Exam #1 Practice Questions for Patho/Pharm I

Drugs with an accepted medical use in the United States but with some potential for abuse are classified as which Schedule?

a. I

b. II

c. III

D. IV

IV

Drugs are classified according to their effects on particular body systems and what other factors?

a. Therapeutic uses and chemical characteristics

b. Therapeutic uses and usual route of administration

c. Chemical characteristics and adverse effects

d. Adverse effects and usually route of administration

a

What is the name of the process that occurs from the time a drug enters the body to the time it enters the bloodstream to be circulated. 

a. Distribution

b. Metabolism

c. Excretion

d. Absorption

d

The nurse is caring for a diverse group of clients. In which client should the nurse assess for an alteration in drug metabolism?

a. 41-year-old with kidney stones

b. 35-year-old with cervical cancer

c. 32-year-old with urinary tract infection

d. 50-year-old with cirrhosis of the liver

d

What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body?

a. decreased gastric motility.

b. decreased cognition

c. decreased glomerular filtration rate

d. decreased activity

c

A nurse has been administering a drug to a client intramuscularly (IM). The health care provider discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to:

a. passive diffusion.

b. active transport.

c. glomerular filtration.

d. first-pass effect.

d

The fact that a physician wrote an erroneous order excuses the nurse from legal liability if they carry out that order.

a. true

b. false

b

It is safer and quicker to utilize abbreviations for drug names and routes of administration.

a. true

b. false

b

Many clients who the nurse cares for in the hospital are also taking over-the-counter (OTC) medications. Which core client variable is needed to assess the client's OTC medication use?

a. life span

b. lifestyle

c. environment

d. health status

d

To safely administer medications to clients, a nurse’s responsibilities include what intervention?

a. interpreting the prescriber's prescriptions accurately

b. making dosage adjustments safely and in a timely fashion

c. delegating the administration of medications efficiently

d. identifying the most appropriate medication for a client's health problem.

a

A nurse is reviewing the medication list of a patient who takes several oral drugs. The nurse knows that some medications undergo a significant first-pass effect. Which statement best describes the first-pass effect?

a. The drug is inactivated in the liver before reaching systemic circulation.

b. The drug is metabolized in the kidneys before reaching systemic circulation.

c. The drug binds to plasma proteins, reducing its effectiveness.

d. The drug accumulates in fat tissue, prolonging its action.

a

A patient with hepatitis is prescribed diazepam for anxiety. The nurse knows that liver impairment may:

a. Prevent the drug from being absorbed in the GI tract

b. Decrease drug metabolism, increasing risk of sedation and toxicity

c. Increase drug metabolism, requiring higher doses

d. Increase renal excretion, reducing drug effectiveness

b

A patient with liver disease has a serum albumin level of 2.0 g/dL (normal 3.5–5.0 g/dL). The patient is prescribed warfarin. The nurse anticipates that the patient is at increased risk for:

a. Decreased drug effect due to rapid metabolism

b. Drug toxicity due to more free (unbound) drug in circulation

c. Reduced absorption of the drug in the GI tract

d. Increased renal excretion of the drug

b

A nurse reviews the morning labs and sees that a patient’s serum creatinine
has increased from 1.0 to 2.3 mg/dL since starting gentamicin.
What should the nurse do first?

a. Document the result and reassess in 4 hours

b. Hold the dose and notify the provider

c. Administer the gentamicin as scheduled

d. Encourage the patient to drink more water

b

Aspirin is generally avoided in pediatric patients due to the risk of Reye's syndrome.

a. true

b. false

a

Why is the maximum recommended daily dose of over-the-counter acetaminophen lower for a patient with alcohol use disorder than for a healthy adult?

a. Alcohol causes the kidneys to excrete acetaminophen too quickly.

b. Alcohol prevents acetaminophen from relieving pain.

c. Chronic alcohol use makes the liver produce more toxic byproducts from the drug.

d. Acetaminophen causes alcohol levels in the blood to double.

c

Allopurinol prevents formation of uric acid by inhibiting xanthine oxidase.

a. true

b. false

a

A client with a history of chronic pain related to rheumatoid arthritis presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What assessment is most appropriate?

