NSG 124 PHARMACOLOGY EXAM 200 ACTUAL EXAM
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1. A patient is prescribed a medication that undergoes extensive first-pass
metabolism. The nurse expects that this drug will be administered by which route?
A Intravenous
B Oral
C Subcutaneous
D Topical
Correct Answer: A
Rationale: First-pass metabolism refers to the rapid uptake and metabolism of a
drug by the liver after oral absorption, significantly reducing its bioavailability. To
avoid this effect, drugs with high first-pass metabolism are often given
intravenously, which bypasses the gastrointestinal tract and liver initially. Oral
administration would result in reduced systemic levels. Subcutaneous and topical
routes may still be affected but not as directly bypassed as IV.
2. A nurse is teaching a patient about a drug with a narrow therapeutic index.
Which statement by the patient indicates understanding?
A I can double the dose if I miss one.
B Small changes in dose can cause toxicity.
C This drug has a wide safety margin.
D Blood levels are not important for this drug.
Correct Answer: B
Rationale: A narrow therapeutic index means the difference between the
therapeutic dose and the toxic dose is small. Therefore, small changes in dose or
drug levels can lead to toxicity or lack of effect. Doubling doses is dangerous, the
safety margin is low, and blood level monitoring is critical.
3. A patient is receiving a drug that acts as a competitive antagonist at beta-1
receptors. Which effect does the nurse expect?
A Increased heart rate
B Decreased heart rate
C Bronchodilation
,D Increased contractility
Correct Answer: B
Rationale: Competitive antagonism at beta-1 receptors blocks the effects of
norepinephrine and epinephrine, leading to decreased heart rate and reduced
contractility. Beta-1 receptors are primarily in the heart. Increased heart rate and
contractility would be from agonists. Bronchodilation is beta-2 mediated.
4. A drug has a half-life of 4 hours. How much of the drug will remain in the body
after 16 hours if the initial dose is 200 mg?
A 100 mg
B 50 mg
C 25 mg
D 12.5 mg
Correct Answer: D
Rationale: Half-life is the time for drug concentration to reduce by 50 percent.
After 4 hours, 100 mg remains. After 8 hours, 50 mg remains. After 12 hours, 25
mg remains. After 16 hours, 12.5 mg remains. The calculation is 200 times 0.5
raised to the power of 4 (four half-lives).
5. A nurse administers an opioid analgesic that is a full agonist at mu receptors.
Which assessment finding indicates a therapeutic effect?
A Respiratory rate of 8 breaths per minute
B Patient reports pain decreased from 8 to 3 on a 0 to 10 scale
C Pupil dilation
D Increased bowel sounds
Correct Answer: B
Rationale: Full mu receptor agonists such as morphine provide pain relief as their
primary therapeutic effect. A decrease in pain scale indicates efficacy. Respiratory
depression and constipation are adverse effects, not therapeutic. Opioids cause
miosis, not mydriasis.
6. A patient develops angioedema after taking lisinopril. The nurse recognizes this
as which type of adverse drug reaction?
A Type I hypersensitivity
B Type II cytotoxic reaction
C Type III immune complex reaction
D Type IV delayed hypersensitivity
Correct Answer: A
,Rationale: Angioedema from ACE inhibitors such as lisinopril is a Type I
hypersensitivity reaction mediated by IgE and mast cell degranulation. It is not
cytotoxic, immune complex mediated, or T cell mediated delayed hypersensitivity.
7. A drug is a weak acid with a pKa of 4.5. In which body fluid will it be most
highly absorbed from the stomach?
A Gastric fluid at pH 1.5
B Small intestinal fluid at pH 6.5
C Blood at pH 7.4
D Urine at pH 8.0
Correct Answer: A
Rationale: Weak acids are best absorbed in acidic environments where they are
nonionized and lipid soluble. At pH 1.5, which is below the pKa, the drug is
predominantly nonionized. At higher pH values, ionization increases, reducing
absorption.
8. A patient is receiving digoxin and develops vomiting, yellow vision, and a heart
rate of 45 beats per minute. Which laboratory value is most important for the nurse
to check?
A Serum potassium
B Serum sodium
C Serum magnesium
D Serum calcium
Correct Answer: A
Rationale: Digoxin toxicity is potentiated by hypokalemia. Vomiting, visual
disturbances, and bradycardia are classic signs of digoxin toxicity. Low potassium
increases the risk of arrhythmias and binding of digoxin to sodium-potassium
ATPase. Sodium, magnesium, and calcium changes are less directly implicated.
