BIO290 / BIO 290 Pharmacology Exam 2
Study Guide | Modules 2 & 3 Complete
Review with Drug Mechanisms, Adverse
Effects, Contraindications & Key Concepts |
Joyce University | 2026 Update
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
146 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses application-level mastery of core pharmacology concepts across Modules 2 and 3,
including autonomic pharmacology, cardiovascular and renal agents, antimicrobials, endocrine drugs, CNS
agents, and related adverse effects and contraindications. Items require students to interpret mechanisms,
predict therapeutic and adverse outcomes, and apply contraindication and monitoring principles to clinical
scenarios.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 77% (standard for pre-licensure pharmacology exams).
HIGHP - Page 1 of 46
,1. A patient with asthma is prescribed a nonselective beta-adrenergic blocker for
hypertension. Which adverse effect is most directly explained by blockade of beta-2
receptors in the airways?
[ ] A. Reflex tachycardia
[ ] B. Bronchoconstriction
[ ] C. Hyperglycemia
[ ] D. Mydriasis
CORRECT: B. Bronchoconstriction
Beta-2 receptors in bronchial smooth muscle mediate bronchodilation; blockade promotes
bronchoconstriction and can precipitate bronchospasm in asthma. Reflex tachycardia and mydriasis are not
beta-2 effects, and hyperglycemia is more associated with alpha-2 or nonselective blockade affecting insulin
release.
2. A patient taking lisinopril develops a persistent dry cough. Which mechanism best
explains this adverse effect?
[ ] A. Accumulation of bradykinin and substance P
[ ] B. Direct irritation of bronchial beta-2 receptors
[ ] C. Increased angiotensin II in the lungs
[ ] D. Blockade of aldosterone receptors in the airway
CORRECT: A. Accumulation of bradykinin and substance P
ACE inhibitors reduce degradation of bradykinin and substance P, which irritate airway sensory nerves and
cause cough. Angiotensin II is decreased, not increased, and beta-2 or aldosterone receptor airway effects
do not account for this class-specific adverse effect.
3. Which instruction is most important for a patient starting metronidazole for a anaerobic
infection?
[ ] A. Take with dairy products to reduce GI upset
[ ] B. Avoid alcohol-containing products during therapy and for 3 days after
[ ] C. Double the dose if a dose is missed
[ ] D. Expect red-orange discoloration of urine
CORRECT: B. Avoid alcohol-containing products during therapy and for 3 days after
Metronidazole can produce a disulfiram-like reaction with alcohol (flushing, nausea, tachycardia), so alcohol
must be avoided during and shortly after therapy. Dairy does not reduce GI upset, missed doses are not
doubled, and red-orange urine is associated with rifampin or phenazopyridine, not metronidazole.
HIGHP - Page 2 of 46
,4. A patient with type 2 diabetes is prescribed metformin. Which laboratory value should
be monitored most closely because of an increased risk of lactic acidosis?
[ ] A. Serum potassium
[ ] B. Serum creatinine
[ ] C. Serum calcium
[ ] D. Serum magnesium
CORRECT: B. Serum creatinine
Metformin is renally eliminated; renal impairment increases metformin accumulation and the risk of lactic
acidosis, so serum creatinine and eGFR are key monitoring parameters. Potassium, calcium, and
magnesium are not the primary labs linked to metformin-associated lactic acidosis.
5. Which statement best describes the mechanism of action of proton pump inhibitors
(PPIs) such as omeprazole?
[ ] A. They neutralize gastric acid directly in the lumen.
[ ] B. They irreversibly inhibit the H+/K+-ATPase pump in parietal cells.
[ ] C. They block histamine H2 receptors on parietal cells.
[ ] D. They coat the ulcer surface to protect against acid.
CORRECT: B. They irreversibly inhibit the H+/K+-ATPase pump in parietal cells.
PPIs are prodrugs activated in acidic canaliculi and irreversibly inhibit the parietal cell H+/K+-ATPase,
suppressing acid secretion. Antacids neutralize acid, H2 blockers act at histamine receptors, and sucralfate
provides a protective barrier.
6. A patient receiving heparin has a platelet count drop from 250,000 to 80,000/mm3 with
new thrombosis. Which condition should be suspected?
[ ] A. Heparin-induced thrombocytopenia (HIT)
[ ] B. Vitamin K deficiency
[ ] C. Disseminated intravascular coagulation from sepsis
[ ] D. Immune thrombocytopenic purpura
CORRECT: A. Heparin-induced thrombocytopenia (HIT)
HIT is an immune-mediated reaction to heparin-platelet factor 4 complexes causing thrombocytopenia and
paradoxical thrombosis. Vitamin K deficiency affects clotting factors, not platelet count, and DIC or ITP would
not be directly linked to heparin exposure with this pattern.
