FORTIS COLLEGE
NUR 100 PHARMACOLOGY
FINAL EXAMINATION
2026/2027 Academic Year
ALL 250 QUESTIONS WITH CORRECT ANSWERS AND RATIONALES
Already Graded A+
Comprehensive Cumulative Final Examination
Covering All Body Systems and Pharmacology Principles
11 Sections | 250 Multiple-Choice Questions
Cognitive Levels: Recall (25%) | Application (55%) | Analysis (20%)
,FORTIS NUR 100 PHARMACOLOGY FINAL EXAM 2026/2027
Section 1: Pharmacokinetics and Pharmacodynamics
Q1: A nurse is administering warfarin to a client with atrial fibrillation. The client asks why they cannot
take the same dose as their friend who also takes warfarin. Which response by the nurse is best?
A. The dose is based on your weight, so heavier people always need higher doses.
B. Warfarin has a narrow therapeutic index, so your dose must be individualized based on your INR results.
**[CORRECT]**
C. Your friend must have a more severe condition, which is why they need a different dose.
D. The pharmacy determines the dose based on your age alone.
Correct Answer: B
Rationale: Warfarin has a narrow therapeutic index, meaning the difference between a therapeutic and toxic dose is small.
Dosing must be individualized using INR monitoring. Weight and age alone do not determine warfarin dosing; pharmacogenetics
(CYP2C9 and VKORC1 variants), diet, and drug interactions also play significant roles.
Q2: A nurse is reviewing the medication profile of a client taking phenytoin (Dilantin) for seizure
management. The client has an albumin level of 2.0 g/dL. Which effect should the nurse anticipate?
A. Decreased total phenytoin level with no change in clinical effect
B. Increased free (unbound) phenytoin level increasing the risk of toxicity **[CORRECT]**
C. Decreased free phenytoin level causing loss of seizure control
D. No effect on phenytoin levels because it is not highly protein-bound
Correct Answer: B
Rationale: Phenytoin is approximately 90% protein-bound, primarily to albumin. Hypoalbuminemia reduces available binding
sites, increasing the free (active) fraction of phenytoin, which raises the risk of toxicity even if total phenytoin appears normal.
The nurse should monitor for nystagmus, ataxia, and confusion.
Q3: A client is prescribed a medication with a half-life of 12 hours. The nurse administers the first dose at
0800. At what approximate time will 87.5% of the drug be eliminated from the body?
A. 1200 (4 hours after the dose)
B. 2000 (12 hours after the dose)
C. 0800 the next day (24 hours after the dose)
D. 0800 two days after the dose (48 hours after the dose) **[CORRECT]**
Correct Answer: D
Rationale: After one half-life (12 hours), 50% remains. After two half-lives (24 hours), 25% remains. After three half-lives (36
hours), 12.5% remains, meaning 87.5% has been eliminated. It takes approximately four to five half-lives to reach steady state
or near-complete elimination.
Q4: A nurse is caring for a client with liver cirrhosis who is prescribed morphine for pain management.
Which pharmacokinetic alteration is most important for the nurse to consider?
A. Increased first-pass metabolism leading to decreased drug effect
B. Decreased first-pass metabolism leading to increased bioavailability and risk of toxicity **[CORRECT]**
C. Increased renal excretion requiring higher doses for pain relief
D. Enhanced protein binding leading to decreased free drug levels
Correct Answer: B
Rationale: Morphine undergoes significant first-pass metabolism in the liver. In cirrhosis, hepatic blood flow and metabolic
capacity are reduced, decreasing first-pass metabolism and increasing bioavailability of orally administered morphine. This
places the client at higher risk for respiratory depression, requiring careful dose reduction.
Fortis College NUR 100 Pharmacology Page 2
,Q5: A nursing student asks the instructor why some medications cannot cross the blood-brain barrier.
Which response by the instructor is most accurate?
