NR-226 – Pharmacology | Comprehensive Study
Guide, Drug Classifications, Medication
Administration, Dosage Calculations,
Pharmacokinetics, Patient Safety, and Exam
Preparation
1. A nurse is preparing to administer a medication that has a high first-pass
effect. The nurse should anticipate that this medication will be administered
via which route?
A. Oral
B. Intravenous
C. Subcutaneous
D. Intramuscular
Rationale: The first-pass effect refers to the metabolism of a drug in the liver
before it reaches systemic circulation. This occurs most significantly with oral
medications. The intravenous (IV) route bypasses this effect entirely, as the drug
is directly injected into the bloodstream. Other routes like sublingual, transdermal,
and rectal also partially bypass first-pass metabolism.
2. A patient is prescribed a medication that is 99% protein-bound. The nurse
should monitor for which potential complication if the patient is also given a
second medication with higher binding affinity?
A. Decreased therapeutic effect of the first drug.
B. Increased risk of toxicity of the first drug.
C. No significant interaction.
D. Increased excretion of the first drug.
Rationale: Protein binding is reversible and saturable. A second drug with higher
affinity will displace the first drug from protein binding sites. This increases the
concentration of the free (active) form of the first drug in the bloodstream,
significantly increasing its pharmacological effect and risk of toxicity.
3. Which of the following represents the correct sequence of the
pharmacokinetic phases?
A. Distribution, Absorption, Metabolism, Excretion
B. Absorption, Distribution, Metabolism, Excretion
,C. Metabolism, Absorption, Distribution, Excretion
D. Excretion, Distribution, Absorption, Metabolism
Rationale: The order of pharmacokinetic phases is Absorption (drug enters
circulation) → Distribution (drug moves to tissues) → Metabolism (drug is
chemically altered) → Excretion (drug is removed from the body). This sequence
is often remembered using the acronym ADME.
4. A patient is receiving an intravenous infusion of a medication. The nurse
notes that the infusion is running at a rate of 50 mL/hr. The medication's
concentration is 200 mg in 250 mL. How many mg/hr is the patient receiving?
A. 20 mg/hr
B. 30 mg/hr
C. 40 mg/hr
D. 50 mg/hr
Rationale: First, calculate the concentration: 200 mg / 250 mL = 0.8 mg/mL. Then
multiply by the infusion rate: 0.8 mg/mL × 50 mL/hr = 40 mg/hr.
5. The nurse is teaching a patient about a new medication. Which statement
by the patient indicates a need for further teaching?
A. "I should take this medication with food as directed."
B. "I can stop taking this medication when I feel better."
C. "I should not drink alcohol while on this medication."
D. "I need to take this medication at the same time every day."
Rationale: Many medications, especially antibiotics and antihypertensives, must
be taken for the full prescribed course to be effective and to prevent relapse or
resistance. Stopping a medication prematurely when symptoms improve is a
common and dangerous error. The patient requires further education about
completing the entire course of therapy.
6. A patient with hepatic cirrhosis is prescribed a medication that is
extensively metabolized by the liver. The nurse should anticipate the provider
will order:
A. A higher dose.
B. A lower dose.
C. An increased dosing frequency.
D. No change in the dose.
,Rationale: Hepatic cirrhosis impairs liver function, reducing the metabolism of
many drugs. This leads to drug accumulation and increased risk of toxicity. The
provider will typically order a lower dose or an extended dosing interval.
7. The nurse is calculating a medication dose for a pediatric patient. Which is
the most accurate method for determining the safe dose range?
A. Standard adult dose divided by 2.
B. The Clark's Rule using the child's weight.
C. The provider's order, using the child's weight in kg.
D. Using the child's age in months.
Rationale: Pediatric dosing is almost always based on weight in kilograms.
While there are rules of thumb (Clark's, Young's), the most accurate and safest
method is to use the ordered dose (often in mg/kg) and calculate precisely using
the patient's current weight. This minimizes the risk of medication errors.
8. Which of the following is the nurse's primary responsibility before
administering any medication?
A. Document the patient's allergies.
B. Verify the patient's identity using two identifiers.
C. Check the patient's blood pressure.
D. Review the medication's side effects.
Rationale: The six rights of medication administration are a standard of practice.
The very first and most critical step is to identify the right patient. This is done
using two patient-specific identifiers (e.g., name and date of birth, or name and
medical record number) to prevent administration to the wrong individual.
