NSG 318 Pharmacology for Nursing Practice | Exam 2 Review | 2026/2027
NSG 318: Pharmacology for Nursing Practice
Grand Canyon University | Exam 2 Review | 2026/2027
60 Questions with Correct Answers & Rationales
Pharmacology Competency & NCLEX-RN Preparation
Instructions
This practice exam contains 60 multiple-choice questions aligned with NSG 318 Pharmacology for Nursing
Practice and the NCSBN NCLEX-RN Test Plan.
Each question has four options (A through D). Select the single best answer.
Correct answers are provided in bold cyan text, followed by a detailed rationale explaining the clinical
reasoning.
Read each question carefully. Many questions include clinical vignettes requiring application of
pharmacological knowledge and nursing judgment.
Focus on patient safety, nursing monitoring, patient education, and evidence-based practice as described in
the rationales.
A Quick Reference Answer Key is provided at the end for rapid self-assessment.
This review is intended for study purposes and NCLEX-RN preparation. It does not replace assigned
course materials or textbook readings.
Table of Contents
Instructions ....................................................................................................................................... 1
Table of Contents .............................................................................................................................. 1
Section 1: Pharmacokinetics & Pharmacodynamics Fundamentals (Q1–Q9) ................................ 3
Section 2: Medication Administration & Dosage Calculations (Q10–Q16) ..................................... 5
Section 3: Cardiovascular Pharmacology (Q17–Q26) ....................................................................... 7
Section 4: Respiratory Pharmacology (Q27–Q33) ........................................................................... 10
Section 5: Endocrine Pharmacology (Q34–Q42) .............................................................................. 13
Section 6: Antibiotics & Anti-Infectives (Q43–Q50) ........................................................................ 16
Section 7: Pain Management & CNS Pharmacology (Q51–Q56) ................................................... 19
Section 8: GI Pharmacology & Nursing Implications (Q57–Q60) .................................................. 21
Page 1
, NSG 318 Pharmacology for Nursing Practice | Exam 2 Review | 2026/2027
Quick Reference Answer Key ............................................................................................................ 23
Scoring Guide ................................................................................................................................. 24
Note: After opening this document in Microsoft Word, right-click the Table of Contents and select “Update Field” →
“Update entire table” to populate page numbers.
Page 2
, NSG 318 Pharmacology for Nursing Practice | Exam 2 Review | 2026/2027
Section 1: Pharmacokinetics & Pharmacodynamics Fundamentals (Q1–Q9)
1. A nurse is administering morphine intravenously to a postoperative patient. The medication reference
states the onset is 1–2 minutes, peak is 15–30 minutes, and duration is 4–5 hours. The patient requests pain
medication at 08:00, and the nurse administers the IV morphine at 08:05. At what time should the nurse
expect the maximum pain-relieving effect of this dose?
A. 08:07 B. 08:20–08:35 C. 09:00 D. 12:00
Answer: B. 08:20–08:35
Rationale: The peak effect of IV morphine occurs 15–30 minutes after administration. Since the drug was given at
08:05, the nurse should expect the maximum analgesic effect between approximately 08:20 and 08:35. Understanding
onset, peak, and duration is essential for evaluating medication effectiveness and timing reassessments per the
NCSBN NCLEX test plan.
2. A patient with chronic liver disease is prescribed a medication that undergoes extensive first-pass
metabolism. The prescriber changes the route from oral to sublingual. What is the primary pharmacokinetic
rationale for this route change?
A. The sublingual route avoids hepatic first-pass B. The sublingual route speeds up renal excretion of the
metabolism, increasing bioavailability drug
C. The sublingual route reduces protein binding of the D. The sublingual route decreases the drug’s half-life
drug
Answer: A. The sublingual route avoids hepatic first-pass metabolism, increasing bioavailability
Rationale: Drugs absorbed through the sublingual mucosa enter the systemic circulation directly via the venous
drainage into the superior vena cava, bypassing the portal circulation and hepatic first-pass metabolism. This
significantly increases bioavailability compared to the oral route, which is particularly important for patients with liver
impairment who may have reduced metabolic capacity.
3. A nurse is caring for a patient receiving warfarin (Coumadin) who is newly prescribed amiodarone for
atrial fibrillation. The nurse anticipates that the interaction between these medications will most likely
cause which effect?
A. Decreased INR due to increased warfarin B. Increased INR due to inhibition of warfarin
metabolism metabolism by amiodarone
C. No significant interaction between these medications D. Decreased amiodarone effectiveness due to warfarin
competition
Answer: B. Increased INR due to inhibition of warfarin metabolism by amiodarone
Rationale: Amiodarone is a potent CYP450 inhibitor (particularly CYP2C9 and CYP3A4) that reduces the hepatic
metabolism of warfarin, leading to increased warfarin plasma levels and a higher INR. This significantly increases the
risk of bleeding. Per ISMP guidelines, patients receiving this combination require more frequent INR monitoring and
possible warfarin dose reduction.
