CONCORDIA UNIVERSITY, ST. PAUL – NUR 378
PHARMACOLOGY IN NURSING EXAM 3 – 100
ORIGINAL EXAM-PREPARATION QUESTIONS AND
ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: PAIN MANAGEMENT AND ANALGESIC
PRINCIPLES
1. Which characteristic best distinguishes chronic pain from acute pain?
A) Chronic pain persists beyond the expected period of healing.
B) Chronic pain always produces severe tachycardia.
C) Chronic pain occurs only after surgery.
D) Chronic pain responds exclusively to opioid medications.
Correct Answer: Chronic pain persists beyond the expected period of healing.
Rationale: Chronic pain generally continues or recurs beyond the expected period of tissue
healing and may involve complex physical and psychosocial factors. Acute pain is typically
associated with identifiable injury and has a more predictable course. Effective chronic-pain
management may combine pharmacologic, behavioral, physical, and other approaches
rather than relying exclusively on opioids.
2. Which medication is classified as a nonopioid analgesic?
A) Morphine
B) Acetaminophen
C) Fentanyl
D) Hydromorphone
Correct Answer: Acetaminophen
Rationale: Acetaminophen is a nonopioid analgesic commonly used for mild to moderate
pain and fever. Morphine, fentanyl, and hydromorphone are opioid analgesics.
Acetaminophen does not provide the respiratory-depressant effects associated with opioids,
but excessive dosing can cause serious hepatic injury, making dose awareness essential.
,3. A patient receiving an opioid reports increasing pain despite taking the medication as
prescribed. Which phenomenon may explain the reduced response?
A) Tolerance
B) Idiosyncratic reaction
C) Allergic sensitization
D) Therapeutic duplication
Correct Answer: Tolerance
Rationale: Tolerance occurs when repeated exposure to a medication results in a diminished
response, requiring consideration of dose adjustment or alternative strategies. Tolerance is
different from addiction and physical dependence. Nurses should assess the patient
comprehensively rather than assuming that increasing pain automatically indicates
medication-seeking behavior.
4. Which assessment is the priority immediately before administering IV morphine?
A) Bowel sounds
B) Skin temperature
C) Respiratory status
D) Appetite
Correct Answer: Respiratory status
Rationale: Opioids can suppress respiratory drive, making respiratory assessment a priority
before administration. The nurse should evaluate respiratory rate, depth, oxygenation, and
level of consciousness. Although constipation and gastrointestinal effects are important
opioid concerns, respiratory depression can become rapidly life-threatening and therefore
requires immediate attention.
5. Which finding most strongly suggests opioid-induced respiratory depression?
A) Respiratory rate of 8/min with increasing sedation
B) Mild nausea after administration
C) Increased appetite
D) Warm, dry skin
Correct Answer: Respiratory rate of 8/min with increasing sedation
Rationale: Marked respiratory slowing accompanied by increasing sedation is a classic
warning sign of clinically significant opioid toxicity. Opioids depress central respiratory drive
and can progress to apnea. The nurse should promptly assess the patient, support ventilation
,as needed, and follow emergency protocols, including appropriate opioid-antagonist therapy
when indicated.
6. Which medication is an opioid antagonist used to reverse opioid-induced respiratory
depression?
A) Naloxone
B) Sumatriptan
C) Gabapentin
D) Ketorolac
Correct Answer: Naloxone
Rationale: Naloxone competitively antagonizes opioid receptors and can rapidly reverse
opioid-induced respiratory and central nervous system depression. Because its duration may
be shorter than that of some opioids, repeated dosing or continued monitoring may be
necessary. The nurse must continue respiratory assessment after administration rather than
assuming one dose ends the risk.
7. Which adverse effect should a nurse anticipate most consistently with opioid therapy?
A) Severe diarrhea
B) Constipation
C) Hyperactivity
D) Polyuria
Correct Answer: Constipation
Rationale: Opioids decrease gastrointestinal motility and commonly produce constipation.
Unlike some adverse effects that may lessen with continued treatment, opioid-related
constipation often persists. Preventive measures may include adequate hydration, dietary
fiber when appropriate, activity, and prescribed bowel-regimen medications. Patients should
receive anticipatory education rather than waiting for severe constipation.
