1. A nurse is preparing to administer an oral medication. Which statement by the nurse
indicates an understanding of the first-pass effect?
A) “The drug is absorbed directly into the systemic circulation without any changes.”
B) “A portion of the drug is metabolized in the liver before it reaches systemic circulation.”
C) “The drug bypasses the stomach and is absorbed in the small intestine.”
D) “The kidneys excrete a large amount of the drug before it reaches the target site.”
Correct Answer: B
Rationale: The first-pass effect refers to the hepatic metabolism of an orally administered drug
before it enters the systemic circulation, reducing the amount of active drug available.
2. A client asks why a medication is given sublingually rather than orally. The nurse’s best
response is that sublingual administration:
A) Avoids first-pass metabolism
B) Requires a larger dose
C) Causes more gastrointestinal upset
D) Is less expensive
,Correct Answer: A
Rationale: Sublingual administration allows the drug to dissolve under the tongue and be
absorbed directly into the bloodstream, bypassing the liver and first-pass metabolism.
3. A nurse is reviewing a drug that has a half-life of 6 hours. Approximately how long will it
take for 97% of the drug to be eliminated from the body?
A) 6 hours
B) 12 hours
C) 24–30 hours
D) 48 hours
Correct Answer: C
Rationale: It takes approximately 4–5 half-lives for a drug to be eliminated. For a half-life of 6
hours, 4–5 half-lives equals 24–30 hours.
4. A nurse is teaching a client about a drug that is an antagonist. The nurse explains that this
drug will:
A) Bind to a receptor and produce a response
B) Bind to a receptor and block a response
C) Increase the effect of endogenous hormones
D) Act as a replacement for a missing substance
Correct Answer: B
Rationale: An antagonist binds to a receptor but does not activate it, thereby blocking the
action of agonists or endogenous substances.
5. A client with malnutrition has low albumin levels. The nurse should monitor for increased
effects of drugs that are:
A) Highly protein-bound
B) Weakly acidic
C) Water-soluble
D) Metabolized by the liver
Correct Answer: A
Rationale: Low albumin reduces protein binding, leading to a higher free (active) drug
concentration and increased risk of toxicity for highly protein-bound drugs.
6. A nurse is caring for a client with end-stage renal disease. The nurse should anticipate that
drugs excreted by the kidneys will require:
A) An increased dose
B) A decreased dose or longer dosing interval
,C) No change in dosing
D) Administration via intramuscular injection only
Correct Answer: B
Rationale: Impaired renal function decreases drug excretion, potentially causing accumulation
and toxicity; doses are often reduced or intervals extended.
7. A client is prescribed an enteric-coated aspirin tablet. Which client statement indicates a
need for further teaching?
A) “I should swallow the tablet whole.”
B) “The coating helps protect my stomach.”
C) “I can crush the tablet if I need to.”
D) “I should not take antacids at the same time unless approved.”
Correct Answer: C
Rationale: Crushing an enteric-coated tablet destroys the protective coating, which can cause
gastric irritation or drug inactivation.
8. A drug has a narrow therapeutic index. The nurse should:
A) Administer the drug without any special monitoring
B) Monitor serum drug levels closely
C) Give the drug only on an empty stomach
D) Administer a loading dose with each dose
Correct Answer: B
Rationale: Drugs with a narrow therapeutic index have a small margin between therapeutic and
toxic levels, necessitating close monitoring of serum levels.
9. Two drugs are prescribed that have a synergistic effect. The nurse understands this means
the drugs will:
A) Counteract each other’s effects
B) Produce an effect equal to the sum of their individual effects
C) Produce an effect greater than the sum of their individual effects
D) Have no interaction
Correct Answer: C
Rationale: Synergism is when the combined effect of two drugs is greater than the sum of their
separate effects.
10. A client is receiving a loading dose of an intravenous antibiotic. The primary purpose of
the loading dose is to:
A) Reduce adverse effects
, B) Achieve therapeutic drug levels quickly
C) Prolong the duration of action
D) Decrease the frequency of administration
Correct Answer: B
Rationale: A loading dose is a larger initial dose used to rapidly achieve a therapeutic plasma
concentration.
11. A nurse is teaching a client about the use of a transdermal patch. Which instruction is
essential?
A) Apply the patch over a bony prominence
B) Rotate application sites and remove the old patch before applying a new one
C) Apply the patch only when symptoms occur
D) Cut the patch in half if the dose seems too strong
Correct Answer: B
Rationale: Patches should be rotated to prevent skin irritation. The old patch must be removed
to prevent overdose. Cutting may alter drug delivery.
12. A client has a phenytoin level of 25 mcg/mL (therapeutic: 10–20 mcg/mL). The nurse
should:
A) Administer the next dose as prescribed
B) Hold the medication and notify the prescriber
C) Increase the dose to prevent seizures
D) Administer half the prescribed dose
Correct Answer: B
Rationale: A level above 20 mcg/mL indicates toxicity. The nurse should hold the dose and
notify the prescriber for further instructions.
13. A client taking warfarin asks about taking over-the-counter pain relievers. The nurse
should recommend:
A) Ibuprofen
B) Naproxen
C) Aspirin
D) Acetaminophen (with prescriber guidance)
Correct Answer: D
Rationale: Acetaminophen is generally safer with warfarin, though it still requires monitoring.
