NURSING PHARMACOLOGY
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS (Q1–10)
Q1. A nurse is teaching a client about the "first-pass effect." Which route is most affected?
A. Intravenous
B. Sublingual
C. Oral
D. Transdermal
Answer: C
Rationale: Oral medications are absorbed in the GI tract and travel to the liver via the portal
vein. The liver metabolizes a large portion of the drug before it reaches systemic circulation,
significantly reducing bioavailability. Routes that bypass first-pass include IV, sublingual, rectal,
transdermal, and inhalation.
Q2. A nurse is reviewing a prescription for a "trough level." When should the blood be drawn?
A. 30 minutes after the dose
B. Mid-way between doses
C. 15 minutes before the next dose
D. 2 hours after infusion starts
Answer: C
Rationale: The trough represents the lowest drug concentration in the bloodstream. It is
measured immediately before the next scheduled dose (typically 15–30 minutes prior). This
helps determine if the dosage is adequate to maintain therapeutic levels.
Q3. A client is prescribed a highly protein-bound medication. Which condition increases
toxicity risk?
A. Decreased liver function
B. Increased protein intake
C. Decreased serum albumin
D. Increased renal excretion
Answer: C
Rationale: When serum albumin is decreased (malnutrition, liver disease, nephrotic syndrome),
more unbound (free) drug is available in the bloodstream. Only the unbound fraction is
pharmacologically active, so decreased albumin increases drug effect and toxicity risk.
,Q4. A medication with a half-life of 12 hours is given at 0800. When will steady state be
reached?
A. 1200 same day
B. 2000 same day
C. 0800 on the third day
D. 0800 on the fifth day
Answer: C
Rationale: Steady state is reached in approximately 4–5 half-lives. With a 12-hour half-life, 4–5
half-lives = 48–60 hours, which is approximately 2–2.5 days. The medication would reach steady
state around 0800 on the third day.
Q5. Which term describes a drug that binds to a receptor and stimulates a response?
A. Antagonist
B. Agonist
C. Partial agonist
D. Inverse agonist
Answer: B
Rationale: An agonist binds to a receptor and stimulates it to produce a response similar to the
endogenous substance. An antagonist blocks the receptor. A partial agonist produces a partial
response. An inverse agonist produces the opposite effect.
Q6. A nurse is teaching about a CYP450 enzyme inducer. Which instruction is correct?
A. "This can increase metabolism of other drugs, reducing their effectiveness."
B. "Avoid grapefruit juice."
C. "This slows breakdown of other drugs."
D. "Take on an empty stomach."
Answer: A
Rationale: CYP450 enzyme inducers (rifampin, carbamazepine, phenytoin, St. John's Wort)
speed up the metabolism of co-administered drugs, decreasing their serum levels and
therapeutic effectiveness. Grapefruit juice inhibits CYP450 enzymes (opposite effect).
Q7. A nurse is preparing to administer eye drops. Which actions are correct? Select all that
apply.
A. Position supine with head tilted back.
B. Ask client to look up.
C. Instill into center of conjunctival sac.
D. Instruct client to blink vigorously.
E. Apply pressure to inner canthus for 1 minute.
, Answer: A, B, C, E
Rationale: These actions ensure proper instillation and prevent systemic absorption. Blinking
vigorously expels the medication and is incorrect. Pressure on the inner canthus (punctal
occlusion) prevents drainage into the nasolacrimal duct and systemic absorption.
Q8. A nurse is teaching about transdermal patches. Which statements indicate
understanding? Select all that apply.
A. "I will apply to hairless skin."
B. "I will remove the old patch first."
C. "I will apply a heating pad over it."
D. "I can cut the patch in half."
E. "I will rotate application sites."
Answer: A, B, E
Rationale: Transdermal patches should be applied to hairless, intact skin. Old patches must be
removed before applying new ones to prevent overdose. Sites should be rotated to prevent skin
irritation. Heating pads increase absorption (dangerous). Patches should never be cut.
Q9. A nurse receives a verbal medication order. What is the appropriate action?
A. Document without verification
B. Repeat the order back for verification
C. Ask another nurse to interpret
D. Administer immediately
Answer: B
Rationale: Read-back verification reduces transcription and communication errors. The nurse
writes down the order, reads it back to the prescriber, and obtains confirmation before
administering.
Q10. A nurse is preparing a high-alert medication. Which action ensures safety?
A. Administer as ordered
B. Independent double-check by another nurse
C. Ask client to verify dose
D. Administer at slower rate
Answer: B
Rationale: High-alert medications (insulin, heparin, concentrated electrolytes) require
independent double-verification by another licensed nurse. This means both nurses calculate
the dose separately and compare results before administration.
