PHARMACOLOGY FINAL EXAM (HS MISC) – ECPI
UNIVERSITY NEWPORT NEWS | 2026/2027 QUESTIONS
AND VERIFIED ANSWERS STUDY GUIDE.
DOMAIN 1: PHARMACOLOGY PRINCIPLES & MEDICATION SAFETY
(Questions 1-10)
Q1. A nurse is preparing to administer digoxin 0.25 mg PO to a 72-year-old patient. Which actions
demonstrate adherence to the rights of medication administration? (Select all that apply)
• A. Verify the patient's name and date of birth against the MAR [CORRECT]
• B. Check the medication label three times before administration [CORRECT]
• C. Confirm the patient's apical heart rate is 58 bpm before giving the dose
• D. Document the medication immediately after the patient takes it [CORRECT]
• E. Explain to the patient that digoxin is for blood pressure control
Correct Answers: A, B, D
Rationale: The rights of medication administration include right patient (two identifiers), right drug
(three label checks), right dose, right route, right time, right documentation, right reason, and right
response. Checking apical pulse is a drug-specific safety measure, not one of the standard rights (though
heart rate <60 bpm requires holding digoxin). Documentation must be immediate. The nurse must
verify the correct indication (heart failure/AFib, not hypertension).
Q2. [Dosage Calculation - Oral Liquid] The provider orders amoxicillin 500 mg PO every 8 hours for a
patient with pneumonia. Available is amoxicillin oral suspension 250 mg/5 mL. How many mL should
the nurse administer per dose? (Round to the nearest whole number)
Correct Answer: 10 mL [CORRECT]
Rationale: Using dimensional analysis: (500 mg / 1) × (5 mL / 250 mg) = 2500/250 = 10 mL. The nurse
should administer 10 mL per dose to deliver the ordered 500 mg. Always verify the concentration on the
label and use a calibrated oral syringe for accurate measurement.
,Q3. A nurse is reviewing pharmacokinetics with a nursing student. Which statement by the student
indicates understanding of drug metabolism?
• A. "Most drugs are metabolized in the kidneys and excreted through the liver."
• B. "The liver is the primary site of drug metabolism through the cytochrome P450 enzyme
system." [CORRECT]
• C. "Drug metabolism always converts active drugs into inactive compounds."
• D. "First-pass metabolism increases the bioavailability of oral medications."
Correct Answer: B
Rationale: The liver is the primary organ for drug metabolism, primarily via the cytochrome P450
enzyme system. The kidneys are responsible for excretion, not metabolism. Some drugs are converted to
active metabolites (prodrugs). First-pass metabolism decreases bioavailability of oral drugs by
metabolizing them before they reach systemic circulation.
Q4. A nurse is caring for a pediatric patient weighing 22 kg. The provider orders acetaminophen 15
mg/kg PO every 6 hours PRN for pain. What is the maximum safe single dose for this child? (Round to
the nearest whole number)
Correct Answer: 330 mg [CORRECT]
Rationale: Calculation: 22 kg × 15 mg/kg = 330 mg per dose. The pediatric safe dose range for
acetaminophen is 10-15 mg/kg every 4-6 hours, not to exceed 75 mg/kg/day (max 4,000 mg/day). For
this 22-kg child, the maximum daily dose is 1,650 mg/day (22 kg × 75 mg/kg), allowing up to 5 doses in
24 hours if needed.
Q5. A nurse is reviewing a medication order for warfarin 5 mg PO daily. The patient's INR is 3.8
(therapeutic range 2.0-3.0). Which pharmacodynamic principle explains why the nurse should hold the
dose and notify the provider?
, • A. The drug acts as an agonist at vitamin K receptors
• B. The therapeutic index is narrow, increasing risk of toxicity [CORRECT]
• C. The drug has a synergistic interaction with platelets
• D. The medication demonstrates antagonistic effects against heparin
Correct Answer: B
Rationale: Warfarin has a narrow therapeutic index (small margin between therapeutic and toxic
effects), requiring careful monitoring of INR. An INR of 3.8 exceeds the therapeutic range of 2.0-3.0,
indicating increased bleeding risk. Warfarin is a vitamin K antagonist (not agonist). Holding the dose
and notifying the provider prevents hemorrhagic complications.
Q6. A pregnant patient at 8 weeks gestation asks the nurse about medication safety. Which statement by
the nurse is correct regarding pregnancy risk categories?
• A. "Category A drugs have demonstrated fetal risk in controlled studies."
• B. "Category X drugs have benefits that outweigh potential risks in pregnancy."
• C. "Category D drugs should be avoided unless absolutely necessary due to demonstrated fetal
risk." [CORRECT]
• D. "All antibiotics are safe during pregnancy and carry no risk categories."
