NURS 300 (Pharmacology) Unit Exam 1
Latest 2026/2027 | Newly Released
San Diego State University (SDSU).
50 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A patient is prescribed phenytoin for seizure control. The nurse understands that phenytoin
follows zero-order kinetics at therapeutic plasma concentrations. This means that:
A. A constant fraction of the drug is eliminated per unit time
B. A constant amount of the drug is eliminated per unit time regardless of concentration
C. The half-life decreases as plasma concentration increases
D. The drug is primarily eliminated by renal tubular secretion
Correct Answer: B
Phenytoin exhibits zero-order kinetics at therapeutic concentrations, meaning a fixed amount of
drug is metabolized per unit time rather than a fixed percentage. This occurs because the
metabolic enzymes become saturated. Small dose increases can cause disproportionate plasma
level rises and toxicity. First-order kinetics, where a constant fraction is eliminated, applies only
at low phenytoin concentrations.
Q2. A nurse is administering a medication via the intramuscular route. To ensure proper
absorption, the nurse should select a site with:
A. Minimal blood flow to prolong drug release
B. Adequate muscle mass and blood supply
C. Maximum subcutaneous fat to enhance lipophilic drug storage
D. Direct access to the portal circulation
Correct Answer: B
Intramuscular administration relies on adequate muscle mass and vascularity for drug absorption
into the systemic circulation. Sites such as the vastus lateralis, ventrogluteal, and deltoid provide
sufficient muscle depth and blood supply. Minimal blood flow would delay absorption, excessive
fat is inappropriate for intramuscular injection, and the portal circulation is accessed only by oral
or enteral routes.
,Q3. A patient is taking a drug that is a substrate of CYP3A4 and begins drinking grapefruit juice
daily. The nurse should monitor for:
A. Decreased drug effect due to enzyme induction
B. Increased drug effect due to enzyme inhibition
C. No change in drug metabolism
D. Enhanced renal excretion of the drug
Correct Answer: B
Grapefruit juice contains furanocoumarins that irreversibly inhibit intestinal CYP3A4, reducing
first-pass metabolism and increasing bioavailability of susceptible drugs such as simvastatin,
felodipine, and cyclosporine. This inhibition can produce toxic plasma concentrations. Enzyme
induction would decrease drug effect, and grapefruit juice does not affect renal excretion.
Q4. A patient with chronic pain is prescribed morphine sulfate extended-release tablets. The
nurse discovers the patient has been crushing the tablets to "get faster relief." The priority
nursing action is to:
A. Document the finding and continue current dosing
B. Educate the patient about the danger of rapid absorption and potential overdose
C. Switch the patient to immediate-release morphine without consulting the prescriber
D. Administer an additional dose to compensate for lost medication
Correct Answer: B
Crushing extended-release morphine destroys the controlled-release matrix, causing immediate
release of the entire dose and risking fatal respiratory depression. Patient education about proper
administration is the priority. Documentation alone is insufficient, nurses cannot independently
change prescriptions, and additional dosing would compound the overdose risk.
Q5. A drug that produces its effect by occupying a receptor without activating it, thereby
preventing an agonist from binding, is classified as:
A. A competitive antagonist
B. A noncompetitive antagonist
C. An inverse agonist
D. A physiological antagonist
Correct Answer: A
, A competitive antagonist binds reversibly to the same receptor site as the agonist, competing for
occupancy and preventing agonist-induced activation. The effect can be overcome by increasing
agonist concentration. Noncompetitive antagonists bind irreversibly or at allosteric sites, inverse
agonists reduce constitutive activity, and physiological antagonists act at different receptors to
produce opposite effects.
Q6. A patient is taking propranolol and is scheduled for surgery. The nurse should anticipate that
the anesthesiologist will:
A. Discontinue propranolol 48 hours before surgery
B. Continue propranolol through the morning of surgery
C. Switch to a selective beta-1 blocker immediately
D. Administer atropine to counteract beta-blockade
Correct Answer: B
Abrupt discontinuation of beta-blockers before surgery can cause rebound hypertension,
tachycardia, and myocardial ischemia. Current guidelines recommend continuing beta-blockers
perioperatively to maintain cardiovascular stability. Switching agents or administering atropine
prophylactically is not standard practice and may introduce additional risks.
Q7. A patient is prescribed succinylcholine for rapid sequence intubation. The nurse should have
which medication immediately available?
A. Naloxone
B. Atropine
C. Neostigmine
D. Dantrolene
Correct Answer: D
Succinylcholine can trigger malignant hyperthermia in susceptible individuals, a hypermetabolic
crisis requiring immediate dantrolene administration to inhibit calcium release from the
sarcoplasmic reticulum. Naloxone reverses opioids, atropine treats bradycardia, and neostigmine
reverses nondepolarizing neuromuscular blockers but potentiates depolarizing blockade from
succinylcholine.
Q8. A patient is taking levodopa-carbidopa and reports that the medication effect wears off
before the next dose. The nurse understands that the prescriber may:
Latest 2026/2027 | Newly Released
San Diego State University (SDSU).
