COMPREHENSIVE EXAMINATION - NCLEX-RN ALIGNED
NUR2474 / NUR 2474 EXAM 1 (LATEST )
PHARMACOLOGY FOR PROFESSIONAL NURSING - RASMUSSEN
Total Questions: 100 | Sections: 8 | Time Allowed: 150 Minutes | Cognitive Levels: 20% Recall / 50% Application / 30%
Analysis
One best answer per question. Select the single best response (A-D).
Student Name: _______________________ Date: _______________________ Score: ______ / 100
Section 1: Pharmacokinetics & Pharmacodynamics
Questions 1 - 15
Q1. A 58-year-old patient with chronic stable angina asks the nurse why the provider prescribed sublingual
nitroglycerin instead of an oral tablet. The nurse's response should be based on which pharmacokinetic
principle?
A. Sublingual administration bypasses hepatic first-pass metabolism, allowing the drug to reach systemic
circulation rapidly and in higher concentration *[CORRECT]*
B. Sublingual administration produces a longer duration of action than the oral route
C. Sublingual administration is less expensive and easier for patients to self-administer than oral tablets
D. Sublingual administration prevents the drug from being destroyed by hydrochloric acid in the stomach
Correct Answer: A
Rationale: Per NUR 2474 pharmacology standards, drugs absorbed sublingually enter the systemic circulation
directly through the oral mucosa, bypassing portal circulation and hepatic first-pass metabolism, which rapidly
inactivates oral nitroglycerin. The advantage is speed and higher bioavailability, not duration, cost, or acid
protection. Options B, C, and D misidentify the rationale for choosing the sublingual route.
Q2. A nurse is reviewing pharmacokinetics with a nursing student. A newly administered drug has a half-life
of 6 hours. Approximately how long will it take for about 94 percent of a single dose to be eliminated from
the body?
A. 12 hours
B. 18 hours
C. 48 hours
D. 24 hours *[CORRECT]*
Correct Answer: D
Rationale: Approximately 94 percent of a drug is eliminated after four half-lives, so 4 times 6 hours equals 24
hours. Twelve hours is only two half-lives (75 percent eliminated), 18 hours is three half-lives (87.5 percent), and 48
hours is eight half-lives, which exceeds the requirement. This concept appears throughout the NUR 2474
curriculum and underpins NCLEX-RN questions on drug accumulation and dosing intervals.
Comprehensive Examination - 100 Questions 1
,NUR2474 Exam 1 | Pharmacology for Professional Nursing Rasmussen University - Edition
Q3. A patient taking warfarin, which is 99 percent protein bound, is newly prescribed
sulfamethoxazole-trimethoprim, a highly protein-bound antibiotic. The nurse recognizes that the primary
risk of this interaction is:
A. Displacement of warfarin from plasma proteins, increasing free warfarin levels and the risk of bleeding
*[CORRECT]*
B. Decreased warfarin metabolism, requiring an increase in the warfarin dose
C. Enhanced warfarin protein binding, lowering the therapeutic effect and causing clot formation
D. Increased renal excretion of warfarin, shortening its half-life and decreasing anticoagulation
Correct Answer: A
Rationale: When two highly protein-bound drugs are given together, the second drug displaces the first from
albumin, suddenly increasing the concentration of free, active warfarin and markedly elevating bleeding risk. The
correct nursing response is to anticipate an increased INR and monitor for bleeding. Options B, C, and D describe
mechanisms that do not occur with protein-binding displacement, a core NUR 2474 drug interaction concept.
Q4. A patient receiving digoxin has a serum digoxin level drawn 8 hours after the morning dose. The result is
2.8 ng/mL (therapeutic range 0.5 to 2.0 ng/mL). Which nursing action is most appropriate?
A. Document the finding as within the therapeutic range and continue care
B. Administer the next scheduled dose earlier to maintain the level
C. Withhold the drug and notify the provider because the level indicates potential toxicity *[CORRECT]*
D. Encourage increased fluid intake and recheck the level in 1 hour
Correct Answer: C
Rationale: A digoxin level of 2.8 ng/mL exceeds the therapeutic range of 0.5 to 2.0 ng/mL and places the patient at
risk for digoxin toxicity, so the nurse should hold the dose and notify the provider while monitoring for nausea,
visual disturbances, and dysrhythmias. Administering further doses is unsafe, and fluids alone will not correct
toxicity. NCLEX-RN standards expect the nurse to interpret serum drug levels against the therapeutic range before
administration.
