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PBSC Pharmacy Final
Exam Study Guide
Topic Test: Latest Concepts in Pharmacotherapeutics 2026 Total Questions: 82 Instructions: Choose the correct answer(s) for each question. Correct answers are highlighted in bold and are followed by a rationale. Module 1: Autonomic Nervous System & Pain Management
1. A patient receiving morphine sulfate begins to show signs of respiratory depression. Which medication should the nurse anticipate administering? A. Naloxone (Narcan) B. Flumazenil C. Acetylcysteine (Mucomyst) D. Protamine sulfate Rationale: Naloxone is a competitive opioid antagonist that rapidly reverses the effects of opioids, including respiratory depression. Flumazenil reverses benzodiazepines. Acetylcysteine is for acetaminophen overdose. Protamine sulfate reverses heparin. 2. Which of the following are common adverse effects of opioid analgesics? (Select all that apply) A. Constipation B. Respiratory depression C. Hypertension D. Sedation E. Diarrhea Rationale: Opioids commonly cause constipation (due to decreased GI motility), sedation, and respiratory depression due to their effects on the CNS. They typically
cause hypotension, not hypertension, and diarrhea is not an expected effect; in fact, opioids are used to treat diarrhea.
3. A patient is prescribed atropine before a surgical procedure. What is the primary purpose of this pre-medication? A. To induce amnesia B. To dry oral and respiratory secretions C. To provide long-acting pain relief D. To decrease the risk of post-op infection Rationale: Atropine is an anticholinergic drug that blocks the action of acetylcholine. This leads to a decrease in secretions (dry mouth), making it useful as a preoperative medication to reduce the risk of aspiration. 4. A patient with asthma uses an albuterol (ProAir, Ventolin) inhaler. The nurse understands that this medication produces its therapeutic effect by: A. Blocking leukotriene receptors B. Inhibiting the release of inflammatory mediators C. Stimulating beta-2 adrenergic receptors D. Blocking muscarinic receptors in the bronchi Rationale: Albuterol is a short-acting beta-2 agonist (SABA). It works by stimulating beta-2 adrenergic receptors in the smooth muscle of the bronchi, causing bronchodilation. **Module 2: Cardiovascular Pharmacology
- Which medications are considered first-line therapy for the treatment of essential hypertension? (Select all that apply)** A. ACE inhibitors B. Thiazide diuretics C. Loop diuretics D. Beta-blockers E. Angiotensin II receptor blockers (ARBs) Rationale: According to current guidelines, first-line agents for hypertension include ACE inhibitors, ARBs, thiazide diuretics, and dihydropyridine calcium channel blockers. Beta-blockers are no longer considered first-line unless a specific comorbidity (like heart failure or post-MI) exists. Loop diuretics are reserved for fluid overload states like heart failure or renal disease. 6. Which lab value is most important for the nurse to monitor in a patient taking warfarin (Coumadin)? A. aPTT
Rationale: The symptoms described are classic signs of digoxin toxicity. Hypokalemia increases the binding of digoxin to the Na/K-ATPase pump, making the heart more sensitive to the drug and precipitating toxicity even at therapeutic levels.
10. A patient is prescribed nitroglycerin for angina. What instruction is most important to include in patient teaching? A. "Swallow the tablet whole with a full glass of water." B. "You can store the tablets in your bathroom medicine cabinet for easy access." C. "If you get a headache, stop taking the medication immediately." D. "Place the tablet under your tongue and let it dissolve; do not swallow it." Rationale: Nitroglycerin tablets for acute angina are administered sublingually (under the tongue) to allow for rapid absorption directly into the bloodstream, bypassing first-pass metabolism in the liver. Swallowing it would render it ineffective. 11. Which medications are used in the management of hyperlipidemia? (Select all that apply) A. Atorvastatin (Lipitor) B. Simvastatin (Zocor) C. Niacin D. Furosemide (Lasix) E. Ezetimibe (Zetia) Rationale: Statins (atorvastatin, simvastatin) are the mainstay of lipid-lowering therapy. Niacin and ezetimibe are also used, often as adjunctive therapy. Furosemide is a diuretic and has no effect on cholesterol levels. **Module 3: Endocrine Pharmacology
- Which insulins are classified as rapid-acting and should be administered immediately before or after a meal? (Select all that apply)** A. Regular insulin (Humulin R) B. Insulin lispro (Humalog) C. Insulin glargine (Lantus) D. Insulin aspart (NovoLog) E. NPH insulin (Humulin N) Rationale: Insulin lispro and insulin aspart are rapid-acting analogs. Their onset is within 15 minutes, making them ideal for mealtime coverage. Regular insulin is short- acting. NPH is intermediate-acting, and glargine is long-acting. 13. A patient taking metformin (Glucophage) is scheduled for a CT scan with IV contrast. What is the priority nursing action?
