Relias RN Pharmacology A | Relias
Learning | Academic Year 2026/2027 |
Comprehensive Competency Exam
SECTION I: PHARMACOKINETICS & PHARMACODYNAMICS (Questions 1–25)
Question 1
A nurse is administering an oral medication to a patient. The nurse understands
that oral medications have the slowest absorption rate compared to other routes.
How long does it typically take for oral medications to reach peak plasma
concentration?
A. 5–15 minutes
B. 15–30 minutes
C. 30–90 minutes
D. 90–120 minutes
Correct Answer: C
Rationale: Oral administration is the enteral route with the slowest
absorption because the drug must pass through the gastrointestinal tract and
liver before entering systemic circulation. Peak plasma concentration for most
orally administered drugs occurs between 30 and 90 minutes. Options A and B
describe onset times for rapid-acting insulin or IV medications, while option D
exceeds the typical oral absorption window.
Question 2
A patient receiving a new medication asks the nurse how the drug will reach their
body tissues. Which of the following best describes the pharmacokinetic phase of
distribution?
A. Movement of the drug from the site of administration into the bloodstream
B. Biotransformation of the drug primarily in the liver via CYP450 enzymes
C. Movement of the drug from the bloodstream to body tissues, determined by
,blood flow, plasma protein binding, and drug solubility
D. Elimination of the drug from the body primarily through the kidneys
Correct Answer: C
Rationale: Distribution is the pharmacokinetic phase in which the drug
moves from the systemic circulation into body tissues. This process is influenced
by blood flow to tissues, plasma protein binding (bound drugs cannot distribute),
and drug solubility (lipophilic drugs cross cell membranes more readily). Option A
describes absorption, option B describes metabolism, and option D describes
excretion.
Question 3
A nurse is caring for a patient with liver impairment who is prescribed a
medication metabolized by the CYP450 enzyme system. The nurse should monitor
this patient closely for which of the following?
A. Decreased therapeutic effect due to reduced absorption
B. Increased risk of drug toxicity due to impaired metabolism
C. Rapid drug excretion leading to subtherapeutic levels
D. Enhanced distribution to target tissues
Correct Answer: B
Rationale: The CYP450 enzyme system in the liver is the primary site of
drug metabolism (biotransformation). Hepatic impairment reduces metabolic
capacity, leading to drug accumulation and increased risk of toxicity. The nurse
should assess for signs of adverse effects and monitor drug levels when
applicable. Absorption and distribution are not directly affected by liver
impairment, and excretion is primarily a renal function.
Question 4
Which of the following medications has a narrow therapeutic index requiring
close serum level monitoring?
,A. Amoxicillin
B. Warfarin
C. Metformin
D. Omeprazole
Correct Answer: B
Rationale: The therapeutic index (TI) is the ratio of the lethal dose to the
effective dose. Drugs with a narrow TI, such as warfarin, digoxin, and lithium,
have a small margin between therapeutic and toxic doses, requiring close
monitoring. Amoxicillin, metformin, and omeprazole have wide therapeutic
indices and do not require routine serum drug level monitoring.
Question 5
A nurse is preparing to administer medication to a patient. Which of the following
represents the correct implementation of the Six Rights of Medication
Administration?
A. Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right
Documentation
B. Right Patient, Right Drug, Right Doctor, Right Route, Right Time, Right Room
C. Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Evaluation
D. Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Reason
Correct Answer: A
Rationale: The Six Rights of Medication Administration are: Right Patient,
Right Drug, Right Dose, Right Route, Right Time, and Right Documentation. Some
institutions expand this to include Right Reason, Right to Refuse, and Right
Education, but the core Six Rights remain as listed in option A. Options B, C, and D
contain incorrect elements.
Question 6
A patient asks the nurse why they need to take a medication on an empty
stomach. The nurse explains this is related to which pharmacokinetic principle?
, A. Distribution
B. Metabolism
C. Absorption
D. Excretion
Correct Answer: C
Rationale: Food can affect the absorption of certain medications by
altering gastric pH, delaying gastric emptying, or binding to the drug. Taking a
medication on an empty stomach ensures optimal absorption and therapeutic
effect. Distribution, metabolism, and excretion are not directly affected by the
presence of food in the stomach at the time of administration.
Question 7
A nurse is administering a medication that is highly protein-bound. The patient
has low serum albumin. What effect should the nurse anticipate?
A. Decreased drug effect due to increased binding
B. Increased drug effect due to more free drug
C. No change in drug effect
D. Increased excretion of the drug
Correct Answer: B
Rationale: When a drug is highly protein-bound, only the unbound (free)
portion is pharmacologically active. Low serum albumin means fewer binding
sites, resulting in more free drug circulating and an increased therapeutic effect—
potentially leading to toxicity. The nurse should monitor for adverse effects.
Question 8
Which of the following describes the first-pass effect?
