1
NUR210 / NUR 210 Exam 2 Principles of
Pharmacology Actual Exam 2026/2027 |
Complete Exam-Style Questions | 100%
Verified – Detailed Rationales – Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Pharmacokinetics and Pharmacodynamics | Q1 – Q15
Section 2 | Medication Administration and Dosage Calculations | Q16 – Q30
Section 3 | Autonomic and Cardiovascular Pharmacology | Q31 – Q45
Section 4 | Central Nervous System and Psychiatric Pharmacology | Q46 – Q60
Section 5 | Anti-infectives, Endocrine, and Respiratory Pharmacology | Q61 – Q75
SECTION 1: PHARMACOKINETICS AND PHARMACODYNAMICS
Question 1 of 75
A 68-year-old female patient with a diagnosis of cirrhosis presents to the emergency department
with altered mental status. The physician prescribes Lorazepam 2 mg intravenous push for
anxiety. The nurse recognizes that due to the patient's liver dysfunction, the half-life of this
benzodiazepine will be prolonged. Which pharmacokinetic phase is most directly responsible for
this alteration in drug duration?
A. Absorption from the intramuscular compartment
B. Distribution to the central nervous system
C. Hepatic metabolism and biotransformation ✓ CORRECT
D. Renal excretion of the active metabolite
Correct Answer: C
Rationale: Lorazepam undergoes phase II conjugation (glucuronidation) in the liver, and
cirrhosis significantly impairs this metabolic process, leading to drug accumulation and
,2
prolonged half-life. Absorption is not a factor here because the medication is administered
intravenously, and while renal excretion occurs later, the prolonged duration is primarily due to
the inability of the liver to metabolize the parent drug efficiently. Nurses must closely monitor
patients with hepatic impairment for signs of excessive sedation or respiratory depression when
administering metabolized drugs.
Question 2 of 75
A 45-year-old male patient is prescribed a new oral medication for hypertension that has a high
first-pass effect. The patient asks the nurse why he cannot take this medication sublingually
instead of swallowing it to avoid stomach upset. How should the nurse explain the
pharmacokinetic advantage of the sublingual route in this context?
A. It bypasses the hepatic first-pass effect, increasing bioavailability ✓ CORRECT
B. It facilitates faster absorption into the portal vein system
C. It allows the drug to be metabolized by gastric acids
D. It ensures the drug is excreted unchanged by the kidneys
Correct Answer: A
Rationale: The sublingual route drains directly into the systemic circulation via the superior vena
cava, bypassing the portal circulation and the liver's first-pass metabolism, thereby significantly
increasing bioavailability. Sublingual administration does not facilitate absorption into the portal
vein; rather, it avoids it, and gastric acids would degrade the drug rather than metabolize it
effectively. This route is clinically valuable for drugs like nitroglycerin that have high first-pass
extraction ratios.
Question 3 of 75
While administering an intravenous antibiotic, a 22-year-old female patient reports a burning
sensation along the vein and develops redness and swelling at the insertion site. The nurse
immediately stops the infusion and recognizes this manifestation as which type of
hypersensitivity reaction?
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A. Type I: Anaphylactic reaction mediated by IgE
B. Type II: Cytotoxic reaction mediated by IgG
C. Type III: Immune complex reaction causing serum sickness
D. Type IV: Delayed cell-mediated reaction ✓ CORRECT
Correct Answer: D
Rationale: The local irritation, redness, and swelling at the IV site are characteristic of a Type IV
hypersensitivity reaction, which is a delayed, cell-mediated response involving T-cells rather
than antibodies. Type I reactions are systemic and immediate, involving histamine release
leading to bronchospasm or shock, while Type II and Type III reactions involve antibody-antigen
complexes that affect larger systems like the kidneys or blood vessels. Local IV site irritation is
rarely life-threatening but requires immediate intervention to prevent tissue damage.
Question 4 of 75
A 55-year-old male with a history of heart failure is prescribed Digoxin. The nurse understands
that Digoxin has a narrow therapeutic index. Which laboratory result indicates that the drug
concentration is within the toxic range, necessitating immediate intervention?
