NUR 212 PHARMACOLOGY FOR NURSING
FINAL EXAMINATION
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2026/2027 Academic Year — Comprehensive Pharmacology Competency Assessment
Undergraduate Nursing Program | 75 Multiple-Choice Questions | Testing Time: 105 Minutes
Department of Nursing Sciences
College of Health Professions
CONFIDENTIAL — FOR AUTHORIZED USE ONLY
This examination is the property of the Department of Nursing Sciences.
Unauthorized reproduction or distribution is prohibited.
, NUR 212 Pharmacology Final Exam | 2026/2027
EXAMINATION INSTRUCTIONS AND SPECIFICATIONS
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Total Questions: 75 Multiple-Choice Questions (MCQ)
Testing Time: 105 minutes (1 hour 45 minutes)
Passing Score: 75–80% (56–60 correct answers out of 75)
Calculator Policy: Basic four-function calculator permitted for dosage calculations
Question Format: Single-best-answer MCQ format; Select-All-That-Apply (SATA) questions are
clearly marked
Scoring: No penalty for incorrect answers; attempt all questions
Answer Sheet: Record answers on the provided answer sheet; ensure question numbers correspond
Domains Covered:
1. Pharmacokinetics & Pharmacodynamics Fundamentals (8 questions)
2. Medication Safety & High-Alert Drug Protocols (7 questions)
3. Autonomic Nervous System Pharmacology (7 questions)
4. Cardiovascular & Renal Pharmacotherapy (8 questions)
5. Respiratory & Allergy Medications (6 questions)
6. Gastrointestinal & Antiemetic Pharmacology (6 questions)
7. Endocrine & Diabetes Pharmacotherapy (8 questions)
8. Neurologic & Psychiatric Medications (7 questions)
9. Anti-Infectives & Antimicrobial Stewardship (7 questions)
10. Pain Management & Controlled Substance Regulations (6 questions)
11. Pediatric, Geriatric & Special Population Considerations (5 questions)
Important Reminders:
• Read each question carefully before selecting your answer.
• For SATA questions, select ALL answers that apply — there may be 2–5 correct responses.
• Use the provided scratch paper for dosage calculations; show your work.
• Manage your time carefully: approximately 1.4 minutes per question.
• If unsure of an answer, eliminate obviously incorrect options and make your best choice.
• Notify the proctor immediately if you have any concerns about the exam materials.
DOMAIN 1: PHARMACOKINETICS & PHARMACODYNAMICS FUNDAMENTALS
(Questions 1-8)
This domain assesses understanding of drug absorption, distribution, metabolism, and excretion, as
well as receptor interactions, dose-response relationships, and factors that modify drug effects. Mastery
of pharmacokinetic principles is essential for safe medication administration.
1. A patient receives 500 mg of a drug with a half-life of 6 hours. How much of the drug will
remain in the body after 24 hours assuming first-order kinetics?
A. 31.25 mg
B. 62.5 mg
C. 125 mg
D. 15.625 mg
Correct Answer: A
Rationale: After 24 hours, four half-lives have elapsed (24 ÷ 6 = 4). Using first-order kinetics: 500 mg
→ 250 mg (1st half-life) → 125 mg (2nd) → 62.5 mg (3rd) → 31.25 mg (4th). Understanding half-life
calculations is essential for determining dosing intervals and predicting drug accumulation.
2
, NUR 212 Pharmacology Final Exam | 2026/2027
2. A drug with a high first-pass effect is prescribed orally. Which statement best explains
the clinical implication of this pharmacokinetic property?
A. The drug will have enhanced bioavailability when taken with food
B. A significantly higher oral dose is needed compared to the IV dose to achieve the same
therapeutic effect
C. The drug should only be administered intravenously
D. First-pass metabolism increases the drug's duration of action
Correct Answer: B
Rationale: First-pass effect refers to the extensive metabolism of a drug by the liver and gut wall before
it reaches systemic circulation. This significantly reduces bioavailability, meaning that a much larger
oral dose is required to achieve the same plasma concentration as an IV dose. Drugs like propranolol,
lidocaine, and morphine are classic examples. While IV administration bypasses first-pass metabolism,
it is not the only route—sublingual and rectal routes can also partially bypass it.
3. Which of the following patients is most likely to experience drug toxicity due to altered
pharmacokinetics related to plasma protein binding?