A. "Only water-soluble drugs can cross the blood-brain barrier effectively."
B. "The BBB selectively allows lipid-soluble and un-ionized drugs to cross, while blocking large, ionized, and
water-soluble molecules." **[CORRECT]**
C. "All medications must be injected intrathecally to reach the central nervous system."
D. "The BBB prevents all foreign substances from entering the brain."
Correct Answer: B
Rationale: The blood-brain barrier is formed by tight endothelial junctions in cerebral capillaries. Lipid-soluble, non-ionized, and
small molecules passively diffuse across the BBB, while large, ionized, or water-soluble molecules are largely excluded. This is
why diazepam has rapid CNS effects, whereas atenolol has minimal CNS penetration.
Q6: A client taking oral contraceptives develops a yeast infection and is prescribed fluconazole (Diflucan).
What is the nurse's priority concern regarding this drug interaction?
A. Fluconazole induces CYP3A4, decreasing oral contraceptive levels and increasing the risk of pregnancy
**[CORRECT]**
B. Fluconazole increases oral contraceptive levels, increasing the risk of estrogen-related side effects
C. The oral contraceptive decreases the effectiveness of fluconazole
D. There is no significant interaction between these two medications
Correct Answer: A
Rationale: Fluconazole and other azole antifungals can reduce the efficacy of oral contraceptives through altered estrogen
metabolism and effects on enterohepatic recirculation. The nurse should advise the client to use a backup contraceptive method
during fluconazole therapy. This is a commonly tested drug interaction in nursing pharmacology.
Q7: A nurse is administering naloxone (Narcan) to a client who received an overdose of morphine. Which
receptor concept best explains how naloxone reverses the respiratory depression?
A. Naloxone is a partial agonist that partially stimulates mu receptors
B. Naloxone is a competitive antagonist that binds to mu receptors without activating them, displacing morphine
**[CORRECT]**
C. Naloxone is a noncompetitive antagonist that permanently blocks mu receptors
D. Naloxone is an inverse agonist that reverses the effect of morphine at all receptor types
Correct Answer: B
Rationale: Naloxone is a competitive antagonist at mu-opioid receptors. It competes with morphine for the same binding sites but
does not activate the receptor, displacing morphine and reversing respiratory depression and sedation. Because it is competitive, its
effects may wear off before the morphine, requiring repeated dosing.
Q8: A nurse is comparing two drugs on a dose-response curve. Drug A produces a maximal response at 5
mg, and Drug B produces a maximal response at 50 mg, but both achieve the same maximum effect. What
is the correct interpretation?
A. Drug A is more efficacious than Drug B
B. Drug B is more potent than Drug A
C. Drug A is more potent than Drug B, but both have equal efficacy **[CORRECT]**
D. Drug B is more efficacious than Drug A because it requires a higher dose
Correct Answer: C
Rationale: Potency refers to the amount of drug needed to produce a given effect; Drug A is more potent because it achieves the
same effect at a lower dose. Efficacy refers to the maximum effect regardless of dose. Since both reach the same maximal
response, they have equal efficacy. A common pitfall is confusing potency with efficacy.
Q9: A client taking St. John's wort is started on sertraline (Zoloft) for depression. The nurse should
monitor the client for which potential adverse effect?
, A. Increased depression due to reduced sertraline absorption
B. Serotonin syndrome due to additive serotonergic effects from St. John's wort **[CORRECT]**
C. Hypertensive crisis from tyramine interaction
D. No interaction because St. John's wort is a natural supplement
Correct Answer: B
Rationale: St. John's wort has serotonergic activity, and the combination with SSRIs increases the risk of serotonin syndrome.
Additionally, St. John's wort induces CYP3A4, potentially lowering sertraline levels. The nurse should monitor for agitation,
hyperreflexia, diaphoresis, tremor, and fever.
Q10: A nurse is caring for a client with end-stage renal disease who is prescribed gabapentin (Neurontin)
for neuropathic pain. Which adjustment is most important?
A. Increase the dose because gabapentin is poorly absorbed in renal failure
B. Extend the dosing interval or reduce the dose because gabapentin is renally excreted unchanged
**[CORRECT]**
C. No adjustment is needed because gabapentin is metabolized by the liver
D. Switch to an IV formulation because oral absorption is impaired
Correct Answer: B
Rationale: Gabapentin is not metabolized by the liver and is excreted unchanged by the kidneys. In renal impairment, the drug
accumulates, increasing the risk of CNS toxicity including ataxia, dizziness, and sedation. Dosing must be adjusted based on
creatinine clearance, typically by extending the interval or reducing the dose.
