NURS 251 Pharmacology Final Exam Portage Learning Question
Bank (Latest 2026/2027 Edition) – 100% Correct Questions,
Answers & Detailed Rationales Geneva College
Instructor: Professor Stepp
Total Questions: 60 |
Time Allowed: 120 Minutes |
Passing Score: 70%
Instructions: Select the BEST answer for each question based on pharmacological
principles and nursing responsibilities.
SECTION 1: FOUNDATIONAL PHARMACOLOGY (Pharmacokinetics &
Pharmacodynamics)
Questions 1–9
Q1
A nurse is caring for a patient receiving oral propranolol for hypertension. The nurse
recalls that propranolol undergoes extensive first-pass metabolism in the liver. Which
clinical implication is most important for the nurse to consider?
,A) The oral dose must be significantly higher than the intravenous dose to achieve
therapeutic effect.
B) First-pass metabolism increases the risk of hepatotoxicity with propranolol.
C) The drug should be administered on an empty stomach to bypass hepatic
metabolism.
D) First-pass metabolism is avoided if the patient has renal impairment.
Answer: A
Rationale: Propranolol is a high-extraction drug that undergoes extensive hepatic
first-pass metabolism, meaning a large portion of an oral dose is metabolized before
reaching systemic circulation; therefore, oral doses are typically much higher than
parenteral doses to achieve equivalent therapeutic plasma levels. Option B is incorrect
because first-pass metabolism does not inherently increase hepatotoxicity risk. Option
C is incorrect because food does not bypass hepatic metabolism. Option D is incorrect
because first-pass metabolism is a hepatic process unaffected by renal function.
Q2
A patient is prescribed a drug with a half-life of 8 hours. The nurse understands that
steady-state plasma concentration will be reached after approximately how many hours
of continuous administration?
A) 8 hours
B) 16 hours
C) 32 hours
D) 40 hours
Answer: D
Rationale: Steady-state plasma concentration is generally achieved after approximately
4 to 5 half-lives; with an 8-hour half-life, this equals 32 to 40 hours, making 40 hours the
,most accurate estimate among the choices. Option A represents one half-life, at which
point only 50% of steady state is reached. Option B represents two half-lives (75% of
steady state). Option C represents four half-lives, which is close but 5 half-lives (40
hours) is the standard clinical estimate for steady state.
Q3
A patient with severe liver cirrhosis is prescribed a drug that is highly protein-bound and
metabolized by the liver. The nurse anticipates that the patient will require which dosage
adjustment?
A) A higher dose due to increased plasma protein binding
B) A lower dose due to decreased metabolism and potential for increased free drug
concentration
C) No adjustment because liver disease does not affect highly protein-bound drugs
D) An increased dosing frequency due to shortened half-life
Answer: B
Rationale: Liver cirrhosis reduces albumin synthesis and hepatic enzymatic activity,
leading to decreased protein binding and impaired metabolism; this increases the free
(active) fraction of the drug, raising the risk of toxicity and necessitating a lower dose.
Option A is incorrect because liver disease decreases, not increases, protein binding.
Option C is incorrect because liver disease profoundly affects protein-bound drugs.
Option D is incorrect because liver impairment typically prolongs, not shortens, drug
half-life.
Q4
, A nurse is administering morphine sulfate via intramuscular injection. Which factor
most significantly influences the rate of drug absorption from an IM site?
A) The molecular weight of the drug
B) Blood flow to the injection site
C) The pH of the patient's gastric secretions
D) The patient's respiratory rate
Answer: B
Rationale: Intramuscular absorption depends primarily on blood flow to the injection site
because the drug must dissolve in tissue fluid and diffuse into the bloodstream; highly
perfused muscles (e.g., deltoid) yield faster absorption than poorly perfused sites.
Option A is less clinically significant than blood flow for IM absorption. Option C is
irrelevant because gastric pH affects oral, not parenteral, absorption. Option D is
unrelated to IM drug absorption kinetics.
Q5
A patient asks why a sublingual nitroglycerin tablet works faster than a swallowed oral
nitroglycerin tablet. The nurse's best response is based on which pharmacokinetic
principle?
A) Sublingual administration bypasses first-pass hepatic metabolism and enters
systemic circulation directly.
B) The sublingual tablet dissolves more quickly in saliva than in gastric acid.
C) Swallowed nitroglycerin is destroyed by gastric enzymes before absorption.
D) Sublingual administration increases the drug's volume of distribution.
