FORTIS COLLEGE
NUR 100 PHARMACOLOGY
FINAL EXAMINATION
2026/2027
All Questions and Correct Answers | Graded A+
Comprehensive Pharmacology Review | 120 Questions | Evidence-Based
,Section 1: Pharmacokinetics and Pharmacodynamics (Q1-Q18)
Q1: A nurse is reviewing the pharmacokinetics of a newly prescribed medication. Which process describes the
movement of a drug from the site of administration into the bloodstream?
A. Distribution
B. Metabolism
C. Absorption **[CORRECT]**
D. Excretion
Correct Answer: C
Rationale: Absorption is the process by which a drug moves from its site of administration into the systemic circulation.
Distribution refers to the transport of drugs throughout the body, metabolism involves biochemical alteration of the drug,
and excretion is the elimination of the drug from the body. In NUR 100, understanding absorption is foundational for
predicting onset of action and bioavailability.
Q2: A patient with liver cirrhosis is prescribed a medication that undergoes extensive first-pass metabolism. The
nurse should expect which alteration in dosing?
A. Increased dose due to rapid clearance
B. Decreased dose due to reduced metabolism **[CORRECT]**
C. No change in dosing required
D. Increased frequency of administration
Correct Answer: B
Rationale: First-pass metabolism occurs in the liver, where a significant portion of an orally administered drug is metabolized
before reaching systemic circulation. In liver cirrhosis, hepatic function is impaired, reducing first-pass metabolism and
increasing bioavailability. Therefore, the dose should be decreased to prevent drug toxicity. Increasing the dose would
worsen toxicity, not improve therapeutic effect.
Q3: Which factor most significantly affects the distribution of a drug in the body?
A. Gastric emptying time
B. Protein binding **[CORRECT]**
C. Renal filtration rate
D. Gastric pH level
Correct Answer: B
Rationale: Protein binding is the most significant factor affecting drug distribution. Drugs bound to plasma proteins
(primarily albumin) are too large to cross cell membranes and remain in the vascular compartment, while unbound (free)
drugs are pharmacologically active and able to distribute to tissues. Gastric emptying and pH affect absorption, while renal
filtration affects excretion. NUR 100 emphasizes protein binding as a key distribution concept.
Q4: A nurse is administering a highly protein-bound drug (98% bound) to an older adult who is malnourished and
has low albumin levels. What is the most important nursing consideration?
A. The drug will be less effective due to decreased absorption
B. The risk of drug toxicity increases due to more free drug available **[CORRECT]**
C. The drug will be excreted more rapidly by the kidneys
D. The drug will have a delayed onset of action
Correct Answer: B
, Rationale: When albumin levels are low, fewer protein-binding sites are available, leaving more unbound (free) drug
circulating. Since only free drug is pharmacologically active, this increases the risk of toxicity at normal doses. The nurse
should assess for signs of adverse effects and monitor drug levels closely. This is a critical NUR 100 concept for geriatric and
malnourished patients.
Q5: The nurse is teaching a patient about a medication with a narrow therapeutic index. Which statement by the
patient indicates understanding?
A. This drug has a wide margin of safety so I do not need to worry about the dose.
B. I need to have my blood levels checked regularly while taking this medication. **[CORRECT]**
C. I can double my dose if I miss a dose to catch up.
D. This medication will work the same in everyone regardless of other conditions.
Correct Answer: B
Rationale: A narrow therapeutic index means the difference between a therapeutic dose and a toxic dose is very small. Drugs
like digoxin, warfarin, lithium, and aminoglycosides require regular serum drug level monitoring to ensure safety. Doubling a
dose is dangerous, and individual factors significantly affect drug response. Regular blood level monitoring is the correct
patient understanding for NUR 100 exam preparation.
Q6: A patient taking warfarin is started on phenobarbital for seizure management. What should the nurse
anticipate?
A. Increased risk of bleeding due to inhibited warfarin metabolism
B. Decreased INR due to enhanced warfarin metabolism **[CORRECT]**
C. No significant interaction between these medications
D. Increased warfarin levels due to competition for protein binding
Correct Answer: B
Rationale: Phenobarbital is a potent hepatic enzyme inducer (CYP450 system), specifically inducing CYP2C9 and CYP3A4,
which metabolize warfarin. Enhanced metabolism of warfarin decreases its anticoagulant effect, lowering the INR and
potentially leading to thromboembolic events. The nurse should anticipate the need for increased warfarin dosage and more
frequent INR monitoring. This is a classic NUR 100 drug interaction scenario.
