NUR 210 | PRINCIPLES OF
PHARMACOLOGY | EXAM 2 ADVANCED
STUDY GUIDE 2026
1. A patient is prescribed a medication that is known to have a high first-pass effect. Which
route of administration would result in the lowest bioavailability for this drug?
A. Intravenous
B. Sublingual
C. Transdermal
D. Oral
Answer: D
Conceptual Explanation: The first-pass effect occurs when a drug is metabolized by the
liver before reaching systemic circulation. Oral medications pass through the portal vein to
the liver first, significantly reducing bioavailability compared to parenteral or sublingual
routes.
,2. A patient with heart failure is receiving Digoxin. Which electrolyte imbalance should the
nurse monitor most closely to prevent Digoxin toxicity?
A. Hypokalemia
B. Hypernatremia
C. Hypocalcemia
D. Hypermagnesemia
Answer: A
Conceptual Explanation: Hypokalemia (low potassium) increases the risk of Digoxin
toxicity because Digoxin competes with potassium for binding sites on the Na+/K+ ATPase
pump.
3. A nurse is preparing to administer Lisinopril to a patient. Which physiological finding would
be a contraindication for this medication?
A. Blood pressure of 150/90 mmHg
B. History of angioedema
C. Heart rate of 60 bpm
D. Serum sodium of 135 mEq/L
Answer: B
Conceptual Explanation: Angioedema is a life-threatening adverse effect of ACE inhibitors
like Lisinopril. A history of this reaction is a strict contraindication.
, 4. A patient is prescribed Albuterol and Beclomethasone inhalers for asthma. What
instruction should the nurse provide regarding administration?
A. Use the Beclomethasone first, then the Albuterol.
B. Use the Beclomethasone only during an acute attack.
C. Mix both medications in a nebulizer.
D. Use the Albuterol first, wait 5 minutes, then use the Beclomethasone.
Answer: D
Conceptual Explanation: Albuterol is a bronchodilator that opens the airways, allowing
the corticosteroid (Beclomethasone) to penetrate deeper into the lungs. A 5-minute gap is
recommended between different inhalers.
5. Which medication is considered a selective Beta-1 blocker, making it safer for patients with
asthma or COPD?
A. Propranolol
B. Timolol
C. Nadolol
D. Metoprolol
Answer: D
PHARMACOLOGY | EXAM 2 ADVANCED
STUDY GUIDE 2026
1. A patient is prescribed a medication that is known to have a high first-pass effect. Which
route of administration would result in the lowest bioavailability for this drug?
A. Intravenous
B. Sublingual
C. Transdermal
D. Oral
Answer: D
Conceptual Explanation: The first-pass effect occurs when a drug is metabolized by the
liver before reaching systemic circulation. Oral medications pass through the portal vein to
the liver first, significantly reducing bioavailability compared to parenteral or sublingual
routes.
,2. A patient with heart failure is receiving Digoxin. Which electrolyte imbalance should the
nurse monitor most closely to prevent Digoxin toxicity?
A. Hypokalemia
B. Hypernatremia
C. Hypocalcemia
D. Hypermagnesemia
Answer: A
Conceptual Explanation: Hypokalemia (low potassium) increases the risk of Digoxin
toxicity because Digoxin competes with potassium for binding sites on the Na+/K+ ATPase
pump.
3. A nurse is preparing to administer Lisinopril to a patient. Which physiological finding would
be a contraindication for this medication?
A. Blood pressure of 150/90 mmHg
B. History of angioedema
C. Heart rate of 60 bpm
D. Serum sodium of 135 mEq/L
Answer: B
Conceptual Explanation: Angioedema is a life-threatening adverse effect of ACE inhibitors
like Lisinopril. A history of this reaction is a strict contraindication.
, 4. A patient is prescribed Albuterol and Beclomethasone inhalers for asthma. What
instruction should the nurse provide regarding administration?
A. Use the Beclomethasone first, then the Albuterol.
B. Use the Beclomethasone only during an acute attack.
C. Mix both medications in a nebulizer.
D. Use the Albuterol first, wait 5 minutes, then use the Beclomethasone.
Answer: D
Conceptual Explanation: Albuterol is a bronchodilator that opens the airways, allowing
the corticosteroid (Beclomethasone) to penetrate deeper into the lungs. A 5-minute gap is
recommended between different inhalers.
5. Which medication is considered a selective Beta-1 blocker, making it safer for patients with
asthma or COPD?
A. Propranolol
B. Timolol
C. Nadolol
D. Metoprolol
Answer: D
