NU 150 Exam 3 Pharmacology Review:
200 Verified Q&As (2026/2027 Update)
Q1. A nurse is preparing to administer morning medications. Which of the following
therapeutic actions best describes the mechanism of action of a proton pump inhibitor
(PPI) like omeprazole?
A. It chemically neutralizes hydrochloric acid in the stomach lumen.
B. It binds to H2 receptors on parietal cells, blocking histamine-induced acid production.
C. It blocks the H+/K+ ATPase enzyme system in parietal cells, halting the final step of acid
secretion.
D. It forms a protective, gel-like barrier over gastric ulcerations.
, VERIFIED ANSWER: C. It blocks the H+/K+ ATPase enzyme system in parietal cells,
halting the final step of acid secretion.
RATIONALE: Proton pump inhibitors irreversibly bind to the hydrogen-potassium
ATPase enzyme system (the proton pump) within gastric parietal cells. This action blocks
the final common pathway of gastric acid production, making it highly effective for GERD
and peptic ulcer disease. Choice A describes antacids; Choice B describes H2 receptor
antagonists; Choice D describes mucosal protectants like sucralfate.
Q2. A patient taking levofloxacin for a complicated urinary tract infection develops
severe, watery diarrhea and intense abdominal cramping. What should the nurse
suspect is occurring?
A. An expected, self-limiting adverse effect of broad-spectrum therapy.
B. A Type 1 hypersensitivity reaction to the fluoroquinolone class.
C. A secondary superinfection caused by Clostridium difficile.
D. Acute toxic megacolon secondary to chemical drug irritation.
VERIFIED ANSWER: C. A secondary superinfection caused by Clostridium difficile.
RATIONALE: Broad-spectrum fluoroquinolones like levofloxacin eradicate normal
intestinal flora. This allows opportunistic, toxin-producing pathogens like Clostridium
difficile to proliferate, resulting in antibiotic-associated pseudomembranous colitis. This
requires immediate stool testing and cessation of the causative antibiotic.
Q3. A nurse is reviewing a patient's chart who has been taking high-dose ibuprofen
daily for osteoarthritis for over a year. The nurse should recognize that this patient is at
highest risk for which systemic complications?
A. Respiratory depression and profound sedation.
B. Gastrointestinal ulceration and myocardial infarction.
C. Hepatic encephalopathy and hyperbilirubinemia.
D. Severe leukopenia and hemolytic anemia.
VERIFIED ANSWER: B. Gastrointestinal ulceration and myocardial infarction.
RATIONALE: Non-selective NSAIDs inhibit both COX-1 and COX-2 enzymes. Inhibiting
COX-1 depletes protective GI prostaglandins, leading to mucosal breakdown and
ulceration. Additionally, non-aspirin NSAIDs carry a black box warning for increasing the
risk of serious thrombotic events, myocardial infarction, stroke, and new-onset or
worsening hypertension.
, Q4. A client with a known history of severe chronic alcohol use disorder is admitted for
minor musculoskeletal pain. The provider prescribes acetaminophen. The nurse knows
that the maximum daily safe dose of acetaminophen for this specific client is:
A. 4,000 mg per day.
B. 3,000 mg per day.
C. 2,000 mg per day.
D. 1,000 mg per day.
VERIFIED ANSWER: C. 2,000 mg per day.
RATIONALE: While the absolute maximum daily limit of acetaminophen for a healthy
adult is 4,000 mg (and frequently capped at 3,000 mg in older populations), patients with
chronic alcohol abuse or underlying hepatic impairment must not exceed 2,000 mg per
day. Chronic alcohol consumption induces the CYP2E1 pathway, accelerating the
formation of the highly hepatotoxic metabolite NAPQI, which exhausts glutathione stores.
Q5. The nurse administers intravenous morphine sulfate to a postoperative client.
Which assessment finding requires an immediate, priority nursing intervention?
A. The client reports a pain level of 4 out of 10.
B. The client's pupillary exam shows bilateral constriction (miosis).
C. The client's respiratory rate is 8 breaths per minute.
D. The client has not had a bowel movement in 48 hours.
VERIFIED ANSWER: C. The client's respiratory rate is 8 breaths per minute.
RATIONALE: The most dangerous, life-threatening adverse effect of opioid agonists like
morphine is central nervous system and respiratory depression. A respiratory rate below 10
to 12 breaths per minute requires immediate stimulation, oxygen supplementation, and
potential administration of the opioid antagonist naloxone. Constipation and miosis are
expected side effects but are not immediately life-threatening.