Correct Answer: C
Rationale: Category D medications have demonstrated fetal risk but may be used if benefits outweigh
risks (e.g., antiepileptics, ACE inhibitors). Category A drugs are safest with no fetal risk. Category X drugs
(warfarin, isotretinoin, methotrexate) are contraindicated in pregnancy due to clear fetal abnormalities.
Many antibiotics have specific pregnancy categories—not all are safe.
Q7. A nurse discovers a medication error where a patient received hydralazine 20 mg IV instead of the
ordered hydroxyzine 25 mg IM. Which action should the nurse take first?
• A. Complete an incident report before notifying the provider
• B. Assess the patient for adverse effects and notify the provider immediately [CORRECT]
, • C. Wait to see if the patient develops symptoms before taking action
• D. Administer the correct medication immediately without documentation
Correct Answer: B
Rationale: Patient safety is the priority. The nurse must immediately assess the patient for hypotension,
tachycardia, or other adverse effects from the wrong medication, then notify the provider. Incident
reports are completed after patient stabilization. Never delay assessment or withhold information. The
correct medication should only be given after provider notification and patient evaluation.
Q8. A nurse is caring for an 84-year-old patient with multiple comorbidities. Which factors should the
nurse consider regarding geriatric pharmacokinetics? (Select all that apply)
• A. Decreased gastric acid production may reduce drug absorption [CORRECT]
• B. Increased body fat percentage affects distribution of lipid-soluble drugs [CORRECT]
• C. Hepatic blood flow increases with age, enhancing drug metabolism
• D. Decreased glomerular filtration rate prolongs drug elimination [CORRECT]
• E. Older adults require higher doses of all medications due to tolerance
Correct Answers: A, B, D
Rationale: Geriatric patients experience decreased gastric acid (reducing absorption of some drugs),
increased body fat (prolonging effects of lipid-soluble drugs like diazepam), decreased hepatic blood
flow and enzyme activity (slowing metabolism), and decreased GFR (prolonging elimination). These
changes typically require lower starting doses with slower titration, not higher doses.
Q9. A nurse is preparing to administer two medications via IV push that are incompatible when mixed.
Which type of drug interaction is occurring?
• A. Synergistic interaction
• B. Antagonistic interaction
• C. Chemical incompatibility [CORRECT]
• D. Pharmacokinetic interaction
UNIVERSITY NEWPORT NEWS | 2026/2027 QUESTIONS
AND VERIFIED ANSWERS STUDY GUIDE.
DOMAIN 1: PHARMACOLOGY PRINCIPLES & MEDICATION SAFETY
(Questions 1-10)
Q1. A nurse is preparing to administer digoxin 0.25 mg PO to a 72-year-old patient. Which actions
demonstrate adherence to the rights of medication administration? (Select all that apply)
• A. Verify the patient's name and date of birth against the MAR [CORRECT]
• B. Check the medication label three times before administration [CORRECT]
• C. Confirm the patient's apical heart rate is 58 bpm before giving the dose
• D. Document the medication immediately after the patient takes it [CORRECT]
• E. Explain to the patient that digoxin is for blood pressure control
Correct Answers: A, B, D
Rationale: The rights of medication administration include right patient (two identifiers), right drug
(three label checks), right dose, right route, right time, right documentation, right reason, and right
response. Checking apical pulse is a drug-specific safety measure, not one of the standard rights (though
heart rate <60 bpm requires holding digoxin). Documentation must be immediate. The nurse must
verify the correct indication (heart failure/AFib, not hypertension).
Q2. [Dosage Calculation - Oral Liquid] The provider orders amoxicillin 500 mg PO every 8 hours for a
patient with pneumonia. Available is amoxicillin oral suspension 250 mg/5 mL. How many mL should
the nurse administer per dose? (Round to the nearest whole number)
Correct Answer: 10 mL [CORRECT]
Rationale: Using dimensional analysis: (500 mg / 1) × (5 mL / 250 mg) = 2500/250 = 10 mL. The nurse
should administer 10 mL per dose to deliver the ordered 500 mg. Always verify the concentration on the
label and use a calibrated oral syringe for accurate measurement.
,Q3. A nurse is reviewing pharmacokinetics with a nursing student. Which statement by the student
indicates understanding of drug metabolism?
• A. "Most drugs are metabolized in the kidneys and excreted through the liver."
• B. "The liver is the primary site of drug metabolism through the cytochrome P450 enzyme
system." [CORRECT]
• C. "Drug metabolism always converts active drugs into inactive compounds."
• D. "First-pass metabolism increases the bioavailability of oral medications."
