, Nursing Pharmacology Test Bank
Table of Contents
Nursing Pharmacology Test Bank .................................................................................................................. 2
Chapter 1: Pharmacokinetics & Pharmacodynamics .............................................................................. 3
Chapter 2: Legal/Ethical.................................................................................................................................. 12
Chapter 3: Antimicrobials ............................................................................................................................... 20
Chapter 4: Autonomic Nervous System..................................................................................................... 28
Chapter 5: Respiratory System ..................................................................................................................... 36
Chapter 6: Cardiovascular & Renal Systems............................................................................................ 42
Chapter 7: Gastrointestinal System ............................................................................................................ 51
Chapter 8: Central Nervous System ............................................................................................................ 58
Chapter 9: Endocrine & Reproductive Systems ..................................................................................... 65
Chapter 10: Pain & Musculoskeletal System ........................................................................................... 72
Nursing Pharmacology Test Bank
Based on Nursing Pharmacology, 2nd Edition (Open RN / WisTech Open, Pressbooks)
200 High-Yield, NCLEX-Style Multiple Choice Questions with Rationales
,Chapter 1: Pharmacokinetics & Pharmacodynamics
1. A nurse is administering an oral medication to a client. Which statement best describes
the first-pass effect?
A. The drug binds to plasma proteins immediately after absorption
B. The drug is partially deactivated by the liver and intestines before reaching systemic
circulation
C. The drug reaches peak concentration within one hour of administration
D. The drug is excreted unchanged in the urine
Correct Answer: B Rationale: The first-pass effect occurs when an orally or enterally
administered drug is absorbed into the portal circulation and partially metabolized by
intestinal and liver enzymes before it reaches the systemic circulation, reducing the
concentration of active drug available. This is why alternate routes (IV, transdermal,
inhalation) are used to bypass this effect. (Ch. 1.3 Absorption, p. 24–25)
2. A client asks why their fentanyl pain patch works for several days instead of needing to
be taken like a pill every few hours. Which physiologic principle explains this?
A. Transdermal medications undergo an accelerated first-pass effect
B. Transdermal absorption provides slow, steady drug delivery directly into systemic
circulation
C. Transdermal medications bind irreversibly to plasma proteins
D. Transdermal medications are metabolized primarily by Phase III biotransformation
Correct Answer: B Rationale: Transdermal application provides slow, steady drug
delivery directly to the bloodstream without first passing through the liver, making it ideal
for medications needing prolonged, controlled release, such as fentanyl for pain or
nitroglycerin for chronic angina. (Ch. 1.3 Absorption, p. 25–26)
3. An older adult client with significant loss of subcutaneous fat is prescribed a transdermal
medication patch. What is the nurse’s priority concern?
A. Increased risk of first-pass metabolism
B. Decreased absorption of the medication due to reduced subcutaneous fat stores
C. Increased protein binding of the medication
, D. Accelerated renal excretion of the medication
Correct Answer: B Rationale: As adults age, they often have less subcutaneous fat, which
results in decreased absorption of medication from transdermal patches because adequate
subcutaneous fat stores are required for proper absorption. (Ch. 1.3 Absorption, Life Span
Considerations – Older Adult, p. 28)
4. A client with low serum albumin due to liver disease is prescribed warfarin. Why is this
client at increased risk for bleeding?
A. Decreased albumin increases hepatic metabolism of warfarin
B. Decreased albumin results in less protein binding, increasing the amount of free (active)
drug
C. Decreased albumin decreases the volume of distribution
D. Decreased albumin enhances renal excretion of warfarin
Correct Answer: B Rationale: Only free, unbound drug is pharmacologically active.
Albumin is the primary plasma protein responsible for drug binding; when albumin levels
are low (as in malnutrition or liver disease), less drug is bound, leaving more free/active
drug in circulation and increasing the risk of toxicity or exaggerated effect, such as bleeding
with warfarin. (Ch. 1.4 Distribution – Protein-Binding, p. 31–32)
5. A nurse is administering both aspirin and warfarin to a client. Why does this
combination increase the client’s risk for bleeding?
