NUR210 / NUR 210 Exam 2 - Principles of Pharmacology Galen College of Nursing |
NUR210 / NUR 210 Exam 2 (Latest )
Principles of Pharmacology
Galen College of Nursing - Galen Tested Questions with Revised Correct Answers
A+ Guarantee | 50 Comprehensive Questions with Detailed Rationales
Instructions: This examination consists of 50 multiple-choice questions across six content areas. Each question has ONE
correct answer. Select the best response based on pharmacologic principles, medication safety standards, and
evidence-based nursing practice. Detailed rationales and correct answers are provided immediately following each question
for review and self-assessment. Cognitive distribution: 30% recall, 50% application, 20% analysis. Question style: 70%
scenario-based, 25% direct recall, 5% clinical analysis.
Section 1: Pharmacokinetics (Absorption, Distribution, Metabolism, Excretion)
Q1: A 62-year-old patient with acute angina is prescribed nitroglycerin sublingual (SL) tablets. The nurse
understands that the primary pharmacokinetic advantage of the sublingual route over the oral route is:
A. Improved taste and patient compliance with the medication regimen
B. Avoidance of the first-pass hepatic metabolism, allowing rapid systemic absorption
C. Decreased risk of gastrointestinal irritation and gastric ulcer formation
D. Prolonged duration of action due to slower absorption through mucosal tissue
Correct Answer: B
Rationale:
Sublingual administration allows the drug to be absorbed directly into the systemic circulation through the highly
vascular oral mucosa, completely bypassing the portal circulation and the liver's first-pass metabolic effect. This is
pharmacokinetically critical for nitroglycerin because oral nitroglycerin is over 90% metabolized by the liver before
reaching systemic circulation, rendering it essentially inactive. Option A is incorrect because taste is not a
pharmacokinetic factor. Option C confuses adverse-effect profiles with absorption pharmacokinetics. Option D is
incorrect because SL absorption is characteristically rapid (1-3 minutes) and short-acting, not prolonged - which is
exactly why SL nitroglycerin is used for acute angina episodes rather than prophylaxis.
Q2: A patient is started on a medication with a half-life of 12 hours. Assuming no loading dose is given,
approximately how long will it take for the drug to reach steady-state therapeutic levels?
A. 12 hours (one half-life)
B. 24 hours (two half-lives)
C. 48 to 60 hours (four to five half-lives)
D. 72 to 96 hours (six to eight half-lives)
Correct Answer: C
Rationale:
Steady state is achieved when the rate of drug administration equals the rate of drug elimination, creating a plateau in
plasma concentration. Pharmacokinetically, this plateau is reached after approximately 4 to 5 half-lives regardless of
the dose or dosing interval. For a drug with a 12-hour half-life, 4 to 5 half-lives equals 48 to 60 hours. Option A is
incorrect because at one half-life only 50% of steady state is achieved. Options B and D reflect common student
calculation errors. If a therapeutic effect is needed before steady state is reached, a loading dose can be administered to
rapidly achieve therapeutic plasma concentrations, which is the clinical rationale for loading doses of digoxin,
warfarin, and amiodarone.
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,NUR210 / NUR 210 Exam 2 - Principles of Pharmacology Galen College of Nursing |
Q3: A patient taking warfarin (highly protein-bound, 99%) is newly prescribed
sulfamethoxazole-trimethoprim (TMP-SMX), which also binds extensively to plasma proteins. The nurse
anticipates that this interaction will most likely result in:
A. Decreased therapeutic effect of warfarin due to enhanced hepatic metabolism
B. Increased free warfarin levels, raising the risk of bleeding
C. Reduced absorption of warfarin from the gastrointestinal tract
D. Accelerated renal excretion of warfarin, requiring dose increase
Correct Answer: B
Rationale:
Warfarin is approximately 99% bound to plasma albumin, meaning only 1% is free and pharmacologically active.
