McCuistion Pharmacology 12th Ed Test Bank 2026
Section I: Foundations
1. A nurse is reviewing the pharmacokinetic properties of a newly prescribed
medication. Which process describes the movement of a drug from its site of
administration into the systemic circulation?
A. Distribution
B. Metabolism
C. Absorption
D. Excretion
Correct Answer: C
Rationale: Absorption is the process by which a drug moves from its site of
administration into the bloodstream. Distribution (A) refers to the movement of
drugs throughout body tissues. Metabolism (B) involves the biochemical
transformation of drugs, primarily in the liver. Excretion (D) is the elimination of
drugs from the body, primarily through the kidneys.
2. A patient takes oral morphine for chronic pain but reports inadequate relief.
The nurse explains that a significant portion of the drug is inactivated before
reaching systemic circulation. Which phenomenon accounts for this?
A. Protein binding
B. First-pass effect
C. Blood-brain barrier
D. Active transport
Correct Answer: B
Rationale: The first-pass effect occurs when orally administered drugs are
absorbed through the gastrointestinal tract and transported to the liver via the
portal vein, where a significant portion may be metabolized before reaching
systemic circulation. This reduces bioavailability. Protein binding (A) affects drug
distribution. The blood-brain barrier (C) limits drug entry into the CNS. Active
transport (D) is an absorption mechanism requiring energy.
,3. A drug has a half-life of 12 hours. Approximately how long will it take for the
drug to reach steady-state concentration with repeated dosing?
A. 12 hours
B. 24 hours
C. 48 to 60 hours
D. 120 hours
Correct Answer: C
Rationale: It takes approximately 4 to 5 half-lives for a drug to reach
steady-state concentration with repeated dosing. For a drug with a 12-hour half-
life, steady state is achieved in approximately 48 to 60 hours (4 × 12 = 48 hours).
At steady state, the rate of drug administration equals the rate of elimination.
4. A drug is classified as having a narrow therapeutic index. Which nursing
intervention is most important when administering this medication?
A. Administering the drug with food
B. Monitoring drug levels closely and assessing for signs of toxicity
C. Giving the medication only once daily
D. Diluting the medication in a large volume of IV fluid
Correct Answer: B
Rationale: A narrow therapeutic index means the difference between a
therapeutic dose and a toxic dose is very small. Medications such as digoxin,
warfarin, lithium, and aminoglycosides require close serum drug level monitoring
and vigilant assessment for signs of toxicity. Administering with food (A) does not
address the narrow margin of safety. Once-daily dosing (C) is not inherently safer.
Diluting the medication (D) does not change its therapeutic index.
5. A patient is receiving a competitive antagonist medication. Which effect
should the nurse expect?
,A. The drug binds to the receptor and produces a maximal response
B. The drug binds to the receptor and prevents the agonist from producing its
effect
C. The drug increases the number of available receptors
D. The drug enhances the natural neurotransmitter's action
Correct Answer: B
Rationale: A competitive antagonist binds to the same receptor site as the
agonist but does not activate the receptor, thereby blocking the agonist's effect.
The antagonism can be overcome by increasing the concentration of the agonist.
Examples include naloxone (opioid antagonist) and flumazenil (benzodiazepine
antagonist). Option A describes an agonist. Option C is not a mechanism of
antagonists. Option D describes an agonist effect.
6. A highly protein-bound drug (95%) is administered to a patient with
hypoalbuminemia. Which effect is most likely to occur?
A. Decreased risk of adverse effects
B. Increased free drug concentration and greater pharmacological effect
C. Rapid renal excretion of the drug
D. Decreased drug absorption from the GI tract
Correct Answer: B
Rationale: Highly protein-bound drugs rely on albumin for transport in the
bloodstream. In hypoalbuminemia, fewer protein binding sites are available,
leading to an increased free (unbound) drug concentration. Only unbound drug is
pharmacologically active, so this increases the risk of adverse effects, not
decreases them (A). Free drug may be metabolized and excreted, but the primary
concern is increased pharmacological effect. Absorption (D) is not directly
affected by protein binding.
, 7. A nurse is caring for a patient receiving a medication that is a weak acid. The
nurse knows that this drug will be better absorbed in which part of the
gastrointestinal tract?
A. Stomach
B. Duodenum
C. Large intestine
D. Esophagus
Correct Answer: A
Rationale: Weak acidic drugs are better absorbed in the acidic
environment of the stomach because they remain nonionized, which allows them
to cross cell membranes more readily. Weak bases are better absorbed in the
more alkaline environment of the small intestine. The large intestine (C) and
esophagus (D) are not primary sites of drug absorption.
8. Which of the following would be correctly categorized as objective data when
performing a medication assessment?
A. A list of herbal supplements regularly used provided by the patient
B. Lab values associated with the drugs the patient is taking
C. The ages and relationship of all household members to the patient
D. Usual dietary patterns and food intake
Correct Answer: B
Rationale: Objective data are measurable and detectable by someone
other than the patient, including laboratory values, vital signs, and physical
examination findings. Subjective data (A, C, D) are based on what the patient or
family members communicate to the nurse, including health history, signs and
symptoms, and lifestyle information.
9. The nurse is preparing to administer a medication and reviews the patient's
chart for drug allergies, serum creatinine, and blood urea nitrogen (BUN) levels.