50 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A patient is prescribed phenytoin for seizure control. The nurse understands that phenytoin
follows zero-order kinetics at therapeutic plasma concentrations. This means that:
A. A constant fraction of the drug is eliminated per unit time
B. A constant amount of the drug is eliminated per unit time regardless of concentration
C. The half-life decreases as plasma concentration increases
D. The drug is primarily eliminated by renal tubular secretion
Correct Answer: B
Phenytoin exhibits zero-order kinetics at therapeutic concentrations, meaning a fixed amount of
drug is metabolized per unit time rather than a fixed percentage. This occurs because the
metabolic enzymes become saturated. Small dose increases can cause disproportionate plasma
level rises and toxicity. First-order kinetics, where a constant fraction is eliminated, applies only
at low phenytoin concentrations.
Q2. A nurse is administering a medication via the intramuscular route. To ensure proper
absorption, the nurse should select a site with:
A. Minimal blood flow to prolong drug release
B. Adequate muscle mass and blood supply
C. Maximum subcutaneous fat to enhance lipophilic drug storage
D. Direct access to the portal circulation
Correct Answer: B
Intramuscular administration relies on adequate muscle mass and vascularity for drug absorption
into the systemic circulation. Sites such as the vastus lateralis, ventrogluteal, and deltoid provide
sufficient muscle depth and blood supply. Minimal blood flow would delay absorption, excessive
fat is inappropriate for intramuscular injection, and the portal circulation is accessed only by oral
or enteral routes.
,Q3. A patient is taking a drug that is a substrate of CYP3A4 and begins drinking grapefruit juice
daily. The nurse should monitor for:
A. Decreased drug effect due to enzyme induction
B. Increased drug effect due to enzyme inhibition
C. No change in drug metabolism
D. Enhanced renal excretion of the drug
Correct Answer: B
Grapefruit juice contains furanocoumarins that irreversibly inhibit intestinal CYP3A4, reducing
first-pass metabolism and increasing bioavailability of susceptible drugs such as simvastatin,
felodipine, and cyclosporine. This inhibition can produce toxic plasma concentrations. Enzyme
induction would decrease drug effect, and grapefruit juice does not affect renal excretion.
Q4. A patient with chronic pain is prescribed morphine sulfate extended-release tablets. The
nurse discovers the patient has been crushing the tablets to "get faster relief." The priority
nursing action is to:
A. Document the finding and continue current dosing
B. Educate the patient about the danger of rapid absorption and potential overdose
C. Switch the patient to immediate-release morphine without consulting the prescriber
D. Administer an additional dose to compensate for lost medication
Correct Answer: B
Crushing extended-release morphine destroys the controlled-release matrix, causing immediate
release of the entire dose and risking fatal respiratory depression. Patient education about proper
administration is the priority. Documentation alone is insufficient, nurses cannot independently
change prescriptions, and additional dosing would compound the overdose risk.
Q5. A drug that produces its effect by occupying a receptor without activating it, thereby
preventing an agonist from binding, is classified as:
A. A competitive antagonist
B. A noncompetitive antagonist
C. An inverse agonist
D. A physiological antagonist
Correct Answer: A
, A competitive antagonist binds reversibly to the same receptor site as the agonist, competing for
occupancy and preventing agonist-induced activation. The effect can be overcome by increasing
agonist concentration. Noncompetitive antagonists bind irreversibly or at allosteric sites, inverse
agonists reduce constitutive activity, and physiological antagonists act at different receptors to
produce opposite effects.
Q6. A patient is taking propranolol and is scheduled for surgery. The nurse should anticipate that
the anesthesiologist will:
A. Discontinue propranolol 48 hours before surgery
B. Continue propranolol through the morning of surgery
C. Switch to a selective beta-1 blocker immediately
D. Administer atropine to counteract beta-blockade
Correct Answer: B
Abrupt discontinuation of beta-blockers before surgery can cause rebound hypertension,
tachycardia, and myocardial ischemia. Current guidelines recommend continuing beta-blockers
perioperatively to maintain cardiovascular stability. Switching agents or administering atropine
prophylactically is not standard practice and may introduce additional risks.
Q7. A patient is prescribed succinylcholine for rapid sequence intubation. The nurse should have
which medication immediately available?
A. Naloxone
B. Atropine
C. Neostigmine
D. Dantrolene
Correct Answer: D
Succinylcholine can trigger malignant hyperthermia in susceptible individuals, a hypermetabolic
crisis requiring immediate dantrolene administration to inhibit calcium release from the
sarcoplasmic reticulum. Naloxone reverses opioids, atropine treats bradycardia, and neostigmine
reverses nondepolarizing neuromuscular blockers but potentiates depolarizing blockade from
succinylcholine.
Q8. A patient is taking levodopa-carbidopa and reports that the medication effect wears off
before the next dose. The nurse understands that the prescriber may:
