BSN3A Pharmacology – Exam Practice Questions & Verified Answers with Rationales (2026 Latest Update) –
Comprehensive 250-Question Practice Exam
Questions 1–250
1. A patient is prescribed a medication that undergoes extensive first-pass metabolism. Which route
of administration would the nurse expect to have the highest bioavailability?
A) Oral
B) Sublingual
C) Intravenous
D) Rectal
Answer C: Intravenous
Rationale: IV administration bypasses first-pass metabolism entirely, delivering 100% bioavailability.
2. A patient asks the nurse why the oral dose of a drug is higher than the IV dose. The nurse explains
this is due to:
A) Faster absorption orally
B) First-pass effect in the liver
C) Decreased protein binding
D) Increased renal excretion
Answer B: First-pass effect in the liver
Rationale: Oral drugs are metabolized in the liver before reaching systemic circulation, reducing
bioavailability.
3. Which route of administration has the fastest onset of action?
A) Oral
B) Subcutaneous
C) Intravenous
D) Transdermal
Answer C: Intravenous
Rationale: IV administration delivers the drug directly into the bloodstream for immediate effect.
,4. A patient has a serum drug half-life of 4 hours. After 16 hours, what percentage of the drug remains
in the body?
A) 25%
B) 6.25%
C) 12.5%
D) 50%
Answer B: 6.25%
Rationale: After 4 half-lives (16 hours), drug concentration is 6.25% of original
(50%→25%→12.5%→6.25%).
5. Which factor increases the risk of drug toxicity in older adults?
A) Increased hepatic blood flow
B) Increased renal clearance
C) Decreased renal function and decreased hepatic metabolism
D) Increased gastric emptying
Answer C: Decreased renal function and decreased hepatic metabolism
Rationale: Age-related decline in renal and hepatic function reduces drug clearance, increasing toxicity risk.
6. A patient with liver disease is prescribed a medication metabolized by the liver. The nurse
anticipates:
A) Decreased drug effect
B) Increased drug effect and risk of toxicity
C) No change in drug effect
D) Faster drug excretion
Answer B: Increased drug effect and risk of toxicity
Rationale: Impaired hepatic metabolism leads to drug accumulation, increasing therapeutic and adverse
effects.
7. A patient with renal impairment is prescribed a medication excreted by the kidneys. The nurse
should monitor for:
A) Decreased drug effect
,B) Increased drug levels and toxicity
C) No change in drug levels
D) Faster drug excretion
Answer B: Increased drug levels and toxicity
Rationale: Renal impairment reduces drug excretion, leading to accumulation and toxicity.
8. The term "bioavailability" refers to:
A) The speed of drug absorption
B) The fraction of an administered dose that reaches systemic circulation
C) The drug's affinity for its receptor
D) The drug's duration of action
Answer B: The fraction of an administered dose that reaches systemic circulation
Rationale: Bioavailability measures the proportion of drug that enters systemic circulation unchanged.
9. Which drug property determines the volume of distribution (Vd)?
A) Molecular weight
B) Lipid solubility and protein binding
C) Route of administration
D) Half-life
Answer B: Lipid solubility and protein binding
Rationale: Lipid-soluble drugs have a larger Vd; protein-bound drugs have a smaller Vd.
10. A patient is prescribed a highly protein-bound drug. Which condition would increase the risk of
toxicity?
A) High protein levels
B) Low protein levels (malnutrition, liver disease)
C) Decreased renal function
D) Increased gastric emptying
Answer B: Low protein levels (malnutrition, liver disease)
Rationale: Low protein levels increase free (active) drug, leading to toxicity.
11. The nurse explains that drug excretion primarily occurs through which organ?
, A) Liver
j0
B) Lungs
j0
C) Kidneys
j0
D) Skin
j0
Answer C: Kidneys j0 j0
Rationale: The kidneys are the primary route of drug excretion through urine.
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
12. A patient is prescribed a weak acid drug. The nurse expects this drug to be excreted faster
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
j0 when urine pH is: j0 j0 j0
A) Acidic
j0
B) Alkaline
j0
C) Neutral
j0
D) Variable
j0
Answer B: Alkaline j0 j0
Rationale: Weak acids are ionized in alkaline urine, trapped, and excreted faster.
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
13. A patient is prescribed a weak base drug. The nurse expects this drug to be excreted faster
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
j0 when urine pH is: j0 j0 j0
A) Acidic
j0
B) Alkaline
j0
C) Neutral
j0
D) Variable
j0
Answer A: Acidic j0 j0
Rationale: Weak bases are ionized in acidic urine, trapped, and excreted faster.
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
14. Which of the following is an example of an antagonist drug?
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
A) A drug that activates a receptor
j0 j0 j0 j0 j0 j0
B) A drug that blocks a receptor
j0 j0 j0 j0 j0 j0
C) A drug that increases enzyme activity
j0 j0 j0 j0 j0 j0
D) A drug that mimics a neurotransmitter
j0 j0 j0 j0 j0 j0
Answer B: A drug that blocks a receptor
j0 j0 j0 j0 j0 j0 j0
Rationale: Antagonists bind to receptors and block their activation by agonists.
