Chamberlain University
LANIF • 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 — Final Examination Review
F U N D A M E N TA LS O F N U R S I N G : P H A R M A CO LO G Y, OX YG E N AT I O N , I S O L AT I O N & CO N V E R S I O N S
INSTITUTION Chamberlain University COURSE CODE NR 224
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Final Examination Review TOTAL QUESTIONS 46 Questions
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Pharmacokinetics, pharmacodynamics, drug classifications, and medication administration routes are core competencies.
▸ Oxygenation therapy, hypoxia recognition, pulse oximetry interpretation, and oxygen delivery devices are emphasized.
▸ Isolation precautions (Standard, Contact, Droplet, Airborne), PPE requirements, and transmission-based precautions are
testable content.
▸ Weight/volume conversions, metric system, and medication dosage calculations are essential nursing skills.
▸ 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 — PHARMACOLOGY: PHARMACOKINETICS, DRUG EFFECTS & Questions 1
ADMINISTRATION ROUTES – 24
1. What is the quickest route to absorb medication?
A. Oral
B. Subcutaneous
C. Intravenous (IV)
D. Intramuscular
CORRECT ANSWER C — Intravenous (IV) injection produces the most rapid absorption because medications are available
immediately when they enter the systemic circulation
RATIONALE Intravenous administration is the fastest route because the drug is delivered directly into the bloodstream —
there is NO absorption phase. IV medications achieve 100% bioavailability with immediate onset of action.
This makes IV the preferred route in emergencies when rapid therapeutic effect is critical. However, this also
carries the highest risk for adverse reactions because the drug reaches peak concentration almost
instantaneously, and once injected, the drug cannot be retrieved. The rank order from fastest to slowest: IV >
inhalation > sublingual/buccal > intramuscular > subcutaneous > rectal > oral > transdermal. Oral (A) is the
slowest due to GI absorption and first-pass metabolism.
,2. What factors influence drug absorption?
A. Only the patient's age and gender
B. Route of administration, ability of a medication to dissolve, blood flow to the site of administration, body surface
area, lipid solubility
C. Only the time of day the medication is given
D. The color and shape of the medication
CORRECT ANSWER B — Route of administration, ability of a medication to dissolve, blood flow to the site of
administration, body surface area, lipid solubility
RATIONALE Five key factors influence drug absorption: (1) Route of administration — IV bypasses absorption entirely; oral
must survive GI environment. (2) Ability to dissolve — liquid medications absorb faster than tablets; enteric-
coated and sustained-release formulations dissolve more slowly. (3) Blood flow to the administration site —
highly perfused areas (muscle during exercise) absorb faster; poor perfusion (shock, vasoconstriction) slows
absorption. (4) Body surface area — larger surface area (small intestine with villi) increases absorption; this is
why most oral drugs are absorbed in the small intestine. (5) Lipid solubility — lipid-soluble (lipophilic)
medications cross cell membranes more easily; water-soluble medications have limited membrane
penetration. Understanding these factors helps the nurse predict onset and duration of drug action.
3. What is biotransformation?
A. The process of drug absorption from the GI tract
B. Occurs under the influence of enzymes that detoxify, break down, and remove biologically active chemicals
C. The elimination of drugs through the kidneys only
D. The binding of drugs to plasma proteins
CORRECT ANSWER B — Occurs under the influence of enzymes that detoxify, break down, and remove biologically active
chemicals
RATIONALE Biotransformation (drug metabolism) is the enzymatic alteration of drug molecules, primarily occurring in the
liver. The cytochrome P450 (CYP450) enzyme system is the major metabolic pathway. The purpose is to
convert lipid-soluble drugs (which would be reabsorbed by the kidneys) into more water-soluble metabolites
that can be excreted. Metabolism may produce inactive metabolites, active metabolites (prodrugs like
codeine → morphine), or occasionally toxic metabolites (acetaminophen overdose → NAPQI). Liver disease
(cirrhosis, hepatitis) impairs biotransformation, leading to drug accumulation and toxicity — doses of
hepatically metabolized drugs must be reduced. First-pass metabolism specifically refers to orally
administered drugs being metabolized before reaching systemic circulation.