A. Both drugs increase hepatic enzyme induction
B. Both drugs compete for the same plasma protein-binding sites, increasing unbound drug
levels
C. Both drugs are excreted through the same renal pathway
D. Both drugs cross the blood-brain barrier
Correct Answer: B Rationale: Aspirin and warfarin compete for the same plasma protein-
binding sites. When administered together, the competition increases the amount of
unbound (free) drug for both medications, increasing their pharmacologic effects and the
client’s risk of bleeding. (Ch. 1.4 Distribution – Protein-Binding, p. 32)
Table of Contents
Nursing Pharmacology Test Bank .................................................................................................................. 2
Chapter 1: Pharmacokinetics & Pharmacodynamics .............................................................................. 3
Chapter 2: Legal/Ethical.................................................................................................................................. 12
Chapter 3: Antimicrobials ............................................................................................................................... 20
Chapter 4: Autonomic Nervous System..................................................................................................... 28
Chapter 5: Respiratory System ..................................................................................................................... 36
Chapter 6: Cardiovascular & Renal Systems............................................................................................ 42
Chapter 7: Gastrointestinal System ............................................................................................................ 51
Chapter 8: Central Nervous System ............................................................................................................ 58
Chapter 9: Endocrine & Reproductive Systems ..................................................................................... 65
Chapter 10: Pain & Musculoskeletal System ........................................................................................... 72
Nursing Pharmacology Test Bank
Based on Nursing Pharmacology, 2nd Edition (Open RN / WisTech Open, Pressbooks)
200 High-Yield, NCLEX-Style Multiple Choice Questions with Rationales
,Chapter 1: Pharmacokinetics & Pharmacodynamics
1. A nurse is administering an oral medication to a client. Which statement best describes
the first-pass effect?
A. The drug binds to plasma proteins immediately after absorption
B. The drug is partially deactivated by the liver and intestines before reaching systemic
circulation
C. The drug reaches peak concentration within one hour of administration
D. The drug is excreted unchanged in the urine
Correct Answer: B Rationale: The first-pass effect occurs when an orally or enterally
administered drug is absorbed into the portal circulation and partially metabolized by
intestinal and liver enzymes before it reaches the systemic circulation, reducing the
concentration of active drug available. This is why alternate routes (IV, transdermal,
inhalation) are used to bypass this effect. (Ch. 1.3 Absorption, p. 24–25)
2. A client asks why their fentanyl pain patch works for several days instead of needing to
be taken like a pill every few hours. Which physiologic principle explains this?
A. Transdermal medications undergo an accelerated first-pass effect
B. Transdermal absorption provides slow, steady drug delivery directly into systemic
circulation
C. Transdermal medications bind irreversibly to plasma proteins
D. Transdermal medications are metabolized primarily by Phase III biotransformation
Correct Answer: B Rationale: Transdermal application provides slow, steady drug
delivery directly to the bloodstream without first passing through the liver, making it ideal
for medications needing prolonged, controlled release, such as fentanyl for pain or
nitroglycerin for chronic angina. (Ch. 1.3 Absorption, p. 25–26)
3. An older adult client with significant loss of subcutaneous fat is prescribed a transdermal
medication patch. What is the nurse’s priority concern?
A. Increased risk of first-pass metabolism
B. Decreased absorption of the medication due to reduced subcutaneous fat stores
C. Increased protein binding of the medication
, D. Accelerated renal excretion of the medication
Correct Answer: B Rationale: As adults age, they often have less subcutaneous fat, which
results in decreased absorption of medication from transdermal patches because adequate
subcutaneous fat stores are required for proper absorption. (Ch. 1.3 Absorption, Life Span
Considerations – Older Adult, p. 28)
4. A client with low serum albumin due to liver disease is prescribed warfarin. Why is this
client at increased risk for bleeding?
A. Decreased albumin increases hepatic metabolism of warfarin
B. Decreased albumin results in less protein binding, increasing the amount of free (active)
drug
C. Decreased albumin decreases the volume of distribution
D. Decreased albumin enhances renal excretion of warfarin
Correct Answer: B Rationale: Only free, unbound drug is pharmacologically active.
Albumin is the primary plasma protein responsible for drug binding; when albumin levels
are low (as in malnutrition or liver disease), less drug is bound, leaving more free/active
drug in circulation and increasing the risk of toxicity or exaggerated effect, such as bleeding
with warfarin. (Ch. 1.4 Distribution – Protein-Binding, p. 31–32)
5. A nurse is administering both aspirin and warfarin to a client. Why does this
combination increase the client’s risk for bleeding?
A. Both drugs increase hepatic enzyme induction
B. Both drugs compete for the same plasma protein-binding sites, increasing unbound drug
levels
C. Both drugs are excreted through the same renal pathway
D. Both drugs cross the blood-brain barrier
Correct Answer: B Rationale: Aspirin and warfarin compete for the same plasma protein-
binding sites. When administered together, the competition increases the amount of
unbound (free) drug for both medications, increasing their pharmacologic effects and the
client’s risk of bleeding. (Ch. 1.4 Distribution – Protein-Binding, p. 32)
