1
NSG 3180 Galen College of Nursing — Unit 1 Exam
Introduction to Pharmacology and Communication/Teamwork
| 2026/2027 Edition
DOMAIN 1: PHARMACOKINETICS (10 Questions)
Absorption (3 Questions)
Question 1 (Multiple Choice) A patient is prescribed propranolol 40 mg PO daily for hypertension.
The nurse understands that this medication undergoes significant first-pass metabolism. What
percentage of an oral dose is typically metabolized by the liver before reaching systemic
circulation?
A. 5-15%
B. 20-30%
C. 50-70%
D. 90-95%
[CORRECT: C]
Rationale: Propranolol undergoes extensive first-pass hepatic metabolism, with approximately
50-70% of an oral dose being metabolized by the liver before reaching systemic circulation. This
significantly reduces bioavailability and explains why oral doses are typically higher than IV
doses for equivalent therapeutic effects. Nurses must recognize that first-pass metabolism affects
drug efficacy and may require dose adjustments when switching routes of administration.
1|P age
, 2
Question 2 (Select-All-That-Apply) Which factors can decrease the rate of gastrointestinal
absorption of oral medications? (Select all that apply)
A. Increased gastric motility
B. Presence of food in the stomach
C. High gastric pH (alkaline environment)
D. Co-administration with antacids
E. Enteric-coated tablet formulation
F. Increased splanchnic blood flow
[CORRECT: B, C, D, E]
Rationale: Food in the stomach (B) can delay gastric emptying and reduce absorption rate. High
gastric pH/alkaline environment (C) affects ionization of weak acids. Antacids (D) alter pH and
may chelate certain drugs. Enteric coatings (E) are specifically designed to resist gastric acid and
delay absorption until the drug reaches the intestine. Increased gastric motility (A) and
increased splanchnic blood flow (F) would typically enhance, not decrease, absorption rates.
Question 3 (Scenario-Based Application) A 72-year-old patient with achlorhydria (absence of
gastric acid) is prescribed an enteric-coated aspirin tablet. The nurse anticipates which clinical
outcome?
A. Rapid absorption in the stomach with increased risk of GI bleeding
B. Delayed absorption until intestinal pH triggers dissolution
C. No absorption due to lack of acid for drug ionization
D. Immediate release causing gastric mucosal irritation
[CORRECT: B]
Rationale: Enteric-coated formulations are designed to resist dissolution in acidic gastric pH and
dissolve in the more alkaline intestinal environment (pH > 5.5). Achlorhydria does not prevent
absorption; rather, the coating ensures the drug passes through the stomach intact and releases
in the intestine, protecting the gastric mucosa from direct aspirin irritation while maintaining
therapeutic absorption.
2|P age
, 3
Distribution (2 Questions)
Question 4 (Multiple Choice) A patient with severe hypoalbuminemia (albumin 2.1 g/dL) is
receiving warfarin therapy. The nurse should prioritize monitoring for which complication?
A. Decreased therapeutic effect due to reduced drug binding
B. Increased risk of bleeding due to elevated free drug concentration
C. Prolonged half-life from enhanced protein binding
D. Reduced volume of distribution causing drug accumulation
[CORRECT: B]
Rationale: Warfarin is highly protein-bound (99%), primarily to albumin. In severe
hypoalbuminemia, fewer binding sites are available, resulting in increased free (unbound) drug
concentration. Since only free drug is pharmacologically active, the patient is at significantly
increased risk for bleeding complications even with "therapeutic" total drug levels. This
demonstrates the critical relationship between protein binding, free drug availability, and
toxicity risk.
Question 5 (Multiple Choice) The volume of distribution (Vd) for digoxin is approximately 500 L
in a 70-kg adult. This large Vd indicates which pharmacokinetic characteristic?
A. The drug is primarily confined to the plasma compartment
B. Extensive tissue binding and distribution throughout body tissues
C. Rapid renal elimination preventing tissue accumulation
D. High protein binding limiting distribution to vascular space
[CORRECT: B]
Rationale: A volume of distribution (Vd) of 500 L far exceeds total body water (~42 L) and even
total body volume, indicating extensive distribution into tissues beyond the vascular
compartment. Digoxin binds to skeletal and cardiac muscle Na+/K+-ATPase receptors, resulting
3|P age
, 4
in high tissue concentrations relative to plasma. This extensive tissue distribution has clinical
implications: loading doses are required to saturate tissue binding sites, and toxicity may persist
long after plasma levels decline due to tissue redistribution.
Metabolism/Biotransformation (3 Questions)
Question 6 (Multiple Choice) A drug has a half-life of 12 hours. If a patient receives a single 400
mg dose, approximately how much drug remains after 36 hours?
A. 25 mg
B. 50 mg
C. 100 mg
D. 200 mg
[CORRECT: B]
Rationale: After one half-life (12 hours), 50% remains (200 mg). After two half-lives (24 hours),
25% remains (100 mg). After three half-lives (36 hours), 12.5% remains (50 mg). Understanding
half-life is essential for determining dosing intervals and predicting when steady-state
concentrations will be achieved (typically 4-5 half-lives). For drugs with a 12-hour half-life,
steady state is reached in approximately 2.5-3 days of regular administration.
Question 7 (True/False) A patient with cirrhosis who takes a medication metabolized by CYP3A4
enzymes will likely require a decreased dose because liver dysfunction impairs Phase I
biotransformation reactions.