The nurse's actions are reflective of which phase of the nursing process?
Section I: Foundations
1. A nurse is reviewing the pharmacokinetic properties of a newly prescribed
medication. Which process describes the movement of a drug from its site of
administration into the systemic circulation?
A. Distribution
B. Metabolism
C. Absorption
D. Excretion
Correct Answer: C
Rationale: Absorption is the process by which a drug moves from its site of
administration into the bloodstream. Distribution (A) refers to the movement of
drugs throughout body tissues. Metabolism (B) involves the biochemical
transformation of drugs, primarily in the liver. Excretion (D) is the elimination of
drugs from the body, primarily through the kidneys.
2. A patient takes oral morphine for chronic pain but reports inadequate relief.
The nurse explains that a significant portion of the drug is inactivated before
reaching systemic circulation. Which phenomenon accounts for this?
A. Protein binding
B. First-pass effect
C. Blood-brain barrier
D. Active transport
Correct Answer: B
Rationale: The first-pass effect occurs when orally administered drugs are
absorbed through the gastrointestinal tract and transported to the liver via the
portal vein, where a significant portion may be metabolized before reaching
systemic circulation. This reduces bioavailability. Protein binding (A) affects drug
distribution. The blood-brain barrier (C) limits drug entry into the CNS. Active
transport (D) is an absorption mechanism requiring energy.
,3. A drug has a half-life of 12 hours. Approximately how long will it take for the
drug to reach steady-state concentration with repeated dosing?
A. 12 hours
B. 24 hours
C. 48 to 60 hours
D. 120 hours
Correct Answer: C
Rationale: It takes approximately 4 to 5 half-lives for a drug to reach
steady-state concentration with repeated dosing. For a drug with a 12-hour half-
life, steady state is achieved in approximately 48 to 60 hours (4 × 12 = 48 hours).
At steady state, the rate of drug administration equals the rate of elimination.
4. A drug is classified as having a narrow therapeutic index. Which nursing
intervention is most important when administering this medication?
A. Administering the drug with food
B. Monitoring drug levels closely and assessing for signs of toxicity
C. Giving the medication only once daily
D. Diluting the medication in a large volume of IV fluid
Correct Answer: B
Rationale: A narrow therapeutic index means the difference between a
therapeutic dose and a toxic dose is very small. Medications such as digoxin,
warfarin, lithium, and aminoglycosides require close serum drug level monitoring
and vigilant assessment for signs of toxicity. Administering with food (A) does not
address the narrow margin of safety. Once-daily dosing (C) is not inherently safer.
Diluting the medication (D) does not change its therapeutic index.
5. A patient is receiving a competitive antagonist medication. Which effect
should the nurse expect?
,A. The drug binds to the receptor and produces a maximal response
B. The drug binds to the receptor and prevents the agonist from producing its
effect
C. The drug increases the number of available receptors
D. The drug enhances the natural neurotransmitter's action
Correct Answer: B
Rationale: A competitive antagonist binds to the same receptor site as the
agonist but does not activate the receptor, thereby blocking the agonist's effect.
The antagonism can be overcome by increasing the concentration of the agonist.
Examples include naloxone (opioid antagonist) and flumazenil (benzodiazepine
antagonist). Option A describes an agonist. Option C is not a mechanism of
antagonists. Option D describes an agonist effect.
6. A highly protein-bound drug (95%) is administered to a patient with
hypoalbuminemia. Which effect is most likely to occur?
A. Decreased risk of adverse effects
B. Increased free drug concentration and greater pharmacological effect
C. Rapid renal excretion of the drug
D. Decreased drug absorption from the GI tract
Correct Answer: B
Rationale: Highly protein-bound drugs rely on albumin for transport in the
bloodstream. In hypoalbuminemia, fewer protein binding sites are available,
leading to an increased free (unbound) drug concentration. Only unbound drug is
pharmacologically active, so this increases the risk of adverse effects, not
decreases them (A). Free drug may be metabolized and excreted, but the primary
concern is increased pharmacological effect. Absorption (D) is not directly
affected by protein binding.
, 7. A nurse is caring for a patient receiving a medication that is a weak acid. The
nurse knows that this drug will be better absorbed in which part of the
gastrointestinal tract?
A. Stomach
B. Duodenum
C. Large intestine
D. Esophagus
Correct Answer: A
Rationale: Weak acidic drugs are better absorbed in the acidic
environment of the stomach because they remain nonionized, which allows them
to cross cell membranes more readily. Weak bases are better absorbed in the
more alkaline environment of the small intestine. The large intestine (C) and
esophagus (D) are not primary sites of drug absorption.
8. Which of the following would be correctly categorized as objective data when
performing a medication assessment?
A. A list of herbal supplements regularly used provided by the patient
B. Lab values associated with the drugs the patient is taking
C. The ages and relationship of all household members to the patient
D. Usual dietary patterns and food intake
Correct Answer: B
Rationale: Objective data are measurable and detectable by someone
other than the patient, including laboratory values, vital signs, and physical
examination findings. Subjective data (A, C, D) are based on what the patient or
family members communicate to the nurse, including health history, signs and
symptoms, and lifestyle information.
9. The nurse is preparing to administer a medication and reviews the patient's
chart for drug allergies, serum creatinine, and blood urea nitrogen (BUN) levels.
The nurse's actions are reflective of which phase of the nursing process?
