NUR 2474 / NUR 2474 QUIZ 3 (LATEST )
Pharmacology for Professional Nursing — Rasmussen University
Comprehensive Examination | 75 Questions | Time Limit: 90 Minutes | Passing Score: 77%
Instructions: Select the single best answer for each question. Mark your choice by indicating the corresponding letter (A,
B, C, or D). Calculators are permitted for Section 3 (Dosage Calculations). Round all calculations to the nearest tenth unless
otherwise instructed. Each question includes a rationale explaining the correct answer and why distractors are incorrect.
Examination Structure:
Section 1: Pharmacokinetics & Pharmacodynamics (10 Qs) • Section 2: Medication Safety & Administration (10 Qs) •
Section 3: Dosage Calculations & Medication Math (10 Qs) • Section 4: Cardiovascular Pharmacology (12 Qs) • Section 5:
Respiratory Pharmacology (8 Qs) • Section 6: Gastrointestinal & Renal Pharmacology (8 Qs) • Section 7: Endocrine
Pharmacology (9 Qs) • Section 8: Neurological & Psychopharmacology (8 Qs)
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS
*Q1:* A patient is prescribed oral propranolol 40 mg. The nurse understands that oral medications undergo
first-pass metabolism in the liver, which reduces bioavailability. Which statement best describes the first-pass
effect?
A. The drug is metabolized in the kidneys before reaching systemic circulation
B. The drug is metabolized by the liver before reaching systemic circulation, reducing the active drug
available *[CORRECT]*
C. The drug is excreted unchanged in the urine
D. The drug binds to plasma proteins, reducing free drug availability
Correct Answer: B
Rationale: The first-pass effect (presystemic metabolism) occurs when a drug is absorbed from the GI tract and transported via
the portal vein to the liver, where a portion is metabolized before reaching systemic circulation, reducing bioavailability. Renal
excretion (A) happens after distribution. Urinary excretion of unchanged drug (C) is elimination, not first-pass. Protein binding
(D) affects distribution, not bioavailability. (NUR 2474 Curriculum: Pharmacokinetics — Absorption & Bioavailability;
NCLEX-RN: Pharmacology standard on drug absorption.)
*Q2:* A patient on a medication with a narrow therapeutic index (e.g., warfarin) requires close monitoring.
The nurse correctly identifies that a narrow therapeutic index means:
A. The drug has a wide margin of safety
B. There is a small difference between the therapeutic dose and the toxic dose *[CORRECT]*
C. The drug is highly protein-bound
D. The drug reaches steady state quickly
Correct Answer: B
Rationale: Therapeutic index (TI) = LD50/ED50. A narrow TI indicates a small margin between therapeutic and toxic doses,
requiring close serum drug level monitoring (e.g., warfarin, digoxin, lithium, phenytoin). A wide margin of safety (A) describes a
high TI. Protein binding (C) and steady state (D) are unrelated concepts. (NUR 2474: Drug Safety & Monitoring; NCLEX-RN
Pharmacology.)
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,NUR 2474 — Pharmacology for Professional Nursing — Quiz 3 (2026/2027) Rasmussen University
*Q3:* A patient receiving IV phenytoin (a highly protein-bound drug) develops hypoalbuminemia (serum
albumin 2.0 g/dL). The nurse anticipates which effect on the drug's pharmacologic activity?
A. Decreased free drug levels and decreased effect
B. Increased free drug levels and increased risk of toxicity *[CORRECT]*
C. No change in free drug levels
D. Increased drug metabolism by the liver
Correct Answer: B
Rationale: When albumin is low (hypoalbuminemia), fewer protein-binding sites are available, increasing the free (active)
fraction of highly protein-bound drugs like phenytoin, warfarin, and valproic acid. This raises the risk of toxicity even if total
drug levels appear within range. Option A is incorrect because free drug increases, not decreases. Option C is incorrect because
binding is altered. Option D is not the primary concern. (NUR 2474: Protein Binding & Distribution; NCLEX-RN: Laboratory
monitoring.)
*Q4:* The nurse is teaching a patient about a drug with a half-life of 12 hours. Approximately how long will it
take for the drug to reach steady state?
