Exam 2: NSG 124 Pharmacology | Review with Questions and Verified Answers NEW 2026/2027 Update
HERZING UNIVERSITY | NSG 124 PHARMACOLOGY | EXAM 2 PREPARATION
Exam 2: NSG 124 Pharmacology
Review with Questions and Verified Answers | NEW 2026/2027 Update | Graded A
Course / Exam NSG 124 Pharmacology | Exam 2 Comprehensive Review
Total Questions 80 multiple-choice questions (A-D), one correct answer each, with verified answers and
detailed rationales
Coverage Six sections: pharmacokinetics/dynamics, autonomic, central nervous, cardiovascular/renal,
endocrine, and pain/anti-inflammatory pharmacology
Cognitive Levels 30% recall, 50% application, 20% analysis | 75% scenario-based, 25% direct recall and
classification
SECTION 1
Pharmacokinetics and Pharmacodynamics (Questions 1-15)
Absorption, bioavailability, and first-pass effect | distribution and protein binding | metabolism, CYP450, and
elimination kinetics | excretion and half-life | receptor theory | dose-response | therapeutic index
Q1: A patient with severe postoperative pain and persistent nausea requires an opioid analgesic
that bypasses hepatic first-pass metabolism to ensure complete drug delivery. Which
prescription should the nurse anticipate?
A. Oral morphine sulfate solution
B. Intravenous morphine sulfate [CORRECT]
C. Oral oxycodone immediate-release tablets
D. Oral codeine with acetaminophen
Correct Answer: B
Rationale: Intravenous administration delivers drug directly into systemic circulation, completely
bypassing gastrointestinal absorption and portal-hepatic first-pass metabolism, so essentially the entire dose
reaches the bloodstream. Oral morphine undergoes extensive first-pass metabolism with bioavailability of
only about 30 percent, and nausea further compromises oral absorption and tolerability. Oral oxycodone
and oral codeine also undergo partial first-pass metabolism, making them unsuitable when complete
delivery is required. The nurse must still monitor intravenous opioids closely for respiratory depression and
sedation.
NSG 124 Pharmacology | Herzing University Curriculum-Aligned Review 1
,Exam 2: NSG 124 Pharmacology | Review with Questions and Verified Answers NEW 2026/2027 Update
Q2: Which statement by a nursing student most accurately describes the pharmacokinetic term
bioavailability?
A. The fraction of an administered dose that reaches systemic circulation in unchanged,
active form [CORRECT]
B. The degree to which a drug binds to plasma albumin in the bloodstream
C. The rate at which a drug is chemically transformed by hepatic CYP450 enzymes
D. The time required for the plasma concentration of a drug to decrease by one half
Correct Answer: A
Rationale: Bioavailability is defined as the fraction of the administered dose that reaches systemic
circulation intact; intravenous administration provides 100 percent bioavailability by definition. Option B
describes plasma protein binding, option C describes metabolism rate, and option D defines half-life,
which is a measure of elimination. Bioavailability is reduced by factors such as first-pass hepatic
metabolism, incomplete absorption, and intestinal P-glycoprotein efflux, all core NSG124 absorption
concepts.
Q3: A patient receives a single 100 mg intravenous dose of a drug with a half-life of 6 hours.
How much of the drug will remain in the body 18 hours after administration?
A. 50 mg
B. 25 mg
C. 12.5 mg [CORRECT]
D. 6.25 mg
Correct Answer: C
Rationale: Eighteen hours represents three half-lives: 100 mg falls to 50 mg at 6 hours, to 25 mg at 12
hours, and to 12.5 mg at 18 hours. Option A reflects only one half-life and option B only two half-lives,
showing that the distractors test correct half-life counting. Clinically, approximately 94 to 97 percent of a
drug is eliminated after 4 to 5 half-lives, which is also the time needed to reach steady state with repeated
dosing. This calculation skill underlies safe timing of therapeutic drug monitoring.