A. Administer the metformin as scheduled to control blood glucose during the test. B. Hold the metformin on the day of the test and for 48 hours afterwards. C. Increase the dose of metformin to counteract the contrast dye. D. Ensure the patient eats a large meal before the test. Rationale: IV contrast can cause acute kidney injury. Metformin is renally excreted, and if kidney function is compromised, the drug can accumulate, leading to a high risk of lactic acidosis. The standard of care is to hold metformin on the day of the procedure and for 48 hours after, restarting only after renal function is confirmed to be normal.
14. Which adverse effects are commonly associated with long-term corticosteroid (e.g., prednisone) therapy? (Select all that apply) A. Hyperglycemia B. Osteoporosis C. Weight loss D. Immunosuppression E. Hypokalemia Rationale: Corticosteroids have many adverse effects. They cause hyperglycemia (by increasing gluconeogenesis), osteoporosis (by decreasing bone formation), and immunosuppression. They typically cause weight gain due to increased appetite and fluid retention, not weight loss. They can also cause hypokalemia. 15. A patient with type 2 diabetes is started on pioglitazone (Actos). The nurse knows this drug works by: A. Increasing insulin secretion from the pancreas B. Decreasing glucose production in the liver C. Increasing insulin sensitivity in muscle and fat tissue D. Blocking the breakdown of carbohydrates in the gut Rationale: Pioglitazone is a thiazolidinedione (TZD). It works as an insulin sensitizer, primarily by activating PPAR-gamma receptors, which increases insulin sensitivity in peripheral tissues (muscle and fat). 16. A patient is prescribed levothyroxine (Synthroid). What is the most important teaching point regarding administration? A. Take with food to prevent stomach upset. B. Take on an empty stomach, first thing in the morning, with water. C. Take at bedtime to minimize daytime drowsiness. D. Crush the tablet and mix with applesauce if it's hard to swallow.
20. Which antibiotics are considered aminoglycosides? (Select all that apply) A. Gentamicin B. Tobramycin C. Amikacin D. Ceftriaxone E. Azithromycin Rationale: Gentamicin, tobramycin, and amikacin are all aminoglycosides. Ceftriaxone is a third-generation cephalosporin. Azithromycin is a macrolide. 21. A patient is taking clarithromycin for an H. pylori infection. The nurse knows this drug is classified as a: A. Tetracycline B. Macrolide C. Fluoroquinolone D. Sulfonamide Rationale: Clarithromycin, along with erythromycin and azithromycin, belongs to the macrolide class of antibiotics. **Module 5: Respiratory & Gastrointestinal Pharmacology
- Which medications are used for the management of asthma? (Select all that apply)** A. Albuterol (ProAir) B. Fluticasone (Flovent) C. Montelukast (Singulair) D. Furosemide (Lasix) E. Ipratropium (Atrovent) Rationale: Asthma management includes bronchodilators (albuterol - SABA, ipratropium - anticholinergic), anti-inflammatories (fluticasone - inhaled corticosteroid), and leukotriene receptor antagonists (montelukast). Furosemide is a diuretic and has no role in asthma. 23. A patient is prescribed omeprazole (Prilosec) for GERD. The nurse understands that this drug works by: A. Neutralizing stomach acid B. Blocking histamine (H2) receptors in the stomach C. Inhibiting the proton pump (H+/K+ ATPase) in gastric parietal cells D. Coating and protecting the esophageal lining
Rationale: Omeprazole is a proton pump inhibitor (PPI). It works by irreversibly inhibiting the proton pump, the final step in gastric acid secretion, leading to a profound and long-lasting reduction in acid production.
