NSG 318 Exam 1 | (2026) Pharmacology Exam
Questions | Study Guide (PDF)
1. A nurse administers a medication that is highly protein-
bound (98%). Which concurrent condition would most
likely lead to drug toxicity?
a) High dietary protein intake
b) Administration of a second highly protein-bound drug
c) Intravenous administration
d) First-pass effect
Answer: b
Rationale: Highly protein-bound drugs compete for
limited binding sites on albumin. When a second highly
protein-bound drug is given, it displaces the first drug,
increasing the free (active) fraction. This can lead to
toxicity even if the total drug concentration remains
normal.
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,2. A drug has a half-life of 6 hours. How many hours will
it take to reach 94% steady state concentration?
a) 12 hours
b) 18 hours
c) 24 hours
d) 30 hours
Answer: c
Rationale: Steady state is achieved after approximately
5 half-lives. 6 hours × 5 = 30 hours. At 4 half-lives (24
hours), the concentration is about 94% of steady state.
The standard teaching is 5 half-lives for >97%.
3. Which route of administration completely bypasses the
first-pass effect?
a) Oral
b) Sublingual
c) Rectal
d) Subcutaneous
2
,Answer: b
Rationale: Sublingual administration allows the drug to
diffuse directly into systemic circulation via the highly
vascularized oral mucosa, bypassing the portal circulation
and hepatic first-pass metabolism. Rectal administration
partially bypasses but not completely.
4. A patient with liver cirrhosis is prescribed morphine,
which undergoes extensive first-pass metabolism. What
change is expected?
a) Decreased bioavailability of oral morphine
b) Increased bioavailability of oral morphine
c) No change in bioavailability
d) Faster elimination of morphine
Answer: b
Rationale: Liver cirrhosis reduces hepatic blood flow and
metabolizing enzyme activity, decreasing first-pass
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, extraction. This increases oral bioavailability, requiring a
lower dose to avoid toxicity.
5. Which factor does NOT affect drug absorption from
the gastrointestinal tract?
a) Gastric emptying time
b) Presence of food in the stomach
c) Hepatic blood flow
d) pH of the GI tract
Answer: c
Rationale: Hepatic blood flow affects drug metabolism
(first-pass effect) and distribution, not absorption.
Absorption is influenced by factors that affect movement
from GI lumen into blood: pH, gastric emptying, food,
blood flow to GI tract, and surface area.
6. A patient has a serum albumin level of 2.0 g/dL
(normal 3.5-5.0). Which medication property would most
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Questions | Study Guide (PDF)
1. A nurse administers a medication that is highly protein-
bound (98%). Which concurrent condition would most
likely lead to drug toxicity?
a) High dietary protein intake
b) Administration of a second highly protein-bound drug
c) Intravenous administration
d) First-pass effect
Answer: b
Rationale: Highly protein-bound drugs compete for
limited binding sites on albumin. When a second highly
protein-bound drug is given, it displaces the first drug,
increasing the free (active) fraction. This can lead to
toxicity even if the total drug concentration remains
normal.
1
,2. A drug has a half-life of 6 hours. How many hours will
it take to reach 94% steady state concentration?
a) 12 hours
b) 18 hours
c) 24 hours
d) 30 hours
Answer: c
Rationale: Steady state is achieved after approximately
5 half-lives. 6 hours × 5 = 30 hours. At 4 half-lives (24
hours), the concentration is about 94% of steady state.
The standard teaching is 5 half-lives for >97%.
3. Which route of administration completely bypasses the
first-pass effect?
a) Oral
b) Sublingual
c) Rectal
d) Subcutaneous
2
,Answer: b
Rationale: Sublingual administration allows the drug to
diffuse directly into systemic circulation via the highly
vascularized oral mucosa, bypassing the portal circulation
and hepatic first-pass metabolism. Rectal administration
partially bypasses but not completely.
4. A patient with liver cirrhosis is prescribed morphine,
which undergoes extensive first-pass metabolism. What
change is expected?
a) Decreased bioavailability of oral morphine
b) Increased bioavailability of oral morphine
c) No change in bioavailability
d) Faster elimination of morphine
Answer: b
Rationale: Liver cirrhosis reduces hepatic blood flow and
metabolizing enzyme activity, decreasing first-pass
3
, extraction. This increases oral bioavailability, requiring a
lower dose to avoid toxicity.
5. Which factor does NOT affect drug absorption from
the gastrointestinal tract?
a) Gastric emptying time
b) Presence of food in the stomach
c) Hepatic blood flow
d) pH of the GI tract
Answer: c
Rationale: Hepatic blood flow affects drug metabolism
(first-pass effect) and distribution, not absorption.
Absorption is influenced by factors that affect movement
from GI lumen into blood: pH, gastric emptying, food,
blood flow to GI tract, and surface area.
6. A patient has a serum albumin level of 2.0 g/dL
(normal 3.5-5.0). Which medication property would most
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