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
Comprehensive 250-Question Practice Exam
Questions 1–250
1. A patient is prescribed a medication that undergoes extensive first-pass metabolism. Which route
of administration would the nurse expect to have the highest bioavailability?
A) Oral
B) Sublingual
C) Intravenous
D) Rectal
Answer C: Intravenous
Rationale: IV administration bypasses first-pass metabolism entirely, delivering 100% bioavailability.
2. A patient asks the nurse why the oral dose of a drug is higher than the IV dose. The nurse explains
this is due to:
A) Faster absorption orally
B) First-pass effect in the liver
C) Decreased protein binding
D) Increased renal excretion
Answer B: First-pass effect in the liver
Rationale: Oral drugs are metabolized in the liver before reaching systemic circulation, reducing
bioavailability.
3. Which route of administration has the fastest onset of action?
A) Oral
B) Subcutaneous
C) Intravenous
D) Transdermal
Answer C: Intravenous
Rationale: IV administration delivers the drug directly into the bloodstream for immediate effect.
,4. A patient has a serum drug half-life of 4 hours. After 16 hours, what percentage of the drug remains
in the body?
A) 25%
B) 6.25%
C) 12.5%
D) 50%
Answer B: 6.25%
Rationale: After 4 half-lives (16 hours), drug concentration is 6.25% of original
(50%→25%→12.5%→6.25%).
5. Which factor increases the risk of drug toxicity in older adults?
A) Increased hepatic blood flow
B) Increased renal clearance
C) Decreased renal function and decreased hepatic metabolism
D) Increased gastric emptying
Answer C: Decreased renal function and decreased hepatic metabolism
Rationale: Age-related decline in renal and hepatic function reduces drug clearance, increasing toxicity risk.
6. A patient with liver disease is prescribed a medication metabolized by the liver. The nurse
anticipates:
A) Decreased drug effect
B) Increased drug effect and risk of toxicity
C) No change in drug effect
D) Faster drug excretion
Answer B: Increased drug effect and risk of toxicity
Rationale: Impaired hepatic metabolism leads to drug accumulation, increasing therapeutic and adverse
effects.
7. A patient with renal impairment is prescribed a medication excreted by the kidneys. The nurse
should monitor for:
A) Decreased drug effect
,B) Increased drug levels and toxicity
C) No change in drug levels
D) Faster drug excretion
Answer B: Increased drug levels and toxicity
Rationale: Renal impairment reduces drug excretion, leading to accumulation and toxicity.
8. The term "bioavailability" refers to:
A) The speed of drug absorption
B) The fraction of an administered dose that reaches systemic circulation
C) The drug's affinity for its receptor
D) The drug's duration of action
Answer B: The fraction of an administered dose that reaches systemic circulation
Rationale: Bioavailability measures the proportion of drug that enters systemic circulation unchanged.
9. Which drug property determines the volume of distribution (Vd)?
A) Molecular weight
B) Lipid solubility and protein binding
C) Route of administration
D) Half-life
Answer B: Lipid solubility and protein binding
Rationale: Lipid-soluble drugs have a larger Vd; protein-bound drugs have a smaller Vd.
10. A patient is prescribed a highly protein-bound drug. Which condition would increase the risk of
toxicity?
A) High protein levels
B) Low protein levels (malnutrition, liver disease)
C) Decreased renal function
D) Increased gastric emptying
Answer B: Low protein levels (malnutrition, liver disease)
Rationale: Low protein levels increase free (active) drug, leading to toxicity.
11. The nurse explains that drug excretion primarily occurs through which organ?
, A) Liver
j0
B) Lungs
j0
C) Kidneys
j0
D) Skin
j0
Answer C: Kidneys j0 j0
Rationale: The kidneys are the primary route of drug excretion through urine.
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
12. A patient is prescribed a weak acid drug. The nurse expects this drug to be excreted faster
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
j0 when urine pH is: j0 j0 j0
A) Acidic
j0
B) Alkaline
j0
C) Neutral
j0
D) Variable
j0
Answer B: Alkaline j0 j0
Rationale: Weak acids are ionized in alkaline urine, trapped, and excreted faster.
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
13. A patient is prescribed a weak base drug. The nurse expects this drug to be excreted faster
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
j0 when urine pH is: j0 j0 j0
A) Acidic
j0
B) Alkaline
j0
C) Neutral
j0
D) Variable
j0
Answer A: Acidic j0 j0
Rationale: Weak bases are ionized in acidic urine, trapped, and excreted faster.
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
14. Which of the following is an example of an antagonist drug?
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
A) A drug that activates a receptor
j0 j0 j0 j0 j0 j0
B) A drug that blocks a receptor
j0 j0 j0 j0 j0 j0
C) A drug that increases enzyme activity
j0 j0 j0 j0 j0 j0
D) A drug that mimics a neurotransmitter
j0 j0 j0 j0 j0 j0
Answer B: A drug that blocks a receptor
j0 j0 j0 j0 j0 j0 j0
Rationale: Antagonists bind to receptors and block their activation by agonists.
j0 j0 j0 j0 j0 j0 j0 j0 j0 j0
