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1. A nurse is administering a medication that must bypass the first-pass effect. Which route should the nurse expect to use?
A. Oral
B. Subcutaneous
C. Intravenous
D. Rectal
Correct answer: C
Rationale: IV administration bypasses the liver, avoiding first-pass metabolism.
6. A nurse is reviewing a medication with a low therapeutic index. Which is the nurse’s priority action?
A. Instruct the patient to take the drug with food
B. Monitor the patient for drug interactions
C. Ensure frequent monitoring of blood drug levels
D. Give the medication once per day for safety
Correct Answer: C
🧠 Rationale: A low therapeutic index means the difference between therapeutic and toxic levels is small, so close monitoring is essential.
The nurse prepares to give insulin. Which safety action is required before administration?
A. Wipe vial top with alcohol
B. Verify dose with a second RN
C. Shake the vial to mix well
D. Mix all types of insulin together in one syringe
Correct Answer: B
🧠 Rationale: Insulin is a high-alert medication; a second nurse must verify the dose to prevent serious harm.
A nurse must give a subcutaneous injection. Which action is appropriate?
A. Choose a 45° angle for injection into a thin adult
B. Insert the needle at 90° regardless of body size
C. Avoid pinching the skin
D. Choose the deltoid as the preferred site
Correct Answer: A
🧠 Rationale: Thin patients require a 45° angle. The deltoid is for IM injections, not subcutaneous.
Which medication effect is most likely to be undesirable and unrelated to the drug's primary therapeutic purpose?
A. Potency
B. Secondary effect
C. Maximum efficacy
D. Peak effect
Correct answer: B
🧠 Rationale: Secondary effects can be beneficial or harmful, but they are not the intended therapeutic effect (e.g., drowsiness from antihistamines).
A nurse is preparing to administer a drug that undergoes a high first-pass effect. Which route would bypass this effect?
A. Oral
B. Rectal
C. Intravenous
D. Sublingual
Answer: C. Intravenous
Rationale: IV drugs go directly into systemic circulation, bypassing the liver and avoiding the first-pass effect.
Scenario:
Cloey, now thriving and planning a Pinterest-perfect wedding, is prescribed a new oral medication for her seasonal allergies. She tells her nurse friend, “If this pill doesn’t work, I’m gonna mix it with wine and hope for the best.” Later, she complains that the medication “did nothing” and says, “It passed through me like Shrinka Dinky passed through my life — fast and pointless.”
Question:
Why might Cloey’s medication have been ineffective?
A. She’s metabolizing it too slowly
B. The drug experienced first-pass metabolism
C. The drug was administered intravenously
D. She mixed it with grapefruit juice
Correct Answer: B
🧠 Rationale: Oral drugs may be significantly metabolized by the liver before reaching systemic circulation, reducing bioavailability — the classic first-pass effect.
Scenario:
Nathan is shadowing on the floor and overhears a provider say, “Give the patient ‘diltiazem’ for the heart rate.” Without verifying the MAR or reading the label, Nathan grabs diazepam instead and says, “Close enough — they both sound fancy.” After the med is given, the patient becomes sedated but their heart rate stays the same.
Question:
What is the best explanation for this error?
A. Incorrect dose calculation
B. Wrong route of administration
C. Look-alike/sound-alike drug confusion
D. Delayed peak level timing
Correct Answer: C
🧠 Rationale: Diltiazem (a calcium channel blocker) and diazepam (a sedative) are classic look-alike/sound-alike meds. Without triple-checking, this can lead to serious errors — especially when your coworker is a walking liability.
2. Which of the following are components of pharmacokinetics? (Select all that apply)
A. Absorption
B. Excretion
C. Metabolism
D. Receptor binding
E. Distribution
Correct answers: A, B, C, E
Rationale: Receptor binding is pharmacodynamics, not pharmacokinetics.
Which of the following correctly describes an antagonist drug?
A. Binds to receptors and produces a strong desired response
B. Binds to receptors and prevents other substances from producing a response
C. Binds to multiple receptors to increase bioavailability
D. Has the same effect as an agonist with fewer side effects
Correct Answer: B
🧠 Rationale: Antagonists block or dampen biological responses by binding to and inhibiting receptor activity.
Which are part of the "Six Rights" of medication administration? (Select all that apply)
A. Right patient
B. Right frequency
C. Right time
D. Right documentation
E. Right location
Correct Answers: A, C, D
🧠 Rationale: The Six Rights include: right patient, drug, dose, time, route, and documentation.
A patient is ordered a ventrogluteal IM injection. Where should the nurse place the injection?
A. Upper outer quadrant of the buttock
B. Between the acromion and deltoid groove
C. Lateral aspect of the thigh
D. Between the greater trochanter and anterior iliac spine
Correct Answer: D
🧠 Rationale: The ventrogluteal site is located by placing a hand on the greater trochanter and index finger toward the anterior superior iliac spine.
Which drug interaction results in one drug reducing or blocking the effect of another?