Q4: A patient stabilized on felodipine for hypertension begins drinking two large glasses of
grapefruit juice daily. Two days later the patient reports dizziness, flushing, and
lightheadedness on standing. What is the most likely pharmacologic explanation?
A. Grapefruit juice induces CYP3A4 and lowers felodipine levels
B. Grapefruit juice inhibits intestinal CYP3A4, raising felodipine bioavailability and
levels [CORRECT]
C. Grapefruit juice displaces felodipine from plasma albumin binding sites
D. Grapefruit juice increases the renal clearance of felodipine
Correct Answer: B
NSG 124 Pharmacology | Herzing University Curriculum-Aligned Review 2
,Exam 2: NSG 124 Pharmacology | Review with Questions and Verified Answers NEW 2026/2027 Update
Rationale: Grapefruit juice irreversibly inhibits CYP3A4 in the intestinal wall, reducing presystemic
first-pass metabolism of felodipine and increasing bioavailability, which produces exaggerated
hypotension. Option A reverses the mechanism because inhibition, not induction, occurs; the effect can
persist 24 to 72 hours after the last glass. Option C describes protein-binding displacement and option D
describes enhanced excretion, neither of which applies to this interaction. Nurses teach patients on
felodipine, simvastatin, and many other CYP3A4 substrates to avoid grapefruit juice entirely.
Q5: A nurse is teaching a nursing student about repeated fixed dosing of a medication. When
does a drug given at consistent intervals reach steady-state plasma concentration?
A. After the very first dose
B. In approximately 4 to 5 half-lives of the drug [CORRECT]
C. In approximately 1 to 2 half-lives of the drug
D. Only if a loading dose is administered first
Correct Answer: B
Rationale: With repeated dosing, accumulation approaches plateau in about 4 to 5 half-lives regardless of
dose size, because the amount eliminated each interval eventually equals the amount absorbed. A single
dose never achieves steady state, and one to two half-lives reaches only 50 to 75 percent of plateau. A
loading dose achieves therapeutic levels faster but does not shorten the time to steady state, which remains
governed by half-life. This principle explains why drugs such as lithium and digoxin require weeks of
therapy before full effect is judged.
Q6: A patient on long-term warfarin therapy is newly prescribed
trimethoprim-sulfamethoxazole. Three days later the patient develops bruising and bleeding
gums. Which mechanism best explains these findings?
A. The antibiotic destroys warfarin within the intestinal lumen
B. The antibiotic induces hepatic metabolism of warfarin, lowering its level
C. The antibiotic displaces warfarin from plasma protein-binding sites and inhibits its
metabolism, increasing free warfarin levels [CORRECT]
D. The antibiotic increases the renal excretion of unchanged warfarin
Correct Answer: C
Rationale: Warfarin is about 99 percent albumin bound; trimethoprim-sulfamethoxazole both displaces
warfarin from albumin and inhibits CYP2C9, sharply raising free warfarin concentration and producing
bleeding. Displacement transiently increases free drug even though total level may appear normal, which is
a classic NSG124 distribution concept. Option B reverses the direction of the metabolic interaction, and
options A and D describe mechanisms that do not occur here. The nurse anticipates INR monitoring,
bleeding precautions, and possible vitamin K administration.
NSG 124 Pharmacology | Herzing University Curriculum-Aligned Review 3
, Exam 2: NSG 124 Pharmacology | Review with Questions and Verified Answers NEW 2026/2027 Update
Q7: According to receptor theory, which pair of properties defines a full agonist?
A. Affinity for the receptor but no intrinsic activity
B. Affinity for the receptor plus maximal intrinsic activity [CORRECT]
C. No receptor affinity but strong intrinsic activity
D. Moderate affinity with intrinsic activity between zero and 100 percent
Correct Answer: B
Rationale: A full agonist both binds the receptor (affinity) and activates it to produce the maximal
possible response (intrinsic activity of 100 percent), mimicking the endogenous ligand. Option A defines a
competitive antagonist, which occupies receptors without activating them. Option D defines a partial
agonist such as buprenorphine, which binds well but produces a blunted ceiling response. Option C is
pharmacologically impossible because intrinsic activity requires receptor binding first.