Q7: A drug with high lipid solubility is most likely to cross which barrier?
A. The renal glomerular filtration barrier
B. The blood-brain barrier **[CORRECT]**
C. The gastric mucosal barrier
D. The intestinal epithelial tight junctions
Correct Answer: B
Rationale: The blood-brain barrier (BBB) is highly selective, allowing only small, lipid-soluble, non-ionized molecules to pass
through. Drugs with high lipid solubility readily cross the BBB, which is essential for CNS-active medications. The renal
filtration barrier primarily restricts based on molecular size, while gastric and intestinal barriers relate more to absorption
processes. NUR 100 emphasizes BBB penetration for psychotropic and anesthetic drugs.
Q8: Which of the following best describes the mechanism of a drug acting as an agonist?
A. Blocking the receptor and preventing the natural neurotransmitter from binding
B. Binding to the receptor and producing a maximal biological response **[CORRECT]**
C. Inhibiting the enzyme that metabolizes the natural ligand
D. Competing with the natural ligand for binding without activating the receptor
Correct Answer: B
, Rationale: An agonist binds to a receptor and activates it, producing a biological response. A full agonist produces the
maximum response possible. Antagonists block receptors, partial agonists produce submaximal responses, and competitive
inhibitors bind without activating the receptor. Understanding receptor theory, including agonist and antagonist
mechanisms, is a core NUR 100 pharmacology concept tested on the final exam.
Q9: A nurse is caring for a patient receiving intravenous morphine. The medication was administered 30 minutes
ago, but the patient reports no pain relief. Which pharmacokinetic phase should the nurse evaluate first?
A. Excretion
B. Metabolism
C. Distribution **[CORRECT]**
D. Absorption
Correct Answer: C
Rationale: For intravenously administered drugs, absorption is essentially instantaneous because the drug enters the
bloodstream directly. Since the drug is in the bloodstream but not providing pain relief, the nurse should evaluate
distribution, which is the process of the drug moving from the blood to the site of action (CNS for morphine). Poor
distribution, rather than absorption or excretion, is the most likely pharmacokinetic explanation for delayed onset of IV
medications.
Q10: The nurse is reviewing medication orders for a patient with decreased renal function. Which type of
medication adjustment is most likely needed?
A. Increased dosing frequency to maintain therapeutic levels
B. Extended dosing interval or reduced dose of renally excreted drugs **[CORRECT]**
C. No adjustment needed since hepatic metabolism compensates
D. Addition of a CYP450 inducer to enhance clearance
Correct Answer: B
Rationale: Drugs eliminated primarily by renal excretion (such as aminoglycosides, digoxin, lithium, and many antibiotics)
accumulate in patients with decreased renal function. The nurse should anticipate extended dosing intervals or reduced
doses to prevent toxicity. Increasing frequency would worsen accumulation, and CYP450 inducers affect hepatic, not renal,
clearance. NUR 100 emphasizes renal dose adjustments as a critical safety competency.
Q11: A patient asks the nurse why their oral medication takes longer to work than the intravenous form of the
same drug. What is the best response by the nurse?
A. Oral medications are weaker than IV medications.
B. Oral medications must be absorbed through the gastrointestinal tract before entering the bloodstream.
**[CORRECT]**
C. IV medications are given at higher doses.
D. Oral medications are broken down by stomach acid and become ineffective.
Correct Answer: B
Rationale: Oral medications undergo absorption through the GI tract, which includes dissolution, passage through the gastric
mucosa, and first-pass hepatic metabolism before reaching systemic circulation. This process creates a delayed onset
compared to IV administration, where the drug is instantly available in the bloodstream. The dose may be the same, and oral
medications are not inherently weaker, making this the most accurate patient education response aligned with NUR 100
principles.
Q12: Which cytochrome P450 enzyme is responsible for metabolizing the largest number of commonly
prescribed drugs?