Answer: A
Bank (Latest 2026/2027 Edition) – 100% Correct Questions,
Answers & Detailed Rationales Geneva College
Instructor: Professor Stepp
Total Questions: 60 |
Time Allowed: 120 Minutes |
Passing Score: 70%
Instructions: Select the BEST answer for each question based on pharmacological
principles and nursing responsibilities.
SECTION 1: FOUNDATIONAL PHARMACOLOGY (Pharmacokinetics &
Pharmacodynamics)
Questions 1–9
Q1
A nurse is caring for a patient receiving oral propranolol for hypertension. The nurse
recalls that propranolol undergoes extensive first-pass metabolism in the liver. Which
clinical implication is most important for the nurse to consider?
,A) The oral dose must be significantly higher than the intravenous dose to achieve
therapeutic effect.
B) First-pass metabolism increases the risk of hepatotoxicity with propranolol.
C) The drug should be administered on an empty stomach to bypass hepatic
metabolism.
D) First-pass metabolism is avoided if the patient has renal impairment.
Answer: A
Rationale: Propranolol is a high-extraction drug that undergoes extensive hepatic
first-pass metabolism, meaning a large portion of an oral dose is metabolized before
reaching systemic circulation; therefore, oral doses are typically much higher than
parenteral doses to achieve equivalent therapeutic plasma levels. Option B is incorrect
because first-pass metabolism does not inherently increase hepatotoxicity risk. Option
C is incorrect because food does not bypass hepatic metabolism. Option D is incorrect
because first-pass metabolism is a hepatic process unaffected by renal function.
Q2
A patient is prescribed a drug with a half-life of 8 hours. The nurse understands that
steady-state plasma concentration will be reached after approximately how many hours
of continuous administration?
A) 8 hours
B) 16 hours
C) 32 hours
D) 40 hours
Answer: D
Rationale: Steady-state plasma concentration is generally achieved after approximately
4 to 5 half-lives; with an 8-hour half-life, this equals 32 to 40 hours, making 40 hours the
,most accurate estimate among the choices. Option A represents one half-life, at which
point only 50% of steady state is reached. Option B represents two half-lives (75% of
steady state). Option C represents four half-lives, which is close but 5 half-lives (40
hours) is the standard clinical estimate for steady state.
Q3
A patient with severe liver cirrhosis is prescribed a drug that is highly protein-bound and
metabolized by the liver. The nurse anticipates that the patient will require which dosage
adjustment?
A) A higher dose due to increased plasma protein binding
B) A lower dose due to decreased metabolism and potential for increased free drug
concentration
C) No adjustment because liver disease does not affect highly protein-bound drugs
D) An increased dosing frequency due to shortened half-life
Answer: B
Rationale: Liver cirrhosis reduces albumin synthesis and hepatic enzymatic activity,
leading to decreased protein binding and impaired metabolism; this increases the free
(active) fraction of the drug, raising the risk of toxicity and necessitating a lower dose.
Option A is incorrect because liver disease decreases, not increases, protein binding.
Option C is incorrect because liver disease profoundly affects protein-bound drugs.
Option D is incorrect because liver impairment typically prolongs, not shortens, drug
half-life.
Q4
, A nurse is administering morphine sulfate via intramuscular injection. Which factor
most significantly influences the rate of drug absorption from an IM site?
A) The molecular weight of the drug
B) Blood flow to the injection site
C) The pH of the patient's gastric secretions
D) The patient's respiratory rate
Answer: B
Rationale: Intramuscular absorption depends primarily on blood flow to the injection site
because the drug must dissolve in tissue fluid and diffuse into the bloodstream; highly
perfused muscles (e.g., deltoid) yield faster absorption than poorly perfused sites.
Option A is less clinically significant than blood flow for IM absorption. Option C is
irrelevant because gastric pH affects oral, not parenteral, absorption. Option D is
unrelated to IM drug absorption kinetics.
Q5
A patient asks why a sublingual nitroglycerin tablet works faster than a swallowed oral
nitroglycerin tablet. The nurse's best response is based on which pharmacokinetic
principle?
A) Sublingual administration bypasses first-pass hepatic metabolism and enters
systemic circulation directly.
B) The sublingual tablet dissolves more quickly in saliva than in gastric acid.
C) Swallowed nitroglycerin is destroyed by gastric enzymes before absorption.
D) Sublingual administration increases the drug's volume of distribution.
Answer: A
