D441 Pharmacology Midterm Study Guide 2026 |WGU
1. Which pharmacokinetic process is primarily affected by the first-pass effect?
A. Metabolism
B. Distribution
C. Excretion
D. Absorption
Answer: A
Rationale: The first-pass effect refers to the metabolism of a drug by the liver after it is
absorbed from the gastrointestinal tract and before it reaches the systemic circulation.
2. A drug with a narrow therapeutic index requires which nursing action?
A. Administering the drug with food only
B. Doubling the dose if a dose is missed
C. Monitoring serum drug levels closely
D. Assessing for skin rashes only
Answer: C
Rationale: Drugs with a narrow therapeutic index have a small window between effective
and toxic doses, requiring therapeutic drug monitoring.
3. Which receptor is primarily responsible for bronchodilation when stimulated
by an agonist like Albuterol?
A. Alpha-1
B. Beta-1
C. Muscarinic
D. Beta-2
Answer: D
,Rationale: Beta-2 receptors are located in the smooth muscles of the lungs; stimulation
causes relaxation and bronchodilation.
4. What is a common side effect of ACE inhibitors like Lisinopril that often leads
to discontinuation?
A. Dry, hacking cough
B. Peripheral edema
C. Tachycardia
D. Hypokalemia
Answer: A
Rationale: ACE inhibitors prevent the breakdown of bradykinin in the lungs, which can
cause a persistent dry cough.
5. When administering Furosemide (Lasix), the nurse should prioritize
monitoring which electrolyte?
A. Sodium
B. Calcium
C. Potassium
D. Magnesium
Answer: C
Rationale: Furosemide is a loop diuretic that promotes the excretion of potassium, putting
patients at risk for hypokalemia.
6. Which medication is used as the reversal agent for an opioid overdose?
A. Flumazenil
B. Protamine sulfate
C. Acetylcysteine
D. Naloxone
Answer: D
, Rationale: Naloxone is an opioid antagonist that competes for opioid receptor sites to
reverse respiratory depression.
7. A patient on Warfarin therapy should have which lab value monitored
regularly?
A. aPTT
B. HgbA1c
C. INR
D. Serum creatinine
Answer: C
Rationale: The International Normalized Ratio (INR) is used to monitor the effectiveness
of Warfarin therapy.
8. What is the mechanism of action for NSAIDs like Ibuprofen?
A. Activation of serotonin receptors
B. Blocking of mu-opioid receptors
C. Inhibition of cyclooxygenase (COX) enzymes
D. Inhibition of leukotriene synthesis
Answer: C
Rationale: NSAIDs work by inhibiting COX-1 and COX-2 enzymes, which reduces the
production of prostaglandins.
9. A patient taking Digoxin reports seeing yellow-green halos around lights. This
is a sign of:
A. Normal drug effect
B. Digoxin toxicity
C. Hypocalcemia
D. Ocular hypertension
Answer: B
1. Which pharmacokinetic process is primarily affected by the first-pass effect?
A. Metabolism
B. Distribution
C. Excretion
D. Absorption
Answer: A
Rationale: The first-pass effect refers to the metabolism of a drug by the liver after it is
absorbed from the gastrointestinal tract and before it reaches the systemic circulation.
2. A drug with a narrow therapeutic index requires which nursing action?
A. Administering the drug with food only
B. Doubling the dose if a dose is missed
C. Monitoring serum drug levels closely
D. Assessing for skin rashes only
Answer: C
Rationale: Drugs with a narrow therapeutic index have a small window between effective
and toxic doses, requiring therapeutic drug monitoring.
3. Which receptor is primarily responsible for bronchodilation when stimulated
by an agonist like Albuterol?
A. Alpha-1
B. Beta-1
C. Muscarinic
D. Beta-2
Answer: D
,Rationale: Beta-2 receptors are located in the smooth muscles of the lungs; stimulation
causes relaxation and bronchodilation.
4. What is a common side effect of ACE inhibitors like Lisinopril that often leads
to discontinuation?
A. Dry, hacking cough
B. Peripheral edema
C. Tachycardia
D. Hypokalemia
Answer: A
Rationale: ACE inhibitors prevent the breakdown of bradykinin in the lungs, which can
cause a persistent dry cough.
5. When administering Furosemide (Lasix), the nurse should prioritize
monitoring which electrolyte?
A. Sodium
B. Calcium
C. Potassium
D. Magnesium
Answer: C
Rationale: Furosemide is a loop diuretic that promotes the excretion of potassium, putting
patients at risk for hypokalemia.
6. Which medication is used as the reversal agent for an opioid overdose?
A. Flumazenil
B. Protamine sulfate
C. Acetylcysteine
D. Naloxone
Answer: D
, Rationale: Naloxone is an opioid antagonist that competes for opioid receptor sites to
reverse respiratory depression.
7. A patient on Warfarin therapy should have which lab value monitored
regularly?
A. aPTT
B. HgbA1c
C. INR
D. Serum creatinine
Answer: C
Rationale: The International Normalized Ratio (INR) is used to monitor the effectiveness
of Warfarin therapy.
8. What is the mechanism of action for NSAIDs like Ibuprofen?
A. Activation of serotonin receptors
B. Blocking of mu-opioid receptors
C. Inhibition of cyclooxygenase (COX) enzymes
D. Inhibition of leukotriene synthesis
Answer: C
Rationale: NSAIDs work by inhibiting COX-1 and COX-2 enzymes, which reduces the
production of prostaglandins.
9. A patient taking Digoxin reports seeing yellow-green halos around lights. This
is a sign of:
A. Normal drug effect
B. Digoxin toxicity
C. Hypocalcemia
D. Ocular hypertension
Answer: B