A. 24 hours
B. 48 hours
C. Approximately 60 hours (about 5 half-lives) *[CORRECT]*
D. 12 hours
Correct Answer: C
Rationale: Steady state is reached in approximately 4-5 half-lives. With a 12-hour half-life, steady state occurs in about 48-60
hours. Option A (24 hours = 2 half-lives) and D (12 hours = 1 half-life) are too short; option B (48 hours = 4 half-lives) is close
but 5 half-lives (~60 hours) is the more accurate standard. (NUR 2474: Half-life & Steady State; NCLEX-RN Pharmacology.)
*Q5:* A patient receives a loading dose of digoxin followed by daily maintenance doses. The nurse explains
that the loading dose is given to:
A. Maintain therapeutic blood levels over time
B. Rapidly achieve therapeutic drug levels in the plasma *[CORRECT]*
C. Reduce adverse effects of the medication
D. Prevent drug interactions
Correct Answer: B
Rationale: A loading dose is a higher initial dose given to quickly achieve therapeutic plasma concentrations (especially for drugs
with long half-lives like digoxin, amiodarone, phenytoin), followed by maintenance doses to sustain levels. Option A describes
maintenance dosing. Options C and D are not purposes of a loading dose. (NUR 2474: Loading vs Maintenance Dose;
NCLEX-RN: Drug therapy principles.)
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, NUR 2474 — Pharmacology for Professional Nursing — Quiz 3 (2026/2027) Rasmussen University
*Q6:* Two drugs act on the same receptor. Drug A produces a maximal response; Drug B produces a partial
response but blocks Drug A when given together. The nurse correctly identifies Drug B as:
A. A full agonist
B. A partial agonist *[CORRECT]*
C. A competitive antagonist
D. An inverse agonist
Correct Answer: B
Rationale: A partial agonist produces a submaximal response compared to a full agonist but acts as a competitive antagonist in the
presence of a full agonist, reducing the overall response. A full agonist (A) produces maximal response. A competitive antagonist
(C) produces no intrinsic activity. An inverse agonist (D) reduces baseline receptor activity below resting. (NUR 2474: Receptor
Theory & Agonist/Antagonist; NCLEX-RN Pharmacodynamics.)
*Q7:* A patient develops a rash, fever, and eosinophilia after starting a new antibiotic. The nurse recognizes
this as which type of adverse drug reaction?
A. Idiosyncratic reaction
B. Predictable side effect
C. Allergic (hypersensitivity) reaction *[CORRECT]*
D. Toxic reaction from overdose
Correct Answer: C
Rationale: Rash, fever, and eosinophilia are classic signs of a Type I or Type IV hypersensitivity (allergic) reaction, which is
immune-mediated and unrelated to the drug's pharmacologic action. An idiosyncratic reaction (A) is unpredictable and genetically
based. A side effect (B) is a predictable, mild secondary effect. A toxic reaction (D) results from excessive dosing. (NUR 2474:
Adverse Drug Reactions; NCLEX-RN: Safe medication administration.)
*Q8:* A drug's onset of action refers to:
A. The time it takes for the drug to reach minimum effective concentration and produce a therapeutic effect
*[CORRECT]*
B. The time it takes for the drug to reach its maximum concentration
C. The duration the drug maintains therapeutic effect
D. The time required for the drug to be eliminated from the body
Correct Answer: A
Rationale: Onset is the time it takes for a drug to reach the minimum effective concentration and produce a therapeutic response.
Peak (B) is the time to maximum concentration. Duration (C) is the length of time the drug maintains effect. Elimination half-life
(D) is the time for plasma concentration to decrease by 50%. (NUR 2474: Onset, Peak, Duration; NCLEX-RN: Pharmacokinetics.)
*Q9:* A patient who has been taking lorazepam (a benzodiazepine) for several months reports requiring
increasing doses to achieve the same sedative effect. The nurse identifies this phenomenon as:
A. Dependence
B. Tolerance *[CORRECT]*
C. Withdrawal
D. Idiosyncrasy
Correct Answer: B
Rationale: Tolerance is a decreased pharmacologic response to a drug requiring increased doses to achieve the same effect,
common with opioids, benzodiazepines, nitrates, and other CNS depressants. Dependence (A) refers to physical or psychological
need. Withdrawal (C) is the syndrome that occurs when the drug is discontinued. Idiosyncrasy (D) is an unpredictable reaction.
(NUR 2474: Tolerance vs Dependence; NCLEX-RN: Substance use & chronic therapy.)
