,NR 293 Exam 1 Pharmacology for Nursing Questions & Answers |
2026/2027 Chamberlain
1.** A nurse is preparing to administer an oral medication. Which statement
by the nurse indicates an understanding of the first-pass effect?
A) "The drug is absorbed directly into the systemic circulation without any
changes."
B) "A portion of the drug is metabolized in the liver before it reaches
systemic circulation."
C) "The drug bypasses the stomach and is absorbed in the small intestine."
D) "The kidneys excrete a large amount of the drug before it reaches the
target site."
**Correct Answer:** B) "A portion of the drug is metabolized in the liver
before it reaches systemic circulation."
**Rationale:** The first-pass effect refers to the hepatic metabolism of an
orally administered drug before it enters the systemic circulation, reducing
the amount of active drug available. Drugs absorbed from the GI tract travel
via the portal vein to the liver, where they may be extensively metabolized
before reaching systemic circulation.
---
**2.** A client asks why a medication is given sublingually rather than orally.
The nurse's best response is that sublingual administration:
A) Avoids first-pass metabolism
B) Requires a larger dose
C) Causes more gastrointestinal upset
,D) Is less expensive
**Correct Answer:** A) Avoids first-pass metabolism
**Rationale:** Sublingual administration allows the drug to dissolve under
the tongue and be absorbed directly into the bloodstream, bypassing the
liver and first-pass metabolism. This route provides rapid onset and avoids
destruction of the drug by gastric acids and hepatic enzymes.
---
**3.** A nurse is reviewing a drug that has a half-life of 6 hours.
Approximately how long will it take for 97% of the drug to be eliminated from
the body?
A) 6 hours
B) 12 hours
C) 24–30 hours
D) 48 hours
**Correct Answer:** C) 24–30 hours
**Rationale:** It takes approximately 4–5 half-lives for a drug to be
eliminated from the body. For a half-life of 6 hours, 4–5 half-lives equals 24–
30 hours. After each half-life, 50% of the remaining drug is eliminated, so
after 4 half-lives, approximately 93.75% is eliminated; after 5 half-lives,
approximately 96.875% is eliminated.
---
, **4.** A client with malnutrition has low albumin levels. The nurse should
monitor for increased effects of drugs that are:
A) Highly protein-bound
B) Weakly acidic
C) Water-soluble
D) Metabolized by the liver
**Correct Answer:** A) Highly protein-bound
**Rationale:** Low albumin reduces protein binding, leading to a higher free
(active) drug concentration and increased risk of toxicity for highly protein-
bound drugs. Only unbound (free) drug is pharmacologically active;
decreased protein binding increases the fraction of free drug available to
exert effects.
---
**5.** A nurse is caring for a client with end-stage renal disease. The nurse
should anticipate that drugs excreted by the kidneys will require:
A) An increased dose
B) A decreased dose or longer dosing interval
C) No change in dosing
D) A different route of administration
**Correct Answer:** B) A decreased dose or longer dosing interval
2026/2027 Chamberlain
1.** A nurse is preparing to administer an oral medication. Which statement
by the nurse indicates an understanding of the first-pass effect?
A) "The drug is absorbed directly into the systemic circulation without any
changes."
B) "A portion of the drug is metabolized in the liver before it reaches
systemic circulation."
C) "The drug bypasses the stomach and is absorbed in the small intestine."
D) "The kidneys excrete a large amount of the drug before it reaches the
target site."
**Correct Answer:** B) "A portion of the drug is metabolized in the liver
before it reaches systemic circulation."
**Rationale:** The first-pass effect refers to the hepatic metabolism of an
orally administered drug before it enters the systemic circulation, reducing
the amount of active drug available. Drugs absorbed from the GI tract travel
via the portal vein to the liver, where they may be extensively metabolized
before reaching systemic circulation.
---
**2.** A client asks why a medication is given sublingually rather than orally.
The nurse's best response is that sublingual administration:
A) Avoids first-pass metabolism
B) Requires a larger dose
C) Causes more gastrointestinal upset
,D) Is less expensive
**Correct Answer:** A) Avoids first-pass metabolism
**Rationale:** Sublingual administration allows the drug to dissolve under
the tongue and be absorbed directly into the bloodstream, bypassing the
liver and first-pass metabolism. This route provides rapid onset and avoids
destruction of the drug by gastric acids and hepatic enzymes.
---
**3.** A nurse is reviewing a drug that has a half-life of 6 hours.
Approximately how long will it take for 97% of the drug to be eliminated from
the body?
A) 6 hours
B) 12 hours
C) 24–30 hours
D) 48 hours
**Correct Answer:** C) 24–30 hours
**Rationale:** It takes approximately 4–5 half-lives for a drug to be
eliminated from the body. For a half-life of 6 hours, 4–5 half-lives equals 24–
30 hours. After each half-life, 50% of the remaining drug is eliminated, so
after 4 half-lives, approximately 93.75% is eliminated; after 5 half-lives,
approximately 96.875% is eliminated.
---
, **4.** A client with malnutrition has low albumin levels. The nurse should
monitor for increased effects of drugs that are:
A) Highly protein-bound
B) Weakly acidic
C) Water-soluble
D) Metabolized by the liver
**Correct Answer:** A) Highly protein-bound
**Rationale:** Low albumin reduces protein binding, leading to a higher free
(active) drug concentration and increased risk of toxicity for highly protein-
bound drugs. Only unbound (free) drug is pharmacologically active;
decreased protein binding increases the fraction of free drug available to
exert effects.
---
**5.** A nurse is caring for a client with end-stage renal disease. The nurse
should anticipate that drugs excreted by the kidneys will require:
A) An increased dose
B) A decreased dose or longer dosing interval
C) No change in dosing
D) A different route of administration
**Correct Answer:** B) A decreased dose or longer dosing interval
