NURS 5334 Advanced Pharm for NPs Final Exam
Questions and 100% Correct Answers 2025/26 Update –
UTA (Questions 1-180)
Q1: A patient has been on a drug with a half-life of 12 hours. Approximately how long will it
take to reach steady state?
• A) 24 hours
• B) 36 hours
• C) 48 hours
• D) 60 hours
☑ Correct Answer: D) 60 hours
*Rationale: Steady state is reached in 4–5 half-lives. 12 hours × 5 = 60 hours.*
Q2: Which CYP450 enzyme is most commonly responsible for drug-drug interactions?
• A) CYP1A2
• B) CYP2C9
• C) CYP2D6
• D) CYP3A4
☑ Correct Answer: D) CYP3A4
*Rationale: CYP3A4 metabolizes ~50% of all drugs and is inhibited/induced by many common
medications.*
Q3: A patient taking warfarin starts rifampin. What effect is expected?
, • A) Increased INR, bleeding risk
• B) Decreased INR, clotting risk
• C) No change in INR
• D) Increased warfarin absorption
☑ Correct Answer: B) Decreased INR, clotting risk
Rationale: Rifampin is a potent CYP inducer, increasing warfarin metabolism and reducing its
effect.
Q4: Which drug requires CYP2D6 testing before use due to poor metabolizer risk?
• A) Metoprolol
• B) Codeine
• C) Atorvastatin
• D) Lisinopril
☑ Correct Answer: B) Codeine
*Rationale: Codeine is a prodrug converted to morphine by CYP2D6. Poor metabolizers get no
pain relief; ultra-rapid metabolizers risk toxicity.*
Q5: A patient with renal impairment (CrCl <30 mL/min) is prescribed a medication excreted
primarily by the kidneys. The NP should:
• A) Increase the dose
• B) Decrease the dose or prolong interval
• C) Give a loading dose only
• D) No change needed
,☑ Correct Answer: B) Decrease the dose or prolong interval
Rationale: Reduced GFR decreases drug clearance, increasing half-life and toxicity risk.
Q6: Which of the following has 100% bioavailability?
• A) Oral tablet
• B) Sublingual
• C) Intramuscular
• D) Intravenous
☑ Correct Answer: D) Intravenous
Rationale: IV administration bypasses absorption and first-pass metabolism entirely.
Q7: A patient is prescribed a loading dose of digoxin. The purpose is to:
• A) Reduce side effects
• B) Achieve therapeutic levels quickly
• C) Prolong the half-life
• D) Increase protein binding
☑ Correct Answer: B) Achieve therapeutic levels quickly
*Rationale: Loading dose rapidly reaches steady state without waiting 4–5 half-lives.*
Q8: Grapefruit juice inhibits which CYP enzyme?
• A) CYP2D6
• B) CYP3A4
, • C) CYP2C19
• D) CYP1A2
☑ Correct Answer: B) CYP3A4
Rationale: Grapefruit juice increases levels of drugs like statins, calcium channel blockers, and
some immunosuppressants.
Q9: A narrow therapeutic index (NTI) drug requires:
• A) Over-the-counter availability
• B) Once-daily dosing
• C) Therapeutic drug monitoring
• D) High protein binding
☑ Correct Answer: C) Therapeutic drug monitoring
Rationale: Small difference between therapeutic and toxic doses makes monitoring essential
(e.g., warfarin, lithium, phenytoin).
Q10: Which abbreviation is error-prone and should be avoided?
• A) PO
• B) U
• C) BID
• D) PRN
☑ Correct Answer: B) U
Rationale: "U" can be mistaken for "0" or "4" (e.g., 4U vs 40). Must write "units."
Q11: Which drug is a prodrug requiring CYP2C19 activation?
Questions and 100% Correct Answers 2025/26 Update –
UTA (Questions 1-180)
Q1: A patient has been on a drug with a half-life of 12 hours. Approximately how long will it
take to reach steady state?
• A) 24 hours
• B) 36 hours
• C) 48 hours
• D) 60 hours
☑ Correct Answer: D) 60 hours
*Rationale: Steady state is reached in 4–5 half-lives. 12 hours × 5 = 60 hours.*
Q2: Which CYP450 enzyme is most commonly responsible for drug-drug interactions?
• A) CYP1A2
• B) CYP2C9
• C) CYP2D6
• D) CYP3A4
☑ Correct Answer: D) CYP3A4
*Rationale: CYP3A4 metabolizes ~50% of all drugs and is inhibited/induced by many common
medications.*
Q3: A patient taking warfarin starts rifampin. What effect is expected?
, • A) Increased INR, bleeding risk
• B) Decreased INR, clotting risk
• C) No change in INR
• D) Increased warfarin absorption
☑ Correct Answer: B) Decreased INR, clotting risk
Rationale: Rifampin is a potent CYP inducer, increasing warfarin metabolism and reducing its
effect.
Q4: Which drug requires CYP2D6 testing before use due to poor metabolizer risk?
• A) Metoprolol
• B) Codeine
• C) Atorvastatin
• D) Lisinopril
☑ Correct Answer: B) Codeine
*Rationale: Codeine is a prodrug converted to morphine by CYP2D6. Poor metabolizers get no
pain relief; ultra-rapid metabolizers risk toxicity.*
Q5: A patient with renal impairment (CrCl <30 mL/min) is prescribed a medication excreted
primarily by the kidneys. The NP should:
• A) Increase the dose
• B) Decrease the dose or prolong interval
• C) Give a loading dose only
• D) No change needed
,☑ Correct Answer: B) Decrease the dose or prolong interval
Rationale: Reduced GFR decreases drug clearance, increasing half-life and toxicity risk.
Q6: Which of the following has 100% bioavailability?
• A) Oral tablet
• B) Sublingual
• C) Intramuscular
• D) Intravenous
☑ Correct Answer: D) Intravenous
Rationale: IV administration bypasses absorption and first-pass metabolism entirely.
Q7: A patient is prescribed a loading dose of digoxin. The purpose is to:
• A) Reduce side effects
• B) Achieve therapeutic levels quickly
• C) Prolong the half-life
• D) Increase protein binding
☑ Correct Answer: B) Achieve therapeutic levels quickly
*Rationale: Loading dose rapidly reaches steady state without waiting 4–5 half-lives.*
Q8: Grapefruit juice inhibits which CYP enzyme?
• A) CYP2D6
• B) CYP3A4
, • C) CYP2C19
• D) CYP1A2
☑ Correct Answer: B) CYP3A4
Rationale: Grapefruit juice increases levels of drugs like statins, calcium channel blockers, and
some immunosuppressants.
Q9: A narrow therapeutic index (NTI) drug requires:
• A) Over-the-counter availability
• B) Once-daily dosing
• C) Therapeutic drug monitoring
• D) High protein binding
☑ Correct Answer: C) Therapeutic drug monitoring
Rationale: Small difference between therapeutic and toxic doses makes monitoring essential
(e.g., warfarin, lithium, phenytoin).
Q10: Which abbreviation is error-prone and should be avoided?
• A) PO
• B) U
• C) BID
• D) PRN
☑ Correct Answer: B) U
Rationale: "U" can be mistaken for "0" or "4" (e.g., 4U vs 40). Must write "units."
Q11: Which drug is a prodrug requiring CYP2C19 activation?
