NRG 200 Pharmacology for Human
Caring Nursing – Final Exam (2025/2026
Verified Version)
Section 1: Foundational Pharmacology & Nursing Process (Q1–30)
1. A nurse is preparing to administer a medication that has a high first-pass effect. Which
route would the nurse expect to avoid?
a) Intravenous
b) Sublingual
c) Oral
d) Transdermal
Rationale: Oral drugs undergo first-pass metabolism in the liver, reducing bioavailability.
Sublingual, IV, and transdermal routes bypass the liver initially.
2. The half-life of a drug is 4 hours. How much of the drug remains after 16 hours if the initial
dose was 200 mg?
a) 50 mg
b) 25 mg
c) 12.5 mg
d) 6.25 mg
Rationale: After 1 half-life (4h) → 100 mg; 8h → 50 mg; 12h → 25 mg; 16h → 12.5 mg.
3. Which statement best reflects the principle of “Human Caring” in pharmacology?
a) Medications should be given strictly on schedule regardless of patient preference.
b) The nurse considers the patient’s values, beliefs, and comfort when planning
medication administration.
c) Pharmacokinetics is irrelevant to caring practice.
d) Only the physician determines the patient’s medication response.
Rationale: Human caring integrates respect for patient individuality, values, and holistic
needs into every nursing action, including drug administration.
4. A patient is prescribed a drug that is a weak acid. In which pH environment will it be best
absorbed orally?
a) Alkaline (small intestine)
b) Acidic (stomach)
c) Neutral (blood)
d) Any pH, absorption is equal
Rationale: Weak acids are non-ionized and lipid-soluble in acidic environments (stomach),
enhancing absorption.
,5. Which laboratory value indicates impaired renal function that would require dosage
adjustment?
a) ALT 25 U/L
b) Creatinine 2.5 mg/dL
c) Hemoglobin 14 g/dL
d) Albumin 4.0 g/dL
Rationale: Elevated serum creatinine (>1.2 for women, >1.3 for men) indicates reduced GFR;
many drugs excreted renally need adjustment.
6. The nurse administers naloxone to a patient with respiratory depression. This is an
example of:
a) Agonist action
b) Antagonist action
c) Synergistic effect
d) Tolerance reversal
Rationale: Naloxone blocks opioid receptors, reversing effects of opioids—a pure antagonist.
7. A patient develops a rash, urticaria, and wheezing 10 minutes after penicillin. The nurse’s
priority action is:
a) Apply topical hydrocortisone.
b) Stop the infusion and call a rapid response.
c) Administer diphenhydramine orally.
d) Reassure the patient it’s a mild reaction.
Rationale: Wheezing and urticaria after penicillin suggest anaphylaxis; immediate airway
protection and emergency response are critical.
8. Which drug administration route has the slowest onset of action?
a) Intravenous
b) Intramuscular
c) Transdermal
d) Sublingual
Rationale: Transdermal delivery relies on slow diffusion through skin layers; onset can be
hours.
9. A nurse is teaching about medication adherence. Which statement by the patient
indicates understanding?
a) “I can stop antibiotics when I feel better.”
b) “I will take the full course of antibiotics even if symptoms improve.”
c) “I will double the next dose if I miss one.”
d) “Splitting pills is fine for any medication.”
Rationale: Completing full antibiotic course prevents resistance and recurrence.
,10. The nurse identifies a drug interaction between warfarin and St. John’s wort. What is the
expected outcome?
a) Increased bleeding risk
b) Decreased warfarin effect
c) No change
d) Increased INR
Rationale: St. John’s wort induces CYP enzymes, reducing warfarin efficacy and INR.
11. Which phase of pharmacokinetics involves movement of drug from bloodstream to
tissues?
a) Absorption
b) Distribution
c) Metabolism
d) Excretion
Rationale: Distribution = transport via circulation to target tissues/organs.
12. A patient with liver cirrhosis has reduced albumin. How does this affect drug
distribution?
a) Decreased free drug concentration
b) Increased free drug concentration
c) No effect
d) Decreased volume of distribution
Rationale: Low albumin means fewer binding sites → more free (active) drug → risk of
toxicity.
