Chamberlain NR-293 Pharmacology
Exam 1, 2 & Final Review Questions
And Well Graded Solutions With
Rationales Updated 2026-2027
Ace your Chamberlain University NR-293 Pharmacology course with this comprehensive study bundle.
This guide features verified multiple-choice questions, accurate answers, and detailed rationales
covering Exam 1, Exam 2, and the cumulative Final Exam. Master high-yield topics including
pharmacokinetics, the autonomic nervous system, cardiovascular meds, diuretics, anticoagulants,
antimicrobials, and endocrine drugs. Perfect for Edapt module reviews and ATI proctored exam prep
💊 Part 1: Foundational Principles & Autonomic Nervous
System (Questions 1–25)
1. A nurse is reviewing a patient's medication profile and notes a drug with a high first-
pass effect. Which route of administration should the nurse expect to require a
significantly higher dose compared to the intravenous route?
o A) Oral
o B) Sublingual
o C) Transdermal
o D) Intramuscular
o Rationale: Drugs given orally travel through the gastrointestinal tract and enter the
portal circulation, where the liver metabolizes a large portion of the drug before it
reaches systemic circulation (first-pass effect). This requires higher oral doses
compared to routes that bypass the liver.
2. A patient is prescribed a medication that is highly protein-bound. The nurse notes
that the patient's serum albumin level is severely low. For which consequence should
the nurse monitor?
o A) Decreased therapeutic effect of the drug
o B) Rapid excretion of the drug by the kidneys
o C) Increased risk of drug toxicity
o D) Delayed absorption of the medication
o Rationale: When a drug is highly protein-bound, it normally binds to albumin, leaving
only a small amount of "free," active drug. If albumin is low, there are fewer binding
sites, leading to an increased amount of free active drug in the bloodstream, which
increases the risk of toxicity.
3. A patient is prescribed an anticholinergic medication. Which clinical manifestation
should the nurse monitor for as a common side effect?
o A) Excessive salivation
o B) Increased bowel sounds and diarrhea
o C) Urinary retention and blurred vision
o D) Bradycardia and pupillary constriction
1|Page
,o Rationale: Anticholinergic medications block parasympathetic nerve impulses. This
leads to classic drying effects, often summarized as "can't see, can't spit, can't pee,
can't shit" (blurred vision, dry mouth, urinary retention, and constipation).
4. A nurse receives a STAT medication order for a patient in acute distress. Within
what maximum timeframe must the nurse administer this medication?
o A) 5 minutes
o B) 15 minutes
o C) 30 minutes
o D) 60 minutes
o Rationale: According to standard nursing protocol and institutional safety
benchmarks, a "STAT" order indicates an immediate, life-threatening need and must
be administered within 30 minutes of being written.
5. A nurse is teaching a patient about a newly prescribed transdermal patch. Which
instruction should the nurse include to ensure patient safety?
o **A) Rotate application sites with each new patch.
o B) Apply heat to the patch to speed up drug absorption.
o C) Shave the area with a razor before applying the patch.
o D) Dispose of the used patch directly into a standard trash can.
o Rationale: Rotating patch sites prevents skin irritation and breakdown. Heat should
never be applied as it causes vasodilation and dangerously accelerates drug
absorption. Shaving can cause micro-abrasions (clipping hair is preferred), and
patches must be disposed of safely away from children/pets.
6. A nurse is preparing to administer phenytoin to a patient with a history of seizures.
Which laboratory value is most critical for the nurse to evaluate before administering
this drug?
o A) Serum potassium level
o B) Serum phenytoin level
o C) Activated partial thromboplastin time
o D) White blood cell count
o Rationale: Phenytoin has a narrow therapeutic range (typically 10-20 mcg/mL).
Monitoring the serum drug level is critical to prevent subtherapeutic levels (causing
seizures) or supratherapeutic levels (causing toxicity, nystagmus, and ataxia).