24. Which medications are proton pump inhibitors (PPIs)? (Select all that apply) A. Omeprazole (Prilosec) B. Esomeprazole (Nexium) C. Ranitidine (Zantac) D. Pantoprazole (Protonix) E. Famotidine (Pepcid) Rationale: Omeprazole, esomeprazole, and pantoprazole are PPIs. Ranitidine and famotidine are H2 receptor blockers, which work by a different mechanism. 25. A patient taking ondansetron (Zofran) for nausea should be monitored for which potential adverse effect? A. QT interval prolongation B. Tinnitus C. Dry mouth D. Diarrhea Rationale: Ondansetron, a 5-HT3 receptor antagonist, carries a known risk of prolonging the QT interval on an ECG, which can predispose a patient to life- threatening dysrhythmias like Torsades de Pointes. **Module 6: Psychiatric & Neurological Pharmacology
- A patient is prescribed sertraline (Zoloft) for depression. The nurse knows this medication is classified as a:** A. Tricyclic antidepressant (TCA) B. Monoamine oxidase inhibitor (MAOI) C. Selective serotonin reuptake inhibitor (SSRI) D. Serotonin-norepinephrine reuptake inhibitor (SNRI) Rationale: Sertraline is one of the most commonly prescribed SSRIs. It works by selectively inhibiting the reuptake of serotonin, increasing its availability in the synaptic cleft. 27. A patient taking phenytoin (Dilantin) for seizures should be educated about which of the following? A. The medication can be stopped once seizures are controlled for 6 months. B. Good oral hygiene, including regular brushing and flossing, is essential. C. It is safe to drink alcohol in moderation while on this medication. D. The medication rarely interacts with other drugs.
reduce common adverse effects like GI upset, stomatitis, and bone marrow suppression without compromising the drug's therapeutic efficacy.
31. Which of the following are appropriate nursing interventions for a patient who is at risk for falls due to sedating medications? (Select all that apply) A. Keep the bed in the highest position for easy egress. B. Place the call light within easy reach. C. Encourage the patient to get up without assistance to maintain independence. D. Use night lights in the room and bathroom. E. Ensure the patient wears nonskid footwear when walking. Rationale: Fall prevention strategies include placing the call light within reach, using night lights for visibility, and ensuring nonskid footwear. The bed should be kept in the lowest position. Patients should be encouraged to ask for assistance when getting up. 32. A patient on long-term warfarin therapy has an INR of 5.2 (therapeutic range is 2-3). The patient is not bleeding. What is the nurse's priority action? A. Administer a stat dose of warfarin to re-stabilize the levels. B. Hold the next dose of warfarin and notify the healthcare provider. C. Administer Vitamin K immediately as an antidote. D. Reassure the patient that this is a normal finding. Rationale: An INR of 5.2 is supratherapeutic and indicates a high risk of bleeding. The first step in a non-bleeding patient is to hold the next dose(s) of warfarin and notify the provider, who may order a one-time dose of oral Vitamin K if the INR is significantly elevated. 33. Which medications are used as antidotes or reversal agents? (Select all that apply) A. Naloxone for opioid overdose B. Flumazenil for benzodiazepine overdose C. Protamine sulfate for heparin overdose D. Vitamin K for warfarin overdose E. Acetylcysteine for acetaminophen overdose Rationale: These are all standard reversal agents. Naloxone reverses opioids, flumazenil reverses benzodiazepines, protamine neutralizes heparin, Vitamin K reverses warfarin, and acetylcysteine is the antidote for acetaminophen toxicity. 34. A patient is prescribed a loop diuretic and digoxin. The nurse monitors the patient's potassium level closely. Why? A. Low potassium increases the risk of digoxin toxicity. B. High potassium increases the risk of digoxin toxicity.
C. Low potassium decreases the effectiveness of the diuretic. D. High potassium decreases the effectiveness of digoxin. Rationale: Loop diuretics like furosemide cause hypokalemia (low potassium). Hypokalemia makes the myocardium more sensitive to digoxin, dramatically increasing the risk of life-threatening digoxin toxicity.
