R ASMU SSE N U NI VE R SI TY
C O M P R E H E N S I V E E X A M I N AT I O N
NUR2407/2407 ONLY:
PHARMACOLOGY EXAM 2
(LATEST 2026/2027) RASMUSSEN
Course: NUR 2407 PHARMACOLOGY
Student Name:
Student ID:
Date:
Score:
N C L E X- R N P H A R M AC O L O G Y S TA N D A R D S | 2 0 2 0 2 7
EDITION
,NUR2407/2407 ONLY: PHARMACOLOGY EXAM 2 (LATEST 2026/2027) RASMUSSEN
NUR2407/2407 ONLY: PHARMACOLOGY EXAM 2
(LATEST 2026/2027) RASMUSSEN
Aligned with the Rasmussen University NUR 2407 Course Syllabus, NCLEX-RN Pharmacology Standards, and Nursing
Pharmacology Competencies (2026/2027 Edition)
Total: 100 Questions | 8 Sections | Multiple Choice (A-D), One Correct Answer | Suggested Time: 180 Minutes
Cognitive Levels: 20% Recall, 50% Application, 30% Analysis | Format: 75% Scenario-Based, 25% Direct Knowledge
Answers, rationale statements, and content focus are provided with each item for comprehensive examination
preparation.
Question
Section Content Focus
s
Section 1: Pharmacokinetics and Absorption, distribution, metabolism, excretion, half-life, steady
1-10 (10)
Pharmacodynamics Review state, therapeutic index, receptor theory, drug interactions
Section 2: Medication Safety and Rights of administration, high-alert medications, LASA drugs,
11-22 (12)
Administration controlled substances, routes, error prevention
Section 3: Dosage Calculations and Metric conversions, dimensional analysis, IV flow rates,
23-37 (15)
Medication Math reconstitution, weight-based and BSA dosing, rounding rules
Section 4: Cardiovascular Antihypertensives, heart failure drugs, antidysrhythmics,
38-55 (18)
Pharmacology antianginals, anticoagulants, antiplatelets, statins, thrombolytics
Section 5: Respiratory Bronchodilators, inhaled and systemic corticosteroids, leukotriene
56-67 (12)
Pharmacology modifiers, mast cell stabilizers, antihistamines, decongestants
PPIs, H2 receptor antagonists, antacids, promotility and
Section 6: Gastrointestinal and
antiemetic agents, bowel regimens, IBD drugs, diuretics, BPH 68-79 (12)
Renal Pharmacology
agents
Section 7: Endocrine Insulin therapy, oral antidiabetics, thyroid agents, corticosteroids,
80-91 (12)
Pharmacology adrenal suppression, weight-based endocrine dosing
Section 8: Neurological and Anticonvulsants, antiparkinsonian agents, antidepressants,
92-100 (9)
Psychopharmacology MAOIs, mood stabilizers, antipsychotics, benzodiazepines
Section 1: Pharmacokinetics and Pharmacodynamics Review
Questions 1 through 10 (10 questions) | Absorption, distribution, metabolism, excretion, half-life, steady state, therapeutic
index, receptor theory, drug interactions
Rasmussen University - NUR 2407 Pharmacology 1
,NUR2407/2407 ONLY: PHARMACOLOGY EXAM 2 (LATEST 2026/2027) RASMUSSEN
Q1. A nursing student asks the instructor to explain the first-pass effect. Which statement by the
student indicates a correct understanding of this pharmacokinetic principle?
A. Drugs absorbed from the stomach and small intestine bypass the liver before reaching systemic
circulation.
B. Oral medications are partially metabolized by the liver before reaching systemic circulation.
[CORRECT]
C. The first-pass effect increases the bioavailability of most oral medications.
D. Intravenous medications must circulate through the liver before they can act.
Correct Answer: B
Rationale: Per the NUR 2407 pharmacokinetics curriculum, orally administered drugs are absorbed via the
portal circulation and undergo hepatic metabolism before reaching the systemic circulation, which is the
definition of the first-pass effect. This process DECREASES the bioavailability of highly extracted oral
drugs such as nitroglycerin, which is why alternate routes are used. Option A reverses the concept, option C
states the opposite of the true effect, and option D is wrong because IV administration bypasses first-pass
metabolism entirely.
Q2. A client with advanced cirrhosis and a serum albumin level of 2.1 g/dL has been taking
phenytoin 300 mg orally every day. Which assessment finding should the nurse recognize as the
most likely consequence of this laboratory value?
