NSG 318 Final Exam – Pharmacology Exam –
NGN Questions and Case Scenarios (Guarantee
Pass)
SECTION 1: FOUNDATIONAL PHARMACOLOGY
Question 1
A patient receives an IV medication that produces immediate therapeutic
effects, whereas the same drug given orally has a delayed onset. Which
pharmacokinetic principle best explains this difference?
A. First-pass metabolism
B. Bioavailability
C. Protein binding
D. Renal clearance
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: B. Bioavailability
Rationale: Bioavailability refers to the proportion of a drug that reaches systemic
circulation in an active form. IV administration has 100% bioavailability, while oral
drugs undergo absorption barriers and partial first-pass metabolism, delaying
onset and reducing available drug concentration.
Incorrect:
• A. First-pass metabolism is a component but not the complete explanation
• C. Protein binding affects distribution, not onset
• D. Renal clearance affects elimination, not absorption/onset
</details>
Question 2
,Which statement best reflects the concept of a partial agonist?
A. It blocks receptors without activating them
B. It produces full receptor activation at low doses
C. It activates receptors but produces a submaximal response
D. It irreversibly binds and deactivates receptors
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: C. It activates receptors but produces a submaximal response
Rationale: Partial agonists bind to receptors and activate them but elicit a weaker
response compared to full agonists, even when occupying all available receptors.
Incorrect:
• A. Describes an antagonist
• B. Describes a full agonist
• D. Describes an irreversible antagonist
</details>
Question 3
A patient's lab results show an AST of 60 U/L and ALT of 70 U/L. Which class of
medications should the nurse question administering?
A. Antibiotics
B. Antihypertensives
C. Hepatotoxic drugs such as acetaminophen
D. Anticoagulants
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: C. Hepatotoxic drugs such as acetaminophen
Rationale: Elevated AST and ALT indicate liver injury. High AST suggests liver
damage, and the nurse should avoid hepatotoxic drugs such as acetaminophen.
The provider should be notified.
,</details>
Question 4
A patient has a creatinine level of 2.2 mg/dL. Which medication should the
nurse question?
A. Acetaminophen
B. Gentamicin
C. Hydrochlorothiazide
D. Metoprolol
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: B. Gentamicin
Rationale: High creatinine indicates impaired kidney function. Gentamicin is
nephrotoxic and unsafe for patients with elevated creatinine or BUN.
</details>
Question 5
Which of the following is included in the Six Rights of medication
administration?
A. Right Reason
B. Right Assessment
C. Right Documentation
D. Right Evaluation
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: C. Right Documentation
Rationale: The core six rights are: Right Patient, Right Drug, Right Dose, Right
Route, Right Time, and Right Documentation. Reason, assessment, education,
evaluation, and refusal are often added as clinical rights but are not part of the
traditional six rights.
, </details>
Question 6
What is the therapeutic index?
A. The time for drug concentration to fall by half
B. The ratio between effective dose and toxic dose
C. The ability of a drug to produce its intended effect
D. The number of doses required to maintain steady state
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: B. The ratio between effective dose and toxic dose
Rationale: The therapeutic index compares the effective dose to the toxic dose. A
narrow therapeutic index indicates a small margin of safety and requires close
monitoring.
</details>
Question 7
A patient is prescribed 500 mg of a medication and the pharmacy provides 250
mg tablets. How many tablets should the nurse administer?
A. 1 tablet
B. 2 tablets
C. 3 tablets
D. 4 tablets
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: B. 2 tablets
Rationale: 500 ÷ 250 = 2 tablets. Correct math ensures safety—overdose can
cause toxicity, while underdose makes therapy ineffective.
</details>
NGN Questions and Case Scenarios (Guarantee
Pass)
SECTION 1: FOUNDATIONAL PHARMACOLOGY
Question 1
A patient receives an IV medication that produces immediate therapeutic
effects, whereas the same drug given orally has a delayed onset. Which
pharmacokinetic principle best explains this difference?
A. First-pass metabolism
B. Bioavailability
C. Protein binding
D. Renal clearance
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: B. Bioavailability
Rationale: Bioavailability refers to the proportion of a drug that reaches systemic
circulation in an active form. IV administration has 100% bioavailability, while oral
drugs undergo absorption barriers and partial first-pass metabolism, delaying
onset and reducing available drug concentration.
Incorrect:
• A. First-pass metabolism is a component but not the complete explanation
• C. Protein binding affects distribution, not onset
• D. Renal clearance affects elimination, not absorption/onset
</details>
Question 2
,Which statement best reflects the concept of a partial agonist?
A. It blocks receptors without activating them
B. It produces full receptor activation at low doses
C. It activates receptors but produces a submaximal response
D. It irreversibly binds and deactivates receptors
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: C. It activates receptors but produces a submaximal response
Rationale: Partial agonists bind to receptors and activate them but elicit a weaker
response compared to full agonists, even when occupying all available receptors.
Incorrect:
• A. Describes an antagonist
• B. Describes a full agonist
• D. Describes an irreversible antagonist
</details>
Question 3
A patient's lab results show an AST of 60 U/L and ALT of 70 U/L. Which class of
medications should the nurse question administering?
A. Antibiotics
B. Antihypertensives
C. Hepatotoxic drugs such as acetaminophen
D. Anticoagulants
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: C. Hepatotoxic drugs such as acetaminophen
Rationale: Elevated AST and ALT indicate liver injury. High AST suggests liver
damage, and the nurse should avoid hepatotoxic drugs such as acetaminophen.
The provider should be notified.
,</details>
Question 4
A patient has a creatinine level of 2.2 mg/dL. Which medication should the
nurse question?
A. Acetaminophen
B. Gentamicin
C. Hydrochlorothiazide
D. Metoprolol
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: B. Gentamicin
Rationale: High creatinine indicates impaired kidney function. Gentamicin is
nephrotoxic and unsafe for patients with elevated creatinine or BUN.
</details>
Question 5
Which of the following is included in the Six Rights of medication
administration?
A. Right Reason
B. Right Assessment
C. Right Documentation
D. Right Evaluation
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: C. Right Documentation
Rationale: The core six rights are: Right Patient, Right Drug, Right Dose, Right
Route, Right Time, and Right Documentation. Reason, assessment, education,
evaluation, and refusal are often added as clinical rights but are not part of the
traditional six rights.
, </details>
Question 6
What is the therapeutic index?
A. The time for drug concentration to fall by half
B. The ratio between effective dose and toxic dose
C. The ability of a drug to produce its intended effect
D. The number of doses required to maintain steady state
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: B. The ratio between effective dose and toxic dose
Rationale: The therapeutic index compares the effective dose to the toxic dose. A
narrow therapeutic index indicates a small margin of safety and requires close
monitoring.
</details>
Question 7
A patient is prescribed 500 mg of a medication and the pharmacy provides 250
mg tablets. How many tablets should the nurse administer?
A. 1 tablet
B. 2 tablets
C. 3 tablets
D. 4 tablets
<details> <summary><b>Answer & Rationale</b></summary>
Correct Answer: B. 2 tablets
Rationale: 500 ÷ 250 = 2 tablets. Correct math ensures safety—overdose can
cause toxicity, while underdose makes therapy ineffective.
</details>