7. Which patient teaching is essential for a patient prescribed levothyroxine?
[ ] A. Take the medication at bedtime with a high-fiber snack.
[ ] B. Take it in the morning on an empty stomach, 30-60 minutes before breakfast.
[ ] C. Take it with calcium supplements to prevent bone loss.
HIGHP - Page 3 of 46
, [ ] D. Stop the medication once energy levels improve.
CORRECT: B. Take it in the morning on an empty stomach, 30-60 minutes before breakfast.
Levothyroxine absorption is enhanced on an empty stomach, so it should be taken in the morning 30-60
minutes before eating. Calcium and high-fiber foods impair absorption, and therapy is lifelong for most
patients, not stopped when symptoms improve.
8. A patient on furosemide reports muscle cramps and fatigue. Which electrolyte
imbalance is most likely?
[ ] A. Hyperkalemia
[ ] B. Hypokalemia
[ ] C. Hypernatremia
[ ] D. Hypercalcemia
CORRECT: B. Hypokalemia
Loop diuretics such as furosemide increase renal potassium excretion, commonly causing hypokalemia with
muscle cramps, fatigue, and weakness. Hyperkalemia is more typical of potassium-sparing diuretics, and
hypernatremia or hypercalcemia are not the classic furosemide-related imbalances.
9. Which finding is most characteristic of an adverse effect of opioid analgesics such as
morphine?
[ ] A. Diarrhea
[ ] B. Respiratory depression
[ ] C. Hypertension
[ ] D. Mydriasis
CORRECT: B. Respiratory depression
Opioids activate mu receptors in the brainstem, depressing respiratory drive, which is the most serious
adverse effect. Constipation, not diarrhea, is common; hypotension rather than hypertension occurs; and
miosis, not mydriasis, is typical.
10. A patient is prescribed warfarin and asks about dietary vitamin K. Which response is
most accurate?
[ ] A. Avoid all vitamin K-rich foods completely.
[ ] B. Maintain a consistent intake of vitamin K-rich foods and monitor INR regularly.
[ ] C. Increase vitamin K intake to enhance warfarin's effect.
[ ] D. Vitamin K intake has no effect on warfarin therapy.
CORRECT: B. Maintain a consistent intake of vitamin K-rich foods and monitor INR regularly.
Warfarin inhibits vitamin K-dependent clotting factors, so consistent dietary vitamin K intake is important to
HIGHP - Page 4 of 46
Study Guide | Modules 2 & 3 Complete
Review with Drug Mechanisms, Adverse
Effects, Contraindications & Key Concepts |
Joyce University | 2026 Update
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
146 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses application-level mastery of core pharmacology concepts across Modules 2 and 3,
including autonomic pharmacology, cardiovascular and renal agents, antimicrobials, endocrine drugs, CNS
agents, and related adverse effects and contraindications. Items require students to interpret mechanisms,
predict therapeutic and adverse outcomes, and apply contraindication and monitoring principles to clinical
scenarios.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 77% (standard for pre-licensure pharmacology exams).
HIGHP - Page 1 of 46
,1. A patient with asthma is prescribed a nonselective beta-adrenergic blocker for
hypertension. Which adverse effect is most directly explained by blockade of beta-2
receptors in the airways?
[ ] A. Reflex tachycardia
[ ] B. Bronchoconstriction
[ ] C. Hyperglycemia
[ ] D. Mydriasis
CORRECT: B. Bronchoconstriction
Beta-2 receptors in bronchial smooth muscle mediate bronchodilation; blockade promotes
bronchoconstriction and can precipitate bronchospasm in asthma. Reflex tachycardia and mydriasis are not
beta-2 effects, and hyperglycemia is more associated with alpha-2 or nonselective blockade affecting insulin
release.
2. A patient taking lisinopril develops a persistent dry cough. Which mechanism best
explains this adverse effect?
[ ] A. Accumulation of bradykinin and substance P
[ ] B. Direct irritation of bronchial beta-2 receptors
[ ] C. Increased angiotensin II in the lungs
[ ] D. Blockade of aldosterone receptors in the airway
CORRECT: A. Accumulation of bradykinin and substance P
ACE inhibitors reduce degradation of bradykinin and substance P, which irritate airway sensory nerves and
cause cough. Angiotensin II is decreased, not increased, and beta-2 or aldosterone receptor airway effects
do not account for this class-specific adverse effect.
3. Which instruction is most important for a patient starting metronidazole for a anaerobic
infection?
[ ] A. Take with dairy products to reduce GI upset
[ ] B. Avoid alcohol-containing products during therapy and for 3 days after
[ ] C. Double the dose if a dose is missed
[ ] D. Expect red-orange discoloration of urine
CORRECT: B. Avoid alcohol-containing products during therapy and for 3 days after
Metronidazole can produce a disulfiram-like reaction with alcohol (flushing, nausea, tachycardia), so alcohol
must be avoided during and shortly after therapy. Dairy does not reduce GI upset, missed doses are not
doubled, and red-orange urine is associated with rifampin or phenazopyridine, not metronidazole.