, 4. What is the role of metabolism?
A. To make drugs more potent and longer-lasting
B. After a medication reaches its site of action, it becomes metabolized into a less active or inactive form that is easier
to excrete
C. To transport drugs through the bloodstream
D. To increase drug absorption in the GI tract
CORRECT ANSWER B — After a medication reaches its site of action, it becomes metabolized into a less active or inactive
form that is easier to excrete
RATIONALE Drug metabolism (biotransformation) converts active drug molecules into forms that are more water-soluble
and therefore more easily excreted by the kidneys. Most drugs are metabolized to less active or inactive
compounds — this is the body's way of terminating drug action and eliminating foreign substances. However,
some drugs (prodrugs) require metabolism to become active: codeine is metabolized to morphine,
clopidogrel to its active metabolite, and enalapril to enalaprilat. The liver is the primary site, but metabolism
also occurs in the GI tract, lungs, kidneys, and skin. The first-pass effect: orally administered drugs pass
through the hepatic portal system before reaching systemic circulation, where a significant portion may be
metabolized, reducing bioavailability.
5. Define therapeutic effect.
A. An unintended harmful reaction to a medication
B. The expected or predicted physiological response caused by a medication; some medications have more than one
therapeutic effect
C. A reaction that occurs only at toxic doses
D. The placebo effect of a medication
CORRECT ANSWER B — The expected or predicted physiological response caused by a medication; some medications
have more than one therapeutic effect
RATIONALE The therapeutic effect is the desired, intended physiological response for which the medication was
prescribed. It is the reason the drug is administered. Many medications have multiple therapeutic effects —
for example, corticosteroids decrease swelling, inhibit inflammation, and reduce allergic responses
simultaneously. Aspirin at low doses provides antiplatelet effects; at higher doses it provides analgesia and
antipyresis. The nurse must know the therapeutic effect to: (1) evaluate whether the medication is effective
(did the blood pressure decrease? did the pain improve?), (2) educate the patient about expected benefits,
and (3) distinguish therapeutic effects from adverse effects. Assessment of therapeutic response is part of the
evaluation phase of the nursing process.
LANIF • 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 — Final Examination Review
F U N D A M E N TA LS O F N U R S I N G : P H A R M A CO LO G Y, OX YG E N AT I O N , I S O L AT I O N & CO N V E R S I O N S
INSTITUTION Chamberlain University COURSE CODE NR 224
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Final Examination Review TOTAL QUESTIONS 46 Questions
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Pharmacokinetics, pharmacodynamics, drug classifications, and medication administration routes are core competencies.
▸ Oxygenation therapy, hypoxia recognition, pulse oximetry interpretation, and oxygen delivery devices are emphasized.
▸ Isolation precautions (Standard, Contact, Droplet, Airborne), PPE requirements, and transmission-based precautions are
testable content.
▸ Weight/volume conversions, metric system, and medication dosage calculations are essential nursing skills.
▸ 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 — PHARMACOLOGY: PHARMACOKINETICS, DRUG EFFECTS & Questions 1
ADMINISTRATION ROUTES – 24
1. What is the quickest route to absorb medication?
A. Oral
B. Subcutaneous
C. Intravenous (IV)
D. Intramuscular
CORRECT ANSWER C — Intravenous (IV) injection produces the most rapid absorption because medications are available
immediately when they enter the systemic circulation
RATIONALE Intravenous administration is the fastest route because the drug is delivered directly into the bloodstream —
there is NO absorption phase. IV medications achieve 100% bioavailability with immediate onset of action.
This makes IV the preferred route in emergencies when rapid therapeutic effect is critical. However, this also
carries the highest risk for adverse reactions because the drug reaches peak concentration almost
instantaneously, and once injected, the drug cannot be retrieved. The rank order from fastest to slowest: IV >
inhalation > sublingual/buccal > intramuscular > subcutaneous > rectal > oral > transdermal. Oral (A) is the
slowest due to GI absorption and first-pass metabolism.
,2. What factors influence drug absorption?
