NU141
Pharmacology for Nursing
Midterm Exam Review
2025
1. Which class of drugs is primarily used to reduce preload in heart failure patients?
A) Beta blockers
B) Loop diuretics
C) ACE inhibitors
D) Calcium channel blockers
Answer: B) Loop diuretics
Rationale: Loop diuretics (like furosemide) decrease fluid volume by promoting sodium and
water excretion, reducing preload and alleviating symptoms of heart failure.
2. A nurse is administering digoxin to a patient. What electrolyte imbalance increases the risk
of digoxin toxicity?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hyponatremia
Answer: B) Hypokalemia
Rationale: Low potassium levels enhance digoxin’s effects, increasing toxicity risk. It's crucial
to monitor potassium in patients on digoxin.
3. Which analgesic class has ceiling effects limiting their analgesic properties?
A) Opioids
B) NSAIDs
C) Acetaminophen
D) Antidepressants
Answer: B) NSAIDs
Rationale: NSAIDs have a ceiling effect where increasing doses no longer increase pain relief
but may raise adverse effect risk.
4. Which of the following antibiotics requires monitoring of peak and trough levels due to
nephrotoxicity?
,A) Vancomycin
B) Ciprofloxacin
C) Amoxicillin
D) Erythromycin
Answer: A) Vancomycin
Rationale: Vancomycin's narrow therapeutic window necessitates serum level monitoring to
avoid nephrotoxicity and ototoxicity.
5. When educating a patient about the use of metformin, which adverse effect must be
emphasized?
A) Lactic acidosis
B) Hyperglycemia
C) Hypokalemia
D) Renal calculi
Answer: A) Lactic acidosis
Rationale: Metformin can rarely cause lactic acidosis, especially in renal impairment; therefore,
renal function must be monitored.
6. Why should NSAIDs be used cautiously in patients with a history of peptic ulcers?
A) They increase gastric pH
B) They inhibit prostaglandin synthesis
C) They increase mucus production
D) They deactivate Helicobacter pylori
Answer: B) They inhibit prostaglandin synthesis
Rationale: NSAIDs inhibit prostaglandins that protect the gastric mucosa, increasing risk of
ulcers and bleeding.
7. Which medication is a known antidote for opioid overdose?
A) Flumazenil
B) Naloxone
C) Atropine
D) Protamine sulfate
Answer: B) Naloxone
Rationale: Naloxone competitively blocks opioid receptors, reversing respiratory depression
caused by opioid overdose.
8. Which pharmacokinetic process is primarily affected by hepatic impairment?
A) Absorption
B) Distribution
C) Metabolism
,D) Excretion
Answer: C) Metabolism
Rationale: The liver metabolizes many drugs; liver impairment slows metabolism, prolonging
drug half-life and increasing toxicity risk.
9. A nurse should monitor for which side effect when caring for a patient on aminoglycosides?
A) Nephrotoxicity
B) Hyperkalemia
C) Hepatotoxicity
D) Bradycardia
Answer: A) Nephrotoxicity
Rationale: Aminoglycosides like gentamicin can cause kidney damage; renal function
monitoring is essential.
10. Warfarin's anticoagulant effect is monitored using which laboratory test?
A) Prothrombin time (PT)/INR
B) Activated partial thromboplastin time (aPTT)
C) Platelet count
D) Bleeding time
Answer: A) Prothrombin time (PT)/INR
Rationale: PT/INR assesses the extrinsic pathway affected by warfarin, guiding dose
adjustments.
11. Which drug class is contraindicated in pregnancy due to risk of fetal malformations?
A) ACE inhibitors
B) Beta blockers
C) Calcium channel blockers
D) SSRIs
Answer: A) ACE inhibitors
Rationale: ACE inhibitors are teratogenic during pregnancy, particularly in the second and third
trimesters.
12. Which route of administration has the fastest onset of action?
A) Oral
B) Intramuscular
C) Subcutaneous
D) Intravenous
Answer: D) Intravenous
Rationale: IV administration delivers drug directly into circulation, resulting in the fastest onset.
, 13. What is the primary purpose of combining isoniazid and rifampin in tuberculosis treatment?
A) To reduce side effects
B) To prevent resistance
C) To enhance absorption
D) To shorten dosing schedule
Answer: B) To prevent resistance
Rationale: Combination therapy reduces the risk of Mycobacterium tuberculosis developing
resistance.
14. Which symptom indicates toxicity in a patient receiving phenytoin?
A) Bradycardia
B) Gingival hyperplasia
C) Ataxia and nystagmus
D) Rash
Answer: C) Ataxia and nystagmus
Rationale: Neurological symptoms like ataxia and nystagmus are common signs of phenytoin
toxicity.
15. A patient on beta blockers complains of fatigue and cold extremities. What is the most
appropriate nursing action?
A) Discontinue beta blocker immediately
B) Assess for bradycardia and hypotension
C) Instruct the patient to increase fluid intake
D) Check blood glucose levels
Answer: B) Assess for bradycardia and hypotension
Rationale: Beta blockers can reduce heart rate and cardiac output leading to fatigue and cold
limbs; vital signs should be evaluated first.
16. Which drug class is first-line therapy for controlling seizures in epilepsy?
A) Benzodiazepines
B) Barbiturates
C) Hydantoins
D) SSRIs
Answer: C) Hydantoins
Rationale: Phenytoin, a hydantoin, is commonly used for seizure control due to its
effectiveness in partial and generalized seizures.