8. Which statement best describes physical dependence on an opioid?
A) The patient deliberately misuses the medication.
B) The medication produces no physiologic adaptation.
C) Abrupt discontinuation may cause withdrawal symptoms.
D) The patient always develops compulsive drug-seeking behavior.
Correct Answer: Abrupt discontinuation may cause withdrawal symptoms.
, Rationale: Physical dependence means the body has adapted to continued drug exposure, so
abrupt discontinuation can produce withdrawal symptoms. Dependence does not
automatically mean addiction. Addiction involves problematic compulsive use despite harm.
Distinguishing these concepts helps nurses provide appropriate education and avoid
stigmatizing patients receiving legitimate pain treatment.
9. Which medication would generally be inappropriate for routine treatment of severe
respiratory depression caused by opioids?
A) Naloxone
B) Oxygen therapy
C) Airway support
D) Acetaminophen
Correct Answer: Acetaminophen
Rationale: Acetaminophen does not reverse opioid-induced respiratory depression.
Management centers on airway and ventilatory support and opioid antagonism with
naloxone when clinically appropriate. Oxygen may support oxygenation but does not directly
reverse opioid effects. Prompt recognition is critical because untreated opioid-induced
respiratory depression can progress to cardiac arrest.
10. What is the primary therapeutic purpose of multimodal pain management?
A) Eliminate the need for assessment
B) Use different mechanisms to improve analgesia while reducing reliance on one
medication
C) Ensure every patient receives an opioid
D) Replace pharmacologic therapy completely
Correct Answer: Use different mechanisms to improve analgesia while reducing reliance
on one medication
Rationale: Multimodal analgesia combines interventions with different mechanisms, such as
nonopioid analgesics, regional techniques, physical measures, and carefully selected opioids.
The strategy can improve pain control while reducing opioid exposure and related adverse
effects. Pain assessment remains essential because treatment must be individualized to the
patient's condition and response.
11. Which patient factor increases concern for opioid accumulation and adverse effects?
A) Severe renal impairment
B) Mild seasonal allergies
C) Normal hepatic function
PHARMACOLOGY IN NURSING EXAM 3 – 100
ORIGINAL EXAM-PREPARATION QUESTIONS AND
ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: PAIN MANAGEMENT AND ANALGESIC
PRINCIPLES
1. Which characteristic best distinguishes chronic pain from acute pain?
A) Chronic pain persists beyond the expected period of healing.
B) Chronic pain always produces severe tachycardia.
C) Chronic pain occurs only after surgery.
D) Chronic pain responds exclusively to opioid medications.
Correct Answer: Chronic pain persists beyond the expected period of healing.
Rationale: Chronic pain generally continues or recurs beyond the expected period of tissue
healing and may involve complex physical and psychosocial factors. Acute pain is typically
associated with identifiable injury and has a more predictable course. Effective chronic-pain
management may combine pharmacologic, behavioral, physical, and other approaches
rather than relying exclusively on opioids.
2. Which medication is classified as a nonopioid analgesic?
A) Morphine
B) Acetaminophen
C) Fentanyl
D) Hydromorphone
Correct Answer: Acetaminophen
Rationale: Acetaminophen is a nonopioid analgesic commonly used for mild to moderate
pain and fever. Morphine, fentanyl, and hydromorphone are opioid analgesics.
Acetaminophen does not provide the respiratory-depressant effects associated with opioids,
but excessive dosing can cause serious hepatic injury, making dose awareness essential.
,3. A patient receiving an opioid reports increasing pain despite taking the medication as
prescribed. Which phenomenon may explain the reduced response?
A) Tolerance
B) Idiosyncratic reaction
C) Allergic sensitization
D) Therapeutic duplication
Correct Answer: Tolerance
Rationale: Tolerance occurs when repeated exposure to a medication results in a diminished
response, requiring consideration of dose adjustment or alternative strategies. Tolerance is
different from addiction and physical dependence. Nurses should assess the patient
comprehensively rather than assuming that increasing pain automatically indicates
medication-seeking behavior.