35. What is the most common cause of non-adherence to medication regimens in older adults? A. Lack of transportation to the pharmacy B. Inability to afford the medications C. Forgetting to take doses D. Intolerable adverse effects Rationale: While all are valid reasons, forgetfulness is cited as the single most common cause of non-adherence. Other factors include polypharmacy, complex regimens, and cognitive decline. 36. A patient is taking atorvastatin (Lipitor). The nurse should instruct the patient to report which symptom immediately? A. Mild headache B. Unexplained muscle pain or weakness C. Constipation D. Occasional heartburn Rationale: Unexplained muscle pain, tenderness, or weakness could be a sign of myopathy or, in rare cases, rhabdomyolysis (muscle breakdown), which can lead to kidney failure. This is a serious adverse effect of statins that requires immediate attention. 37. Which medications are considered high-alert medications by the Institute for Safe Medication Practices (ISMP)? (Select all that apply) A. Insulin B. Oral antibiotics C. Warfarin D. IV heparin E. Chemotherapeutic agents Rationale: High-alert medications are drugs that bear a heightened risk of causing significant patient harm when used in error. Insulin, anticoagulants (warfarin, heparin), and chemotherapeutic agents are classic examples. Oral antibiotics are not typically on this list.
42. A patient is prescribed a monoamine oxidase inhibitor (MAOI) for depression. What is the most critical dietary teaching point? A. Avoid foods high in potassium. B. Avoid foods high in tyramine (e.g., aged cheese, cured meats). C. Increase intake of caffeine to counteract sedation. D. Take the medication with a full glass of milk. Rationale: MAOIs inhibit the breakdown of tyramine. Consuming tyramine-rich foods can lead to a severe hypertensive crisis, which is a medical emergency. This is a critical, life-saving teaching point. 43. A patient receiving a blood transfusion begins to experience lower back pain and chills. What is the priority action? A. Slow the rate of the transfusion. B. Administer diphenhydramine (Benadryl). C. Stop the transfusion and keep the IV line open with normal saline. D. Reassure the patient that this is a common reaction. Rationale: Lower back pain and chills are classic signs of a hemolytic transfusion reaction, which can be life-threatening. The priority is to stop the transfusion immediately to prevent more incompatible blood from being infused and then assess the patient. 44. Which of the following statements about acetaminophen (Tylenol) is true? A. It has strong anti-inflammatory properties. B. It is safer than NSAIDs for patients with a history of GI bleeding. C. The maximum daily dose for a healthy adult is 4 grams. D. It is safe to take with any amount of alcohol. Rationale: Acetaminophen is an analgesic and antipyretic but has very little anti- inflammatory effect. Its main advantage over NSAIDs is the lack of GI irritation or bleeding risk. The maximum safe daily dose is 3-4 grams, and it should never be taken with alcohol due to the risk of severe hepatotoxicity. 45. A patient on long-term phenytoin therapy should be monitored for which potential deficiency? A. Vitamin B B. Iron C. Folic acid D. Potassium Rationale: Phenytoin is known to interfere with folate metabolism, potentially leading to folic acid deficiency and, in some cases, megaloblastic anemia. Supplementation may be required.
