D027 NURS 5204
Advanced Pathopharmacological
Foundations
Objective Assessment Prep
2026
(With Solutions)
Multiple Choice (15 questions)
A patient with chronic kidney disease is prescribed digoxin. The nurse notes that the patient's
potassium level is 3.0 mEq/L. What is the priority nursing action?
A) Administer digoxin as ordered
B) Hold digoxin and notify the healthcare provider
C) Increase the dose of digoxin
D) Administer potassium supplements after digoxin
Answer: B) Hold digoxin and notify the healthcare provider
Rationale: Hypokalemia increases the risk of digoxin toxicity, so holding the drug and notifyin
the provider is essential.
A patient receiving warfarin therapy has an INR of 5.5. What is the safest immediate nursing
action?
A) Administer vitamin K as ordered
B) Increase the dose of warfarin
C) Monitor the patient without intervention
D) Hold the next dose of warfarin and notify the provider
Answer: D) Hold the next dose of warfarin and notify the provider
Rationale: An INR above therapeutic range increases bleeding risk. Holding warfarin and
notifying the provider is appropriate.
Which mechanism best explains the anti-inflammatory effects of corticosteroids?
A) Blocking acetylcholine receptors
B) Inhibiting phospholipase A2 and reducing prostaglandins
C) Activating beta-2 adrenergic receptors
,D) Increasing histamine release from mast cells
Answer: B) Inhibiting phospholipase A2 and reducing prostaglandins
Rationale: Corticosteroids suppress inflammation by inhibiting phospholipase A2, leading to
decreased prostaglandin and leukotriene synthesis.
A patient on theophylline presents with confusion and tachycardia. What is the most likely
cause?
A) Theophylline therapeutic effect
B) Theophylline toxicity
C) Beta-blocker overdose
D) Allergic reaction
Answer: B) Theophylline toxicity
Rationale: Confusion and tachycardia are signs of theophylline toxicity due to its narrow
therapeutic window.
Which phase of drug metabolism is primarily involved in conjugation reactions making drugs
more water-soluble?
A) Phase I
B) Phase II
C) Phase III
D) Phase IV
Answer: B) Phase II
Rationale: Phase II metabolism involves conjugation reactions (e.g., glucuronidation) which
increase drug solubility for excretion.
A nurse teaches a patient about the action of beta-blockers. What effect does this drug class
have on the heart?
A) Increases heart rate and contractility
B) Decreases heart rate and contractility
C) Causes vasodilation only
D) Stimulates alpha-1 receptors
Answer: B) Decreases heart rate and contractility
Rationale: Beta-blockers reduce heart rate and contractility by blocking beta-1 receptors in th
heart.
Which of the following drugs is most likely to cause serotonin syndrome when combined with
an SSRI?
A) Lithium
B) Ibuprofen
C) Furosemide
D) Metformin
Answer: A) Lithium
Rationale: Lithium combined with SSRIs can increase risk of serotonin syndrome due to
,additive serotonergic effects.
What is the primary site of action for loop diuretics?
A) Proximal convoluted tubule
B) Thick ascending loop of Henle
C) Distal convoluted tubule
D) Collecting duct
Answer: B) Thick ascending loop of Henle
Rationale: Loop diuretics inhibit sodium-potassium-chloride co-transporters in the thick
ascending loop.
A patient on heparin therapy has a sudden drop in platelet count. What is the priority
consideration?
A) Normal anticoagulant effect
B) Heparin induced thrombocytopenia (HIT)
C) Vitamin K deficiency
D) Iron deficiency anemia
Answer: B) Heparin induced thrombocytopenia (HIT)
Rationale: HIT is an immune-mediated reaction causing thrombocytopenia and paradoxical
thrombosis risk.
Which neurotransmitter is most inhibited by benzodiazepines in the CNS?
A) Dopamine
B) GABA
C) Acetylcholine
D) Serotonin
Answer: B) GABA
Rationale: Benzodiazepines enhance GABA receptor activity causing CNS depression.
Which of the following is an example of a prodrug?
