NUR 2407 Pharmacology Final/Comprehensive Exam
2026/2027
Rasmussen University |Verified Q&A with Rationales
100% Correct | Grade A | Pass Guaranteed - A+ Graded
Section 1: Pharmacokinetics, Pharmacodynamics, and Medication Safety (Questions 1-10)
Q1: A patient with hepatic cirrhosis has a reduced ability to metabolize medications. Which
pharmacokinetic process is primarily affected?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Correct Answer: C
Rationale: [CORRECT] The liver is the primary site of drug metabolism (biotransformation),
primarily via the cytochrome P450 enzyme system. Cirrhosis impairs this function, leading to
decreased first-pass metabolism, increased bioavailability, and a prolonged half-life for heavily
metabolized drugs. Option A is incorrect because absorption primarily occurs in the GI tract.
Option B is incorrect because distribution is primarily affected by protein binding and blood
flow. Option D is incorrect because excretion is primarily a renal function.
Q2: Which of the following are included in the "Rights" of medication administration? (Select all
that apply)
A. Right route
B. Right room number
C. Right documentation
D. Right dose
,E. Right allergy status
Correct Answer: A, C, D, E
Rationale: [CORRECT] The expanded rights of medication administration ensure patient safety
by verifying the right patient (using two identifiers, not room number), right drug, right dose,
right route, right time, right documentation, and right to know (including allergies). Option B is
incorrect because using a room number is a common and dangerous medication error; two
unique patient identifiers must be used.
Q3: The nurse is caring for four patients who have all received medications within the last 30
minutes. In which order should the nurse assess these patients? (Prioritize)
A patient who received IV penicillin and is scratching their arms and has swollen lips.
A patient who received subcutaneous heparin who reports pain at the injection site.
A patient who received oral metoprolol and has a heart rate of 58 bpm.
A patient who received IV morphine and has a respiratory rate of 10 breaths/min.
A. 4, 1, 3, 2
B. 1, 4, 3, 2
C. 4, 3, 1, 2
D. 1, 3, 4, 2
Correct Answer: A
Rationale: [CORRECT] The patient with respiratory depression (10 breaths/min) from morphine
is the highest priority because it threatens airway and breathing. The second priority is the patient
with signs of anaphylaxis (swollen lips, scratching) from penicillin. The third priority is the
patient with mild bradycardia (58 bpm) from metoprolol, which requires monitoring but is not
immediately life-threatening. The lowest priority is the patient with localized injection site pain,
which is an expected, non-life-threatening effect.
Q4: A patient asks the nurse why their oral blood pressure medication is prescribed instead of the
intravenous (IV) form. Which response correctly explains the concept of the first-pass effect?
A. "The IV form bypasses the liver, so more of the drug reaches your bloodstream
compared to the oral form."
B. "The oral form is absorbed faster because it goes directly into the systemic circulation."
,C. "The IV form is broken down by stomach acids before it can work."
D. "The oral form is safer because it bypasses the liver completely."
Correct Answer: A
Rationale: [CORRECT] The first-pass effect occurs when oral drugs are absorbed in the GI tract
and transported directly to the liver via the portal vein, where a significant portion is metabolized
before reaching systemic circulation. IV drugs bypass this, resulting in higher initial
bioavailability. Option B is incorrect because oral drugs do not go directly into systemic
circulation. Option C is incorrect because IV drugs do not go through the stomach. Option D is
incorrect because oral drugs go through the liver, which is exactly why they have lower
bioavailability, not necessarily safer.
Q5: A highly protein-bound drug (98%) is administered to a patient who is malnourished and has
low albumin levels. What is the expected pharmacodynamic effect?
A. Decreased risk of toxicity
B. Increased therapeutic effect
C. Decreased half-life of the drug
D. Increased excretion of the drug
Correct Answer: B
Rationale: [CORRECT] Protein binding acts as a reservoir, keeping drugs inactive. In a
malnourished patient with low albumin, fewer binding sites are available, leaving more free
(active) drug in the bloodstream. This increases the drug's pharmacodynamic effect and increases
the risk of toxicity. Option A is incorrect because less protein binding increases toxicity risk.
Option C is incorrect because free drug is distributed to tissues, but the half-life may actually be
shortened as free drug is cleared faster, though the immediate effect is increased activity. Option
D is incorrect because excretion rates depend on the specific drug's clearance mechanisms, not
directly on protein binding.