46. A patient is prescribed allopurinol (Zyloprim) for chronic gout. The nurse understands that this medication works by: A. Increasing the urinary excretion of uric acid B. Decreasing the inflammation in the affected joint C. Inhibiting the enzyme xanthine oxidase, reducing uric acid production D. Blocking the pain signals from the joint Rationale: Allopurinol is a xanthine oxidase inhibitor. It works by inhibiting the enzyme responsible for the final steps in uric acid synthesis, thereby lowering serum uric acid levels and preventing gout flares. It does not treat acute flares. 47. Which of the following antibiotics requires monitoring of "peak" and "trough" levels to ensure efficacy and prevent toxicity? A. Penicillin B. Gentamicin C. Azithromycin D. Doxycycline Rationale: Aminoglycosides like gentamicin have a narrow therapeutic index. Peak levels are drawn to ensure the drug is high enough to be effective, and trough levels are drawn to ensure the drug is not accumulating to toxic levels, which can cause nephrotoxicity and ototoxicity. 48. A patient is prescribed clopidogrel (Plavix) after receiving a drug-eluting stent. The nurse knows this medication is classified as a(n): A. Thrombolytic B. Antiplatelet agent C. Anticoagulant D. Factor Xa inhibitor Rationale: Clopidogrel is an antiplatelet medication. It works by irreversibly inhibiting the P2Y12 ADP receptor on platelets, preventing platelet aggregation and thrombus formation, which is critical to prevent stent thrombosis. 49. A patient is about to start taking isotretinoin (Amnesteem, Claravis) for severe cystic acne. Which laboratory test is most critical to monitor before, during, and after treatment? A. Complete blood count (CBC) B. Liver function tests C. Serum electrolytes D. Pregnancy test Rationale: Isotretinoin is a known teratogen and is absolutely contraindicated in pregnancy due to the high risk of severe fetal abnormalities. It is part of the iPLEDGE
B. Sexual dysfunction C. Sedation D. Hypertension Rationale: SSRIs are associated with a high incidence of sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction). While some patients may experience initial weight loss or sedation, sexual dysfunction is a very common and often persistent adverse effect.
54. A patient is prescribed lithium for bipolar disorder. The nurse's teaching should include that which of the following can significantly affect lithium levels? A. High-fiber diet B. Sodium intake C. Amount of sunlight exposure D. Intake of Vitamin C Rationale: Lithium is a salt ion. Its serum concentration is closely tied to the body's sodium and fluid balance. If a patient becomes dehydrated or has a low sodium intake (e.g., from a low-salt diet, sweating, or diuretics), the kidneys will reabsorb more lithium, leading to potentially toxic levels. High sodium intake can cause lower, sub-therapeutic levels. 55. Which of the following is a critical adverse effect of IV vincristine, a chemotherapeutic agent? A. Cardiotoxicity B. Pulmonary fibrosis C. Neurotoxicity D. Hemorrhagic cystitis Rationale: Vincristine is a vinca alkaloid that works by inhibiting microtubule formation. Its dose-limiting toxicity is neurotoxicity, which can manifest as peripheral neuropathy (numbness, tingling, pain), loss of deep tendon reflexes, and even autonomic neuropathy. Hemorrhagic cystitis is associated with cyclophosphamide. Cardiotoxicity is associated with doxorubicin. Pulmonary fibrosis is associated with bleomycin. 56. The nurse is preparing to administer digoxin to a patient. Which assessment finding would be most important to report to the provider before giving the dose? A. The patient's heart rate is 58 bpm. B. The patient's blood pressure is 130/80 mmHg. C. The patient reports having a headache. D. The patient's respiratory rate is 18 breaths/min.
Rationale: Digoxin increases the force of contraction and slows the heart rate. A heart rate of 58 bpm is bradycardic. The nurse should hold the dose and check the latest heart rate and potassium level. A key nursing responsibility is to check the apical pulse for one full minute before administering digoxin, and to hold the dose if the pulse is below 60 bpm in an adult (or per specific parameters).
57. A patient is prescribed a nicotine patch for smoking cessation. What is the most important teaching point regarding safety? A. The patch can be cut in half to adjust the dose. B. The patch should be placed on the same site each day to ensure absorption. C. Used patches should be disposed of carefully, away from children and pets. D. The patch can be worn in the shower or while swimming. Rationale: Used nicotine patches still contain a significant amount of nicotine, which is a toxic substance. They must be folded in half (sticky sides together) and disposed of in a secure trash can where children or pets cannot access them, as ingestion can be fatal. 58. A patient is prescribed ferrous sulfate (iron) for iron-deficiency anemia. Which statement indicates the patient understands how to take the medication? A. "I will take this medication with a glass of milk to prevent stomach upset." B. "I will take this medication with orange juice to help absorb it." C. "I will take this medication with my antacid to prevent nausea." D. "I will take this medication at bedtime to avoid side effects." Rationale: Iron is best absorbed in an acidic environment. Taking it with a source of Vitamin C, such as a glass of orange juice, significantly enhances its absorption. Milk and antacids can decrease absorption. 59. Which of the following is a classic sign of a potential transfusion reaction that the nurse should assess for? A. Flushing and urticaria (hives) B. Increased urine output C. Bradycardia D. Hypertension Rationale: Signs of a transfusion reaction can vary but often include fever, chills, flushing, urticaria (hives), itching, dyspnea, hypotension, and lower back pain. The nurse should stop the transfusion immediately at the first sign of a reaction. 60. A patient with diabetes is prescribed prednisone for a severe allergic reaction. The nurse should anticipate that the patient's blood glucose levels will likely:
B. Euphoria C. Agitation and aggressive behavior D. Forgetfulness Rationale: Montelukast carries a Black Box Warning regarding serious neuropsychiatric events. Patients and families should be counseled to be alert for and report any unusual changes in behavior, mood, agitation, aggression, or suicidal thoughts.
