NSG 318 INTRODUCTION TO PHARMACOLOGY – FINAL EXAM
STUDY RESOURCE 2026-2027
SECTION 1: BASIC PRINCIPLES OF
PHARMACOLOGY (Questions 1–30)
Question 1: A patient who takes a medication that is 95% protein-bound begins taking
a second highly protein-bound medication. The nurse should monitor for which
potential effect?
A) Decreased therapeutic effect of the first medication
B) Increased risk of toxicity from the first medication
C) Rapid renal excretion of both medications
D) Decreased absorption of both medications
Correct Answer: B) Increased risk of toxicity from the first medication
Rationale: When two highly protein-bound drugs are administered together, they compete
for binding sites on plasma proteins. The drug with lower binding affinity is displaced,
increasing the free (active) fraction of the other drug, which increases the risk of toxicity.
This is a clinically significant drug interaction.
Question 2: The nurse is reviewing a patient's medication list and notes a drug with a
half-life of 24 hours. Approximately how many days will it take for this drug to reach
steady-state?
A) 1 day
B) 2 days
C) 4 days
D) 5 days
Correct Answer: D) 5 days
,Rationale: Steady-state is reached after approximately 4-5 half-lives. For a drug with a 24-
hour half-life, steady-state would be reached in approximately 4-5 days (96-120 hours).
The half-life determines dosing intervals and the time required to reach therapeutic levels.
Question 3: A patient's serum drug level is above the minimum toxic concentration. The
nurse should assess the patient for signs of:
A) Inadequate therapeutic effect
B) Drug toxicity
C) Allergic reaction
D) Drug tolerance
Correct Answer: B) Drug toxicity
Rationale: The minimum toxic concentration (MTC) is the lowest serum drug concentration
at which toxic effects occur. If the drug level exceeds the MTC, the patient is at risk for
toxicity and should be monitored for adverse effects. The therapeutic range lies between
the minimum effective concentration (MEC) and the MTC.
Question 4: Which of the following statements best describes the mechanism of action
of a competitive antagonist?
A) It binds irreversibly to the receptor, preventing agonist binding
B) It binds reversibly to the receptor and competes with agonists
C) It activates the receptor and produces a maximal response
D) It binds to a different site on the receptor and alters its shape
Correct Answer: B) It binds reversibly to the receptor and competes with agonists
Rationale: A competitive antagonist binds reversibly to the same receptor site as an
agonist and competes for binding. Increasing the concentration of agonist can overcome
the blockade. Noncompetitive antagonists (A) bind irreversibly or at a different site (D),
reducing maximal response. An agonist (C) activates the receptor.
,Question 5: A patient with hepatic impairment is prescribed a medication that
undergoes extensive first-pass metabolism. The nurse should anticipate:
A) Higher oral bioavailability requiring a lower dose
B) Lower oral bioavailability requiring a higher dose
C) No change in dosing requirements
D) Rapid renal elimination
Correct Answer: A) Higher oral bioavailability requiring a lower dose
Rationale: Drugs with high first-pass metabolism are extensively metabolized by the liver
before reaching systemic circulation. In patients with hepatic impairment, first-pass
metabolism is reduced, leading to higher bioavailability and increased risk of toxicity. A
lower dose may be required.
Question 6: A patient is prescribed a medication that is a weak acid. The nurse
understands that this drug will be better absorbed in which part of the GI tract?
A) The stomach (acidic environment)
B) The small intestine (alkaline environment)
C) The colon
D) The rectum
Correct Answer: A) The stomach (acidic environment)
Rationale: Weak acids are nonionized (and therefore more lipid-soluble and absorbable) in
acidic environments such as the stomach. Weak bases are better absorbed in alkaline
environments such as the small intestine. This principle is known as pH partitioning.
Question 7: The nurse is preparing to administer a medication that is known to induce
CYP450 enzymes. Which of the following is a potential consequence of this induction?
A) Increased effectiveness of other CYP450 substrates
B) Decreased effectiveness of other CYP450 substrates
C) Increased risk of toxicity from other CYP450 substrates
D) No effect on other medications
, Correct Answer: B) Decreased effectiveness of other CYP450 substrates
Rationale: CYP450 enzyme inducers increase the rate of metabolism of drugs that are
substrates for these enzymes. This leads to lower serum concentrations and decreased
therapeutic effects of these drugs. Examples of inducers include rifampin, phenytoin,
carbamazepine, and St. John's wort.
Question 8: A patient's serum creatinine is elevated. The nurse should consider this
finding when administering medications that are primarily:
A) Metabolized by the liver
B) Excreted by the kidneys
C) Bound to plasma proteins
D) Administered orally
Correct Answer: B) Excreted by the kidneys
Rationale: Elevated serum creatinine indicates impaired renal function. Medications that
are primarily renally excreted may accumulate, requiring dose reduction or extended
dosing intervals. Liver function (A) is assessed by AST, ALT, and bilirubin. Protein binding
(C) is not directly assessed by creatinine.
Question 9: A patient is prescribed a medication and the nurse notes that the
therapeutic index is narrow. This means:
A) The drug has a wide margin of safety
B) The drug has a small margin of safety between therapeutic and toxic doses
C) The drug is safe for use in all populations
D) The drug has no side effects
Correct Answer: B) The drug has a small margin of safety between therapeutic and
toxic doses
Rationale: A narrow therapeutic index means there is a small difference between the
therapeutic dose and the toxic dose. Drugs with narrow therapeutic indices (e.g., digoxin,
STUDY RESOURCE 2026-2027
SECTION 1: BASIC PRINCIPLES OF
PHARMACOLOGY (Questions 1–30)
Question 1: A patient who takes a medication that is 95% protein-bound begins taking
a second highly protein-bound medication. The nurse should monitor for which
potential effect?
