Pharmacology For Nurses: A
Pathophysiologic Approach, 7th Edition
Comprehensive Exam (Chapters 1-3,
Unit 1: Core Principles of Pharmacology
1. A nursing instructor is teaching a class on the history of pharmacology. Which student statement
indicates a need for further teaching?
a) "Early researchers often used themselves as test subjects."
b) "Modern pharmacology began in the early 1600s."
c) "Initial drugs were derived from natural sources like plants."
d) "The goal of early pharmacology was to relieve human suffering."
Correct Answer: b
Rationale: Modern pharmacology began in the early 1800s, not the 1600s . While early researchers did
use themselves as test subjects (a) and initial drugs came from nature (c) to relieve suffering (d), the
timeline for modern pharmacology is distinctly the 19th century.
2. A patient asks the nurse, "What is the difference between a generic drug and a brand-name drug?"
What is the nurse’s best response?
a) "Generic drugs are made from different ingredients than brand-name drugs."
b) "Brand-name drugs are always safer because they cost more."
c) "Generic drugs have the same active ingredient but may have different inactive fillers."
d) "You should only take brand-name drugs because generics are not FDA approved."
Correct Answer: c
Rationale: Generic drugs contain the same active ingredient and are bioequivalent to the brand-name
drug, but they may have different binders, dyes, or preservatives (inactive ingredients) . Cost does not
determine safety (b), and generics are strictly approved by the FDA (d).
3. A patient is prescribed a calcium channel blocker for hypertension. The nurse explains that this drug
works by blocking calcium channels in the heart. This explanation is an example of:
a) Therapeutic classification
,b) Pharmacologic classification
c) Clinical indication
d) Trade name identification
Correct Answer: b
Rationale: Pharmacologic classification describes how a drug works (its mechanism of action), such as
blocking calcium channels . Therapeutic classification describes what the drug treats (e.g.,
antihypertensive).
4. The nurse is reviewing a patient’s medication list and notes a discrepancy between the patient’s
verbal report and the prescription bottle. The nurse should first:
a) Assume the patient is confused and re-ask the question later.
b) Ask the patient clarifying questions and verify the generic name with the pharmacy.
c) Remove the medication from the list to avoid polypharmacy.
d) Administer the medication based on the bottle alone.
Correct Answer: b
Rationale: Medication reconciliation requires clarification. The nurse must verify the drug, dose, and
purpose by asking the patient and checking with the pharmacy or prescriber to prevent errors .
5. Which legislation was the first to require drug manufacturers to prove safety before marketing a
drug?
a) Pure Food and Drug Act (1906)
b) Food, Drug, and Cosmetic Act (1938)
c) Durham-Humphrey Amendment (1951)
d) Kefauver-Harris Amendment (1962)
Correct Answer: b
Rationale: The Food, Drug, and Cosmetic Act of 1938 was enacted after the sulfanilamide tragedy,
mandating proof of safety before marketing. The 1906 Act addressed misbranding, while the 1962
Amendment added efficacy requirements.
6. A patient with a history of seizures is switched from a brand-name antiepileptic to a generic
formulation by the pharmacy. Three days later, the patient has a breakthrough seizure. What is the
priority nursing action?
a) Document that the generic medication is ineffective for all patients.
b) Advise the patient to stop the generic and resume the brand name immediately.
c) Report the change and the seizure to the healthcare provider; monitor drug levels.
d) Double the dose of the generic medication to achieve therapeutic effects.
Correct Answer: c
Rationale: Antiepileptics are narrow therapeutic index drugs. Even small changes in bioavailability
, between brand and generic can cause toxicity or treatment failure . The nurse must report this to the
provider immediately.
7. A patient asks about an over-the-counter (OTC) cold remedy. The nurse notes the patient takes
warfarin (Coumadin). What is the nurse’s priority response?
a) "It is safe because OTC drugs are natural."
b) "You should avoid OTC drugs and just rest."
c) "Let’s check the label for interactions; some OTC drugs contain aspirin or vitamin K."
d) "You can take the OTC drug as long as you double your warfarin dose."
Correct Answer: c
Rationale: OTC drugs can interact significantly with prescription medications. Many cold remedies
contain aspirin (increases bleeding risk) or vitamin K (antagonizes warfarin) . Nurses must assess for
interactions.
8. The nurse is teaching a patient about St. John’s Wort, which the patient is taking for depression.
The nurse knows it is essential to warn the patient about potential interactions with which type of
medication?
a) Antihypertensives
b) Oral contraceptives and antidepressants
c) Topical antibiotics
d) Insulin
Correct Answer: b
Rationale: St. John’s Wort is a potent inducer of the CYP450 enzyme system. It can reduce the efficacy
of oral contraceptives (leading to breakthrough bleeding or pregnancy) and antidepressants (leading to
serotonin syndrome or reduced effect) .
Unit 2: Pharmacokinetics and Pharmacodynamics
9. A patient with liver failure is receiving a medication that is extensively metabolized by the liver. The
nurse anticipates that the patient is at risk for:
a) Reduced therapeutic effect
b) Drug toxicity and prolonged duration of action
c) Immediate allergic reaction
d) Enhanced absorption in the GI tract
Correct Answer: b
Rationale: The liver is the primary site of drug metabolism (biotransformation). If the liver is failing, the
drug cannot be broken down efficiently, leading to accumulation, toxicity, and a prolonged duration of
action.
