NUR 2474 Final Examination –
questions and answers with
rationales/graded A+/2026
update/100% correct /instant
download
Latest 2026 Blueprint
Total Questions: 85
Time Allowed: 2 hours
Passing Score: 78%
Content Areas: Pharmacokinetics/Pharmacodynamics (15%), Autonomic & CNS
Drugs (25%), Cardiovascular & Renal Drugs (25%), Endocrine & GI Drugs
(15%), Antimicrobials & Anti-inflammatories (10%), Miscellaneous (10%)
Section 1: Pharmacokinetics & Pharmacodynamics (Q1–Q12)
1. A patient with liver cirrhosis is prescribed a drug that undergoes extensive
first-pass metabolism. What change in drug action should the nurse expect?
A. Decreased bioavailability and reduced effect
B. Increased bioavailability and enhanced effect
C. No change in drug effect
D. Faster drug excretion
Correct Answer: B – Rationale: First-pass metabolism occurs in the liver. With
cirrhosis, hepatic function is impaired, leading to reduced metabolism
and increased bioavailability, which may cause toxicity or enhanced effect.
2. Which phase of pharmacokinetics is most affected in a patient with chronic
kidney disease?
A. Absorption
B. Distribution
,C. Metabolism
D. Excretion
Correct Answer: D – Rationale: Excretion occurs primarily via the kidneys.
Impaired renal function leads to drug accumulation and increased risk of adverse
effects.
3. A drug has a half-life of 6 hours. How long will it take to reach steady state?
A. 12 hours
B. 18 hours
C. 24 hours
D. 30 hours
Correct Answer: D – Rationale: Steady state is reached after approximately 4–5
half-lives. 5 × 6 = 30 hours.
4. Which drug-receptor interaction produces the maximum possible effect
regardless of dose?
A. Partial agonist
B. Antagonist
C. Full agonist
D. Inverse agonist
Correct Answer: C – Rationale: A full agonist binds to a receptor and produces
a maximal response. Partial agonists have lower efficacy; antagonists block
responses.
5. A patient is prescribed a drug that is 95% protein-bound. Which
concurrent medication could cause toxicity by displacing this drug?
A. Warfarin
B. Aspirin (high dose)
C. Digoxin
D. Metformin
Correct Answer: B – Rationale: High-dose aspirin (a highly protein-bound drug)
competes for binding sites, increasing free drug levels of other protein-bound drugs
like warfarin or phenytoin, leading to toxicity.
6. The nurse understands that enterohepatic recirculation leads to:
A. Shorter duration of action
B. Decreased drug half-life
, C. Prolonged drug effect
D. Reduced drug absorption
Correct Answer: C – Rationale: Enterohepatic recirculation reabsorbs the drug
from the intestine after biliary excretion, prolonging its presence in the body.
7. Which CYP450 enzyme is most commonly involved in drug-drug
interactions?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C9
Correct Answer: B – Rationale: CYP3A4 metabolizes ~50% of all drugs and is
inhibited/induced by many agents (e.g., grapefruit juice, rifampin).
8. An agonist with high potency requires:
A. High dose to produce effect
B. Low dose to produce effect
C. Long half-life
D. IV administration only
Correct Answer: B – Rationale: Potency refers to the dose required to produce a
given effect. High potency = low dose needed.
9. A patient takes digoxin and verapamil. Which effect is expected?
A. Decreased digoxin levels
B. Increased risk of digoxin toxicity
C. No interaction
D. Reduced blood pressure only
Correct Answer: B – Rationale: Verapamil (a calcium channel blocker) decreases
renal clearance and P-glycoprotein transport of digoxin, increasing digoxin levels
and toxicity risk.
10. Which route of administration bypasses the first-pass effect?
A. Oral
B. Sublingual
C. Rectal (lower portion)
D. Both B and C
questions and answers with
rationales/graded A+/2026
update/100% correct /instant
download
Latest 2026 Blueprint
Total Questions: 85
Time Allowed: 2 hours
Passing Score: 78%
Content Areas: Pharmacokinetics/Pharmacodynamics (15%), Autonomic & CNS
Drugs (25%), Cardiovascular & Renal Drugs (25%), Endocrine & GI Drugs
(15%), Antimicrobials & Anti-inflammatories (10%), Miscellaneous (10%)
Section 1: Pharmacokinetics & Pharmacodynamics (Q1–Q12)
1. A patient with liver cirrhosis is prescribed a drug that undergoes extensive
first-pass metabolism. What change in drug action should the nurse expect?
A. Decreased bioavailability and reduced effect
B. Increased bioavailability and enhanced effect
C. No change in drug effect
D. Faster drug excretion
Correct Answer: B – Rationale: First-pass metabolism occurs in the liver. With
cirrhosis, hepatic function is impaired, leading to reduced metabolism
and increased bioavailability, which may cause toxicity or enhanced effect.
2. Which phase of pharmacokinetics is most affected in a patient with chronic
kidney disease?
A. Absorption
B. Distribution
,C. Metabolism
D. Excretion
Correct Answer: D – Rationale: Excretion occurs primarily via the kidneys.
Impaired renal function leads to drug accumulation and increased risk of adverse
effects.
3. A drug has a half-life of 6 hours. How long will it take to reach steady state?
A. 12 hours
B. 18 hours
C. 24 hours
D. 30 hours
Correct Answer: D – Rationale: Steady state is reached after approximately 4–5
half-lives. 5 × 6 = 30 hours.
4. Which drug-receptor interaction produces the maximum possible effect
regardless of dose?
A. Partial agonist
B. Antagonist
C. Full agonist
D. Inverse agonist
Correct Answer: C – Rationale: A full agonist binds to a receptor and produces
a maximal response. Partial agonists have lower efficacy; antagonists block
responses.
5. A patient is prescribed a drug that is 95% protein-bound. Which
concurrent medication could cause toxicity by displacing this drug?
A. Warfarin
B. Aspirin (high dose)
C. Digoxin
D. Metformin
Correct Answer: B – Rationale: High-dose aspirin (a highly protein-bound drug)
competes for binding sites, increasing free drug levels of other protein-bound drugs
like warfarin or phenytoin, leading to toxicity.
6. The nurse understands that enterohepatic recirculation leads to:
A. Shorter duration of action
B. Decreased drug half-life
, C. Prolonged drug effect
D. Reduced drug absorption
Correct Answer: C – Rationale: Enterohepatic recirculation reabsorbs the drug
from the intestine after biliary excretion, prolonging its presence in the body.
7. Which CYP450 enzyme is most commonly involved in drug-drug
interactions?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C9
Correct Answer: B – Rationale: CYP3A4 metabolizes ~50% of all drugs and is
inhibited/induced by many agents (e.g., grapefruit juice, rifampin).
8. An agonist with high potency requires:
A. High dose to produce effect
B. Low dose to produce effect
C. Long half-life
D. IV administration only
Correct Answer: B – Rationale: Potency refers to the dose required to produce a
given effect. High potency = low dose needed.
9. A patient takes digoxin and verapamil. Which effect is expected?
A. Decreased digoxin levels
B. Increased risk of digoxin toxicity
C. No interaction
D. Reduced blood pressure only
Correct Answer: B – Rationale: Verapamil (a calcium channel blocker) decreases
renal clearance and P-glycoprotein transport of digoxin, increasing digoxin levels
and toxicity risk.
10. Which route of administration bypasses the first-pass effect?
A. Oral
B. Sublingual
C. Rectal (lower portion)
D. Both B and C