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Pharmacology for Professional Nursing — Rasmussen University
Comprehensive Examination | 75 Questions | Time Limit: 90 Minutes | Passing Score: 77%
Instructions: Select the single best answer for each question. Mark your choice by indicating the corresponding letter (A,
B, C, or D). Calculators are permitted for Section 3 (Dosage Calculations). Round all calculations to the nearest tenth unless
otherwise instructed. Each question includes a rationale explaining the correct answer and why distractors are incorrect.
Examination Structure:
Section 1: Pharmacokinetics & Pharmacodynamics (10 Qs) • Section 2: Medication Safety & Administration (10 Qs) •
Section 3: Dosage Calculations & Medication Math (10 Qs) • Section 4: Cardiovascular Pharmacology (12 Qs) • Section 5:
Respiratory Pharmacology (8 Qs) • Section 6: Gastrointestinal & Renal Pharmacology (8 Qs) • Section 7: Endocrine
Pharmacology (9 Qs) • Section 8: Neurological & Psychopharmacology (8 Qs)
SECTION 1: PHARMACOKINETICS & PHARMACODYNAMICS
*Q1:* A patient is prescribed oral propranolol 40 mg. The nurse understands that oral medications undergo
first-pass metabolism in the liver, which reduces bioavailability. Which statement best describes the first-pass
effect?
A. The drug is metabolized in the kidneys before reaching systemic circulation
B. The drug is metabolized by the liver before reaching systemic circulation, reducing the active drug
available *[CORRECT]*
C. The drug is excreted unchanged in the urine
D. The drug binds to plasma proteins, reducing free drug availability
Correct Answer: B
Rationale: The first-pass effect (presystemic metabolism) occurs when a drug is absorbed from the GI tract and transported via
the portal vein to the liver, where a portion is metabolized before reaching systemic circulation, reducing bioavailability. Renal
excretion (A) happens after distribution. Urinary excretion of unchanged drug (C) is elimination, not first-pass. Protein binding
(D) affects distribution, not bioavailability. (NUR 2474 Curriculum: Pharmacokinetics — Absorption & Bioavailability;
NCLEX-RN: Pharmacology standard on drug absorption.)
*Q2:* A patient on a medication with a narrow therapeutic index (e.g., warfarin) requires close monitoring.
The nurse correctly identifies that a narrow therapeutic index means:
A. The drug has a wide margin of safety
B. There is a small difference between the therapeutic dose and the toxic dose *[CORRECT]*
C. The drug is highly protein-bound
D. The drug reaches steady state quickly
Correct Answer: B
Rationale: Therapeutic index (TI) = LD50/ED50. A narrow TI indicates a small margin between therapeutic and toxic doses,
requiring close serum drug level monitoring (e.g., warfarin, digoxin, lithium, phenytoin). A wide margin of safety (A) describes a
high TI. Protein binding (C) and steady state (D) are unrelated concepts. (NUR 2474: Drug Safety & Monitoring; NCLEX-RN
Pharmacology.)
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,NUR 2474 — Pharmacology for Professional Nursing — Quiz 3 (2026/2027) Rasmussen University
*Q3:* A patient receiving IV phenytoin (a highly protein-bound drug) develops hypoalbuminemia (serum
albumin 2.0 g/dL). The nurse anticipates which effect on the drug's pharmacologic activity?
A. Decreased free drug levels and decreased effect
B. Increased free drug levels and increased risk of toxicity *[CORRECT]*
C. No change in free drug levels
D. Increased drug metabolism by the liver
Correct Answer: B
Rationale: When albumin is low (hypoalbuminemia), fewer protein-binding sites are available, increasing the free (active)
fraction of highly protein-bound drugs like phenytoin, warfarin, and valproic acid. This raises the risk of toxicity even if total
drug levels appear within range. Option A is incorrect because free drug increases, not decreases. Option C is incorrect because
binding is altered. Option D is not the primary concern. (NUR 2474: Protein Binding & Distribution; NCLEX-RN: Laboratory
monitoring.)
*Q4:* The nurse is teaching a patient about a drug with a half-life of 12 hours. Approximately how long will it
take for the drug to reach steady state?