Correct Answer: B
Rationale: The liver is the primary organ for drug metabolism, primarily via the cytochrome P450
enzyme system. The kidneys are responsible for excretion, not metabolism. Some drugs are converted to
active metabolites (prodrugs). First-pass metabolism decreases bioavailability of oral drugs by
metabolizing them before they reach systemic circulation.
Q4. A nurse is caring for a pediatric patient weighing 22 kg. The provider orders acetaminophen 15
mg/kg PO every 6 hours PRN for pain. What is the maximum safe single dose for this child? (Round to
the nearest whole number)
Correct Answer: 330 mg [CORRECT]
Rationale: Calculation: 22 kg × 15 mg/kg = 330 mg per dose. The pediatric safe dose range for
acetaminophen is 10-15 mg/kg every 4-6 hours, not to exceed 75 mg/kg/day (max 4,000 mg/day). For
this 22-kg child, the maximum daily dose is 1,650 mg/day (22 kg × 75 mg/kg), allowing up to 5 doses in
24 hours if needed.
Q5. A nurse is reviewing a medication order for warfarin 5 mg PO daily. The patient's INR is 3.8
(therapeutic range 2.0-3.0). Which pharmacodynamic principle explains why the nurse should hold the
dose and notify the provider?
, • A. The drug acts as an agonist at vitamin K receptors
• B. The therapeutic index is narrow, increasing risk of toxicity [CORRECT]
• C. The drug has a synergistic interaction with platelets
• D. The medication demonstrates antagonistic effects against heparin
Correct Answer: B
Rationale: Warfarin has a narrow therapeutic index (small margin between therapeutic and toxic
effects), requiring careful monitoring of INR. An INR of 3.8 exceeds the therapeutic range of 2.0-3.0,
indicating increased bleeding risk. Warfarin is a vitamin K antagonist (not agonist). Holding the dose
and notifying the provider prevents hemorrhagic complications.
Q6. A pregnant patient at 8 weeks gestation asks the nurse about medication safety. Which statement by
the nurse is correct regarding pregnancy risk categories?
• A. "Category A drugs have demonstrated fetal risk in controlled studies."
• B. "Category X drugs have benefits that outweigh potential risks in pregnancy."
• C. "Category D drugs should be avoided unless absolutely necessary due to demonstrated fetal
risk." [CORRECT]
• D. "All antibiotics are safe during pregnancy and carry no risk categories."
Correct Answer: C
Rationale: Category D medications have demonstrated fetal risk but may be used if benefits outweigh
risks (e.g., antiepileptics, ACE inhibitors). Category A drugs are safest with no fetal risk. Category X drugs
(warfarin, isotretinoin, methotrexate) are contraindicated in pregnancy due to clear fetal abnormalities.
Many antibiotics have specific pregnancy categories—not all are safe.
Q7. A nurse discovers a medication error where a patient received hydralazine 20 mg IV instead of the
ordered hydroxyzine 25 mg IM. Which action should the nurse take first?
• A. Complete an incident report before notifying the provider
• B. Assess the patient for adverse effects and notify the provider immediately [CORRECT]
, • C. Wait to see if the patient develops symptoms before taking action
• D. Administer the correct medication immediately without documentation
Correct Answer: B
Rationale: Patient safety is the priority. The nurse must immediately assess the patient for hypotension,
tachycardia, or other adverse effects from the wrong medication, then notify the provider. Incident
reports are completed after patient stabilization. Never delay assessment or withhold information. The
correct medication should only be given after provider notification and patient evaluation.
Q8. A nurse is caring for an 84-year-old patient with multiple comorbidities. Which factors should the
nurse consider regarding geriatric pharmacokinetics? (Select all that apply)
• A. Decreased gastric acid production may reduce drug absorption [CORRECT]
• B. Increased body fat percentage affects distribution of lipid-soluble drugs [CORRECT]
• C. Hepatic blood flow increases with age, enhancing drug metabolism
• D. Decreased glomerular filtration rate prolongs drug elimination [CORRECT]
• E. Older adults require higher doses of all medications due to tolerance
Correct Answers: A, B, D
Rationale: Geriatric patients experience decreased gastric acid (reducing absorption of some drugs),
increased body fat (prolonging effects of lipid-soluble drugs like diazepam), decreased hepatic blood
flow and enzyme activity (slowing metabolism), and decreased GFR (prolonging elimination). These
changes typically require lower starting doses with slower titration, not higher doses.
Q9. A nurse is preparing to administer two medications via IV push that are incompatible when mixed.
Which type of drug interaction is occurring?
• A. Synergistic interaction
• B. Antagonistic interaction
• C. Chemical incompatibility [CORRECT]
• D. Pharmacokinetic interaction
