NR 293
Pharmacology
Midterm Exam Review
2026
1. Multiple Choice Which phase of pharmacokinetics primarily involves the
liver? A) Absorption B) Distribution C) Metabolism D) Excretion
Answer: C) Metabolism Rationale: The liver is the primary organ
responsible for drug metabolism, transforming drugs into more water-
soluble compounds for elimination.
2. True/False Drugs that are highly protein-bound have a longer duration
of action in the bloodstream. Answer: True Rationale: Protein binding
limits drug elimination and metabolism, prolonging the drug's half-life.
3. Short Answer Name two cytochrome P450 enzymes most commonly
involved in drug-drug interactions. Answer: CYP3A4 and CYP2D6
Rationale: These enzymes metabolize many drugs and often cause
significant interactions when inhibited or induced.
4. Matching Match the following terms with their correct definitions: a)
Bioavailability b) Half-life c) Therapeutic index d) Agonist
5. Time required for plasma drug concentration to reduce by half
6. Ratio of toxic dose to therapeutic dose
7. The amount of drug reaching systemic circulation after administration
8. A drug that activates a receptor to produce a biological response
Answer: a-3, b-1, c-2, d-4 Rationale: Understanding these definitions is
fundamental for clinical dosing and safety.
5. Fill in the Blank The ___________ route of drug administration avoids
first-pass metabolism. Answer: Sublingual Rationale: Sublingual
absorption allows direct entry into systemic circulation, bypassing the
liver.
6. Multiple Choice Which of the following drugs is a selective beta-1
, blocker? A) Propranolol B) Atenolol C) Carvedilol D) Labetalol
Answer: B) Atenolol Rationale: Atenolol selectively blocks beta-1
receptors, mainly affecting cardiac tissue with fewer respiratory side
effects.
7. True/False The volume of distribution (Vd) helps determine the loading
dose of a drug. Answer: True Rationale: Vd indicates how extensively a
drug distributes into tissue versus plasma, aiding in dose calculations.
8. Short Answer Explain the clinical significance of the “first-pass effect”.
Answer: The first-pass effect reduces the bioavailability of some orally
administered drugs by metabolizing them in the liver before reaching
systemic circulation. Rationale: Nursing considerations include choosing
alternate routes or adjusting oral doses accordingly.
9. Matching Match the following drug classes with their primary mechanism
of action: a) ACE inhibitors b) Loop diuretics c) Calcium channel blockers d)
Proton pump inhibitors
10. Inhibit H+/K+ ATPase in gastric parietal cells
11. Block angiotensin converting enzyme, reducing angiotensin II
12. Inhibit Na+-K+-2Cl- cotransporter in the loop of Henle
13. Block L-type calcium channels in vascular smooth muscle
Answer: a-2, b-3, c-4, d-1 Rationale: Mechanisms guide therapeutic use
and side effect profiles.
10. Fill in the Blank The primary route of excretion for most drugs and
their metabolites is through the __________. Answer: Kidneys Rationale:
Renal excretion clears many drugs, critical in dosing for renal impairment.
11. Multiple Choice Which pharmacodynamic parameter best describes
the potency of a drug? A) Efficacy B) ED50 C) Therapeutic index D) Half-life
Answer: B) ED50 Rationale: ED50 is the dose that produces 50% of the
maximum effect, reflecting potency.
12. True/False An antagonist drug binds to a receptor and activates it to
produce a response. Answer: False Rationale: Antagonists bind without
activating the receptor, blocking agonist effects.
13. Short Answer List two nursing considerations when administering
, drugs with narrow therapeutic indices. Answer: Monitor blood drug levels
regularly, adjust dose carefully, watch for signs of toxicity. Rationale:
Drugs like digoxin require close monitoring due to potential toxicity.
14. Matching Match the following terms with examples: a) Partial agonist
b) Competitive antagonist c) Non-competitive antagonist d) Inverse agonist
15. Naloxone
16. Buprenorphine
17. Flumazenil
18. Beta-carbolines (benzodiazepine inverse agonists)
Answer: a-2, b-1, c-3, d-4 Rationale: These terms describe different
receptor interactions affecting drug responses.
15. Fill in the Blank ___________ describes the phenomenon where
repeated drug use results in reduced responsiveness. Answer: Tolerance
Rationale: Tolerance can necessitate dosage adjustments to maintain
effect.
16. Multiple Choice Which condition most affects drug distribution due to
alterations in plasma proteins? A) Liver cirrhosis B) Renal failure C)
Diabetes mellitus D) Hyperthyroidism
Answer: A) Liver cirrhosis Rationale: Hypoalbuminemia in liver disease
decreases protein binding, increasing free drug concentration.
17. True/False Patients with renal impairment may require increased
doses of renally-excreted drugs. Answer: False Rationale: Doses often
need to be decreased to prevent toxicity due to impaired clearance.
18. Short Answer Define “pharmacogenomics” and its relevance to
nursing care. Answer: Pharmacogenomics studies how genetic variations
affect drug response; nurses must recognize genetic factors affecting
efficacy and toxicity. Rationale: Personalized medicine can optimize
treatment.