7. A patient with a history of alcohol use disorder is admitted to the hospital. The nurse
anticipates an order for which medication class to manage acute alcohol withdrawal
symptoms?
o A) Opioid antagonists
o B) Beta-blockers
o C) Benzodiazepines
o D) Tricyclic antidepressants
o Rationale: Benzodiazepines (such as chlordiazepoxide or lorazepam) are the gold
standard for alcohol withdrawal because they stabilize central nervous system
hyperactivity, preventing seizures and delirium tremens.
8. A patient is prescribed bethanechol for postoperative urinary retention. Which
physiological response indicates that the medication is effective?
o A) Decreased heart rate
o B) Pupillary dilation
o C) Voiding of urine
o D) Relaxation of the bronchial smooth muscle
2|Page
,o Rationale: Bethanechol is a cholinergic agonist that stimulates the muscarinic
receptors of the bladder, causing detrusor muscle contraction and sphincter
relaxation, which results in urination.
9. A patient is brought to the emergency department with a suspected benzodiazepine
overdose. Which antidote should the nurse prepare to administer?
o A) Naloxone
o B) Flumazenil
o C) Acetylcysteine
o D) Protamine sulfate
o Rationale: Flumazenil is the specific antagonist for benzodiazepines. It works by
competitively inhibiting activity at the benzodiazepine receptor site on the
GABA/benzodiazepine receptor complex.
10. A nurse is completing a medication reconciliation for a newly admitted patient. Which
action represents the primary goal of this safety protocol?
o A) Ensuring the patient can afford their discharge medications
o B) Double-checking the expiration dates of all home medications
o C) Preventing medication errors, omissions, and duplications at transition
points
o D) Teaching the patient about the mechanism of action of each drug
o Rationale: Medication reconciliation is done at admission, transfer, and discharge to
compare the patient's current list of home medications against new provider orders
to avoid errors like omissions, duplications, or dangerous interactions.
11. A nurse is preparing to administer an intradermal injection for a tuberculosis skin
test. At which angle should the nurse insert the needle?
o A) 5 to 15 degrees
o B) 25 to 30 degrees
o C) 45 degrees
o D) 90 degrees
o Rationale: Intradermal injections are placed just below the epidermis. An angle of 5
to 15 degrees with the bevel up ensures the medication forms a wheal under the skin
surface without puncturing deeper subcutaneous tissues.
12. A patient is experiencing an anaphylactic reaction to an intravenous antibiotic. Which
medication is the drug of choice to reverse this life-threatening event?
o A) Diphenhydramine
o B) Methylprednisolone
o C) Epinephrine
o D) Albuterol
o Rationale: Epinephrine is the primary drug for anaphylaxis because its alpha-1, beta-
1, and beta-2 agonist properties cause immediate vasoconstriction (raising blood
pressure), cardiac stimulation, and bronchodilation (opening the airway).
13. A patient is taking a monoamine oxidase inhibitor (MAOI) for depression. Which
dietary restriction must the nurse emphasize during patient teaching?
o A) Avoid foods high in calcium like milk and cheese.
o B) Restrict fluids containing caffeine or artificial sweeteners.
o C) Avoid aged foods containing tyramine, such as cured meats and aged
cheeses.
o D) Limit intake of green leafy vegetables high in vitamin K.
o Rationale: MAOIs prevent the breakdown of tyramine. Consuming foods rich in
tyramine (aged cheeses, red wine, cured meats) can cause a massive release of
norepinephrine, leading to a life-threatening hypertensive crisis.
3|Page
, 14. A nurse is monitoring a patient who has been taking lithium for bipolar disorder. The
patient reports experiencing severe diarrhea, vomiting, and tremors. Which nursing
action is the priority?
o A) Hold the next dose of lithium and request a serum lithium level.
o B) Administer an antiemetic and encourage oral fluid intake.
o C) Document the findings as expected side effects of early therapy.
o D) Instruct the patient to increase their dietary sodium intake.
o Rationale: Diarrhea, vomiting, and coarse tremors are classic signs of lithium toxicity.
The nurse must hold the drug immediately and assess the serum lithium level (toxic
range is typically > 1.5 mEq/L).