a. Assess the client's allergy status.

b. Assess the client for recent exacerbations of rheumatoid arthritis.

c. Assess the client's use of salicylates.

d. Assess the client's use of acetaminophen.

c

A nurse is preparing a presentation for a local community group about over-the-counter analgesics, including NSAIDs. Which possible reaction would the nurse integrate into the presentation as a serious risk with this class of drugs?

a. Dry mouth

b. Constipation

c. Gastrointestinal bleeding

d. Mild drowsiness

c

A client is prescribed a corticosteroid to reduce inflammation caused by an autoimmune disorder. Which information would the nurse include when teaching the client about this medication?

a. Take the medication until symptoms subside.

b. The medication is prescribed in gradually decreasing doses.

c. Stop the medication if weight gain occurs.

d. There are minimal adverse effects of this medication.

b

Which statement by a client prescribed a corticosteroid demonstrates a need for additional information about the medication?

a. "I'll be able to be more independent and not restricted by my symptoms."

b. "This medicine will help make me more comfortable."

c. "I'll be so happy to get some symptom relief."

d. "It's so good to know there is a possible cure for my problem."

d

A client with rheumatic disease is being prescribed salicylate therapy. The nurse should teach the client to monitor for which adverse effects?

a. irritation of oral mucosa

b. visual changes

c. ringing in the ear

d. increased hair growth

c

The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following?

a. To decrease pain

b. To inhibit platelet aggregation

c. To decrease temperature

d. To treat osteoarthritis

b

A 64-year-old client has been prescribed ibuprofen for osteoarthritis. Which adverse reaction should the client report with the use of ibuprofen?

a. Flatulence

b. Nausea

c. Headache

d. Tarry stool

d

A patient presents to the emergency department after taking an unknown quantity of acetaminophen. Which laboratory test is most important for the nurse to monitor?

a. Blood glucose

b. White blood cell count

c. Complete blood count (CBC)

d. Liver function tests (AST, ALT)

d

A patient with osteoarthritis is prescribed ibuprofen 400 mg orally every 6 hours as needed. Which nursing instruction is most important to teach the patient? 

a. "You do not need to report swelling in your ankles while taking this medication." 

b. "Stop taking the medication if you notice black or tarry stools." 

c. "You can take ibuprofen together with low-dose aspirin without spacing the doses." 

d. "Take the medication on an empty stomach for best absorption."

b

A nurse is caring for a patient who received morphine IV for post-operative pain. Which assessment finding requires immediate intervention?

a. Patient reports mild nausea

b. Blood pressure 120/78 mmHg

c. Pain reported as 4/10
d. Respiratory rate of 8 breaths per minute

d

A nursing student is developing a care plan for a patient experiencing low back pain from a soft tissue injury. The patient prefers to avoid medications when possible.

Which non-pharmacologic intervention would best support the patient’s comfort during the acute inflammatory phase?

a. Heat therapy and massage

b. Mechanical Traction

c. Weight-bearing exercise 

d. Rest, cold packs, and elevation (when anatomically feasible) 

d

Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug?

a. Conversion of cardiac arrhythmias

b. Treatment of peptic ulcer disease

c. Antidote for acetaminophen poisoning

d. Treatment of bronchospasm

c

The instructor is teaching about the use of mucolytics. The nursing student demonstrates an understanding of the action of the mucolytic drugs when stating which?

a. They are used to break down the thickness of secretions.

b. They are used to relieve a nonproductive cough.

c. They are used to depress the cough center in the medulla.

d. They are used to relieve a productive cough.

a

Type IV hypersensitivity is also called delayed hypersensitivity.

a. true

b. false

a

Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction.

a. true

b. false

a

In early stages of progressive COPD, client likely need corticosteroid therapy.

a. true

b. false

a

What symptom may be the only symptom present in some people with asthma?

a. Wheezing

b. Dyspnea

c. Chronic cough

d. Orthopnea

c

Theophylline can usually be given without adjustments in clients with abnormal kidney function.

a. true

b. false

b

High doses of nebulized albuterol have been associated with what signs and symptoms?