Q8: A nurse reviews the home medication list of a patient prescribed digoxin, warfarin,
lithium, and phenytoin. Which nursing action is most important based on the pharmacologic
property these four drugs share?
A. Administering all four drugs with food to reduce gastrointestinal irritation
B. Monitoring serum drug levels closely because all four have narrow therapeutic indices
[CORRECT]
C. Encouraging high fluid intake to prevent crystalluria from all four drugs
D. Scheduling all four doses at least 2 hours apart from one another
Correct Answer: B
Rationale: Digoxin, warfarin, lithium, and phenytoin are classic narrow therapeutic index drugs in which
therapeutic doses lie close to toxic doses, so therapeutic drug monitoring is essential for safety. Reference
ranges include digoxin 0.5 to 2.0 nanograms per milliliter, lithium 0.6 to 1.2 milliequivalents per liter,
phenytoin 10 to 20 micrograms per milliliter, and INR goals for warfarin of 2 to 3. Food timing, fluid
intake, and dose spacing are relevant nursing interventions but do not address the shared high-alert
property. These drugs also appear on the high-alert medication list for concentrated forms and monitoring
requirements.
Q9: Drug X lowers blood pressure at an ED50 of 2 mg, whereas Drug Y requires an ED50 of
10 mg; both drugs produce the same maximal response. Which conclusion is accurate?
A. Drug X is safer than Drug Y because it is more potent
B. Drug Y is more efficacious than Drug X
C. Drug X is more potent than Drug Y, but efficacy is equal [CORRECT]
D. Drug X has a higher ceiling of clinical effect than Drug Y
Correct Answer: C
NSG 124 Pharmacology | Herzing University Curriculum-Aligned Review 4
HERZING UNIVERSITY | NSG 124 PHARMACOLOGY | EXAM 2 PREPARATION
Exam 2: NSG 124 Pharmacology
Review with Questions and Verified Answers | NEW 2026/2027 Update | Graded A
Course / Exam NSG 124 Pharmacology | Exam 2 Comprehensive Review
Total Questions 80 multiple-choice questions (A-D), one correct answer each, with verified answers and
detailed rationales
Coverage Six sections: pharmacokinetics/dynamics, autonomic, central nervous, cardiovascular/renal,
endocrine, and pain/anti-inflammatory pharmacology
Cognitive Levels 30% recall, 50% application, 20% analysis | 75% scenario-based, 25% direct recall and
classification
SECTION 1
Pharmacokinetics and Pharmacodynamics (Questions 1-15)
Absorption, bioavailability, and first-pass effect | distribution and protein binding | metabolism, CYP450, and
elimination kinetics | excretion and half-life | receptor theory | dose-response | therapeutic index
Q1: A patient with severe postoperative pain and persistent nausea requires an opioid analgesic
that bypasses hepatic first-pass metabolism to ensure complete drug delivery. Which
prescription should the nurse anticipate?
A. Oral morphine sulfate solution
B. Intravenous morphine sulfate [CORRECT]
C. Oral oxycodone immediate-release tablets
D. Oral codeine with acetaminophen
Correct Answer: B
Rationale: Intravenous administration delivers drug directly into systemic circulation, completely
bypassing gastrointestinal absorption and portal-hepatic first-pass metabolism, so essentially the entire dose
reaches the bloodstream. Oral morphine undergoes extensive first-pass metabolism with bioavailability of
only about 30 percent, and nausea further compromises oral absorption and tolerability. Oral oxycodone
and oral codeine also undergo partial first-pass metabolism, making them unsuitable when complete
delivery is required. The nurse must still monitor intravenous opioids closely for respiratory depression and
sedation.