HIGHP - Page 2 of 46
,4. A patient with type 2 diabetes is prescribed metformin. Which laboratory value should
be monitored most closely because of an increased risk of lactic acidosis?
[ ] A. Serum potassium
[ ] B. Serum creatinine
[ ] C. Serum calcium
[ ] D. Serum magnesium
CORRECT: B. Serum creatinine
Metformin is renally eliminated; renal impairment increases metformin accumulation and the risk of lactic
acidosis, so serum creatinine and eGFR are key monitoring parameters. Potassium, calcium, and
magnesium are not the primary labs linked to metformin-associated lactic acidosis.
5. Which statement best describes the mechanism of action of proton pump inhibitors
(PPIs) such as omeprazole?
[ ] A. They neutralize gastric acid directly in the lumen.
[ ] B. They irreversibly inhibit the H+/K+-ATPase pump in parietal cells.
[ ] C. They block histamine H2 receptors on parietal cells.
[ ] D. They coat the ulcer surface to protect against acid.
CORRECT: B. They irreversibly inhibit the H+/K+-ATPase pump in parietal cells.
PPIs are prodrugs activated in acidic canaliculi and irreversibly inhibit the parietal cell H+/K+-ATPase,
suppressing acid secretion. Antacids neutralize acid, H2 blockers act at histamine receptors, and sucralfate
provides a protective barrier.
6. A patient receiving heparin has a platelet count drop from 250,000 to 80,000/mm3 with
new thrombosis. Which condition should be suspected?
[ ] A. Heparin-induced thrombocytopenia (HIT)
[ ] B. Vitamin K deficiency
[ ] C. Disseminated intravascular coagulation from sepsis
[ ] D. Immune thrombocytopenic purpura
CORRECT: A. Heparin-induced thrombocytopenia (HIT)
HIT is an immune-mediated reaction to heparin-platelet factor 4 complexes causing thrombocytopenia and
paradoxical thrombosis. Vitamin K deficiency affects clotting factors, not platelet count, and DIC or ITP would
not be directly linked to heparin exposure with this pattern.
7. Which patient teaching is essential for a patient prescribed levothyroxine?
[ ] A. Take the medication at bedtime with a high-fiber snack.
[ ] B. Take it in the morning on an empty stomach, 30-60 minutes before breakfast.
[ ] C. Take it with calcium supplements to prevent bone loss.
HIGHP - Page 3 of 46
, [ ] D. Stop the medication once energy levels improve.
CORRECT: B. Take it in the morning on an empty stomach, 30-60 minutes before breakfast.
Levothyroxine absorption is enhanced on an empty stomach, so it should be taken in the morning 30-60
minutes before eating. Calcium and high-fiber foods impair absorption, and therapy is lifelong for most
patients, not stopped when symptoms improve.
8. A patient on furosemide reports muscle cramps and fatigue. Which electrolyte
imbalance is most likely?
[ ] A. Hyperkalemia
[ ] B. Hypokalemia
[ ] C. Hypernatremia
[ ] D. Hypercalcemia
CORRECT: B. Hypokalemia
Loop diuretics such as furosemide increase renal potassium excretion, commonly causing hypokalemia with
muscle cramps, fatigue, and weakness. Hyperkalemia is more typical of potassium-sparing diuretics, and
hypernatremia or hypercalcemia are not the classic furosemide-related imbalances.
9. Which finding is most characteristic of an adverse effect of opioid analgesics such as
morphine?
[ ] A. Diarrhea
[ ] B. Respiratory depression
[ ] C. Hypertension
[ ] D. Mydriasis
CORRECT: B. Respiratory depression
Opioids activate mu receptors in the brainstem, depressing respiratory drive, which is the most serious
adverse effect. Constipation, not diarrhea, is common; hypotension rather than hypertension occurs; and
miosis, not mydriasis, is typical.
10. A patient is prescribed warfarin and asks about dietary vitamin K. Which response is
most accurate?
[ ] A. Avoid all vitamin K-rich foods completely.
[ ] B. Maintain a consistent intake of vitamin K-rich foods and monitor INR regularly.
[ ] C. Increase vitamin K intake to enhance warfarin's effect.
[ ] D. Vitamin K intake has no effect on warfarin therapy.
CORRECT: B. Maintain a consistent intake of vitamin K-rich foods and monitor INR regularly.
Warfarin inhibits vitamin K-dependent clotting factors, so consistent dietary vitamin K intake is important to
HIGHP - Page 4 of 46
