NRG 200 Pharmacology for Human Caring Nursing
Midterm Exam | Expert Verified Questions and
Correct Answers plus Rationale | New Update 2026/27
| Already Graded A+
Question 1
Which term describes the process by which a drug is chemically changed in
the liver?
• □
A. Absorption
• □
B. Distribution
• ☑
C. Metabolism
• □
D. Excretion
Correct Answer: C — Metabolism
Rationale: Metabolism (biotransformation) occurs primarily in the liver and
converts drugs into inactive or active metabolites. The liver uses the cytochrome
P450 (CYP450) enzyme system to metabolize drugs. Metabolism is essential for
drug elimination because it converts lipid-soluble drugs into water-soluble
metabolites that can be excreted by the kidneys. Absorption (A) is the movement
of a drug from its administration site into the bloodstream. Distribution (B) is the
transport of a drug through the bloodstream to its site of action. Excretion (D) is
the elimination of drugs from the body, primarily through the kidneys.
Understanding metabolism is crucial for anticipating drug interactions, as many
drugs can inhibit or induce CYP450 enzymes, altering the metabolism of other
medications.
,Question 2
Which factor places a patient at highest risk for medication toxicity?
• □
A. Increased protein binding
• ☑
B. Impaired renal function
• □
C. Increased gastric motility
• □
D. Rapid absorption
Correct Answer: B — Impaired renal function
Rationale: Decreased kidney function reduces drug excretion, leading to drug
accumulation and toxicity. The kidneys are the primary route of drug elimination.
When renal function is impaired (e.g., acute kidney injury, chronic kidney disease),
drugs that are primarily excreted renally accumulate, leading to toxic levels.
Impaired renal function is the most significant risk factor for medication toxicity
because it affects the final elimination of drugs and their metabolites. Patients with
renal impairment require dose adjustments (reduced doses or extended dosing
intervals) for renally eliminated drugs (e.g., digoxin, aminoglycosides,
vancomycin). Increased protein binding (A) actually reduces the free drug
concentration, decreasing the risk of toxicity. Increased gastric motility (C) may
affect absorption but is not the primary risk for toxicity. Rapid absorption (D) can
increase peak concentrations but is not as significant a risk as impaired elimination.
Question 3
A nurse administers medication using the "six rights." Which is included?
• □
A. Right diagnosis
, • ☑
B. Right documentation
• □
C. Right insurance
• □
D. Right equipment
Correct Answer: B — Right documentation
Rationale: The six rights of medication administration include: right patient,
right medication, right dose, right route, right time, and right documentation.
Documentation ensures accurate recording of administration, prevents medication
errors, and promotes continuity of care. Some institutions extend this to include
"right reason" and "right response" (making eight rights). The nurse should
document the medication administered, dose, route, time, and site of
administration. Documentation should occur immediately after administration to
prevent errors and ensure accurate record-keeping. The other options (right
diagnosis, right insurance, right equipment) are not part of the six rights.
Question 4
A provider orders 750 mg of a medication. The available dose is 250 mg/5 mL.
How many mL should the nurse administer?
• □
A. 10 mL
• □
B. 12 mL
• ☑
C. 15 mL
• □
D. 20 mL
, Correct Answer: C — 15 mL
Expert Rationale:
• Ordered dose: 750 mg
• Available concentration: 250 mg/5 mL
• Calculation: 750 ÷ 250 = 3
• 3 × 5 mL = 15 mL
Dimensional Analysis:
750 mg × 5 mL/250 mg = 15 mL
The nurse should always double-check medication calculations using a second
method or have another nurse verify the calculation. Medication errors often occur
due to calculation mistakes. The nurse should also consider whether the medication
is available in a single-dose vial or requires reconstitution.
Question 5
Which route of medication administration bypasses first-pass metabolism?
• □
A. Oral
• □
B. Rectal
• ☑
C. Sublingual
• □
D. Enteral
Correct Answer: C — Sublingual
Rationale: Sublingual medications are absorbed directly into systemic
circulation through the rich vascular network under the tongue, bypassing hepatic
first-pass metabolism. First-pass metabolism (hepatic first-pass effect) occurs when
Midterm Exam | Expert Verified Questions and
Correct Answers plus Rationale | New Update 2026/27
| Already Graded A+
Question 1
Which term describes the process by which a drug is chemically changed in
the liver?
