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NUR 210 Exam 4 Principles of Pharmacology Galen
College of Nursing Actual Exam 2026/2027 Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Part I: Pharmacokinetics, Pharmacodynamics & Drug Interactions (Questions 1-15)
Q1: A patient who recently switched from IV to oral morphine asks the nurse why the pill dose is so
much higher than the injection was. The nurse explains that oral morphine gets processed by the liver
before it ever reaches the bloodstream. About how much of an oral morphine dose is typically broken
down during this first-pass effect?
A. About 10-20%
B. About 30-40%
C. Up to 60-70% [CORRECT]
D. Nearly 90-95%
Correct Answer: C
Rationale: The best answer is C. Oral morphine undergoes extensive first-pass hepatic metabolism, and
its bioavailability is only around 25-30%. This means roughly 60-70% of the dose is metabolized by the
liver before it ever reaches systemic circulation. This is exactly why oral morphine doses are
considerably higher than parenteral doses to achieve comparable pain relief.
Q2: A 68-year-old patient with liver cirrhosis is prescribed lorazepam for anxiety. The nurse knows that
lorazepam is metabolized via glucuronidation rather than the CYP450 system. Based on this
pharmacokinetic profile, what is the most appropriate nursing consideration?
A. This drug is preferred in hepatic impairment because glucuronidation remains relatively intact even
when Phase I oxidation is compromised [CORRECT]
B. The dose should be reduced by 50% due to impaired Phase I metabolism
C. The patient will require more frequent dosing because clearance is rapid
D. This medication is contraindicated in all patients with liver disease
Correct Answer: A
Rationale: This choice is correct because lorazepam undergoes glucuronidation, which is a Phase II
metabolic pathway that stays fairly preserved even when Phase I oxidation via CYP450 is compromised
in liver disease. This makes lorazepam a safer benzodiazepine choice for patients with hepatic
impairment compared to drugs like diazepam that rely heavily on oxidative metabolism.
,2
Q3: A patient on warfarin starts taking metronidazole for a bacterial infection and presents two weeks
later with nosebleeds and bruising. The nurse suspects a drug-drug interaction. Which pharmacokinetic
principle best explains this clinical change?
A. Metronidazole displaces warfarin from protein binding sites, increasing free drug concentration
B. Metronidazole induces CYP2C9, increasing warfarin metabolism
C. Metronidazole increases warfarin absorption from the GI tract
D. Metronidazole inhibits CYP2C9, decreasing warfarin metabolism and increasing its anticoagulant
effect [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Metronidazole is a known inhibitor of CYP2C9, the primary enzyme
responsible for metabolizing the more potent S-enantiomer of warfarin. When this enzyme is inhibited,
warfarin clearance decreases, plasma levels rise, and the patient's INR increases, leading to signs of
bleeding such as bruising and epistaxis. This is why close INR monitoring is essential when metronidazole
is prescribed to patients on warfarin.
Q4: A patient asks why naloxone reverses opioid overdose but doesn't affect their blood pressure
medication. The nurse explains that naloxone is best described as:
A. A nonselective agonist at all receptor types
B. A partial agonist at mu-opioid receptors
C. An opioid receptor antagonist that displaces opioids without activating the receptor [CORRECT]
D. A competitive inhibitor of opioid metabolism
Correct Answer: C
Rationale: This choice is correct because naloxone is a pure opioid antagonist that competes with opioid
agonists like morphine and heroin for binding sites on mu-opioid receptors. It displaces the opioid
without activating the receptor itself, which rapidly reverses respiratory depression and sedation. It has
no effect on non-opioid receptors, which is why it doesn't impact blood pressure medications.
Q5: A patient has been taking digoxin 0.25 mg daily for 3 weeks. The nurse checks a serum digoxin level
and finds it is 2.8 ng/mL (therapeutic range 0.5-2.0 ng/mL). The patient reports nausea and seeing
yellow halos around lights. Which pharmacodynamic concept best explains this clinical picture?
