option A is incorrect. Options C and D are not universally applicable.
---
**Question 3**
The term "first-pass metabolism" refers to:
A. Metabolism of a drug by the kidneys
B. The initial metabolism of an orally administered drug by the liver before it reaches
systemic circulation ✓
C. Excretion of a drug through the lungs
D. Binding of a drug to plasma proteins
**Correct Answer: B ✓**
Rationale: First-pass metabolism occurs when an orally administered drug is absorbed
from the GI tract and transported via the portal vein to the liver, where a significant
portion is metabolized before reaching systemic circulation. This reduces
bioavailability. IV and sublingual routes bypass first-pass metabolism.
---
raTiONales/graDeD a+/2026 uPDaTe/100% COrreCT
/iNsTaNT DOWNlOaD
Section 1: Advanced Pharmacology – Pharmacokinetics and Pharmacodynamics
Questions 1 to 20
**Question 1**
A patient with liver cirrhosis is prescribed a medication that is extensively metabolized
by the liver. The nurse practitioner anticipates that the prescriber will:
A. Increase the dose to achieve therapeutic effect
B. Decrease the dose or prolong the dosing interval ✓
C. Change the route to intramuscular
D. Add a second drug to enhance metabolism
**Correct Answer: B ✓**
Rationale: Liver disease reduces hepatic metabolism, leading to drug accumulation and
toxicity. Dose reduction or extended dosing intervals are required to prevent adverse
effects. Increasing the dose (A) would worsen toxicity. Changing the route (C) does not
address reduced metabolism. Adding another drug (D) would increase the risk of drug
interactions.
---
**Question 2**
A drug with a narrow therapeutic index requires:
A. No special monitoring
, B. Regular monitoring of serum drug levels to maintain therapeutic range and avoid
toxicity ✓
C. Only once-daily dosing
D. Administration with food only
**Correct Answer: B ✓**
Rationale: Drugs with a narrow therapeutic index (e.g., warfarin, digoxin, phenytoin,
lithium, vancomycin) have a small margin between therapeutic and toxic doses. Regular
monitoring of serum drug levels (peak and trough) is essential to ensure efficacy and
prevent toxicity. Option A is incorrect. Options C and D are not universally applicable.
---
**Question 3**
The term "first-pass metabolism" refers to:
A. Metabolism of a drug by the kidneys
B. The initial metabolism of an orally administered drug by the liver before it reaches
systemic circulation ✓
C. Excretion of a drug through the lungs
D. Binding of a drug to plasma proteins
**Correct Answer: B ✓**
Rationale: First-pass metabolism occurs when an orally administered drug is absorbed
from the GI tract and transported via the portal vein to the liver, where a significant
portion is metabolized before reaching systemic circulation. This reduces
bioavailability. IV and sublingual routes bypass first-pass metabolism.
---