9. A nurse is administering warfarin and knows that it exerts its effect by inhibiting
which vitamin?
A Vitamin A
B Vitamin B12
C Vitamin C
D Vitamin K
Correct Answer: D
Rationale: Warfarin inhibits vitamin K epoxide reductase, leading to depletion of
reduced vitamin K. This prevents gamma carboxylation of clotting factors II, VII,
IX, and X. Vitamins A, B12, and C are not involved in this pathway.
, 10. A patient on heparin therapy develops excessive bleeding. Which medication
should the nurse anticipate administering?
A Protamine sulfate
B Vitamin K
C Aminocaproic acid
D Desmopressin
Correct Answer: A
Rationale: Protamine sulfate is a specific antagonist that neutralizes heparin by
forming an inactive complex. Vitamin K reverses warfarin, not heparin.
Aminocaproic acid is used for fibrinolysis. Desmopressin is used for hemophilia
and von Willebrand disease.
11. A patient with type 2 diabetes is started on metformin. The nurse explains that
this drug primarily works by which mechanism?
A Increasing insulin secretion from the pancreas
B Decreasing hepatic glucose production and increasing insulin sensitivity
C Slowing carbohydrate absorption in the intestine
D Excreting glucose in the urine
Correct Answer: B
Rationale: Metformin reduces hepatic gluconeogenesis and increases peripheral
glucose uptake. It does not increase insulin secretion, so it rarely causes
hypoglycemia. It does not act on intestinal absorption or cause urinary glucose
excretion.
12. A nurse is monitoring a patient receiving furosemide. Which laboratory finding
is most concerning for an adverse effect of this drug?
A Serum sodium 138 mEq/L
B Serum potassium 2.9 mEq/L
C Serum chloride 100 mEq/L
D Blood glucose 95 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes loss of potassium, sodium, and
chloride. Hypokalemia (potassium below 3.5 mEq/L) increases the risk of
arrhythmias and digoxin toxicity. The other values are within normal limits.
13. A patient is prescribed losartan. The nurse understands that this drug belongs to
which class?
A ACE inhibitor
B Beta blocker
C Angiotensin II receptor blocker
QUESTIONS AND 100% VERIFIED ANSWERS ALREADY
GRADED A+ NEW!!!!!!!!!!
1. A patient is prescribed a medication that undergoes extensive first-pass
metabolism. The nurse expects that this drug will be administered by which route?
A Intravenous
B Oral
C Subcutaneous
D Topical
Correct Answer: A
Rationale: First-pass metabolism refers to the rapid uptake and metabolism of a
drug by the liver after oral absorption, significantly reducing its bioavailability. To
avoid this effect, drugs with high first-pass metabolism are often given
intravenously, which bypasses the gastrointestinal tract and liver initially. Oral
administration would result in reduced systemic levels. Subcutaneous and topical
routes may still be affected but not as directly bypassed as IV.
2. A nurse is teaching a patient about a drug with a narrow therapeutic index.
Which statement by the patient indicates understanding?
A I can double the dose if I miss one.
B Small changes in dose can cause toxicity.
C This drug has a wide safety margin.
D Blood levels are not important for this drug.
Correct Answer: B
Rationale: A narrow therapeutic index means the difference between the
therapeutic dose and the toxic dose is small. Therefore, small changes in dose or
drug levels can lead to toxicity or lack of effect. Doubling doses is dangerous, the
safety margin is low, and blood level monitoring is critical.
3. A patient is receiving a drug that acts as a competitive antagonist at beta-1
receptors. Which effect does the nurse expect?
A Increased heart rate
B Decreased heart rate
C Bronchodilation
,D Increased contractility
Correct Answer: B
Rationale: Competitive antagonism at beta-1 receptors blocks the effects of
norepinephrine and epinephrine, leading to decreased heart rate and reduced
contractility. Beta-1 receptors are primarily in the heart. Increased heart rate and
contractility would be from agonists. Bronchodilation is beta-2 mediated.
4. A drug has a half-life of 4 hours. How much of the drug will remain in the body
after 16 hours if the initial dose is 200 mg?
A 100 mg
B 50 mg
C 25 mg
D 12.5 mg
Correct Answer: D
Rationale: Half-life is the time for drug concentration to reduce by 50 percent.
After 4 hours, 100 mg remains. After 8 hours, 50 mg remains. After 12 hours, 25
mg remains. After 16 hours, 12.5 mg remains. The calculation is 200 times 0.5
raised to the power of 4 (four half-lives).
