NURS 180 | Pharmacology | Exam 1 Advanced Review 2026 |WCU
1. A patient with liver cirrhosis is prescribed a drug that is highly protein-bound.
What is the primary pharmacokinetic concern for this patient?
A. There will be an increase in the free, active fraction of the drug, increasing toxicity risk.
B. The drug will be absorbed more slowly in the GI tract.
C. The drug will be excreted more rapidly by the kidneys.
D. The drug will be unable to cross the blood-brain barrier.
Answer: A
Rationale: In patients with liver disease, albumin levels decrease. Since highly protein-
bound drugs compete for binding sites, lower albumin levels result in more free drug
circulating in the plasma, potentially leading to toxic effects.
2. Which statement best describes the ‘First-Pass Effect’ in pharmacology?
A. The initial metabolism of a drug in the liver before it reaches systemic circulation.
B. The time it takes for a drug to reach its peak therapeutic level.
C. The process of a drug moving from the blood into the tissues.
D. The excretion of a drug via the biliary system into the feces.
Answer: A
Rationale: The first-pass effect occurs when an oral drug is absorbed from the GI tract into
the portal vein and metabolized by the liver before reaching the rest of the body,
significantly reducing its bioavailability.
,3. A drug has a half-life of 4 hours. If a dose of 1000 mg is administered, how
much of the drug will remain in the body after 12 hours?
A. 500 mg
B. 250 mg
C. 62.5 mg
D. 125 mg
Answer: D
Rationale: After 4 hours (1 half-life), 500 mg remains. After 8 hours (2 half-lives), 250 mg
remains. After 12 hours (3 half-lives), 125 mg remains.
4. When administering a drug with a narrow therapeutic index, the nurse should
prioritize which action?
A. Checking the patient’s blood pressure every 15 minutes.
B. Administering the drug with food to prevent GI upset.
C. Encouraging the patient to increase fluid intake.
D. Monitoring serum drug levels closely.
Answer: D
Rationale: A narrow therapeutic index means the difference between a therapeutic dose
and a toxic dose is very small, requiring precise monitoring of blood levels.
5. Which of the following describes a drug that acts as a ‘partial agonist’?
A. It binds to a receptor but produces no response.
B. It binds to a receptor and produces a maximal response.
C. It binds to a receptor and produces a response that is less than that of a full agonist.
D. It prevents other drugs from binding to the receptor.
Answer: C
Rationale: Partial agonists have moderate intrinsic activity, meaning they bind to
receptors but only produce a sub-maximal biological response compared to full agonists.
, 6. What is the primary site for drug metabolism in the human body?
A. Kidneys
B. Small Intestine
C. Liver
D. Lungs
Answer: C
Rationale: The liver is the primary organ responsible for drug metabolism, utilizing the
cytochrome P450 enzyme system.
7. A patient is receiving an intravenous (IV) medication. What is the
bioavailability of this drug?
A. 25%
B. 100%
C. 75%
D. 50%
Answer: B
Rationale: Bioavailability is the fraction of an administered dose that reaches systemic
circulation. IV administration bypasses absorption barriers, resulting in 100%
bioavailability.
8. Which physiological change in geriatric patients most significantly impacts
drug distribution?
A. Increased total body water
B. Decreased body fat percentage
C. Increased glomerular filtration rate
D. Decreased serum albumin levels
Answer: D
Rationale: Older adults often have decreased albumin production, which affects the
distribution of protein-bound drugs, increasing the risk of toxicity.
1. A patient with liver cirrhosis is prescribed a drug that is highly protein-bound.
What is the primary pharmacokinetic concern for this patient?
A. There will be an increase in the free, active fraction of the drug, increasing toxicity risk.
B. The drug will be absorbed more slowly in the GI tract.
C. The drug will be excreted more rapidly by the kidneys.
D. The drug will be unable to cross the blood-brain barrier.
Answer: A
Rationale: In patients with liver disease, albumin levels decrease. Since highly protein-
bound drugs compete for binding sites, lower albumin levels result in more free drug
circulating in the plasma, potentially leading to toxic effects.
2. Which statement best describes the ‘First-Pass Effect’ in pharmacology?
A. The initial metabolism of a drug in the liver before it reaches systemic circulation.
B. The time it takes for a drug to reach its peak therapeutic level.
C. The process of a drug moving from the blood into the tissues.
D. The excretion of a drug via the biliary system into the feces.
Answer: A
Rationale: The first-pass effect occurs when an oral drug is absorbed from the GI tract into
the portal vein and metabolized by the liver before reaching the rest of the body,
significantly reducing its bioavailability.
,3. A drug has a half-life of 4 hours. If a dose of 1000 mg is administered, how
much of the drug will remain in the body after 12 hours?
A. 500 mg
B. 250 mg
C. 62.5 mg
D. 125 mg
Answer: D
Rationale: After 4 hours (1 half-life), 500 mg remains. After 8 hours (2 half-lives), 250 mg
remains. After 12 hours (3 half-lives), 125 mg remains.
4. When administering a drug with a narrow therapeutic index, the nurse should
prioritize which action?
A. Checking the patient’s blood pressure every 15 minutes.
B. Administering the drug with food to prevent GI upset.
C. Encouraging the patient to increase fluid intake.
D. Monitoring serum drug levels closely.
Answer: D
Rationale: A narrow therapeutic index means the difference between a therapeutic dose
and a toxic dose is very small, requiring precise monitoring of blood levels.
5. Which of the following describes a drug that acts as a ‘partial agonist’?
A. It binds to a receptor but produces no response.
B. It binds to a receptor and produces a maximal response.
C. It binds to a receptor and produces a response that is less than that of a full agonist.
D. It prevents other drugs from binding to the receptor.
Answer: C
Rationale: Partial agonists have moderate intrinsic activity, meaning they bind to
receptors but only produce a sub-maximal biological response compared to full agonists.
, 6. What is the primary site for drug metabolism in the human body?
A. Kidneys
B. Small Intestine
C. Liver
D. Lungs
Answer: C
Rationale: The liver is the primary organ responsible for drug metabolism, utilizing the
cytochrome P450 enzyme system.
7. A patient is receiving an intravenous (IV) medication. What is the
bioavailability of this drug?
A. 25%
B. 100%
C. 75%
D. 50%
Answer: B
Rationale: Bioavailability is the fraction of an administered dose that reaches systemic
circulation. IV administration bypasses absorption barriers, resulting in 100%
bioavailability.
8. Which physiological change in geriatric patients most significantly impacts
drug distribution?
A. Increased total body water
B. Decreased body fat percentage
C. Increased glomerular filtration rate
D. Decreased serum albumin levels
Answer: D
Rationale: Older adults often have decreased albumin production, which affects the
distribution of protein-bound drugs, increasing the risk of toxicity.
