Foundations of Pharmacology
Which agency is responsible for ensuring that medications marketed in the U.S. are safe and effective?
A. CDC
B. FDA
C. NIH
D. Joint Commission
Correct Answer: B
Rationale: The FDA evaluates medications for safety and effectiveness before approval.
Which adverse effect must be taught to a patient taking daily low-dose aspirin?
A. Tremors
B. GI irritation and bleeding
C. Increased platelet count
D. Sedation
Correct Answer: B
Rationale: Aspirin increases the risk of gastric irritation and GI bleeding.
Which insulin has no peak and lasts 18-24 hours?
A. Regular
B. Lispro
C. Glargine
D. NPH
Correct Answer: C
Rationale: Insulin glargine provides steady basal insulin with no peak.
Which IV drug is first-line for status epilepticus?
A. Baclofen
B. Lorazepam
C. Carbamazepine
D. Gabapentin
Correct Answer: B
Rationale: Lorazepam rapidly enhances GABA inhibition.
Which antibiotic class is most associated with anaphylaxis?
A. Macrolides
B. Penicillins
C. Tetracyclines
D. Sulfonamides
Correct Answer: B
Rationale: Penicillins have the highest rate of severe allergic reactions.
Which medication should be used before an inhaled corticosteroid?
A. Tiotropium
B. Fluticasone
C. Albuterol
D. Montelukast
Correct Answer: C
Rationale: Albuterol opens the airways so ICS medication penetrates better.
Which adverse effect is expected with aluminum-based antacids?
A. Diarrhea
B. Constipation
C. Nausea
D. GI bleeding
Correct Answer: B
Rationale: Aluminum salts slow GI motility.
What is the reversal agent for opioid overdose?
A. Atropine
B. Naloxone
C. Vitamin K
D. Flumazenil
Correct Answer: B
Rationale: Naloxone reverses opioid-induced respiratory depression.
A patient questions a medication before administration. What is the best nursing action?
A. Reassure them and give the drug
B. Recheck the order
C. Ask another nurse
D. Tell the provider later
Correct Answer: B
Rationale: If the client questions a drug, the nurse must recheck the order immediately to prevent medication errors.
A patient taking warfarin + levothyroxine is at risk for which condition?
A. Clot formation
B. Bleeding
C. Hypertension
D. Insomnia
Correct Answer: B
Rationale: Levothyroxine increases the breakdown of clotting factors, potentiating warfarin’s anticoagulation.
A rapid-acting insulin such as lispro should be administered:
A. At bedtime
B. 1 hour before meals
C. Immediately before eating
D. Without regard to meals
Correct Answer: C
Rationale: Lispro acts within minutes-food must be available to prevent hypoglycemia.
Which symptom triad suggests morphine toxicity?
A. Dilated pupils, tachypnea, confusion
B. Pinpoint pupils, respiratory depression, coma
C. Tachypnea, agitation, flushing
D. Tremors, hypertension, fever
Correct Answer: B
Rationale: Classic opioid overdose features.
Which two findings should be prioritized for a patient receiving gentamicin + vancomycin?
A. Vision and skin
B. Hearing and renal function
C. GI upset and rash
D. HR and BP
Correct Answer: B
Rationale: Both drugs are nephrotoxic and ototoxic.
Which adverse effect requires immediate reporting when taking tiotropium?
A. Dry mouth
B. Blurred vision
C. Mild headache
D. Cough
Correct Answer: B
Rationale: Blurred vision may indicate acute narrow-angle glaucoma.
What is the highest-priority teaching for alendronate?
A. Take at bedtime
B. Take with juice
C. Take first thing in the morning with water
D. Take with food
Correct Answer: C
Rationale: Must be taken upright on an empty stomach to avoid esophageal injury.
After administering IV furosemide too rapidly, the nurse should monitor for:
A. Hepatotoxicity
B. Ototoxicity
C. Hypertension
D. Edema
Correct Answer: B
Rationale: Rapid IV furosemide can cause hearing loss.
Which organ is primarily responsible for drug elimination?
A. Liver
B. Lungs
C. Kidneys
D. Skin
Correct Answer: C
Rationale: The kidneys perform the majority of drug excretion.
Which finding requires withholding oral metoprolol?
A. BP 141/92
B. HR 54
C. HR 72
D. BG 156
Correct Answer: B
Rationale: HR < 55 indicates excessive beta-blockade.
Long-term PPI use (e.g., omeprazole) increases risk for which lab abnormality?
A. Hyperkalemia
B. Hypomagnesemia
C. Anemia
D. Thrombocytopenia
Correct Answer: B
Rationale: PPIs impair magnesium absorption.
Which electrolyte imbalance is associated with oxcarbazepine?
A. Hyperkalemia
B. Hyponatremia
C. Hypocalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Oxcarbazepine may trigger SIADH, causing low sodium.
Which adverse effect is associated with ciprofloxacin?
A. Anemia
B. Tendon rupture
C. Sedation
D. Hypertension
Correct Answer: B
Rationale: Fluoroquinolones can cause Achilles tendon rupture.