Q11: A nurse is teaching a client about the four processes of pharmacokinetics. The nurse correctly
explains that distribution refers to which process?
A. The movement of a drug from its site of administration into the bloodstream
B. The movement of a drug from the bloodstream into tissues and body fluids **[CORRECT]**
C. The biochemical alteration of a drug by the body
D. The elimination of a drug or its metabolites from the body
Correct Answer: B
Rationale: The four pharmacokinetic processes are absorption (entry into blood), distribution (movement from blood into tissues),
metabolism (biochemical transformation), and excretion (removal from body). Factors affecting distribution include blood flow,
protein binding, lipid solubility, and the blood-brain barrier.
Q12: A client is prescribed a drug with a very low therapeutic index. Which nursing action is the highest
priority?
A. Administer the drug with food to reduce GI upset
B. Monitor drug levels closely and assess for signs of toxicity **[CORRECT]**
C. Encourage the client to take the drug at the same time each day
D. Teach the client to avoid grapefruit juice
Correct Answer: B
Rationale: A low (narrow) therapeutic index means the difference between a therapeutic dose and a toxic dose is very small.
Drugs like digoxin, warfarin, lithium, phenytoin, and aminoglycosides have narrow therapeutic indices. The nursing priority is to
closely monitor serum drug levels, therapeutic effects, and signs of toxicity.
Q13: A client taking cimetidine (Tagamet) is also prescribed theophylline (Theo-Dur) for COPD. What
effect should the nurse anticipate?
A. Decreased theophylline effectiveness due to reduced absorption
B. Increased theophylline levels and risk of toxicity due to CYP1A2 inhibition **[CORRECT]**
C. No interaction because these drugs use different metabolic pathways
D. Increased metabolism of cimetidine leading to ulcer recurrence
Correct Answer: B
NUR 100 PHARMACOLOGY
FINAL EXAMINATION
2026/2027 Academic Year
ALL 250 QUESTIONS WITH CORRECT ANSWERS AND RATIONALES
Already Graded A+
Comprehensive Cumulative Final Examination
Covering All Body Systems and Pharmacology Principles
11 Sections | 250 Multiple-Choice Questions
Cognitive Levels: Recall (25%) | Application (55%) | Analysis (20%)
,FORTIS NUR 100 PHARMACOLOGY FINAL EXAM 2026/2027
Section 1: Pharmacokinetics and Pharmacodynamics
Q1: A nurse is administering warfarin to a client with atrial fibrillation. The client asks why they cannot
take the same dose as their friend who also takes warfarin. Which response by the nurse is best?
A. The dose is based on your weight, so heavier people always need higher doses.
B. Warfarin has a narrow therapeutic index, so your dose must be individualized based on your INR results.
**[CORRECT]**
C. Your friend must have a more severe condition, which is why they need a different dose.
D. The pharmacy determines the dose based on your age alone.
Correct Answer: B
Rationale: Warfarin has a narrow therapeutic index, meaning the difference between a therapeutic and toxic dose is small.
Dosing must be individualized using INR monitoring. Weight and age alone do not determine warfarin dosing; pharmacogenetics
(CYP2C9 and VKORC1 variants), diet, and drug interactions also play significant roles.
Q2: A nurse is reviewing the medication profile of a client taking phenytoin (Dilantin) for seizure
management. The client has an albumin level of 2.0 g/dL. Which effect should the nurse anticipate?
A. Decreased total phenytoin level with no change in clinical effect
B. Increased free (unbound) phenytoin level increasing the risk of toxicity **[CORRECT]**
C. Decreased free phenytoin level causing loss of seizure control
D. No effect on phenytoin levels because it is not highly protein-bound
Correct Answer: B
Rationale: Phenytoin is approximately 90% protein-bound, primarily to albumin. Hypoalbuminemia reduces available binding
sites, increasing the free (active) fraction of phenytoin, which raises the risk of toxicity even if total phenytoin appears normal.
