Final Exam Summary Study Flashcards by Lauryn Parent

Vocab: Bioavailability

The portion of a drug dose that reaches systemic circulation in an active form.

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Vocab: Agonist

A drug that binds to a receptor and produces a response.

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Vocab: A drug that binds to a receptor and produces a response.

Agonist

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Vocab: Antagonist

A drug that binds to a receptor and blocks or dampens a response.

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Vocab: A drug that binds to a receptor and blocks or dampens a response.

Antagonist

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Vocab: Half-life

Time required for plasma drug concentration to decrease by half.

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Vocab: Time required for plasma drug concentration to decrease by half.

Half-life

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Vocab: Teratogenicity

The potential of a drug to cause fetal malformations.

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Vocab: The potential of a drug to cause fetal malformations.

Teratogenicity

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Vocab: Controlled substance schedule

Classification indicating abuse potential and legal controls (Schedules I–V).

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Which name reflects the chemical structure of a drug?
A. Brand name
B. Generic name
C. Chemical name
D. Street name

C
Rationale: Chemical names describe molecular composition.

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The FDA phase that continually evaluates a drug after approval is:
A. Phase 0
B. Phase 1
C. Phase 3
D. Phase 4

D (Phase 4)
Rationale: Phase 4 is post-marketing surveillance for long-term effects.

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Schedule II controlled substances are characterized by:
A. No accepted medical use and high abuse potential
B. High abuse potential but accepted medical uses and severe dependence risk
C. Low abuse potential and OTC availability
D. No regulatory controls

B
Rationale: Schedule II (e.g., narcotics) have high abuse potential but medical uses.

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True or False?
Generic and brand name drugs are bioequivalent and have the same therapeutic effect.

True
Rationale: Generics are required to be bioequivalent to brands.

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Which route of administration bypasses the first-pass effect?
A. Oral (PO)
B. Intravenous (IV)
C. Enteric tablet
D. Sublingual that is swallowed

B. (IV)
Rationale: IV delivers drug directly into systemic circulation, avoiding hepatic first-pass.

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Protein binding affects distribution because:
A. Bound drug is immediately active at receptor sites.
B. Tightly bound drug is released slowly, reducing free active drug.
C. Protein binding increases excretion rate.
D. Protein binding only occurs in the brain

B.
Rationale: Only unbound (free) drug is pharmacologically active; high binding prolongs release.

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The nurse explains “first-pass effect” as:
A. A drug’s effect during the first dose only.
B. Hepatic metabolism of oral drugs lowering the amount that reaches circulation.
C. A renal filtration mechanism.
D. A GI motility phenomenon only.

B
Rationale: First-pass hepatic metabolism reduces oral bioavailability.

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An agonist drug:
A. Blocks receptor activity.
B. Binds and produces the intended effect.
C. Is always toxic.
D. Prevents absorption.

B
Rationale: Agonists activate receptors to elicit response.

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A patient asks why a brand-name drug costs more than a generic. The nurse responds:
A. Brand names are more effective.
B. Brand names have exclusive patent protection and marketing costs.
C. Generics are unsafe.
D. Insurance requires brand always.

B
Rationale: Patents and R&D/marketing increase brand cost; generics are bioequivalent.

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True or False?
The placenta and breast milk act as barriers that fully prevent drug passage to the fetus/baby.

False.
Rationale: Many drugs cross these barriers; some can affect fetus or infant.

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Which statement about half-life is correct?
A. It is the time it takes for a drug to start working.
B. It is the time required for the plasma concentration to fall by 50%.
C. It always equals one hour.
D. It is unrelated to dosing frequency.

B
Rationale: Half-life determines dosing intervals and accumulation.

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Hepatic metabolism primarily accomplishes:
A. Distribution of drugs to tissues.
B. Biotransformation to more water-soluble metabolites for excretion.
C. Immediate renal excretion without change.
D. Enhancing drug potency.

B
Rationale: Liver enzymes metabolize drugs to promote elimination.

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Which factor does NOT influence individual drug responses?
A. Age and weight
B. Genetics and gender
C. Time of day and diet
D. The drug’s brand name only

D
Rationale: Brand name alone doesn’t change pharmacodynamics; human factors influence responses.

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A nurse counsels a patient that OTC drugs:
A. Are always safe and free of interactions.
B. May interact with prescriptions and should be reported to providers.
C. Don’t need to be disclosed.
D. Are regulated the same as prescription medications for all purposes.

B
Rationale: OTCs can interact and have side effects; they should be disclosed.

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True or False? Alternative/herbal therapies are FDA-regulated and have standardized dosing like prescription drugs.

False. Rationale: Many herbal products are not FDA-regulated with standardized dosing or purity.

A drug classified as a Category X in pregnancy means: A. It is safe during pregnancy. B. Animal studies show risk but human studies show no risk. C. Studies demonstrate fetal abnormalities and risks outweigh benefits. D. It is recommended for breastfeeding.

C Rationale: Category X indicates fetal risk and contraindication in pregnancy.

Which nursing action is most important before administering a new medication? A. Ask the patient if they like the color of the pill. B. Assess allergies and verify two patient identifiers. C. Give the med immediately to be efficient. D. Wait until discharge.

B Rationale: Allergy check and correct patient ID are critical safety steps.

A drug that blocks the receptor and prevents other ligands from activating it is called a(n): A. Agonist B. Antagonist C. Partial agonist only D. Enzyme inhibitor only

B Rationale: Antagonists occupy receptors without activating them, blocking effects.

Which organ is most important in drug excretion? A. Lung B. Kidney C. Skin D. Brain

B. (Kidney) Rationale: Kidneys excrete many drugs and metabolites via urine.

True or False? A nurse should assume a patient will report all herbal/alternative therapies they use without being asked.

False. Rationale: Patients often do not volunteer this information; nurses must ask.

Which describes a drug’s bioavailability? A. The taste of the drug. B. The fraction of unchanged drug reaching systemic circulation after administration. C. The pharmacologic class only. D. The cost of the drug.

B Rationale: Bioavailability measures the active drug fraction reaching circulation.

If a medication has a very long half-life, the nurse should expect: A. It will need very frequent dosing. B. It may accumulate and require less frequent dosing or a loading dose. C. It is ineffective. D. It must be given only topically.

B Rationale: Long half-lives lead to accumulation and longer dosing intervals; loading doses may be used to reach therapeutic levels faster.

Which statement is true about brand vs generic drugs? A. Brand drugs always have different active ingredients than generics. B. Generics must demonstrate bioequivalence before approval. C. Generics are never covered by insurance. D. Generic names change yearly.

B Rationale: Bioequivalence ensures generics have same therapeutic effect.

Which phase of clinical trials tests efficacy in patients with the disease? A. Phase 1 B. Phase 2 C. Phase 3 D. Phase 4

B. (Phase 2) Rationale: Phase 2 tests efficacy and side effects in patients with the condition.

True or False? Nurses are responsible for securing controlled substances, ensuring accurate counts, and witnessing waste when required.

