NURS 305 Pharmacology
Final Assessment Review
Questions & Solutions
2025
©2025
, 1. A 72‑year‑old patient with atrial fibrillation is started on clopidogrel.
Despite adherence to therapy, the patient suffers a transient ischemic
attack (TIA). Genetic testing reveals reduced CYP2C19 activity. Which
explanation best describes this clinical scenario?
A. The patient is a CYP2C19 ultra‑rapid metabolizer, leading to excessive
drug clearance.
B. The patient is a CYP2C19 poor metabolizer, resulting in insufficient
bioactivation of clopidogrel.
C. CYP3A4 induction by concomitant medications has reduced clopidogrel
efficacy.
D. Clopidogrel’s mechanism of action is not affected by CYP450
metabolism.
> Correct ANS: B. The patient is a CYP2C19 poor metabolizer,
resulting in insufficient bioactivation of clopidogrel.
> Rationale: Clopidogrel is a prodrug that requires biotransformation
by CYP2C19. Reduced enzyme activity (poor metabolizer status) leads to
subtherapeutic levels of the active metabolite, thereby diminishing the
antiplatelet effect and increasing the risk of thrombotic events.
---
2. A 45‑year‑old patient with moderate-to-severe chronic pain is
switched from codeine to an opioid analgesic after demonstrating poor
pain control. Pharmacogenomic testing reveals the patient is a CYP2D6
poor metabolizer. Which opioid is more appropriate for this patient?
A. Hydrocodone
B. Oxycodone
C. Morphine
D. Tramadol
> Correct ANS: C. Morphine
> Rationale: Codeine requires CYP2D6 for conversion to morphine and
©2025
,thus will be less effective in CYP2D6 poor metabolizers. Morphine, which
does not require biotransformation by CYP2D6 to achieve its analgesic
effect, is more suitable in patients with this genetic profile.
---
3. A patient receiving digoxin for heart failure is also prescribed
verapamil for rate control. Which pharmacokinetic interaction is most
concerning in this combination?
A. Verapamil induces hepatic enzymes, lowering digoxin levels.
B. Verapamil inhibits intestinal P‑glycoprotein, increasing digoxin
absorption.
C. Digoxin upregulates renal excretion pathways, reducing verapamil
effect.
D. Digoxin antagonizes the effects of verapamil at the cellular receptor
level.
> Correct ANS: B. Verapamil inhibits intestinal P‑glycoprotein,
increasing digoxin absorption.
> Rationale: Verapamil is known to inhibit P‑glycoprotein, the
transporter responsible for limiting digoxin absorption. This results in
higher circulating levels of digoxin, thereby increasing the risk of toxicity.
---
4. A patient with hyperlipidemia is initiated on a statin to reduce
cardiovascular risk. Which enzyme is inhibited by statins, and what is the
primary therapeutic benefit of this inhibition?
A. HMG‑CoA reductase; reducing low‑density lipoprotein (LDL) levels
B. Cyclooxygenase; reducing inflammation
C. Angiotensin‑converting enzyme; lowering blood pressure
D. Acetylcholinesterase; improving neural transmission
> Correct ANS: A. HMG‑CoA reductase; reducing low‑density
lipoprotein (LDL) levels.
©2025
, > Rationale: Statins inhibit HMG‑CoA reductase, the rate‑limiting
enzyme in cholesterol synthesis. This effects a decrease in LDL
cholesterol, which is associated with reduced atherosclerotic risk.
---
5. A 60‑year‑old patient with type 2 diabetes and hypertension is
started on an ACE inhibitor. Which laboratory parameter should the
nurse monitor closely during the early phase of treatment?
A. Serum sodium
B. Serum potassium
C. Blood glucose
D. Serum calcium
> Correct ANS: B. Serum potassium
> Rationale: ACE inhibitors can lead to hyperkalemia due to decreased
aldosterone secretion. Monitoring serum potassium is critical, especially
in older patients or those with renal impairment.
---
6. A new monoclonal antibody is developed for cancer treatment. Its
pharmacokinetic profile is described as having linear kinetics with low
renal clearance. Which elimination pathway most likely predominates for
this agent?
A. Biliary excretion
B. Proteolytic catabolism
C. Glomerular filtration
D. Unchanged fecal excretion
> Correct ANS: B. Proteolytic catabolism
> Rationale: Monoclonal antibodies are typically large proteins that are
not excreted by the kidneys but are instead degraded into peptides and
amino acids via proteolytic catabolism.