15. A nurse is teaching a patient about a new prescription for carbidopa-levodopa for
Parkinson's disease. Which statement by the patient indicates an accurate
understanding of the medication?
o A) "This medication will completely cure my Parkinson's disease."
o B) "I should expect my symptoms to fully disappear within 24 hours."
o C) "I need to avoid high-protein meals when taking this drug."
o D) "If I feel dizzy when standing up, I should stop taking the drug."
o Rationale: High-protein foods can reduce the absorption of levodopa across the
blood-brain barrier. The drug is palliative, not curative, takes weeks to show full
effect, and causes orthostatic hypotension (which requires careful position changes,
not sudden discontinuation).
16. A patient is prescribed zolpidem for insomnia. Which safety instruction should the
nurse provide to the patient?
o A) Take the medication immediately before going to bed.
o B) Take the medication with a heavy, high-fat evening meal.
o C) Expect the medication to keep you asleep for at least 12 hours.
o D) It is safe to consume a glass of wine to enhance the sedative effect.
o Rationale: Zolpidem has a rapid onset of action. To prevent falls and injury, it must
be taken right before bed when the patient can dedicate 7 to 8 hours to sleep.
Alcohol must be avoided due to additive CNS depression.
17. A patient is prescribed an agonist medication. How should the nurse explain the
action of this drug to the patient?
o A) It binds to a receptor and prevents any physiological activity.
o B) It binds to a receptor and mimics the body's natural response.
o C) It speeds up the clearance of other medications from the liver.
* D) It chemically destroys target cells to cure the underlying disease.
* Rationale: Agonists are drugs that bind to specific cellular receptors and activate
them, mimicking the endogenous substances that normally trigger that physiological
response.
18. A nurse is assessing an older adult patient who is taking multiple medications. Which
physiological change of aging increases this patient's risk for drug toxicity?
o A) Increased total body water
o B) Increased rate of gastrointestinal motility
o C) Decreased glomerular filtration rate
o D) Hyperalbuminemia
o Rationale: Aging naturally decreases renal blood flow and the glomerular filtration
rate (GFR). This delays the clearance of water-soluble drugs from the body, leading
to drug accumulation and an increased risk of toxicity.
4|Page
Exam 1, 2 & Final Review Questions
And Well Graded Solutions With
Rationales Updated 2026-2027
Ace your Chamberlain University NR-293 Pharmacology course with this comprehensive study bundle.
This guide features verified multiple-choice questions, accurate answers, and detailed rationales
covering Exam 1, Exam 2, and the cumulative Final Exam. Master high-yield topics including
pharmacokinetics, the autonomic nervous system, cardiovascular meds, diuretics, anticoagulants,
antimicrobials, and endocrine drugs. Perfect for Edapt module reviews and ATI proctored exam prep
💊 Part 1: Foundational Principles & Autonomic Nervous
System (Questions 1–25)
1. A nurse is reviewing a patient's medication profile and notes a drug with a high first-
pass effect. Which route of administration should the nurse expect to require a
significantly higher dose compared to the intravenous route?
o A) Oral
o B) Sublingual
o C) Transdermal
o D) Intramuscular
o Rationale: Drugs given orally travel through the gastrointestinal tract and enter the
portal circulation, where the liver metabolizes a large portion of the drug before it
reaches systemic circulation (first-pass effect). This requires higher oral doses
compared to routes that bypass the liver.
2. A patient is prescribed a medication that is highly protein-bound. The nurse notes
that the patient's serum albumin level is severely low. For which consequence should
the nurse monitor?
o A) Decreased therapeutic effect of the drug
o B) Rapid excretion of the drug by the kidneys
o C) Increased risk of drug toxicity
o D) Delayed absorption of the medication
o Rationale: When a drug is highly protein-bound, it normally binds to albumin, leaving
only a small amount of "free," active drug. If albumin is low, there are fewer binding
sites, leading to an increased amount of free active drug in the bloodstream, which
increases the risk of toxicity.
