NRG 200 | PHARMACOLOGY FOR HUMAN CARING NURSING
NRG 200 Pharmacology
Midterm Exam
Official Practice Exam | 2026/2027 Edition
Questions: 75 Minutes: 90 Passing Score: 80% Recertification: Annual
Table of Contents
Section 1: Pharmacokinetics & Pharmacodynamics (15 Questions)
Section 2: Medication Administration & Safety (15 Questions)
Section 3: Central Nervous System Drugs (15 Questions)
Section 4: Cardiovascular & Renal Drugs (15 Questions)
Section 5: Anti-Infective & Immunosuppressive Drugs (15 Questions)
Instructions
This practice exam contains 75 multiple-choice questions divided into 5 sections. You have 90 minutes to complete the
entire exam. Select the single best answer for each question. A score of 80% or higher (60 out of 75) is required to
pass. Review each rationale carefully to strengthen your understanding of pharmacology principles, medication safety,
and clinical application for the NRG 200 midterm.
NRG 200 Pharmacology Midterm -- 2026/2027 | Passing Score: 80% | Page 1 of 40
,Section | Pharmacokinetics & Pharmacodynamics -- 2026/2027
Q1 Question 1 of 75
A 68-year-old patient with cirrhosis of the liver is prescribed a medication that is highly
metabolized by the liver. The nurse anticipates that the prescribed dose will need to be
adjusted in which direction and for which reason?
A. Increased because the damaged liver metabolizes drugs more rapidly
B. Unchanged because liver disease does not affect drug metabolism
C. Decreased because impaired hepatic metabolism reduces first-pass elimination
D. Increased because cirrhosis increases protein binding of the drug
Correct Answer: C
Rationale:
Cirrhosis impairs hepatic enzyme function and reduces first-pass metabolism, leading to higher drug
bioavailability and prolonged half-life, requiring a dose decrease. The liver does not metabolize drugs
faster when diseased, and liver disease typically decreases protein binding rather than increasing it.
Q2 Question 2 of 75
A nurse administers an intravenous medication to a patient and observes that the drug
reaches its peak plasma concentration within 30 seconds. This rapid onset is primarily due
to which pharmacokinetic factor?
A. The intravenous route bypasses absorption barriers and delivers drug directly into
circulation
B. The drug has a very long half-life that accelerates distribution
C. First-pass metabolism is enhanced by the IV route
D. The drug binds extensively to plasma proteins
Correct Answer: A
Rationale:
The intravenous route bypasses the absorption phase entirely, delivering the drug directly into the
bloodstream for immediate systemic availability. A long half-life slows elimination rather than
accelerating onset, first-pass metabolism applies to oral drugs, and protein binding reduces free drug
availability.
NRG 200 Pharmacology Midterm -- 2026/2027 | Passing Score: 80% | Page 2 of 40
,Q3 Question 3 of 75
A patient taking warfarin has a new prescription for an antibiotic that is a potent
cytochrome P450 enzyme inhibitor. The nurse should monitor for which expected effect on
warfarin levels and action?
A. Decreased warfarin effect because the antibiotic competes for receptor sites
B. Increased warfarin effect because inhibited metabolism raises plasma warfarin levels
C. No change because warfarin is not metabolized by cytochrome P450 enzymes
D. Decreased warfarin effect because enzyme inhibition accelerates warfarin elimination
Correct Answer: B
Rationale:
Cytochrome P450 enzyme inhibitors slow the metabolism of drugs like warfarin that are substrates of
those enzymes, leading to higher plasma levels and increased anticoagulant effect. Warfarin is
primarily metabolized by CYP2C9, and enzyme inhibition reduces rather than accelerates elimination.
Q4 Question 4 of 75
A nurse is teaching a patient about a drug that has a narrow therapeutic index. The nurse
explains that a drug with a narrow therapeutic index has which characteristic?
