Chamberlain University
2 MAXE • 422 RN
★ ★
C College of Nursing
J O U R N E Y T O E X T R A O R D I N A R Y CO M PA S S I O N AT E C A R E
EST. 1889
NR 224 — Examination 2
F U N D A M E N TA LS O F N U R S I N G : M E D I C AT I O N S , I M M O B I L I TY, W O U N D H E A L I N G & S A F E TY
INSTITUTION Chamberlain University COURSE CODE NR 224
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 2 — Fundamentals of Nursing TOTAL QUESTIONS 48 Questions
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice — Select All That Apply
Included
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Pharmacokinetics (ADME), medication administration routes, and the six rights of medication administration are core
competencies.
▸ Immobility complications across all body systems — respiratory, cardiovascular, musculoskeletal, integumentary, and
elimination — are emphasized.
▸ Wound healing intention types, ear drop administration, fire safety (RACE/PASS), and injection techniques are testable content.
▸ Correct answers and clinical rationales appear below each question for NCLEX board review purposes.
▸ All content reflects current evidence-based nursing practice and ANA standards.
SECTION I — PHARMACOKINETICS, MEDICATION ADMINISTRATION & Questions 1 –
DRUG NAMES 11
1. You are caring for a patient who has diabetes complicated by kidney disease. You need to make a detailed
assessment when administering medications because this patient may experience problems with:
A. Absorption
B. Biotransformation
C. Distribution
D. Excretion
CORRECT ANSWER D — Excretion
RATIONALE Kidney disease primarily impairs drug excretion — the final phase of pharmacokinetics. When renal function
is compromised, drugs and their metabolites that are normally eliminated through the kidneys accumulate in
the body, leading to drug toxicity. This is particularly dangerous for medications with a narrow therapeutic
index and those that are primarily renally excreted. The nurse must monitor BUN and creatinine, and
anticipate that renally excreted medications will require dosage reduction or extended dosing intervals.
Absorption (A) is primarily a GI concern; biotransformation (B) is hepatic; distribution (C) is affected by protein
binding and circulation.
,2. Which of the following indicates that an elderly client has been affected by polypharmacy?
A. Medications that might prove beneficial are not prescribed.
B. Medications are used to counteract side effects of currently prescribed medications.
C. There is no improvement in a condition even after discontinuation of a medication.
D. Medications that are contraindicated are not prescribed.
CORRECT ANSWER B — Medications are used to counteract side effects of currently prescribed medications
RATIONALE Polypharmacy often manifests as a "prescribing cascade" — a new medication is added to treat the side
effects of an existing medication, which may then produce additional side effects requiring yet more
medications. This is particularly prevalent in the elderly, who take more medications for multiple chronic
conditions and are more susceptible to adverse drug effects. For example, a patient on an antihypertensive
develops peripheral edema and is prescribed a diuretic; the diuretic causes hypokalemia, leading to a
potassium supplement. The nurse's role includes thorough medication reconciliation, assessing for duplicate
therapies, and questioning whether new symptoms could be drug-induced rather than new pathology.
3. When caring for clients experiencing pain, a nurse should recognize that which of the following natural substances
decrease pain transmission? (Select all that apply)
A. Substance P
B. Serotonin
C. Bradykinin
D. Endorphins
E. Histamine
CORRECT ANSWER B, D — Serotonin and Endorphins
RATIONALE Endorphins and serotonin are endogenous (naturally produced) neurotransmitters that inhibit pain
transmission in the central nervous system. Endorphins are the body's natural opioids — they bind to opioid
receptors and produce analgesia, euphoria, and stress reduction. Serotonin modulates descending pain
inhibitory pathways in the brainstem and spinal cord. In contrast, Substance P (A), bradykinin (C), and
histamine (E) are pronociceptive — they INCREASE pain transmission and perception. Substance P is a key
neurotransmitter for pain signaling in the dorsal horn. Understanding which substances inhibit versus
promote pain helps the nurse anticipate the effects of analgesic medications and understand the
pathophysiology of pain.
4. A nurse is administering eardrops to an 8-year-old patient with an ear infection. How does the nurse pull the
patient's ear when administering the medication?
A. Outward
B. Back
C. Upward and back
D. Upward and outward
CORRECT ANSWER D — Upward and outward
RATIONALE For children older than 3 years and adults, the pinna (auricle) is pulled upward and outward to straighten the
external auditory canal, allowing the eardrops to reach the tympanic membrane. This maneuver straightens
the natural S-curve of the adult ear canal. For children younger than 3 years, the pinna is pulled down and
back because their ear canal is shorter and differently angled. Pulling the ear incorrectly causes the drops to
pool in the external canal without reaching the tympanic membrane, reducing therapeutic effectiveness.
Eardrops should be at room temperature to prevent vertigo, dizziness, or nausea from thermal stimulation of
the vestibular system.