Q6: The nurse receives an order for "Epinephrine 0.1 mg IV." The pharmacy sends a vial labeled
"Epinephrine 1:10,000 for IV use" and another labeled "Epinephrine 1:1,000 for IM use." Which
vial should the nurse use?
A. The 1:10,000 vial because it is specifically labeled for IV use and has the correct
concentration.
B. The 1:1,000 vial because 0.1 mg is easily drawn from this concentration.
, C. Either vial, as they contain the exact same medication.
D. Neither vial; the order must be clarified because epinephrine is a high-alert medication.
Correct Answer: A
Rationale: [CORRECT] Epinephrine is a high-alert medication. 1:10,000 contains 0.1 mg/mL,
which matches the dose and route. 1:1,000 contains 1 mg/mL; using this IV could lead to a
massive, fatal overdose. Option B is incorrect because drawing 0.1 mL from a 1 mg/mL vial
requires precise measurement in a syringe not designed for IV push, leading to high error risk.
Option C is incorrect because while the drug is the same, the concentrations are vastly different.
Option D is incorrect because the order is clear and safe when using the correct concentration.
Q7: A patient develops a severe, unexpected rash with blistering and sloughing of the skin after
starting a new antiepileptic drug. The nurse recognizes this as which type of adverse drug
reaction?
A. Type A (Augmented) reaction
B. Type B (Bizarre) reaction
C. Therapeutic effect
D. Idiosyncratic reaction
Correct Answer: B
Rationale: [CORRECT] Type B reactions are unpredictable, not related to the drug's
pharmacological action, and often immune-mediated or genetic. Severe skin reactions like
Stevens-Johnson Syndrome (SJS) are classic Type B reactions. Option A is incorrect because
Type A reactions are predictable dose-dependent extensions of the drug's normal pharmacology
(e.g., hypotension from an antihypertensive). Option C is incorrect because a rash is not the
intended therapeutic effect. Option D is incorrect because while SJS has a genetic component, an
idiosyncratic reaction typically refers to an abnormal, unexpected metabolic response, whereas
SJS is formally classified as a Type B hypersensitivity.
Q8: Which of the following controlled substances has the highest potential for abuse and no
accepted medical use in the United States?
A. Schedule I
B. Schedule II
C. Schedule III
2026/2027
Rasmussen University |Verified Q&A with Rationales
100% Correct | Grade A | Pass Guaranteed - A+ Graded
Section 1: Pharmacokinetics, Pharmacodynamics, and Medication Safety (Questions 1-10)
Q1: A patient with hepatic cirrhosis has a reduced ability to metabolize medications. Which
pharmacokinetic process is primarily affected?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Correct Answer: C
Rationale: [CORRECT] The liver is the primary site of drug metabolism (biotransformation),
primarily via the cytochrome P450 enzyme system. Cirrhosis impairs this function, leading to
decreased first-pass metabolism, increased bioavailability, and a prolonged half-life for heavily
metabolized drugs. Option A is incorrect because absorption primarily occurs in the GI tract.
Option B is incorrect because distribution is primarily affected by protein binding and blood
flow. Option D is incorrect because excretion is primarily a renal function.
Q2: Which of the following are included in the "Rights" of medication administration? (Select all
that apply)
A. Right route
B. Right room number
C. Right documentation
D. Right dose
,E. Right allergy status
Correct Answer: A, C, D, E
Rationale: [CORRECT] The expanded rights of medication administration ensure patient safety
by verifying the right patient (using two identifiers, not room number), right drug, right dose,
right route, right time, right documentation, and right to know (including allergies). Option B is
incorrect because using a room number is a common and dangerous medication error; two
unique patient identifiers must be used.
Q3: The nurse is caring for four patients who have all received medications within the last 30
minutes. In which order should the nurse assess these patients? (Prioritize)
A patient who received IV penicillin and is scratching their arms and has swollen lips.
A patient who received subcutaneous heparin who reports pain at the injection site.
A patient who received oral metoprolol and has a heart rate of 58 bpm.
A patient who received IV morphine and has a respiratory rate of 10 breaths/min.
A. 4, 1, 3, 2
B. 1, 4, 3, 2
C. 4, 3, 1, 2
D. 1, 3, 4, 2
Correct Answer: A
Rationale: [CORRECT] The patient with respiratory depression (10 breaths/min) from morphine
is the highest priority because it threatens airway and breathing. The second priority is the patient
with signs of anaphylaxis (swollen lips, scratching) from penicillin. The third priority is the
patient with mild bradycardia (58 bpm) from metoprolol, which requires monitoring but is not
immediately life-threatening. The lowest priority is the patient with localized injection site pain,
which is an expected, non-life-threatening effect.