Q5. A patient in the emergency department is started on an antiarrhythmic drug that has a half-life of 36
hours. The provider orders a large initial dose followed by smaller scheduled doses. The nurse explains to a
student nurse that this initial dose is ordered to:
A. Reduce the risk of allergic reactions when starting a new medication
B. Achieve a therapeutic plasma level quickly because steady state would otherwise take many days
*[CORRECT]*
C. Determine whether the patient will tolerate the maintenance dose
D. Offset the decreased renal excretion expected with this drug class
Correct Answer: B
Rationale: This is a loading dose, ordered for drugs with long half-lives so therapeutic levels are reached rapidly
instead of waiting the 4 to 5 half-lives needed to reach steady state, which here would take nearly a week. Loading
doses do not assess tolerance, prevent allergy, or compensate for renal function. NUR 2474 curriculum emphasizes
distinguishing loading doses from maintenance doses when planning care.
Comprehensive Examination - 100 Questions 2
,NUR2474 Exam 1 | Pharmacology for Professional Nursing Rasmussen University - Edition
Q6. A nursing instructor asks a student how many half-lives are generally required for a drug to reach steady
state with regular dosing. The correct response is:
A. 1 to 2 half-lives
B. 2 to 3 half-lives
C. 4 to 5 half-lives *[CORRECT]*
D. 8 to 10 half-lives
Correct Answer: C
Rationale: Steady state, in which the amount of drug eliminated equals the amount administered with each dose, is
achieved after approximately 4 to 5 half-lives regardless of dose size or interval. Fewer half-lives produce
subtherapeutic accumulation, and 8 to 10 half-lives is far longer than necessary. This recall-level fact is a foundation
of the NUR 2474 pharmacokinetics module and is frequently tested on NCLEX-RN style examinations.
Q7. A patient who received an excessive dose of morphine sulfate develops respiratory depression. The
nurse administers naloxone, which reverses the respiratory depression by:
A. Competitively blocking opioid receptors, displacing morphine from receptor sites *[CORRECT]*
B. Metabolizing morphine more rapidly through hepatic enzyme induction
C. Binding directly to morphine molecules and chemically neutralizing them in the bloodstream
D. Blocking morphine absorption from the gastrointestinal tract
Correct Answer: A
Rationale: Naloxone is a competitive opioid receptor antagonist: it occupies mu opioid receptor sites, displaces
morphine, and reverses respiratory depression without producing analgesia. It does not alter morphine metabolism,
chemically neutralize the drug, or affect absorption. Per NUR 2474 curriculum, distinguishing agonists from
antagonists by their receptor activity is an essential pharmacodynamic competency.
Q8. The nurse identifies which of the following medications as having a narrow therapeutic index, requiring
routine serum drug level monitoring?
A. Amoxicillin
B. Ibuprofen
C. Diphenhydramine
D. Lithium carbonate *[CORRECT]*
Correct Answer: D
Rationale: Lithium has a narrow therapeutic index, meaning the toxic dose is only slightly above the therapeutic
dose, so serum levels are monitored regularly, commonly targeting 0.6 to 1.2 mEq/L. Amoxicillin, ibuprofen, and
diphenhydramine have wide therapeutic indices and do not require routine serum level monitoring. NCLEX-RN
pharmacology standards expect nurses to recognize narrow therapeutic index drugs such as lithium, digoxin,
warfarin, and phenytoin as high-risk medications.
Comprehensive Examination - 100 Questions 3
, NUR2474 Exam 1 | Pharmacology for Professional Nursing Rasmussen University - Edition
Q9. A patient receives morphine 5 mg intravenously and is later switched to an oral form. The nurse explains
that the oral dose will be higher than the intravenous dose primarily because:
A. Oral drugs are more potent than intravenous drugs
B. Oral bioavailability is reduced by incomplete absorption and first-pass hepatic metabolism
*[CORRECT]*
C. Intravenous drugs bind to plasma proteins more than oral drugs
D. Oral drugs have a shorter half-life and are eliminated before acting
Correct Answer: B
Rationale: Drugs given by mouth undergo absorption across the GI tract and first-pass metabolism by the liver
before reaching systemic circulation, so their bioavailability is a fraction of the 100 percent bioavailability of
intravenous doses, requiring a higher oral dose for the same effect. Potency and protein binding differences do not
explain the dose gap. NUR 2474 curriculum highlights bioavailability as the reason many drugs cannot be
interchanged between routes.
