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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] .
,Page 2 of 77
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 3 of 77
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 4 of 77
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] .
