NURS_1150: Nurse Pharmacology I Exam_1_ Prep
with Detailed Rationales
Course Code: NURS_1150
Course Name: Nurse Pharmacology I
Topic: Exam 1 Review & NCLEX NGN Style Core Concepts
Academic Year: 2026/2027
1. Which medication administration route should the nurse prioritize for
immediate systemic effect in a 45-year-old male patient presenting to the
emergency department with acute crushing chest pain, a blood pressure of
88/52 mmHg, and an electrocardiogram (ECG) demonstrating ST-segment
elevation?
A) Oral swallow of regular-release tablets
B) Subcutaneous injection into the abdomen
C) Intravenous bolus injection
D) Transdermal patch application
CORRECT ANSWER: C) Intravenous bolus injection
, RATIONALE: An intravenous bolus injection provides the fastest onset
of action because it bypasses the barriers of drug absorption, placing the
medication directly into the systemic circulation with 100% bioavailability.
In an emergent clinical scenario like an acute myocardial infarction,
achieving immediate therapeutic serum levels is critical.
• Distractor A (Oral swallow) is incorrect because oral medications undergo
the first-pass hepatic metabolism, significantly delaying onset (often 30 to
60 minutes) and reducing bioavailability.
• Distractor B (Subcutaneous injection) relies on erratic capillary diffusion,
which is highly compromised in a patient with systemic hypotension (88/52
mmHg) due to peripheral vasoconstriction.
• Distractor D (Transdermal patch) is designed for sustained, slow release
over hours or days and is entirely inappropriate for acute, life-threatening
emergencies.
2. A nurse is reviewing lab values for an 82-year-old female resident in a
long-term care facility who is prescribed digoxin 0.125 mg daily for chronic
heart failure. The patient's lab results reveal a serum creatinine of 2.1
mg/dL, a blood urea nitrogen (BUN) of 42 mg/dL, and an estimated
glomerular filtration rate (eGFR) of 26 mL/min/1.73m². What
pharmacokinetic alteration must the nurse anticipate?
A) Increased hepatic first-pass metabolism
B) Decreased renal excretion leading to prolonged half-life
C) Decreased drug distribution due to diminished adipose tissue
D) Increased gastrointestinal absorption rate
CORRECT ANSWER: B) Decreased renal excretion leading to prolonged
half-life
RATIONALE: Decreased renal excretion leading to prolonged half-life
is the primary pharmacokinetic alteration in this patient. Digoxin is cleared
predominantly via renal elimination. An eGFR of 26 mL/min/1.73m² and a
serum creatinine of 2.1 mg/dL indicate severe renal impairment (Stage 4
chronic kidney disease). When renal clearance drops, the elimination half-
life of digoxin extends significantly, causing the drug to accumulate in the
plasma and exponentially increasing the risk of life-threatening digitalis
toxicity.
,• Distractor A (Increased hepatic first-pass metabolism) is incorrect
because digoxin is not heavily metabolized by the liver, and aging typically
decreases, rather than increases, hepatic metabolic capacity.
• Distractor C (Decreased drug distribution) is incorrect because digoxin is
highly tissue-bound (particularly to skeletal muscle) rather than adipose-
bound; its loading dose changes little with fat loss, though reduced lean body
mass in the elderly can shrink its true volume of distribution.
• Distractor D (Increased gastrointestinal absorption) is incorrect because
aging generally results in gastric atrophy and decreased intestinal blood
flow, which slow down or reduce absorption rather than increasing it.
3. During an admission assessment, a 29-year-old female patient tells the
nurse that she takes St. John's Wort daily for mild depressive symptoms.
The nurse notes the patient is also prescribed oral contraceptive pills
(ethinyl estradiol/levonorgestrel). What pharmacological mechanism
underlies the nurse’s primary education point?
A) St. John's Wort inhibits Cytochrome P450 (CYP3A4) enzymes, inducing
toxicity.
B) St. John's Wort induces Cytochrome P450 (CYP3A4) enzymes,
accelerating contraceptive clearance.
C) St. John's Wort acts as a competitive antagonist at estrogen receptor sites.