True. Rationale: Controlled substance handling is a regulated nursing responsibility.

A patient asks whether a “natural” herbal remedy is safe; the best nurse response is: A. “Natural always means safe; use as much as you want.” B. “Herbal products can have side effects and interactions; tell me what you’re taking so we can check.” C. “You don’t need to tell the provider.” D. “Herbal products are FDA-tested like drugs.”

B Rationale: Nurses should inquire and evaluate for interactions and risks with other meds.

Vocab: ADPIE

Assessment, Diagnosis, Planning, Implementation, Evaluation (nursing process).

Five Rights of Medication Administration

Right patient, right drug, right dose, right route, right time.

Vocab: Therapeutic level

Drug concentration range that produces desired effect without toxicity.

Vocab: Drug concentration range that produces desired effect without toxicity.

Therapeutic level

Vocab: Any preventable event that may cause or lead to inappropriate medication use or patient harm.

Medication Error

Vocab: First-pass effect

Hepatic metabolism that reduces bioavailability of some oral drugs.

Vocab: Hepatic metabolism that reduces bioavailability of some oral drugs.

First-pass effect

The first step in the nursing process is: A. Implementation B. Diagnosis C. Assessment D. Evaluation

C Rationale: Assessment gathers data to inform subsequent steps.

Which of the following is NOT one of the “Five Rights”? A. Right documentation B. Right reason C. Right dose D. Right patient

B Rationale: Right reason is sometimes included as an “other right,” but the classic five rights are patient, drug, dose, route, time.

A nurse discovers a medication error that occurred during administration. The priority action is to: A. Hide the error to avoid consequences. B. Report the error and assess the patient for harm. C. Call the patient’s family only. D. Wait until the next shift to report.

B Rationale: Patient safety requires immediate assessment and reporting to prevent harm.

True or False? Nurses are the final safety check in the medication chain (provider, pharmacist, nurse).

True. Rationale: Nurses verify orders, dosing, and administer medications safely.

Which system is best to use for medication calculations in clinical practice? A. Household only B. Metric system C. Roman numerals D. Verbal descriptors only

B Rationale: Metric units are standardized and preferred for accuracy.

Convert: 0.01 g = ? mg. A. 0.1 mg B. 1 mg C. 10 mg D. 100 mg

C. (10 mg) Rationale: 1 g = 1000 mg; 0.01 g = 10 mg.

A patient needs 1 g of antibiotic PO; tablets available are 500 mg. How many tablets should be given? A. 1 B. 2 C. 3 D. 4

B. (2 tablets) Rationale: 500 mg × 2 = 1000 mg (1 g).

A drug is supplied as 500 mg in 2.5 mL. Ordered dose is 100 mg IV. How many mL to administer? A. 0.25 mL B. 0.5 mL C. 0.75 mL D. 1.0 mL

B. (0.5 mL) Rationale: (100 mg/500 mg) × 2.5 mL = 0.5 mL.

Heparin 15,000 units is ordered; vial label: 10,000 units/mL. How many mL needed? A. 0.67 mL B. 1.5 mL C. 1.0 mL D. 2.0 mL

B. (1.5 mL) Rationale: 15,000 units ÷ 10,000 units/mL = 1.5 mL.

True or False? To ensure patient adherence, making the drug regimen manageable and providing education are key nursing responsibilities.

True. Rationale: Simplified regimens and education increase compliance.

How many mL are in 2 tablespoons? A. 5 mL B. 15 mL C. 30 mL D. 10 mL

C. (30 mL) Rationale: 1 TBSP = 15 mL; 2 TBSP = 30 mL.

1 oz = ? mL (common conversion used in practice). A. 15 mL B. 30 mL C. 45 mL D. 60 mL

B. (30 mL) Rationale: 1 ounce (~fluid oz) ≈ 30 mL in medical rounding.

A drug is supplied as 1 g/3.5 mL. Order: 700 mg PO. How many mL? A. 1.75 mL B. 2.45 mL C. 2.1 mL D. 3.0 mL

B. (2.45 mL) Rationale: (700 mg/1000 mg) × 3.5 mL = 2.45 mL.

When transcribing dosages, which practice reduces error risk? A. Writing “.5 mg” (no leading zero) B. Using trailing zeros (e.g., 5.0 mg) C. Using leading zeros for doses <1 (e.g., 0.5 mg) and avoiding unnecessary trailing zeros D. Abbreviating drug names heavily

C Rationale: Leading zeros prevent tenfold errors; trailing zeros can cause misreading.

A nurse should use which method to check a high-risk medication calculation? A. Rely only on memory B. Use dimensional analysis and have a second nurse verify C. Skip double-checks for familiar meds D. Administer then calculate

B Rationale: Dimensional analysis and independent double-checks reduce errors for high-risk drugs.

True or False? 2.2 lb is approximately equal to 1 kg.

True. Rationale: 1 kg ≈ 2.2046 lb; 2.2 is the common clinical approximation.

A 150 lb patient’s weight in kg is approximately: A. 34 kg B. 68 kg C. 75 kg D. 120 kg

B. (68 kg) Rationale: 150 lb ÷ 2.2 ≈ 68.2 kg.

When a medication error occurs, reporting is important because: A. It punishes the nurse. B. It helps identify system failures and prevents future errors. C. It is optional. D. It hides the problem.

B Rationale: Reporting improves systems to enhance safety.

The best way to set up a dosage equation is to: A. Guess based on previous doses. B. Identify the desired unit, confirm compatibility, set up proportion, solve, and reassess. C. Use household conversions only. D. Ask the patient for the dose.

B Rationale: Systematic steps reduce calculation errors.

True or False? Electronic charting and barcode medication administration eliminate all medication errors.

False. Rationale: Technology reduces but does not eliminate human/system errors.

Which practice supports safe medication administration? A. Skipping patient education to save time B. Confirming allergies, using two identifiers, and checking the MAR before giving meds C. Administering meds without checking the label D. Using verbal orders without documentation

B Rationale: Standard safety checks prevent errors and adverse reactions.

0.5 L equals how many mL? A. 5 mL B. 50 mL C. 500 mL D. 5,000 mL

C. (500 mL) Rationale: 1 L = 1000 mL; 0.5 L = 500 mL.

If a medication is supplied in 500 mg/2 mL and an order is for 250 mg, how many mL should be administered? A. 0.5 mL B. 1.0 mL C. 2.0 mL D. 4.0 mL

B. (1.0 mL) Rationale: 250 mg is half of 500 mg, so half the volume (1 mL).

Which practice when teaching patients about medications improves adherence? A. Provide complex schedules with many doses at odd hours. B. Simplify the regimen, use reminders, and explain purpose and side effects. C. Avoid discussing side effects. D. Encourage stopping when feeling better.

B Rationale: Clarity and manageable regimens improve adherence.

True or False? The nurse should always reassess after solving a dosage calculation to ensure the dose makes clinical sense.

True Rationale: A reasonableness check catches calculation or unit errors.