Which class may block the effects of albuterol?
A. ARBs
B. Calcium channel blockers
C. Beta blockers
D. Alpha blockers
Correct Answer: C
Rationale: Nonselective beta blockers inhibit β2-mediated bronchodilation.
Which medication is first-line for chronic tophaceous gout?
A. Colchicine
B. Allopurinol
C. Probenecid
D. Pegloticase
Correct Answer: B
Rationale: Allopurinol blocks xanthine oxidase, reducing uric acid formation.
Which is the antidote for acetaminophen overdose?
A. Naloxone
B. Vitamin K
C. Acetylcysteine
D. Atropine
Correct Answer: C
Rationale: Acetylcysteine replenishes glutathione to prevent hepatic failure.
Which pregnancy category indicates a medication that is absolutely contraindicated due to known fetal harm?
A. A
B. B
C. X
D. F
Correct Answer: C
Rationale: Category X drugs are known teratogens.
Which medication is used to treat malignant hyperthermia?
A. Isoflurane
B. Phenytoin
C. Dantrolene
D. Nitrous oxide
Correct Answer: C
Rationale: Dantrolene suppresses excessive skeletal muscle calcium release.
Which complication is associated with metformin, especially during surgery or renal impairment?
A. Cerebral edema
B. Lactic acidosis
C. Cardiomyopathy
D. Hypokalemia
Correct Answer: B
Rationale: Metformin accumulation can cause fatal lactic acidosis.
What is the antidote for benzodiazepine toxicity?
A. Naloxone
B. Flumazenil
C. Naltrexone
D. Atropine
Correct Answer: B
Rationale: Flumazenil reverses CNS depression by blocking benzo receptors.
Which antifungal requires 1 L normal saline before infusion to reduce nephrotoxicity?
A. Fluconazole
B. Itraconazole
C. Amphotericin B
D. Nystatin
Correct Answer: C
Rationale: Pre-hydration reduces renal injury.
Which adverse effect is associated with cromolyn?
A. Bronchospasm
B. Constipation
C. Insomnia
D. Hypertension
Correct Answer: A
Rationale: Although rare, cromolyn may trigger paradoxical bronchospasm.
Which medication is a vesicant requiring close IV monitoring?
A. Fluconazole
B. Doxorubicin
C. Metformin
D. Azithromycin
Correct Answer: B
Rationale: Doxorubicin extravasation causes severe tissue necrosis.
A patient receiving propofol must be monitored carefully because:
A. It causes hypertension
B. It grows bacteria rapidly
C. It requires IM administration
D. It has no sedation risks
Correct Answer: B
Rationale: Propofol’s lipid base supports rapid bacterial growth; aseptic technique is critical.
A patient with cirrhosis is receiving a reduced medication dose. Which pharmacokinetic process is impaired?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Correct Answer: C
Rationale: Liver disease decreases drug metabolism, requiring dose reduction to prevent toxicity.
A patient with atrial fibrillation is prescribed warfarin to prevent:
A. Ventricular tachycardia
B. Pulmonary edema
C. Thromboembolic stroke
D. Hypotension
Correct Answer: C
Rationale: AF increases clot formation risk; warfarin prevents stroke.
Which OTC product must be separated from levothyroxine by 4 hours?
A. Vitamin C
B. Magnesium antacids
C. Acetaminophen
D. Vitamin B complex
Correct Answer: B
Rationale: Magnesium and iron bind levothyroxine and impair absorption.
Which benzodiazepine is indicated specifically for muscle spasticity?
A. Midazolam
B. Diazepam
C. Alprazolam
D. Buspirone
Correct Answer: B
Rationale: Diazepam reduces spasticity via GABA potentiation.
A patient on cyclosporine presents with a rising creatinine. What does this indicate?
A. Expected finding
B. Early nephrotoxicity
C. Dehydration
D. Overdose of other medications
Correct Answer: B
Rationale: Cyclosporine is highly nephrotoxic; rising creatinine is a red flag.
Which instruction shows correct understanding of inhaled glucocorticoid use in COPD?
A. “I use it for acute attacks.”
B. “I take it only when I wheeze.”
C. “I use it every day to prevent exacerbations.”
D. “It works immediately.”
Correct Answer: C
Rationale: ICS therapy is preventive, not rescue.
Which assessment is priority before starting methotrexate for RA?
A. Lipid panel
B. Pregnancy test
C. Dental hygiene review
D. NSAID use history
Correct Answer: B
Rationale: Methotrexate is highly teratogenic.
A patient who recently had a stent placed takes clopidogrel and omeprazole OTC. What should the nurse prioritize teaching?
A. Stop clopidogrel before surgery
B. Limit activity
C. Omeprazole may reduce clopidogrel’s effectiveness
D. Take the heartburn medication daily
Correct Answer: C
Rationale: Omeprazole inhibits CYP2C19, decreasing clopidogrel activation and increasing stent-related MI risk.