Q6. An operating room nurse is preparing to administer preoperative atropine. The
nurse should instruct the patient that the primary therapeutic goal of this medication is
to:
A. Provide conscious sedation and alleviate baseline situational anxiety.
B. Decrease oral, salivary, and respiratory secretions to prevent aspiration.
C. Stimulate bladder contraction to prevent postoperative urinary retention.
D. Lower the heart rate to minimize myocardial oxygen demands under anesthesia.
, VERIFIED ANSWER: B. Decrease oral, salivary, and respiratory secretions to prevent
aspiration.
RATIONALE: Atropine is a potent anticholinergic drug that blocks muscarinic
acetylcholine receptors. Preoperatively, it is used to dry oral and respiratory secretions,
which drastically reduces the risk of aspiration during endotracheal intubation and
general anesthesia. Because it blocks parasympathetic inputs, it causes tachycardia and
urinary retention, rather than treating them.
Q7. A student nurse asks how beta-lactam antibiotics, such as penicillins and
cephalosporins, achieve their bactericidal effects. The supervising nurse correctly
responds that these drugs:
A. Bind irreversibly to the 50S ribosomal subunit to disrupt protein translation.
B. Inhibit bacterial DNA gyrase, stopping DNA replication.
C. Disrupt the synthesis of the bacterial peptidoglycan cell wall, causing osmotic lysis.
D. Antagonize folic acid synthesis pathways required for bacterial survival.
VERIFIED ANSWER: C. Disrupt the synthesis of the bacterial peptidoglycan cell wall,
causing osmotic lysis.
RATIONALE: Penicillins and cephalosporins are beta-lactam antibiotics that selectively
target penicillin-binding proteins (PBPs) in the bacterial cell wall. By inhibiting the cross-
linking of peptidoglycan strands, the cell wall becomes structurally unstable, leading to
fluid influx, osmotic swelling, and bactericidal lysis.
Q8. A patient on a continuous IV infusion of an opioid agonist reports severe abdominal
bloating and lack of bowel movements. Which bowel regimen should the nurse
anticipate the provider ordering?
A. A bulk-forming laxative such as psyllium.
B. Continuous monitoring without active chemical laxative interventions.
C. A combination of a stimulant laxative (senna) and a stool softener (docusate).
D. An osmotic laxative restricted to a single PRN dose.
VERIFIED ANSWER: C. A combination of a stimulant laxative (senna) and a stool
softener (docusate).
RATIONALE: Opioids directly stimulate mu receptors in the enteric nervous system,
causing profound decreases in peristalsis and increased water reabsorption. This results in
opioid-induced constipation, for which tolerance never develops. A proactive, daily
200 Verified Q&As (2026/2027 Update)
Q1. A nurse is preparing to administer morning medications. Which of the following
therapeutic actions best describes the mechanism of action of a proton pump inhibitor
(PPI) like omeprazole?
A. It chemically neutralizes hydrochloric acid in the stomach lumen.
B. It binds to H2 receptors on parietal cells, blocking histamine-induced acid production.
C. It blocks the H+/K+ ATPase enzyme system in parietal cells, halting the final step of acid
secretion.
D. It forms a protective, gel-like barrier over gastric ulcerations.
, VERIFIED ANSWER: C. It blocks the H+/K+ ATPase enzyme system in parietal cells,
halting the final step of acid secretion.
RATIONALE: Proton pump inhibitors irreversibly bind to the hydrogen-potassium
ATPase enzyme system (the proton pump) within gastric parietal cells. This action blocks
the final common pathway of gastric acid production, making it highly effective for GERD
and peptic ulcer disease. Choice A describes antacids; Choice B describes H2 receptor
antagonists; Choice D describes mucosal protectants like sucralfate.
Q2. A patient taking levofloxacin for a complicated urinary tract infection develops
severe, watery diarrhea and intense abdominal cramping. What should the nurse
suspect is occurring?
A. An expected, self-limiting adverse effect of broad-spectrum therapy.
B. A Type 1 hypersensitivity reaction to the fluoroquinolone class.
C. A secondary superinfection caused by Clostridium difficile.
D. Acute toxic megacolon secondary to chemical drug irritation.
VERIFIED ANSWER: C. A secondary superinfection caused by Clostridium difficile.
RATIONALE: Broad-spectrum fluoroquinolones like levofloxacin eradicate normal
intestinal flora. This allows opportunistic, toxin-producing pathogens like Clostridium
difficile to proliferate, resulting in antibiotic-associated pseudomembranous colitis. This
requires immediate stool testing and cessation of the causative antibiotic.
Q3. A nurse is reviewing a patient's chart who has been taking high-dose ibuprofen
daily for osteoarthritis for over a year. The nurse should recognize that this patient is at
highest risk for which systemic complications?
A. Respiratory depression and profound sedation.
B. Gastrointestinal ulceration and myocardial infarction.
C. Hepatic encephalopathy and hyperbilirubinemia.
D. Severe leukopenia and hemolytic anemia.
VERIFIED ANSWER: B. Gastrointestinal ulceration and myocardial infarction.