©2025
Final Assessment Review
Questions & Solutions
2025
©2025
, 1. A 72‑year‑old patient with atrial fibrillation is started on clopidogrel.
Despite adherence to therapy, the patient suffers a transient ischemic
attack (TIA). Genetic testing reveals reduced CYP2C19 activity. Which
explanation best describes this clinical scenario?
A. The patient is a CYP2C19 ultra‑rapid metabolizer, leading to excessive
drug clearance.
B. The patient is a CYP2C19 poor metabolizer, resulting in insufficient
bioactivation of clopidogrel.
C. CYP3A4 induction by concomitant medications has reduced clopidogrel
efficacy.
D. Clopidogrel’s mechanism of action is not affected by CYP450
metabolism.
> Correct ANS: B. The patient is a CYP2C19 poor metabolizer,
resulting in insufficient bioactivation of clopidogrel.
> Rationale: Clopidogrel is a prodrug that requires biotransformation
by CYP2C19. Reduced enzyme activity (poor metabolizer status) leads to
subtherapeutic levels of the active metabolite, thereby diminishing the
antiplatelet effect and increasing the risk of thrombotic events.
---
2. A 45‑year‑old patient with moderate-to-severe chronic pain is
switched from codeine to an opioid analgesic after demonstrating poor
pain control. Pharmacogenomic testing reveals the patient is a CYP2D6
poor metabolizer. Which opioid is more appropriate for this patient?
A. Hydrocodone
B. Oxycodone
C. Morphine
D. Tramadol
> Correct ANS: C. Morphine
> Rationale: Codeine requires CYP2D6 for conversion to morphine and
©2025
,thus will be less effective in CYP2D6 poor metabolizers. Morphine, which
does not require biotransformation by CYP2D6 to achieve its analgesic
effect, is more suitable in patients with this genetic profile.
---
3. A patient receiving digoxin for heart failure is also prescribed
verapamil for rate control. Which pharmacokinetic interaction is most
concerning in this combination?
A. Verapamil induces hepatic enzymes, lowering digoxin levels.
B. Verapamil inhibits intestinal P‑glycoprotein, increasing digoxin
absorption.
C. Digoxin upregulates renal excretion pathways, reducing verapamil
effect.
D. Digoxin antagonizes the effects of verapamil at the cellular receptor
level.
> Correct ANS: B. Verapamil inhibits intestinal P‑glycoprotein,
increasing digoxin absorption.
> Rationale: Verapamil is known to inhibit P‑glycoprotein, the
transporter responsible for limiting digoxin absorption. This results in
higher circulating levels of digoxin, thereby increasing the risk of toxicity.
---
4. A patient with hyperlipidemia is initiated on a statin to reduce
cardiovascular risk. Which enzyme is inhibited by statins, and what is the
primary therapeutic benefit of this inhibition?
A. HMG‑CoA reductase; reducing low‑density lipoprotein (LDL) levels
B. Cyclooxygenase; reducing inflammation
C. Angiotensin‑converting enzyme; lowering blood pressure
D. Acetylcholinesterase; improving neural transmission
> Correct ANS: A. HMG‑CoA reductase; reducing low‑density
lipoprotein (LDL) levels.
©2025
, > Rationale: Statins inhibit HMG‑CoA reductase, the rate‑limiting
enzyme in cholesterol synthesis. This effects a decrease in LDL
cholesterol, which is associated with reduced atherosclerotic risk.
---
5. A 60‑year‑old patient with type 2 diabetes and hypertension is
started on an ACE inhibitor. Which laboratory parameter should the
nurse monitor closely during the early phase of treatment?
A. Serum sodium
B. Serum potassium
C. Blood glucose
D. Serum calcium
> Correct ANS: B. Serum potassium
> Rationale: ACE inhibitors can lead to hyperkalemia due to decreased
aldosterone secretion. Monitoring serum potassium is critical, especially
in older patients or those with renal impairment.
---
6. A new monoclonal antibody is developed for cancer treatment. Its
pharmacokinetic profile is described as having linear kinetics with low
renal clearance. Which elimination pathway most likely predominates for
this agent?
A. Biliary excretion
B. Proteolytic catabolism
C. Glomerular filtration
D. Unchanged fecal excretion
> Correct ANS: B. Proteolytic catabolism
> Rationale: Monoclonal antibodies are typically large proteins that are
not excreted by the kidneys but are instead degraded into peptides and
amino acids via proteolytic catabolism.
©2025