3. A patient is prescribed an anticholinergic medication. Which clinical manifestation
should the nurse monitor for as a common side effect?
o A) Excessive salivation
o B) Increased bowel sounds and diarrhea
o C) Urinary retention and blurred vision
o D) Bradycardia and pupillary constriction
1|Page
,o Rationale: Anticholinergic medications block parasympathetic nerve impulses. This
leads to classic drying effects, often summarized as "can't see, can't spit, can't pee,
can't shit" (blurred vision, dry mouth, urinary retention, and constipation).
4. A nurse receives a STAT medication order for a patient in acute distress. Within
what maximum timeframe must the nurse administer this medication?
o A) 5 minutes
o B) 15 minutes
o C) 30 minutes
o D) 60 minutes
o Rationale: According to standard nursing protocol and institutional safety
benchmarks, a "STAT" order indicates an immediate, life-threatening need and must
be administered within 30 minutes of being written.
5. A nurse is teaching a patient about a newly prescribed transdermal patch. Which
instruction should the nurse include to ensure patient safety?
o **A) Rotate application sites with each new patch.
o B) Apply heat to the patch to speed up drug absorption.
o C) Shave the area with a razor before applying the patch.
o D) Dispose of the used patch directly into a standard trash can.
o Rationale: Rotating patch sites prevents skin irritation and breakdown. Heat should
never be applied as it causes vasodilation and dangerously accelerates drug
absorption. Shaving can cause micro-abrasions (clipping hair is preferred), and
patches must be disposed of safely away from children/pets.
6. A nurse is preparing to administer phenytoin to a patient with a history of seizures.
Which laboratory value is most critical for the nurse to evaluate before administering
this drug?
o A) Serum potassium level
o B) Serum phenytoin level
o C) Activated partial thromboplastin time
o D) White blood cell count
o Rationale: Phenytoin has a narrow therapeutic range (typically 10-20 mcg/mL).
Monitoring the serum drug level is critical to prevent subtherapeutic levels (causing
seizures) or supratherapeutic levels (causing toxicity, nystagmus, and ataxia).
7. A patient with a history of alcohol use disorder is admitted to the hospital. The nurse
anticipates an order for which medication class to manage acute alcohol withdrawal
symptoms?
o A) Opioid antagonists
o B) Beta-blockers
o C) Benzodiazepines
o D) Tricyclic antidepressants
o Rationale: Benzodiazepines (such as chlordiazepoxide or lorazepam) are the gold
standard for alcohol withdrawal because they stabilize central nervous system
hyperactivity, preventing seizures and delirium tremens.
8. A patient is prescribed bethanechol for postoperative urinary retention. Which
physiological response indicates that the medication is effective?
o A) Decreased heart rate
o B) Pupillary dilation
o C) Voiding of urine
o D) Relaxation of the bronchial smooth muscle
2|Page
,o Rationale: Bethanechol is a cholinergic agonist that stimulates the muscarinic
receptors of the bladder, causing detrusor muscle contraction and sphincter
relaxation, which results in urination.
9. A patient is brought to the emergency department with a suspected benzodiazepine
overdose. Which antidote should the nurse prepare to administer?
o A) Naloxone
o B) Flumazenil
o C) Acetylcysteine
o D) Protamine sulfate
o Rationale: Flumazenil is the specific antagonist for benzodiazepines. It works by
competitively inhibiting activity at the benzodiazepine receptor site on the
GABA/benzodiazepine receptor complex.
10. A nurse is completing a medication reconciliation for a newly admitted patient. Which
action represents the primary goal of this safety protocol?
o A) Ensuring the patient can afford their discharge medications
o B) Double-checking the expiration dates of all home medications
o C) Preventing medication errors, omissions, and duplications at transition
points
o D) Teaching the patient about the mechanism of action of each drug
o Rationale: Medication reconciliation is done at admission, transfer, and discharge to
compare the patient's current list of home medications against new provider orders
to avoid errors like omissions, duplications, or dangerous interactions.
11. A nurse is preparing to administer an intradermal injection for a tuberculosis skin
test. At which angle should the nurse insert the needle?
o A) 5 to 15 degrees
o B) 25 to 30 degrees
o C) 45 degrees
o D) 90 degrees
o Rationale: Intradermal injections are placed just below the epidermis. An angle of 5
to 15 degrees with the bevel up ensures the medication forms a wheal under the skin
surface without puncturing deeper subcutaneous tissues.