The nurse should monitor for nystagmus, ataxia, and confusion.
Q3: A client is prescribed a medication with a half-life of 12 hours. The nurse administers the first dose at
0800. At what approximate time will 87.5% of the drug be eliminated from the body?
A. 1200 (4 hours after the dose)
B. 2000 (12 hours after the dose)
C. 0800 the next day (24 hours after the dose)
D. 0800 two days after the dose (48 hours after the dose) **[CORRECT]**
Correct Answer: D
Rationale: After one half-life (12 hours), 50% remains. After two half-lives (24 hours), 25% remains. After three half-lives (36
hours), 12.5% remains, meaning 87.5% has been eliminated. It takes approximately four to five half-lives to reach steady state
or near-complete elimination.
Q4: A nurse is caring for a client with liver cirrhosis who is prescribed morphine for pain management.
Which pharmacokinetic alteration is most important for the nurse to consider?
A. Increased first-pass metabolism leading to decreased drug effect
B. Decreased first-pass metabolism leading to increased bioavailability and risk of toxicity **[CORRECT]**
C. Increased renal excretion requiring higher doses for pain relief
D. Enhanced protein binding leading to decreased free drug levels
Correct Answer: B
Rationale: Morphine undergoes significant first-pass metabolism in the liver. In cirrhosis, hepatic blood flow and metabolic
capacity are reduced, decreasing first-pass metabolism and increasing bioavailability of orally administered morphine. This
places the client at higher risk for respiratory depression, requiring careful dose reduction.
Fortis College NUR 100 Pharmacology Page 2
,Q5: A nursing student asks the instructor why some medications cannot cross the blood-brain barrier.
Which response by the instructor is most accurate?
A. "Only water-soluble drugs can cross the blood-brain barrier effectively."
B. "The BBB selectively allows lipid-soluble and un-ionized drugs to cross, while blocking large, ionized, and
water-soluble molecules." **[CORRECT]**
C. "All medications must be injected intrathecally to reach the central nervous system."
D. "The BBB prevents all foreign substances from entering the brain."
Correct Answer: B
Rationale: The blood-brain barrier is formed by tight endothelial junctions in cerebral capillaries. Lipid-soluble, non-ionized, and
small molecules passively diffuse across the BBB, while large, ionized, or water-soluble molecules are largely excluded. This is
why diazepam has rapid CNS effects, whereas atenolol has minimal CNS penetration.
Q6: A client taking oral contraceptives develops a yeast infection and is prescribed fluconazole (Diflucan).
What is the nurse's priority concern regarding this drug interaction?
A. Fluconazole induces CYP3A4, decreasing oral contraceptive levels and increasing the risk of pregnancy
**[CORRECT]**
B. Fluconazole increases oral contraceptive levels, increasing the risk of estrogen-related side effects
C. The oral contraceptive decreases the effectiveness of fluconazole
D. There is no significant interaction between these two medications
Correct Answer: A
Rationale: Fluconazole and other azole antifungals can reduce the efficacy of oral contraceptives through altered estrogen
metabolism and effects on enterohepatic recirculation. The nurse should advise the client to use a backup contraceptive method
during fluconazole therapy. This is a commonly tested drug interaction in nursing pharmacology.
Q7: A nurse is administering naloxone (Narcan) to a client who received an overdose of morphine. Which
receptor concept best explains how naloxone reverses the respiratory depression?
A. Naloxone is a partial agonist that partially stimulates mu receptors
B. Naloxone is a competitive antagonist that binds to mu receptors without activating them, displacing morphine
**[CORRECT]**
C. Naloxone is a noncompetitive antagonist that permanently blocks mu receptors
D. Naloxone is an inverse agonist that reverses the effect of morphine at all receptor types
Correct Answer: B
Rationale: Naloxone is a competitive antagonist at mu-opioid receptors. It competes with morphine for the same binding sites but
does not activate the receptor, displacing morphine and reversing respiratory depression and sedation. Because it is competitive, its
effects may wear off before the morphine, requiring repeated dosing.