The metric prefix “milli-” means: A. One thousand times larger B. One thousandth (1/1000) C. One millionth D. Ten times larger

B. (one thousandth) Rationale: “milli” = 10⁻³

Vocab: Homeostasis

The cell’s goal of maintaining a stable internal environment. (Maintaining balance of internal conditions.)

Bactericidal vs. bacteriostatic

Bactericidal kills bacteria; bacteriostatic inhibits growth so the immune system can clear infection.

Peak and trough

Drug-level monitoring points: peak (highest) and trough (lowest) concentrations used to guide dosing for certain antibiotics.

Which cell structure contains the genetic material necessary for cellular reproduction? A. Mitochondrion B. Nucleus C. Cell membrane D. Ribosome

B Rationale: The nucleus houses DNA and regulates cell reproduction

True or False? Receptor sites are located only inside the nucleus.

False. Rationale: Receptor sites are commonly on the cell membrane to receive external signals.

A nurse should expect a provider to switch from a broad-spectrum antibiotic to a narrow-spectrum antibiotic when: A. The patient develops a rash. B. Culture and sensitivity results identify the organism. C. The patient’s fever resolves in 24 hours. D. The patient asks for a different medication.

B. Rationale: Narrow agents are used once the causative organism and sensitivities are known.

Which mechanism is NOT a common way bacteria develop resistance? A. Producing an enzyme that inactivates the drug B. Increasing cell wall permeability to allow more drug in C. Altering receptor sites so the drug no longer binds D. Pumping the drug out of the cell (efflux)

B. Rationale: Resistance typically decreases permeability to prevent drug entry, not increase it.

Which patient teaching helps prevent antimicrobial resistance? A. Stop antibiotics when symptoms improve. B. Save leftover antibiotics for future use. C. Take the full prescribed course at scheduled times. D. Double the dose if you forget one.

C. Rationale: Completing full regimen and correct timing helps maintain therapeutic levels and prevents resistance.

Aminoglycosides require peak and trough monitoring because: A. They cross the placenta easily. B. They have a narrow therapeutic index and cause nephrotoxicity/ototoxicity. C. They are only effective when given orally. D. They cause severe photosensitivity.

B. Rationale: Monitoring reduces risk of toxicity given narrow safety margin.

True or False? Aminoglycosides are safe in pregnancy

False. Rationale: Aminoglycosides are contraindicated in pregnancy due to ototoxicity and nephrotoxicity risks.

Which adverse effect is classically associated with vancomycin when infused too rapidly? A. Red man (red neck) syndrome B. Tendon rupture C. Photosensitivity D. Teeth staining

A. Rationale: Rapid vancomycin infusion can cause histamine-mediated flushing ("red man").

A patient receiving a carbapenem reports new onset seizures. The nurse should: A. Document it as unrelated. B. Recognize seizures are a known adverse effect and notify the prescribing clinician. C. Give an extra dose of the carbapenem. D. Encourage rest and return later.

B. Rationale: Carbapenems can lower seizure threshold; this is clinically significant.

Which antibiotic class is associated with tendonitis and tendon rupture, especially in older adults? A. Cephalosporins B. Fluoroquinolones C. Tetracyclines D. Sulfonamides

B. Rationale: Fluoroquinolones carry a black box warning for tendon injury.

True or False? Cephalosporins may cause cross-sensitivity reactions in patients with penicillin allergy.

True. Rationale: Structural similarities can cause cross-reactivity in some patients.

Which antibiotic is specifically noted for treating MRSA and requires trough monitoring? A. Amoxicillin B. Vancomycin C. Ciprofloxacin D. Doxycycline

B. Rationale: Vancomycin is a mainstay for MRSA and warrants peak/trough monitoring.

A pregnant patient should avoid which antibiotic class because it is teratogenic and affects developing bones and teeth? A. Tetracyclines B. Penicillins C. Macrolides D. Aminoglycosides

A. Rationale: Tetracyclines can cause permanent teeth discoloration and bone growth issues in the fetus.

Sulfonamides are contraindicated in pregnancy primarily because: A. They cause tendon rupture. B. They are nephrotoxic to the mother. C. They are teratogenic and can cause fetal harm. D. They induce red man syndrome.

C. Rationale: Sulfonamides have teratogenic concerns (e.g., neural tube risks) and neonatal kernicterus risk.

Which clinical sign is least specific for infection? A. Purulence B. Fever C. Redness D. Lethargy

D. Rationale: Lethargy is nonspecific and may occur for many reasons; the others are more typical infection signs.

Which antibiotic administration advice is correct for many penicillins and tetracyclines? A. Take with antacids to prevent nausea. B. Take with meals to improve absorption. C. Take on an empty stomach when indicated for optimal absorption. D. Mix with milk for better effect.

C. Rationale: Some agents (e.g., certain penicillins, tetracyclines) have absorption affected by food; instructions often specify empty stomach.

True or False? Broad-spectrum antibiotics should always be used instead of obtaining cultures.

False. Rationale: Cultures guide targeted therapy; broad agents are used empirically then narrowed.

Which AE is especially associated with clindamycin and carbapenems? A. Red man syndrome B. C. difficile colitis (pseudomembranous colitis) C. Tendon rupture D. Photosensitivity

B. Rationale: Clindamycin and broad-spectrum agents can disrupt normal flora and precipitate C. diff.

A nurse is teaching about photosensitivity risk with an antibiotic. Which class should be emphasized? A. Fluoroquinolones and sulfonamides B. Aminoglycosides C. Beta-lactams only D. Vancomycin only

A. Rationale: Photosensitivity is noted with fluoroquinolones and sulfa drugs.

Which statement about antibiotic goals is most accurate? A. Antibiotics should eliminate every bacterium in the body. B. The goal is to reduce bacterial population so the immune system can clear the infection. C. Antibiotics are primarily used to treat viral infections. D. Antibiotics do not require dosing schedules.

B. Rationale: Antibiotics reduce burden; host immunity completes eradication.

A nurse preparing to administer gentamicin knows the major toxicities to assess for are: A. Cardiotoxicity and sedation B. Nephrotoxicity and ototoxicity C. Hyperglycemia and rash D. Photosensitivity and tendon pain

B. Rationale: Aminoglycosides are nephro- and ototoxic.

Which is an important teaching point for patients prescribed sulfonamides? A. They are safe in pregnancy. B. Use sunscreen and avoid UV exposure. C. They do not interact with other medications. D. They prevent all future UTIs.

B. Rationale: Sulfonamides can cause photosensitivity; sun protection is recommended.

True or False? Antibiotics developed by genetic engineering are considered synthetic.

False. Rationale: They are produced via genetic engineering (biotech), distinct from purely synthetic drugs.

The development of new bacterial strains each year poses which major challenge? A. Reduced need for infection control B. Difficulty in developing effective new antibiotics C. Elimination of bacterial resistance D. No impact on clinical practice

B Rationale: Evolving bacteria make antibiotic development challenging.