A. Additive
B. Synergistic
C. Potentiation
D. Antagonistic
Correct answer: D
🧠 Rationale: Antagonistic interactions decrease the effect of another drug (e.g., naloxone blocks opioids).
Which factor would most likely decrease the rate of drug absorption?
A. Increased blood flow
B. Alkaline pH in the stomach
C. Presence of food
D. Active transport
Answer: C. Presence of food
Rationale: Food can slow gastric emptying and bind to drugs, delaying absorption.
A nurse is teaching a patient about drug metabolism. What is the primary organ responsible for this process?
A. Kidneys
B. Liver
C. Lungs
D. Pancreas
Answer: B. Liver
Rationale: The liver contains enzymes that chemically modify drugs for excretion.
Which strategy prevents look-alike/sound-alike medication errors?
A. Crushing all tablets
B. Relying solely on the MAR
C. Using Tall Man lettering and double-checking names
D. Storing them on the same shelf
Answer: C. Using Tall Man lettering and double-checking names
Rationale: Tall Man lettering helps distinguish similarly named drugs.
3. A patient has a low albumin level. What is the nurse’s priority concern regarding drug therapy?
A. Drug metabolism will increase.
B. Drug binding may decrease, increasing free drug levels.
C. Drug will be eliminated more slowly.
D. The drug will be inactivated before absorption.
Correct answer: B
Rationale: Low albumin = fewer binding sites = higher free drug = increased risk of toxicity.
A nurse gives a patient two medications that together have a synergistic effect. What does this mean?
A. One drug cancels out the effect of the other
B. Both drugs compete for the same receptor
C. The combined effect is greater than the sum of each drug alone
D. The drugs produce identical effects at different times
Correct Answer: C
🧠 Rationale: A synergistic effect amplifies the result beyond what each drug could do individually.
A nurse administers an oral medication that requires absorption in the stomach. What factors could slow absorption? (Select all that apply)
A. Patient just exercised heavily
B. Drug was taken with milk
C. Drug is enteric-coated
D. Patient has low blood flow to the GI tract
E. Drug is administered via IV
Correct Answers: A, B, C, D
🧠 Rationale: Exercise diverts blood from GI; milk and enteric coatings delay dissolution; poor perfusion slows uptake. IV bypasses absorption, so it’s unrelated here.
What nursing interventions promote medication safety in a hospital setting? (Select all that apply)
A. Use a distraction-free medication preparation zone
B. Accept verbal orders only in emergencies
C. Administer medications prepared by another nurse
D. Double-check high-alert medications
E. Keep look-alike drugs in the same storage bin for quick access
Correct Answers: A, B, D
🧠 Rationale: Safety is promoted by avoiding distractions, verifying high-alert meds, and following verbal order protocols. Never give drugs you didn’t prepare, and look-alike meds should be separated.
A nurse is preparing to administer a medication with a high first-pass effect. Which route should the nurse question?
A. Sublingual
B. Rectal
C. Intravenous
D. Oral
Correct answer: D
🧠 Rationale: Oral drugs pass through the liver before entering systemic circulation, often reducing effectiveness.
A patient has a low albumin level. What effect does this have on protein-bound drugs?
A. No effect
B. Increased excretion
C. Increased free drug in plasma
D. Delayed onset of action
Answer: C. Increased free drug in plasma
Rationale: Less protein binding leads to more active (free) drug in circulation, increasing effects and toxicity risk.
Which type of drug interaction occurs when the combined effect equals the sum of individual effects?
A. Additive
B. Synergistic
C. Antagonistic
D. Potentiation
Answer: A. Additive
Rationale: Additive effects mean 1+1=2, such as acetaminophen + codeine.
What action should the nurse take if a prescriber’s handwriting is illegible?
A. Ask another nurse to interpret
B. Give the most commonly prescribed dose
C. Clarify the order with the prescriber
D. Document and give the drug later
Answer: C. Clarify the order with the prescriber
Rationale: Nurses must clarify unclear orders to ensure safe administration.
4. Which of the following influence the rate of drug absorption? (Select all that apply)
A. Blood flow
B. Drug color
C. Food in the stomach
D. Route of administration
E. Exercise
Correct answers: A, C, D, E
Tnurse knows the drug has reached its maximum efficacy when:
A. The therapeutic index is highest
B. Increasing the dose no longer increases therapeutic effect
C. The drug peak is lowest
D. The minimum effective concentration is surpassed
Correct Answer: B
🧠 Rationale: Maximum efficacy is the highest possible effect a drug can produce — beyond that, increasing the dose only raises toxicity risk.
A nurse is preparing to administer eardrops to a 4-year-old child. What should the nurse do?
A. Pull the auricle up and back
B. Pull the auricle down and back
C. Insert the dropper deep into the ear canal
D. Warm the medication and apply it to the outer ear
Correct Answer: A
🧠 Rationale: For children over 3 years old, pull the ear up and back to straighten the canal for better delivery.
