NUR 210 EXAM 1 PHARMACOLOGY PRINCIPLES 2026/2027 |
Questions and Answers | Pharmacokinetics,
Pharmacodynamics, Medication Safety | Pass Guaranteed -
A+ Graded
Unit 1: Pharmacokinetics (Absorption, Distribution, Metabolism, Excretion) (20
Questions)
Q1: A patient with severe nausea is prescribed promethazine 25 mg. The nurse notes
the patient has been vomiting frequently and is unable to tolerate oral medications.
Which route of administration would provide the most reliable absorption for this
patient?
A. Oral tablet crushed and mixed with applesauce.
B. Intramuscular injection in the vastus lateralis. [CORRECT]
C. Rectal suppository inserted immediately after a bowel movement.
D. Subcutaneous injection in the abdomen.
Correct Answer: B
Rationale: Intramuscular injection provides reliable absorption bypassing the
gastrointestinal tract, which is essential when vomiting prevents oral medication
retention. Oral route (option A) is contraindicated due to vomiting. Rectal route (option
C) is unpredictable—insertion after bowel movement improves retention but absorption
is variable due to rectal venous drainage (superior rectal vein → portal system,
,middle/inferior → systemic circulation). Subcutaneous promethazine (option D) is
contraindicated due to severe tissue irritation, necrosis, and pain; this is a high-alert
medication error risk.
Q2: A patient is taking tetracycline 500 mg PO four times daily. The nurse observes the
patient taking the medication with a glass of milk at breakfast. Which is the priority
nursing intervention?
A. Document that the medication was taken as prescribed.
B. Instruct the patient to take tetracycline with milk to reduce gastric irritation.
C. Educate the patient that dairy products form insoluble chelation complexes with
tetracycline, reducing absorption by up to 50%, and advise taking with water 1 hour
before or 2 hours after meals. [CORRECT]
D. Notify the physician immediately to change the antibiotic.
Correct Answer: C
Rationale: Tetracyclines chelate divalent cations (calcium, magnesium, iron, aluminum)
forming insoluble complexes that reduce absorption significantly. Dairy products
contain calcium. This is a knowledge-based intervention requiring patient education, not
physician notification (option D) unless therapeutic failure occurs. Documentation
without intervention (option A) is inadequate. Encouraging milk (option B) worsens the
interaction.
,Q3: A patient with heart failure has decreased cardiac output and poor peripheral
perfusion. The nurse is administering digoxin 0.25 mg IM. Which factor will most
significantly affect drug absorption from this injection?
A. Gastric pH levels.
B. Blood flow to the injection site. [CORRECT]
C. First-pass hepatic metabolism.
D. Protein binding capacity.
Correct Answer: B
Rationale: Intramuscular absorption depends primarily on blood flow to the muscle. In
heart failure with poor perfusion, absorption is delayed and unpredictable. Gastric pH
(option A) is irrelevant for parenteral routes. First-pass metabolism (option C) occurs
after absorption into systemic circulation, not at the injection site. Protein binding
(option D) affects distribution, not absorption from IM sites.
Q4: A patient is receiving lidocaine via continuous IV infusion for ventricular
arrhythmias. The nurse understands that drugs administered intravenously have 100%
bioavailability because:
A. They bypass the hepatic first-pass effect entirely.
B. They enter systemic circulation directly without absorption barriers. [CORRECT]
C. They are not subject to protein binding.
D. They avoid renal excretion mechanisms.
, Correct Answer: B
Rationale: IV administration delivers drug directly into systemic circulation, eliminating
absorption barriers and providing 100% bioavailability by definition. First-pass effect
(option A) occurs after absorption but before systemic circulation; IV drugs do enter the
liver but after reaching circulation. Protein binding (option C) and renal excretion (option
D) occur after administration regardless of route and do not affect bioavailability
calculations.
Q5: A patient has a body fat percentage of 45% (obese). The nurse is administering a
highly lipophilic drug (log P >5). How will this patient's body composition affect drug
distribution?
A. The drug will have a smaller volume of distribution and shorter duration.
B. The drug will accumulate in adipose tissue, creating a large volume of distribution
and potentially prolonged duration. [CORRECT]
C. The drug will be rapidly excreted unchanged by the kidneys.
D. The drug will have enhanced hepatic metabolism due to increased liver size.
Correct Answer: B
Rationale: Lipophilic drugs distribute extensively into adipose tissue. In obesity, this
creates a large volume of distribution (Vd), acting as a reservoir that slowly releases
drug, potentially prolonging duration and half-life. Option A describes hydrophilic drugs.
Lipophilic drugs are not primarily renally excreted unchanged (option C). Obesity does
not proportionally increase metabolic capacity (option D).