A. Decreased seizure protection because an increased fraction of phenytoin is bound to protein.
B. Signs of phenytoin toxicity such as nystagmus, ataxia, and lethargy.
C. No change in drug response because phenytoin does not bind to plasma proteins.
D. Enhanced renal clearance of the unbound fraction of the drug. [CORRECT]
Correct Answer: D
Rationale: Phenytoin is approximately 90 percent protein bound, per NUR 2407 content on protein binding
and drug distribution. With hypoalbuminemia, fewer binding sites are available, so the free (active) fraction
of phenytoin rises even though the total serum level may appear therapeutic, placing the client at risk for
toxicity such as nystagmus and ataxia. Option A reverses the physiology, option C is false because phenytoin
is highly protein bound, and option D is incorrect because a higher free fraction increases pharmacologic
effect rather than simply enhancing clearance.
Q3. A newly prescribed medication has a half-life of 12 hours. The nurse should teach the client
that the drug will reach a steady-state serum concentration in approximately how long?
A. 12 to 24 hours
B. 24 to 36 hours
C. 48 to 60 hours [CORRECT]
D. 7 to 10 days
Correct Answer: C
Rationale: NUR 2407 pharmacokinetics standards state that steady state is reached after about 4 to 5
half-lives of consistent dosing. With a 12-hour half-life, steady state occurs in approximately 48 to 60 hours,
regardless of the dose size. Options A and B describe only 1 to 3 half-lives, when serum levels are still
climbing, and option D greatly exceeds the expected time frame.
Rasmussen University - NUR 2407 Pharmacology 2
, NUR2407/2407 ONLY: PHARMACOLOGY EXAM 2 (LATEST 2026/2027) RASMUSSEN
Q4. A client arrives in the emergency department following a generalized tonic-clonic seizure and
the provider orders a large initial intravenous dose of levetiracetam. When the new nurse asks why
this dose is so much larger than the maintenance dose, which response by the preceptor is most
accurate?
A. A loading dose keeps serum levels constant the same way repeated small maintenance doses do.
B. A loading dose rapidly achieves a therapeutic serum level so drug action begins immediately.
[CORRECT]
C. A loading dose decreases the risk of hypersensitivity reactions to antiseizure drugs.
D. A loading dose compensates for the slow renal clearance associated with seizures.
Correct Answer: B
Rationale: Per NUR 2407 curriculum on dose-response relationships, a loading dose is an initial higher
dose given to rapidly achieve the target plasma concentration in urgent situations such as active seizures.
Maintenance doses are then used to sustain that level. Option A describes the purpose of maintenance
dosing, option C confuses loading doses with allergy testing, and option D is incorrect because loading doses
are not adjusted for renal clearance.
Q5. Which medication requires the closest monitoring of serum drug levels because it has a narrow
therapeutic index?
A. Digoxin [CORRECT]
B. Amoxicillin
C. Metformin
D. Furosemide
Correct Answer: A
Rationale: NUR 2407 content on the therapeutic index identifies digoxin as a narrow-therapeutic-index
drug, meaning the toxic concentration is very close to the therapeutic concentration, so serum levels, apical
pulse, and potassium values must be monitored closely. Amoxicillin, metformin, and furosemide have wide
therapeutic indices and are monitored through clinical response and laboratory work such as renal function
and electrolytes rather than frequent serum drug levels.
Q6. A postoperative client is found with a respiratory rate of 6 breaths per minute, pinpoint pupils,
and a sedation score of 4 after receiving intravenous morphine 30 minutes ago. Naloxone is
administered. The nurse understands that naloxone produces its effect by which mechanism?
A. Increasing the hepatic metabolism of morphine.
B. Enhancing reuptake of morphine from the receptor sites.
C. Directly stimulating the respiratory center in the brainstem.
D. Competitively binding to opioid receptors and displacing morphine. [CORRECT]
Correct Answer: D
Rationale: NUR 2407 pharmacodynamics teaches that naloxone is a competitive opioid antagonist: it
occupies mu receptors, displaces the agonist, and reverses respiratory depression. Because its duration is
shorter than many opioids, resedation can occur and repeated dosing may be needed. Option A is incorrect
because naloxone does not alter metabolism, option B describes no known mechanism, and option C
describes a respiratory stimulant such as doxapram rather than an antagonist.
