NUR 635 FINAL REVIEW TYLER/SARHAN EXAM BANK AND A NEW
UPDATED STUDY GUIDE 2026/2027 ALL COMPLETE ACTUAL QUESTIONS
AND CORRECT VERIFIED ANSWERS
1. A 42-year-old patient is prescribed a medication that is highly lipid soluble
and extensively metabolized by the liver before reaching systemic
circulation. The provider explains that the amount of unchanged medication
reaching the bloodstream after oral administration may be substantially
lower than the administered dose. Which pharmacokinetic concept best
explains this phenomenon?
A. Renal clearance
B. First-pass metabolism
C. Protein binding
D. Volume of distribution
Answer: B
2. A patient receiving a medication that normally follows first-order
elimination asks why the dose must be taken at regular intervals. The nurse
explains that first-order elimination means the body generally removes
what proportion of the drug during a given period?
A. A constant amount regardless of concentration
B. The entire drug dose during each interval
C. A constant fraction of the drug present
D. Only the protein-bound fraction
Answer: C
3. A patient taking phenytoin develops increasing serum concentrations after
only a small dosage increase. The provider explains that the metabolic
pathway is becoming saturated. Which pharmacokinetic change is most
consistent with this situation?
A. The medication is demonstrating capacity-limited elimination
B. The medication has developed increased renal filtration
C. The medication is undergoing enhanced first-pass metabolism
pg. 1
, D. The medication has developed a larger therapeutic window
Answer: A
4. A patient asks why an intravenous medication can produce an immediate
therapeutic effect compared with an equivalent oral dose. Which
explanation is most accurate?
A. Intravenous administration bypasses gastrointestinal absorption and
provides complete systemic availability
B. Intravenous medications are always metabolized more slowly
C. Oral medications cannot reach systemic circulation
D. Intravenous administration prevents all adverse drug reactions
Answer: A
5. A patient taking several highly protein-bound medications develops signs of
toxicity after beginning another highly protein-bound drug. Which
pharmacokinetic principle should the provider consider?
A. Increased gastric emptying
B. Competition for plasma protein-binding sites
C. Reduced hepatic blood flow caused by dehydration
D. Increased renal tubular secretion
Answer: B
6. A patient with severe hepatic impairment is prescribed a medication that
normally undergoes extensive hepatic metabolism. Which change would
the provider most anticipate?
A. Increased drug clearance
B. Reduced serum concentration
C. Prolonged drug half-life
D. Faster renal elimination
Answer: C
7. A patient begins an antidepressant and asks when a meaningful
improvement in mood should generally be expected. Which response is
most appropriate?
A. Therapeutic improvement may require several weeks despite earlier
pg. 2
, pharmacologic effects
B. Full therapeutic effects should occur within 30 minutes
C. Improvement should always occur after the first dose
D. The medication should be stopped if mood does not improve within 24
hours
Answer: A
8. A patient prescribed an SSRI also takes another serotonergic medication.
Which assessment finding should prompt immediate concern for serotonin
toxicity?
A. Mild dry mouth and constipation
B. Bradycardia and hypothermia
C. Muscle rigidity, agitation, hyperreflexia, and elevated temperature
D. Increased appetite and mild fatigue
Answer: C
9. A patient taking an SSRI reports several days of progressively worsening
agitation, tremor, sweating, diarrhea, and muscle twitching after another
serotonergic medication was added. Which action is most appropriate?
A. Continue both medications and reassess in one month
B. Suspect serotonin syndrome and obtain urgent medical evaluation
C. Increase the SSRI dose to overcome tolerance
D. Add a stimulant to counteract sedation
Answer: B
10. A patient taking an antidepressant reports suicidal thoughts shortly after
starting therapy. Which nursing response is the priority?
A. Tell the patient that suicidal thoughts are an expected therapeutic effect
B. Recommend stopping all medications without consultation
C. Assess immediate suicide risk and arrange appropriate safety
intervention
D. Reassure the patient that antidepressants eliminate suicide risk
Answer: C
pg. 3
, 11. A patient with moderate generalized anxiety disorder wants a medication
that is not a controlled substance and has low potential for dependence.
Which medication is commonly used for this purpose?
A. Buspirone
B. Alprazolam
C. Diazepam
D. Phenobarbital
Answer: A
12. A patient prescribed buspirone asks why it cannot be used effectively as an
immediate rescue medication during a panic episode. Which explanation is
best?
A. It requires regular administration and does not provide immediate
anxiolysis
B. It permanently blocks all serotonin receptors
C. It produces immediate anesthesia
D. It is effective only when taken with alcohol
Answer: A
13. A patient taking a benzodiazepine for anxiety reports increasing daytime
drowsiness. Which teaching point is most important?
A. Combine the medication with alcohol to improve relaxation
B. Avoid driving or other activities requiring alertness until the response is
known
C. Double the dose if anxiety returns
D. Stop the medication abruptly after prolonged use
Answer: B
14. A patient has taken a benzodiazepine daily for several months and asks
whether the medication can simply be stopped. Which response is most
appropriate?
