2470 Introductory Pharmacology - Final Exam Review (Qns & Ans) - OSU 2025, Exams of Nursing

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247 0 Introductory

Pharmacology for Nurses

Final Exam Review

(Questions & Solutions)

1. Multiple Choice Question: A 65-year-old patient with hypertension is started on lisinopril. Which pharmacologic effect of lisinopril is most directly responsible for lowering blood pressure?

• A. Inhibition of angiotensin-converting enzyme
• B. Blockade of beta-adrenergic receptors
• C. Activation of calcium channels
• D. Stimulation of aldosterone release Correct ANS : A. Inhibition of angiotensin-converting enzyme Rationale: Lisinopril, an ACE inhibitor, decreases the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to vasodilation and reduced aldosterone secretion, thereby lowering blood pressure. Nurses must understand this mechanism to monitor for hypotension and renal effects.

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2. Fill-in-the-Blank Question: The four key processes that determine a drug’s fate in the body are collectively known as __________. Correct ANS : pharmacokinetics Rationale: Pharmacokinetics includes absorption, distribution, metabolism, and

Rationale: Oral bioavailability is influenced by the gastrointestinal environment (pH, motility), first-pass hepatic metabolism, the physicochemical property of the drug (solubility, stability), and whether food alters absorption. Injection technique is not relevant for oral bioavailability.

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5. Multiple Choice Question: A nurse is reviewing the actions of beta-blockers for a patient with tachycardia and hypertension. Which of the following best describes the primary mechanism of action for these drugs?

• A. Blocking beta-adrenergic receptors
• B. Inhibiting angiotensin II receptors
• C. Stimulating parasympathetic activity
• D. Inhibiting calcium influx in vascular smooth muscle Correct ANS : A. Blocking beta-adrenergic receptors Rationale: Beta-blockers competitively block beta receptors on the heart and blood vessels, reducing heart rate, cardiac output, and blood pressure. This understanding is essential for monitoring adverse effects like bradycardia and hypotension.

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6. Fill-in-the-Blank Question: When converting a dose from micrograms (mcg) to milligrams (mg), the nurse divides by __________.

Correct ANS : 1, Rationale: Since 1 mg = 1,000 mcg, this conversion is critical for accurate medication dosing and avoiding errors, making unit conversion a fundamental nursing skill.

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7. True/False Question: True or False: The therapeutic index of a drug is defined as the ratio between the toxic dose and the effective dose, indicating the drug’s safety margin. Correct ANS : True Rationale: A high therapeutic index indicates a wide safety margin. Drugs with a narrow therapeutic index require closer monitoring because small dosing errors can lead to toxicity.

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8. Multiple Response Question: Which of the following factors should a nurse assess when calculating a dosage for a renally excreted medication? (Select all that apply)

• A. Serum creatinine level
• B. Patient’s age
• C. Body weight
• D. Liver enzyme activity
• E. Creatinine clearance (CrCl)

Correct ANS : hepatic Rationale: Hepatic metabolism (or biotransformation) is a crucial pharmacokinetic process that affects drug duration and clearance. This concept is important for dose adjustments in patients with liver impairment.

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11. True/False Question: True or False: Drug–drug interactions often occur when two medications bind to the same receptor sites, resulting in competitive antagonism. Correct ANS : True Rationale: Competitive antagonism occurs when two drugs compete for the same receptor, potentially diminishing each other’s effects. Recognizing such interactions is integral to preventing adverse outcomes in polypharmacy.

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12. Multiple Response Question: Which of the following adverse effects are most commonly associated with opioid administration? (Select all that apply)

• A. Respiratory depression
• B. Constipation
• C. Hypotension
• D. Sedation
• E. Diarrhea

Correct ANS s: A, B, D Rationale: Opioids commonly cause respiratory depression, constipation, and sedation as a result of their effects on the central nervous system and gastrointestinal tract. Diarrhea is not typically associated with opioid use.