Pathophysiologic Approach, 7th Edition
Comprehensive Exam (Chapters 1-3,
Unit 1: Core Principles of Pharmacology
1. A nursing instructor is teaching a class on the history of pharmacology. Which student statement
indicates a need for further teaching?
a) "Early researchers often used themselves as test subjects."
b) "Modern pharmacology began in the early 1600s."
c) "Initial drugs were derived from natural sources like plants."
d) "The goal of early pharmacology was to relieve human suffering."
Correct Answer: b
Rationale: Modern pharmacology began in the early 1800s, not the 1600s . While early researchers did
use themselves as test subjects (a) and initial drugs came from nature (c) to relieve suffering (d), the
timeline for modern pharmacology is distinctly the 19th century.
2. A patient asks the nurse, "What is the difference between a generic drug and a brand-name drug?"
What is the nurse’s best response?
a) "Generic drugs are made from different ingredients than brand-name drugs."
b) "Brand-name drugs are always safer because they cost more."
c) "Generic drugs have the same active ingredient but may have different inactive fillers."
d) "You should only take brand-name drugs because generics are not FDA approved."
Correct Answer: c
Rationale: Generic drugs contain the same active ingredient and are bioequivalent to the brand-name
drug, but they may have different binders, dyes, or preservatives (inactive ingredients) . Cost does not
determine safety (b), and generics are strictly approved by the FDA (d).
3. A patient is prescribed a calcium channel blocker for hypertension. The nurse explains that this drug
works by blocking calcium channels in the heart. This explanation is an example of:
a) Therapeutic classification
,b) Pharmacologic classification
c) Clinical indication
d) Trade name identification
Correct Answer: b
Rationale: Pharmacologic classification describes how a drug works (its mechanism of action), such as
blocking calcium channels . Therapeutic classification describes what the drug treats (e.g.,
antihypertensive).
4. The nurse is reviewing a patient’s medication list and notes a discrepancy between the patient’s
verbal report and the prescription bottle. The nurse should first:
a) Assume the patient is confused and re-ask the question later.
b) Ask the patient clarifying questions and verify the generic name with the pharmacy.
c) Remove the medication from the list to avoid polypharmacy.
d) Administer the medication based on the bottle alone.
Correct Answer: b
Rationale: Medication reconciliation requires clarification. The nurse must verify the drug, dose, and
purpose by asking the patient and checking with the pharmacy or prescriber to prevent errors .
5. Which legislation was the first to require drug manufacturers to prove safety before marketing a
drug?
a) Pure Food and Drug Act (1906)
b) Food, Drug, and Cosmetic Act (1938)
c) Durham-Humphrey Amendment (1951)
d) Kefauver-Harris Amendment (1962)
Correct Answer: b
Rationale: The Food, Drug, and Cosmetic Act of 1938 was enacted after the sulfanilamide tragedy,
mandating proof of safety before marketing. The 1906 Act addressed misbranding, while the 1962
Amendment added efficacy requirements.
6. A patient with a history of seizures is switched from a brand-name antiepileptic to a generic
formulation by the pharmacy. Three days later, the patient has a breakthrough seizure. What is the
priority nursing action?
a) Document that the generic medication is ineffective for all patients.
b) Advise the patient to stop the generic and resume the brand name immediately.
c) Report the change and the seizure to the healthcare provider; monitor drug levels.
d) Double the dose of the generic medication to achieve therapeutic effects.
Correct Answer: c
Rationale: Antiepileptics are narrow therapeutic index drugs. Even small changes in bioavailability
, between brand and generic can cause toxicity or treatment failure . The nurse must report this to the
provider immediately.
7. A patient asks about an over-the-counter (OTC) cold remedy. The nurse notes the patient takes
warfarin (Coumadin). What is the nurse’s priority response?
a) "It is safe because OTC drugs are natural."
b) "You should avoid OTC drugs and just rest."
c) "Let’s check the label for interactions; some OTC drugs contain aspirin or vitamin K."
d) "You can take the OTC drug as long as you double your warfarin dose."
Correct Answer: c
Rationale: OTC drugs can interact significantly with prescription medications. Many cold remedies
contain aspirin (increases bleeding risk) or vitamin K (antagonizes warfarin) . Nurses must assess for
interactions.
8. The nurse is teaching a patient about St. John’s Wort, which the patient is taking for depression.
The nurse knows it is essential to warn the patient about potential interactions with which type of
medication?
a) Antihypertensives
b) Oral contraceptives and antidepressants
c) Topical antibiotics
d) Insulin
Correct Answer: b
Rationale: St. John’s Wort is a potent inducer of the CYP450 enzyme system. It can reduce the efficacy
of oral contraceptives (leading to breakthrough bleeding or pregnancy) and antidepressants (leading to
serotonin syndrome or reduced effect) .
Unit 2: Pharmacokinetics and Pharmacodynamics
9. A patient with liver failure is receiving a medication that is extensively metabolized by the liver. The
nurse anticipates that the patient is at risk for:
a) Reduced therapeutic effect
b) Drug toxicity and prolonged duration of action
c) Immediate allergic reaction
d) Enhanced absorption in the GI tract
Correct Answer: b
Rationale: The liver is the primary site of drug metabolism (biotransformation). If the liver is failing, the
drug cannot be broken down efficiently, leading to accumulation, toxicity, and a prolonged duration of
action.