A. CYP1A2
NUR 100 PHARMACOLOGY
FINAL EXAMINATION
2026/2027
All Questions and Correct Answers | Graded A+
Comprehensive Pharmacology Review | 120 Questions | Evidence-Based
,Section 1: Pharmacokinetics and Pharmacodynamics (Q1-Q18)
Q1: A nurse is reviewing the pharmacokinetics of a newly prescribed medication. Which process describes the
movement of a drug from the site of administration into the bloodstream?
A. Distribution
B. Metabolism
C. Absorption **[CORRECT]**
D. Excretion
Correct Answer: C
Rationale: Absorption is the process by which a drug moves from its site of administration into the systemic circulation.
Distribution refers to the transport of drugs throughout the body, metabolism involves biochemical alteration of the drug,
and excretion is the elimination of the drug from the body. In NUR 100, understanding absorption is foundational for
predicting onset of action and bioavailability.
Q2: A patient with liver cirrhosis is prescribed a medication that undergoes extensive first-pass metabolism. The
nurse should expect which alteration in dosing?
A. Increased dose due to rapid clearance
B. Decreased dose due to reduced metabolism **[CORRECT]**
C. No change in dosing required
D. Increased frequency of administration
Correct Answer: B
Rationale: First-pass metabolism occurs in the liver, where a significant portion of an orally administered drug is metabolized
before reaching systemic circulation. In liver cirrhosis, hepatic function is impaired, reducing first-pass metabolism and
increasing bioavailability. Therefore, the dose should be decreased to prevent drug toxicity. Increasing the dose would
worsen toxicity, not improve therapeutic effect.
Q3: Which factor most significantly affects the distribution of a drug in the body?
A. Gastric emptying time
B. Protein binding **[CORRECT]**
C. Renal filtration rate
D. Gastric pH level
Correct Answer: B
Rationale: Protein binding is the most significant factor affecting drug distribution. Drugs bound to plasma proteins
(primarily albumin) are too large to cross cell membranes and remain in the vascular compartment, while unbound (free)
drugs are pharmacologically active and able to distribute to tissues. Gastric emptying and pH affect absorption, while renal
filtration affects excretion. NUR 100 emphasizes protein binding as a key distribution concept.
Q4: A nurse is administering a highly protein-bound drug (98% bound) to an older adult who is malnourished and
has low albumin levels. What is the most important nursing consideration?
A. The drug will be less effective due to decreased absorption
B. The risk of drug toxicity increases due to more free drug available **[CORRECT]**
C. The drug will be excreted more rapidly by the kidneys
D. The drug will have a delayed onset of action
Correct Answer: B
, Rationale: When albumin levels are low, fewer protein-binding sites are available, leaving more unbound (free) drug
circulating. Since only free drug is pharmacologically active, this increases the risk of toxicity at normal doses. The nurse
should assess for signs of adverse effects and monitor drug levels closely. This is a critical NUR 100 concept for geriatric and
malnourished patients.
Q5: The nurse is teaching a patient about a medication with a narrow therapeutic index. Which statement by the
patient indicates understanding?
A. This drug has a wide margin of safety so I do not need to worry about the dose.
B. I need to have my blood levels checked regularly while taking this medication. **[CORRECT]**
C. I can double my dose if I miss a dose to catch up.
D. This medication will work the same in everyone regardless of other conditions.
Correct Answer: B
Rationale: A narrow therapeutic index means the difference between a therapeutic dose and a toxic dose is very small. Drugs
like digoxin, warfarin, lithium, and aminoglycosides require regular serum drug level monitoring to ensure safety. Doubling a
dose is dangerous, and individual factors significantly affect drug response. Regular blood level monitoring is the correct
patient understanding for NUR 100 exam preparation.
Q6: A patient taking warfarin is started on phenobarbital for seizure management. What should the nurse
anticipate?
A. Increased risk of bleeding due to inhibited warfarin metabolism
B. Decreased INR due to enhanced warfarin metabolism **[CORRECT]**
C. No significant interaction between these medications
D. Increased warfarin levels due to competition for protein binding
Correct Answer: B
Rationale: Phenobarbital is a potent hepatic enzyme inducer (CYP450 system), specifically inducing CYP2C9 and CYP3A4,
which metabolize warfarin. Enhanced metabolism of warfarin decreases its anticoagulant effect, lowering the INR and
potentially leading to thromboembolic events. The nurse should anticipate the need for increased warfarin dosage and more
frequent INR monitoring. This is a classic NUR 100 drug interaction scenario.