a. Tachycardia, hypokalemia, and hyperglycemia

b. Tachycardia, hyperkalemia, and hyperglycemi

c. Bradycardia, hypokalemia, and hypoglycemia

d. Bradycardia, hyperkalemia, and hyperglycemia

a

A nurse is providing discharge planning for a 45-year-old client who has a prescription for oral albuterol. The nurse will question the client about their intake of which of the following?

a. Coffee

b. Salt

c. Vitamin C

d. Alcohol

a

A nurse is teaching a client diagnosed with asthma about the disease. Which should the nurse instruct the client to avoid because it may cause bronchoconstriction?

a. Fatigue

b. Direct sunlight

c. Extremely cold temperatures

d. Food high in calcium

c

A 30-year-old female patient with a history of asthma presents to the emergency department with increased wheezing and shortness of breath following exposure to pollen.

Which of the following is the primary mechanism contributing to her symptoms?

a. Viral infection

b. Bronchoconstriction caused by inflammatory mediators 

c. Pulmonary edema

d. Airway obstruction due to excess mucus production

b

A 30-year-old patient is diagnosed with moderate persistent asthma. The patient reports symptoms most days of the week and nighttime awakenings more than once a week. She currently uses albuterol as needed but is not on any daily medication.

Which medication is considered first-line daily controller therapy for this patient?

a. Oral corticosteroid (e.g., prednisone) daily

b. Inhaled corticosteroid (e.g., fluticasone)

c. Leukotriene receptor antagonist (e.g., montelukast)

d. Long-acting beta-agonist (e.g., salmeterol) alone 

b

A 25-year-old male presents with a runny nose, body aches, and fever. They ask the nurse whether they have a cold or the flu.

What differentiates the flu from a common cold in this patient?

a. All of the above

b. The duration of symptoms 

c. The potential for bacterial complications

d. The presence of fatigue and high fever in the flu 

a

A patient with chronic obstructive pulmonary disease (COPD) is struggling with daily activities due to breathlessness.

What is a key non-pharmacological intervention the nurse can recommend helping this patient?

a. Limit fluid intake to reduce mucus

b. Modify physical activity to include rest periods

c. Engage in high-intensity strength training

d. Increase dietary sodium intake

b

A nurse is administering a medication that has a high first-pass effect. Which route of administration would the nurse expect to result in the lowest bioavailability of the drug

a. Oral

b. Intravenous

c. Sublingual

d. Intramuscular

a

A patient with liver cirrhosis has a low serum albumin level. How will this affect the pharmacokinetics of a highly protein-bound medication?

a. There will be more free, active drug in the bloodstream, increasing the risk of toxicity.

b. The drug will be inactive because it cannot bind to protein.

c. The drug will be excreted more slowly by the kidneys.

d. The drug's half-life will significantly decrease.

a

SELECT ALL THAT APPLY: Which actions by the nurse demonstrate the "Rights of Medication Administration"?

a. Verifying the patient's identity using two unique identifiers.

b. Checking the medication label against the MAR three times.

c. Crushing an extended-release tablet for a patient with dysphagia.

d. Documenting administration immediately after the patient swallows the med.

a, b, d

A nurse asks a patient, "Can you explain to me in your own words how you will take this medicine at home?" Which technique is being used?

a. Teach-back method

b. Passive learning

c. Affective domain teaching

d. Motivational interviewing

a

True or False: Pharmacogenetics is the study of how a person's genetic makeup affects their response to drugs.

True

A patient with asthma is ordered Albuterol (agonist) and Propranolol (antagonist). What is the priority pharmacodynamic concern?

a. The drugs have antagonistic effects; Propranolol may cause bronchoconstriction.

b. The drugs will have a synergistic effect.

c. Propranolol increases the absorption of Albuterol.

d. Albuterol will cause hyperkalemia.

a

Which phase of pharmacokinetics is most affected by chronic kidney disease (CKD)?

a. Excretion

b. Absorption

c. Metabolism

d. Distribution

a

Arrange the steps of the "Triple Check" for medication safety.

a. Before preparing/pouring. 

b. Before giving to the patient.

c. When reaching for the med.

c, a, b

Which type of drug "mimics" body molecules to activate a receptor?

a. Agonist

b. Antagonist

c. Inhibitor

d. Partial Antagonist

a

SELECT ALL THAT APPLY: High-Alert Medications include:

a. Insulin

b. Heparin

c. Potassium Chloride 

d. Multivitamins

a, b, c

True or False: A narrow Therapeutic Index (TI) means the drug is very safe.