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS (Q1–10)
Q1. A nurse is teaching a client about the "first-pass effect." Which route is most affected?
A. Intravenous
B. Sublingual
C. Oral
D. Transdermal
Answer: C
Rationale: Oral medications are absorbed in the GI tract and travel to the liver via the portal
vein. The liver metabolizes a large portion of the drug before it reaches systemic circulation,
significantly reducing bioavailability. Routes that bypass first-pass include IV, sublingual, rectal,
transdermal, and inhalation.
Q2. A nurse is reviewing a prescription for a "trough level." When should the blood be drawn?
A. 30 minutes after the dose
B. Mid-way between doses
C. 15 minutes before the next dose
D. 2 hours after infusion starts
Answer: C
Rationale: The trough represents the lowest drug concentration in the bloodstream. It is
measured immediately before the next scheduled dose (typically 15–30 minutes prior). This
helps determine if the dosage is adequate to maintain therapeutic levels.
Q3. A client is prescribed a highly protein-bound medication. Which condition increases
toxicity risk?
A. Decreased liver function
B. Increased protein intake
C. Decreased serum albumin
D. Increased renal excretion
Answer: C
Rationale: When serum albumin is decreased (malnutrition, liver disease, nephrotic syndrome),
more unbound (free) drug is available in the bloodstream. Only the unbound fraction is
pharmacologically active, so decreased albumin increases drug effect and toxicity risk.
,Q4. A medication with a half-life of 12 hours is given at 0800. When will steady state be
reached?
A. 1200 same day
B. 2000 same day
C. 0800 on the third day
D. 0800 on the fifth day
Answer: C
Rationale: Steady state is reached in approximately 4–5 half-lives. With a 12-hour half-life, 4–5
half-lives = 48–60 hours, which is approximately 2–2.5 days. The medication would reach steady
state around 0800 on the third day.
Q5. Which term describes a drug that binds to a receptor and stimulates a response?
A. Antagonist
B. Agonist
C. Partial agonist
D. Inverse agonist
Answer: B
Rationale: An agonist binds to a receptor and stimulates it to produce a response similar to the
endogenous substance. An antagonist blocks the receptor. A partial agonist produces a partial
response. An inverse agonist produces the opposite effect.
Q6. A nurse is teaching about a CYP450 enzyme inducer. Which instruction is correct?
A. "This can increase metabolism of other drugs, reducing their effectiveness."
B. "Avoid grapefruit juice."
C. "This slows breakdown of other drugs."
D. "Take on an empty stomach."
Answer: A
Rationale: CYP450 enzyme inducers (rifampin, carbamazepine, phenytoin, St. John's Wort)
speed up the metabolism of co-administered drugs, decreasing their serum levels and
therapeutic effectiveness. Grapefruit juice inhibits CYP450 enzymes (opposite effect).
Q7. A nurse is preparing to administer eye drops. Which actions are correct? Select all that
apply.
A. Position supine with head tilted back.
B. Ask client to look up.
C. Instill into center of conjunctival sac.
D. Instruct client to blink vigorously.
E. Apply pressure to inner canthus for 1 minute.
, Answer: A, B, C, E
Rationale: These actions ensure proper instillation and prevent systemic absorption. Blinking
vigorously expels the medication and is incorrect. Pressure on the inner canthus (punctal
occlusion) prevents drainage into the nasolacrimal duct and systemic absorption.
Q8. A nurse is teaching about transdermal patches. Which statements indicate
understanding? Select all that apply.
A. "I will apply to hairless skin."
B. "I will remove the old patch first."
C. "I will apply a heating pad over it."
D. "I can cut the patch in half."
E. "I will rotate application sites."
Answer: A, B, E
Rationale: Transdermal patches should be applied to hairless, intact skin. Old patches must be
removed before applying new ones to prevent overdose. Sites should be rotated to prevent skin
irritation. Heating pads increase absorption (dangerous). Patches should never be cut.
Q9. A nurse receives a verbal medication order. What is the appropriate action?
A. Document without verification
B. Repeat the order back for verification
C. Ask another nurse to interpret
D. Administer immediately
Answer: B
Rationale: Read-back verification reduces transcription and communication errors. The nurse
writes down the order, reads it back to the prescriber, and obtains confirmation before
administering.
Q10. A nurse is preparing a high-alert medication. Which action ensures safety?
A. Administer as ordered
B. Independent double-check by another nurse
C. Ask client to verify dose
D. Administer at slower rate
Answer: B
Rationale: High-alert medications (insulin, heparin, concentrated electrolytes) require
independent double-verification by another licensed nurse. This means both nurses calculate
the dose separately and compare results before administration.
