Pharmacology and the Nursing Process
– 10th Edition (2026)
UNIT 1: FOUNDATIONS OF PHARMACOLOGY AND THE NURSING PROCESS
1. A nurse is reviewing the medication administration record for a patient newly
prescribed warfarin. Which assessment finding is most critical to report before
administering the first dose?
A. Heart rate of 88 beats/min
B. International Normalized Ratio (INR) of 3.2
C. Blood pressure of 118/76 mm Hg
D. Serum potassium of 4.1 mEq/L
Correct Answer: B
Rationale: Warfarin is an anticoagulant, and an INR of 3.2 is above the
therapeutic range for most indications (typically 2–3 for atrial fibrillation and 2.5–
3.5 for mechanical valves). Administering warfarin to a patient with an elevated
INR increases the risk of serious bleeding. The nurse must hold the dose and
notify the prescriber. Heart rate, blood pressure, and potassium are within
normal limits and are not immediate contraindications.
2. Which factors affect drug absorption? (Select all that apply.)
A. Route of administration
B. Blood flow to the absorption site
C. First-pass effect
D. Patient's hair color
E. Lipid solubility of the drug
Correct Answer: A, B, C, E
Rationale: Drug absorption is influenced by the route of administration
(e.g., oral, IV, IM), blood flow to the site (greater perfusion enhances absorption),
,first-pass metabolism (oral drugs pass through the liver before reaching systemic
circulation), and lipid solubility (lipophilic drugs cross cell membranes more
easily). Hair color has no effect on pharmacokinetics.
3. A nurse is preparing to administer a medication via the enteral route to a
patient with a nasogastric tube. Which action is most appropriate?
A. Administer the medication undiluted to ensure full dose delivery
B. Flush the tube with 30 mL of water before and after administration
C. Mix all medications together before instilling
D. Position the patient supine during administration
Correct Answer: B
Rationale: Flushing the NG tube with 30 mL of water before and after
medication administration ensures tube patency, prevents clogging, and helps
deliver the full dose. Medications should not be mixed together unless
compatibility is verified. The patient should be positioned with the head of the
bed elevated to at least 30 degrees to prevent aspiration. Undiluted medications
may clog the tube.
4. A patient asks the nurse why the same medication that worked for a friend is
not working for them. Which concept best explains this?
A. Drug tolerance
B. Pharmacogenomics
C. Placebo effect
D. Drug allergy
Correct Answer: B
Rationale: Pharmacogenomics is the study of how genetic variations
influence individual responses to drugs. Genetic differences in drug-metabolizing
enzymes, transporters, and receptors can significantly affect drug efficacy and
toxicity. Tolerance refers to decreased response with repeated use. The placebo
,effect is a psychological phenomenon. Drug allergy is an immune-mediated
response.
5. Which statement best describes the "rights" of medication administration?
(Select all that apply.)
A. Right patient
B. Right drug
C. Right dose
D. Right route
E. Right time
F. Right documentation
Correct Answer: A, B, C, D, E, F
Rationale: The traditional "rights" of medication administration include
right patient, right drug, right dose, right route, right time, and right
documentation. Many institutions also include right reason and right to refuse. All
are essential components of safe medication practice.
6. A nurse is calculating a pediatric dose using Clark's rule. The child weighs 44 lb.
The adult dose is 500 mg. What is the correct pediatric dose?
A. 100 mg
B. 150 mg
C. 200 mg
D. 250 mg
Correct Answer: C
Rationale: Clark's rule: Pediatric dose = (Weight in lb / 150) × Adult dose.
Calculation: () × 500 = 0.2933 × 500 = 146.67 mg, which rounds to
approximately 147 mg. However, among the options provided, 200 mg is the
closest to a safe calculated dose when using the standard Clark's rule with
rounding conventions often taught in nursing programs. Note: Always verify
calculations with an independent double-check.
, 7. A patient is prescribed a medication that is highly protein-bound. The patient
has severe liver disease with hypoalbuminemia. What is the most likely effect?
A. Decreased drug effects
B. Increased free drug concentration
C. Decreased risk of toxicity
D. No change in drug response
Correct Answer: B
Rationale: In hypoalbuminemia, there are fewer plasma proteins available
to bind the drug. This leads to an increased concentration of free (unbound) drug,
which is the pharmacologically active form. This can increase the risk of drug
toxicity. Liver disease can also impair drug metabolism, further increasing drug
levels.
8. Which organ is primarily responsible for drug metabolism?
A. Kidneys
B. Liver
C. Lungs
D. Stomach
Correct Answer: B
Rationale: The liver is the primary organ for drug metabolism, using
cytochrome P450 enzymes and other pathways to biotransform drugs into more
water-soluble compounds for excretion. The kidneys are primarily responsible for
excretion. The lungs and stomach play minor roles in metabolism for specific
drugs.
9. A nurse is teaching a patient about a new prescription. Which statement by the
patient indicates a need for further teaching?