A. A 25-year-old male taking a highly protein-bound drug with normal albumin levels
B. A 68-year-old female with hypoalbuminemia (albumin 2.1 g/dL) taking warfarin (Coumadin),
which is 99% protein-bound
C. A 40-year-old female taking a drug that is only 10% protein-bound
D. A 55-year-old male with elevated albumin levels taking a moderately protein-bound drug
Correct Answer: B
Rationale: Highly protein-bound drugs (like warfarin at 99%) rely on albumin for binding in the
bloodstream. In hypoalbuminemia, fewer binding sites are available, increasing the free (active) drug
concentration and the risk of toxicity. This is especially dangerous for drugs with a narrow therapeutic
index. The elderly patient with low albumin is at the highest risk because both age-related changes and
low protein levels alter pharmacokinetics.
4. A nurse is caring for a patient with a creatinine clearance of 25 mL/min. Which
pharmacokinetic phase is most affected, and what is the primary nursing implication?
A. Absorption; administer drugs with antacids to enhance uptake
B. Distribution; increase the loading dose to achieve therapeutic levels
C. Metabolism; avoid all drugs metabolized by the liver
D. Excretion; dose reduction and extended dosing intervals are typically required
Correct Answer: D
Rationale: Creatinine clearance of 25 mL/min indicates severe renal impairment, which primarily
affects the excretion phase of pharmacokinetics. Drugs eliminated renally will accumulate, increasing
the risk of toxicity. The clinical implication is to reduce doses and/or extend dosing intervals for renally
cleared drugs. Absorption and metabolism are not primarily affected by renal function. Increasing the
loading dose would worsen potential toxicity.
5. A patient is taking a drug that is a substrate of the cytochrome P450 enzyme CYP3A4.
The physician adds ketoconazole, a potent CYP3A4 inhibitor. What is the expected effect
on the substrate drug?
A. Decreased plasma levels of the substrate drug
B. No change in substrate drug levels
C. Increased plasma levels of the substrate drug, raising toxicity risk
D. Accelerated metabolism of the substrate drug
Correct Answer: C
Rationale: Ketoconazole is a potent inhibitor of CYP3A4. When a CYP inhibitor is co-administered with
a substrate drug, the enzyme cannot metabolize the substrate as efficiently, leading to increased plasma
concentrations and potential toxicity. This is a critical drug-drug interaction concept. Nurses should
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FINAL EXAMINATION
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
2026/2027 Academic Year — Comprehensive Pharmacology Competency Assessment
Undergraduate Nursing Program | 75 Multiple-Choice Questions | Testing Time: 105 Minutes
Department of Nursing Sciences
College of Health Professions
CONFIDENTIAL — FOR AUTHORIZED USE ONLY
This examination is the property of the Department of Nursing Sciences.
Unauthorized reproduction or distribution is prohibited.
, NUR 212 Pharmacology Final Exam | 2026/2027
EXAMINATION INSTRUCTIONS AND SPECIFICATIONS
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━━━
Total Questions: 75 Multiple-Choice Questions (MCQ)
Testing Time: 105 minutes (1 hour 45 minutes)
Passing Score: 75–80% (56–60 correct answers out of 75)
Calculator Policy: Basic four-function calculator permitted for dosage calculations
Question Format: Single-best-answer MCQ format; Select-All-That-Apply (SATA) questions are
clearly marked
Scoring: No penalty for incorrect answers; attempt all questions
Answer Sheet: Record answers on the provided answer sheet; ensure question numbers correspond
Domains Covered:
1. Pharmacokinetics & Pharmacodynamics Fundamentals (8 questions)
2. Medication Safety & High-Alert Drug Protocols (7 questions)
3. Autonomic Nervous System Pharmacology (7 questions)
4. Cardiovascular & Renal Pharmacotherapy (8 questions)
5. Respiratory & Allergy Medications (6 questions)
6. Gastrointestinal & Antiemetic Pharmacology (6 questions)
7. Endocrine & Diabetes Pharmacotherapy (8 questions)
8. Neurologic & Psychiatric Medications (7 questions)
9. Anti-Infectives & Antimicrobial Stewardship (7 questions)
10. Pain Management & Controlled Substance Regulations (6 questions)
11. Pediatric, Geriatric & Special Population Considerations (5 questions)
Important Reminders:
• Read each question carefully before selecting your answer.
• For SATA questions, select ALL answers that apply — there may be 2–5 correct responses.
• Use the provided scratch paper for dosage calculations; show your work.
• Manage your time carefully: approximately 1.4 minutes per question.