A) Morphine
B) Clopidogrel
C) Diazepam
D) Phenytoin
Answer: B) Clopidogrel
Rationale: Clopidogrel requires metabolic activation to its active form.
Which adverse effect is most common with ACE inhibitors?
A) Hypokalemia
B) Persistent dry cough
C) Tachycardia
D) Hyperglycemia
Answer: B) Persistent dry cough
, Rationale: ACE inhibitors increase bradykinin leading to a characteristic dry cough.
A patient taking rifampin experiences decreased efficacy of oral contraceptives. Why?
A) Rifampin inhibits CYP enzymes
B) Rifampin induces CYP enzymes
C) Rifampin blocks estrogen receptors
D) Rifampin decreases absorption of contraceptives
Answer: B) Rifampin induces CYP enzymes
Rationale: Rifampin induces hepatic enzymes that increase metabolism of oral contraceptives
reducing their effectiveness.
A patient with type 1 diabetes presents with ketoacidosis. Which medication is contraindicate
A) Metformin
B) Insulin
C) Sodium bicarbonate
D) Thiazolidinediones
Answer: A) Metformin
Rationale: Metformin should not be used in ketoacidosis because it does not correct insulin
deficiency.
Which factor most affects drug absorption via the oral route?
A) Drug solubility
B) Renal clearance
C) Liver metabolism
D) Urine pH
Answer: A) Drug solubility
Rationale: Drug solubility directly impacts how well it is absorbed in the GI tract.
True/False (10 questions)
T/F: The first-pass effect reduces the bioavailability of drugs administered orally.
Answer: True
Rationale: The first-pass effect involves metabolism by the liver reducing oral drug availabilit
before systemic circulation.
T/F: NSAIDs increase prostaglandin synthesis to reduce inflammation.
Answer: False
Rationale: NSAIDs inhibit cyclooxygenase enzymes, decreasing prostaglandin production and
thus inflammation.
T/F: Digoxin has a narrow therapeutic index, requiring close monitoring of serum levels.
Answer: True
Rationale: Digoxin toxicity risk necessitates monitoring due to its narrow therapeutic window
Advanced Pathopharmacological
Foundations
Objective Assessment Prep
2026
(With Solutions)
Multiple Choice (15 questions)
A patient with chronic kidney disease is prescribed digoxin. The nurse notes that the patient's
potassium level is 3.0 mEq/L. What is the priority nursing action?
A) Administer digoxin as ordered
B) Hold digoxin and notify the healthcare provider
C) Increase the dose of digoxin
D) Administer potassium supplements after digoxin
Answer: B) Hold digoxin and notify the healthcare provider
Rationale: Hypokalemia increases the risk of digoxin toxicity, so holding the drug and notifyin
the provider is essential.
A patient receiving warfarin therapy has an INR of 5.5. What is the safest immediate nursing
action?
A) Administer vitamin K as ordered
B) Increase the dose of warfarin
C) Monitor the patient without intervention
D) Hold the next dose of warfarin and notify the provider
Answer: D) Hold the next dose of warfarin and notify the provider
Rationale: An INR above therapeutic range increases bleeding risk. Holding warfarin and
notifying the provider is appropriate.
Which mechanism best explains the anti-inflammatory effects of corticosteroids?
A) Blocking acetylcholine receptors
B) Inhibiting phospholipase A2 and reducing prostaglandins
C) Activating beta-2 adrenergic receptors
,D) Increasing histamine release from mast cells
Answer: B) Inhibiting phospholipase A2 and reducing prostaglandins
Rationale: Corticosteroids suppress inflammation by inhibiting phospholipase A2, leading to
decreased prostaglandin and leukotriene synthesis.
A patient on theophylline presents with confusion and tachycardia. What is the most likely
cause?
A) Theophylline therapeutic effect
B) Theophylline toxicity
C) Beta-blocker overdose
D) Allergic reaction
Answer: B) Theophylline toxicity
Rationale: Confusion and tachycardia are signs of theophylline toxicity due to its narrow
therapeutic window.
Which phase of drug metabolism is primarily involved in conjugation reactions making drugs
more water-soluble?