A. The patient is experiencing an idiosyncratic reaction to digoxin
B. The drug has a wide therapeutic index with minimal safety margin
C. The drug has a narrow therapeutic index and the patient has reached toxic levels [CORRECT]
D. The patient has developed tolerance to the therapeutic effects of digoxin
Correct Answer: C
, 3
Rationale: The best answer is C. Digoxin has a narrow therapeutic index, meaning the difference
between a therapeutic dose and a toxic dose is small. A level of 2.8 ng/mL exceeds the therapeutic
range, and the nausea and visual disturbances are classic signs of digoxin toxicity that occur when levels
rise above the narrow safety margin. This matches the pharmacological principle that drugs with narrow
therapeutic windows require frequent monitoring.
Q6: A medication label states: "Administer on an empty stomach because food decreases absorption by
40%." Which pharmacokinetic process is primarily affected by this instruction?
A. Absorption [CORRECT]
B. Distribution
C. Metabolism
D. Elimination
Correct Answer: A
Rationale: This choice is correct because when food decreases the amount of drug that enters the
bloodstream by 40%, this directly impacts absorption. Taking the medication on an empty stomach
ensures that the full intended dose reaches systemic circulation without interference from food
components that may bind the drug or alter GI motility.
Q7: A patient has been taking carbamazepine for epilepsy for 6 months and recently started rifampin for
tuberculosis. Two weeks later, the patient has a breakthrough seizure. Carbamazepine levels are
subtherapeutic. Which pharmacokinetic interaction best explains this?
A. Rifampin inhibits CYP3A4, decreasing carbamazepine metabolism
B. Rifampin competes with carbamazepine for protein binding sites
C. Rifampin decreases carbamazepine absorption in the small intestine
D. Rifampin induces CYP3A4, increasing carbamazepine metabolism and lowering levels [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Rifampin is a potent inducer of the CYP3A4 enzyme system, which
metabolizes carbamazepine. When enzyme induction occurs, the liver breaks down carbamazepine
faster, leading to subtherapeutic drug levels and breakthrough seizures. This is a classic example of why
anticonvulsant levels must be monitored when enzyme inducers are added, and it aligns with Galen
College NUR 210 curriculum on CYP450 interactions.
Q8: The time required for the plasma concentration of a drug to decrease by 50% is clinically defined as:
A. Steady state
B. Therapeutic index
C. Bioavailability
D. Half-life [CORRECT]
NUR 210 Exam 4 Principles of Pharmacology Galen
College of Nursing Actual Exam 2026/2027 Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Part I: Pharmacokinetics, Pharmacodynamics & Drug Interactions (Questions 1-15)
Q1: A patient who recently switched from IV to oral morphine asks the nurse why the pill dose is so
much higher than the injection was. The nurse explains that oral morphine gets processed by the liver
before it ever reaches the bloodstream. About how much of an oral morphine dose is typically broken
down during this first-pass effect?
A. About 10-20%
B. About 30-40%
C. Up to 60-70% [CORRECT]
D. Nearly 90-95%
Correct Answer: C
Rationale: The best answer is C. Oral morphine undergoes extensive first-pass hepatic metabolism, and
its bioavailability is only around 25-30%. This means roughly 60-70% of the dose is metabolized by the
liver before it ever reaches systemic circulation. This is exactly why oral morphine doses are
considerably higher than parenteral doses to achieve comparable pain relief.
Q2: A 68-year-old patient with liver cirrhosis is prescribed lorazepam for anxiety. The nurse knows that
lorazepam is metabolized via glucuronidation rather than the CYP450 system. Based on this
pharmacokinetic profile, what is the most appropriate nursing consideration?
A. This drug is preferred in hepatic impairment because glucuronidation remains relatively intact even
when Phase I oxidation is compromised [CORRECT]
B. The dose should be reduced by 50% due to impaired Phase I metabolism
C. The patient will require more frequent dosing because clearance is rapid
D. This medication is contraindicated in all patients with liver disease
Correct Answer: A
Rationale: This choice is correct because lorazepam undergoes glucuronidation, which is a Phase II
metabolic pathway that stays fairly preserved even when Phase I oxidation via CYP450 is compromised
in liver disease. This makes lorazepam a safer benzodiazepine choice for patients with hepatic
impairment compared to drugs like diazepam that rely heavily on oxidative metabolism.
,2
Q3: A patient on warfarin starts taking metronidazole for a bacterial infection and presents two weeks
later with nosebleeds and bruising. The nurse suspects a drug-drug interaction. Which pharmacokinetic
principle best explains this clinical change?