12. A patient is experiencing an anaphylactic reaction to an intravenous antibiotic. Which
medication is the drug of choice to reverse this life-threatening event?
o A) Diphenhydramine
o B) Methylprednisolone
o C) Epinephrine
o D) Albuterol
o Rationale: Epinephrine is the primary drug for anaphylaxis because its alpha-1, beta-
1, and beta-2 agonist properties cause immediate vasoconstriction (raising blood
pressure), cardiac stimulation, and bronchodilation (opening the airway).
13. A patient is taking a monoamine oxidase inhibitor (MAOI) for depression. Which
dietary restriction must the nurse emphasize during patient teaching?
o A) Avoid foods high in calcium like milk and cheese.
o B) Restrict fluids containing caffeine or artificial sweeteners.
o C) Avoid aged foods containing tyramine, such as cured meats and aged
cheeses.
o D) Limit intake of green leafy vegetables high in vitamin K.
o Rationale: MAOIs prevent the breakdown of tyramine. Consuming foods rich in
tyramine (aged cheeses, red wine, cured meats) can cause a massive release of
norepinephrine, leading to a life-threatening hypertensive crisis.
3|Page
, 14. A nurse is monitoring a patient who has been taking lithium for bipolar disorder. The
patient reports experiencing severe diarrhea, vomiting, and tremors. Which nursing
action is the priority?
o A) Hold the next dose of lithium and request a serum lithium level.
o B) Administer an antiemetic and encourage oral fluid intake.
o C) Document the findings as expected side effects of early therapy.
o D) Instruct the patient to increase their dietary sodium intake.
o Rationale: Diarrhea, vomiting, and coarse tremors are classic signs of lithium toxicity.
The nurse must hold the drug immediately and assess the serum lithium level (toxic
range is typically > 1.5 mEq/L).
15. A nurse is teaching a patient about a new prescription for carbidopa-levodopa for
Parkinson's disease. Which statement by the patient indicates an accurate
understanding of the medication?
o A) "This medication will completely cure my Parkinson's disease."
o B) "I should expect my symptoms to fully disappear within 24 hours."
o C) "I need to avoid high-protein meals when taking this drug."
o D) "If I feel dizzy when standing up, I should stop taking the drug."
o Rationale: High-protein foods can reduce the absorption of levodopa across the
blood-brain barrier. The drug is palliative, not curative, takes weeks to show full
effect, and causes orthostatic hypotension (which requires careful position changes,
not sudden discontinuation).
16. A patient is prescribed zolpidem for insomnia. Which safety instruction should the
nurse provide to the patient?
o A) Take the medication immediately before going to bed.
o B) Take the medication with a heavy, high-fat evening meal.
o C) Expect the medication to keep you asleep for at least 12 hours.
o D) It is safe to consume a glass of wine to enhance the sedative effect.
o Rationale: Zolpidem has a rapid onset of action. To prevent falls and injury, it must
be taken right before bed when the patient can dedicate 7 to 8 hours to sleep.
Alcohol must be avoided due to additive CNS depression.
17. A patient is prescribed an agonist medication. How should the nurse explain the
action of this drug to the patient?
o A) It binds to a receptor and prevents any physiological activity.
o B) It binds to a receptor and mimics the body's natural response.
o C) It speeds up the clearance of other medications from the liver.
* D) It chemically destroys target cells to cure the underlying disease.
* Rationale: Agonists are drugs that bind to specific cellular receptors and activate
them, mimicking the endogenous substances that normally trigger that physiological
response.
18. A nurse is assessing an older adult patient who is taking multiple medications. Which
physiological change of aging increases this patient's risk for drug toxicity?
o A) Increased total body water
o B) Increased rate of gastrointestinal motility
o C) Decreased glomerular filtration rate
o D) Hyperalbuminemia
o Rationale: Aging naturally decreases renal blood flow and the glomerular filtration
rate (GFR). This delays the clearance of water-soluble drugs from the body, leading
to drug accumulation and an increased risk of toxicity.
4|Page