A. True
B. False
[CORRECT: A]
Rationale: True. Cirrhosis causes hepatocellular damage and reduced functional hepatic mass,
4|P age
NSG 3180 Galen College of Nursing — Unit 1 Exam
Introduction to Pharmacology and Communication/Teamwork
| 2026/2027 Edition
DOMAIN 1: PHARMACOKINETICS (10 Questions)
Absorption (3 Questions)
Question 1 (Multiple Choice) A patient is prescribed propranolol 40 mg PO daily for hypertension.
The nurse understands that this medication undergoes significant first-pass metabolism. What
percentage of an oral dose is typically metabolized by the liver before reaching systemic
circulation?
A. 5-15%
B. 20-30%
C. 50-70%
D. 90-95%
[CORRECT: C]
Rationale: Propranolol undergoes extensive first-pass hepatic metabolism, with approximately
50-70% of an oral dose being metabolized by the liver before reaching systemic circulation. This
significantly reduces bioavailability and explains why oral doses are typically higher than IV
doses for equivalent therapeutic effects. Nurses must recognize that first-pass metabolism affects
drug efficacy and may require dose adjustments when switching routes of administration.
1|P age
, 2
Question 2 (Select-All-That-Apply) Which factors can decrease the rate of gastrointestinal
absorption of oral medications? (Select all that apply)
A. Increased gastric motility
B. Presence of food in the stomach
C. High gastric pH (alkaline environment)
D. Co-administration with antacids
E. Enteric-coated tablet formulation
F. Increased splanchnic blood flow
[CORRECT: B, C, D, E]
Rationale: Food in the stomach (B) can delay gastric emptying and reduce absorption rate. High
gastric pH/alkaline environment (C) affects ionization of weak acids. Antacids (D) alter pH and
may chelate certain drugs. Enteric coatings (E) are specifically designed to resist gastric acid and
delay absorption until the drug reaches the intestine. Increased gastric motility (A) and
increased splanchnic blood flow (F) would typically enhance, not decrease, absorption rates.
Question 3 (Scenario-Based Application) A 72-year-old patient with achlorhydria (absence of
gastric acid) is prescribed an enteric-coated aspirin tablet. The nurse anticipates which clinical
outcome?
A. Rapid absorption in the stomach with increased risk of GI bleeding
B. Delayed absorption until intestinal pH triggers dissolution
C. No absorption due to lack of acid for drug ionization
D. Immediate release causing gastric mucosal irritation
[CORRECT: B]
Rationale: Enteric-coated formulations are designed to resist dissolution in acidic gastric pH and
dissolve in the more alkaline intestinal environment (pH > 5.5). Achlorhydria does not prevent
absorption; rather, the coating ensures the drug passes through the stomach intact and releases
in the intestine, protecting the gastric mucosa from direct aspirin irritation while maintaining
therapeutic absorption.
2|P age
, 3
Distribution (2 Questions)
Question 4 (Multiple Choice) A patient with severe hypoalbuminemia (albumin 2.1 g/dL) is
receiving warfarin therapy. The nurse should prioritize monitoring for which complication?
A. Decreased therapeutic effect due to reduced drug binding
B. Increased risk of bleeding due to elevated free drug concentration
C. Prolonged half-life from enhanced protein binding
D. Reduced volume of distribution causing drug accumulation
[CORRECT: B]
Rationale: Warfarin is highly protein-bound (99%), primarily to albumin. In severe
hypoalbuminemia, fewer binding sites are available, resulting in increased free (unbound) drug
concentration. Since only free drug is pharmacologically active, the patient is at significantly
increased risk for bleeding complications even with "therapeutic" total drug levels. This
demonstrates the critical relationship between protein binding, free drug availability, and
toxicity risk.
Question 5 (Multiple Choice) The volume of distribution (Vd) for digoxin is approximately 500 L
in a 70-kg adult. This large Vd indicates which pharmacokinetic characteristic?
A. The drug is primarily confined to the plasma compartment
B. Extensive tissue binding and distribution throughout body tissues
C. Rapid renal elimination preventing tissue accumulation
D. High protein binding limiting distribution to vascular space
[CORRECT: B]
Rationale: A volume of distribution (Vd) of 500 L far exceeds total body water (~42 L) and even
total body volume, indicating extensive distribution into tissues beyond the vascular
compartment. Digoxin binds to skeletal and cardiac muscle Na+/K+-ATPase receptors, resulting
3|P age
, 4
in high tissue concentrations relative to plasma. This extensive tissue distribution has clinical
implications: loading doses are required to saturate tissue binding sites, and toxicity may persist
long after plasma levels decline due to tissue redistribution.
Metabolism/Biotransformation (3 Questions)
Question 6 (Multiple Choice) A drug has a half-life of 12 hours. If a patient receives a single 400
mg dose, approximately how much drug remains after 36 hours?
A. 25 mg
B. 50 mg
C. 100 mg
D. 200 mg
[CORRECT: B]
Rationale: After one half-life (12 hours), 50% remains (200 mg). After two half-lives (24 hours),
25% remains (100 mg). After three half-lives (36 hours), 12.5% remains (50 mg). Understanding
half-life is essential for determining dosing intervals and predicting when steady-state
concentrations will be achieved (typically 4-5 half-lives). For drugs with a 12-hour half-life,
steady state is reached in approximately 2.5-3 days of regular administration.
Question 7 (True/False) A patient with cirrhosis who takes a medication metabolized by CYP3A4
enzymes will likely require a decreased dose because liver dysfunction impairs Phase I
biotransformation reactions.
A. True
B. False
[CORRECT: A]
Rationale: True. Cirrhosis causes hepatocellular damage and reduced functional hepatic mass,
4|P age