13. The nurse administers a drug known to be a CYP3A4 inhibitor. Which effect is expected
on a coadministered drug metabolized by CYP3A4?
a) Faster metabolism
b) Increased serum levels
c) Decreased half-life
d) Reduced adverse effects
Rationale: Inhibition of CYP3A4 slows metabolism → higher drug levels.
14. A patient asks why a subcutaneous injection is given in the abdomen. The nurse explains:
a) Abdominal skin is less sensitive.
b) Abdomen has faster absorption due to increased blood flow.
c) It is easier for the patient to see.
d) It prevents all injection site reactions.
Rationale: Subcutaneous abdomen has good perfusion, leading to more consistent
absorption.
, 15. Which is a common adverse effect of many antihypertensives that requires fall
precautions?
a) Tachycardia
b) Orthostatic hypotension
c) Hyperglycemia
d) Insomnia
Rationale: Orthostatic hypotension increases fall risk; nursing diagnosis “Risk for falls.”
16. A nurse uses the “Rights of Medication Administration.” Which is an additional right
emphasized in human caring?
a) Right to refuse medication after explanation
b) Right room number
c) Right to know the cost of the drug
d) Right to choose generic brand
Rationale: In human caring, respecting autonomy includes the patient’s right to refuse after
informed consent/education.
17. A patient is on digoxin and develops nausea, vomiting, and yellow vision. The nurse
anticipates:
a) Normal therapeutic effect
b) Digoxin toxicity
c) Allergic reaction
d) Drug tolerance
Rationale: Yellow/green halos, GI symptoms, bradycardia = digoxin toxicity; check digoxin
level.
18. Which food should the nurse instruct a patient taking warfarin to avoid consuming
consistently in large amounts?
a) Apples
b) Spinach
c) White rice
d) Chicken
Rationale: Spinach (vitamin K) antagonizes warfarin effect; avoid sudden changes in intake.
19. A patient receives morphine sulfate 4 mg IV. Fifteen minutes later, the respiratory rate is
8 breaths/min. The nurse should:
a) Increase oxygen to 6 L.
b) Prepare to administer naloxone.
c) Stimulate the patient to breathe.
d) Document as expected effect.
Rationale: RR <10 after opioid indicates respiratory depression; naloxone reverses opioid
effect.
Caring Nursing – Final Exam (2025/2026
Verified Version)
Section 1: Foundational Pharmacology & Nursing Process (Q1–30)
1. A nurse is preparing to administer a medication that has a high first-pass effect. Which
route would the nurse expect to avoid?
a) Intravenous
b) Sublingual
c) Oral
d) Transdermal
Rationale: Oral drugs undergo first-pass metabolism in the liver, reducing bioavailability.
Sublingual, IV, and transdermal routes bypass the liver initially.
2. The half-life of a drug is 4 hours. How much of the drug remains after 16 hours if the initial
dose was 200 mg?
a) 50 mg
b) 25 mg
c) 12.5 mg
d) 6.25 mg
Rationale: After 1 half-life (4h) → 100 mg; 8h → 50 mg; 12h → 25 mg; 16h → 12.5 mg.
3. Which statement best reflects the principle of “Human Caring” in pharmacology?
a) Medications should be given strictly on schedule regardless of patient preference.
b) The nurse considers the patient’s values, beliefs, and comfort when planning
medication administration.
c) Pharmacokinetics is irrelevant to caring practice.
d) Only the physician determines the patient’s medication response.
Rationale: Human caring integrates respect for patient individuality, values, and holistic
needs into every nursing action, including drug administration.
4. A patient is prescribed a drug that is a weak acid. In which pH environment will it be best
absorbed orally?
a) Alkaline (small intestine)
b) Acidic (stomach)
c) Neutral (blood)
d) Any pH, absorption is equal
Rationale: Weak acids are non-ionized and lipid-soluble in acidic environments (stomach),
enhancing absorption.
,5. Which laboratory value indicates impaired renal function that would require dosage
adjustment?
a) ALT 25 U/L
b) Creatinine 2.5 mg/dL
c) Hemoglobin 14 g/dL
d) Albumin 4.0 g/dL
Rationale: Elevated serum creatinine (>1.2 for women, >1.3 for men) indicates reduced GFR;
many drugs excreted renally need adjustment.