When a second highly protein-bound drug like TMP-SMX is introduced, it competes for albumin binding sites and
displaces warfarin into the free (active) form. Even small shifts in protein binding produce dramatic increases in free
drug concentration with narrow-therapeutic-index agents. Option A is incorrect because the interaction is
pharmacokinetic displacement, not enzyme induction. Option C is incorrect because absorption is unaffected in this
interaction. Option D is incorrect because renal excretion does not increase; in fact, the displaced free drug may
redistribute into tissues. The nurse must monitor INR closely and assess for bruising, bleeding gums, melena, and
hematuria.
Q4: A patient with epilepsy has been taking phenytoin for seizure control. The provider adds rifampin for a
newly diagnosed tuberculosis infection. The nurse should monitor closely for which anticipated
pharmacokinetic effect?
A. Increased phenytoin levels due to CYP450 enzyme inhibition by rifampin
B. Decreased phenytoin levels due to CYP450 enzyme induction by rifampin
C. No change in phenytoin levels because rifampin does not interact with CYP enzymes
D. Increased phenytoin toxicity due to competition for renal tubular secretion
Correct Answer: B
Rationale:
Rifampin is a classic CYP450 enzyme inducer, along with phenytoin, carbamazepine, and phenobarbital. Enzyme
induction causes the liver to synthesize more CYP450 enzyme protein, accelerating the metabolism of concurrently
administered drugs metabolized by the same pathway. This results in decreased plasma levels and potential therapeutic
failure of phenytoin, which may trigger breakthrough seizures. Option A describes enzyme inhibition (seen with
cimetidine, erythromycin, ketoconazole, and grapefruit juice). Option C is incorrect because rifampin is one of the
most potent inducers known. Option D is incorrect because the interaction is hepatic, not renal. The nurse should
anticipate the need for increased phenytoin dosing and monitor serum phenytoin levels (therapeutic range 10-20
mcg/mL).
Revised Correct Answers - A+ Guarantee Page 2
, NUR210 / NUR 210 Exam 2 - Principles of Pharmacology Galen College of Nursing |
Q5: A nurse is teaching a patient who was newly prescribed simvastatin for hyperlipidemia. Which dietary
instruction is most important to include in the discharge teaching based on the drug's pharmacokinetic
profile?
A. Increase intake of green leafy vegetables to enhance the drug's cholesterol-lowering effect
B. Avoid grapefruit juice because it inhibits CYP3A4 and can increase simvastatin levels
C. Take the medication with a high-fat meal to improve absorption
D. Limit fluid intake to prevent rapid renal excretion of the medication
Correct Answer: B
Rationale:
Grapefruit juice irreversibly inhibits intestinal CYP3A4, the primary enzyme responsible for simvastatin metabolism.
This inhibition can increase simvastatin plasma concentrations up to several-fold, dramatically elevating the risk of
myopathy and rhabdomyolysis. The FDA specifically recommends avoiding grapefruit juice while taking simvastatin.
Option A is incorrect because green leafy vegetables interact with warfarin (vitamin K), not statins. Option C is
incorrect because simvastatin absorption is not improved by high-fat meals; in fact, food can reduce bioavailability.
Option D is incorrect because statins are metabolized hepatically, not renally excreted in significant amounts. Other
CYP3A4 substrates affected by grapefruit include certain calcium channel blockers and benzodiazepines.
Q6: A patient in the intensive care unit receives 500 mg of medication X intravenously. The same patient later
receives 500 mg of medication X orally and only 350 mg reaches systemic circulation. What is the approximate
oral bioavailability of this medication?
A. 35 percent
B. 50 percent
C. 70 percent
D. 100 percent
Correct Answer: C
Rationale:
Bioavailability is defined as the fraction of administered drug that reaches systemic circulation in an active form.
Intravenous administration is by definition 100% bioavailable because the drug enters directly into the bloodstream.
Oral bioavailability is calculated as (amount reaching systemic circulation / amount administered) x 100. Therefore,
350 mg / 500 mg x 100 = 70%. Option A incorrectly equates the 350 mg directly with a percentage. Option B is a
miscalculation. Option D is incorrect because only IV dosing yields 100% bioavailability. Reduced oral bioavailability
is typically due to incomplete absorption and/or first-pass hepatic metabolism, which is why some drugs like
nitroglycerin and lidocaine cannot be effectively administered orally.