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13. Multiple Choice Question: A nurse is interpreting a patient’s medication order that includes “PRN.” What does “PRN” indicate in the prescription?

• A. Administer on a fixed schedule
• B. Administer as needed
• C. Administer via intramuscular injection
• D. Administer only after meals Correct ANS : B. Administer as needed Rationale: “PRN” is an abbreviation for the Latin term “pro re nata,” meaning “as needed.” This allows flexibility in administration based on the patient’s current symptoms or condition.

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14. Fill-in-the-Blank Question: The branch of pharmacology that studies the biological effects of drugs and their mechanisms of action is called __________.

Correct ANS s: A, B, C, D Rationale: Safe IV drug administration requires confirming patient identity, ensuring the medication is within the expiration date, accurately calculating the dose, and having a second check by a colleague. Ignoring reconstitution instructions is unsafe and should be avoided.

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17. Multiple Choice Question: A nurse is asked to administer a drug with a narrow therapeutic index. Which of the following is most important when administering this type of drug?

• A. Using a standard dose for all patients
• B. Monitoring serum drug levels frequently
• C. Relying solely on patient-reported outcomes
• D. Administering the drug immediately after a meal Correct ANS : B. Monitoring serum drug levels frequently Rationale: Drugs with a narrow therapeutic index require close monitoring (e.g., serum levels, clinical indicators) to avoid toxicity or therapeutic failure. This is especially crucial in drugs like digoxin or warfarin.

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18. Fill-in-the-Blank Question: The measure of the amount of drug in the plasma relative to the amount

distributed in the tissues is called the __________. Correct ANS : volume of distribution Rationale: The volume of distribution (Vd) provides insight into how extensively a drug disperses into body tissues; a larger Vd indicates extensive distribution beyond the plasma compartment. This parameter is key in calculating loading doses.

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19. True/False Question: True or False: Bioavailability less than 100% indicates that a fraction of the drug is lost during absorption and first-pass hepatic metabolism. Correct ANS : True Rationale: Bioavailability represents the proportion of an administered drug that reaches systemic circulation in its active form. When less than 100%, it shows that some of the drug is metabolized or degraded before reaching the bloodstream.

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20. Multiple Response Question: Which factors can alter the pharmacokinetics of a medication in a patient? (Select all that apply)

• A. Genetic variations in drug metabolism
• B. Age and body composition

Question: For drugs that are primarily eliminated by the kidneys, dosing adjustments are often based on estimated __________ clearance. Correct ANS : creatinine Rationale: Creatinine clearance (CrCl) is used to assess renal function. Adjusting doses by CrCl helps prevent drug accumulation and toxicity in patients with impaired kidney function.

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23. True/False Question: True or False: Pharmacologic antagonists that bind irreversibly to receptors result in a permanent loss of receptor function until new receptors are synthesized. Correct ANS : True Rationale: Irreversible antagonists permanently inactivate receptors by covalently binding to them. New receptors must be made to restore normal function, which is essential for understanding drug duration and recovery of activity.

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24. Multiple Response Question: Which additional patient-specific factors must be considered when calculating a medication’s dose? (Select all that apply)

• A. Age and developmental stage
• B. Pregnancy or lactation status
• C. Weight and body surface area
• D. Allergies and adverse reaction history
• E. The patient’s astrological sign Correct ANS s: A, B, C, D Rationale: Accurate dosing requires consideration of age, weight, pregnancy, and allergy history. These factors affect drug safety and efficacy. An astrological sign is not clinically relevant.

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25. Multiple Choice Question: 

A nurse is reviewing the pharmacologic profile of a new medication that is extensively protein-bound. What is the clinical significance of high protein binding?

• A. It increases the drug’s clearance rate.
• B. It decreases the free (active) concentration of the drug.
• C. It enhances the drug’s bioavailability.
• D. It causes the drug to be rapidly excreted in urine. Correct ANS : B. It decreases the free (active) concentration of the drug. Rationale: Highly protein-bound drugs have a lower fraction of free (active) drug available to interact with target sites, potentially affecting both efficacy and risk of drug–drug interaction.