A. Potassium 3.5 mEq/L and Digoxin level 0.8 ng/mL
B. Potassium 4.0 mEq/L and Digoxin level 1.2 ng/mL
C. Potassium 2.8 mEq/L and Digoxin level 2.5 ng/mL ✓ CORRECT
D. Potassium 5.2 mEq/L and Digoxin level 0.5 ng/mL
Correct Answer: C
Rationale: A digoxin level above 2.0 ng/mL is considered toxic, and hypokalemia (potassium 2.8
mEq/L) potentiates digoxin toxicity by displacing the drug from binding sites, increasing the risk
of life-threatening dysrhythmias. A level of 0.8 to 2.0 ng/mL is generally considered therapeutic,
and hyperkalemia is less likely to trigger digoxin toxicity compared to hypokalemia. Nurses must
, 4
monitor electrolytes closely, as hypokalemia and hypomagnesemia significantly increase the risk
of digoxin-induced arrhythmias.
Question 5 of 75
A 30-year-old female patient is taking Phenobarbital for seizure control and requests to start an
oral contraceptive. The nurse warns the patient that the effectiveness of the birth control pill may
be reduced. Which pharmacokinetic interaction explains this phenomenon?
A. Protein binding displacement
B. Enzyme induction ✓ CORRECT
C. Enzyme inhibition
D. Competitive antagonism
Correct Answer: B
Rationale: Phenobarbital is a potent hepatic enzyme inducer that increases the synthesis of
cytochrome P450 enzymes, accelerating the metabolism of oral contraceptives and reducing their
serum concentration and efficacy. Enzyme inhibition would have the opposite effect, increasing
drug levels, and protein binding displacement typically affects free drug levels rather than
metabolic speed. Patients on enzyme-inducing drugs often require an alternative or higher-dose
form of contraception to prevent unintended pregnancy.
Question 6 of 75
A 70-year-old patient is admitted with confusion and is found to have a serum creatinine of 2.5
mg/dL. The physician prescribes a medication that is primarily excreted by the kidneys. Which
adjustment to the dosing regimen is most appropriate to prevent toxicity in this patient?
A. Increase the dosage frequency
B. Administer the medication with food
NUR210 / NUR 210 Exam 2 Principles of
Pharmacology Actual Exam 2026/2027 |
Complete Exam-Style Questions | 100%
Verified – Detailed Rationales – Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Pharmacokinetics and Pharmacodynamics | Q1 – Q15
Section 2 | Medication Administration and Dosage Calculations | Q16 – Q30
Section 3 | Autonomic and Cardiovascular Pharmacology | Q31 – Q45
Section 4 | Central Nervous System and Psychiatric Pharmacology | Q46 – Q60
Section 5 | Anti-infectives, Endocrine, and Respiratory Pharmacology | Q61 – Q75
SECTION 1: PHARMACOKINETICS AND PHARMACODYNAMICS
Question 1 of 75
A 68-year-old female patient with a diagnosis of cirrhosis presents to the emergency department
with altered mental status. The physician prescribes Lorazepam 2 mg intravenous push for
anxiety. The nurse recognizes that due to the patient's liver dysfunction, the half-life of this
benzodiazepine will be prolonged. Which pharmacokinetic phase is most directly responsible for
this alteration in drug duration?
A. Absorption from the intramuscular compartment
B. Distribution to the central nervous system
C. Hepatic metabolism and biotransformation ✓ CORRECT
D. Renal excretion of the active metabolite
Correct Answer: C
Rationale: Lorazepam undergoes phase II conjugation (glucuronidation) in the liver, and
cirrhosis significantly impairs this metabolic process, leading to drug accumulation and
,2
prolonged half-life. Absorption is not a factor here because the medication is administered
intravenously, and while renal excretion occurs later, the prolonged duration is primarily due to
the inability of the liver to metabolize the parent drug efficiently. Nurses must closely monitor
patients with hepatic impairment for signs of excessive sedation or respiratory depression when
administering metabolized drugs.
Question 2 of 75
A 45-year-old male patient is prescribed a new oral medication for hypertension that has a high
first-pass effect. The patient asks the nurse why he cannot take this medication sublingually
instead of swallowing it to avoid stomach upset. How should the nurse explain the
pharmacokinetic advantage of the sublingual route in this context?
