NUR 253 EXAM 1 REVIEW QUESTIONS
& VERIFIED ANSWERS (A+
GUARANTEE) | GALEN COLLEGE OF
NURSING (2026/2027)
1. A patient is prescribed a drug with a very high first-pass effect. Which route of
administration would be least effective for achieving a therapeutic blood level?
A. Oral
B. Sublingual
C. Intravenous
D. Transdermal
Answer: A
Conceptual Explanation: The first-pass effect occurs when a drug is metabolized in the
liver before it reaches systemic circulation. Oral medications travel through the portal vein
to the liver first, significantly reducing bioavailability for drugs with high first-pass
metabolism.
,2. A nurse is monitoring a patient receiving a drug with a narrow therapeutic index. What is
the priority nursing action?
A. Assess for a history of drug allergies.
B. Monitor serum drug levels frequently.
C. Encourage increased fluid intake.
D. Administer the drug with food to prevent GI upset.
Answer: B
Conceptual Explanation: Drugs with a narrow therapeutic index have a small margin of
safety between therapeutic and toxic doses. Frequent monitoring of serum levels is
essential to prevent toxicity.
3. When considering the pharmacokinetics of a drug, which process is primarily affected by a
patient’s low serum albumin level?
A. Distribution
B. Metabolism
C. Absorption
D. Excretion
Answer: A
, Conceptual Explanation: Many drugs bind to albumin for transport. Low albumin levels
(hypoalbuminemia) result in fewer binding sites, leaving more ‘free’ drug in the
bloodstream, which affects the distribution and increases the risk of toxicity.
4. A patient with chronic renal failure is prescribed a medication that is primarily excreted by
the kidneys. What adjustment does the nurse anticipate?
A. A higher dose to overcome poor filtration.
B. Discontinuing the medication immediately.
C. Changing the route to intramuscular.
D. A decrease in the dosage or increased dosing interval.
Answer: D
Conceptual Explanation: Impaired renal function reduces the body’s ability to excrete
drugs, leading to potential accumulation. Dosage reduction or longer intervals between
doses are required to prevent toxicity.
5. Which term describes the process by which a drug molecule binds to a receptor and
produces a maximal response?
A. Antagonist
B. Agonist
C. Partial Agonist
D. Competitive Inhibitor
& VERIFIED ANSWERS (A+
GUARANTEE) | GALEN COLLEGE OF
NURSING (2026/2027)
1. A patient is prescribed a drug with a very high first-pass effect. Which route of
administration would be least effective for achieving a therapeutic blood level?
A. Oral
B. Sublingual
C. Intravenous
D. Transdermal
Answer: A
Conceptual Explanation: The first-pass effect occurs when a drug is metabolized in the
liver before it reaches systemic circulation. Oral medications travel through the portal vein
to the liver first, significantly reducing bioavailability for drugs with high first-pass
metabolism.
,2. A nurse is monitoring a patient receiving a drug with a narrow therapeutic index. What is
the priority nursing action?
A. Assess for a history of drug allergies.
B. Monitor serum drug levels frequently.
C. Encourage increased fluid intake.
D. Administer the drug with food to prevent GI upset.
Answer: B
Conceptual Explanation: Drugs with a narrow therapeutic index have a small margin of
safety between therapeutic and toxic doses. Frequent monitoring of serum levels is
essential to prevent toxicity.
3. When considering the pharmacokinetics of a drug, which process is primarily affected by a
patient’s low serum albumin level?
A. Distribution
B. Metabolism
C. Absorption
D. Excretion
Answer: A
, Conceptual Explanation: Many drugs bind to albumin for transport. Low albumin levels
(hypoalbuminemia) result in fewer binding sites, leaving more ‘free’ drug in the
bloodstream, which affects the distribution and increases the risk of toxicity.
4. A patient with chronic renal failure is prescribed a medication that is primarily excreted by
the kidneys. What adjustment does the nurse anticipate?
A. A higher dose to overcome poor filtration.
B. Discontinuing the medication immediately.
C. Changing the route to intramuscular.
D. A decrease in the dosage or increased dosing interval.
Answer: D
Conceptual Explanation: Impaired renal function reduces the body’s ability to excrete
drugs, leading to potential accumulation. Dosage reduction or longer intervals between
doses are required to prevent toxicity.
5. Which term describes the process by which a drug molecule binds to a receptor and
produces a maximal response?
A. Antagonist
B. Agonist
C. Partial Agonist
D. Competitive Inhibitor
