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NURS 6521 Advanced Pharmacology Midterm
Exam 2026/2027 | Actual Exam Questions with
Verified Answers & Detailed Rationales | NGN
Grade A Study Guide
1. Absorption is affected by:
A. Route, pH, blood flow, GI motility, and surface area
B. Only the route of administration
C. Patient age and weight only
D. Time of day and food intake only
Correct Answer: A
Rationale: Drug absorption is influenced by multiple factors including the route of
administration, pH of the environment, blood flow to the absorption site,
gastrointestinal motility, and available surface area for absorption.
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2. The first-pass effect significantly reduces the bioavailability of:
A. Intravenously administered drugs
B. Orally administered drugs
C. Sublingually administered drugs
D. Transdermally administered drugs
Correct Answer: B
Rationale: The first-pass effect occurs when orally administered drugs are metabolized
in the liver before reaching systemic circulation, significantly reducing their
bioavailability.
3. Which form of a drug absorbs more readily across cell membranes?
A. Ionized form
B. Unionized form
C. Protein-bound form
D. Water-soluble form
Correct Answer: B
Rationale: Unionized (nonpolar) forms of drugs are lipophilic and can readily cross cell
membranes, while ionized forms are less able to penetrate lipid bilayers.
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4. Drug distribution is determined by which of the following factors? (Select all that
apply.)
A. Blood flow to tissues
B. Capillary permeability
C. Plasma protein binding
D. Lipid solubility
Correct Answer: A, B, C, D
Rationale: Drug distribution is influenced by regional blood flow, the permeability of
capillaries, the degree of plasma protein binding, and the drug's lipid solubility.
5. Highly protein-bound drugs such as warfarin may:
A. Have increased distribution to tissues
B. Compete with other drugs for binding sites
C. Be excreted more rapidly
D. Have no first-pass effect
Correct Answer: B
Rationale: Highly protein-bound drugs can compete with each other for binding sites on
plasma proteins such as albumin, potentially leading to increased free drug levels and
toxicity.
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6. Drug metabolism primarily occurs in which organ?
A. Kidney
B. Liver
C. Lungs
D. Intestines
Correct Answer: B
Rationale: The liver is the primary site of drug metabolism, where cytochrome P450
enzymes facilitate Phase I and Phase II metabolic reactions.
7. Phase I metabolism includes which of the following reactions? (Select all that apply.)
A. Oxidation
B. Reduction
C. Hydrolysis
D. Conjugation
Correct Answer: A, B, C
Rationale: Phase I metabolism involves oxidation, reduction, and hydrolysis reactions
that typically increase drug polarity. Phase II involves conjugation.
NURS 6521 Advanced Pharmacology Midterm
Exam 2026/2027 | Actual Exam Questions with
Verified Answers & Detailed Rationales | NGN
Grade A Study Guide
1. Absorption is affected by:
A. Route, pH, blood flow, GI motility, and surface area
B. Only the route of administration
C. Patient age and weight only
D. Time of day and food intake only
Correct Answer: A
Rationale: Drug absorption is influenced by multiple factors including the route of
administration, pH of the environment, blood flow to the absorption site,
gastrointestinal motility, and available surface area for absorption.
,2|Page
2. The first-pass effect significantly reduces the bioavailability of:
A. Intravenously administered drugs
B. Orally administered drugs
C. Sublingually administered drugs
D. Transdermally administered drugs
Correct Answer: B
Rationale: The first-pass effect occurs when orally administered drugs are metabolized
in the liver before reaching systemic circulation, significantly reducing their
bioavailability.
3. Which form of a drug absorbs more readily across cell membranes?
A. Ionized form
B. Unionized form
C. Protein-bound form
D. Water-soluble form
Correct Answer: B
Rationale: Unionized (nonpolar) forms of drugs are lipophilic and can readily cross cell
membranes, while ionized forms are less able to penetrate lipid bilayers.
,3|Page
4. Drug distribution is determined by which of the following factors? (Select all that
apply.)
A. Blood flow to tissues
B. Capillary permeability
C. Plasma protein binding
D. Lipid solubility
Correct Answer: A, B, C, D
Rationale: Drug distribution is influenced by regional blood flow, the permeability of
capillaries, the degree of plasma protein binding, and the drug's lipid solubility.
5. Highly protein-bound drugs such as warfarin may:
A. Have increased distribution to tissues
B. Compete with other drugs for binding sites
C. Be excreted more rapidly
D. Have no first-pass effect
Correct Answer: B
Rationale: Highly protein-bound drugs can compete with each other for binding sites on
plasma proteins such as albumin, potentially leading to increased free drug levels and
toxicity.
, 4|Page
6. Drug metabolism primarily occurs in which organ?
A. Kidney
B. Liver
C. Lungs
D. Intestines
Correct Answer: B
Rationale: The liver is the primary site of drug metabolism, where cytochrome P450
enzymes facilitate Phase I and Phase II metabolic reactions.
7. Phase I metabolism includes which of the following reactions? (Select all that apply.)
A. Oxidation
B. Reduction
C. Hydrolysis
D. Conjugation
Correct Answer: A, B, C
Rationale: Phase I metabolism involves oxidation, reduction, and hydrolysis reactions
that typically increase drug polarity. Phase II involves conjugation.