Q10. A patient who drinks a large glass of grapefruit juice each morning takes felodipine for hypertension.
The nurse should teach the patient that grapefruit juice:
A. Accelerates felodipine metabolism, lowering the drug level and reducing blood pressure control
B. Binds felodipine in the intestine and prevents any absorption of the dose
C. Inhibits intestinal CYP3A4 enzymes, raising felodipine levels and increasing the risk of hypotension and
dizziness *[CORRECT]*
D. Has no interaction with felodipine because felodipine is eliminated renally unchanged
Correct Answer: C
Rationale: Grapefruit juice inhibits CYP3A4 enzymes in the intestinal wall and liver, decreasing first-pass
metabolism of felodipine and many other drugs, which elevates serum levels and increases adverse effects such as
hypotension and dizziness. The interaction does not lower levels, block absorption, or spare drugs that undergo
hepatic metabolism. Evidence-based patient teaching in NUR 2474 includes identifying grapefruit juice interactions
for calcium channel blockers and statins.
Q11. An 82-year-old patient with an elevated serum creatinine and decreased creatinine clearance is
prescribed a renally eliminated medication. The nurse anticipates which prescriber adjustment?
A. A lower dose or longer dosing interval to prevent drug accumulation and toxicity *[CORRECT]*
B. A higher dose to overcome resistance caused by aging kidneys
C. No change, because renal function does not affect drug elimination
D. Switching the patient to the same drug by the intravenous route at the same dose
Correct Answer: A
Rationale: Reduced renal function slows excretion, so unchanged doses accumulate and produce toxicity; the
standard evidence-based response is to reduce the dose or lengthen the interval based on creatinine clearance.
Increasing the dose would worsen accumulation, and changing the route does not address impaired elimination.
NUR 2474 and NCLEX-RN standards emphasize individualizing doses for older adults because of age-related
declines in renal clearance.
Comprehensive Examination - 100 Questions 4
NUR2474 / NUR 2474 EXAM 1 (LATEST )
PHARMACOLOGY FOR PROFESSIONAL NURSING - RASMUSSEN
Total Questions: 100 | Sections: 8 | Time Allowed: 150 Minutes | Cognitive Levels: 20% Recall / 50% Application / 30%
Analysis
One best answer per question. Select the single best response (A-D).
Student Name: _______________________ Date: _______________________ Score: ______ / 100
Section 1: Pharmacokinetics & Pharmacodynamics
Questions 1 - 15
Q1. A 58-year-old patient with chronic stable angina asks the nurse why the provider prescribed sublingual
nitroglycerin instead of an oral tablet. The nurse's response should be based on which pharmacokinetic
principle?
A. Sublingual administration bypasses hepatic first-pass metabolism, allowing the drug to reach systemic
circulation rapidly and in higher concentration *[CORRECT]*
B. Sublingual administration produces a longer duration of action than the oral route
C. Sublingual administration is less expensive and easier for patients to self-administer than oral tablets
D. Sublingual administration prevents the drug from being destroyed by hydrochloric acid in the stomach
Correct Answer: A
Rationale: Per NUR 2474 pharmacology standards, drugs absorbed sublingually enter the systemic circulation
directly through the oral mucosa, bypassing portal circulation and hepatic first-pass metabolism, which rapidly
inactivates oral nitroglycerin. The advantage is speed and higher bioavailability, not duration, cost, or acid
protection. Options B, C, and D misidentify the rationale for choosing the sublingual route.
Q2. A nurse is reviewing pharmacokinetics with a nursing student. A newly administered drug has a half-life
of 6 hours. Approximately how long will it take for about 94 percent of a single dose to be eliminated from
the body?
A. 12 hours
B. 18 hours
C. 48 hours
D. 24 hours *[CORRECT]*
Correct Answer: D
Rationale: Approximately 94 percent of a drug is eliminated after four half-lives, so 4 times 6 hours equals 24
hours. Twelve hours is only two half-lives (75 percent eliminated), 18 hours is three half-lives (87.5 percent), and 48
hours is eight half-lives, which exceeds the requirement. This concept appears throughout the NUR 2474
curriculum and underpins NCLEX-RN questions on drug accumulation and dosing intervals.