Q4: A patient asks the nurse why their oral blood pressure medication is prescribed instead of the
intravenous (IV) form. Which response correctly explains the concept of the first-pass effect?
A. "The IV form bypasses the liver, so more of the drug reaches your bloodstream
compared to the oral form."
B. "The oral form is absorbed faster because it goes directly into the systemic circulation."
,C. "The IV form is broken down by stomach acids before it can work."
D. "The oral form is safer because it bypasses the liver completely."
Correct Answer: A
Rationale: [CORRECT] The first-pass effect occurs when oral drugs are absorbed in the GI tract
and transported directly to the liver via the portal vein, where a significant portion is metabolized
before reaching systemic circulation. IV drugs bypass this, resulting in higher initial
bioavailability. Option B is incorrect because oral drugs do not go directly into systemic
circulation. Option C is incorrect because IV drugs do not go through the stomach. Option D is
incorrect because oral drugs go through the liver, which is exactly why they have lower
bioavailability, not necessarily safer.
Q5: A highly protein-bound drug (98%) is administered to a patient who is malnourished and has
low albumin levels. What is the expected pharmacodynamic effect?
A. Decreased risk of toxicity
B. Increased therapeutic effect
C. Decreased half-life of the drug
D. Increased excretion of the drug
Correct Answer: B
Rationale: [CORRECT] Protein binding acts as a reservoir, keeping drugs inactive. In a
malnourished patient with low albumin, fewer binding sites are available, leaving more free
(active) drug in the bloodstream. This increases the drug's pharmacodynamic effect and increases
the risk of toxicity. Option A is incorrect because less protein binding increases toxicity risk.
Option C is incorrect because free drug is distributed to tissues, but the half-life may actually be
shortened as free drug is cleared faster, though the immediate effect is increased activity. Option
D is incorrect because excretion rates depend on the specific drug's clearance mechanisms, not
directly on protein binding.
Q6: The nurse receives an order for "Epinephrine 0.1 mg IV." The pharmacy sends a vial labeled
"Epinephrine 1:10,000 for IV use" and another labeled "Epinephrine 1:1,000 for IM use." Which
vial should the nurse use?
A. The 1:10,000 vial because it is specifically labeled for IV use and has the correct
concentration.
B. The 1:1,000 vial because 0.1 mg is easily drawn from this concentration.
, C. Either vial, as they contain the exact same medication.
D. Neither vial; the order must be clarified because epinephrine is a high-alert medication.
Correct Answer: A
Rationale: [CORRECT] Epinephrine is a high-alert medication. 1:10,000 contains 0.1 mg/mL,
which matches the dose and route. 1:1,000 contains 1 mg/mL; using this IV could lead to a
massive, fatal overdose. Option B is incorrect because drawing 0.1 mL from a 1 mg/mL vial
requires precise measurement in a syringe not designed for IV push, leading to high error risk.
Option C is incorrect because while the drug is the same, the concentrations are vastly different.
Option D is incorrect because the order is clear and safe when using the correct concentration.
Q7: A patient develops a severe, unexpected rash with blistering and sloughing of the skin after
starting a new antiepileptic drug. The nurse recognizes this as which type of adverse drug
reaction?
A. Type A (Augmented) reaction
B. Type B (Bizarre) reaction
C. Therapeutic effect
D. Idiosyncratic reaction
Correct Answer: B
Rationale: [CORRECT] Type B reactions are unpredictable, not related to the drug's
pharmacological action, and often immune-mediated or genetic. Severe skin reactions like
Stevens-Johnson Syndrome (SJS) are classic Type B reactions. Option A is incorrect because
Type A reactions are predictable dose-dependent extensions of the drug's normal pharmacology
(e.g., hypotension from an antihypertensive). Option C is incorrect because a rash is not the
intended therapeutic effect. Option D is incorrect because while SJS has a genetic component, an
idiosyncratic reaction typically refers to an abnormal, unexpected metabolic response, whereas
SJS is formally classified as a Type B hypersensitivity.
Q8: Which of the following controlled substances has the highest potential for abuse and no
accepted medical use in the United States?
A. Schedule I
B. Schedule II
C. Schedule III