A) Phase I
B) Phase II
C) Phase III
D) Phase IV
Answer: B) Phase II
Rationale: Phase II metabolism involves conjugation reactions (e.g., glucuronidation) which
increase drug solubility for excretion.
A nurse teaches a patient about the action of beta-blockers. What effect does this drug class
have on the heart?
A) Increases heart rate and contractility
B) Decreases heart rate and contractility
C) Causes vasodilation only
D) Stimulates alpha-1 receptors
Answer: B) Decreases heart rate and contractility
Rationale: Beta-blockers reduce heart rate and contractility by blocking beta-1 receptors in th
heart.
Which of the following drugs is most likely to cause serotonin syndrome when combined with
an SSRI?
A) Lithium
B) Ibuprofen
C) Furosemide
D) Metformin
Answer: A) Lithium
Rationale: Lithium combined with SSRIs can increase risk of serotonin syndrome due to
,additive serotonergic effects.
What is the primary site of action for loop diuretics?
A) Proximal convoluted tubule
B) Thick ascending loop of Henle
C) Distal convoluted tubule
D) Collecting duct
Answer: B) Thick ascending loop of Henle
Rationale: Loop diuretics inhibit sodium-potassium-chloride co-transporters in the thick
ascending loop.
A patient on heparin therapy has a sudden drop in platelet count. What is the priority
consideration?
A) Normal anticoagulant effect
B) Heparin induced thrombocytopenia (HIT)
C) Vitamin K deficiency
D) Iron deficiency anemia
Answer: B) Heparin induced thrombocytopenia (HIT)
Rationale: HIT is an immune-mediated reaction causing thrombocytopenia and paradoxical
thrombosis risk.
Which neurotransmitter is most inhibited by benzodiazepines in the CNS?
A) Dopamine
B) GABA
C) Acetylcholine
D) Serotonin
Answer: B) GABA
Rationale: Benzodiazepines enhance GABA receptor activity causing CNS depression.
Which of the following is an example of a prodrug?
A) Morphine
B) Clopidogrel
C) Diazepam
D) Phenytoin
Answer: B) Clopidogrel
Rationale: Clopidogrel requires metabolic activation to its active form.
Which adverse effect is most common with ACE inhibitors?
A) Hypokalemia
B) Persistent dry cough
C) Tachycardia
D) Hyperglycemia
Answer: B) Persistent dry cough
, Rationale: ACE inhibitors increase bradykinin leading to a characteristic dry cough.
A patient taking rifampin experiences decreased efficacy of oral contraceptives. Why?
A) Rifampin inhibits CYP enzymes
B) Rifampin induces CYP enzymes
C) Rifampin blocks estrogen receptors
D) Rifampin decreases absorption of contraceptives
Answer: B) Rifampin induces CYP enzymes
Rationale: Rifampin induces hepatic enzymes that increase metabolism of oral contraceptives
reducing their effectiveness.
A patient with type 1 diabetes presents with ketoacidosis. Which medication is contraindicate
A) Metformin
B) Insulin
C) Sodium bicarbonate
D) Thiazolidinediones
Answer: A) Metformin
Rationale: Metformin should not be used in ketoacidosis because it does not correct insulin
deficiency.
Which factor most affects drug absorption via the oral route?
A) Drug solubility
B) Renal clearance
C) Liver metabolism
D) Urine pH
Answer: A) Drug solubility
Rationale: Drug solubility directly impacts how well it is absorbed in the GI tract.
True/False (10 questions)
T/F: The first-pass effect reduces the bioavailability of drugs administered orally.
Answer: True
Rationale: The first-pass effect involves metabolism by the liver reducing oral drug availabilit
before systemic circulation.
T/F: NSAIDs increase prostaglandin synthesis to reduce inflammation.
Answer: False
Rationale: NSAIDs inhibit cyclooxygenase enzymes, decreasing prostaglandin production and
thus inflammation.
T/F: Digoxin has a narrow therapeutic index, requiring close monitoring of serum levels.
Answer: True
Rationale: Digoxin toxicity risk necessitates monitoring due to its narrow therapeutic window