• □
A. Absorption
• □
B. Distribution
• ☑
C. Metabolism
• □
D. Excretion
Correct Answer: C — Metabolism
Rationale: Metabolism (biotransformation) occurs primarily in the liver and
converts drugs into inactive or active metabolites. The liver uses the cytochrome
P450 (CYP450) enzyme system to metabolize drugs. Metabolism is essential for
drug elimination because it converts lipid-soluble drugs into water-soluble
metabolites that can be excreted by the kidneys. Absorption (A) is the movement
of a drug from its administration site into the bloodstream. Distribution (B) is the
transport of a drug through the bloodstream to its site of action. Excretion (D) is
the elimination of drugs from the body, primarily through the kidneys.
Understanding metabolism is crucial for anticipating drug interactions, as many
drugs can inhibit or induce CYP450 enzymes, altering the metabolism of other
medications.
,Question 2
Which factor places a patient at highest risk for medication toxicity?
• □
A. Increased protein binding
• ☑
B. Impaired renal function
• □
C. Increased gastric motility
• □
D. Rapid absorption
Correct Answer: B — Impaired renal function
Rationale: Decreased kidney function reduces drug excretion, leading to drug
accumulation and toxicity. The kidneys are the primary route of drug elimination.
When renal function is impaired (e.g., acute kidney injury, chronic kidney disease),
drugs that are primarily excreted renally accumulate, leading to toxic levels.
Impaired renal function is the most significant risk factor for medication toxicity
because it affects the final elimination of drugs and their metabolites. Patients with
renal impairment require dose adjustments (reduced doses or extended dosing
intervals) for renally eliminated drugs (e.g., digoxin, aminoglycosides,
vancomycin). Increased protein binding (A) actually reduces the free drug
concentration, decreasing the risk of toxicity. Increased gastric motility (C) may
affect absorption but is not the primary risk for toxicity. Rapid absorption (D) can
increase peak concentrations but is not as significant a risk as impaired elimination.
Question 3
A nurse administers medication using the "six rights." Which is included?
• □
A. Right diagnosis
, • ☑
B. Right documentation
• □
C. Right insurance
• □
D. Right equipment
Correct Answer: B — Right documentation
Rationale: The six rights of medication administration include: right patient,
right medication, right dose, right route, right time, and right documentation.
Documentation ensures accurate recording of administration, prevents medication
errors, and promotes continuity of care. Some institutions extend this to include
"right reason" and "right response" (making eight rights). The nurse should
document the medication administered, dose, route, time, and site of
administration. Documentation should occur immediately after administration to
prevent errors and ensure accurate record-keeping. The other options (right
diagnosis, right insurance, right equipment) are not part of the six rights.
Question 4
A provider orders 750 mg of a medication. The available dose is 250 mg/5 mL.
How many mL should the nurse administer?
• □
A. 10 mL
• □
B. 12 mL
• ☑
C. 15 mL
• □
D. 20 mL
, Correct Answer: C — 15 mL
Expert Rationale:
• Ordered dose: 750 mg
• Available concentration: 250 mg/5 mL
• Calculation: 750 ÷ 250 = 3
• 3 × 5 mL = 15 mL
Dimensional Analysis:
750 mg × 5 mL/250 mg = 15 mL
The nurse should always double-check medication calculations using a second
method or have another nurse verify the calculation. Medication errors often occur
due to calculation mistakes. The nurse should also consider whether the medication
is available in a single-dose vial or requires reconstitution.
Question 5
Which route of medication administration bypasses first-pass metabolism?
• □
A. Oral
• □
B. Rectal
• ☑
C. Sublingual
• □
D. Enteral
Correct Answer: C — Sublingual
Rationale: Sublingual medications are absorbed directly into systemic
circulation through the rich vascular network under the tongue, bypassing hepatic
first-pass metabolism. First-pass metabolism (hepatic first-pass effect) occurs when