4. Which assessment is the priority immediately before administering IV morphine?
A) Bowel sounds
B) Skin temperature
C) Respiratory status
D) Appetite
Correct Answer: Respiratory status
Rationale: Opioids can suppress respiratory drive, making respiratory assessment a priority
before administration. The nurse should evaluate respiratory rate, depth, oxygenation, and
level of consciousness. Although constipation and gastrointestinal effects are important
opioid concerns, respiratory depression can become rapidly life-threatening and therefore
requires immediate attention.
5. Which finding most strongly suggests opioid-induced respiratory depression?
A) Respiratory rate of 8/min with increasing sedation
B) Mild nausea after administration
C) Increased appetite
D) Warm, dry skin
Correct Answer: Respiratory rate of 8/min with increasing sedation
Rationale: Marked respiratory slowing accompanied by increasing sedation is a classic
warning sign of clinically significant opioid toxicity. Opioids depress central respiratory drive
and can progress to apnea. The nurse should promptly assess the patient, support ventilation
,as needed, and follow emergency protocols, including appropriate opioid-antagonist therapy
when indicated.
6. Which medication is an opioid antagonist used to reverse opioid-induced respiratory
depression?
A) Naloxone
B) Sumatriptan
C) Gabapentin
D) Ketorolac
Correct Answer: Naloxone
Rationale: Naloxone competitively antagonizes opioid receptors and can rapidly reverse
opioid-induced respiratory and central nervous system depression. Because its duration may
be shorter than that of some opioids, repeated dosing or continued monitoring may be
necessary. The nurse must continue respiratory assessment after administration rather than
assuming one dose ends the risk.
7. Which adverse effect should a nurse anticipate most consistently with opioid therapy?
A) Severe diarrhea
B) Constipation
C) Hyperactivity
D) Polyuria
Correct Answer: Constipation
Rationale: Opioids decrease gastrointestinal motility and commonly produce constipation.
Unlike some adverse effects that may lessen with continued treatment, opioid-related
constipation often persists. Preventive measures may include adequate hydration, dietary
fiber when appropriate, activity, and prescribed bowel-regimen medications. Patients should
receive anticipatory education rather than waiting for severe constipation.
8. Which statement best describes physical dependence on an opioid?
A) The patient deliberately misuses the medication.
B) The medication produces no physiologic adaptation.
C) Abrupt discontinuation may cause withdrawal symptoms.
D) The patient always develops compulsive drug-seeking behavior.
Correct Answer: Abrupt discontinuation may cause withdrawal symptoms.
, Rationale: Physical dependence means the body has adapted to continued drug exposure, so
abrupt discontinuation can produce withdrawal symptoms. Dependence does not
automatically mean addiction. Addiction involves problematic compulsive use despite harm.
Distinguishing these concepts helps nurses provide appropriate education and avoid
stigmatizing patients receiving legitimate pain treatment.
9. Which medication would generally be inappropriate for routine treatment of severe
respiratory depression caused by opioids?
A) Naloxone
B) Oxygen therapy
C) Airway support
D) Acetaminophen
Correct Answer: Acetaminophen
Rationale: Acetaminophen does not reverse opioid-induced respiratory depression.
Management centers on airway and ventilatory support and opioid antagonism with
naloxone when clinically appropriate. Oxygen may support oxygenation but does not directly
reverse opioid effects. Prompt recognition is critical because untreated opioid-induced
respiratory depression can progress to cardiac arrest.
10. What is the primary therapeutic purpose of multimodal pain management?
A) Eliminate the need for assessment
B) Use different mechanisms to improve analgesia while reducing reliance on one
medication
C) Ensure every patient receives an opioid
D) Replace pharmacologic therapy completely
Correct Answer: Use different mechanisms to improve analgesia while reducing reliance
on one medication
Rationale: Multimodal analgesia combines interventions with different mechanisms, such as
nonopioid analgesics, regional techniques, physical measures, and carefully selected opioids.
The strategy can improve pain control while reducing opioid exposure and related adverse
effects. Pain assessment remains essential because treatment must be individualized to the
patient's condition and response.
11. Which patient factor increases concern for opioid accumulation and adverse effects?
A) Severe renal impairment
B) Mild seasonal allergies
C) Normal hepatic function
