1
Relias RN Pharmacology Test A Relias Actual
Exam 2026/2027: With Questions and
Answers | 100% Verified | Graded for
Nursing Competency Success – Pass
Guaranteed - A+ Graded
Section 1: Pharmacokinetics and Pharmacodynamics (8 questions)
Q1: A patient with liver cirrhosis is prescribed a medication that undergoes extensive first-pass
metabolism. Which pharmacokinetic change is most likely to occur?
• A. Decreased bioavailability due to increased first-pass effect
• B. Increased bioavailability due to decreased first-pass metabolism
• C. No change in drug metabolism
• D. Increased renal clearance of the drug
Correct Answer: B
Rationale: Liver cirrhosis reduces functional hepatocytes and hepatic blood flow, decreasing
first-pass metabolism. This results in increased bioavailability (more drug reaches systemic
circulation unchanged) and prolonged half-life. Option A is opposite of the correct effect. Option
C is incorrect—liver disease significantly alters drug metabolism. Option D is unrelated—renal
clearance is not directly affected by hepatic first-pass metabolism.
Q2: A patient is taking warfarin (highly protein-bound) and develops hypoalbuminemia due to
malnutrition. What is the primary concern?
• A. Decreased free drug concentration leading to therapeutic failure
• B. Increased free drug concentration leading to increased risk of bleeding
• C. No effect on drug action
• D. Decreased drug metabolism
Correct Answer: B
,2
Rationale: Warfarin is 99% protein-bound (primarily to albumin). Hypoalbuminemia reduces
binding sites, increasing the free (unbound) fraction of drug. Only free drug is pharmacologically
active, so increased free fraction increases anticoagulant effect and bleeding risk despite normal
total drug levels. Option A is opposite. Option C is false—protein binding significantly affects
drug action. Option D is not the primary concern.
Q3: A drug has a half-life of 6 hours. Approximately how long will it take to reach steady state
with continuous dosing?
• A. 6 hours
• B. 12 hours
• C. 24-30 hours (4-5 half-lives)
• D. 48 hours
Correct Answer: C
Rationale: Steady state (where drug elimination equals drug input, and plasma concentrations
plateau) is reached in approximately 4-5 half-lives regardless of dosing interval. With a 6-hour
half-life: 5 × 6 = 30 hours. Options A and B represent only 1-2 half-lives (50-75% of steady
state). Option D exceeds necessary time.
Q4: A patient is a poor metabolizer via CYP2D6. Which drug effect is most likely?
• A. Increased efficacy of codeine for pain relief
• B. Decreased efficacy of codeine (reduced conversion to morphine) and increased
toxicity of tramadol
• C. No effect on prodrug metabolism
• D. Decreased toxicity of all opioids
Correct Answer: B
Rationale: CYP2D6 poor metabolizers cannot effectively convert codeine (prodrug) to active
morphine, reducing analgesia. Conversely, they cannot metabolize tramadol (also a prodrug) to
its active metabolite O-desmethyltramadol, but parent drug accumulation increases serotonin
syndrome risk. Option A is opposite—poor metabolizers get less morphine. Option C is false—
prodrug metabolism is directly affected. Option D is incorrect—toxicity depends on specific
drug.
, 3
Q5: Which pharmacodynamic term describes the maximum effect a drug can produce regardless
of dose?
• A. Potency
• B. Efficacy
• C. Therapeutic index
• D. Bioavailability
Correct Answer: B
Rationale: Efficacy refers to the maximum biological effect a drug can produce (ceiling effect),
reflecting intrinsic activity. Potency (Option A) is the dose required to produce a given effect.
Therapeutic index (Option C) is the ratio of toxic to therapeutic dose. Bioavailability (Option D)
is a pharmacokinetic, not pharmacodynamic, parameter.
Q6: A patient taking phenytoin (enzyme inducer) starts taking oral contraceptives. What
interaction is likely?
• A. Increased contraceptive efficacy due to enzyme inhibition
• B. Decreased contraceptive efficacy due to increased metabolism of estrogen/progestin
• C. No interaction between these drugs
• D. Increased phenytoin toxicity
Correct Answer: B
Rationale: Phenytoin induces CYP450 enzymes (particularly CYP3A4 and CYP1A2),
increasing metabolism of oral contraceptive steroids. This reduces contraceptive efficacy and
increases risk of unintended pregnancy. Option A is opposite. Option C is false—significant
interaction exists. Option D is less likely than contraceptive failure.
Q7: A drug with a narrow therapeutic index requires which monitoring approach?