A nurse is reviewing the receptor theory of drug action. Which statement indicates correct understanding?
A. “All drugs activate receptors and cause a response.”
B. “Receptors are always found inside the cell’s nucleus.”
C. “Drugs can activate or block receptor activity.”
D. “Receptor binding only occurs with IV drugs.”
Correct answer: C
🧠 Rationale: Drugs can be agonists (activate) or antagonists (block). Receptors are usually on the cell membrane, not just inside the nucleus.
Which actions should a nurse take when administering a transdermal patch? (Select all that apply)
A. Wear gloves when applying
B. Apply to a hairy surface for better absorption
C. Rotate sites to avoid irritation
D. Document the location and time of application
E. Apply heat over the patch to speed absorption
Correct answers: A, C, D
🧠 Rationale: Gloves prevent drug exposure. Patches should go on hairless, intact skin. Site rotation and documentation are critical for safety.
Scenario:
Jaden, a 5’1" nursing student with strong opinions and a caffeine dependency, is recovering post-op in PACU after a minor procedure. A nurse administers an oral extended-release pain med, but 10 minutes later Jaden is dramatically clutching her stomach screaming, “It’s not working! I feel everything! I’m dying!” She threatens to sue unless her “pain gets a proper peak level.”
Question:
What went wrong with Jaden’s pain management plan?
A. She was given the wrong dose
B. The nurse crushed an extended-release med
C. The route bypassed first-pass metabolism
D. The nurse forgot to check her creatinine level
Correct Answer: B
🧠 Rationale: Crushing an extended-release oral med destroys the slow-release mechanism, potentially reducing efficacy and increasing side effects — and pain.
What is the best nursing action after a medication error?
A. Document the error in the nurse’s notes
B. Ignore the error if no harm occurred
C. Report the error according to policy
D. Tell the patient only if they ask
Answer: C. Report the error according to policy
Rationale: Prompt reporting is part of a just and safe culture and promotes patient safety.
A nurse is administering ear drops to a 2-year-old. Which technique is correct?
A. Pull auricle up and back
B. Pull auricle down and back
C. Pull auricle straight out
D. No manipulation is needed
Answer: B. Pull auricle down and back
Rationale: For children under 3, pull the ear down and back to straighten the canal.
5. Which term describes the amount of drug available to the systemic circulation after administration?
A. Half-life
B. Loading dose
C. Bioavailability
D. Maintenance dose
Correct answer: C
A patient asks why their medication causes both dry mouth and drowsiness. Which explanation by the nurse is best?
A. "The drug is not specific and acts on multiple receptor sites."
B. "Your drug dose is too high."
C. "Those are signs of a drug allergy."
D. "It means the drug is not working as intended."
Correct Answer: A
🧠 Rationale: Nonselective drugs act on various receptors in different tissues, causing multiple (often unrelated) effects.
Which statements indicate the nurse understands safe administration of rectal suppositories? (Select all that apply)
A. "I will wear gloves during administration."
B. "I will place the patient in Sims’ position."
C. "I will insert the suppository just past the external sphincter."
D. "I can cut the suppository in half if the dose is too high."
Correct Answers: A, B
🧠 Rationale: Use gloves for hygiene and Sims’ position for access. Suppositories must go past the internal sphincter to be retained. Cutting is not recommended unless pre-scored and pharmacist approved.
A patient is taking a medication that affects multiple receptor types across various organs. This drug is considered:
A. Specific
B. Nonspecific
C. Selective
D. Potent
Correct answer: B
🧠 Rationale: Nonspecific drugs act on multiple sites, such as cholinergic drugs affecting the bladder, heart, and eyes.
A patient prescribed a new antihypertensive drug reports dizziness. What is the nurse's priority action?
A. Instruct the patient to drink a full glass of water
B. Encourage daily exercise
C. Instruct the patient to change positions slowly
D. Discontinue the medication immediately
Correct answer: C
🧠 Rationale: Orthostatic hypotension is common with antihypertensives. Changing position slowly reduces risk of falls.
A patient receives a drug that acts as an agonist. What should the nurse expect?
A. The drug will block receptor sites
B. The drug will produce no action
C. The drug will enhance the normal cellular response
D. The drug will cause a toxic response
Answer: C. The drug will enhance the normal cellular response
Rationale: Agonists bind and activate receptors, mimicking endogenous substances.
Which medication route is most affected by the first-pass effect?
A. Intramuscular
B. Intravenous
C. Oral
D. Sublingual
Answer: C. Oral
Rationale: Oral drugs are absorbed via the GI tract and metabolized by the liver before systemic circulation.
The nurse is explaining drug tolerance to a patient. Which statement best describes it?
A. A drug becomes more toxic over time
B. A patient experiences fewer side effects
C. Increasing doses are needed for the same effect
D. The drug loses all therapeutic value
Answer: C. Increasing doses are needed for the same effect
Rationale: Tolerance means reduced response, requiring higher doses for effectiveness.