, 5. A postoperative patient is receiving morphine sulfate via PCA. The nurse assesses that the patient's respirations are
depressed. The effects of the morphine sulfate can be classified as:
A. Allergic.
B. Idiosyncratic.
C. Therapeutic.
D. Toxic.
CORRECT ANSWER D — Toxic
RATIONALE Respiratory depression from morphine is classified as a toxic effect — it occurs when drug levels exceed the
therapeutic range, even when the dose is within prescribed limits. Opioids depress the brainstem's
respiratory center, reducing its responsiveness to CO2. Toxic effects are dose-related and predictable
extensions of the drug's pharmacologic action. This is distinct from an allergic reaction (A — immune-
mediated, not dose-related), an idiosyncratic reaction (B — genetically determined abnormal response), or a
therapeutic effect (C — the desired clinical response, which for morphine is pain relief). Respiratory rate
below 12/min requires immediate intervention including notification of the provider, stimulation of the
patient, and preparation to administer naloxone if severe.
6. Time it takes for a medication to produce a response:
A. Onset
B. Plateau
C. Trough
D. Duration
CORRECT ANSWER A — Onset
RATIONALE Onset of action is the time from medication administration to the first observable therapeutic response.
Different routes have vastly different onset times: IV medications have an onset of seconds to minutes
(immediate bioavailability), oral medications have an onset of 30-60 minutes (must dissolve and be
absorbed), and intramuscular injections have an onset of 10-30 minutes (dependent on muscle blood flow).
Understanding onset is critical for timing medication administration appropriately — for example,
administering pre-procedure pain medication early enough that onset occurs before the painful procedure
begins. Plateau (B) is steady state; trough (C) is the lowest concentration before the next dose; duration (D) is
the length of therapeutic effect.
7. Point at which blood serum concentration is reached and maintained:
A. Onset
B. Plateau
C. Trough
D. Duration
CORRECT ANSWER B — Plateau
RATIONALE Plateau (steady state) is the point at which the rate of drug administration equals the rate of drug elimination
— the serum concentration stabilizes within the therapeutic range. Steady state is typically achieved after
approximately 4-5 half-lives of the medication. This is clinically significant because: (1) therapeutic drug
monitoring (peak/trough levels) should be drawn only after steady state is reached to reflect accurate
concentrations; (2) loading doses may be given to reach steady state more rapidly; (3) if a drug's dose or
interval is changed, 4-5 half-lives must pass before the new steady state is achieved. For drugs with long half-
lives (e.g., digoxin ~36-48 hours, amiodarone ~25-100 days), achieving steady state can take weeks.
2 MAXE • 422 RN
★ ★
C College of Nursing
J O U R N E Y T O E X T R A O R D I N A R Y CO M PA S S I O N AT E C A R E
EST. 1889
NR 224 — Examination 2
F U N D A M E N TA LS O F N U R S I N G : M E D I C AT I O N S , I M M O B I L I TY, W O U N D H E A L I N G & S A F E TY
INSTITUTION Chamberlain University COURSE CODE NR 224
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 2 — Fundamentals of Nursing TOTAL QUESTIONS 48 Questions
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice — Select All That Apply
Included
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Pharmacokinetics (ADME), medication administration routes, and the six rights of medication administration are core
competencies.
▸ Immobility complications across all body systems — respiratory, cardiovascular, musculoskeletal, integumentary, and
elimination — are emphasized.
▸ Wound healing intention types, ear drop administration, fire safety (RACE/PASS), and injection techniques are testable content.
▸ Correct answers and clinical rationales appear below each question for NCLEX board review purposes.
▸ All content reflects current evidence-based nursing practice and ANA standards.
SECTION I — PHARMACOKINETICS, MEDICATION ADMINISTRATION & Questions 1 –
DRUG NAMES 11
1. You are caring for a patient who has diabetes complicated by kidney disease. You need to make a detailed
assessment when administering medications because this patient may experience problems with:
A. Absorption
B. Biotransformation
C. Distribution
D. Excretion
CORRECT ANSWER D — Excretion
RATIONALE Kidney disease primarily impairs drug excretion — the final phase of pharmacokinetics. When renal function
is compromised, drugs and their metabolites that are normally eliminated through the kidneys accumulate in
the body, leading to drug toxicity. This is particularly dangerous for medications with a narrow therapeutic
index and those that are primarily renally excreted. The nurse must monitor BUN and creatinine, and
anticipate that renally excreted medications will require dosage reduction or extended dosing intervals.
Absorption (A) is primarily a GI concern; biotransformation (B) is hepatic; distribution (C) is affected by protein
binding and circulation.
,2. Which of the following indicates that an elderly client has been affected by polypharmacy?