17. Which of the following increases the risk of serotonin syndrome?
A) Combining SSRIs and MAO inhibitors
Pharmacology for Nursing
Midterm Exam Review
2025
1. Which class of drugs is primarily used to reduce preload in heart failure patients?
A) Beta blockers
B) Loop diuretics
C) ACE inhibitors
D) Calcium channel blockers
Answer: B) Loop diuretics
Rationale: Loop diuretics (like furosemide) decrease fluid volume by promoting sodium and
water excretion, reducing preload and alleviating symptoms of heart failure.
2. A nurse is administering digoxin to a patient. What electrolyte imbalance increases the risk
of digoxin toxicity?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hyponatremia
Answer: B) Hypokalemia
Rationale: Low potassium levels enhance digoxin’s effects, increasing toxicity risk. It's crucial
to monitor potassium in patients on digoxin.
3. Which analgesic class has ceiling effects limiting their analgesic properties?
A) Opioids
B) NSAIDs
C) Acetaminophen
D) Antidepressants
Answer: B) NSAIDs
Rationale: NSAIDs have a ceiling effect where increasing doses no longer increase pain relief
but may raise adverse effect risk.
4. Which of the following antibiotics requires monitoring of peak and trough levels due to
nephrotoxicity?
,A) Vancomycin
B) Ciprofloxacin
C) Amoxicillin
D) Erythromycin
Answer: A) Vancomycin
Rationale: Vancomycin's narrow therapeutic window necessitates serum level monitoring to
avoid nephrotoxicity and ototoxicity.
5. When educating a patient about the use of metformin, which adverse effect must be
emphasized?
A) Lactic acidosis
B) Hyperglycemia
C) Hypokalemia
D) Renal calculi
Answer: A) Lactic acidosis
Rationale: Metformin can rarely cause lactic acidosis, especially in renal impairment; therefore,
renal function must be monitored.
6. Why should NSAIDs be used cautiously in patients with a history of peptic ulcers?
A) They increase gastric pH
B) They inhibit prostaglandin synthesis
C) They increase mucus production
D) They deactivate Helicobacter pylori
Answer: B) They inhibit prostaglandin synthesis
Rationale: NSAIDs inhibit prostaglandins that protect the gastric mucosa, increasing risk of
ulcers and bleeding.
7. Which medication is a known antidote for opioid overdose?
A) Flumazenil
B) Naloxone
C) Atropine
D) Protamine sulfate
Answer: B) Naloxone
Rationale: Naloxone competitively blocks opioid receptors, reversing respiratory depression
caused by opioid overdose.
8. Which pharmacokinetic process is primarily affected by hepatic impairment?
A) Absorption
B) Distribution
C) Metabolism
,D) Excretion
Answer: C) Metabolism
Rationale: The liver metabolizes many drugs; liver impairment slows metabolism, prolonging
drug half-life and increasing toxicity risk.
9. A nurse should monitor for which side effect when caring for a patient on aminoglycosides?
A) Nephrotoxicity
B) Hyperkalemia
C) Hepatotoxicity
D) Bradycardia
Answer: A) Nephrotoxicity
Rationale: Aminoglycosides like gentamicin can cause kidney damage; renal function
monitoring is essential.
10. Warfarin's anticoagulant effect is monitored using which laboratory test?
A) Prothrombin time (PT)/INR
B) Activated partial thromboplastin time (aPTT)
C) Platelet count
D) Bleeding time
Answer: A) Prothrombin time (PT)/INR
Rationale: PT/INR assesses the extrinsic pathway affected by warfarin, guiding dose
adjustments.
11. Which drug class is contraindicated in pregnancy due to risk of fetal malformations?
A) ACE inhibitors
B) Beta blockers
C) Calcium channel blockers
D) SSRIs
Answer: A) ACE inhibitors
Rationale: ACE inhibitors are teratogenic during pregnancy, particularly in the second and third
trimesters.
12. Which route of administration has the fastest onset of action?
A) Oral
B) Intramuscular
C) Subcutaneous
D) Intravenous
Answer: D) Intravenous
Rationale: IV administration delivers drug directly into circulation, resulting in the fastest onset.
, 13. What is the primary purpose of combining isoniazid and rifampin in tuberculosis treatment?
A) To reduce side effects
B) To prevent resistance
C) To enhance absorption
D) To shorten dosing schedule
Answer: B) To prevent resistance
Rationale: Combination therapy reduces the risk of Mycobacterium tuberculosis developing
resistance.
14. Which symptom indicates toxicity in a patient receiving phenytoin?
A) Bradycardia
B) Gingival hyperplasia
C) Ataxia and nystagmus
D) Rash
Answer: C) Ataxia and nystagmus
Rationale: Neurological symptoms like ataxia and nystagmus are common signs of phenytoin
toxicity.
15. A patient on beta blockers complains of fatigue and cold extremities. What is the most
appropriate nursing action?
A) Discontinue beta blocker immediately
B) Assess for bradycardia and hypotension
C) Instruct the patient to increase fluid intake
D) Check blood glucose levels
Answer: B) Assess for bradycardia and hypotension
Rationale: Beta blockers can reduce heart rate and cardiac output leading to fatigue and cold
limbs; vital signs should be evaluated first.
16. Which drug class is first-line therapy for controlling seizures in epilepsy?
A) Benzodiazepines
B) Barbiturates
C) Hydantoins
D) SSRIs
Answer: C) Hydantoins
Rationale: Phenytoin, a hydantoin, is commonly used for seizure control due to its
effectiveness in partial and generalized seizures.
17. Which of the following increases the risk of serotonin syndrome?
A) Combining SSRIs and MAO inhibitors