Questions and Answers | Pharmacokinetics,
Pharmacodynamics, Medication Safety | Pass Guaranteed -
A+ Graded
Unit 1: Pharmacokinetics (Absorption, Distribution, Metabolism, Excretion) (20
Questions)
Q1: A patient with severe nausea is prescribed promethazine 25 mg. The nurse notes
the patient has been vomiting frequently and is unable to tolerate oral medications.
Which route of administration would provide the most reliable absorption for this
patient?
A. Oral tablet crushed and mixed with applesauce.
B. Intramuscular injection in the vastus lateralis. [CORRECT]
C. Rectal suppository inserted immediately after a bowel movement.
D. Subcutaneous injection in the abdomen.
Correct Answer: B
Rationale: Intramuscular injection provides reliable absorption bypassing the
gastrointestinal tract, which is essential when vomiting prevents oral medication
retention. Oral route (option A) is contraindicated due to vomiting. Rectal route (option
C) is unpredictable—insertion after bowel movement improves retention but absorption
is variable due to rectal venous drainage (superior rectal vein → portal system,
,middle/inferior → systemic circulation). Subcutaneous promethazine (option D) is
contraindicated due to severe tissue irritation, necrosis, and pain; this is a high-alert
medication error risk.
Q2: A patient is taking tetracycline 500 mg PO four times daily. The nurse observes the
patient taking the medication with a glass of milk at breakfast. Which is the priority
nursing intervention?
A. Document that the medication was taken as prescribed.
B. Instruct the patient to take tetracycline with milk to reduce gastric irritation.
C. Educate the patient that dairy products form insoluble chelation complexes with
tetracycline, reducing absorption by up to 50%, and advise taking with water 1 hour
before or 2 hours after meals. [CORRECT]
D. Notify the physician immediately to change the antibiotic.
Correct Answer: C
Rationale: Tetracyclines chelate divalent cations (calcium, magnesium, iron, aluminum)
forming insoluble complexes that reduce absorption significantly. Dairy products
contain calcium. This is a knowledge-based intervention requiring patient education, not
physician notification (option D) unless therapeutic failure occurs. Documentation
without intervention (option A) is inadequate. Encouraging milk (option B) worsens the
interaction.
,Q3: A patient with heart failure has decreased cardiac output and poor peripheral
perfusion. The nurse is administering digoxin 0.25 mg IM. Which factor will most
significantly affect drug absorption from this injection?
A. Gastric pH levels.
B. Blood flow to the injection site. [CORRECT]
C. First-pass hepatic metabolism.
D. Protein binding capacity.
Correct Answer: B
Rationale: Intramuscular absorption depends primarily on blood flow to the muscle. In
heart failure with poor perfusion, absorption is delayed and unpredictable. Gastric pH
(option A) is irrelevant for parenteral routes. First-pass metabolism (option C) occurs
after absorption into systemic circulation, not at the injection site. Protein binding
(option D) affects distribution, not absorption from IM sites.
Q4: A patient is receiving lidocaine via continuous IV infusion for ventricular
arrhythmias. The nurse understands that drugs administered intravenously have 100%
bioavailability because:
A. They bypass the hepatic first-pass effect entirely.
B. They enter systemic circulation directly without absorption barriers. [CORRECT]
C. They are not subject to protein binding.
D. They avoid renal excretion mechanisms.
, Correct Answer: B
Rationale: IV administration delivers drug directly into systemic circulation, eliminating
absorption barriers and providing 100% bioavailability by definition. First-pass effect
(option A) occurs after absorption but before systemic circulation; IV drugs do enter the
liver but after reaching circulation. Protein binding (option C) and renal excretion (option
D) occur after administration regardless of route and do not affect bioavailability
calculations.
Q5: A patient has a body fat percentage of 45% (obese). The nurse is administering a
highly lipophilic drug (log P >5). How will this patient's body composition affect drug
distribution?
A. The drug will have a smaller volume of distribution and shorter duration.
B. The drug will accumulate in adipose tissue, creating a large volume of distribution
and potentially prolonged duration. [CORRECT]
C. The drug will be rapidly excreted unchanged by the kidneys.
D. The drug will have enhanced hepatic metabolism due to increased liver size.
Correct Answer: B
Rationale: Lipophilic drugs distribute extensively into adipose tissue. In obesity, this
creates a large volume of distribution (Vd), acting as a reservoir that slowly releases
drug, potentially prolonging duration and half-life. Option A describes hydrophilic drugs.
Lipophilic drugs are not primarily renally excreted unchanged (option C). Obesity does
not proportionally increase metabolic capacity (option D).