A key nursing role in preventing antimicrobial resistance is: A. Counseling patients to stop early if they feel better. B. Ensuring accurate dosing, timing, and patient education to complete therapy. C. Prescribing antibiotics for viral illnesses. D. Recommending leftover antibiotics for family members.

B Rationale: Nurses ensure adherence and appropriate use, reducing resistance risk.

Which antibiotic can color body fluids (urine, sweat, tears) orange and is used in TB therapy? A. Rifampin (antimycobacterial) B. Metronidazole C. Vancomycin D. Amoxicillin

A Rationale: Rifampin causes orange discoloration of bodily fluids.

Which antibiotic class is noted to have 5 generations with increasing effectiveness against gram-negative organisms? A. Macrolides B. Cephalosporins C. Sulfonamides D. Aminoglycosides

B Rationale: Cephalosporins are classified into generations with differing spectrums.

True or False? Educating patients to avoid indiscriminate use of antibiotics (e.g., for viral infections) helps reduce resistance.

True Rationale: Antibiotic misuse is a major driver of resistance.

The primary difficulty in treating a viral infection is that viruses: A. Do not respond to antibiotics. B. Only inject their DNA/RNA into the host cell. C. Must enter a host cell, making it difficult to kill the virus without harming the host cell. D. Are rarely contagious, limiting the need for treatment.

C Rationale: Viruses must enter a host cell, making it difficult to treat/kill the virus without harming/killing the host cell.

Which isolation precaution should a nurse implement for a patient diagnosed with Influenza A? A. Contact B. Airborne C. Standard D. Droplet

D Rationale: Isolation precautions for Influenza and Respiratory Viruses are listed as Droplet.

C Rationale: Viruses must enter a host cell, making it difficult to treat/kill the virus without harming/killing the host cell.

Which isolation precaution should a nurse implement for a patient diagnosed with Influenza A? A. Contact B. Airborne C. Standard D. Droplet

D Rationale: Isolation precautions for Influenza and Respiratory Viruses are listed as Droplet.

The primary target of the Human Immunodeficiency Virus (HIV) is: A. Red Blood Cells (RBCs) B. Helper T cells (CD-4 cells) C. B cells (Bone Marrow) D. Neutrophils

B Rationale: HIV attacks Helper T cells (CD-4 cells).

True or False? Loss of Helper T Cell function, which allows for the emergence of opportunistic infections and cancers, is characteristic of Acquired Immune Deficiency Syndrome (AIDS)

True Rationale: Loss of Helper T Cell function leading to an immune system unable to function and the emergence of opportunistic infections and cancers is characteristic of Acquired Immune Deficiency Syndrome (AIDS).

Which class of antiretroviral drugs works by preventing the transfer of DNA/RNA information, thereby preventing the virus from taking over the host cell to reproduce? A. Protease Inhibitors B. Fusion/Entry Inhibitors C. Nonnucleoside reverse transcriptase inhibitors (NNRTIs) D. Nucleoside reverse transcriptase inhibitors (NRTIs)

C Rationale: NNRTIs "Prevent the transfer of DNA/RNA information" and make the "Virus unable to take over host cell to reproduce".

Which antiretroviral drug is the only one listed as a preferred regimen during pregnancy for HIV? A. Nevirapine B. Zidovudine C. Delavirdine D. Enfuvirtide

B Rationale: Zidovudine is the only one listed as a preferred regimen during pregnancy.

The class of antiretroviral drugs that prevents the maturation of the virus by inhibiting an essential enzyme, thus making the virus unable to attach itself to a cell, is: A. Integrase Inhibitors B. CCR5 Coreceptor Antagonists C. Fusion/Entry Inhibitors D. Protease Inhibitors

D Rationale: Protease Inhibitors work by inhibiting Protease, which is essential for the maturation of the virus.

True or False? Influenza and respiratory viruses typically present with classic "flu" symptoms, including GI upset, nausea, vomiting, and diarrhea

B Rationale: Influenza and respiratory viruses invade the respiratory tract and give S/S of the "flu," but the content specifically states "Not GI upset, NV, diarrhea".

Acyclovir, Valacyclovir, and Famciclovir are commonly used to treat which group of infections? A. Hepatitis B and C B. Influenza and RSV C. Herpes and Cytomegalovirus (CMV) D. Fungal infections

C Rationale: These drugs are listed under the Herpes and Cytomegalovirus (CMV) section.

What is a key nursing intervention regarding the administration schedule for antiretroviral agents? A. Administer once daily to reduce toxicity. B. Administer on an empty stomach to increase absorption. C. Administer around the clock to maintain critical concentration (therapeutic levels). D. Administer only when the patient shows signs of opportunistic infection

C Rationale: The nurse should "Administer around the clock to maintain critical concentration (therapeutic levels)".

A major contraindication for the use of CCR5 Coreceptor Antagonists is: A. History of severe asthma. B. Liver dysfunction. C. Active peptic ulcer disease. D. Peripheral neuropathy.

B Rationale: Contraindications for CCR5 Coreceptor Antagonists include Liver dysfunction, which makes them hepatotoxic.

The primary concern for a fetus if the mother contracts Cytomegalovirus (CMV) during pregnancy is: A. The fetus will develop minor respiratory symptoms. B. It can be fatal to the fetus. C. The fetus will develop mild liver toxicity. D. The fetus will develop only a temporary rash.

B Rationale: CMV "Can be fatal to the fetus if contracted during pregnancy".

True or False? Anti-Hepatitis B agents cure the infection and prevent the risk of transmission to others.

False Rationale: Anti-Hepatitis B agents block viral replication and decrease viral load, but they do not cure = risk of transmission".

Healthcare workers are listed as being at risk for Hepatitis B due to: A. Sexual contact. B. Contaminated needles. C. Needle sticks. D. Birth to a mother with Hep B

C Rationale: Healthcare workers are at risk, specifically due to "Needle sticks".

The class of drugs that prevents the virus from entering the host cell and is reserved for treatment unresponsive to other antiretrovirals is given via the subQ route: A. Integrase Inhibitors B. Fusion/Entry Inhibitor C. NNRTIs D. NRTIs

B Rationale: The Fusion/Entry Inhibitor prevents the virus from entering the host cell and is given sub Q.

Infections caused by a fungus are called: A. Mycosis B. Protozoal infections C. Helminthiasis D. Dermatophytes

A Rationale: Infections caused by a fungus are called mycosis.

Fungal infections can range from annoying localized infections to potentially fatal systemic infections. Fungi are often resistant to antibiotics because they possess a: A. Lipid cell wall. B. Ridged cell wall. C. Soft nucleus. D. Flexible cell membrane

B Rationale: Fungi have a ridged cell wall, making them resistant to antibiotics.

Which group of individuals is particularly susceptible to fungal infections due to a suppressed immune system? A. Organ transplant recipients B. Patients with uncontrolled hypertension C. Patients with chronic kidney disease D. Patients with Type 2 Diabetes

A Rationale: Immunocompromised individuals are susceptible, including organ transplant recipients.