9. A patient is prescribed a medication that has a half-life of 6 hours. The
nurse explains that steady-state concentration will be achieved in
approximately:
A. 12 hours
B. 18 hours
C. 24-30 hours
D. 48 hours
Rationale: Steady state is achieved when the rate of drug administration equals the
rate of elimination. It takes approximately 4 to 5 half-lives to reach 95% of steady
state. 4 × 6 hours = 24 hours; 5 × 6 = 30 hours. Therefore, the range of 24-30 hours
is the closest answer.
, 10. The nurse is caring for a patient who is experiencing an anaphylactic
reaction. Which medication should the nurse prepare to administer first?
A. Diphenhydramine IV
B. Methylprednisolone IV
C. Epinephrine IM
D. Albuterol via nebulizer
Rationale: The first-line treatment for anaphylaxis is intramuscular (IM)
epinephrine. It rapidly reverses the life-threatening effects of vasodilation,
bronchospasm, and edema. Antihistamines and corticosteroids are secondary
therapies that work more slowly.
11. A patient is being discharged with a prescription for a transdermal patch.
Which instruction is correct?
A. Apply the patch directly to a bony prominence.
B. Rotate application sites to prevent skin irritation.
C. Cut the patch in half if a lower dose is needed.
D. Apply heat to the patch to increase absorption.
Rationale: Rotating application sites prevents skin irritation and ensures consistent
absorption. Applying a patch to the same site repeatedly can cause irritation and
reduce efficacy. Patches should never be cut unless specifically designed to be, and
heat should be avoided as it can cause dose dumping.
12. A drug with a narrow therapeutic index requires the nurse to:
A. Administer the drug only intravenously.
B. Monitor serum drug levels closely.
C. Administer the drug with food.
D. Encourage the patient to drink extra fluids.
Rationale: A narrow therapeutic index means the difference between a therapeutic
and a toxic dose is very small. Therefore, therapeutic drug monitoring (TDM) is
essential to ensure the drug level remains within the safe and effective range.
13. The nurse is teaching a patient about a new drug that is a prodrug. Which
explanation is correct?
A. The drug is active and does not need to be metabolized.
B. The drug is inactive until metabolized by the body.
C. The drug will be immediately excreted by the kidneys.
D. The drug has a very short half-life.
Guide, Drug Classifications, Medication
Administration, Dosage Calculations,
Pharmacokinetics, Patient Safety, and Exam
Preparation
1. A nurse is preparing to administer a medication that has a high first-pass
effect. The nurse should anticipate that this medication will be administered
via which route?
A. Oral
B. Intravenous
C. Subcutaneous
D. Intramuscular
Rationale: The first-pass effect refers to the metabolism of a drug in the liver
before it reaches systemic circulation. This occurs most significantly with oral
medications. The intravenous (IV) route bypasses this effect entirely, as the drug
is directly injected into the bloodstream. Other routes like sublingual, transdermal,
and rectal also partially bypass first-pass metabolism.
2. A patient is prescribed a medication that is 99% protein-bound. The nurse
should monitor for which potential complication if the patient is also given a
second medication with higher binding affinity?
A. Decreased therapeutic effect of the first drug.
B. Increased risk of toxicity of the first drug.
C. No significant interaction.
D. Increased excretion of the first drug.
Rationale: Protein binding is reversible and saturable. A second drug with higher
affinity will displace the first drug from protein binding sites. This increases the
concentration of the free (active) form of the first drug in the bloodstream,
significantly increasing its pharmacological effect and risk of toxicity.
3. Which of the following represents the correct sequence of the
pharmacokinetic phases?
A. Distribution, Absorption, Metabolism, Excretion
B. Absorption, Distribution, Metabolism, Excretion
,C. Metabolism, Absorption, Distribution, Excretion
D. Excretion, Distribution, Absorption, Metabolism
Rationale: The order of pharmacokinetic phases is Absorption (drug enters
circulation) → Distribution (drug moves to tissues) → Metabolism (drug is
chemically altered) → Excretion (drug is removed from the body). This sequence
is often remembered using the acronym ADME.
4. A patient is receiving an intravenous infusion of a medication. The nurse
notes that the infusion is running at a rate of 50 mL/hr. The medication's
concentration is 200 mg in 250 mL. How many mg/hr is the patient receiving?
A. 20 mg/hr
B. 30 mg/hr
C. 40 mg/hr
D. 50 mg/hr
Rationale: First, calculate the concentration: 200 mg / 250 mL = 0.8 mg/mL. Then
multiply by the infusion rate: 0.8 mg/mL × 50 mL/hr = 40 mg/hr.