Q7: A drug with high lipid solubility is most likely to cross which barrier?
A. The renal glomerular filtration barrier
B. The blood-brain barrier **[CORRECT]**
C. The gastric mucosal barrier
D. The intestinal epithelial tight junctions
Correct Answer: B
Rationale: The blood-brain barrier (BBB) is highly selective, allowing only small, lipid-soluble, non-ionized molecules to pass
through. Drugs with high lipid solubility readily cross the BBB, which is essential for CNS-active medications. The renal
filtration barrier primarily restricts based on molecular size, while gastric and intestinal barriers relate more to absorption
processes. NUR 100 emphasizes BBB penetration for psychotropic and anesthetic drugs.
Q8: Which of the following best describes the mechanism of a drug acting as an agonist?
A. Blocking the receptor and preventing the natural neurotransmitter from binding
B. Binding to the receptor and producing a maximal biological response **[CORRECT]**
C. Inhibiting the enzyme that metabolizes the natural ligand
D. Competing with the natural ligand for binding without activating the receptor
Correct Answer: B
, Rationale: An agonist binds to a receptor and activates it, producing a biological response. A full agonist produces the
maximum response possible. Antagonists block receptors, partial agonists produce submaximal responses, and competitive
inhibitors bind without activating the receptor. Understanding receptor theory, including agonist and antagonist
mechanisms, is a core NUR 100 pharmacology concept tested on the final exam.
Q9: A nurse is caring for a patient receiving intravenous morphine. The medication was administered 30 minutes
ago, but the patient reports no pain relief. Which pharmacokinetic phase should the nurse evaluate first?
A. Excretion
B. Metabolism
C. Distribution **[CORRECT]**
D. Absorption
Correct Answer: C
Rationale: For intravenously administered drugs, absorption is essentially instantaneous because the drug enters the
bloodstream directly. Since the drug is in the bloodstream but not providing pain relief, the nurse should evaluate
distribution, which is the process of the drug moving from the blood to the site of action (CNS for morphine). Poor
distribution, rather than absorption or excretion, is the most likely pharmacokinetic explanation for delayed onset of IV
medications.
Q10: The nurse is reviewing medication orders for a patient with decreased renal function. Which type of
medication adjustment is most likely needed?
A. Increased dosing frequency to maintain therapeutic levels
B. Extended dosing interval or reduced dose of renally excreted drugs **[CORRECT]**
C. No adjustment needed since hepatic metabolism compensates
D. Addition of a CYP450 inducer to enhance clearance
Correct Answer: B
Rationale: Drugs eliminated primarily by renal excretion (such as aminoglycosides, digoxin, lithium, and many antibiotics)
accumulate in patients with decreased renal function. The nurse should anticipate extended dosing intervals or reduced
doses to prevent toxicity. Increasing frequency would worsen accumulation, and CYP450 inducers affect hepatic, not renal,
clearance. NUR 100 emphasizes renal dose adjustments as a critical safety competency.
Q11: A patient asks the nurse why their oral medication takes longer to work than the intravenous form of the
same drug. What is the best response by the nurse?
A. Oral medications are weaker than IV medications.
B. Oral medications must be absorbed through the gastrointestinal tract before entering the bloodstream.
**[CORRECT]**
C. IV medications are given at higher doses.
D. Oral medications are broken down by stomach acid and become ineffective.
Correct Answer: B
Rationale: Oral medications undergo absorption through the GI tract, which includes dissolution, passage through the gastric
mucosa, and first-pass hepatic metabolism before reaching systemic circulation. This process creates a delayed onset
compared to IV administration, where the drug is instantly available in the bloodstream. The dose may be the same, and oral
medications are not inherently weaker, making this the most accurate patient education response aligned with NUR 100
principles.
Q12: Which cytochrome P450 enzyme is responsible for metabolizing the largest number of commonly
prescribed drugs?
A. CYP1A2
