1. A nurse is preparing to administer an oral medication that is extensively metabolized by the
liver. The client has cirrhosis. The nurse should anticipate that the drug's effect may be:
A) Decreased due to increased first-pass metabolism
B) Increased and prolonged due to reduced hepatic clearance
C) Unchanged because oral drugs bypass the liver
D) Reduced because of increased protein binding
Correct Answer: B
Rationale: Impaired liver function reduces drug metabolism, leading to higher serum levels and
prolonged drug effects, increasing the risk of toxicity.
2. A client is taking a drug that is a CYP450 inducer. The nurse should monitor for:
A) Increased effects of other drugs metabolized by the same enzyme
B) Decreased effects of other drugs metabolized by the same enzyme
C) No change in drug metabolism
D) Increased risk of allergic reactions
Correct Answer: B
Rationale: CYP450 inducers accelerate the metabolism of co-administered drugs, reducing their
serum levels and therapeutic effects.
,3. A client is prescribed a highly protein-bound medication. The nurse should monitor for
increased drug activity if the client has:
A) Hyperlipidemia
B) Hypoalbuminemia
C) Polycythemia
D) Hyperglycemia
Correct Answer: B
Rationale: Low albumin reduces protein binding, increasing free (active) drug concentration and
the risk of toxicity.
4. A nurse is administering a drug with a half-life of 12 hours. Approximately how long will it
take to reach steady state with consistent dosing?
A) 12 hours
B) 24 hours
C) 48–60 hours
D) 72–96 hours
Correct Answer: C
Rationale: Steady state is reached after about 4–5 half-lives; 4–5 × 12 hours = 48–60 hours.
5. A client is prescribed an agonist drug. The nurse explains that this drug:
A) Blocks receptor activation
B) Binds to a receptor and produces a response
C) Prevents neurotransmitter reuptake
D) Acts only on enzymes
Correct Answer: B
Rationale: An agonist binds to and activates a receptor, mimicking endogenous substances.
6. A nurse is teaching a client about the first-pass effect. Which statement by the client
indicates understanding?
A) "The drug is absorbed directly into the bloodstream from the stomach."
B) "A portion of the drug is metabolized in the liver before reaching systemic circulation."
C) "The drug bypasses the liver and goes straight to the kidneys."
D) "The drug is fully absorbed before reaching the liver."
Correct Answer: B
Rationale: First-pass metabolism reduces the amount of active drug that reaches systemic
circulation after oral administration.
,7. A nurse is administering an enteric-coated tablet. The client asks if they can crush it. The
nurse's best response is:
A) "Yes, crushing it will help you swallow it."
B) "No, crushing can destroy the coating and cause stomach irritation or reduce effectiveness."
C) "You can chew it if you don't want to swallow it whole."
D) "It doesn't matter; the drug is the same."
Correct Answer: B
Rationale: Enteric coatings protect the stomach from the drug or protect the drug from
stomach acid; crushing destroys this protection.
8. A client is prescribed a transdermal patch. The nurse instructs the client to:
A) Apply the patch to a hairy area
B) Rotate application sites and remove the old patch before applying a new one
C) Apply the patch only when symptoms occur
D) Cut the patch if the dose seems too strong
Correct Answer: B
Rationale: Site rotation prevents irritation; removing the old patch prevents overdose. Patches
should not be cut.
9. A drug has a narrow therapeutic index. The nurse should:
A) Administer it without monitoring
B) Closely monitor serum drug levels and signs of toxicity
C) Give the drug only intravenously
D) Administer double doses
Correct Answer: B
Rationale: Small changes in dose can cause toxicity or treatment failure; close monitoring is
essential.
10. A nurse is administering an otic medication to a 2-year-old. The nurse pulls the pinna:
A) Upward and backward
B) Downward and backward
C) Upward and forward
D) Straight up
Correct Answer: B
Rationale: In children under 3, the eustachian tube is shorter and more horizontal; pulling the
pinna downward and backward straightens the canal.
, 11. A client is prescribed sublingual nitroglycerin. The nurse instructs the client to:
A) Swallow the tablet with a full glass of water
B) Place the tablet under the tongue and let it dissolve
C) Chew the tablet before swallowing
D) Take the tablet with food
Correct Answer: B
Rationale: Sublingual administration bypasses first-pass metabolism and provides rapid
absorption through the oral mucosa.
12. A nurse is calculating a medication dose based on body surface area. This method is used
primarily for:
A) All drugs given to adults
B) Chemotherapy and pediatric medications
C) Drugs with wide safety margins
D) Topical preparations
Correct Answer: B
Rationale: BSA dosing is more precise for drugs with narrow therapeutic ranges, especially
antineoplastics and pediatric drugs.
13. A client with renal impairment is prescribed a drug excreted unchanged in the urine. The
nurse should anticipate:
A) An increased dose
B) A decreased dose or extended dosing interval
C) No change in dose
D) The drug to be contraindicated in all cases
Correct Answer: B
Rationale: Reduced renal excretion leads to drug accumulation; dose adjustments prevent
toxicity.