NSG 124 Pharmacology | Herzing University Curriculum-Aligned Review 1
,Exam 2: NSG 124 Pharmacology | Review with Questions and Verified Answers NEW 2026/2027 Update
Q2: Which statement by a nursing student most accurately describes the pharmacokinetic term
bioavailability?
A. The fraction of an administered dose that reaches systemic circulation in unchanged,
active form [CORRECT]
B. The degree to which a drug binds to plasma albumin in the bloodstream
C. The rate at which a drug is chemically transformed by hepatic CYP450 enzymes
D. The time required for the plasma concentration of a drug to decrease by one half
Correct Answer: A
Rationale: Bioavailability is defined as the fraction of the administered dose that reaches systemic
circulation intact; intravenous administration provides 100 percent bioavailability by definition. Option B
describes plasma protein binding, option C describes metabolism rate, and option D defines half-life,
which is a measure of elimination. Bioavailability is reduced by factors such as first-pass hepatic
metabolism, incomplete absorption, and intestinal P-glycoprotein efflux, all core NSG124 absorption
concepts.
Q3: A patient receives a single 100 mg intravenous dose of a drug with a half-life of 6 hours.
How much of the drug will remain in the body 18 hours after administration?
A. 50 mg
B. 25 mg
C. 12.5 mg [CORRECT]
D. 6.25 mg
Correct Answer: C
Rationale: Eighteen hours represents three half-lives: 100 mg falls to 50 mg at 6 hours, to 25 mg at 12
hours, and to 12.5 mg at 18 hours. Option A reflects only one half-life and option B only two half-lives,
showing that the distractors test correct half-life counting. Clinically, approximately 94 to 97 percent of a
drug is eliminated after 4 to 5 half-lives, which is also the time needed to reach steady state with repeated
dosing. This calculation skill underlies safe timing of therapeutic drug monitoring.
Q4: A patient stabilized on felodipine for hypertension begins drinking two large glasses of
grapefruit juice daily. Two days later the patient reports dizziness, flushing, and
lightheadedness on standing. What is the most likely pharmacologic explanation?
A. Grapefruit juice induces CYP3A4 and lowers felodipine levels
B. Grapefruit juice inhibits intestinal CYP3A4, raising felodipine bioavailability and
levels [CORRECT]
C. Grapefruit juice displaces felodipine from plasma albumin binding sites
D. Grapefruit juice increases the renal clearance of felodipine
Correct Answer: B
NSG 124 Pharmacology | Herzing University Curriculum-Aligned Review 2
,Exam 2: NSG 124 Pharmacology | Review with Questions and Verified Answers NEW 2026/2027 Update
Rationale: Grapefruit juice irreversibly inhibits CYP3A4 in the intestinal wall, reducing presystemic
first-pass metabolism of felodipine and increasing bioavailability, which produces exaggerated
hypotension. Option A reverses the mechanism because inhibition, not induction, occurs; the effect can
persist 24 to 72 hours after the last glass. Option C describes protein-binding displacement and option D
describes enhanced excretion, neither of which applies to this interaction. Nurses teach patients on
felodipine, simvastatin, and many other CYP3A4 substrates to avoid grapefruit juice entirely.
Q5: A nurse is teaching a nursing student about repeated fixed dosing of a medication. When
does a drug given at consistent intervals reach steady-state plasma concentration?
A. After the very first dose
B. In approximately 4 to 5 half-lives of the drug [CORRECT]
C. In approximately 1 to 2 half-lives of the drug
D. Only if a loading dose is administered first
Correct Answer: B
Rationale: With repeated dosing, accumulation approaches plateau in about 4 to 5 half-lives regardless of
dose size, because the amount eliminated each interval eventually equals the amount absorbed. A single
dose never achieves steady state, and one to two half-lives reaches only 50 to 75 percent of plateau. A
loading dose achieves therapeutic levels faster but does not shorten the time to steady state, which remains
governed by half-life. This principle explains why drugs such as lithium and digoxin require weeks of
therapy before full effect is judged.