Revised Correct Answers - A+ Guarantee Page 3
NUR210 / NUR 210 Exam 2 (Latest )
Principles of Pharmacology
Galen College of Nursing - Galen Tested Questions with Revised Correct Answers
A+ Guarantee | 50 Comprehensive Questions with Detailed Rationales
Instructions: This examination consists of 50 multiple-choice questions across six content areas. Each question has ONE
correct answer. Select the best response based on pharmacologic principles, medication safety standards, and
evidence-based nursing practice. Detailed rationales and correct answers are provided immediately following each question
for review and self-assessment. Cognitive distribution: 30% recall, 50% application, 20% analysis. Question style: 70%
scenario-based, 25% direct recall, 5% clinical analysis.
Section 1: Pharmacokinetics (Absorption, Distribution, Metabolism, Excretion)
Q1: A 62-year-old patient with acute angina is prescribed nitroglycerin sublingual (SL) tablets. The nurse
understands that the primary pharmacokinetic advantage of the sublingual route over the oral route is:
A. Improved taste and patient compliance with the medication regimen
B. Avoidance of the first-pass hepatic metabolism, allowing rapid systemic absorption
C. Decreased risk of gastrointestinal irritation and gastric ulcer formation
D. Prolonged duration of action due to slower absorption through mucosal tissue
Correct Answer: B
Rationale:
Sublingual administration allows the drug to be absorbed directly into the systemic circulation through the highly
vascular oral mucosa, completely bypassing the portal circulation and the liver's first-pass metabolic effect. This is
pharmacokinetically critical for nitroglycerin because oral nitroglycerin is over 90% metabolized by the liver before
reaching systemic circulation, rendering it essentially inactive. Option A is incorrect because taste is not a
pharmacokinetic factor. Option C confuses adverse-effect profiles with absorption pharmacokinetics. Option D is
incorrect because SL absorption is characteristically rapid (1-3 minutes) and short-acting, not prolonged - which is
exactly why SL nitroglycerin is used for acute angina episodes rather than prophylaxis.
Q2: A patient is started on a medication with a half-life of 12 hours. Assuming no loading dose is given,
approximately how long will it take for the drug to reach steady-state therapeutic levels?
A. 12 hours (one half-life)
B. 24 hours (two half-lives)
C. 48 to 60 hours (four to five half-lives)
D. 72 to 96 hours (six to eight half-lives)
Correct Answer: C
Rationale:
Steady state is achieved when the rate of drug administration equals the rate of drug elimination, creating a plateau in
plasma concentration. Pharmacokinetically, this plateau is reached after approximately 4 to 5 half-lives regardless of
the dose or dosing interval. For a drug with a 12-hour half-life, 4 to 5 half-lives equals 48 to 60 hours. Option A is
incorrect because at one half-life only 50% of steady state is achieved. Options B and D reflect common student
calculation errors. If a therapeutic effect is needed before steady state is reached, a loading dose can be administered to
rapidly achieve therapeutic plasma concentrations, which is the clinical rationale for loading doses of digoxin,
warfarin, and amiodarone.
Revised Correct Answers - A+ Guarantee Page 1
,NUR210 / NUR 210 Exam 2 - Principles of Pharmacology Galen College of Nursing |
Q3: A patient taking warfarin (highly protein-bound, 99%) is newly prescribed
sulfamethoxazole-trimethoprim (TMP-SMX), which also binds extensively to plasma proteins. The nurse
anticipates that this interaction will most likely result in:
A. Decreased therapeutic effect of warfarin due to enhanced hepatic metabolism
B. Increased free warfarin levels, raising the risk of bleeding
C. Reduced absorption of warfarin from the gastrointestinal tract
D. Accelerated renal excretion of warfarin, requiring dose increase
Correct Answer: B
Rationale:
Warfarin is approximately 99% bound to plasma albumin, meaning only 1% is free and pharmacologically active.