RATIONALE: Non-selective NSAIDs inhibit both COX-1 and COX-2 enzymes. Inhibiting
COX-1 depletes protective GI prostaglandins, leading to mucosal breakdown and
ulceration. Additionally, non-aspirin NSAIDs carry a black box warning for increasing the
risk of serious thrombotic events, myocardial infarction, stroke, and new-onset or
worsening hypertension.
, Q4. A client with a known history of severe chronic alcohol use disorder is admitted for
minor musculoskeletal pain. The provider prescribes acetaminophen. The nurse knows
that the maximum daily safe dose of acetaminophen for this specific client is:
A. 4,000 mg per day.
B. 3,000 mg per day.
C. 2,000 mg per day.
D. 1,000 mg per day.
VERIFIED ANSWER: C. 2,000 mg per day.
RATIONALE: While the absolute maximum daily limit of acetaminophen for a healthy
adult is 4,000 mg (and frequently capped at 3,000 mg in older populations), patients with
chronic alcohol abuse or underlying hepatic impairment must not exceed 2,000 mg per
day. Chronic alcohol consumption induces the CYP2E1 pathway, accelerating the
formation of the highly hepatotoxic metabolite NAPQI, which exhausts glutathione stores.
Q5. The nurse administers intravenous morphine sulfate to a postoperative client.
Which assessment finding requires an immediate, priority nursing intervention?
A. The client reports a pain level of 4 out of 10.
B. The client's pupillary exam shows bilateral constriction (miosis).
C. The client's respiratory rate is 8 breaths per minute.
D. The client has not had a bowel movement in 48 hours.
VERIFIED ANSWER: C. The client's respiratory rate is 8 breaths per minute.
RATIONALE: The most dangerous, life-threatening adverse effect of opioid agonists like
morphine is central nervous system and respiratory depression. A respiratory rate below 10
to 12 breaths per minute requires immediate stimulation, oxygen supplementation, and
potential administration of the opioid antagonist naloxone. Constipation and miosis are
expected side effects but are not immediately life-threatening.
Q6. An operating room nurse is preparing to administer preoperative atropine. The
nurse should instruct the patient that the primary therapeutic goal of this medication is
to:
A. Provide conscious sedation and alleviate baseline situational anxiety.
B. Decrease oral, salivary, and respiratory secretions to prevent aspiration.
C. Stimulate bladder contraction to prevent postoperative urinary retention.
D. Lower the heart rate to minimize myocardial oxygen demands under anesthesia.
, VERIFIED ANSWER: B. Decrease oral, salivary, and respiratory secretions to prevent
aspiration.
RATIONALE: Atropine is a potent anticholinergic drug that blocks muscarinic
acetylcholine receptors. Preoperatively, it is used to dry oral and respiratory secretions,
which drastically reduces the risk of aspiration during endotracheal intubation and
general anesthesia. Because it blocks parasympathetic inputs, it causes tachycardia and
urinary retention, rather than treating them.
Q7. A student nurse asks how beta-lactam antibiotics, such as penicillins and
cephalosporins, achieve their bactericidal effects. The supervising nurse correctly
responds that these drugs:
A. Bind irreversibly to the 50S ribosomal subunit to disrupt protein translation.
B. Inhibit bacterial DNA gyrase, stopping DNA replication.
C. Disrupt the synthesis of the bacterial peptidoglycan cell wall, causing osmotic lysis.
D. Antagonize folic acid synthesis pathways required for bacterial survival.
VERIFIED ANSWER: C. Disrupt the synthesis of the bacterial peptidoglycan cell wall,
causing osmotic lysis.
RATIONALE: Penicillins and cephalosporins are beta-lactam antibiotics that selectively
target penicillin-binding proteins (PBPs) in the bacterial cell wall. By inhibiting the cross-
linking of peptidoglycan strands, the cell wall becomes structurally unstable, leading to
fluid influx, osmotic swelling, and bactericidal lysis.
Q8. A patient on a continuous IV infusion of an opioid agonist reports severe abdominal
bloating and lack of bowel movements. Which bowel regimen should the nurse
anticipate the provider ordering?
A. A bulk-forming laxative such as psyllium.
B. Continuous monitoring without active chemical laxative interventions.
C. A combination of a stimulant laxative (senna) and a stool softener (docusate).
D. An osmotic laxative restricted to a single PRN dose.
VERIFIED ANSWER: C. A combination of a stimulant laxative (senna) and a stool
softener (docusate).
RATIONALE: Opioids directly stimulate mu receptors in the enteric nervous system,
causing profound decreases in peristalsis and increased water reabsorption. This results in
opioid-induced constipation, for which tolerance never develops. A proactive, daily