A. The margin between a therapeutic dose and a toxic dose is very small
B. The drug is effective at very low doses with no risk of toxicity
C. The drug has a very wide range of safe dosing
D. The drug requires no laboratory monitoring
Correct Answer: A
Rationale:
A narrow therapeutic index means the difference between a therapeutic dose and a toxic dose is
small, requiring careful dosing and monitoring. Drugs with narrow therapeutic indices, such as digoxin
and lithium, are not effective at very low doses without toxicity risk and require close laboratory
monitoring.
NRG 200 Pharmacology Midterm -- 2026/2027 | Passing Score: 80% | Page 3 of 40
, Q5 Question 5 of 75
A pharmacist explains that a drug has a bioavailability of 25 percent when taken orally.
This value means that which proportion of the administered dose reaches systemic
circulation?
A. 25 percent of the oral dose reaches systemic circulation unchanged
B. 75 percent of the oral dose reaches systemic circulation unchanged
C. The drug is 25 percent protein-bound in the plasma
D. 25 percent of the drug is excreted unchanged in the urine
Correct Answer: A
Rationale:
Bioavailability refers to the fraction of an administered dose that reaches systemic circulation in its
active form. A bioavailability of 25 percent means only one-quarter of the oral dose reaches systemic
circulation, while 75 percent is lost during absorption and first-pass metabolism. It does not refer to
protein binding or renal excretion.
Q6 Question 6 of 75
A nurse administers a loading dose of an antiarrhythmic medication to a patient in acute
distress. The primary rationale for using a loading dose is to achieve which
pharmacokinetic goal?
A. Avoid the need for maintenance doses entirely
B. Reduce the total amount of drug the patient will receive
C. Prevent drug accumulation in fatty tissues
D. Rapidly achieve therapeutic plasma drug concentration before steady state
Correct Answer: D
Rationale:
A loading dose rapidly achieves therapeutic plasma concentration by filling the volume of distribution
before steady state is reached, which could otherwise take four to five half-lives. A loading dose does
not eliminate the need for maintenance dosing, and it actually increases the total drug amount initially
given.
NRG 200 Pharmacology Midterm -- 2026/2027 | Passing Score: 80% | Page 4 of 40
NRG 200 Pharmacology
Midterm Exam
Official Practice Exam | 2026/2027 Edition
Questions: 75 Minutes: 90 Passing Score: 80% Recertification: Annual
Table of Contents
Section 1: Pharmacokinetics & Pharmacodynamics (15 Questions)
Section 2: Medication Administration & Safety (15 Questions)
Section 3: Central Nervous System Drugs (15 Questions)
Section 4: Cardiovascular & Renal Drugs (15 Questions)
Section 5: Anti-Infective & Immunosuppressive Drugs (15 Questions)
Instructions
This practice exam contains 75 multiple-choice questions divided into 5 sections. You have 90 minutes to complete the
entire exam. Select the single best answer for each question. A score of 80% or higher (60 out of 75) is required to
pass. Review each rationale carefully to strengthen your understanding of pharmacology principles, medication safety,
and clinical application for the NRG 200 midterm.
NRG 200 Pharmacology Midterm -- 2026/2027 | Passing Score: 80% | Page 1 of 40
,Section | Pharmacokinetics & Pharmacodynamics -- 2026/2027
Q1 Question 1 of 75
A 68-year-old patient with cirrhosis of the liver is prescribed a medication that is highly
metabolized by the liver. The nurse anticipates that the prescribed dose will need to be
adjusted in which direction and for which reason?
A. Increased because the damaged liver metabolizes drugs more rapidly
B. Unchanged because liver disease does not affect drug metabolism
C. Decreased because impaired hepatic metabolism reduces first-pass elimination
D. Increased because cirrhosis increases protein binding of the drug
Correct Answer: C
Rationale:
Cirrhosis impairs hepatic enzyme function and reduces first-pass metabolism, leading to higher drug
bioavailability and prolonged half-life, requiring a dose decrease. The liver does not metabolize drugs
faster when diseased, and liver disease typically decreases protein binding rather than increasing it.