5. The nurse is teaching a patient about a new medication. Which statement
by the patient indicates a need for further teaching?
A. "I should take this medication with food as directed."
B. "I can stop taking this medication when I feel better."
C. "I should not drink alcohol while on this medication."
D. "I need to take this medication at the same time every day."
Rationale: Many medications, especially antibiotics and antihypertensives, must
be taken for the full prescribed course to be effective and to prevent relapse or
resistance. Stopping a medication prematurely when symptoms improve is a
common and dangerous error. The patient requires further education about
completing the entire course of therapy.
6. A patient with hepatic cirrhosis is prescribed a medication that is
extensively metabolized by the liver. The nurse should anticipate the provider
will order:
A. A higher dose.
B. A lower dose.
C. An increased dosing frequency.
D. No change in the dose.
,Rationale: Hepatic cirrhosis impairs liver function, reducing the metabolism of
many drugs. This leads to drug accumulation and increased risk of toxicity. The
provider will typically order a lower dose or an extended dosing interval.
7. The nurse is calculating a medication dose for a pediatric patient. Which is
the most accurate method for determining the safe dose range?
A. Standard adult dose divided by 2.
B. The Clark's Rule using the child's weight.
C. The provider's order, using the child's weight in kg.
D. Using the child's age in months.
Rationale: Pediatric dosing is almost always based on weight in kilograms.
While there are rules of thumb (Clark's, Young's), the most accurate and safest
method is to use the ordered dose (often in mg/kg) and calculate precisely using
the patient's current weight. This minimizes the risk of medication errors.
8. Which of the following is the nurse's primary responsibility before
administering any medication?
A. Document the patient's allergies.
B. Verify the patient's identity using two identifiers.
C. Check the patient's blood pressure.
D. Review the medication's side effects.
Rationale: The six rights of medication administration are a standard of practice.
The very first and most critical step is to identify the right patient. This is done
using two patient-specific identifiers (e.g., name and date of birth, or name and
medical record number) to prevent administration to the wrong individual.
9. A patient is prescribed a medication that has a half-life of 6 hours. The
nurse explains that steady-state concentration will be achieved in
approximately:
A. 12 hours
B. 18 hours
C. 24-30 hours
D. 48 hours
Rationale: Steady state is achieved when the rate of drug administration equals the
rate of elimination. It takes approximately 4 to 5 half-lives to reach 95% of steady
state. 4 × 6 hours = 24 hours; 5 × 6 = 30 hours. Therefore, the range of 24-30 hours
is the closest answer.
, 10. The nurse is caring for a patient who is experiencing an anaphylactic
reaction. Which medication should the nurse prepare to administer first?
A. Diphenhydramine IV
B. Methylprednisolone IV
C. Epinephrine IM
D. Albuterol via nebulizer
Rationale: The first-line treatment for anaphylaxis is intramuscular (IM)
epinephrine. It rapidly reverses the life-threatening effects of vasodilation,
bronchospasm, and edema. Antihistamines and corticosteroids are secondary
therapies that work more slowly.
11. A patient is being discharged with a prescription for a transdermal patch.
Which instruction is correct?
A. Apply the patch directly to a bony prominence.
B. Rotate application sites to prevent skin irritation.
C. Cut the patch in half if a lower dose is needed.
D. Apply heat to the patch to increase absorption.
Rationale: Rotating application sites prevents skin irritation and ensures consistent
absorption. Applying a patch to the same site repeatedly can cause irritation and
reduce efficacy. Patches should never be cut unless specifically designed to be, and
heat should be avoided as it can cause dose dumping.
12. A drug with a narrow therapeutic index requires the nurse to:
A. Administer the drug only intravenously.
B. Monitor serum drug levels closely.
C. Administer the drug with food.
D. Encourage the patient to drink extra fluids.
Rationale: A narrow therapeutic index means the difference between a therapeutic
and a toxic dose is very small. Therefore, therapeutic drug monitoring (TDM) is
essential to ensure the drug level remains within the safe and effective range.
13. The nurse is teaching a patient about a new drug that is a prodrug. Which
explanation is correct?
A. The drug is active and does not need to be metabolized.
B. The drug is inactive until metabolized by the body.
C. The drug will be immediately excreted by the kidneys.
D. The drug has a very short half-life.