Rasmussen University - NUR 2407 Pharmacology 3
C O M P R E H E N S I V E E X A M I N AT I O N
NUR2407/2407 ONLY:
PHARMACOLOGY EXAM 2
(LATEST 2026/2027) RASMUSSEN
Course: NUR 2407 PHARMACOLOGY
Student Name:
Student ID:
Date:
Score:
N C L E X- R N P H A R M AC O L O G Y S TA N D A R D S | 2 0 2 0 2 7
EDITION
,NUR2407/2407 ONLY: PHARMACOLOGY EXAM 2 (LATEST 2026/2027) RASMUSSEN
NUR2407/2407 ONLY: PHARMACOLOGY EXAM 2
(LATEST 2026/2027) RASMUSSEN
Aligned with the Rasmussen University NUR 2407 Course Syllabus, NCLEX-RN Pharmacology Standards, and Nursing
Pharmacology Competencies (2026/2027 Edition)
Total: 100 Questions | 8 Sections | Multiple Choice (A-D), One Correct Answer | Suggested Time: 180 Minutes
Cognitive Levels: 20% Recall, 50% Application, 30% Analysis | Format: 75% Scenario-Based, 25% Direct Knowledge
Answers, rationale statements, and content focus are provided with each item for comprehensive examination
preparation.
Question
Section Content Focus
s
Section 1: Pharmacokinetics and Absorption, distribution, metabolism, excretion, half-life, steady
1-10 (10)
Pharmacodynamics Review state, therapeutic index, receptor theory, drug interactions
Section 2: Medication Safety and Rights of administration, high-alert medications, LASA drugs,
11-22 (12)
Administration controlled substances, routes, error prevention
Section 3: Dosage Calculations and Metric conversions, dimensional analysis, IV flow rates,
23-37 (15)
Medication Math reconstitution, weight-based and BSA dosing, rounding rules
Section 4: Cardiovascular Antihypertensives, heart failure drugs, antidysrhythmics,
38-55 (18)
Pharmacology antianginals, anticoagulants, antiplatelets, statins, thrombolytics
Section 5: Respiratory Bronchodilators, inhaled and systemic corticosteroids, leukotriene
56-67 (12)
Pharmacology modifiers, mast cell stabilizers, antihistamines, decongestants
PPIs, H2 receptor antagonists, antacids, promotility and
Section 6: Gastrointestinal and
antiemetic agents, bowel regimens, IBD drugs, diuretics, BPH 68-79 (12)
Renal Pharmacology
agents
Section 7: Endocrine Insulin therapy, oral antidiabetics, thyroid agents, corticosteroids,
80-91 (12)
Pharmacology adrenal suppression, weight-based endocrine dosing
Section 8: Neurological and Anticonvulsants, antiparkinsonian agents, antidepressants,
92-100 (9)
Psychopharmacology MAOIs, mood stabilizers, antipsychotics, benzodiazepines
Section 1: Pharmacokinetics and Pharmacodynamics Review
Questions 1 through 10 (10 questions) | Absorption, distribution, metabolism, excretion, half-life, steady state, therapeutic
index, receptor theory, drug interactions
Rasmussen University - NUR 2407 Pharmacology 1
,NUR2407/2407 ONLY: PHARMACOLOGY EXAM 2 (LATEST 2026/2027) RASMUSSEN
Q1. A nursing student asks the instructor to explain the first-pass effect. Which statement by the
student indicates a correct understanding of this pharmacokinetic principle?
A. Drugs absorbed from the stomach and small intestine bypass the liver before reaching systemic
circulation.
B. Oral medications are partially metabolized by the liver before reaching systemic circulation.
[CORRECT]
C. The first-pass effect increases the bioavailability of most oral medications.
D. Intravenous medications must circulate through the liver before they can act.
Correct Answer: B
Rationale: Per the NUR 2407 pharmacokinetics curriculum, orally administered drugs are absorbed via the
portal circulation and undergo hepatic metabolism before reaching the systemic circulation, which is the
definition of the first-pass effect. This process DECREASES the bioavailability of highly extracted oral
drugs such as nitroglycerin, which is why alternate routes are used. Option A reverses the concept, option C
states the opposite of the true effect, and option D is wrong because IV administration bypasses first-pass
metabolism entirely.
Q2. A client with advanced cirrhosis and a serum albumin level of 2.1 g/dL has been taking
phenytoin 300 mg orally every day. Which assessment finding should the nurse recognize as the
most likely consequence of this laboratory value?