A. Abrupt discontinuation is recommended
B. The medication should be stopped whenever mild anxiety occurs
C. Long-term therapy should generally be tapered to reduce withdrawal risk
pg. 4
UPDATED STUDY GUIDE 2026/2027 ALL COMPLETE ACTUAL QUESTIONS
AND CORRECT VERIFIED ANSWERS
1. A 42-year-old patient is prescribed a medication that is highly lipid soluble
and extensively metabolized by the liver before reaching systemic
circulation. The provider explains that the amount of unchanged medication
reaching the bloodstream after oral administration may be substantially
lower than the administered dose. Which pharmacokinetic concept best
explains this phenomenon?
A. Renal clearance
B. First-pass metabolism
C. Protein binding
D. Volume of distribution
Answer: B
2. A patient receiving a medication that normally follows first-order
elimination asks why the dose must be taken at regular intervals. The nurse
explains that first-order elimination means the body generally removes
what proportion of the drug during a given period?
A. A constant amount regardless of concentration
B. The entire drug dose during each interval
C. A constant fraction of the drug present
D. Only the protein-bound fraction
Answer: C
3. A patient taking phenytoin develops increasing serum concentrations after
only a small dosage increase. The provider explains that the metabolic
pathway is becoming saturated. Which pharmacokinetic change is most
consistent with this situation?
A. The medication is demonstrating capacity-limited elimination
B. The medication has developed increased renal filtration
C. The medication is undergoing enhanced first-pass metabolism
pg. 1
, D. The medication has developed a larger therapeutic window
Answer: A
4. A patient asks why an intravenous medication can produce an immediate
therapeutic effect compared with an equivalent oral dose. Which
explanation is most accurate?
A. Intravenous administration bypasses gastrointestinal absorption and
provides complete systemic availability
B. Intravenous medications are always metabolized more slowly
C. Oral medications cannot reach systemic circulation
D. Intravenous administration prevents all adverse drug reactions
Answer: A
5. A patient taking several highly protein-bound medications develops signs of
toxicity after beginning another highly protein-bound drug. Which
pharmacokinetic principle should the provider consider?
A. Increased gastric emptying
B. Competition for plasma protein-binding sites
C. Reduced hepatic blood flow caused by dehydration
D. Increased renal tubular secretion
Answer: B
6. A patient with severe hepatic impairment is prescribed a medication that
normally undergoes extensive hepatic metabolism. Which change would
the provider most anticipate?
A. Increased drug clearance
B. Reduced serum concentration
C. Prolonged drug half-life
D. Faster renal elimination
Answer: C
7. A patient begins an antidepressant and asks when a meaningful
improvement in mood should generally be expected. Which response is
most appropriate?
A. Therapeutic improvement may require several weeks despite earlier
pg. 2
, pharmacologic effects
B. Full therapeutic effects should occur within 30 minutes
C. Improvement should always occur after the first dose
D. The medication should be stopped if mood does not improve within 24
hours
Answer: A
8. A patient prescribed an SSRI also takes another serotonergic medication.
Which assessment finding should prompt immediate concern for serotonin
toxicity?
A. Mild dry mouth and constipation
B. Bradycardia and hypothermia
C. Muscle rigidity, agitation, hyperreflexia, and elevated temperature
D. Increased appetite and mild fatigue
Answer: C
9. A patient taking an SSRI reports several days of progressively worsening
agitation, tremor, sweating, diarrhea, and muscle twitching after another
serotonergic medication was added. Which action is most appropriate?
A. Continue both medications and reassess in one month
B. Suspect serotonin syndrome and obtain urgent medical evaluation
C. Increase the SSRI dose to overcome tolerance
D. Add a stimulant to counteract sedation
Answer: B
10. A patient taking an antidepressant reports suicidal thoughts shortly after
starting therapy. Which nursing response is the priority?
A. Tell the patient that suicidal thoughts are an expected therapeutic effect
B. Recommend stopping all medications without consultation
C. Assess immediate suicide risk and arrange appropriate safety
intervention
D. Reassure the patient that antidepressants eliminate suicide risk
Answer: C
pg. 3
, 11. A patient with moderate generalized anxiety disorder wants a medication
that is not a controlled substance and has low potential for dependence.
Which medication is commonly used for this purpose?
A. Buspirone
B. Alprazolam
C. Diazepam
D. Phenobarbital
Answer: A
12. A patient prescribed buspirone asks why it cannot be used effectively as an
immediate rescue medication during a panic episode. Which explanation is
best?
A. It requires regular administration and does not provide immediate
anxiolysis
B. It permanently blocks all serotonin receptors
C. It produces immediate anesthesia
D. It is effective only when taken with alcohol
Answer: A
13. A patient taking a benzodiazepine for anxiety reports increasing daytime
drowsiness. Which teaching point is most important?
A. Combine the medication with alcohol to improve relaxation
B. Avoid driving or other activities requiring alertness until the response is
known
C. Double the dose if anxiety returns
D. Stop the medication abruptly after prolonged use
Answer: B
14. A patient has taken a benzodiazepine daily for several months and asks
whether the medication can simply be stopped. Which response is most
appropriate?
A. Abrupt discontinuation is recommended
B. The medication should be stopped whenever mild anxiety occurs
C. Long-term therapy should generally be tapered to reduce withdrawal risk
pg. 4