D) St. John's Wort increases plasma protein binding of oral contraceptives.
, CORRECT ANSWER: B) St. John's Wort induces Cytochrome P450
(CYP3A4) enzymes, accelerating contraceptive clearance.
RATIONALE: St. John's Wort induces Cytochrome P450 (CYP3A4)
enzymes, accelerating contraceptive clearance. St. John's Wort is a potent
inducer of the hepatic CYP3A4 metabolic enzyme pathway. When a patient
takes an enzyme inducer concurrently with a substrate drug (like ethinyl
estradiol), the rate of hepatic metabolism for the substrate is drastically
accelerated. This causes a precipitous drop in sub-therapeutic blood levels of
the oral contraceptive, resulting in breakthrough ovulation and unintended
pregnancy risk.
• Distractor A (Inhibits Cytochrome P450) is incorrect because St. John's
Wort induces, rather than inhibits, these enzymes (inhibition would cause
toxicity, not loss of efficacy).
• Distractor C (Competitive antagonist) is incorrect because St. John's Wort
alters the pharmacokinetics (metabolism) of the hormone, not its
pharmacodynamics at the receptor level.
• Distractor D (Increases plasma protein binding) is incorrect because
changing protein binding is not the primary mechanism of this well-
documented herb-drug interaction, and higher binding would typically
prolong systemic presence rather than cause rapid metabolic clearance.
4. The nurse is caring for a 68-year-old male patient diagnosed with Type 2
Diabetes Mellitus who has been prescribed metformin 1000 mg twice
daily. The patient is scheduled for an outpatient contrast-enhanced
computed tomography (CT) scan of the abdomen tomorrow morning.
Which nursing action is mandatory to prevent a severe adverse drug event?
A) Administer a double dose of metformin the morning of the procedure to
counteract stress hyperglycemia.
B) Hold the metformin 48 hours prior to the scan and ensure it is withheld
for at least 48 hours post-procedure until renal function is verified.
C) Switch the patient to an oral sulfonylurea the morning of the procedure.
D) Administer the metformin with an intravenous fluid bolus immediately
before the contrast injection.
with Detailed Rationales
Course Code: NURS_1150
Course Name: Nurse Pharmacology I
Topic: Exam 1 Review & NCLEX NGN Style Core Concepts
Academic Year: 2026/2027
1. Which medication administration route should the nurse prioritize for
immediate systemic effect in a 45-year-old male patient presenting to the
emergency department with acute crushing chest pain, a blood pressure of
88/52 mmHg, and an electrocardiogram (ECG) demonstrating ST-segment
elevation?
A) Oral swallow of regular-release tablets
B) Subcutaneous injection into the abdomen
C) Intravenous bolus injection
D) Transdermal patch application
CORRECT ANSWER: C) Intravenous bolus injection
, RATIONALE: An intravenous bolus injection provides the fastest onset
of action because it bypasses the barriers of drug absorption, placing the
medication directly into the systemic circulation with 100% bioavailability.
In an emergent clinical scenario like an acute myocardial infarction,
achieving immediate therapeutic serum levels is critical.
• Distractor A (Oral swallow) is incorrect because oral medications undergo
the first-pass hepatic metabolism, significantly delaying onset (often 30 to
60 minutes) and reducing bioavailability.
• Distractor B (Subcutaneous injection) relies on erratic capillary diffusion,
which is highly compromised in a patient with systemic hypotension (88/52
mmHg) due to peripheral vasoconstriction.
• Distractor D (Transdermal patch) is designed for sustained, slow release
over hours or days and is entirely inappropriate for acute, life-threatening
emergencies.
2. A nurse is reviewing lab values for an 82-year-old female resident in a
long-term care facility who is prescribed digoxin 0.125 mg daily for chronic
heart failure. The patient's lab results reveal a serum creatinine of 2.1
mg/dL, a blood urea nitrogen (BUN) of 42 mg/dL, and an estimated
glomerular filtration rate (eGFR) of 26 mL/min/1.73m². What
pharmacokinetic alteration must the nurse anticipate?