Comprehensive Examination - 100 Questions 1
,NUR2474 Exam 1 | Pharmacology for Professional Nursing Rasmussen University - Edition
Q3. A patient taking warfarin, which is 99 percent protein bound, is newly prescribed
sulfamethoxazole-trimethoprim, a highly protein-bound antibiotic. The nurse recognizes that the primary
risk of this interaction is:
A. Displacement of warfarin from plasma proteins, increasing free warfarin levels and the risk of bleeding
*[CORRECT]*
B. Decreased warfarin metabolism, requiring an increase in the warfarin dose
C. Enhanced warfarin protein binding, lowering the therapeutic effect and causing clot formation
D. Increased renal excretion of warfarin, shortening its half-life and decreasing anticoagulation
Correct Answer: A
Rationale: When two highly protein-bound drugs are given together, the second drug displaces the first from
albumin, suddenly increasing the concentration of free, active warfarin and markedly elevating bleeding risk. The
correct nursing response is to anticipate an increased INR and monitor for bleeding. Options B, C, and D describe
mechanisms that do not occur with protein-binding displacement, a core NUR 2474 drug interaction concept.
Q4. A patient receiving digoxin has a serum digoxin level drawn 8 hours after the morning dose. The result is
2.8 ng/mL (therapeutic range 0.5 to 2.0 ng/mL). Which nursing action is most appropriate?
A. Document the finding as within the therapeutic range and continue care
B. Administer the next scheduled dose earlier to maintain the level
C. Withhold the drug and notify the provider because the level indicates potential toxicity *[CORRECT]*
D. Encourage increased fluid intake and recheck the level in 1 hour
Correct Answer: C
Rationale: A digoxin level of 2.8 ng/mL exceeds the therapeutic range of 0.5 to 2.0 ng/mL and places the patient at
risk for digoxin toxicity, so the nurse should hold the dose and notify the provider while monitoring for nausea,
visual disturbances, and dysrhythmias. Administering further doses is unsafe, and fluids alone will not correct
toxicity. NCLEX-RN standards expect the nurse to interpret serum drug levels against the therapeutic range before
administration.
Q5. A patient in the emergency department is started on an antiarrhythmic drug that has a half-life of 36
hours. The provider orders a large initial dose followed by smaller scheduled doses. The nurse explains to a
student nurse that this initial dose is ordered to:
A. Reduce the risk of allergic reactions when starting a new medication
B. Achieve a therapeutic plasma level quickly because steady state would otherwise take many days
*[CORRECT]*
C. Determine whether the patient will tolerate the maintenance dose
D. Offset the decreased renal excretion expected with this drug class
Correct Answer: B
Rationale: This is a loading dose, ordered for drugs with long half-lives so therapeutic levels are reached rapidly
instead of waiting the 4 to 5 half-lives needed to reach steady state, which here would take nearly a week. Loading
doses do not assess tolerance, prevent allergy, or compensate for renal function. NUR 2474 curriculum emphasizes
distinguishing loading doses from maintenance doses when planning care.
Comprehensive Examination - 100 Questions 2
,NUR2474 Exam 1 | Pharmacology for Professional Nursing Rasmussen University - Edition
Q6. A nursing instructor asks a student how many half-lives are generally required for a drug to reach steady
state with regular dosing. The correct response is:
A. 1 to 2 half-lives
B. 2 to 3 half-lives
C. 4 to 5 half-lives *[CORRECT]*
D. 8 to 10 half-lives
Correct Answer: C
Rationale: Steady state, in which the amount of drug eliminated equals the amount administered with each dose, is
achieved after approximately 4 to 5 half-lives regardless of dose size or interval. Fewer half-lives produce
subtherapeutic accumulation, and 8 to 10 half-lives is far longer than necessary. This recall-level fact is a foundation
of the NUR 2474 pharmacokinetics module and is frequently tested on NCLEX-RN style examinations.