A. Decreased seizure protection because an increased fraction of phenytoin is bound to protein.
B. Signs of phenytoin toxicity such as nystagmus, ataxia, and lethargy.
C. No change in drug response because phenytoin does not bind to plasma proteins.
D. Enhanced renal clearance of the unbound fraction of the drug. [CORRECT]
Correct Answer: D
Rationale: Phenytoin is approximately 90 percent protein bound, per NUR 2407 content on protein binding
and drug distribution. With hypoalbuminemia, fewer binding sites are available, so the free (active) fraction
of phenytoin rises even though the total serum level may appear therapeutic, placing the client at risk for
toxicity such as nystagmus and ataxia. Option A reverses the physiology, option C is false because phenytoin
is highly protein bound, and option D is incorrect because a higher free fraction increases pharmacologic
effect rather than simply enhancing clearance.
Q3. A newly prescribed medication has a half-life of 12 hours. The nurse should teach the client
that the drug will reach a steady-state serum concentration in approximately how long?
A. 12 to 24 hours
B. 24 to 36 hours
C. 48 to 60 hours [CORRECT]
D. 7 to 10 days
Correct Answer: C
Rationale: NUR 2407 pharmacokinetics standards state that steady state is reached after about 4 to 5
half-lives of consistent dosing. With a 12-hour half-life, steady state occurs in approximately 48 to 60 hours,
regardless of the dose size. Options A and B describe only 1 to 3 half-lives, when serum levels are still
climbing, and option D greatly exceeds the expected time frame.
Rasmussen University - NUR 2407 Pharmacology 2
, NUR2407/2407 ONLY: PHARMACOLOGY EXAM 2 (LATEST 2026/2027) RASMUSSEN
Q4. A client arrives in the emergency department following a generalized tonic-clonic seizure and
the provider orders a large initial intravenous dose of levetiracetam. When the new nurse asks why
this dose is so much larger than the maintenance dose, which response by the preceptor is most
accurate?
A. A loading dose keeps serum levels constant the same way repeated small maintenance doses do.
B. A loading dose rapidly achieves a therapeutic serum level so drug action begins immediately.
[CORRECT]
C. A loading dose decreases the risk of hypersensitivity reactions to antiseizure drugs.
D. A loading dose compensates for the slow renal clearance associated with seizures.
Correct Answer: B
Rationale: Per NUR 2407 curriculum on dose-response relationships, a loading dose is an initial higher
dose given to rapidly achieve the target plasma concentration in urgent situations such as active seizures.
Maintenance doses are then used to sustain that level. Option A describes the purpose of maintenance
dosing, option C confuses loading doses with allergy testing, and option D is incorrect because loading doses
are not adjusted for renal clearance.
Q5. Which medication requires the closest monitoring of serum drug levels because it has a narrow
therapeutic index?
A. Digoxin [CORRECT]
B. Amoxicillin
C. Metformin
D. Furosemide
Correct Answer: A
Rationale: NUR 2407 content on the therapeutic index identifies digoxin as a narrow-therapeutic-index
drug, meaning the toxic concentration is very close to the therapeutic concentration, so serum levels, apical
pulse, and potassium values must be monitored closely. Amoxicillin, metformin, and furosemide have wide
therapeutic indices and are monitored through clinical response and laboratory work such as renal function
and electrolytes rather than frequent serum drug levels.
Q6. A postoperative client is found with a respiratory rate of 6 breaths per minute, pinpoint pupils,
and a sedation score of 4 after receiving intravenous morphine 30 minutes ago. Naloxone is
administered. The nurse understands that naloxone produces its effect by which mechanism?
A. Increasing the hepatic metabolism of morphine.
B. Enhancing reuptake of morphine from the receptor sites.
C. Directly stimulating the respiratory center in the brainstem.
D. Competitively binding to opioid receptors and displacing morphine. [CORRECT]
Correct Answer: D
Rationale: NUR 2407 pharmacodynamics teaches that naloxone is a competitive opioid antagonist: it
occupies mu receptors, displaces the agonist, and reverses respiratory depression. Because its duration is
shorter than many opioids, resedation can occur and repeated dosing may be needed. Option A is incorrect
because naloxone does not alter metabolism, option B describes no known mechanism, and option C
describes a respiratory stimulant such as doxapram rather than an antagonist.
Rasmussen University - NUR 2407 Pharmacology 3
