PHARMACOLOGY NURS 251
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient is prescribed a drug with a high ‘first-pass effect’. Which route of administration
would be least effective for achieving systemic bioavailability?
A. Oral
B. Intravenous
C. Sublingual
D. Transdermal
Answer: A
Conceptual Explanation: The first-pass effect occurs when a drug is metabolized by the
liver before reaching systemic circulation, which primarily affects drugs taken orally.
2. Which parameter describes the ratio between a drug’s median lethal dose (LD50) and its
median effective dose (ED50)?
A. Bioavailability
B. Therapeutic Index
C. Efficacy
,D. Potency
Answer: B
Conceptual Explanation: The Therapeutic Index (TI) is a measure of drug safety; a narrow
TI means the difference between a therapeutic and toxic dose is small.
3. A patient taking Phenobarbital (a CYP450 inducer) is started on Warfarin. How should the
nurse expect the Warfarin dosage to be adjusted?
A. The Warfarin dose should be increased.
B. The Warfarin dose should be decreased.
C. The Warfarin dose should remain the same.
D. Warfarin should be discontinued immediately.
Answer: A
Conceptual Explanation: CYP450 inducers increase the metabolism of other drugs (like
Warfarin), reducing their blood levels and requiring a higher dose to maintain efficacy.
4. Which clinical finding is a hallmark symptom of a Cholinergic Crisis?
A. Flaccid paralysis and respiratory failure
B. Dry mouth and constipation
C. Mydriasis and tachycardia
D. Hypertension and urinary retention
, Answer: A
Conceptual Explanation: Cholinergic crisis results from excessive acetylcholine, leading to
muscle overstimulation followed by exhaustion (flaccid paralysis) and respiratory distress.
5. A nurse is administering Atropine to a patient with symptomatic bradycardia. Which
mechanism of action describes this drug?
A. Muscarinic antagonist
B. Cholinergic agonist
C. Adrenergic agonist
D. Beta-1 blocker
Answer: A
Conceptual Explanation: Atropine is an anticholinergic (muscarinic antagonist) that
blocks parasympathetic signals to the heart, thereby increasing heart rate.
6. Which medication is contraindicated in a patient with a history of asthma due to the risk of
bronchoconstriction?
A. Propranolol
B. Metoprolol
C. Amlodipine
D. Lisinopril
Answer: A
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient is prescribed a drug with a high ‘first-pass effect’. Which route of administration
would be least effective for achieving systemic bioavailability?
A. Oral
B. Intravenous
C. Sublingual
D. Transdermal
Answer: A
Conceptual Explanation: The first-pass effect occurs when a drug is metabolized by the
liver before reaching systemic circulation, which primarily affects drugs taken orally.
2. Which parameter describes the ratio between a drug’s median lethal dose (LD50) and its
median effective dose (ED50)?
A. Bioavailability
B. Therapeutic Index
C. Efficacy
,D. Potency
Answer: B
Conceptual Explanation: The Therapeutic Index (TI) is a measure of drug safety; a narrow
TI means the difference between a therapeutic and toxic dose is small.
3. A patient taking Phenobarbital (a CYP450 inducer) is started on Warfarin. How should the
nurse expect the Warfarin dosage to be adjusted?
A. The Warfarin dose should be increased.
B. The Warfarin dose should be decreased.
C. The Warfarin dose should remain the same.
D. Warfarin should be discontinued immediately.
Answer: A
Conceptual Explanation: CYP450 inducers increase the metabolism of other drugs (like
Warfarin), reducing their blood levels and requiring a higher dose to maintain efficacy.
4. Which clinical finding is a hallmark symptom of a Cholinergic Crisis?
A. Flaccid paralysis and respiratory failure
B. Dry mouth and constipation
C. Mydriasis and tachycardia
D. Hypertension and urinary retention
, Answer: A
Conceptual Explanation: Cholinergic crisis results from excessive acetylcholine, leading to
muscle overstimulation followed by exhaustion (flaccid paralysis) and respiratory distress.
5. A nurse is administering Atropine to a patient with symptomatic bradycardia. Which
mechanism of action describes this drug?
A. Muscarinic antagonist
B. Cholinergic agonist
C. Adrenergic agonist
D. Beta-1 blocker
Answer: A
Conceptual Explanation: Atropine is an anticholinergic (muscarinic antagonist) that
blocks parasympathetic signals to the heart, thereby increasing heart rate.
6. Which medication is contraindicated in a patient with a history of asthma due to the risk of
bronchoconstriction?
A. Propranolol
B. Metoprolol
C. Amlodipine
D. Lisinopril
Answer: A