A) Decreased therapeutic effect of the first medication
B) Increased risk of toxicity from the first medication
C) Rapid renal excretion of both medications
D) Decreased absorption of both medications
Correct Answer: B) Increased risk of toxicity from the first medication
Rationale: When two highly protein-bound drugs are administered together, they compete
for binding sites on plasma proteins. The drug with lower binding affinity is displaced,
increasing the free (active) fraction of the other drug, which increases the risk of toxicity.
This is a clinically significant drug interaction.
Question 2: The nurse is reviewing a patient's medication list and notes a drug with a
half-life of 24 hours. Approximately how many days will it take for this drug to reach
steady-state?
A) 1 day
B) 2 days
C) 4 days
D) 5 days
Correct Answer: D) 5 days
,Rationale: Steady-state is reached after approximately 4-5 half-lives. For a drug with a 24-
hour half-life, steady-state would be reached in approximately 4-5 days (96-120 hours).
The half-life determines dosing intervals and the time required to reach therapeutic levels.
Question 3: A patient's serum drug level is above the minimum toxic concentration. The
nurse should assess the patient for signs of:
A) Inadequate therapeutic effect
B) Drug toxicity
C) Allergic reaction
D) Drug tolerance
Correct Answer: B) Drug toxicity
Rationale: The minimum toxic concentration (MTC) is the lowest serum drug concentration
at which toxic effects occur. If the drug level exceeds the MTC, the patient is at risk for
toxicity and should be monitored for adverse effects. The therapeutic range lies between
the minimum effective concentration (MEC) and the MTC.
Question 4: Which of the following statements best describes the mechanism of action
of a competitive antagonist?
A) It binds irreversibly to the receptor, preventing agonist binding
B) It binds reversibly to the receptor and competes with agonists
C) It activates the receptor and produces a maximal response
D) It binds to a different site on the receptor and alters its shape
Correct Answer: B) It binds reversibly to the receptor and competes with agonists
Rationale: A competitive antagonist binds reversibly to the same receptor site as an
agonist and competes for binding. Increasing the concentration of agonist can overcome
the blockade. Noncompetitive antagonists (A) bind irreversibly or at a different site (D),
reducing maximal response. An agonist (C) activates the receptor.
,Question 5: A patient with hepatic impairment is prescribed a medication that
undergoes extensive first-pass metabolism. The nurse should anticipate:
A) Higher oral bioavailability requiring a lower dose
B) Lower oral bioavailability requiring a higher dose
C) No change in dosing requirements
D) Rapid renal elimination
Correct Answer: A) Higher oral bioavailability requiring a lower dose
Rationale: Drugs with high first-pass metabolism are extensively metabolized by the liver
before reaching systemic circulation. In patients with hepatic impairment, first-pass
metabolism is reduced, leading to higher bioavailability and increased risk of toxicity. A
lower dose may be required.
Question 6: A patient is prescribed a medication that is a weak acid. The nurse
understands that this drug will be better absorbed in which part of the GI tract?
A) The stomach (acidic environment)
B) The small intestine (alkaline environment)
C) The colon
D) The rectum
Correct Answer: A) The stomach (acidic environment)
Rationale: Weak acids are nonionized (and therefore more lipid-soluble and absorbable) in
acidic environments such as the stomach. Weak bases are better absorbed in alkaline
environments such as the small intestine. This principle is known as pH partitioning.
Question 7: The nurse is preparing to administer a medication that is known to induce
CYP450 enzymes. Which of the following is a potential consequence of this induction?
A) Increased effectiveness of other CYP450 substrates
B) Decreased effectiveness of other CYP450 substrates
C) Increased risk of toxicity from other CYP450 substrates
D) No effect on other medications
, Correct Answer: B) Decreased effectiveness of other CYP450 substrates
Rationale: CYP450 enzyme inducers increase the rate of metabolism of drugs that are
substrates for these enzymes. This leads to lower serum concentrations and decreased
therapeutic effects of these drugs. Examples of inducers include rifampin, phenytoin,
carbamazepine, and St. John's wort.
Question 8: A patient's serum creatinine is elevated. The nurse should consider this
finding when administering medications that are primarily:
A) Metabolized by the liver
B) Excreted by the kidneys
C) Bound to plasma proteins
D) Administered orally
Correct Answer: B) Excreted by the kidneys
Rationale: Elevated serum creatinine indicates impaired renal function. Medications that
are primarily renally excreted may accumulate, requiring dose reduction or extended
dosing intervals. Liver function (A) is assessed by AST, ALT, and bilirubin. Protein binding
(C) is not directly assessed by creatinine.
Question 9: A patient is prescribed a medication and the nurse notes that the
therapeutic index is narrow. This means:
A) The drug has a wide margin of safety
B) The drug has a small margin of safety between therapeutic and toxic doses
C) The drug is safe for use in all populations
D) The drug has no side effects
Correct Answer: B) The drug has a small margin of safety between therapeutic and
toxic doses
Rationale: A narrow therapeutic index means there is a small difference between the
therapeutic dose and the toxic dose. Drugs with narrow therapeutic indices (e.g., digoxin,