5. A nurse administers an opioid analgesic that is a full agonist at mu receptors.
Which assessment finding indicates a therapeutic effect?
A Respiratory rate of 8 breaths per minute
B Patient reports pain decreased from 8 to 3 on a 0 to 10 scale
C Pupil dilation
D Increased bowel sounds
Correct Answer: B
Rationale: Full mu receptor agonists such as morphine provide pain relief as their
primary therapeutic effect. A decrease in pain scale indicates efficacy. Respiratory
depression and constipation are adverse effects, not therapeutic. Opioids cause
miosis, not mydriasis.
6. A patient develops angioedema after taking lisinopril. The nurse recognizes this
as which type of adverse drug reaction?
A Type I hypersensitivity
B Type II cytotoxic reaction
C Type III immune complex reaction
D Type IV delayed hypersensitivity
Correct Answer: A
,Rationale: Angioedema from ACE inhibitors such as lisinopril is a Type I
hypersensitivity reaction mediated by IgE and mast cell degranulation. It is not
cytotoxic, immune complex mediated, or T cell mediated delayed hypersensitivity.
7. A drug is a weak acid with a pKa of 4.5. In which body fluid will it be most
highly absorbed from the stomach?
A Gastric fluid at pH 1.5
B Small intestinal fluid at pH 6.5
C Blood at pH 7.4
D Urine at pH 8.0
Correct Answer: A
Rationale: Weak acids are best absorbed in acidic environments where they are
nonionized and lipid soluble. At pH 1.5, which is below the pKa, the drug is
predominantly nonionized. At higher pH values, ionization increases, reducing
absorption.
8. A patient is receiving digoxin and develops vomiting, yellow vision, and a heart
rate of 45 beats per minute. Which laboratory value is most important for the nurse
to check?
A Serum potassium
B Serum sodium
C Serum magnesium
D Serum calcium
Correct Answer: A
Rationale: Digoxin toxicity is potentiated by hypokalemia. Vomiting, visual
disturbances, and bradycardia are classic signs of digoxin toxicity. Low potassium
increases the risk of arrhythmias and binding of digoxin to sodium-potassium
ATPase. Sodium, magnesium, and calcium changes are less directly implicated.
9. A nurse is administering warfarin and knows that it exerts its effect by inhibiting
which vitamin?
A Vitamin A
B Vitamin B12
C Vitamin C
D Vitamin K
Correct Answer: D
Rationale: Warfarin inhibits vitamin K epoxide reductase, leading to depletion of
reduced vitamin K. This prevents gamma carboxylation of clotting factors II, VII,
IX, and X. Vitamins A, B12, and C are not involved in this pathway.
, 10. A patient on heparin therapy develops excessive bleeding. Which medication
should the nurse anticipate administering?
A Protamine sulfate
B Vitamin K
C Aminocaproic acid
D Desmopressin
Correct Answer: A
Rationale: Protamine sulfate is a specific antagonist that neutralizes heparin by
forming an inactive complex. Vitamin K reverses warfarin, not heparin.
Aminocaproic acid is used for fibrinolysis. Desmopressin is used for hemophilia
and von Willebrand disease.
11. A patient with type 2 diabetes is started on metformin. The nurse explains that
this drug primarily works by which mechanism?
A Increasing insulin secretion from the pancreas
B Decreasing hepatic glucose production and increasing insulin sensitivity
C Slowing carbohydrate absorption in the intestine
D Excreting glucose in the urine
Correct Answer: B
Rationale: Metformin reduces hepatic gluconeogenesis and increases peripheral
glucose uptake. It does not increase insulin secretion, so it rarely causes
hypoglycemia. It does not act on intestinal absorption or cause urinary glucose
excretion.
12. A nurse is monitoring a patient receiving furosemide. Which laboratory finding
is most concerning for an adverse effect of this drug?
A Serum sodium 138 mEq/L
B Serum potassium 2.9 mEq/L
C Serum chloride 100 mEq/L
D Blood glucose 95 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes loss of potassium, sodium, and
chloride. Hypokalemia (potassium below 3.5 mEq/L) increases the risk of
arrhythmias and digoxin toxicity. The other values are within normal limits.
13. A patient is prescribed losartan. The nurse understands that this drug belongs to
which class?
A ACE inhibitor
B Beta blocker
C Angiotensin II receptor blocker