Q2 Question 2 of 75
A nurse administers an intravenous medication to a patient and observes that the drug
reaches its peak plasma concentration within 30 seconds. This rapid onset is primarily due
to which pharmacokinetic factor?
A. The intravenous route bypasses absorption barriers and delivers drug directly into
circulation
B. The drug has a very long half-life that accelerates distribution
C. First-pass metabolism is enhanced by the IV route
D. The drug binds extensively to plasma proteins
Correct Answer: A
Rationale:
The intravenous route bypasses the absorption phase entirely, delivering the drug directly into the
bloodstream for immediate systemic availability. A long half-life slows elimination rather than
accelerating onset, first-pass metabolism applies to oral drugs, and protein binding reduces free drug
availability.
NRG 200 Pharmacology Midterm -- 2026/2027 | Passing Score: 80% | Page 2 of 40
,Q3 Question 3 of 75
A patient taking warfarin has a new prescription for an antibiotic that is a potent
cytochrome P450 enzyme inhibitor. The nurse should monitor for which expected effect on
warfarin levels and action?
A. Decreased warfarin effect because the antibiotic competes for receptor sites
B. Increased warfarin effect because inhibited metabolism raises plasma warfarin levels
C. No change because warfarin is not metabolized by cytochrome P450 enzymes
D. Decreased warfarin effect because enzyme inhibition accelerates warfarin elimination
Correct Answer: B
Rationale:
Cytochrome P450 enzyme inhibitors slow the metabolism of drugs like warfarin that are substrates of
those enzymes, leading to higher plasma levels and increased anticoagulant effect. Warfarin is
primarily metabolized by CYP2C9, and enzyme inhibition reduces rather than accelerates elimination.
Q4 Question 4 of 75
A nurse is teaching a patient about a drug that has a narrow therapeutic index. The nurse
explains that a drug with a narrow therapeutic index has which characteristic?
A. The margin between a therapeutic dose and a toxic dose is very small
B. The drug is effective at very low doses with no risk of toxicity
C. The drug has a very wide range of safe dosing
D. The drug requires no laboratory monitoring
Correct Answer: A
Rationale:
A narrow therapeutic index means the difference between a therapeutic dose and a toxic dose is
small, requiring careful dosing and monitoring. Drugs with narrow therapeutic indices, such as digoxin
and lithium, are not effective at very low doses without toxicity risk and require close laboratory
monitoring.
NRG 200 Pharmacology Midterm -- 2026/2027 | Passing Score: 80% | Page 3 of 40
, Q5 Question 5 of 75
A pharmacist explains that a drug has a bioavailability of 25 percent when taken orally.
This value means that which proportion of the administered dose reaches systemic
circulation?
A. 25 percent of the oral dose reaches systemic circulation unchanged
B. 75 percent of the oral dose reaches systemic circulation unchanged
C. The drug is 25 percent protein-bound in the plasma
D. 25 percent of the drug is excreted unchanged in the urine
Correct Answer: A
Rationale:
Bioavailability refers to the fraction of an administered dose that reaches systemic circulation in its
active form. A bioavailability of 25 percent means only one-quarter of the oral dose reaches systemic
circulation, while 75 percent is lost during absorption and first-pass metabolism. It does not refer to
protein binding or renal excretion.
Q6 Question 6 of 75
A nurse administers a loading dose of an antiarrhythmic medication to a patient in acute
distress. The primary rationale for using a loading dose is to achieve which
pharmacokinetic goal?
A. Avoid the need for maintenance doses entirely
B. Reduce the total amount of drug the patient will receive
C. Prevent drug accumulation in fatty tissues
D. Rapidly achieve therapeutic plasma drug concentration before steady state
Correct Answer: D
Rationale:
A loading dose rapidly achieves therapeutic plasma concentration by filling the volume of distribution
before steady state is reached, which could otherwise take four to five half-lives. A loading dose does
not eliminate the need for maintenance dosing, and it actually increases the total drug amount initially
given.
NRG 200 Pharmacology Midterm -- 2026/2027 | Passing Score: 80% | Page 4 of 40