• If unsure of an answer, eliminate obviously incorrect options and make your best choice.
• Notify the proctor immediately if you have any concerns about the exam materials.
DOMAIN 1: PHARMACOKINETICS & PHARMACODYNAMICS FUNDAMENTALS
(Questions 1-8)
This domain assesses understanding of drug absorption, distribution, metabolism, and excretion, as
well as receptor interactions, dose-response relationships, and factors that modify drug effects. Mastery
of pharmacokinetic principles is essential for safe medication administration.
1. A patient receives 500 mg of a drug with a half-life of 6 hours. How much of the drug will
remain in the body after 24 hours assuming first-order kinetics?
A. 31.25 mg
B. 62.5 mg
C. 125 mg
D. 15.625 mg
Correct Answer: A
Rationale: After 24 hours, four half-lives have elapsed (24 ÷ 6 = 4). Using first-order kinetics: 500 mg
→ 250 mg (1st half-life) → 125 mg (2nd) → 62.5 mg (3rd) → 31.25 mg (4th). Understanding half-life
calculations is essential for determining dosing intervals and predicting drug accumulation.
2
, NUR 212 Pharmacology Final Exam | 2026/2027
2. A drug with a high first-pass effect is prescribed orally. Which statement best explains
the clinical implication of this pharmacokinetic property?
A. The drug will have enhanced bioavailability when taken with food
B. A significantly higher oral dose is needed compared to the IV dose to achieve the same
therapeutic effect
C. The drug should only be administered intravenously
D. First-pass metabolism increases the drug's duration of action
Correct Answer: B
Rationale: First-pass effect refers to the extensive metabolism of a drug by the liver and gut wall before
it reaches systemic circulation. This significantly reduces bioavailability, meaning that a much larger
oral dose is required to achieve the same plasma concentration as an IV dose. Drugs like propranolol,
lidocaine, and morphine are classic examples. While IV administration bypasses first-pass metabolism,
it is not the only route—sublingual and rectal routes can also partially bypass it.
3. Which of the following patients is most likely to experience drug toxicity due to altered
pharmacokinetics related to plasma protein binding?
A. A 25-year-old male taking a highly protein-bound drug with normal albumin levels
B. A 68-year-old female with hypoalbuminemia (albumin 2.1 g/dL) taking warfarin (Coumadin),
which is 99% protein-bound
C. A 40-year-old female taking a drug that is only 10% protein-bound
D. A 55-year-old male with elevated albumin levels taking a moderately protein-bound drug
Correct Answer: B
Rationale: Highly protein-bound drugs (like warfarin at 99%) rely on albumin for binding in the
bloodstream. In hypoalbuminemia, fewer binding sites are available, increasing the free (active) drug
concentration and the risk of toxicity. This is especially dangerous for drugs with a narrow therapeutic
index. The elderly patient with low albumin is at the highest risk because both age-related changes and
low protein levels alter pharmacokinetics.
4. A nurse is caring for a patient with a creatinine clearance of 25 mL/min. Which
pharmacokinetic phase is most affected, and what is the primary nursing implication?
A. Absorption; administer drugs with antacids to enhance uptake
B. Distribution; increase the loading dose to achieve therapeutic levels
C. Metabolism; avoid all drugs metabolized by the liver
D. Excretion; dose reduction and extended dosing intervals are typically required
Correct Answer: D
Rationale: Creatinine clearance of 25 mL/min indicates severe renal impairment, which primarily
affects the excretion phase of pharmacokinetics. Drugs eliminated renally will accumulate, increasing
the risk of toxicity. The clinical implication is to reduce doses and/or extend dosing intervals for renally
cleared drugs. Absorption and metabolism are not primarily affected by renal function. Increasing the
loading dose would worsen potential toxicity.
5. A patient is taking a drug that is a substrate of the cytochrome P450 enzyme CYP3A4.
The physician adds ketoconazole, a potent CYP3A4 inhibitor. What is the expected effect
on the substrate drug?
A. Decreased plasma levels of the substrate drug
B. No change in substrate drug levels
C. Increased plasma levels of the substrate drug, raising toxicity risk
D. Accelerated metabolism of the substrate drug
Correct Answer: C
Rationale: Ketoconazole is a potent inhibitor of CYP3A4. When a CYP inhibitor is co-administered with
a substrate drug, the enzyme cannot metabolize the substrate as efficiently, leading to increased plasma
concentrations and potential toxicity. This is a critical drug-drug interaction concept. Nurses should
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