NR293 Pharmacology for Nursing Practice Final
Exam 2025/2026 - 85 Questions
SECTION 1: PHARMACOLOGICAL PRINCIPLES (18 Q)
1. Pharmacokinetics in Neonates (SATA)
Which physiological factors increase the half-life of drugs in a 3-day-old neonate?
(Choose 3)
☐ A. Immature glomerular filtration
☐ B. Larger body-surface-area : weight ratio
☐ C. Low gastric acid output
☐ D. Decreased hepatic enzyme activity
☐ E. Increased protein binding
Answer: A, D, B - Immature kidneys & liver + larger BSA → prolonged t½; protein binding
is decreased (E).
Rationale: Neonatal PK review; guides weight-based dosing and longer intervals.
2. Medication Safety (Priority)
Four checks are complete. Before pressing the PCA button for a post-op teen, the
nurse should first:
A. Verify pump settings against MAR
B. Ask the patient to rate pain
C. Check respiratory rate
D. Confirm patient ID band
Answer: C - Respiratory assessment precedes each PCA dose (Opioid safety).
Rationale: 2026 JC Sentinel Alert: respiratory depression is #1 PCA hazard.
3. Pharmacogenomics 2025
A patient has **CYP2D6 4/4 (poor metabolizer). Which statement is correct?
A. Codeine will provide superior analgesia
B. Normal tramadol dose is safe
, C. Avoid codeine; consider morphine instead
D. Increase tramadol frequency
Answer: C - Poor metabolizers cannot convert codeine → morphine → ineffective
analgesia.
Rationale: FDA 2025 black-box revision: avoid codeine in CYP2D6 poor/intermediate.
4. Cultural Considerations
A Vietnamese patient uses Cao Gio (coining) for pain. Concomitant
acetaminophen is ordered. Priority action:
A. Educate to stop folk remedy
B. Assess skin integrity before dosing
C. Increase acetaminophen dose
D. Switch to NSAID
Answer: B - Coining causes petechiae; assess for hepatic impairment if large areas.
Rationale: Cultural humility + safety assessment; acetaminophen safe if no hepatic
issues.
5. Medication Reconciliation
Most common reconciliation error leading to harm:
A. Duplicate therapy
B. Wrong dose
C. Omission of home med
D. Drug-drug interaction
Answer: C - Omissions account for >50 % of reconciliation ADRs.
Rationale: 2025 ISMP data; verify intentional holds with prescriber.
6. Legal/Ethical
A nurse refuses to administer a medication due to safety concerns. Correct
action:
A. Document "refused to give"
B. Follow chain of command; document assessment & notification
, C. Ask colleague to give it
D. Administer and file incident report
Answer: B - Advocate using chain of command; full documentation required.
Rationale: ANA Code 2025: nurse accountable for safe practice; follow policy.
7. Generic vs Brand
A patient worries generic lisinopril won't work. Best response:
A. "Generics are identical in effect"
B. "You'll need frequent levels checked"
C. "It's bioequivalent per FDA"
D. "Pay extra for brand if worried"
Answer: C - Bioequivalence (80-125 % CI) is regulatory standard.
Rationale: Evidence-based reassurance; avoids therapeutic nihilism.
SECTION 2: CARDIOVASCULAR & HEMATOLOGIC (15 Q)
8. Antihypertensive (Calculation)
Order: Labetalol 0.4 mg/kg IV for 80 kg patient. Available: 5 mg/mL. Volume to
draw:
Solution: 0.4 × 80 = 32 mg ÷ 5 mg/mL = 6.4 mL
Answer: 6.4 mL
Rationale: Weight-based IV push; double-check with second nurse.
9. Diuretic Monitoring (SATA)
Which labs require daily monitoring for a patient on furosemide 80 mg BID?