6. The nurse administers naloxone to a patient with respiratory depression. This is an
example of:
a) Agonist action
b) Antagonist action
c) Synergistic effect
d) Tolerance reversal
Rationale: Naloxone blocks opioid receptors, reversing effects of opioids—a pure antagonist.
7. A patient develops a rash, urticaria, and wheezing 10 minutes after penicillin. The nurse’s
priority action is:
a) Apply topical hydrocortisone.
b) Stop the infusion and call a rapid response.
c) Administer diphenhydramine orally.
d) Reassure the patient it’s a mild reaction.
Rationale: Wheezing and urticaria after penicillin suggest anaphylaxis; immediate airway
protection and emergency response are critical.
8. Which drug administration route has the slowest onset of action?
a) Intravenous
b) Intramuscular
c) Transdermal
d) Sublingual
Rationale: Transdermal delivery relies on slow diffusion through skin layers; onset can be
hours.
9. A nurse is teaching about medication adherence. Which statement by the patient
indicates understanding?
a) “I can stop antibiotics when I feel better.”
b) “I will take the full course of antibiotics even if symptoms improve.”
c) “I will double the next dose if I miss one.”
d) “Splitting pills is fine for any medication.”
Rationale: Completing full antibiotic course prevents resistance and recurrence.
,10. The nurse identifies a drug interaction between warfarin and St. John’s wort. What is the
expected outcome?
a) Increased bleeding risk
b) Decreased warfarin effect
c) No change
d) Increased INR
Rationale: St. John’s wort induces CYP enzymes, reducing warfarin efficacy and INR.
11. Which phase of pharmacokinetics involves movement of drug from bloodstream to
tissues?
a) Absorption
b) Distribution
c) Metabolism
d) Excretion
Rationale: Distribution = transport via circulation to target tissues/organs.
12. A patient with liver cirrhosis has reduced albumin. How does this affect drug
distribution?
a) Decreased free drug concentration
b) Increased free drug concentration
c) No effect
d) Decreased volume of distribution
Rationale: Low albumin means fewer binding sites → more free (active) drug → risk of
toxicity.
13. The nurse administers a drug known to be a CYP3A4 inhibitor. Which effect is expected
on a coadministered drug metabolized by CYP3A4?
a) Faster metabolism
b) Increased serum levels
c) Decreased half-life
d) Reduced adverse effects
Rationale: Inhibition of CYP3A4 slows metabolism → higher drug levels.
14. A patient asks why a subcutaneous injection is given in the abdomen. The nurse explains:
a) Abdominal skin is less sensitive.
b) Abdomen has faster absorption due to increased blood flow.
c) It is easier for the patient to see.
d) It prevents all injection site reactions.
Rationale: Subcutaneous abdomen has good perfusion, leading to more consistent
absorption.
, 15. Which is a common adverse effect of many antihypertensives that requires fall
precautions?
a) Tachycardia
b) Orthostatic hypotension
c) Hyperglycemia
d) Insomnia
Rationale: Orthostatic hypotension increases fall risk; nursing diagnosis “Risk for falls.”
16. A nurse uses the “Rights of Medication Administration.” Which is an additional right
emphasized in human caring?
a) Right to refuse medication after explanation
b) Right room number
c) Right to know the cost of the drug
d) Right to choose generic brand
Rationale: In human caring, respecting autonomy includes the patient’s right to refuse after
informed consent/education.
17. A patient is on digoxin and develops nausea, vomiting, and yellow vision. The nurse
anticipates:
a) Normal therapeutic effect
b) Digoxin toxicity
c) Allergic reaction
d) Drug tolerance
Rationale: Yellow/green halos, GI symptoms, bradycardia = digoxin toxicity; check digoxin
level.
18. Which food should the nurse instruct a patient taking warfarin to avoid consuming
consistently in large amounts?
a) Apples
b) Spinach
c) White rice
d) Chicken
Rationale: Spinach (vitamin K) antagonizes warfarin effect; avoid sudden changes in intake.
19. A patient receives morphine sulfate 4 mg IV. Fifteen minutes later, the respiratory rate is
8 breaths/min. The nurse should:
a) Increase oxygen to 6 L.
b) Prepare to administer naloxone.
c) Stimulate the patient to breathe.
d) Document as expected effect.
Rationale: RR <10 after opioid indicates respiratory depression; naloxone reverses opioid
effect.