Q7. A patient who received an excessive dose of morphine sulfate develops respiratory depression. The
nurse administers naloxone, which reverses the respiratory depression by:
A. Competitively blocking opioid receptors, displacing morphine from receptor sites *[CORRECT]*
B. Metabolizing morphine more rapidly through hepatic enzyme induction
C. Binding directly to morphine molecules and chemically neutralizing them in the bloodstream
D. Blocking morphine absorption from the gastrointestinal tract
Correct Answer: A
Rationale: Naloxone is a competitive opioid receptor antagonist: it occupies mu opioid receptor sites, displaces
morphine, and reverses respiratory depression without producing analgesia. It does not alter morphine metabolism,
chemically neutralize the drug, or affect absorption. Per NUR 2474 curriculum, distinguishing agonists from
antagonists by their receptor activity is an essential pharmacodynamic competency.
Q8. The nurse identifies which of the following medications as having a narrow therapeutic index, requiring
routine serum drug level monitoring?
A. Amoxicillin
B. Ibuprofen
C. Diphenhydramine
D. Lithium carbonate *[CORRECT]*
Correct Answer: D
Rationale: Lithium has a narrow therapeutic index, meaning the toxic dose is only slightly above the therapeutic
dose, so serum levels are monitored regularly, commonly targeting 0.6 to 1.2 mEq/L. Amoxicillin, ibuprofen, and
diphenhydramine have wide therapeutic indices and do not require routine serum level monitoring. NCLEX-RN
pharmacology standards expect nurses to recognize narrow therapeutic index drugs such as lithium, digoxin,
warfarin, and phenytoin as high-risk medications.
Comprehensive Examination - 100 Questions 3
, NUR2474 Exam 1 | Pharmacology for Professional Nursing Rasmussen University - Edition
Q9. A patient receives morphine 5 mg intravenously and is later switched to an oral form. The nurse explains
that the oral dose will be higher than the intravenous dose primarily because:
A. Oral drugs are more potent than intravenous drugs
B. Oral bioavailability is reduced by incomplete absorption and first-pass hepatic metabolism
*[CORRECT]*
C. Intravenous drugs bind to plasma proteins more than oral drugs
D. Oral drugs have a shorter half-life and are eliminated before acting
Correct Answer: B
Rationale: Drugs given by mouth undergo absorption across the GI tract and first-pass metabolism by the liver
before reaching systemic circulation, so their bioavailability is a fraction of the 100 percent bioavailability of
intravenous doses, requiring a higher oral dose for the same effect. Potency and protein binding differences do not
explain the dose gap. NUR 2474 curriculum highlights bioavailability as the reason many drugs cannot be
interchanged between routes.
Q10. A patient who drinks a large glass of grapefruit juice each morning takes felodipine for hypertension.
The nurse should teach the patient that grapefruit juice:
A. Accelerates felodipine metabolism, lowering the drug level and reducing blood pressure control
B. Binds felodipine in the intestine and prevents any absorption of the dose
C. Inhibits intestinal CYP3A4 enzymes, raising felodipine levels and increasing the risk of hypotension and
dizziness *[CORRECT]*
D. Has no interaction with felodipine because felodipine is eliminated renally unchanged
Correct Answer: C
Rationale: Grapefruit juice inhibits CYP3A4 enzymes in the intestinal wall and liver, decreasing first-pass
metabolism of felodipine and many other drugs, which elevates serum levels and increases adverse effects such as
hypotension and dizziness. The interaction does not lower levels, block absorption, or spare drugs that undergo
hepatic metabolism. Evidence-based patient teaching in NUR 2474 includes identifying grapefruit juice interactions
for calcium channel blockers and statins.
Q11. An 82-year-old patient with an elevated serum creatinine and decreased creatinine clearance is
prescribed a renally eliminated medication. The nurse anticipates which prescriber adjustment?
A. A lower dose or longer dosing interval to prevent drug accumulation and toxicity *[CORRECT]*
B. A higher dose to overcome resistance caused by aging kidneys
C. No change, because renal function does not affect drug elimination
D. Switching the patient to the same drug by the intravenous route at the same dose
Correct Answer: A
Rationale: Reduced renal function slows excretion, so unchanged doses accumulate and produce toxicity; the
standard evidence-based response is to reduce the dose or lengthen the interval based on creatinine clearance.
Increasing the dose would worsen accumulation, and changing the route does not address impaired elimination.
NUR 2474 and NCLEX-RN standards emphasize individualizing doses for older adults because of age-related
declines in renal clearance.
Comprehensive Examination - 100 Questions 4