False

Why are first-generation antihistamines on the Beer's Criteria list?

a. Anticholinergic effects (confusion, urinary retention).

b. Excessive diarrhea.

c. Weight gain.

d. Hypertension.

a

Primary danger of Polypharmacy?

a. Increased risk of drug-drug interactions.

b. Cost.

c. Excess energy.

d. Meds cancel each other out.

a

Preferred IM site for a 2 mL injection in an adult?

a. Ventrogluteal

b. Dorsogluteal

c. Deltoid

d. Vastus Lateralis

a

True or False: A side effect is a predictable but unavoidable secondary effect.

True

Which process describes movement from the administration site into the blood?

a. Absorption

b. Distribution

c. Metabolism

d. Excretion

a

Which type of medication order is to be administered immediately and only once?

a. Standing order

b. PRN order

c. STAT order

d. Single (One-time) order

c

A nurse is explaining the "First-Pass Effect" to a student. Which statement by the student indicates a correct understanding of why a provider might switch a patient from an oral medication to an IV medication?

a. "The IV route allows the drug to be metabolized by the liver before it reaches the heart."

b. "The IV route bypasses the liver's initial metabolism, allowing more of the active drug to reach the systemic circulation."

c. "The oral route is always faster, but the IV route is safer for the liver."

d. "IV medications are not affected by the patient's genetic makeup."

b

A patient uses Guided Imagery and Deep Breathing exercises alongside their prescribed pain medication to manage chronic back pain. These non-drug interventions are categorized as:

a. Alternative therapies

b. Complementary therapies

c. Allopathic medicine

d. Pharmacodynamics

b

A nurse is preparing to administer an oral medication and realizes the dose is unusually large (e.g., 5 tablets for a single dose). What is the priority nursing action?

a. Administer the medication as ordered, as the pharmacy already verified it.

b. Ask another nurse to double-check the counting of the 5 tablets.

c. Withhold the medication and verify the order with the prescribing provider.

d. Break the tablets in half to make them easier for the patient to swallow.

c

A patient slams their finger in a door. Which specific fibers are responsible for transmitting the initial "sharp, fast" pain sensation to the spinal cord? 

a. C fibers 

b. Alpha-motor neurons 

c. A-delta fibers 

d. Beta-receptors

c

A nurse is teaching a patient about Ibuprofen. Which instruction is most important to prevent a common adverse effect?

a. Take the medication on an empty stomach for faster absorption. 

b. Always take this medication with food or milk. 

c. Drink 4 liters of water daily to prevent liver failure. 

d. Do not take this medication if you have a history of hearing loss.

b

SELECT ALL THAT APPLY. A nurse is caring for a patient receiving IV Morphine. Which assessment findings should the nurse identify as adverse effects of opioid agonists?

a. Respiratory rate of 8 breaths per minute 

b. Urinary retention 

c. Diarrhea 

d. Constipation 

e. Dilated pupils (Mydriasis)

a, b, d

Which medication is the priority "rescue" antagonist to administer to a patient experiencing an opioid-induced respiratory depression?

a. Flumazenil 

b. Naloxone 

c. Acetylcysteine 

d. Glucagon

b

A patient is diagnosed with chronic gout. Which medication does the nurse anticipate being prescribed for long-term "prevention" rather than acute pain?

a. Allopurinol 

b. Colchicine

c. Naproxen 

d. Morphine

a

Which type of hypersensitivity reaction is characterized by an immediate IgE-mediated response, such as anaphylaxis to a bee sting?

a. Type I 

b. Type II 

c. Type III 

d. Type IV

a

True or False. Type IV hypersensitivity (such as a TB skin test or poison ivy) is considered a "delayed" reaction because it is mediated by T-cells rather than antibodies.