A. Only the patient's age and gender
B. Route of administration, ability of a medication to dissolve, blood flow to the site of administration, body surface
area, lipid solubility
C. Only the time of day the medication is given
D. The color and shape of the medication
CORRECT ANSWER B — Route of administration, ability of a medication to dissolve, blood flow to the site of
administration, body surface area, lipid solubility
RATIONALE Five key factors influence drug absorption: (1) Route of administration — IV bypasses absorption entirely; oral
must survive GI environment. (2) Ability to dissolve — liquid medications absorb faster than tablets; enteric-
coated and sustained-release formulations dissolve more slowly. (3) Blood flow to the administration site —
highly perfused areas (muscle during exercise) absorb faster; poor perfusion (shock, vasoconstriction) slows
absorption. (4) Body surface area — larger surface area (small intestine with villi) increases absorption; this is
why most oral drugs are absorbed in the small intestine. (5) Lipid solubility — lipid-soluble (lipophilic)
medications cross cell membranes more easily; water-soluble medications have limited membrane
penetration. Understanding these factors helps the nurse predict onset and duration of drug action.
3. What is biotransformation?
A. The process of drug absorption from the GI tract
B. Occurs under the influence of enzymes that detoxify, break down, and remove biologically active chemicals
C. The elimination of drugs through the kidneys only
D. The binding of drugs to plasma proteins
CORRECT ANSWER B — Occurs under the influence of enzymes that detoxify, break down, and remove biologically active
chemicals
RATIONALE Biotransformation (drug metabolism) is the enzymatic alteration of drug molecules, primarily occurring in the
liver. The cytochrome P450 (CYP450) enzyme system is the major metabolic pathway. The purpose is to
convert lipid-soluble drugs (which would be reabsorbed by the kidneys) into more water-soluble metabolites
that can be excreted. Metabolism may produce inactive metabolites, active metabolites (prodrugs like
codeine → morphine), or occasionally toxic metabolites (acetaminophen overdose → NAPQI). Liver disease
(cirrhosis, hepatitis) impairs biotransformation, leading to drug accumulation and toxicity — doses of
hepatically metabolized drugs must be reduced. First-pass metabolism specifically refers to orally
administered drugs being metabolized before reaching systemic circulation.
, 4. What is the role of metabolism?
A. To make drugs more potent and longer-lasting
B. After a medication reaches its site of action, it becomes metabolized into a less active or inactive form that is easier
to excrete
C. To transport drugs through the bloodstream
D. To increase drug absorption in the GI tract
CORRECT ANSWER B — After a medication reaches its site of action, it becomes metabolized into a less active or inactive
form that is easier to excrete
RATIONALE Drug metabolism (biotransformation) converts active drug molecules into forms that are more water-soluble
and therefore more easily excreted by the kidneys. Most drugs are metabolized to less active or inactive
compounds — this is the body's way of terminating drug action and eliminating foreign substances. However,
some drugs (prodrugs) require metabolism to become active: codeine is metabolized to morphine,
clopidogrel to its active metabolite, and enalapril to enalaprilat. The liver is the primary site, but metabolism
also occurs in the GI tract, lungs, kidneys, and skin. The first-pass effect: orally administered drugs pass
through the hepatic portal system before reaching systemic circulation, where a significant portion may be
metabolized, reducing bioavailability.
5. Define therapeutic effect.
A. An unintended harmful reaction to a medication
B. The expected or predicted physiological response caused by a medication; some medications have more than one
therapeutic effect
C. A reaction that occurs only at toxic doses
D. The placebo effect of a medication
CORRECT ANSWER B — The expected or predicted physiological response caused by a medication; some medications
have more than one therapeutic effect
RATIONALE The therapeutic effect is the desired, intended physiological response for which the medication was
prescribed. It is the reason the drug is administered. Many medications have multiple therapeutic effects —
for example, corticosteroids decrease swelling, inhibit inflammation, and reduce allergic responses
simultaneously. Aspirin at low doses provides antiplatelet effects; at higher doses it provides analgesia and
antipyresis. The nurse must know the therapeutic effect to: (1) evaluate whether the medication is effective
(did the blood pressure decrease? did the pain improve?), (2) educate the patient about expected benefits,
and (3) distinguish therapeutic effects from adverse effects. Assessment of therapeutic response is part of the
evaluation phase of the nursing process.