A patient is prescribed Nystatin oral suspension for Candida mouth infection. What is the correct administration instruction? A. Chew and swallow the tablet whole. B. Swish and spit versus swish and swallow. C. Apply topically to the outside of the mouth. D. Store the medication in the freezer.

B Rationale: The nurse should instruct the patient to "Swish and spit vs swish and swallow"

Multiple Choice Which of the following is a key contraindication for Azole Antifungal agents? A. Cardiac issues B. Hypotension C. Liver and renal issues D. History of migraines

C Rationale: Contraindications for Azole Antifungals include Liver & renal issues.

Which instruction should the nurse provide to a pregnant client regarding the use of Fluconazole? A. It is the preferred regimen during pregnancy. B. It is absolutely contraindicated and should never be used. C. It is used cautiously during pregnancy. D. It is only used if the infection is minor

C Rationale: Fluconazole is "Used cautiously during pregnancy".

True or False? Tinea infections, such as Tinea pedis (athlete's foot) and Tinea cruris (jock itch), are caused by a worm

False Rationale: Tinea means "worm" but is actually a fungus, not a worm.

Which antifungal agent is often reserved for progressive, potentially fatal infections due to its potency and unpleasant adverse effects? A. Fluconazole B. Nystatin C. Terbinafine D. Amphotericin B

D Rationale: Amphotericin B is described as "Very potent" and "Reserved for progressive, potentially fatal infections".

What should the nurse instruct the client to do before applying a topical antiviral agent to an affected area? A. Apply a thin layer of petroleum jelly. B. Wash/cleanse the affected area. C. Use a warming pad on the area. D. Cover the area with a sterile dressing.

B Rationale: The instruction for topical antivirals is to "Wash/cleanse affected area before application".

The most common cause for liver transplants in the US is due to which viral infection? A. Hepatitis B B. Cytomegalovirus (CMV) C. Hepatitis C D. Herpes Simplex Virus 1 (HSV-1)

C Rationale: Most liver transplants in the US are performed due to Hep C.

True or False? Antifungals are not toxic to host cells because they only target the ridged cell wall of the fungus

False Rationale: The content notes that Antifungals can be toxic to host cells.

A patient on Fluconazole is a priority for the nurse to monitor which lab value due to potential adverse effects? A. Electrolytes (Na, K, Cl) B. Kidney and liver function (BUN/Creatinine, AST/ALT) C. Coagulation studies (PT/INR) D. Blood glucose levels

B Rationale: A key nursing intervention is to "Monitor kidney & liver function (BUN)" due to potential AE of liver toxicity and renal impairment/toxicity.

The term for an infection of the groin area caused by a fungus is: A. Tinea pedis B. Tinea cruris C. Ringworm D. Candida albicans

B Rationale: Tinea cruris is defined as jock itch.

Which type of hepatitis is highly contagious and often requires a vaccination series, placing healthcare workers at risk from needle sticks? A. Hepatitis C B. Hepatitis B C. Hepatitis A D. Cytomegalovirus

B Rationale: Hepatitis B requires a vaccination series and puts healthcare workers at risk from needle sticks.

True or False? Integrase Inhibitors are reserved for patients who have been treated with other antivirals but show a return to viral replication

True Rationale: Integrase Inhibitors are "Reserved for pts who have been treated with other antivirals who show a return to viral replication".

A patient on antiretroviral therapy reports extreme fatigue, headache, difficulty breathing, and a severe rash. The nurse should instruct the patient to: A. Continue the medication and take an over-the-counter pain reliever. B. Immediately report these symptoms during their regular check-up. C. DC the medication and wait for the symptoms to resolve. D. Report these symptoms to the provider immediately.

D Rationale: The nurse should educate the patient to "Report extreme fatigue, headache, difficulty breathing, severe rash" as these are signs of adverse effects that require immediate attention from the provider. ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

Protozoal infections are most commonly acquired in: A) Cold climates B) Unsanitary/tropical environments C) Hospitals D) Urban U.S. areas

B) Tropical, crowded, unsanitary areas.

Malaria is transmitted by: A) Tsetse fly B) Mosquito (female Anopheles) C) Black fly D) Housefly

B) Female Anopheles mosquito.

Major symptoms of malaria occur due to: A) Bone loss B) RBC destruction C) Allergies D) High insulin

B) RBC destruction → fever, chills.

Treatment of malaria typically uses: A) Single-drug therapy B) Combination therapy C) No medication D) Only steroids

B) Combination therapy – attacks parasite at multiple stages.

Prophylaxis for malaria should begin: A) After returning home B) 1–2 days before travel and continue post-travel C) Only if symptoms occur D) Weeks after exposure

B) Start before travel, continue 7 days after return.

Chloroquine adverse effects include: A) Vision changes B) Weight gain C) Hyperreflexia D) Leukocytosis

A) Vision changes – may worsen retinal disease.

Which antimalarial is associated with ototoxicity? A) Metronidazole B) Chloroquine C) Albendazole D) Praziquantel

B) Chloroquine – can cause nerve/ear toxicity.

Contraindication for chloroquine: A) Tachycardia B) Retinal disease C) Diarrhea D) Seasonal allergies

B) Retinal disease – may worsen.

T/F: Antimalarials may cause serious cardiac arrhythmias.

True – chloroquine has cardiac toxicity risk.

Amebiasis primarily affects which organ? A) Kidney B) Large intestine C) Skin D) Bone

B) Large intestine – penetrates mucosa.

A characteristic symptom of amebiasis is: A) Bloody diarrhea B) Pale/yellow urine C) Cyanosis D) Painful swallowing

A) Bloody diarrhea – mucosal erosion.

Leishmaniasis is transmitted by: A) Tick B) Sandfly C) Mosquito D) Cat flea

B) Sandfly – protozoa infect macrophages.

Trypanosomiasis (African sleeping sickness) causes: A) Insomnia B) Lethargy and CNS inflammation C) Diarrhea D) Dermatitis

B) CNS inflammation → lethargy, prolonged sleep.

Chagas disease affects primarily: A) Lungs B) Heart (cardiomyopathy) C) Joints D) Kidney

B) Heart muscle – causes cardiomyopathy.

Trichomoniasis is spread by: A) Water B) Soil C) Sexual intercourse D) Airborne particles

C) Sexual intercourse – men often asymptomatic carriers.

Vaginal discharge in trichomoniasis is typically: A) Clear B) Yellow-green and frothy C) Bright red D) Brown

B) Yellow-green, foul-smelling.

Which parasite causes malodorous, “rotten egg” stools? A) Toxoplasmosis B) Giardiasis C) Malaria D) Leishmaniasis

B) Giardiasis – foul-smelling diarrhea.

Toxoplasmosis is often transmitted via: A) Bird droppings B) Cat feces or undercooked meat C) Swimming pools D) Sand

B) Cat feces → pregnant women avoid.

Preferred drug for protozoal infections like giardia or trichomoniasis: A) Vancomycin B) Metronidazole C) Penicillin D) Aspirin

B) Metronidazole – DOC for protozoa.