NSAIDs and aspirin increase bleeding risk significantly.
indicates an understanding of the first-pass effect?
A) “The drug is absorbed directly into the systemic circulation without any changes.”
B) “A portion of the drug is metabolized in the liver before it reaches systemic circulation.”
C) “The drug bypasses the stomach and is absorbed in the small intestine.”
D) “The kidneys excrete a large amount of the drug before it reaches the target site.”
Correct Answer: B
Rationale: The first-pass effect refers to the hepatic metabolism of an orally administered drug
before it enters the systemic circulation, reducing the amount of active drug available.
2. A client asks why a medication is given sublingually rather than orally. The nurse’s best
response is that sublingual administration:
A) Avoids first-pass metabolism
B) Requires a larger dose
C) Causes more gastrointestinal upset
D) Is less expensive
,Correct Answer: A
Rationale: Sublingual administration allows the drug to dissolve under the tongue and be
absorbed directly into the bloodstream, bypassing the liver and first-pass metabolism.
3. A nurse is reviewing a drug that has a half-life of 6 hours. Approximately how long will it
take for 97% of the drug to be eliminated from the body?
A) 6 hours
B) 12 hours
C) 24–30 hours
D) 48 hours
Correct Answer: C
Rationale: It takes approximately 4–5 half-lives for a drug to be eliminated. For a half-life of 6
hours, 4–5 half-lives equals 24–30 hours.
4. A nurse is teaching a client about a drug that is an antagonist. The nurse explains that this
drug will:
A) Bind to a receptor and produce a response
B) Bind to a receptor and block a response
C) Increase the effect of endogenous hormones
D) Act as a replacement for a missing substance
Correct Answer: B
Rationale: An antagonist binds to a receptor but does not activate it, thereby blocking the
action of agonists or endogenous substances.
5. A client with malnutrition has low albumin levels. The nurse should monitor for increased
effects of drugs that are:
A) Highly protein-bound
B) Weakly acidic
C) Water-soluble
D) Metabolized by the liver
Correct Answer: A
Rationale: Low albumin reduces protein binding, leading to a higher free (active) drug
concentration and increased risk of toxicity for highly protein-bound drugs.
6. A nurse is caring for a client with end-stage renal disease. The nurse should anticipate that
drugs excreted by the kidneys will require:
A) An increased dose
B) A decreased dose or longer dosing interval
,C) No change in dosing
D) Administration via intramuscular injection only
Correct Answer: B
Rationale: Impaired renal function decreases drug excretion, potentially causing accumulation
and toxicity; doses are often reduced or intervals extended.
7. A client is prescribed an enteric-coated aspirin tablet. Which client statement indicates a
need for further teaching?
A) “I should swallow the tablet whole.”
B) “The coating helps protect my stomach.”
C) “I can crush the tablet if I need to.”
D) “I should not take antacids at the same time unless approved.”
Correct Answer: C
Rationale: Crushing an enteric-coated tablet destroys the protective coating, which can cause
gastric irritation or drug inactivation.
8. A drug has a narrow therapeutic index. The nurse should:
A) Administer the drug without any special monitoring
B) Monitor serum drug levels closely
C) Give the drug only on an empty stomach
D) Administer a loading dose with each dose
Correct Answer: B
Rationale: Drugs with a narrow therapeutic index have a small margin between therapeutic and
toxic levels, necessitating close monitoring of serum levels.
9. Two drugs are prescribed that have a synergistic effect. The nurse understands this means
the drugs will:
A) Counteract each other’s effects
B) Produce an effect equal to the sum of their individual effects
C) Produce an effect greater than the sum of their individual effects
D) Have no interaction
Correct Answer: C
Rationale: Synergism is when the combined effect of two drugs is greater than the sum of their
separate effects.
10. A client is receiving a loading dose of an intravenous antibiotic. The primary purpose of
the loading dose is to:
A) Reduce adverse effects
, B) Achieve therapeutic drug levels quickly
C) Prolong the duration of action
D) Decrease the frequency of administration
Correct Answer: B
Rationale: A loading dose is a larger initial dose used to rapidly achieve a therapeutic plasma
concentration.
11. A nurse is teaching a client about the use of a transdermal patch. Which instruction is
essential?
A) Apply the patch over a bony prominence
B) Rotate application sites and remove the old patch before applying a new one
C) Apply the patch only when symptoms occur
D) Cut the patch in half if the dose seems too strong
Correct Answer: B
Rationale: Patches should be rotated to prevent skin irritation. The old patch must be removed
to prevent overdose. Cutting may alter drug delivery.
12. A client has a phenytoin level of 25 mcg/mL (therapeutic: 10–20 mcg/mL). The nurse
should:
A) Administer the next dose as prescribed
B) Hold the medication and notify the prescriber
C) Increase the dose to prevent seizures
D) Administer half the prescribed dose
Correct Answer: B
Rationale: A level above 20 mcg/mL indicates toxicity. The nurse should hold the dose and
notify the prescriber for further instructions.
13. A client taking warfarin asks about taking over-the-counter pain relievers. The nurse
should recommend:
A) Ibuprofen
B) Naproxen
C) Aspirin
D) Acetaminophen (with prescriber guidance)
Correct Answer: D
Rationale: Acetaminophen is generally safer with warfarin, though it still requires monitoring.
NSAIDs and aspirin increase bleeding risk significantly.