Q8: A nurse is comparing two drugs on a dose-response curve. Drug A produces a maximal response at 5
mg, and Drug B produces a maximal response at 50 mg, but both achieve the same maximum effect. What
is the correct interpretation?
A. Drug A is more efficacious than Drug B
B. Drug B is more potent than Drug A
C. Drug A is more potent than Drug B, but both have equal efficacy **[CORRECT]**
D. Drug B is more efficacious than Drug A because it requires a higher dose
Correct Answer: C
Rationale: Potency refers to the amount of drug needed to produce a given effect; Drug A is more potent because it achieves the
same effect at a lower dose. Efficacy refers to the maximum effect regardless of dose. Since both reach the same maximal
response, they have equal efficacy. A common pitfall is confusing potency with efficacy.
Q9: A client taking St. John's wort is started on sertraline (Zoloft) for depression. The nurse should
monitor the client for which potential adverse effect?
, A. Increased depression due to reduced sertraline absorption
B. Serotonin syndrome due to additive serotonergic effects from St. John's wort **[CORRECT]**
C. Hypertensive crisis from tyramine interaction
D. No interaction because St. John's wort is a natural supplement
Correct Answer: B
Rationale: St. John's wort has serotonergic activity, and the combination with SSRIs increases the risk of serotonin syndrome.
Additionally, St. John's wort induces CYP3A4, potentially lowering sertraline levels. The nurse should monitor for agitation,
hyperreflexia, diaphoresis, tremor, and fever.
Q10: A nurse is caring for a client with end-stage renal disease who is prescribed gabapentin (Neurontin)
for neuropathic pain. Which adjustment is most important?
A. Increase the dose because gabapentin is poorly absorbed in renal failure
B. Extend the dosing interval or reduce the dose because gabapentin is renally excreted unchanged
**[CORRECT]**
C. No adjustment is needed because gabapentin is metabolized by the liver
D. Switch to an IV formulation because oral absorption is impaired
Correct Answer: B
Rationale: Gabapentin is not metabolized by the liver and is excreted unchanged by the kidneys. In renal impairment, the drug
accumulates, increasing the risk of CNS toxicity including ataxia, dizziness, and sedation. Dosing must be adjusted based on
creatinine clearance, typically by extending the interval or reducing the dose.
Q11: A nurse is teaching a client about the four processes of pharmacokinetics. The nurse correctly
explains that distribution refers to which process?
A. The movement of a drug from its site of administration into the bloodstream
B. The movement of a drug from the bloodstream into tissues and body fluids **[CORRECT]**
C. The biochemical alteration of a drug by the body
D. The elimination of a drug or its metabolites from the body
Correct Answer: B
Rationale: The four pharmacokinetic processes are absorption (entry into blood), distribution (movement from blood into tissues),
metabolism (biochemical transformation), and excretion (removal from body). Factors affecting distribution include blood flow,
protein binding, lipid solubility, and the blood-brain barrier.
Q12: A client is prescribed a drug with a very low therapeutic index. Which nursing action is the highest
priority?
A. Administer the drug with food to reduce GI upset
B. Monitor drug levels closely and assess for signs of toxicity **[CORRECT]**
C. Encourage the client to take the drug at the same time each day
D. Teach the client to avoid grapefruit juice
Correct Answer: B
Rationale: A low (narrow) therapeutic index means the difference between a therapeutic dose and a toxic dose is very small.
Drugs like digoxin, warfarin, lithium, phenytoin, and aminoglycosides have narrow therapeutic indices. The nursing priority is to
closely monitor serum drug levels, therapeutic effects, and signs of toxicity.
Q13: A client taking cimetidine (Tagamet) is also prescribed theophylline (Theo-Dur) for COPD. What
effect should the nurse anticipate?
A. Decreased theophylline effectiveness due to reduced absorption
B. Increased theophylline levels and risk of toxicity due to CYP1A2 inhibition **[CORRECT]**
C. No interaction because these drugs use different metabolic pathways
D. Increased metabolism of cimetidine leading to ulcer recurrence
Correct Answer: B