True

A patient receives a blood transfusion of the wrong blood type. The patient's antibodies begin attacking the foreign red blood cells. Which type of hypersensitivity is this?

a. Type I (Immediate) 

b. Type II (Cytotoxic) 

c. Type III (Immune Complex) 

d. Type IV (Delayed)

b

A nurse is assessing a patient for signs of inflammation. Which "cardinal signs" does the nurse expect to find at the site of injury?

a. Pale skin, coldness, and numbness 

b. Redness, heat, swelling, and pain 

c. Cyanosis, itching, and dry skin 

d. Bleeding, bruising, and bradycardia

b

Which medication is a COX-2 Selective Inhibitor, designed to reduce inflammation with a lower risk of GI bleeding?

a. Aspirin 

b. Celecoxib 

c. Ketorolac 

d. Indomethacin

b

A patient reports a pain level of 8/10. The nurse notes the patient also has a history of long-term opioid use. How might this history affect the current pain management?

a. The patient will require much smaller doses. 

b. The patient has likely developed a tolerance and may require higher doses. 

c. The patient will have a higher risk of diarrhea. 

d. Opioids will no longer work for this patient.

b

While assessing a patient after giving Morphine, the nurse finds the patient difficult to arouse, with a respiratory rate of 7. What is the nurse's first action?

a. Call the surgeon to report the pain is controlled. 

b. Administer the scheduled dose of Ibuprofen. 

c. Stimulate the patient and prepare to administer Naloxone. 

d. Document the respiratory rate and reassess in 1 hour.

c

Two days later, a patient develops a rash and itching after a new antibiotic. The nurse identifies this as a Type I Hypersensitivity reaction. What is the primary chemical mediator?

a. Prostaglandins 

b. Substance P 

c. Histamine 

d. Acetylcholine

c

Match the drug to its category:

Drug - Morphine, Naloxone, Ibuprofen, Celecoxib, Allopurinol

Category - COX-2 Selective Inhibitor, Uric Acid Non-selective, NSAID Inhibitor, Opioid Agonist, Opioid Antagonist

Morphine = Opioid Agonist

Naloxone = Opioid Antagonist

Ibuprofen = NSAID inhibitor

Celecoxib = COX-2 selective inhibitor

Allopurinol = Uric acid non-selective

True or False. Acetaminophen (Tylenol) is the drug of choice for treating inflammation in patients with rheumatoid arthritis.

False

A patient is taking high doses of Acetaminophen. Which laboratory test is most important to monitor?

a. Serum Creatinine 

b. Hemoglobin 

c. AST and ALT  

d. Prothrombin Time

c

Match the hypersensitivity to a classic example:

Type I: 

Type II: 

Type III: 

Type IV:

Type I: Anaphylaxis

Type II: Blood Transfusion Reaction

Type III: Systemic Lupus Erythematosus (SLE)

Type IV: Poison Ivy / TB Skin Test

Which instruction should the nurse provide to a patient taking Aspirin to prevent "Salicylism"?

a. Report any "ringing in the ears" (tinnitus) immediately. 

b. Expect your stools to turn black. 

c. Take the medication with orange juice. 

d. Take only on an empty stomach. 

a

Why is it important to assess a patient's emotional state when managing pain?

a. Pain is purely objective. 

b. Pain is a subjective experience influenced by psychological factors. 

c. Emotional patients require less medication. 

d. Culture determines the speed of drug metabolism.

b

SELECT ALL THAT APPLY. Which substances are "inflammatory mediators" that sensitize pain receptors?

a. Prostaglandins 

b. Bradykinin 

c. Histamine 

d. Dopamine 

e. Substance P

a, b, c, e

A patient with Lupus has kidney damage from antigen-antibody complexes. Which type of hypersensitivity is this?

a. Type I 

b. Type II 

c. Type III 

d. Type IV

c

A patient is prescribed Prednisone. Which statement indicates a need for further teaching?

a. "I should take this in the morning." 

b. "I can stop taking this as soon as I feel better." 

c. "I need to monitor my blood sugar." 

d. "I should avoid being around sick people."

b

Which objective findings are most indicative of acute pain?

a. Bradycardia and decreased respiratory rate. 