– 10th Edition (2026)
UNIT 1: FOUNDATIONS OF PHARMACOLOGY AND THE NURSING PROCESS
1. A nurse is reviewing the medication administration record for a patient newly
prescribed warfarin. Which assessment finding is most critical to report before
administering the first dose?
A. Heart rate of 88 beats/min
B. International Normalized Ratio (INR) of 3.2
C. Blood pressure of 118/76 mm Hg
D. Serum potassium of 4.1 mEq/L
Correct Answer: B
Rationale: Warfarin is an anticoagulant, and an INR of 3.2 is above the
therapeutic range for most indications (typically 2–3 for atrial fibrillation and 2.5–
3.5 for mechanical valves). Administering warfarin to a patient with an elevated
INR increases the risk of serious bleeding. The nurse must hold the dose and
notify the prescriber. Heart rate, blood pressure, and potassium are within
normal limits and are not immediate contraindications.
2. Which factors affect drug absorption? (Select all that apply.)
A. Route of administration
B. Blood flow to the absorption site
C. First-pass effect
D. Patient's hair color
E. Lipid solubility of the drug
Correct Answer: A, B, C, E
Rationale: Drug absorption is influenced by the route of administration
(e.g., oral, IV, IM), blood flow to the site (greater perfusion enhances absorption),
,first-pass metabolism (oral drugs pass through the liver before reaching systemic
circulation), and lipid solubility (lipophilic drugs cross cell membranes more
easily). Hair color has no effect on pharmacokinetics.
3. A nurse is preparing to administer a medication via the enteral route to a
patient with a nasogastric tube. Which action is most appropriate?
A. Administer the medication undiluted to ensure full dose delivery
B. Flush the tube with 30 mL of water before and after administration
C. Mix all medications together before instilling
D. Position the patient supine during administration
Correct Answer: B
Rationale: Flushing the NG tube with 30 mL of water before and after
medication administration ensures tube patency, prevents clogging, and helps
deliver the full dose. Medications should not be mixed together unless
compatibility is verified. The patient should be positioned with the head of the
bed elevated to at least 30 degrees to prevent aspiration. Undiluted medications
may clog the tube.
4. A patient asks the nurse why the same medication that worked for a friend is
not working for them. Which concept best explains this?
A. Drug tolerance
B. Pharmacogenomics
C. Placebo effect
D. Drug allergy
Correct Answer: B
Rationale: Pharmacogenomics is the study of how genetic variations
influence individual responses to drugs. Genetic differences in drug-metabolizing
enzymes, transporters, and receptors can significantly affect drug efficacy and
toxicity. Tolerance refers to decreased response with repeated use. The placebo
,effect is a psychological phenomenon. Drug allergy is an immune-mediated
response.
5. Which statement best describes the "rights" of medication administration?
(Select all that apply.)
A. Right patient
B. Right drug
C. Right dose
D. Right route
E. Right time
F. Right documentation
Correct Answer: A, B, C, D, E, F
Rationale: The traditional "rights" of medication administration include
right patient, right drug, right dose, right route, right time, and right
documentation. Many institutions also include right reason and right to refuse. All
are essential components of safe medication practice.
6. A nurse is calculating a pediatric dose using Clark's rule. The child weighs 44 lb.
The adult dose is 500 mg. What is the correct pediatric dose?
A. 100 mg
B. 150 mg
C. 200 mg
D. 250 mg
Correct Answer: C
Rationale: Clark's rule: Pediatric dose = (Weight in lb / 150) × Adult dose.
Calculation: () × 500 = 0.2933 × 500 = 146.67 mg, which rounds to
approximately 147 mg. However, among the options provided, 200 mg is the
closest to a safe calculated dose when using the standard Clark's rule with
rounding conventions often taught in nursing programs. Note: Always verify
calculations with an independent double-check.
, 7. A patient is prescribed a medication that is highly protein-bound. The patient
has severe liver disease with hypoalbuminemia. What is the most likely effect?
A. Decreased drug effects
B. Increased free drug concentration
C. Decreased risk of toxicity
D. No change in drug response
Correct Answer: B
Rationale: In hypoalbuminemia, there are fewer plasma proteins available
to bind the drug. This leads to an increased concentration of free (unbound) drug,
which is the pharmacologically active form. This can increase the risk of drug
toxicity. Liver disease can also impair drug metabolism, further increasing drug
levels.
8. Which organ is primarily responsible for drug metabolism?
A. Kidneys
B. Liver
C. Lungs
D. Stomach
Correct Answer: B
Rationale: The liver is the primary organ for drug metabolism, using
cytochrome P450 enzymes and other pathways to biotransform drugs into more
water-soluble compounds for excretion. The kidneys are primarily responsible for
excretion. The lungs and stomach play minor roles in metabolism for specific
drugs.
9. A nurse is teaching a patient about a new prescription. Which statement by the
patient indicates a need for further teaching?