Page 3
NSG 318: Pharmacology for Nursing Practice
Grand Canyon University | Exam 2 Review | 2026/2027
60 Questions with Correct Answers & Rationales
Pharmacology Competency & NCLEX-RN Preparation
Instructions
This practice exam contains 60 multiple-choice questions aligned with NSG 318 Pharmacology for Nursing
Practice and the NCSBN NCLEX-RN Test Plan.
Each question has four options (A through D). Select the single best answer.
Correct answers are provided in bold cyan text, followed by a detailed rationale explaining the clinical
reasoning.
Read each question carefully. Many questions include clinical vignettes requiring application of
pharmacological knowledge and nursing judgment.
Focus on patient safety, nursing monitoring, patient education, and evidence-based practice as described in
the rationales.
A Quick Reference Answer Key is provided at the end for rapid self-assessment.
This review is intended for study purposes and NCLEX-RN preparation. It does not replace assigned
course materials or textbook readings.
Table of Contents
Instructions ....................................................................................................................................... 1
Table of Contents .............................................................................................................................. 1
Section 1: Pharmacokinetics & Pharmacodynamics Fundamentals (Q1–Q9) ................................ 3
Section 2: Medication Administration & Dosage Calculations (Q10–Q16) ..................................... 5
Section 3: Cardiovascular Pharmacology (Q17–Q26) ....................................................................... 7
Section 4: Respiratory Pharmacology (Q27–Q33) ........................................................................... 10
Section 5: Endocrine Pharmacology (Q34–Q42) .............................................................................. 13
Section 6: Antibiotics & Anti-Infectives (Q43–Q50) ........................................................................ 16
Section 7: Pain Management & CNS Pharmacology (Q51–Q56) ................................................... 19
Section 8: GI Pharmacology & Nursing Implications (Q57–Q60) .................................................. 21
Page 1
, NSG 318 Pharmacology for Nursing Practice | Exam 2 Review | 2026/2027
Quick Reference Answer Key ............................................................................................................ 23
Scoring Guide ................................................................................................................................. 24
Note: After opening this document in Microsoft Word, right-click the Table of Contents and select “Update Field” →
“Update entire table” to populate page numbers.
Page 2
, NSG 318 Pharmacology for Nursing Practice | Exam 2 Review | 2026/2027
Section 1: Pharmacokinetics & Pharmacodynamics Fundamentals (Q1–Q9)
1. A nurse is administering morphine intravenously to a postoperative patient. The medication reference
states the onset is 1–2 minutes, peak is 15–30 minutes, and duration is 4–5 hours. The patient requests pain
medication at 08:00, and the nurse administers the IV morphine at 08:05. At what time should the nurse
expect the maximum pain-relieving effect of this dose?
A. 08:07 B. 08:20–08:35 C. 09:00 D. 12:00
Answer: B. 08:20–08:35
Rationale: The peak effect of IV morphine occurs 15–30 minutes after administration. Since the drug was given at
08:05, the nurse should expect the maximum analgesic effect between approximately 08:20 and 08:35. Understanding
onset, peak, and duration is essential for evaluating medication effectiveness and timing reassessments per the
NCSBN NCLEX test plan.
2. A patient with chronic liver disease is prescribed a medication that undergoes extensive first-pass
metabolism. The prescriber changes the route from oral to sublingual. What is the primary pharmacokinetic
rationale for this route change?
A. The sublingual route avoids hepatic first-pass B. The sublingual route speeds up renal excretion of the
metabolism, increasing bioavailability drug
C. The sublingual route reduces protein binding of the D. The sublingual route decreases the drug’s half-life
drug
Answer: A. The sublingual route avoids hepatic first-pass metabolism, increasing bioavailability
Rationale: Drugs absorbed through the sublingual mucosa enter the systemic circulation directly via the venous
drainage into the superior vena cava, bypassing the portal circulation and hepatic first-pass metabolism. This
significantly increases bioavailability compared to the oral route, which is particularly important for patients with liver
impairment who may have reduced metabolic capacity.
3. A nurse is caring for a patient receiving warfarin (Coumadin) who is newly prescribed amiodarone for
atrial fibrillation. The nurse anticipates that the interaction between these medications will most likely
cause which effect?
A. Decreased INR due to increased warfarin B. Increased INR due to inhibition of warfarin
metabolism metabolism by amiodarone
C. No significant interaction between these medications D. Decreased amiodarone effectiveness due to warfarin
competition
Answer: B. Increased INR due to inhibition of warfarin metabolism by amiodarone
Rationale: Amiodarone is a potent CYP450 inhibitor (particularly CYP2C9 and CYP3A4) that reduces the hepatic
metabolism of warfarin, leading to increased warfarin plasma levels and a higher INR. This significantly increases the
risk of bleeding. Per ISMP guidelines, patients receiving this combination require more frequent INR monitoring and
possible warfarin dose reduction.
Page 3