b. Increased heart rate, increased blood pressure, and sweating. 

c. Decreased blood pressure and dry skin. 

d. Pupils that are constricted.

b

SELECT ALL THAT APPLY. Avoid which herbs with Ibuprofen due to bleeding risk?

a. Garlic 

b. Ginger

c. Ginkgo Biloba 

d. Echinacea 

e. Ginseng

a, b, c, e

A patient is in the vascular phase of acute inflammation following a skin tear. Which physiological process is primarily responsible for the redness (erythema) and heat (calor) observed at the site?

a. Constriction of the local arterioles. 

b. Increased capillary permeability leading to protein loss. 

c. Vasodilation of the local blood vessels. 

d. Migration of white blood cells to the injury site.

c

A patient is diagnosed with an inflammatory airway condition characterized by "airway remodeling" and hyperresponsiveness. Which condition is the nurse most likely assessing?

a. Acute Rhinitis

b. Asthma

c. Sinusitis

d. Pleural Effusion

b

During a respiratory assessment, the nurse hears high-pitched, musical whistling sounds primarily during expiration. How should the nurse document this finding?

a. Crackles

b. Stridor

c. Wheezing

d. Friction Rub

c

A patient presents with a harsh, high-pitched sound heard on inspiration, often associated with upper airway obstruction. Which breath sound is this?

a. Crackles

b. Stridor

c. Rhonchi

d. Wheezing

b

SELECT ALL THAT APPLY. Which of the following are characteristic of airway inflammation in the respiratory system?

a. Edema of the mucosal lining

b. Excessive mucus production

c. Bronchodilation

d. Cellular infiltration (leukocytes)

e. Increased alveolar surface area

a, b, d

True or False. In a patient with a Ventilation-Perfusion (V/Q) mismatch, "Ventilation" refers to the flow of blood through the pulmonary capillaries.

False

A patient is experiencing an acute asthma attack. Which medication should the nurse prioritize as a "rescue" inhaler?

a. Salmeterol (Long-acting beta agonist)

b. Albuterol (Short-acting beta agonist)

c. Tiotropium (Anticholinergic)

d. Montelukast (Leukotriene modifier)

b

A patient is prescribed Tiotropium for the maintenance treatment of COPD. The nurse should educate the patient that this drug works by:

a. Reducing inflammation in the bronchioles.

b. Blocking acetylcholine receptors to prevent bronchoconstriction.

c. Thinning the mucus so it is easier to cough up.

d. Increasing the production of surfactant.

b

Which adverse effect is most common in a patient using an inhaled corticosteroid (e.g., Fluticasone) without using a spacer or rinsing their mouth?

a. Systemic hypertension

b. Oral candidiasis (Thrush)

c. Hypoglycemia

d. Urinary retention

b

A nurse is preparing to administer Theophylline to a patient with chronic bronchitis. Which assessment is a priority due to the drug’s narrow therapeutic index?

a. Monitoring serum drug levels for toxicity.

b. Checking the patient's blood type.

c. Assessing for peripheral edema.

d. Monitoring for constipation.

a

A patient is taking Montelukast (Singulair). The nurse understands this medication is primarily used for:

a. Immediate relief of an ongoing asthma attack.

b. Prophylaxis and long-term treatment of asthma.

c. Treating bacterial pneumonia.

d. Suppressing a non-productive cough.

b

Why are "first-generation" antihistamines like Diphenhydramine (Benadryl) used less frequently for elderly patients compared to "second-generation" drugs like Loratadine (Claritin)?

a. First-generation drugs cause severe diarrhea.

b. First-generation drugs have significant sedative and anticholinergic effects.

c. Second-generation drugs are much cheaper.

d. First-generation drugs only work for 2 hours.

b

True or False. Intranasal glucocorticoids (like Fluticasone) are most effective when used consistently on a daily basis rather than only "as needed."

true

A patient asks the nurse why they can only use their oxymetazoline (Afrin) nasal spray for 3 days. What is the nurse's best response?

a. "It will stop working completely after 3 days."

b."Prolonged use can cause rebound nasal congestion."

c. "It can cause permanent loss of smell."

d. "It is highly addictive to the central nervous system."

b