Patients must avoid what when taking metronidazole? A) Bananas B) Alcohol C) Dairy D) Salt

B) Alcohol – disulfiram-like reaction.

Metronidazole adverse effects include: A) Rash only B) CNS effects like dizziness C) Hyperglycemia D) Tachycardia

B) CNS effects – safety concerns.

Anthelmintic therapy treats infections with: A) Bacteria B) Worms C) Fungi D) Viruses

B) Worms (helminths).

Pinworms most commonly cause: A) Chest pain B) Rectal itching C) Vomiting D) Jaundice

B) Perianal itching – classic.

Best sample for diagnosing pinworms: A) Blood sample B) Urinalysis C) Stool sample D) Sputum sample

C) Stool sample or tape test.

Main education point for pinworm infection: A) Avoid cold food B) Strict handwashing & hygiene C) Drink more soda D) Avoid dairy

B) Hygiene – very contagious.

Which worm is a flatworm (platyhelminth)? A) Pinworm B) Hookworm C) Tapeworm D) Roundworm

C) Tapeworm – platyhelminth.

Albendazole and mebendazole work by: A) Killing RBCs B) Disrupting worm metabolic pathways C) Increasing glucose D) Blocking serotonin

B) Inhibiting helminth metabolism.

Contraindication for anthelmintics: A) Fever B) Pregnancy C) Sore throat D) Dry mouth

B) Pregnancy – many are teratogenic.

T/F: Anthelmintics may cause abdominal discomfort and diarrhea.

True – GI symptoms common.

Vocab: “Helminth” means: A) Virus B) Worm parasite C) Protozoa D) Bacteria

B) Worm – general term for parasitic worms.

Cancer arises from: A) Cardiac tissue B) Genetically abnormal cells dividing uncontrollably C) Excessive hormone release D) Bacterial invasion

B) Genetically abnormal cells dividing autonomously.

The term “anaplasia” means: A) Normal cell growth B) Loss of cellular function and structure C) Increased RBC count D) High WBC count

B) Loss of cellular differentiation/function.

Which describes cancer cells growing their own blood supply? A) Metastasis B) Leukocytosis C) Angiogenesis D) Autonomy

C) Angiogenesis – formation of new blood vessels.

Metastasis is defined as: A) Tumor shrinking B) Spread to distant sites C) Cellular repair D) Reversible mutation

B) Spread of malignant cells to new locations.

Which is a hematologic malignancy? A) Sarcoma B) Carcinoma C) Leukemia D) Melanoma

C) Leukemia – originates in bone marrow/blood.

Which tissue type is most affected by chemotherapy? A) Slow-growing tissue B) Rapidly dividing tissue C) Cartilage D) Mature neurons

B) Rapidly dividing tissues – hair, GI mucosa, bone marrow.

Combination chemotherapy is used because: A) It reduces cost B) Drugs target different phases for best effect C) It eliminates all AEs D) It improves sleep

B) Targets multiple cell cycle phases → best tumor kill.

A major GI adverse effect of chemo is: A) Constipation only B) Nausea/vomiting C) Anosmia D) Hypertension

B) N/V – extremely common.

Neutropenia places the patient at risk for: A) Hypertension B) Infection C) Hypothermia D) Seizures

B) Infection – low neutrophils.

Safe food recommendations for neutropenic patients include: A) Fresh fruit B) Raw vegetables C) Avoiding raw produce & crowds D) Undercooked meats

C) Avoiding raw produce and crowded environments.

Which antineoplastic group interferes with DNA replication directly (alkylates DNA)? A) Mitotic inhibitors B) Alkylating agents C) Hormone modulators D) Immunosuppressants

B) Alkylating agents – cross-links DNA.

Which category includes methotrexate? A) Antimetabolite B) Alkylating agent C) Antibiotic D) Mitotic inhibitor

A) Antimetabolite – inhibits folate metabolism.

Mitotic inhibitors act by: A) Increasing cell growth B) Preventing microtubule formation C) Enhancing RNA synthesis D) Blocking folate

B) Preventing mitotic spindle formation.

Which antineoplastic is associated with cardiotoxicity? A) Doxorubicin B) Cisplatin C) Etoposide D) Methotrexate

A) Doxorubicin – red devil, cardiotoxic.

Hormone & hormone modulators are used for: A) Childhood fevers B) Hormone-sensitive tumors C) IBS D) Pneumonia

B) Tumors like breast/prostate cancer.

Alopecia occurs because chemo affects: A) Nerves B) Hair follicles (rapidly dividing cells) C) Bone tissue D) Kidney tubules

B) Hair follicles – rapidly dividing.

Palliative chemotherapy aims to: A) Cure cancer B) Shrink tumor to reduce symptoms C) Prevent all metastasis D) Strengthen immunity

B) Reduce symptoms when cure not possible.

T/F: Antiemetics should be given BEFORE chemotherapy infusion.

True – prevents rather than treats N/V.

Supportive care during chemo includes: A) Avoiding hydration B) Rest periods & small meals C) Mandatory strict bedrest D) Only large meals

B) Rest & small frequent meals for symptom support.

Which immunoglobulin is most abundant? A) IgM B) IgA C) IgE D) IgG

D) IgG – main serum antibody.

Which immune cells are involved in cell-mediated immunity? A) B cells B) T cells C) RBCs D) Platelets

B) T cells – cellular immunity.

The inflammatory response cardinal sign “rubor” means: A) Pain B) Redness C) Heat D) Swelling

B) Redness – increased blood flow.

Pyrogens trigger: A) Hypothermia B) Fever C) Tachycardia D) Anemia

B) Fever – reset hypothalamus.

Which WBCs are first responders in infection? A) Basophils B) Neutrophils C) Eosinophils D) Lymphocytes

B) Neutrophils – phagocytes.

Vocab: “MHC” refers to: A) Myocardial hormone C B) Major histocompatibility complex C) Major hepatic cells D) Muscle hemoglobin

B) Major histocompatibility complex – self vs non-self recognition.

Gastric acid helps immunity by: A) Neutralizing RBCs B) Destroying ingested pathogens C) Reducing insulin D) Increasing iron

B) Destroys many swallowed pathogens.

Barrier defenses include: A) Kidneys only B) Skin and mucous membranes C) Only WBCs D) Pancreas

B) Skin/mucosa prevent pathogen entry.

T/F: Chronic inflammation can cause tissue damage.

True – prolonged inflammation disrupts tissue.

Immunosuppressed patients should avoid: A) Crowds and sick contacts B) All cooked foods C) All medications D) Sleep

B) Crowds/sick contacts – infection risk.

Which drug is a common salicylate? A) Ibuprofen B) Aspirin C) Acetaminophen D) Ketorolac

B) Aspirin – prototype salicylate.

A key hematologic effect of NSAIDs is: A) Increased WBC production B) Platelet inhibition and bleeding risk C) Severe anemia always D) No effect on platelets

B) Platelet inhibition – can increase bleeding risk.