14. A client is receiving a loading dose of an IV antibiotic. The purpose is to:
A) Reduce side effects
B) Achieve therapeutic serum levels rapidly
C) Prolong the drug's half-life
D) Decrease the frequency of administration
Correct Answer: B
Rationale: Loading doses rapidly achieve effective concentrations, particularly for drugs with
long half-lives.
liver. The client has cirrhosis. The nurse should anticipate that the drug's effect may be:
A) Decreased due to increased first-pass metabolism
B) Increased and prolonged due to reduced hepatic clearance
C) Unchanged because oral drugs bypass the liver
D) Reduced because of increased protein binding
Correct Answer: B
Rationale: Impaired liver function reduces drug metabolism, leading to higher serum levels and
prolonged drug effects, increasing the risk of toxicity.
2. A client is taking a drug that is a CYP450 inducer. The nurse should monitor for:
A) Increased effects of other drugs metabolized by the same enzyme
B) Decreased effects of other drugs metabolized by the same enzyme
C) No change in drug metabolism
D) Increased risk of allergic reactions
Correct Answer: B
Rationale: CYP450 inducers accelerate the metabolism of co-administered drugs, reducing their
serum levels and therapeutic effects.
,3. A client is prescribed a highly protein-bound medication. The nurse should monitor for
increased drug activity if the client has:
A) Hyperlipidemia
B) Hypoalbuminemia
C) Polycythemia
D) Hyperglycemia
Correct Answer: B
Rationale: Low albumin reduces protein binding, increasing free (active) drug concentration and
the risk of toxicity.
4. A nurse is administering a drug with a half-life of 12 hours. Approximately how long will it
take to reach steady state with consistent dosing?
A) 12 hours
B) 24 hours
C) 48–60 hours
D) 72–96 hours
Correct Answer: C
Rationale: Steady state is reached after about 4–5 half-lives; 4–5 × 12 hours = 48–60 hours.
5. A client is prescribed an agonist drug. The nurse explains that this drug:
A) Blocks receptor activation
B) Binds to a receptor and produces a response
C) Prevents neurotransmitter reuptake
D) Acts only on enzymes
Correct Answer: B
Rationale: An agonist binds to and activates a receptor, mimicking endogenous substances.
6. A nurse is teaching a client about the first-pass effect. Which statement by the client
indicates understanding?
A) "The drug is absorbed directly into the bloodstream from the stomach."
B) "A portion of the drug is metabolized in the liver before reaching systemic circulation."
C) "The drug bypasses the liver and goes straight to the kidneys."
D) "The drug is fully absorbed before reaching the liver."
Correct Answer: B
Rationale: First-pass metabolism reduces the amount of active drug that reaches systemic
circulation after oral administration.
,7. A nurse is administering an enteric-coated tablet. The client asks if they can crush it. The
nurse's best response is:
A) "Yes, crushing it will help you swallow it."
B) "No, crushing can destroy the coating and cause stomach irritation or reduce effectiveness."
C) "You can chew it if you don't want to swallow it whole."
D) "It doesn't matter; the drug is the same."
Correct Answer: B
Rationale: Enteric coatings protect the stomach from the drug or protect the drug from
stomach acid; crushing destroys this protection.
8. A client is prescribed a transdermal patch. The nurse instructs the client to:
A) Apply the patch to a hairy area
B) Rotate application sites and remove the old patch before applying a new one
C) Apply the patch only when symptoms occur
D) Cut the patch if the dose seems too strong
Correct Answer: B
Rationale: Site rotation prevents irritation; removing the old patch prevents overdose. Patches
should not be cut.
9. A drug has a narrow therapeutic index. The nurse should:
A) Administer it without monitoring
B) Closely monitor serum drug levels and signs of toxicity
C) Give the drug only intravenously
D) Administer double doses
Correct Answer: B
Rationale: Small changes in dose can cause toxicity or treatment failure; close monitoring is
essential.
10. A nurse is administering an otic medication to a 2-year-old. The nurse pulls the pinna:
A) Upward and backward
B) Downward and backward
C) Upward and forward
D) Straight up
Correct Answer: B
Rationale: In children under 3, the eustachian tube is shorter and more horizontal; pulling the
pinna downward and backward straightens the canal.
, 11. A client is prescribed sublingual nitroglycerin. The nurse instructs the client to:
A) Swallow the tablet with a full glass of water
B) Place the tablet under the tongue and let it dissolve
C) Chew the tablet before swallowing
D) Take the tablet with food
Correct Answer: B
Rationale: Sublingual administration bypasses first-pass metabolism and provides rapid
absorption through the oral mucosa.
12. A nurse is calculating a medication dose based on body surface area. This method is used
primarily for:
A) All drugs given to adults
B) Chemotherapy and pediatric medications
C) Drugs with wide safety margins
D) Topical preparations
Correct Answer: B
Rationale: BSA dosing is more precise for drugs with narrow therapeutic ranges, especially
antineoplastics and pediatric drugs.
13. A client with renal impairment is prescribed a drug excreted unchanged in the urine. The
nurse should anticipate:
A) An increased dose
B) A decreased dose or extended dosing interval
C) No change in dose
D) The drug to be contraindicated in all cases
Correct Answer: B
Rationale: Reduced renal excretion leads to drug accumulation; dose adjustments prevent
toxicity.
14. A client is receiving a loading dose of an IV antibiotic. The purpose is to:
A) Reduce side effects
B) Achieve therapeutic serum levels rapidly
C) Prolong the drug's half-life
D) Decrease the frequency of administration
Correct Answer: B
Rationale: Loading doses rapidly achieve effective concentrations, particularly for drugs with
long half-lives.