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Which elements should be verified during a final “five rights” medication check? (Select all that apply)

• A. Right patient
• B. Right drug
• C. Right dose
• D. Right route
• E. Right time Correct ANS s: A, B, C, D, E Rationale: The “five rights” of medication administration (patient, drug, dose, route, time) are a fundamental safety strategy designed to minimize medication errors.

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29. Multiple Choice Question: 

A nurse notices that a patient is experiencing signs of toxicity after administration of a drug with a narrow therapeutic index. Which of the following interventions should the nurse expect?

• A. Increase the next dose to compensate for rapid elimination.
• B. Withhold the next dose and notify the provider.
• C. Switch the drug administration route to oral.
• D. Immediately administer an antidote regardless of protocol. Correct ANS : B. Withhold the next dose and notify the provider. Rationale: For drugs with a narrow therapeutic index, signs of toxicity require immediate intervention. Withholding the dose and alerting the provider are essential steps to prevent further harm while determining the next

course of action.

30. Fill-in-the-Blank Question: Before administering medications, a nurse should always __________ all dosage calculations with a colleague to ensure accuracy. Correct ANS : double-check Rationale: Double-checking dosage calculations is necessary for preventing medication errors. Peer verification is a key component of a culture of safety in nursing practice.

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A nurse is administering intravenous (IV) potassium chloride (KCl) to a patient with hypokalemia. Which of the following is the most critical nursing intervention? a) Administering the KCl rapidly to correct the deficiency quickly. b) Monitoring the patient's electrocardiogram (ECG) for signs of hyperkalemia. c) Diluting the KCl in a small volume of IV fluid to minimize fluid overload. d) Administering the KCl via a peripheral IV site to avoid phlebitis. Correct ANS : b) Monitoring the patient's electrocardiogram (ECG) for signs of hyperkalemia. Rationale: Hyperkalemia is a life-threatening complication of potassium administration. ECG changes (peaked T waves, widened QRS

d) Assessing level of consciousness. e) Encouraging the patient to drink fluids. Correct ANS s: a) Administering naloxone, b) Monitoring respiratory rate and depth, d) Assessing level of consciousness. Rationale: Naloxone reverses opioid effects. Respiratory depression is the primary danger. Level of consciousness reflects the severity. Activated charcoal is not routinely used for opioid overdose. Fluids are not the priority. Multiple Choice: A patient with type 2 diabetes is prescribed metformin. The nurse should educate the patient about which of the following potential side effects? a) Hypoglycemia b) Weight gain c) Lactic acidosis d) Hyperkalemia Correct ANS : c) Lactic acidosis Rationale: Metformin can increase the risk of lactic acidosis, especially in patients with kidney or liver problems. Hypoglycemia is less common than with other antidiabetic medications. Weight gain is not a typical side effect. Hyperkalemia is not directly related to metformin. Fill-in-the-Blank: The antidote for a benzodiazepine overdose is \_\_\_\_. Correct ANS : flumazenil

Rationale: Flumazenil is a benzodiazepine receptor antagonist that reverses the sedative effects of benzodiazepines. True/False: A nurse should crush and administer extended-release medications to patients who have difficulty swallowing. ANS : False Rationale: Crushing extended-release medications destroys the mechanism that controls drug release, potentially leading to a rapid dose and adverse effects. Multiple Response: A patient is receiving digoxin. Which of the following assessment findings would the nurse recognize as a sign of digoxin toxicity? (Select all that apply.) a) Blurred vision b) Nausea and vomiting c) Increased heart rate d) Yellow-green halos around lights e) Elevated blood pressure Correct ANS s: a) Blurred vision, b) Nausea and vomiting, d) Yellow- green halos around lights. Rationale: Digoxin toxicity can cause visual disturbances, gastrointestinal symptoms, and cardiac arrhythmias (often bradycardia, not tachycardia). Multiple Choice: