NU 578 Unit 2, covering Codeine, Controlled
Substances, and Psychopharmacology, with
questions and detailed rationales.
150 QUESTIONS
TABLE OF CONTENTS
# TOPIC
NU 578 Unit 2, covering Codeine, Controlled Substances, and Psychopharmacology, with questions and
1
detailed rationales.
Page 1
,Q1
Codeine exerts its analgesic effect primarily through which mechanism?
A) Direct activation of opioid receptors
B) Conversion to morphine, which is responsible for its therapeutic effects CORRECT
C) Blocking sodium channels in the CNS
D) Inhibition of prostaglandin synthesis
Rationale
** Codeine is a weak opioid that is metabolized in the liver to morphine, which is responsible for its
analgesic effects. The capacity to metabolize codeine can vary considerably between individuals.
Q2
A patient is known to be a CYP2D6 ultra-rapid metabolizer. What is the most significant risk
associated with administering codeine to this patient?
A) Reduced therapeutic effect
B) Life-threatening respiratory depression due to rapid conversion to morphine CORRECT
C) Severe constipation
D) Hypertensive crisis
Rationale
** Ultra-rapid metabolizers convert codeine into morphine more rapidly and completely than other people,
resulting in higher-than-expected serum morphine levels. Even at labeled dosages, these individuals
may experience life-threatening or fatal respiratory depression.
Q3
Codeine is contraindicated in which of the following patient populations?
A) Adults with a history of hypertension
B) Children younger than 12 years of age CORRECT
C) Patients with diabetes mellitus
D) Elderly patients with osteoarthritis
Page 2
,Rationale
** Codeine is contraindicated for all children younger than 12 years of age due to the risk of life-
threatening respiratory depression and death. It is also contraindicated for post-operative management in
pediatric patients younger than 18 years of age following tonsillectomy and/or adenoidectomy.
Q4
A breastfeeding mother is prescribed codeine for pain. What is the primary concern for the
nursing infant?
A) The infant may develop jaundice
B) The infant may experience morphine overdose through breast milk CORRECT
C) The infant may develop a rash
D) The infant may have difficulty sleeping
Rationale
** Nursing mothers who are ultra-rapid metabolizers may produce breast milk containing higher-than-
expected levels of morphine, which can lead to severe adverse events in their infants, including
respiratory depression. Breastfeeding is not recommended during treatment with codeine.
Q5
Which of the following is a common adverse effect of morphine related to the respiratory
system?
A) Bronchodilation
B) Increased respiratory rate
C) Respiratory depression CORRECT
D) Hyperventilation
Rationale
** Respiratory depression is a significant and potentially life-threatening adverse effect of morphine.
Morphine should not be given to patients with a respiratory rate less than 12, and respiratory depression
should be reversed with naloxone.
Page 3
, Q6
Morphine is contraindicated in patients with which of the following conditions?
A) History of hypertension
B) History of respiratory disease (COPD/Asthma), head injury, and hypotension CORRECT
with decreased blood volume
C) History of diabetes mellitus
D) History of gastrointestinal bleeding
Rationale
** Morphine is contraindicated in patients with a history of respiratory disease (COPD/Asthma), head
injury (due to increased ICP), concurrent use with CNS depressants, and hypotension with decreased
blood volume.
Q7
Which medication is used to reverse opioid-induced respiratory depression?
A) Flumazenil
B) Naloxone CORRECT
C) Protamine sulfate
D) Vitamin K
Rationale
** Naloxone (Narcan) is an opioid antagonist that competes for opioid receptors, thereby blocking opioid
actions and reversing all narcotic effects including pain relief, euphoria, and respiratory depression.
Q8
Which of the following is NOT a side effect of opioids?
A) Constipation
B) Miosis
C) Diarrhea CORRECT
D) Urinary retention
Page 4
Substances, and Psychopharmacology, with
questions and detailed rationales.
150 QUESTIONS
TABLE OF CONTENTS
# TOPIC
NU 578 Unit 2, covering Codeine, Controlled Substances, and Psychopharmacology, with questions and
1
detailed rationales.
Page 1
,Q1
Codeine exerts its analgesic effect primarily through which mechanism?
A) Direct activation of opioid receptors
B) Conversion to morphine, which is responsible for its therapeutic effects CORRECT
C) Blocking sodium channels in the CNS
D) Inhibition of prostaglandin synthesis
Rationale
** Codeine is a weak opioid that is metabolized in the liver to morphine, which is responsible for its
analgesic effects. The capacity to metabolize codeine can vary considerably between individuals.
Q2
A patient is known to be a CYP2D6 ultra-rapid metabolizer. What is the most significant risk
associated with administering codeine to this patient?
A) Reduced therapeutic effect
B) Life-threatening respiratory depression due to rapid conversion to morphine CORRECT
C) Severe constipation
D) Hypertensive crisis
Rationale
** Ultra-rapid metabolizers convert codeine into morphine more rapidly and completely than other people,
resulting in higher-than-expected serum morphine levels. Even at labeled dosages, these individuals
may experience life-threatening or fatal respiratory depression.
Q3
Codeine is contraindicated in which of the following patient populations?
A) Adults with a history of hypertension
B) Children younger than 12 years of age CORRECT
C) Patients with diabetes mellitus
D) Elderly patients with osteoarthritis
Page 2
,Rationale
** Codeine is contraindicated for all children younger than 12 years of age due to the risk of life-
threatening respiratory depression and death. It is also contraindicated for post-operative management in
pediatric patients younger than 18 years of age following tonsillectomy and/or adenoidectomy.
Q4
A breastfeeding mother is prescribed codeine for pain. What is the primary concern for the
nursing infant?
A) The infant may develop jaundice
B) The infant may experience morphine overdose through breast milk CORRECT
C) The infant may develop a rash
D) The infant may have difficulty sleeping
Rationale
** Nursing mothers who are ultra-rapid metabolizers may produce breast milk containing higher-than-
expected levels of morphine, which can lead to severe adverse events in their infants, including
respiratory depression. Breastfeeding is not recommended during treatment with codeine.
Q5
Which of the following is a common adverse effect of morphine related to the respiratory
system?
A) Bronchodilation
B) Increased respiratory rate
C) Respiratory depression CORRECT
D) Hyperventilation
Rationale
** Respiratory depression is a significant and potentially life-threatening adverse effect of morphine.
Morphine should not be given to patients with a respiratory rate less than 12, and respiratory depression
should be reversed with naloxone.
Page 3
, Q6
Morphine is contraindicated in patients with which of the following conditions?
A) History of hypertension
B) History of respiratory disease (COPD/Asthma), head injury, and hypotension CORRECT
with decreased blood volume
C) History of diabetes mellitus
D) History of gastrointestinal bleeding
Rationale
** Morphine is contraindicated in patients with a history of respiratory disease (COPD/Asthma), head
injury (due to increased ICP), concurrent use with CNS depressants, and hypotension with decreased
blood volume.
Q7
Which medication is used to reverse opioid-induced respiratory depression?
A) Flumazenil
B) Naloxone CORRECT
C) Protamine sulfate
D) Vitamin K
Rationale
** Naloxone (Narcan) is an opioid antagonist that competes for opioid receptors, thereby blocking opioid
actions and reversing all narcotic effects including pain relief, euphoria, and respiratory depression.
Q8
Which of the following is NOT a side effect of opioids?
A) Constipation
B) Miosis
C) Diarrhea CORRECT
D) Urinary retention
Page 4
