N677 Controlled Substance Exam - 3 Versions 200 Questions & Answers with Rationales Academic Year 2026/2027

N677 Controlled Substance Exam - 3
Versions
200 Questions & Answers with Rationales
Academic Year 2026/2027

VERSION A (Questions 1-67)
Question 1
A nurse is caring for a patient prescribed morphine sulfate 10mg IV every 4 hours
PRN for severe pain. The patient reports pain 8/10. Which action should the nurse
take FIRST?
A) Administer the morphine as ordered
B) Assess the patient's respiratory rate
C) Request a higher dose from the provider
D) Offer non-pharmacological pain interventions
Answer: B) Assess the patient's respiratory rate
Rationale: Before administering any opioid medication, the nurse must assess the
patient's respiratory rate, depth, and pattern. Opioids can cause respiratory
depression, and administering morphine to a patient with a respiratory rate below
12 breaths/min could be dangerous. The other options may be appropriate after
assessment.


Question 2
A patient with chronic pain has been taking oxycodone/acetaminophen (Percocet)
10/325 mg every 6 hours for 6 months. Which laboratory value should the nurse
monitor most closely?

,A) Serum creatinine
B) Liver function tests
C) Complete blood count
D) Serum potassium
Answer: B) Liver function tests
Rationale: The acetaminophen component of Percocet can cause hepatotoxicity,
especially with long-term use. The maximum daily dose of acetaminophen is 4,000
mg (3,000 mg in elderly or those with liver disease). Liver function tests should be
monitored regularly in patients on chronic combination opioid/acetaminophen
therapy.


Question 3
Which schedule of controlled substance has the HIGHEST potential for abuse and
NO accepted medical use?
A) Schedule I
B) Schedule II
C) Schedule III
D) Schedule IV
Answer: A) Schedule I
Rationale: Schedule I substances have the highest abuse potential, no currently
accepted medical use in treatment in the United States, and lack accepted safety
for use under medical supervision. Examples include heroin, LSD, and marijuana
(at the federal level).


Question 4
A nurse is preparing to administer fentanyl patch 25 mcg/hr to a patient. Which
action is MOST important?
A) Apply the patch to a hairy area for better adherence
B) Heat the patch before application to increase absorption

,C) Remove the old patch before applying the new one
D) Apply the patch to an area that will be exposed to sunlight
Answer: C) Remove the old patch before applying the new one
Rationale: Fentanyl patches should be applied to a clean, dry, non-irritated, non-
hairy area. The old patch must be removed before applying a new one to prevent
overdose. Heat should not be applied to the patch as it increases absorption and
can lead to fatal overdose. The patch should not be applied to areas exposed to
direct sunlight.


Question 5
A patient prescribed methadone for opioid use disorder is also taking
benzodiazepines. What is the PRIMARY concern?
A) Increased risk of constipation
B) Increased risk of respiratory depression
C) Decreased effectiveness of methadone
D) Increased risk of seizures
Answer: B) Increased risk of respiratory depression
Rationale: Concurrent use of methadone (a full opioid agonist) and
benzodiazepines (CNS depressants) significantly increases the risk of respiratory
depression and fatal overdose. This is a serious drug interaction that requires
careful monitoring and dose adjustment.


Question 6
Which of the following is a Schedule II controlled substance?
A) Alprazolam (Xanax)
B) Codeine combination products
C) Oxycodone (OxyContin)
D) Diazepam (Valium)
Answer: C) Oxycodone (OxyContin)

, Rationale: Oxycodone is a Schedule II controlled substance due to its high abuse
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potential and severe psychological/physical dependence liability. Alprazolam and
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diazepam are Schedule IV, and codeine combination products are typically
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Schedule III or IV depending on the amount of codeine.
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Question 7 k




A patient is receiving naloxone (Narcan) for opioid overdose. What is the PRIORITY
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nursing action after administration?
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A) Monitor for withdrawal symptoms k k k




B) Administer another dose immediately k k k




C) Assess for return of respiratory function k k k k k




D) Call the provider for pain management orders
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Answer: C) Assess for return of respiratory function
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Rationale: The primary action of naloxone is to reverse respiratory depression
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caused by opioid overdose. After administration, the nurse's priority is to assess
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whether respiratory function has improved. The duration of action of naloxone is
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shorter than most opioids, so continued monitoring is essential.
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Question 8 k




A nurse is teaching a patient about tramadol. Which statement indicates the patient
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understands the teaching?
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A) "I can stop taking this medication abruptly when I feel better."
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B) "This medication is not addictive or habit-forming."
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C) "I should not take this medication with alcohol."
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D) "This medication is safe to take with my MAOI."
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Answer: C) "I should not take this medication with alcohol."
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Rationale: Tramadol is a centrally acting analgesic with opioid properties. It should
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not be taken with alcohol or other CNS depressants due to increased risk of
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respiratory depression and seizures. Tramadol is potentially addictive and should
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