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NSG 5240 Advanced Pharmacology MIDTERM
Exam QUESTIONS AND DETAILED SOLUTIONS
JUST RELEASED
NSG 5240 Advanced Pharmacology MIDTERM Exam, designed for advanced practice nursing students.
Each question includes a verified answer and a summarized rationale based on
pharmacokinetic/pharmacodynamic principles, drug classes, clinical indications, adverse effects, and
evidence-based prescribing guidelines.
Note on Exam Coverage: This midterm blueprint typically covers foundational principles (absorption,
distribution, metabolism, excretion), pharmacodynamics (receptors, agonists/antagonists), major drug
classes (antibiotics, cardiovascular drugs, CNS agents, autonomic nervous system drugs, anticoagulants),
and therapeutic decision-making for common acute and chronic conditions.
Domain 1: Pharmacokinetics (Questions 1–40)
1. A patient with chronic kidney disease (CKD) has a decreased glomerular filtration rate (GFR). Which
pharmacokinetic process is most directly affected, potentially leading to drug accumulation and toxicity?
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A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Correct Answer: D. Excretion via the kidneys is reduced when GFR declines, requiring dosage adjustment
for renally cleared drugs.
2. An 80-year-old patient with decreased serum albumin is prescribed warfarin. Which pharmacokinetic
parameter is most likely altered, increasing the risk of adverse effects?
A) Bioavailability
B) Volume of distribution for protein-bound drugs
C) Hepatic metabolism
D) Renal tubular secretion
Correct Answer: B. Hypoalbuminemia increases the free (unbound) fraction of highly protein-bound
drugs like warfarin, potentially enhancing effect and toxicity.
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3. A patient with acute liver failure is prescribed a medication that undergoes extensive first-pass
metabolism. How will this condition affect the drug’s oral bioavailability?
A) Bioavailability will decrease due to impaired gastric emptying
B) Bioavailability will increase because liver extraction is reduced
C) Bioavailability will remain unchanged
D) Bioavailability will decrease due to increased protein binding
Correct Answer: B. First-pass metabolism occurs in the liver; severe liver failure reduces this metabolism,
increasing oral bioavailability.
4. A patient is taking drug X, which is a weak base (pKa 8.4). If the patient develops metabolic alkalosis
(pH 7.55), how would the urine pH affect renal excretion of drug X?
A) Excretion increases because the drug becomes more ionized in alkaline urine
B) Excretion decreases because the drug becomes more non-ionized and is reabsorbed
C) Excretion remains the same
D) Excretion increases due to competition for transporters
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Correct Answer: B. Weak bases are more non-ionized in alkaline pH, favoring tubular reabsorption and
reducing urinary excretion.
5. A patient is started on rifampin, a potent CYP450 inducer, while taking oral contraceptives. What is
the expected clinical consequence?
A) Increased oral contraceptive efficacy
B) Reduced oral contraceptive efficacy and increased risk of breakthrough bleeding or pregnancy
C) No change in contraceptive efficacy
D) Increased risk of thromboembolism from the contraceptive
*Correct Answer: B. Rifampin induces CYP3A4, accelerating metabolism of estrogen/progestin, reducing
contraceptive effectiveness.*
6. Two weeks after starting sertraline (CYP2D6 substrate), a patient begins taking fluoxetine (a potent
CYP2D6 inhibitor). The nurse practitioner should anticipate:
A) Decreased sertraline levels and reduced efficacy
B) Increased sertraline levels and risk of serotonin toxicity
NSG 5240 Advanced Pharmacology MIDTERM
Exam QUESTIONS AND DETAILED SOLUTIONS
JUST RELEASED
NSG 5240 Advanced Pharmacology MIDTERM Exam, designed for advanced practice nursing students.
Each question includes a verified answer and a summarized rationale based on
pharmacokinetic/pharmacodynamic principles, drug classes, clinical indications, adverse effects, and
evidence-based prescribing guidelines.
Note on Exam Coverage: This midterm blueprint typically covers foundational principles (absorption,
distribution, metabolism, excretion), pharmacodynamics (receptors, agonists/antagonists), major drug
classes (antibiotics, cardiovascular drugs, CNS agents, autonomic nervous system drugs, anticoagulants),
and therapeutic decision-making for common acute and chronic conditions.
Domain 1: Pharmacokinetics (Questions 1–40)
1. A patient with chronic kidney disease (CKD) has a decreased glomerular filtration rate (GFR). Which
pharmacokinetic process is most directly affected, potentially leading to drug accumulation and toxicity?
, Page 2 of 135
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Correct Answer: D. Excretion via the kidneys is reduced when GFR declines, requiring dosage adjustment
for renally cleared drugs.
2. An 80-year-old patient with decreased serum albumin is prescribed warfarin. Which pharmacokinetic
parameter is most likely altered, increasing the risk of adverse effects?
A) Bioavailability
B) Volume of distribution for protein-bound drugs
C) Hepatic metabolism
D) Renal tubular secretion
Correct Answer: B. Hypoalbuminemia increases the free (unbound) fraction of highly protein-bound
drugs like warfarin, potentially enhancing effect and toxicity.
, Page 3 of 135
3. A patient with acute liver failure is prescribed a medication that undergoes extensive first-pass
metabolism. How will this condition affect the drug’s oral bioavailability?
A) Bioavailability will decrease due to impaired gastric emptying
B) Bioavailability will increase because liver extraction is reduced
C) Bioavailability will remain unchanged
D) Bioavailability will decrease due to increased protein binding
Correct Answer: B. First-pass metabolism occurs in the liver; severe liver failure reduces this metabolism,
increasing oral bioavailability.
4. A patient is taking drug X, which is a weak base (pKa 8.4). If the patient develops metabolic alkalosis
(pH 7.55), how would the urine pH affect renal excretion of drug X?
A) Excretion increases because the drug becomes more ionized in alkaline urine
B) Excretion decreases because the drug becomes more non-ionized and is reabsorbed
C) Excretion remains the same
D) Excretion increases due to competition for transporters
, Page 4 of 135
Correct Answer: B. Weak bases are more non-ionized in alkaline pH, favoring tubular reabsorption and
reducing urinary excretion.
5. A patient is started on rifampin, a potent CYP450 inducer, while taking oral contraceptives. What is
the expected clinical consequence?
A) Increased oral contraceptive efficacy
B) Reduced oral contraceptive efficacy and increased risk of breakthrough bleeding or pregnancy
C) No change in contraceptive efficacy
D) Increased risk of thromboembolism from the contraceptive
*Correct Answer: B. Rifampin induces CYP3A4, accelerating metabolism of estrogen/progestin, reducing
contraceptive effectiveness.*
6. Two weeks after starting sertraline (CYP2D6 substrate), a patient begins taking fluoxetine (a potent
CYP2D6 inhibitor). The nurse practitioner should anticipate:
A) Decreased sertraline levels and reduced efficacy
B) Increased sertraline levels and risk of serotonin toxicity