64. A patient on IV heparin develops a new, sudden drop in platelet count. The nurse suspects heparin-induced thrombocytopenia (HIT). What is the priority action? A. Continue the heparin and monitor platelets closely. B. Increase the heparin dose to prevent clotting. C. Stop the heparin infusion immediately and notify the provider. D. Administer a platelet transfusion. Rationale: HIT is a life-threatening, immune-mediated reaction to heparin that causes a dangerous drop in platelets and, paradoxically, a high risk of thrombosis (clotting). The priority is to stop ALL heparin products (including flushes) immediately to prevent further complications. 65. Which of the following drugs has a narrow therapeutic index (NTI), meaning there is little difference between a therapeutic and a toxic dose? A. Amoxicillin B. Diphenhydramine (Benadryl) C. Lithium D. Acetaminophen Rationale: Drugs with an NTI require precise dosing and careful monitoring because small changes in dose or blood concentration can lead to therapeutic failure or toxicity. Lithium, digoxin, phenytoin, warfarin, and theophylline are classic examples. Amoxicillin has a wide therapeutic index. 66. The nurse is administering an IV push medication. Which action is correct regarding the "right route"? A. Administer all medications as quickly as possible to minimize patient discomfort. B. Check the medication administration record for the correct route and verify with a drug reference for proper IV push rate. C. If the IV site looks infiltrated, it is safe to push the medication as long as there is a blood return. D. IV push medications never need to be diluted.
Rationale: Ensuring the right route involves more than just giving it IV. The nurse must verify that the route is correct, that the IV site is patent, and must check a reliable drug reference for the correct rate of administration, compatibility, and dilution requirements for that specific medication.
67. A patient with a history of heart failure has gained 5 pounds in 2 days and has 2+ pitting edema in the lower extremities. Which type of medication would the nurse anticipate the provider to order first? A. An ACE inhibitor B. A loop diuretic C. A beta-blocker D. Digoxin Rationale: The patient is showing clear signs of fluid volume overload (acute weight gain, edema). The priority is to remove the excess fluid, which is the role of a loop diuretic like furosemide or bumetanide. While ACE inhibitors and beta-blockers are crucial for long-term HF management, they do not provide rapid diuresis. 68. A patient is prescribed sumatriptan (Imitrex) for acute migraine headaches. The nurse knows this drug is contraindicated in patients with: A. Type 2 diabetes B. Hypertension C. Coronary artery disease D. Hypothyroidism Rationale: Sumatriptan is a 5-HT1 receptor agonist that causes vasoconstriction of cerebral arteries. This mechanism can also cause coronary artery vasospasm, making it contraindicated in patients with a history of coronary artery disease, angina, or uncontrolled hypertension due to the risk of myocardial infarction. 69. A patient is being treated for an acute gout flare. Which of the following medications would be most appropriate for immediate pain relief? A. Allopurinol B. Probenecid C. Colchicine D. Febuxostat Rationale: For an acute gout flare, the goal is to reduce inflammation and pain. Colchicine, NSAIDs (like indomethacin or naproxen), or corticosteroids are used for acute flares. Allopurinol, febuxostat (xanthine oxidase inhibitors), and probenecid (uricosuric) are used for chronic management to lower uric acid levels and prevent future flares. Starting or stopping urate-lowering therapy during an acute flare can actually prolong the flare.