When a second highly protein-bound drug like TMP-SMX is introduced, it competes for albumin binding sites and
displaces warfarin into the free (active) form. Even small shifts in protein binding produce dramatic increases in free
drug concentration with narrow-therapeutic-index agents. Option A is incorrect because the interaction is
pharmacokinetic displacement, not enzyme induction. Option C is incorrect because absorption is unaffected in this
interaction. Option D is incorrect because renal excretion does not increase; in fact, the displaced free drug may
redistribute into tissues. The nurse must monitor INR closely and assess for bruising, bleeding gums, melena, and
hematuria.
Q4: A patient with epilepsy has been taking phenytoin for seizure control. The provider adds rifampin for a
newly diagnosed tuberculosis infection. The nurse should monitor closely for which anticipated
pharmacokinetic effect?
A. Increased phenytoin levels due to CYP450 enzyme inhibition by rifampin
B. Decreased phenytoin levels due to CYP450 enzyme induction by rifampin
C. No change in phenytoin levels because rifampin does not interact with CYP enzymes
D. Increased phenytoin toxicity due to competition for renal tubular secretion
Correct Answer: B
Rationale:
Rifampin is a classic CYP450 enzyme inducer, along with phenytoin, carbamazepine, and phenobarbital. Enzyme
induction causes the liver to synthesize more CYP450 enzyme protein, accelerating the metabolism of concurrently
administered drugs metabolized by the same pathway. This results in decreased plasma levels and potential therapeutic
failure of phenytoin, which may trigger breakthrough seizures. Option A describes enzyme inhibition (seen with
cimetidine, erythromycin, ketoconazole, and grapefruit juice). Option C is incorrect because rifampin is one of the
most potent inducers known. Option D is incorrect because the interaction is hepatic, not renal. The nurse should
anticipate the need for increased phenytoin dosing and monitor serum phenytoin levels (therapeutic range 10-20
mcg/mL).
Revised Correct Answers - A+ Guarantee Page 2
, NUR210 / NUR 210 Exam 2 - Principles of Pharmacology Galen College of Nursing |
Q5: A nurse is teaching a patient who was newly prescribed simvastatin for hyperlipidemia. Which dietary
instruction is most important to include in the discharge teaching based on the drug's pharmacokinetic
profile?
A. Increase intake of green leafy vegetables to enhance the drug's cholesterol-lowering effect
B. Avoid grapefruit juice because it inhibits CYP3A4 and can increase simvastatin levels
C. Take the medication with a high-fat meal to improve absorption
D. Limit fluid intake to prevent rapid renal excretion of the medication
Correct Answer: B
Rationale:
Grapefruit juice irreversibly inhibits intestinal CYP3A4, the primary enzyme responsible for simvastatin metabolism.
This inhibition can increase simvastatin plasma concentrations up to several-fold, dramatically elevating the risk of
myopathy and rhabdomyolysis. The FDA specifically recommends avoiding grapefruit juice while taking simvastatin.
Option A is incorrect because green leafy vegetables interact with warfarin (vitamin K), not statins. Option C is
incorrect because simvastatin absorption is not improved by high-fat meals; in fact, food can reduce bioavailability.
Option D is incorrect because statins are metabolized hepatically, not renally excreted in significant amounts. Other
CYP3A4 substrates affected by grapefruit include certain calcium channel blockers and benzodiazepines.
Q6: A patient in the intensive care unit receives 500 mg of medication X intravenously. The same patient later
receives 500 mg of medication X orally and only 350 mg reaches systemic circulation. What is the approximate
oral bioavailability of this medication?
A. 35 percent
B. 50 percent
C. 70 percent
D. 100 percent
Correct Answer: C
Rationale:
Bioavailability is defined as the fraction of administered drug that reaches systemic circulation in an active form.
Intravenous administration is by definition 100% bioavailable because the drug enters directly into the bloodstream.
Oral bioavailability is calculated as (amount reaching systemic circulation / amount administered) x 100. Therefore,
350 mg / 500 mg x 100 = 70%. Option A incorrectly equates the 350 mg directly with a percentage. Option B is a
miscalculation. Option D is incorrect because only IV dosing yields 100% bioavailability. Reduced oral bioavailability
is typically due to incomplete absorption and/or first-pass hepatic metabolism, which is why some drugs like
nitroglycerin and lidocaine cannot be effectively administered orally.
Revised Correct Answers - A+ Guarantee Page 3