In African American patients, anti-inflammatory drugs may show: A) Increased sensitivity B) Decreased sensitivity and increased risk of GI bleed C) No change in effect D) Only skin reactions

B) Decreased sensitivity and higher GI bleed risk – monitor closely.

The most serious toxicity associated with acetaminophen overdose is: A) Renal failure B) Hepatotoxicity C) GI bleeding D) Hypotension

B) Hepatotoxicity – liver damage is a major concern.

TNF (tumor necrosis factor) blockers are used for: A) Acute viral infections B) Progressive arthritis and some autoimmune diseases C) Poisoning D) Simple headache

B) Progressive arthritis (e.g., RA) and conditions like Crohn’s disease.

TNF blockers are contraindicated in patients with: A) Mild headache B) Any active infection C) Old age alone D) Controlled hypertension

B) Any active infection – they suppress immune response and can worsen infection.

A major black box warning for TNF blockers is: A) Bradycardia B) Serious/fatal infections and risk of lymphoma/cancer C) Immediate renal failure D) Constipation

B) Risk of serious infections and malignancies due to immune suppression.

Gold compounds (gold salts) are reserved for: A) First-line therapy in all arthritis B) Patients unresponsive to conventional arthritis therapies C) Acute bacterial infections D) Simple muscle strain

B) Use in patients who fail conventional therapies.

A common adverse effect of gold salts is: A) Hypoglycemia B) Stomatitis and GI inflammation C) Tachycardia only D) Insomnia

B) Stomatitis and GI irritation, plus bone marrow depression and dermatitis.

Immune stimulants are used to: A) Decrease immune activity in autoimmune disorders B) Energize or ramp up the immune system when fighting prolonged invasion C) Replace vaccines D) Treat pain only

B) Energize the immune system to fight infection or tumor.

Interferons are naturally released in response to: A) Bacterial toxins B) Viral invasion and tumor growth C) Allergens D) Dehydration

B) Viral invasion and tumor presence – they interfere with viral replication and tumor growth.

A common adverse effect of interferons is: A) Severe hypertension B) Flu-like symptoms (myalgia, arthralgia, fever) C) Severe constipation D) Anaphylaxis only

B) Flu-like symptoms plus potential myelosuppression and depression.

Interleukins primarily: A) Suppress the immune system B) Stimulate immunity and inhibit tumor growth C) Stop all WBC production D) Only affect platelets

B) Stimulate immune responses and can inhibit tumor growth.

Colony-stimulating factors (CSFs) are used to: A) Decrease neutrophil counts B) Increase neutrophil production in bone marrow C) Increase platelet count only D) Treat fever

B) Increase neutrophil production and reduce infection risk in neutropenia.

A key adverse effect associated with colony-stimulating factors is: A) Severe hypoglycemia B) Bone pain and fatigue C) Immediate heart failure D) Blindness

B) Bone pain, fatigue, and other bone marrow-related symptoms.

Immune suppressants such as cyclosporine are used for: A) Allergic rhinitis B) Organ transplantation and some autoimmune disorders C) Simple infections D) Mild headaches

B) To prevent transplant rejection and treat certain autoimmune diseases.

A major concern with immune suppressants is: A) Hyperimmunity B) Increased risk for infection and neoplasm development C) Increased fertility D) Increased bone density

B) Infection and cancer risk due to suppressed immune response.

Monoclonal antibodies (MABs) are designed to: A) Non-specifically suppress immunity B) Attach to specific receptor sites and act on specific targets C) Only treat allergies D) Only treat hypertension

B) Highly specific targeted therapy; e.g., for cancers, MS, arthritis.

An important adverse effect of monoclonal antibodies is: A) Pulmonary edema and flu-like symptoms B) Severe hypothermia C) Immediate liver failure D) Tachycardia only

A) Risk of pulmonary edema, flu-like symptoms, and third spacing; also infection and neoplasm risks.

Patients on immune suppressants should be taught to: A) Eat lots of raw fruits/veggies and keep fresh flowers B) Avoid fresh fruits/veggies, undercooked foods, and crowded places C) Avoid all cooked food D) Never wash their hands

B) Reduce exposure to pathogens; strict hand hygiene and food safety.

Vaccines work by: A) Providing passive antibodies directly B) Artificially stimulating active immunity C) Immediately killing all pathogens D) Only treating active infections

B) Artificially stimulating active immunity with weakened/modified antigens.

Immune sera provide: A) Long-term immunity B) Passive artificial immunity (preformed antibodies) C) No real immunity D) Only hydration

B) Passive artificial immunity, often used post-exposure.

Antitoxins are sera containing: A) Viral particles B) Antibodies to specific toxins C) Antivenom to snake bites only D) Normal saline

B) Antibodies directed at specific toxins produced by pathogens.

Antivenoms are used to: A) Prevent hypertension B) Neutralize venom from spider or snake bites C) Relieve headache D) Treat colds

B) Provide antibodies against specific venoms.

Common IM vaccine injection sites in adults include: A) Deltoid, ventrogluteal, and vastus lateralis B) Wrist C) Abdomen only D) Neck region

A) Deltoid, ventrogluteal, vastus lateralis are standard IM sites.

The primary nursing goal of hand washing is to: A) Treat pain B) Prevent transmission of illness and infection C) Lower blood pressure D) Relieve anxiety

B) #1 way to prevent spread of infection.

A major GI adverse effect of many NSAIDs is: A) Hypoglycemia B) GI upset and GI bleeding C) Constipation only D) Gallbladder rupture

B) GI irritation and bleeding – monitor for melena, hematemesis.

Interferons require caution due to risk of: A) Euphoria B) Depression and suicidal ideation C) Insomnia only D) Hypertension only

B) They may cause or worsen depression; monitor mood.

Gold compounds are contraindicated in: A) Allergy only B) Pregnancy and lactation C) All healthy adults D) Children with colds

B) Teratogenic; avoid in pregnancy and lactation.

A key difference between acetaminophen and NSAIDs is that acetaminophen: A) Has strong anti-inflammatory effects B) Has little to no anti-inflammatory effect C) Always causes GI bleeding D) Is not an analgesic

B) Has minimal to no anti-inflammatory effect; mainly analgesic and antipyretic.

Which body system primarily controls bodily functions and responses? A) GI system B) Nervous system C) Immune system D) Endocrine system

B) Nervous system – central control of body function and response.

The central nervous system (CNS) consists of: A) Peripheral nerves only B) Brain and spinal cord C) Brain only D) Spinal cord and muscles

B) Brain and spinal cord.

The blood-brain barrier (BBB) primarily helps prevent which substances from entering the CNS? A) Oxygen and CO₂ B) Large proteins and toxins C) Glucose and electrolytes D) All medications

B) Large proteins and toxins – protects fragile neurons but makes drug therapy harder.

The hindbrain is responsible mainly for: A) Vision and hearing B) Voluntary movement C) Respiration, cardiovascular function, and basic vital reflexes D) Memory and emotion

C) Basic vital functions such as breathing and blood pressure.