Q6: A patient on long-term warfarin therapy is newly prescribed
trimethoprim-sulfamethoxazole. Three days later the patient develops bruising and bleeding
gums. Which mechanism best explains these findings?
A. The antibiotic destroys warfarin within the intestinal lumen
B. The antibiotic induces hepatic metabolism of warfarin, lowering its level
C. The antibiotic displaces warfarin from plasma protein-binding sites and inhibits its
metabolism, increasing free warfarin levels [CORRECT]
D. The antibiotic increases the renal excretion of unchanged warfarin
Correct Answer: C
Rationale: Warfarin is about 99 percent albumin bound; trimethoprim-sulfamethoxazole both displaces
warfarin from albumin and inhibits CYP2C9, sharply raising free warfarin concentration and producing
bleeding. Displacement transiently increases free drug even though total level may appear normal, which is
a classic NSG124 distribution concept. Option B reverses the direction of the metabolic interaction, and
options A and D describe mechanisms that do not occur here. The nurse anticipates INR monitoring,
bleeding precautions, and possible vitamin K administration.
NSG 124 Pharmacology | Herzing University Curriculum-Aligned Review 3
, Exam 2: NSG 124 Pharmacology | Review with Questions and Verified Answers NEW 2026/2027 Update
Q7: According to receptor theory, which pair of properties defines a full agonist?
A. Affinity for the receptor but no intrinsic activity
B. Affinity for the receptor plus maximal intrinsic activity [CORRECT]
C. No receptor affinity but strong intrinsic activity
D. Moderate affinity with intrinsic activity between zero and 100 percent
Correct Answer: B
Rationale: A full agonist both binds the receptor (affinity) and activates it to produce the maximal
possible response (intrinsic activity of 100 percent), mimicking the endogenous ligand. Option A defines a
competitive antagonist, which occupies receptors without activating them. Option D defines a partial
agonist such as buprenorphine, which binds well but produces a blunted ceiling response. Option C is
pharmacologically impossible because intrinsic activity requires receptor binding first.
Q8: A nurse reviews the home medication list of a patient prescribed digoxin, warfarin,
lithium, and phenytoin. Which nursing action is most important based on the pharmacologic
property these four drugs share?
A. Administering all four drugs with food to reduce gastrointestinal irritation
B. Monitoring serum drug levels closely because all four have narrow therapeutic indices
[CORRECT]
C. Encouraging high fluid intake to prevent crystalluria from all four drugs
D. Scheduling all four doses at least 2 hours apart from one another
Correct Answer: B
Rationale: Digoxin, warfarin, lithium, and phenytoin are classic narrow therapeutic index drugs in which
therapeutic doses lie close to toxic doses, so therapeutic drug monitoring is essential for safety. Reference
ranges include digoxin 0.5 to 2.0 nanograms per milliliter, lithium 0.6 to 1.2 milliequivalents per liter,
phenytoin 10 to 20 micrograms per milliliter, and INR goals for warfarin of 2 to 3. Food timing, fluid
intake, and dose spacing are relevant nursing interventions but do not address the shared high-alert
property. These drugs also appear on the high-alert medication list for concentrated forms and monitoring
requirements.
Q9: Drug X lowers blood pressure at an ED50 of 2 mg, whereas Drug Y requires an ED50 of
10 mg; both drugs produce the same maximal response. Which conclusion is accurate?
A. Drug X is safer than Drug Y because it is more potent
B. Drug Y is more efficacious than Drug X
C. Drug X is more potent than Drug Y, but efficacy is equal [CORRECT]
D. Drug X has a higher ceiling of clinical effect than Drug Y
Correct Answer: C
NSG 124 Pharmacology | Herzing University Curriculum-Aligned Review 4