• A. No monitoring needed
• B. Therapeutic drug monitoring (TDM) to maintain plasma concentrations within
therapeutic window and avoid toxicity
• C. Monitoring only for efficacy, not toxicity
• D. Single dose administration only
Relias RN Pharmacology Test A Relias Actual
Exam 2026/2027: With Questions and
Answers | 100% Verified | Graded for
Nursing Competency Success – Pass
Guaranteed - A+ Graded
Section 1: Pharmacokinetics and Pharmacodynamics (8 questions)
Q1: A patient with liver cirrhosis is prescribed a medication that undergoes extensive first-pass
metabolism. Which pharmacokinetic change is most likely to occur?
• A. Decreased bioavailability due to increased first-pass effect
• B. Increased bioavailability due to decreased first-pass metabolism
• C. No change in drug metabolism
• D. Increased renal clearance of the drug
Correct Answer: B
Rationale: Liver cirrhosis reduces functional hepatocytes and hepatic blood flow, decreasing
first-pass metabolism. This results in increased bioavailability (more drug reaches systemic
circulation unchanged) and prolonged half-life. Option A is opposite of the correct effect. Option
C is incorrect—liver disease significantly alters drug metabolism. Option D is unrelated—renal
clearance is not directly affected by hepatic first-pass metabolism.
Q2: A patient is taking warfarin (highly protein-bound) and develops hypoalbuminemia due to
malnutrition. What is the primary concern?
• A. Decreased free drug concentration leading to therapeutic failure
• B. Increased free drug concentration leading to increased risk of bleeding
• C. No effect on drug action
• D. Decreased drug metabolism
Correct Answer: B
,2
Rationale: Warfarin is 99% protein-bound (primarily to albumin). Hypoalbuminemia reduces
binding sites, increasing the free (unbound) fraction of drug. Only free drug is pharmacologically
active, so increased free fraction increases anticoagulant effect and bleeding risk despite normal
total drug levels. Option A is opposite. Option C is false—protein binding significantly affects
drug action. Option D is not the primary concern.
Q3: A drug has a half-life of 6 hours. Approximately how long will it take to reach steady state
with continuous dosing?
• A. 6 hours
• B. 12 hours
• C. 24-30 hours (4-5 half-lives)
• D. 48 hours
Correct Answer: C
Rationale: Steady state (where drug elimination equals drug input, and plasma concentrations
plateau) is reached in approximately 4-5 half-lives regardless of dosing interval. With a 6-hour
half-life: 5 × 6 = 30 hours. Options A and B represent only 1-2 half-lives (50-75% of steady
state). Option D exceeds necessary time.
Q4: A patient is a poor metabolizer via CYP2D6. Which drug effect is most likely?
• A. Increased efficacy of codeine for pain relief
• B. Decreased efficacy of codeine (reduced conversion to morphine) and increased
toxicity of tramadol
• C. No effect on prodrug metabolism
• D. Decreased toxicity of all opioids
Correct Answer: B
Rationale: CYP2D6 poor metabolizers cannot effectively convert codeine (prodrug) to active
morphine, reducing analgesia. Conversely, they cannot metabolize tramadol (also a prodrug) to
its active metabolite O-desmethyltramadol, but parent drug accumulation increases serotonin
syndrome risk. Option A is opposite—poor metabolizers get less morphine. Option C is false—
prodrug metabolism is directly affected. Option D is incorrect—toxicity depends on specific
drug.
, 3
Q5: Which pharmacodynamic term describes the maximum effect a drug can produce regardless
of dose?
• A. Potency
• B. Efficacy
• C. Therapeutic index
• D. Bioavailability
Correct Answer: B
Rationale: Efficacy refers to the maximum biological effect a drug can produce (ceiling effect),
reflecting intrinsic activity. Potency (Option A) is the dose required to produce a given effect.
Therapeutic index (Option C) is the ratio of toxic to therapeutic dose. Bioavailability (Option D)
is a pharmacokinetic, not pharmacodynamic, parameter.
Q6: A patient taking phenytoin (enzyme inducer) starts taking oral contraceptives. What
interaction is likely?
• A. Increased contraceptive efficacy due to enzyme inhibition
• B. Decreased contraceptive efficacy due to increased metabolism of estrogen/progestin
• C. No interaction between these drugs
• D. Increased phenytoin toxicity
Correct Answer: B
Rationale: Phenytoin induces CYP450 enzymes (particularly CYP3A4 and CYP1A2),
increasing metabolism of oral contraceptive steroids. This reduces contraceptive efficacy and
increases risk of unintended pregnancy. Option A is opposite. Option C is false—significant
interaction exists. Option D is less likely than contraceptive failure.
Q7: A drug with a narrow therapeutic index requires which monitoring approach?
• A. No monitoring needed
• B. Therapeutic drug monitoring (TDM) to maintain plasma concentrations within
therapeutic window and avoid toxicity
• C. Monitoring only for efficacy, not toxicity
• D. Single dose administration only
