D441 Pharmacology Midterm Comprehensive Review 2026 |WGU
1. Which pharmacokinetic process is primarily affected by the ‘first-pass effect’
when a drug is administered orally?
A. Absorption
B. Metabolism
C. Distribution
D. Excretion
Answer: B
Rationale: The first-pass effect refers to the rapid hepatic metabolism of an oral drug
before it reaches the systemic circulation, significantly reducing its bioavailability.
2. A drug has a half-life of 4 hours. If a patient takes 400 mg of the drug, how
many milligrams will remain in the body after 12 hours?
A. 200 mg
B. 50 mg
C. 100 mg
D. 25 mg
Answer: B
Rationale: After 4 hours (1 half-life), 200 mg remain. After 8 hours (2 half-lives), 100 mg
remain. After 12 hours (3 half-lives), 50 mg remain.
,3. When a drug is highly protein-bound, what is the clinical significance of a
patient having low albumin levels?
A. Decreased drug effectiveness
B. Increased risk of drug toxicity
C. Delayed onset of action
D. Increased excretion rate
Answer: B
Rationale: Low albumin means fewer binding sites, resulting in more free (active) drug in
the bloodstream, which can lead to toxicity.
4. A drug with a narrow therapeutic index (TI) indicates that:
A. It is safe to use without monitoring
B. There is a small margin between the effective and toxic dose
C. It has a very long half-life
D. It is highly effective for many conditions
Answer: B
Rationale: A narrow therapeutic index means the lethal or toxic dose is close to the
therapeutic dose, requiring close monitoring.
5. Which ‘right’ of medication administration is being followed when the nurse
checks the patient’s ID band?
A. Right Dose
B. Right Documentation
C. Right Route
D. Right Patient
Answer: D
Rationale: Identifying the patient using at least two identifiers, such as name and date of
birth or ID band, ensures the ‘Right Patient’.
, 6. What is the primary action of an agonist drug?
A. To block a receptor
B. To prevent other chemicals from binding
C. To bind to a receptor and trigger a response
D. To speed up the excretion of other drugs
Answer: C
Rationale: An agonist mimics the action of endogenous substances by binding to receptors
and activating them.
7. A nurse is preparing to administer Epinephrine. Which effect should the nurse
expect?
A. Bradycardia
B. Increased heart rate
C. Bronchoconstriction
D. Decreased blood pressure
Answer: B
Rationale: Epinephrine is an adrenergic agonist that stimulates Beta-1 receptors, leading
to an increased heart rate and contractility.
8. Which vital sign must the nurse check before administering Metoprolol?
A. Respiratory rate
B. Temperature
C. Oxygen saturation
D. Heart rate
Answer: D
Rationale: Metoprolol is a beta-blocker that can cause bradycardia; the apical pulse should
be checked, and the drug held if the HR is below 60 bpm.
1. Which pharmacokinetic process is primarily affected by the ‘first-pass effect’
when a drug is administered orally?
A. Absorption
B. Metabolism
C. Distribution
D. Excretion
Answer: B
Rationale: The first-pass effect refers to the rapid hepatic metabolism of an oral drug
before it reaches the systemic circulation, significantly reducing its bioavailability.
2. A drug has a half-life of 4 hours. If a patient takes 400 mg of the drug, how
many milligrams will remain in the body after 12 hours?
A. 200 mg
B. 50 mg
C. 100 mg
D. 25 mg
Answer: B
Rationale: After 4 hours (1 half-life), 200 mg remain. After 8 hours (2 half-lives), 100 mg
remain. After 12 hours (3 half-lives), 50 mg remain.
,3. When a drug is highly protein-bound, what is the clinical significance of a
patient having low albumin levels?
A. Decreased drug effectiveness
B. Increased risk of drug toxicity
C. Delayed onset of action
D. Increased excretion rate
Answer: B
Rationale: Low albumin means fewer binding sites, resulting in more free (active) drug in
the bloodstream, which can lead to toxicity.
4. A drug with a narrow therapeutic index (TI) indicates that:
A. It is safe to use without monitoring
B. There is a small margin between the effective and toxic dose
C. It has a very long half-life
D. It is highly effective for many conditions
Answer: B
Rationale: A narrow therapeutic index means the lethal or toxic dose is close to the
therapeutic dose, requiring close monitoring.
5. Which ‘right’ of medication administration is being followed when the nurse
checks the patient’s ID band?
A. Right Dose
B. Right Documentation
C. Right Route
D. Right Patient
Answer: D
Rationale: Identifying the patient using at least two identifiers, such as name and date of
birth or ID band, ensures the ‘Right Patient’.
, 6. What is the primary action of an agonist drug?
A. To block a receptor
B. To prevent other chemicals from binding
C. To bind to a receptor and trigger a response
D. To speed up the excretion of other drugs
Answer: C
Rationale: An agonist mimics the action of endogenous substances by binding to receptors
and activating them.
7. A nurse is preparing to administer Epinephrine. Which effect should the nurse
expect?
A. Bradycardia
B. Increased heart rate
C. Bronchoconstriction
D. Decreased blood pressure
Answer: B
Rationale: Epinephrine is an adrenergic agonist that stimulates Beta-1 receptors, leading
to an increased heart rate and contractility.
8. Which vital sign must the nurse check before administering Metoprolol?
A. Respiratory rate
B. Temperature
C. Oxygen saturation
D. Heart rate
Answer: D
Rationale: Metoprolol is a beta-blocker that can cause bradycardia; the apical pulse should
be checked, and the drug held if the HR is below 60 bpm.