19. Matching Match the adverse effect with the likely causative drug: a)
Tendon rupture b) Gingival hyperplasia c) Ototoxicity d) Stevens-Johnson
syndrome
20. Phenytoin
21. Ciprofloxacin
Pharmacology
Midterm Exam Review
2026
1. Multiple Choice Which phase of pharmacokinetics primarily involves the
liver? A) Absorption B) Distribution C) Metabolism D) Excretion
Answer: C) Metabolism Rationale: The liver is the primary organ
responsible for drug metabolism, transforming drugs into more water-
soluble compounds for elimination.
2. True/False Drugs that are highly protein-bound have a longer duration
of action in the bloodstream. Answer: True Rationale: Protein binding
limits drug elimination and metabolism, prolonging the drug's half-life.
3. Short Answer Name two cytochrome P450 enzymes most commonly
involved in drug-drug interactions. Answer: CYP3A4 and CYP2D6
Rationale: These enzymes metabolize many drugs and often cause
significant interactions when inhibited or induced.
4. Matching Match the following terms with their correct definitions: a)
Bioavailability b) Half-life c) Therapeutic index d) Agonist
5. Time required for plasma drug concentration to reduce by half
6. Ratio of toxic dose to therapeutic dose
7. The amount of drug reaching systemic circulation after administration
8. A drug that activates a receptor to produce a biological response
Answer: a-3, b-1, c-2, d-4 Rationale: Understanding these definitions is
fundamental for clinical dosing and safety.
5. Fill in the Blank The ___________ route of drug administration avoids
first-pass metabolism. Answer: Sublingual Rationale: Sublingual
absorption allows direct entry into systemic circulation, bypassing the
liver.
6. Multiple Choice Which of the following drugs is a selective beta-1
, blocker? A) Propranolol B) Atenolol C) Carvedilol D) Labetalol
Answer: B) Atenolol Rationale: Atenolol selectively blocks beta-1
receptors, mainly affecting cardiac tissue with fewer respiratory side
effects.
7. True/False The volume of distribution (Vd) helps determine the loading
dose of a drug. Answer: True Rationale: Vd indicates how extensively a
drug distributes into tissue versus plasma, aiding in dose calculations.
8. Short Answer Explain the clinical significance of the “first-pass effect”.
Answer: The first-pass effect reduces the bioavailability of some orally
administered drugs by metabolizing them in the liver before reaching
systemic circulation. Rationale: Nursing considerations include choosing
alternate routes or adjusting oral doses accordingly.
9. Matching Match the following drug classes with their primary mechanism
of action: a) ACE inhibitors b) Loop diuretics c) Calcium channel blockers d)
Proton pump inhibitors
10. Inhibit H+/K+ ATPase in gastric parietal cells
11. Block angiotensin converting enzyme, reducing angiotensin II
12. Inhibit Na+-K+-2Cl- cotransporter in the loop of Henle
13. Block L-type calcium channels in vascular smooth muscle
Answer: a-2, b-3, c-4, d-1 Rationale: Mechanisms guide therapeutic use
and side effect profiles.
10. Fill in the Blank The primary route of excretion for most drugs and
their metabolites is through the __________. Answer: Kidneys Rationale:
Renal excretion clears many drugs, critical in dosing for renal impairment.
11. Multiple Choice Which pharmacodynamic parameter best describes
the potency of a drug? A) Efficacy B) ED50 C) Therapeutic index D) Half-life
Answer: B) ED50 Rationale: ED50 is the dose that produces 50% of the
maximum effect, reflecting potency.
12. True/False An antagonist drug binds to a receptor and activates it to
produce a response. Answer: False Rationale: Antagonists bind without
activating the receptor, blocking agonist effects.
13. Short Answer List two nursing considerations when administering
, drugs with narrow therapeutic indices. Answer: Monitor blood drug levels
regularly, adjust dose carefully, watch for signs of toxicity. Rationale:
Drugs like digoxin require close monitoring due to potential toxicity.
14. Matching Match the following terms with examples: a) Partial agonist
b) Competitive antagonist c) Non-competitive antagonist d) Inverse agonist
15. Naloxone
16. Buprenorphine
17. Flumazenil
18. Beta-carbolines (benzodiazepine inverse agonists)
Answer: a-2, b-1, c-3, d-4 Rationale: These terms describe different
receptor interactions affecting drug responses.
15. Fill in the Blank ___________ describes the phenomenon where
repeated drug use results in reduced responsiveness. Answer: Tolerance
Rationale: Tolerance can necessitate dosage adjustments to maintain
effect.
16. Multiple Choice Which condition most affects drug distribution due to
alterations in plasma proteins? A) Liver cirrhosis B) Renal failure C)
Diabetes mellitus D) Hyperthyroidism
Answer: A) Liver cirrhosis Rationale: Hypoalbuminemia in liver disease
decreases protein binding, increasing free drug concentration.
17. True/False Patients with renal impairment may require increased
doses of renally-excreted drugs. Answer: False Rationale: Doses often
need to be decreased to prevent toxicity due to impaired clearance.
18. Short Answer Define “pharmacogenomics” and its relevance to
nursing care. Answer: Pharmacogenomics studies how genetic variations
affect drug response; nurses must recognize genetic factors affecting
efficacy and toxicity. Rationale: Personalized medicine can optimize
treatment.
19. Matching Match the adverse effect with the likely causative drug: a)
Tendon rupture b) Gingival hyperplasia c) Ototoxicity d) Stevens-Johnson
syndrome
20. Phenytoin
21. Ciprofloxacin