A) Increased hepatic first-pass metabolism
B) Decreased renal excretion leading to prolonged half-life
C) Decreased drug distribution due to diminished adipose tissue
D) Increased gastrointestinal absorption rate
CORRECT ANSWER: B) Decreased renal excretion leading to prolonged
half-life
RATIONALE: Decreased renal excretion leading to prolonged half-life
is the primary pharmacokinetic alteration in this patient. Digoxin is cleared
predominantly via renal elimination. An eGFR of 26 mL/min/1.73m² and a
serum creatinine of 2.1 mg/dL indicate severe renal impairment (Stage 4
chronic kidney disease). When renal clearance drops, the elimination half-
life of digoxin extends significantly, causing the drug to accumulate in the
plasma and exponentially increasing the risk of life-threatening digitalis
toxicity.
,• Distractor A (Increased hepatic first-pass metabolism) is incorrect
because digoxin is not heavily metabolized by the liver, and aging typically
decreases, rather than increases, hepatic metabolic capacity.
• Distractor C (Decreased drug distribution) is incorrect because digoxin is
highly tissue-bound (particularly to skeletal muscle) rather than adipose-
bound; its loading dose changes little with fat loss, though reduced lean body
mass in the elderly can shrink its true volume of distribution.
• Distractor D (Increased gastrointestinal absorption) is incorrect because
aging generally results in gastric atrophy and decreased intestinal blood
flow, which slow down or reduce absorption rather than increasing it.
3. During an admission assessment, a 29-year-old female patient tells the
nurse that she takes St. John's Wort daily for mild depressive symptoms.
The nurse notes the patient is also prescribed oral contraceptive pills
(ethinyl estradiol/levonorgestrel). What pharmacological mechanism
underlies the nurse’s primary education point?
A) St. John's Wort inhibits Cytochrome P450 (CYP3A4) enzymes, inducing
toxicity.
B) St. John's Wort induces Cytochrome P450 (CYP3A4) enzymes,
accelerating contraceptive clearance.
C) St. John's Wort acts as a competitive antagonist at estrogen receptor sites.
D) St. John's Wort increases plasma protein binding of oral contraceptives.
, CORRECT ANSWER: B) St. John's Wort induces Cytochrome P450
(CYP3A4) enzymes, accelerating contraceptive clearance.
RATIONALE: St. John's Wort induces Cytochrome P450 (CYP3A4)
enzymes, accelerating contraceptive clearance. St. John's Wort is a potent
inducer of the hepatic CYP3A4 metabolic enzyme pathway. When a patient
takes an enzyme inducer concurrently with a substrate drug (like ethinyl
estradiol), the rate of hepatic metabolism for the substrate is drastically
accelerated. This causes a precipitous drop in sub-therapeutic blood levels of
the oral contraceptive, resulting in breakthrough ovulation and unintended
pregnancy risk.
• Distractor A (Inhibits Cytochrome P450) is incorrect because St. John's
Wort induces, rather than inhibits, these enzymes (inhibition would cause
toxicity, not loss of efficacy).
• Distractor C (Competitive antagonist) is incorrect because St. John's Wort
alters the pharmacokinetics (metabolism) of the hormone, not its
pharmacodynamics at the receptor level.
• Distractor D (Increases plasma protein binding) is incorrect because
changing protein binding is not the primary mechanism of this well-
documented herb-drug interaction, and higher binding would typically
prolong systemic presence rather than cause rapid metabolic clearance.
4. The nurse is caring for a 68-year-old male patient diagnosed with Type 2
Diabetes Mellitus who has been prescribed metformin 1000 mg twice
daily. The patient is scheduled for an outpatient contrast-enhanced
computed tomography (CT) scan of the abdomen tomorrow morning.
Which nursing action is mandatory to prevent a severe adverse drug event?
A) Administer a double dose of metformin the morning of the procedure to
counteract stress hyperglycemia.
B) Hold the metformin 48 hours prior to the scan and ensure it is withheld
for at least 48 hours post-procedure until renal function is verified.
C) Switch the patient to an oral sulfonylurea the morning of the procedure.
D) Administer the metformin with an intravenous fluid bolus immediately
before the contrast injection.
