BSN Midterm: Pharmacology and Health Assessment (Week 5-6)
2026/2027 UPDATE
1. When performing a physical assessment of the abdomen, in which order
should the nurse perform the assessment techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Inspection, Auscultation, Percussion, Palpation
C. Palpation, Percussion, Auscultation, Inspection
D. Auscultation, Inspection, Palpation, Percussion
Answer: B
Rationale: For the abdomen, auscultation is performed before percussion and palpation to
avoid altering bowel sounds through physical manipulation.
2. A patient is prescribed a medication that has a high ‘first-pass effect.’ Which
route of administration should the nurse expect the provider to avoid if a rapid
systemic effect is needed?
A. Oral
B. Sublingual
C. Intravenous
D. Transdermal
Answer: A
Rationale: The first-pass effect refers to the metabolism of a drug in the liver after oral
absorption, which significantly reduces the concentration of the drug before it reaches
systemic circulation.
,3. The nurse is assessing a patient’s peripheral pulses and notes they are weak
and thready. How should the nurse document this finding on a scale of 0 to 4+?
A. 4+
B. 2+
C. 3+
D. 1+
Answer: D
Rationale: On a standard 0-4+ scale, 0 is absent, 1+ is weak/thready, 2+ is normal, 3+ is
full/increased, and 4+ is bounding.
4. A nurse is preparing to administer Digoxin to a patient. Which assessment is a
priority before administration?
A. Blood pressure
B. Apical pulse for one full minute
C. Respiratory rate
D. Temperature
Answer: B
Rationale: Digoxin is a cardiac glycoside that slows the heart rate; the apical pulse must be
checked for 60 seconds, and the drug is usually withheld if the heart rate is less than 60
bpm.
5. Which of the following describes the ‘therapeutic index’ of a drug?
A. The time it takes for a drug to reach its peak effect
B. The amount of time it takes for half of the drug to be excreted
C. The ratio between a drug’s effective dose and its toxic dose
D. The binding affinity of a drug to a specific receptor
Answer: C
Rationale: The therapeutic index (TI) measures drug safety. A narrow TI means there is a
small margin between the effective dose and the toxic dose, requiring close monitoring.
, 6. During a respiratory assessment, the nurse hears low-pitched, snoring sounds
over the bronchi. These sounds are best described as:
A. Crackles
B. Wheezes
C. Rhonchi
D. Pleural friction rub
Answer: C
Rationale: Rhonchi are continuous, low-pitched, rattling or snoring sounds often caused
by secretions in the larger airways.
7. A patient is taking an ACE inhibitor for hypertension. Which side effect should
the nurse specifically instruct the patient to report?
A. Increased appetite
B. Persistent dry cough
C. Orange-colored urine
D. Tinnitus
Answer: B
Rationale: ACE inhibitors (like Lisinopril) are well known for causing a persistent dry
cough due to the accumulation of bradykinin in the lungs.
8. The nurse notes that a patient has a capillary refill time of 5 seconds. This
finding most likely indicates:
A. Normal peripheral perfusion
B. Poor peripheral perfusion or dehydration
C. Fluid volume excess
D. Venous insufficiency
Answer: B
Rationale: Normal capillary refill is less than 2-3 seconds. A delay indicates poor perfusion,
which can be caused by shock, hypothermia, or dehydration.
2026/2027 UPDATE
1. When performing a physical assessment of the abdomen, in which order
should the nurse perform the assessment techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Inspection, Auscultation, Percussion, Palpation
C. Palpation, Percussion, Auscultation, Inspection
D. Auscultation, Inspection, Palpation, Percussion
Answer: B
Rationale: For the abdomen, auscultation is performed before percussion and palpation to
avoid altering bowel sounds through physical manipulation.
2. A patient is prescribed a medication that has a high ‘first-pass effect.’ Which
route of administration should the nurse expect the provider to avoid if a rapid
systemic effect is needed?
A. Oral
B. Sublingual
C. Intravenous
D. Transdermal
Answer: A
Rationale: The first-pass effect refers to the metabolism of a drug in the liver after oral
absorption, which significantly reduces the concentration of the drug before it reaches
systemic circulation.
,3. The nurse is assessing a patient’s peripheral pulses and notes they are weak
and thready. How should the nurse document this finding on a scale of 0 to 4+?
A. 4+
B. 2+
C. 3+
D. 1+
Answer: D
Rationale: On a standard 0-4+ scale, 0 is absent, 1+ is weak/thready, 2+ is normal, 3+ is
full/increased, and 4+ is bounding.
4. A nurse is preparing to administer Digoxin to a patient. Which assessment is a
priority before administration?
A. Blood pressure
B. Apical pulse for one full minute
C. Respiratory rate
D. Temperature
Answer: B
Rationale: Digoxin is a cardiac glycoside that slows the heart rate; the apical pulse must be
checked for 60 seconds, and the drug is usually withheld if the heart rate is less than 60
bpm.
5. Which of the following describes the ‘therapeutic index’ of a drug?
A. The time it takes for a drug to reach its peak effect
B. The amount of time it takes for half of the drug to be excreted
C. The ratio between a drug’s effective dose and its toxic dose
D. The binding affinity of a drug to a specific receptor
Answer: C
Rationale: The therapeutic index (TI) measures drug safety. A narrow TI means there is a
small margin between the effective dose and the toxic dose, requiring close monitoring.
, 6. During a respiratory assessment, the nurse hears low-pitched, snoring sounds
over the bronchi. These sounds are best described as:
A. Crackles
B. Wheezes
C. Rhonchi
D. Pleural friction rub
Answer: C
Rationale: Rhonchi are continuous, low-pitched, rattling or snoring sounds often caused
by secretions in the larger airways.
7. A patient is taking an ACE inhibitor for hypertension. Which side effect should
the nurse specifically instruct the patient to report?
A. Increased appetite
B. Persistent dry cough
C. Orange-colored urine
D. Tinnitus
Answer: B
Rationale: ACE inhibitors (like Lisinopril) are well known for causing a persistent dry
cough due to the accumulation of bradykinin in the lungs.
8. The nurse notes that a patient has a capillary refill time of 5 seconds. This
finding most likely indicates:
A. Normal peripheral perfusion
B. Poor peripheral perfusion or dehydration
C. Fluid volume excess
D. Venous insufficiency
Answer: B
Rationale: Normal capillary refill is less than 2-3 seconds. A delay indicates poor perfusion,
which can be caused by shock, hypothermia, or dehydration.