A. 24 hours
B. 48 hours
C. Approximately 60 hours (about 5 half-lives) *[CORRECT]*
D. 12 hours
Correct Answer: C
Rationale: Steady state is reached in approximately 4-5 half-lives. With a 12-hour half-life, steady state occurs in about 48-60
hours. Option A (24 hours = 2 half-lives) and D (12 hours = 1 half-life) are too short; option B (48 hours = 4 half-lives) is close
but 5 half-lives (~60 hours) is the more accurate standard. (NUR 2474: Half-life & Steady State; NCLEX-RN Pharmacology.)
*Q5:* A patient receives a loading dose of digoxin followed by daily maintenance doses. The nurse explains
that the loading dose is given to:
A. Maintain therapeutic blood levels over time
B. Rapidly achieve therapeutic drug levels in the plasma *[CORRECT]*
C. Reduce adverse effects of the medication
D. Prevent drug interactions
Correct Answer: B
Rationale: A loading dose is a higher initial dose given to quickly achieve therapeutic plasma concentrations (especially for drugs
with long half-lives like digoxin, amiodarone, phenytoin), followed by maintenance doses to sustain levels. Option A describes
maintenance dosing. Options C and D are not purposes of a loading dose. (NUR 2474: Loading vs Maintenance Dose;
NCLEX-RN: Drug therapy principles.)
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, NUR 2474 — Pharmacology for Professional Nursing — Quiz 3 (2026/2027) Rasmussen University
*Q6:* Two drugs act on the same receptor. Drug A produces a maximal response; Drug B produces a partial
response but blocks Drug A when given together. The nurse correctly identifies Drug B as:
A. A full agonist
B. A partial agonist *[CORRECT]*
C. A competitive antagonist
D. An inverse agonist
Correct Answer: B
Rationale: A partial agonist produces a submaximal response compared to a full agonist but acts as a competitive antagonist in the
presence of a full agonist, reducing the overall response. A full agonist (A) produces maximal response. A competitive antagonist
(C) produces no intrinsic activity. An inverse agonist (D) reduces baseline receptor activity below resting. (NUR 2474: Receptor
Theory & Agonist/Antagonist; NCLEX-RN Pharmacodynamics.)
*Q7:* A patient develops a rash, fever, and eosinophilia after starting a new antibiotic. The nurse recognizes
this as which type of adverse drug reaction?
A. Idiosyncratic reaction
B. Predictable side effect
C. Allergic (hypersensitivity) reaction *[CORRECT]*
D. Toxic reaction from overdose
Correct Answer: C
Rationale: Rash, fever, and eosinophilia are classic signs of a Type I or Type IV hypersensitivity (allergic) reaction, which is
immune-mediated and unrelated to the drug's pharmacologic action. An idiosyncratic reaction (A) is unpredictable and genetically
based. A side effect (B) is a predictable, mild secondary effect. A toxic reaction (D) results from excessive dosing. (NUR 2474:
Adverse Drug Reactions; NCLEX-RN: Safe medication administration.)
*Q8:* A drug's onset of action refers to:
A. The time it takes for the drug to reach minimum effective concentration and produce a therapeutic effect
*[CORRECT]*
B. The time it takes for the drug to reach its maximum concentration
C. The duration the drug maintains therapeutic effect
D. The time required for the drug to be eliminated from the body
Correct Answer: A
Rationale: Onset is the time it takes for a drug to reach the minimum effective concentration and produce a therapeutic response.
Peak (B) is the time to maximum concentration. Duration (C) is the length of time the drug maintains effect. Elimination half-life
(D) is the time for plasma concentration to decrease by 50%. (NUR 2474: Onset, Peak, Duration; NCLEX-RN: Pharmacokinetics.)
*Q9:* A patient who has been taking lorazepam (a benzodiazepine) for several months reports requiring
increasing doses to achieve the same sedative effect. The nurse identifies this phenomenon as:
A. Dependence
B. Tolerance *[CORRECT]*
C. Withdrawal
D. Idiosyncrasy
Correct Answer: B
Rationale: Tolerance is a decreased pharmacologic response to a drug requiring increased doses to achieve the same effect,
common with opioids, benzodiazepines, nitrates, and other CNS depressants. Dependence (A) refers to physical or psychological
need. Withdrawal (C) is the syndrome that occurs when the drug is discontinued. Idiosyncrasy (D) is an unpredictable reaction.
(NUR 2474: Tolerance vs Dependence; NCLEX-RN: Substance use & chronic therapy.)
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