NUR 6011/NUR6011 Exam 2 V3 | Advance
Pharmacology Q&A with Rationale |
William Paterson University
1. A patient with chronic kidney disease is prescribed a medication that is primarily excreted
renally. What adjustment should the clinician anticipate?
A. Decrease the dose or increase the dosing interval
B. Increase the dose frequency
C. Change the route to intramuscular
D. Maintain the standard adult dose
Correct Answer: A
Expert Explanation: Renal impairment reduces the clearance of medications excreted by
the kidneys, leading to potential toxicity. Adjusting the dose downward or extending the
interval between doses ensures that plasma concentrations remain within a safe
therapeutic range. Monitoring serum creatinine and estimated glomerular filtration rate is
essential in these patients.
2. Which of the following best describes the ‘first-pass effect’ in pharmacology?
A. The rapid distribution of a drug to the brain
B. The metabolism of an oral drug in the liver before reaching systemic circulation
C. The excretion of a drug by the lungs
,D. The binding of a drug to plasma proteins in the blood
Correct Answer: B
Expert Explanation: The first-pass effect occurs when an orally administered drug is
absorbed from the GI tract and enters the portal circulation. The liver metabolizes a
significant portion of the drug before it can reach the rest of the body. This process
significantly reduces the bioavailability of many oral medications compared to intravenous
administration.
3. An elderly patient is prescribed a drug with a high volume of distribution (Vd). How does
aging typically affect this parameter for lipophilic drugs?
A. Vd decreases due to increased muscle mass
B. Vd decreases due to increased total body water
C. Vd remains unchanged regardless of body composition
D. Vd increases due to an increase in total body fat percentage
Correct Answer: D
Expert Explanation: As individuals age, they generally experience an increase in body fat
and a decrease in total body water and lean muscle mass. Lipophilic drugs distribute more
extensively into adipose tissue, leading to an increased volume of distribution and a longer
half-life. Clinicians must account for these physiological changes to avoid drug
accumulation and toxicity in older adults.
, 4. A patient taking Lisinopril for hypertension develops a dry, non-productive cough. What is
the physiological cause of this side effect?
A. Inhibition of surfactant production
B. Accumulation of bradykinin in the lungs
C. Direct irritation of the bronchial mucosa by the drug
D. Increased levels of angiotensin II
Correct Answer: B
Expert Explanation: ACE inhibitors prevent the breakdown of bradykinin, a potent
vasodilator and inflammatory mediator. The accumulation of bradykinin in the respiratory
tract triggers the cough reflex in susceptible individuals. If the cough becomes intolerable,
the patient is typically switched to an Angiotensin II Receptor Blocker (ARB) which does
not affect bradykinin metabolism.
5. Which laboratory value is most critical to monitor for a patient newly started on
Spironolactone?
A. Serum Potassium
B. Serum Sodium
C. Blood Urea Nitrogen (BUN)
D. Serum Calcium
Correct Answer: A
Pharmacology Q&A with Rationale |
William Paterson University
1. A patient with chronic kidney disease is prescribed a medication that is primarily excreted
renally. What adjustment should the clinician anticipate?
A. Decrease the dose or increase the dosing interval
B. Increase the dose frequency
C. Change the route to intramuscular
D. Maintain the standard adult dose
Correct Answer: A
Expert Explanation: Renal impairment reduces the clearance of medications excreted by
the kidneys, leading to potential toxicity. Adjusting the dose downward or extending the
interval between doses ensures that plasma concentrations remain within a safe
therapeutic range. Monitoring serum creatinine and estimated glomerular filtration rate is
essential in these patients.
2. Which of the following best describes the ‘first-pass effect’ in pharmacology?
A. The rapid distribution of a drug to the brain
B. The metabolism of an oral drug in the liver before reaching systemic circulation
C. The excretion of a drug by the lungs
,D. The binding of a drug to plasma proteins in the blood
Correct Answer: B
Expert Explanation: The first-pass effect occurs when an orally administered drug is
absorbed from the GI tract and enters the portal circulation. The liver metabolizes a
significant portion of the drug before it can reach the rest of the body. This process
significantly reduces the bioavailability of many oral medications compared to intravenous
administration.
3. An elderly patient is prescribed a drug with a high volume of distribution (Vd). How does
aging typically affect this parameter for lipophilic drugs?
A. Vd decreases due to increased muscle mass
B. Vd decreases due to increased total body water
C. Vd remains unchanged regardless of body composition
D. Vd increases due to an increase in total body fat percentage
Correct Answer: D
Expert Explanation: As individuals age, they generally experience an increase in body fat
and a decrease in total body water and lean muscle mass. Lipophilic drugs distribute more
extensively into adipose tissue, leading to an increased volume of distribution and a longer
half-life. Clinicians must account for these physiological changes to avoid drug
accumulation and toxicity in older adults.
, 4. A patient taking Lisinopril for hypertension develops a dry, non-productive cough. What is
the physiological cause of this side effect?
A. Inhibition of surfactant production
B. Accumulation of bradykinin in the lungs
C. Direct irritation of the bronchial mucosa by the drug
D. Increased levels of angiotensin II
Correct Answer: B
Expert Explanation: ACE inhibitors prevent the breakdown of bradykinin, a potent
vasodilator and inflammatory mediator. The accumulation of bradykinin in the respiratory
tract triggers the cough reflex in susceptible individuals. If the cough becomes intolerable,
the patient is typically switched to an Angiotensin II Receptor Blocker (ARB) which does
not affect bradykinin metabolism.
5. Which laboratory value is most critical to monitor for a patient newly started on
Spironolactone?
A. Serum Potassium
B. Serum Sodium
C. Blood Urea Nitrogen (BUN)
D. Serum Calcium
Correct Answer: A