A. It bypasses the hepatic first-pass effect, increasing bioavailability ✓ CORRECT
B. It facilitates faster absorption into the portal vein system
C. It allows the drug to be metabolized by gastric acids
D. It ensures the drug is excreted unchanged by the kidneys
Correct Answer: A
Rationale: The sublingual route drains directly into the systemic circulation via the superior vena
cava, bypassing the portal circulation and the liver's first-pass metabolism, thereby significantly
increasing bioavailability. Sublingual administration does not facilitate absorption into the portal
vein; rather, it avoids it, and gastric acids would degrade the drug rather than metabolize it
effectively. This route is clinically valuable for drugs like nitroglycerin that have high first-pass
extraction ratios.
Question 3 of 75
While administering an intravenous antibiotic, a 22-year-old female patient reports a burning
sensation along the vein and develops redness and swelling at the insertion site. The nurse
immediately stops the infusion and recognizes this manifestation as which type of
hypersensitivity reaction?
,3
A. Type I: Anaphylactic reaction mediated by IgE
B. Type II: Cytotoxic reaction mediated by IgG
C. Type III: Immune complex reaction causing serum sickness
D. Type IV: Delayed cell-mediated reaction ✓ CORRECT
Correct Answer: D
Rationale: The local irritation, redness, and swelling at the IV site are characteristic of a Type IV
hypersensitivity reaction, which is a delayed, cell-mediated response involving T-cells rather
than antibodies. Type I reactions are systemic and immediate, involving histamine release
leading to bronchospasm or shock, while Type II and Type III reactions involve antibody-antigen
complexes that affect larger systems like the kidneys or blood vessels. Local IV site irritation is
rarely life-threatening but requires immediate intervention to prevent tissue damage.
Question 4 of 75
A 55-year-old male with a history of heart failure is prescribed Digoxin. The nurse understands
that Digoxin has a narrow therapeutic index. Which laboratory result indicates that the drug
concentration is within the toxic range, necessitating immediate intervention?
A. Potassium 3.5 mEq/L and Digoxin level 0.8 ng/mL
B. Potassium 4.0 mEq/L and Digoxin level 1.2 ng/mL
C. Potassium 2.8 mEq/L and Digoxin level 2.5 ng/mL ✓ CORRECT
D. Potassium 5.2 mEq/L and Digoxin level 0.5 ng/mL
Correct Answer: C
Rationale: A digoxin level above 2.0 ng/mL is considered toxic, and hypokalemia (potassium 2.8
mEq/L) potentiates digoxin toxicity by displacing the drug from binding sites, increasing the risk
of life-threatening dysrhythmias. A level of 0.8 to 2.0 ng/mL is generally considered therapeutic,
and hyperkalemia is less likely to trigger digoxin toxicity compared to hypokalemia. Nurses must
, 4
monitor electrolytes closely, as hypokalemia and hypomagnesemia significantly increase the risk
of digoxin-induced arrhythmias.
Question 5 of 75
A 30-year-old female patient is taking Phenobarbital for seizure control and requests to start an
oral contraceptive. The nurse warns the patient that the effectiveness of the birth control pill may
be reduced. Which pharmacokinetic interaction explains this phenomenon?
A. Protein binding displacement
B. Enzyme induction ✓ CORRECT
C. Enzyme inhibition
D. Competitive antagonism
Correct Answer: B
Rationale: Phenobarbital is a potent hepatic enzyme inducer that increases the synthesis of
cytochrome P450 enzymes, accelerating the metabolism of oral contraceptives and reducing their
serum concentration and efficacy. Enzyme inhibition would have the opposite effect, increasing
drug levels, and protein binding displacement typically affects free drug levels rather than
metabolic speed. Patients on enzyme-inducing drugs often require an alternative or higher-dose
form of contraception to prevent unintended pregnancy.
Question 6 of 75
A 70-year-old patient is admitted with confusion and is found to have a serum creatinine of 2.5
mg/dL. The physician prescribes a medication that is primarily excreted by the kidneys. Which
adjustment to the dosing regimen is most appropriate to prevent toxicity in this patient?
A. Increase the dosage frequency
B. Administer the medication with food