(Choose 3)
☐ A. Serum potassium
☐ B. Serum creatinine
☐ C. Serum sodium
☐ D. Serum calcium
☐ E. Serum magnesium
Exam 2025/2026 - 85 Questions
SECTION 1: PHARMACOLOGICAL PRINCIPLES (18 Q)
1. Pharmacokinetics in Neonates (SATA)
Which physiological factors increase the half-life of drugs in a 3-day-old neonate?
(Choose 3)
☐ A. Immature glomerular filtration
☐ B. Larger body-surface-area : weight ratio
☐ C. Low gastric acid output
☐ D. Decreased hepatic enzyme activity
☐ E. Increased protein binding
Answer: A, D, B - Immature kidneys & liver + larger BSA → prolonged t½; protein binding
is decreased (E).
Rationale: Neonatal PK review; guides weight-based dosing and longer intervals.
2. Medication Safety (Priority)
Four checks are complete. Before pressing the PCA button for a post-op teen, the
nurse should first:
A. Verify pump settings against MAR
B. Ask the patient to rate pain
C. Check respiratory rate
D. Confirm patient ID band
Answer: C - Respiratory assessment precedes each PCA dose (Opioid safety).
Rationale: 2026 JC Sentinel Alert: respiratory depression is #1 PCA hazard.
3. Pharmacogenomics 2025
A patient has **CYP2D6 4/4 (poor metabolizer). Which statement is correct?
A. Codeine will provide superior analgesia
B. Normal tramadol dose is safe
, C. Avoid codeine; consider morphine instead
D. Increase tramadol frequency
Answer: C - Poor metabolizers cannot convert codeine → morphine → ineffective
analgesia.
Rationale: FDA 2025 black-box revision: avoid codeine in CYP2D6 poor/intermediate.
4. Cultural Considerations
A Vietnamese patient uses Cao Gio (coining) for pain. Concomitant
acetaminophen is ordered. Priority action:
A. Educate to stop folk remedy
B. Assess skin integrity before dosing
C. Increase acetaminophen dose
D. Switch to NSAID
Answer: B - Coining causes petechiae; assess for hepatic impairment if large areas.
Rationale: Cultural humility + safety assessment; acetaminophen safe if no hepatic
issues.
5. Medication Reconciliation
Most common reconciliation error leading to harm:
A. Duplicate therapy
B. Wrong dose
C. Omission of home med
D. Drug-drug interaction
Answer: C - Omissions account for >50 % of reconciliation ADRs.
Rationale: 2025 ISMP data; verify intentional holds with prescriber.
6. Legal/Ethical
A nurse refuses to administer a medication due to safety concerns. Correct
action:
A. Document "refused to give"
B. Follow chain of command; document assessment & notification
, C. Ask colleague to give it
D. Administer and file incident report
Answer: B - Advocate using chain of command; full documentation required.
Rationale: ANA Code 2025: nurse accountable for safe practice; follow policy.
7. Generic vs Brand
A patient worries generic lisinopril won't work. Best response:
A. "Generics are identical in effect"
B. "You'll need frequent levels checked"
C. "It's bioequivalent per FDA"
D. "Pay extra for brand if worried"
Answer: C - Bioequivalence (80-125 % CI) is regulatory standard.
Rationale: Evidence-based reassurance; avoids therapeutic nihilism.
SECTION 2: CARDIOVASCULAR & HEMATOLOGIC (15 Q)
8. Antihypertensive (Calculation)
Order: Labetalol 0.4 mg/kg IV for 80 kg patient. Available: 5 mg/mL. Volume to
draw:
Solution: 0.4 × 80 = 32 mg ÷ 5 mg/mL = 6.4 mL
Answer: 6.4 mL
Rationale: Weight-based IV push; double-check with second nurse.
9. Diuretic Monitoring (SATA)
Which labs require daily monitoring for a patient on furosemide 80 mg BID?
(Choose 3)
☐ A. Serum potassium
☐ B. Serum creatinine
☐ C. Serum sodium
☐ D. Serum calcium
☐ E. Serum magnesium