A. The elimination of a drug through the kidneys before it reaches target tissues
B. The metabolism of a drug by the liver before it enters systemic circulation
Learning | Academic Year 2026/2027 |
Comprehensive Competency Exam
SECTION I: PHARMACOKINETICS & PHARMACODYNAMICS (Questions 1–25)
Question 1
A nurse is administering an oral medication to a patient. The nurse understands
that oral medications have the slowest absorption rate compared to other routes.
How long does it typically take for oral medications to reach peak plasma
concentration?
A. 5–15 minutes
B. 15–30 minutes
C. 30–90 minutes
D. 90–120 minutes
Correct Answer: C
Rationale: Oral administration is the enteral route with the slowest
absorption because the drug must pass through the gastrointestinal tract and
liver before entering systemic circulation. Peak plasma concentration for most
orally administered drugs occurs between 30 and 90 minutes. Options A and B
describe onset times for rapid-acting insulin or IV medications, while option D
exceeds the typical oral absorption window.
Question 2
A patient receiving a new medication asks the nurse how the drug will reach their
body tissues. Which of the following best describes the pharmacokinetic phase of
distribution?
A. Movement of the drug from the site of administration into the bloodstream
B. Biotransformation of the drug primarily in the liver via CYP450 enzymes
C. Movement of the drug from the bloodstream to body tissues, determined by
,blood flow, plasma protein binding, and drug solubility
D. Elimination of the drug from the body primarily through the kidneys
Correct Answer: C
Rationale: Distribution is the pharmacokinetic phase in which the drug
moves from the systemic circulation into body tissues. This process is influenced
by blood flow to tissues, plasma protein binding (bound drugs cannot distribute),
and drug solubility (lipophilic drugs cross cell membranes more readily). Option A
describes absorption, option B describes metabolism, and option D describes
excretion.
Question 3
A nurse is caring for a patient with liver impairment who is prescribed a
medication metabolized by the CYP450 enzyme system. The nurse should monitor
this patient closely for which of the following?
A. Decreased therapeutic effect due to reduced absorption
B. Increased risk of drug toxicity due to impaired metabolism
C. Rapid drug excretion leading to subtherapeutic levels
D. Enhanced distribution to target tissues
Correct Answer: B
Rationale: The CYP450 enzyme system in the liver is the primary site of
drug metabolism (biotransformation). Hepatic impairment reduces metabolic
capacity, leading to drug accumulation and increased risk of toxicity. The nurse
should assess for signs of adverse effects and monitor drug levels when
applicable. Absorption and distribution are not directly affected by liver
impairment, and excretion is primarily a renal function.
Question 4
Which of the following medications has a narrow therapeutic index requiring
close serum level monitoring?
,A. Amoxicillin
B. Warfarin
C. Metformin
D. Omeprazole
Correct Answer: B
Rationale: The therapeutic index (TI) is the ratio of the lethal dose to the
effective dose. Drugs with a narrow TI, such as warfarin, digoxin, and lithium,
have a small margin between therapeutic and toxic doses, requiring close
monitoring. Amoxicillin, metformin, and omeprazole have wide therapeutic
indices and do not require routine serum drug level monitoring.
Question 5
A nurse is preparing to administer medication to a patient. Which of the following
represents the correct implementation of the Six Rights of Medication
Administration?
A. Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right
Documentation
B. Right Patient, Right Drug, Right Doctor, Right Route, Right Time, Right Room
C. Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Evaluation
D. Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Reason
Correct Answer: A
Rationale: The Six Rights of Medication Administration are: Right Patient,
Right Drug, Right Dose, Right Route, Right Time, and Right Documentation. Some
institutions expand this to include Right Reason, Right to Refuse, and Right
Education, but the core Six Rights remain as listed in option A. Options B, C, and D
contain incorrect elements.
Question 6
A patient asks the nurse why they need to take a medication on an empty
stomach. The nurse explains this is related to which pharmacokinetic principle?
, A. Distribution
B. Metabolism
C. Absorption
D. Excretion
Correct Answer: C
Rationale: Food can affect the absorption of certain medications by
altering gastric pH, delaying gastric emptying, or binding to the drug. Taking a
medication on an empty stomach ensures optimal absorption and therapeutic
effect. Distribution, metabolism, and excretion are not directly affected by the
presence of food in the stomach at the time of administration.
Question 7
A nurse is administering a medication that is highly protein-bound. The patient
has low serum albumin. What effect should the nurse anticipate?
A. Decreased drug effect due to increased binding
B. Increased drug effect due to more free drug
C. No change in drug effect
D. Increased excretion of the drug
Correct Answer: B
Rationale: When a drug is highly protein-bound, only the unbound (free)
portion is pharmacologically active. Low serum albumin means fewer binding
sites, resulting in more free drug circulating and an increased therapeutic effect—
potentially leading to toxicity. The nurse should monitor for adverse effects.
Question 8
Which of the following describes the first-pass effect?
A. The elimination of a drug through the kidneys before it reaches target tissues
B. The metabolism of a drug by the liver before it enters systemic circulation