A. Medications that might prove beneficial are not prescribed.
B. Medications are used to counteract side effects of currently prescribed medications.
C. There is no improvement in a condition even after discontinuation of a medication.
D. Medications that are contraindicated are not prescribed.
CORRECT ANSWER B — Medications are used to counteract side effects of currently prescribed medications
RATIONALE Polypharmacy often manifests as a "prescribing cascade" — a new medication is added to treat the side
effects of an existing medication, which may then produce additional side effects requiring yet more
medications. This is particularly prevalent in the elderly, who take more medications for multiple chronic
conditions and are more susceptible to adverse drug effects. For example, a patient on an antihypertensive
develops peripheral edema and is prescribed a diuretic; the diuretic causes hypokalemia, leading to a
potassium supplement. The nurse's role includes thorough medication reconciliation, assessing for duplicate
therapies, and questioning whether new symptoms could be drug-induced rather than new pathology.
3. When caring for clients experiencing pain, a nurse should recognize that which of the following natural substances
decrease pain transmission? (Select all that apply)
A. Substance P
B. Serotonin
C. Bradykinin
D. Endorphins
E. Histamine
CORRECT ANSWER B, D — Serotonin and Endorphins
RATIONALE Endorphins and serotonin are endogenous (naturally produced) neurotransmitters that inhibit pain
transmission in the central nervous system. Endorphins are the body's natural opioids — they bind to opioid
receptors and produce analgesia, euphoria, and stress reduction. Serotonin modulates descending pain
inhibitory pathways in the brainstem and spinal cord. In contrast, Substance P (A), bradykinin (C), and
histamine (E) are pronociceptive — they INCREASE pain transmission and perception. Substance P is a key
neurotransmitter for pain signaling in the dorsal horn. Understanding which substances inhibit versus
promote pain helps the nurse anticipate the effects of analgesic medications and understand the
pathophysiology of pain.
4. A nurse is administering eardrops to an 8-year-old patient with an ear infection. How does the nurse pull the
patient's ear when administering the medication?
A. Outward
B. Back
C. Upward and back
D. Upward and outward
CORRECT ANSWER D — Upward and outward
RATIONALE For children older than 3 years and adults, the pinna (auricle) is pulled upward and outward to straighten the
external auditory canal, allowing the eardrops to reach the tympanic membrane. This maneuver straightens
the natural S-curve of the adult ear canal. For children younger than 3 years, the pinna is pulled down and
back because their ear canal is shorter and differently angled. Pulling the ear incorrectly causes the drops to
pool in the external canal without reaching the tympanic membrane, reducing therapeutic effectiveness.
Eardrops should be at room temperature to prevent vertigo, dizziness, or nausea from thermal stimulation of
the vestibular system.
, 5. A postoperative patient is receiving morphine sulfate via PCA. The nurse assesses that the patient's respirations are
depressed. The effects of the morphine sulfate can be classified as:
A. Allergic.
B. Idiosyncratic.
C. Therapeutic.
D. Toxic.
CORRECT ANSWER D — Toxic
RATIONALE Respiratory depression from morphine is classified as a toxic effect — it occurs when drug levels exceed the
therapeutic range, even when the dose is within prescribed limits. Opioids depress the brainstem's
respiratory center, reducing its responsiveness to CO2. Toxic effects are dose-related and predictable
extensions of the drug's pharmacologic action. This is distinct from an allergic reaction (A — immune-
mediated, not dose-related), an idiosyncratic reaction (B — genetically determined abnormal response), or a
therapeutic effect (C — the desired clinical response, which for morphine is pain relief). Respiratory rate
below 12/min requires immediate intervention including notification of the provider, stimulation of the
patient, and preparation to administer naloxone if severe.
6. Time it takes for a medication to produce a response:
A. Onset
B. Plateau
C. Trough
D. Duration
CORRECT ANSWER A — Onset
RATIONALE Onset of action is the time from medication administration to the first observable therapeutic response.
Different routes have vastly different onset times: IV medications have an onset of seconds to minutes
(immediate bioavailability), oral medications have an onset of 30-60 minutes (must dissolve and be
absorbed), and intramuscular injections have an onset of 10-30 minutes (dependent on muscle blood flow).
Understanding onset is critical for timing medication administration appropriately — for example,
administering pre-procedure pain medication early enough that onset occurs before the painful procedure
begins. Plateau (B) is steady state; trough (C) is the lowest concentration before the next dose; duration (D) is
the length of therapeutic effect.
7. Point at which blood serum concentration is reached and maintained:
A. Onset
B. Plateau
C. Trough
D. Duration
CORRECT ANSWER B — Plateau
RATIONALE Plateau (steady state) is the point at which the rate of drug administration equals the rate of drug elimination
— the serum concentration stabilizes within the therapeutic range. Steady state is typically achieved after
approximately 4-5 half-lives of the medication. This is clinically significant because: (1) therapeutic drug
monitoring (peak/trough levels) should be drawn only after steady state is reached to reflect accurate
concentrations; (2) loading doses may be given to reach steady state more rapidly; (3) if a drug's dose or
interval is changed, 4-5 half-lives must pass before the new steady state is achieved. For drugs with long half-
lives (e.g., digoxin ~36-48 hours, amiodarone ~25-100 days), achieving steady state can take weeks.