A. Metronidazole displaces warfarin from protein binding sites, increasing free drug concentration
B. Metronidazole induces CYP2C9, increasing warfarin metabolism
C. Metronidazole increases warfarin absorption from the GI tract
D. Metronidazole inhibits CYP2C9, decreasing warfarin metabolism and increasing its anticoagulant
effect [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Metronidazole is a known inhibitor of CYP2C9, the primary enzyme
responsible for metabolizing the more potent S-enantiomer of warfarin. When this enzyme is inhibited,
warfarin clearance decreases, plasma levels rise, and the patient's INR increases, leading to signs of
bleeding such as bruising and epistaxis. This is why close INR monitoring is essential when metronidazole
is prescribed to patients on warfarin.
Q4: A patient asks why naloxone reverses opioid overdose but doesn't affect their blood pressure
medication. The nurse explains that naloxone is best described as:
A. A nonselective agonist at all receptor types
B. A partial agonist at mu-opioid receptors
C. An opioid receptor antagonist that displaces opioids without activating the receptor [CORRECT]
D. A competitive inhibitor of opioid metabolism
Correct Answer: C
Rationale: This choice is correct because naloxone is a pure opioid antagonist that competes with opioid
agonists like morphine and heroin for binding sites on mu-opioid receptors. It displaces the opioid
without activating the receptor itself, which rapidly reverses respiratory depression and sedation. It has
no effect on non-opioid receptors, which is why it doesn't impact blood pressure medications.
Q5: A patient has been taking digoxin 0.25 mg daily for 3 weeks. The nurse checks a serum digoxin level
and finds it is 2.8 ng/mL (therapeutic range 0.5-2.0 ng/mL). The patient reports nausea and seeing
yellow halos around lights. Which pharmacodynamic concept best explains this clinical picture?
A. The patient is experiencing an idiosyncratic reaction to digoxin
B. The drug has a wide therapeutic index with minimal safety margin
C. The drug has a narrow therapeutic index and the patient has reached toxic levels [CORRECT]
D. The patient has developed tolerance to the therapeutic effects of digoxin
Correct Answer: C
, 3
Rationale: The best answer is C. Digoxin has a narrow therapeutic index, meaning the difference
between a therapeutic dose and a toxic dose is small. A level of 2.8 ng/mL exceeds the therapeutic
range, and the nausea and visual disturbances are classic signs of digoxin toxicity that occur when levels
rise above the narrow safety margin. This matches the pharmacological principle that drugs with narrow
therapeutic windows require frequent monitoring.
Q6: A medication label states: "Administer on an empty stomach because food decreases absorption by
40%." Which pharmacokinetic process is primarily affected by this instruction?
A. Absorption [CORRECT]
B. Distribution
C. Metabolism
D. Elimination
Correct Answer: A
Rationale: This choice is correct because when food decreases the amount of drug that enters the
bloodstream by 40%, this directly impacts absorption. Taking the medication on an empty stomach
ensures that the full intended dose reaches systemic circulation without interference from food
components that may bind the drug or alter GI motility.
Q7: A patient has been taking carbamazepine for epilepsy for 6 months and recently started rifampin for
tuberculosis. Two weeks later, the patient has a breakthrough seizure. Carbamazepine levels are
subtherapeutic. Which pharmacokinetic interaction best explains this?
A. Rifampin inhibits CYP3A4, decreasing carbamazepine metabolism
B. Rifampin competes with carbamazepine for protein binding sites
C. Rifampin decreases carbamazepine absorption in the small intestine
D. Rifampin induces CYP3A4, increasing carbamazepine metabolism and lowering levels [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Rifampin is a potent inducer of the CYP3A4 enzyme system, which
metabolizes carbamazepine. When enzyme induction occurs, the liver breaks down carbamazepine
faster, leading to subtherapeutic drug levels and breakthrough seizures. This is a classic example of why
anticonvulsant levels must be monitored when enzyme inducers are added, and it aligns with Galen
College NUR 210 curriculum on CYP450 interactions.
Q8: The time required for the plasma concentration of a drug to decrease by 50% is clinically defined as:
A. Steady state
B. Therapeutic index
C. Bioavailability
D. Half-life [CORRECT]