The cerebellum’s main role is to coordinate: A) Respirations B) Balance and posture C) Hunger and thirst D) Speech

B) Balance, posture, and coordination of voluntary muscles.

The midbrain contains cranial nerves related to which functions? A) Digestion B) Smell only C) Senses and some muscle activities of head/neck D) Hearing only

C) Senses (sight, smell, hearing, balance, taste) and some head/neck muscle activity.

The reticular activating system (RAS) is most involved with: A) Pain modulation B) Sleep-wake cycles and arousal C) Fluid balance D) Immune response

B) Sleep-wake cycle and arousal.

The forebrain includes structures such as: A) Lung lobes B) Brain hemispheres, thalamus, hypothalamus, and limbic system C) Spinal roots D) Peripheral nerves only

B) Major higher-function structures of the brain.

Afferent nerve fibers carry impulses: A) From CNS to periphery B) From PNS to CNS C) From muscles to bone D) From skin to bone

B) From PNS (sensory receptors) to CNS.

Depolarization in an action potential occurs when: A) Potassium rushes into the cell B) Sodium rushes into the cell C) Sodium leaves the cell D) Calcium leaves the cell

B) Sodium rushes into the cell.

The primary function of myelin on long nerves is to: A) Slow impulse conduction B) Speed electrical conduction and protect the nerve C) Store calcium D) Eliminate synapses

B) Speed conduction and protect nerves from fatigue.

Which neurotransmitter is primarily inhibitory in the CNS and helps prevent seizures? A) Dopamine B) GABA C) Norepinephrine D) Acetylcholine

B) GABA – inhibits nerve activity and prevents overexcitability.

Serotonin is involved in: A) Cardiac contractility B) Arousal, sleep, and mood regulation C) Blood clotting only D) Kidney function

B) Arousal, sleep, and mood; low levels associated with depression.

Pain is best described as: A) Completely objective B) A purely physical sensation C) A sensory and emotional, subjective experience D) Always visible on exam

C) A subjective sensory and emotional experience.

Acute pain is typically related to: A) Long-term disease progression B) Recent tissue damage or injury C) Phantom limb phenomena D) Chronic inflammatory conditions

B) Recent tissue damage/injury with expected healing.

Referred pain is: A) Pain felt at the site of injury only B) Pain perceived in an area different from the actual source C) Imaginary pain D) Only seen in children

B) Pain perceived in a different area than the origin (e.g., MI pain in arm).

Phantom pain occurs when: A) Pain is felt in a limb that still exists B) Pain is felt in a part of the body that no longer exists C) Pain is due to psychosis D) Pain is only neuropathic

B) Pain in an amputated or missing body part.

Opioids produce analgesia by binding to: A) GABA receptors B) Opioid receptor sites C) Serotonin receptors D) Dopamine receptors

B) Opioid receptors – producing analgesia, sedation, and euphoria.

A major life-threatening adverse effect of opioid agonists is: A) Hyperventilation B) Respiratory depression C) Tachycardia D) Severe diarrhea

B) Respiratory depression – especially high risk with high doses or combinations.

Opioid agonist-antagonists: A) Only block opioid receptors B) Stimulate some opioid receptors and block others C) Have greater abuse potential than pure agonists D) Do not cause respiratory depression

B) They stimulate some receptors but block others; generally lower abuse potential.

Which medication is an opioid antagonist used to reverse opioid overdose? A) Morphine B) Naloxone C) Midazolam D) Fentanyl

B) Naloxone (Narcan) – reverses opioid effects including respiratory depression.

Naloxone works by: A) Stimulating opioid receptors B) Blocking opioid receptors without activating them C) Increasing GABA release D) Increasing serotonin levels

B) Blocking opioid receptors and reversing opioid effects.

A key contraindication/precaution for opioid use is: A) Mild headache B) Respiratory dysfunction C) History of appendectomy D) Mild nausea

B) Respiratory dysfunction – opioids further suppress respiratory drive.

Migraine headaches are believed to be associated mainly with: A) Infection B) Cranial vasodilation C) Hypoglycemia D) Hypotension

B) Vasodilation of cranial vessels.

Ergot derivatives are used for: A) Constipation B) Prevention/abortion of migraines by vasoconstriction C) Treating hypertension D) Chronic insomnia

B) Prevention or abortion of migraine via vasoconstriction.

A major adverse effect concern with ergot derivatives is: A) Severe vasodilation B) Vasoconstriction leading to chest pain and ischemia C) Hypoglycemia D) Diarrhea

B) Excessive vasoconstriction – can cause chest pain, MI, and peripheral ischemia.

Triptans are used: A) For long-term migraine prevention only B) To acutely treat migraine by cranial vasoconstriction C) Only for tension headaches D) For seizures

B) For acute migraine treatment via cranial vasoconstriction.

Triptans are contraindicated in patients with: A) Allergic rhinitis B) Coronary artery disease (CAD) C) UTI D) Mild anemia

B) CAD – added vasoconstriction can precipitate cardiac ischemia.

Important patient teaching about opioids includes: A) Stop them abruptly when pain improves B) Avoid alcohol and other CNS depressants C) Share remaining tablets with family D) Take extra doses when pain is mild

B) Avoid alcohol/CNS depressants and follow prescribed dose; taper when appropriate.

The best way to evaluate opioid effectiveness is to: A) Assess only vital signs B) Reassess pain using a reliable pain scale C) Check urine output D) Monitor weight monthly

B) Reassess pain intensity and functional status after dosing.

Which benzodiazepine is a commonly used prototype? A) Alprazolam B) Diazepam C) Lorazepam D) Temazepam B) Diazepam – prototype benzodiazepine; enhances GABA to reduce anxiety.

What is a key benzodiazepine contraindication? A) Allergy B) Hypotension C) Diabetes D) Bradycardia A) Allergy – benzos are contraindicated in allergy

psychosis

Abrupt cessation of benzodiazepines may cause: A) Hypertension B) Withdrawal syndrome C) Hallucinations D) Tachypnea B) Withdrawal syndrome – can cause nausea

headache

Which is the benzodiazepine antagonist? A) Naloxone B) Flumazenil C) Naltrexone D) Protamine B) Flumazenil – used to reverse benzo sedation/overdose.

Barbiturates carry a particularly high risk of: A) Hypertension B) Addiction and dependence C) Hyperglycemia D) Diarrhea B) Addiction and dependence – they have high abuse and dependence potential.

Which of the following is the prototype barbiturate? A) Butabarbital B) Phenobarbital C) Secobarbital D) Pentobarbital B) Phenobarbital – classic barbiturate prototype.

Barbiturates should NOT be combined with: A) Antihistamines B) Antibiotics C) Other CNS depressants or alcohol D) Laxatives C) Other CNS depressants or alcohol – greatly increases risk for respiratory depression.

Which anesthetic stage is desired for surgery? A) Stage 1 (analgesia) B) Stage 2 (excitement) C) Stage 3 (surgical anesthesia) D) Stage 4 (medullary paralysis) C) Stage 3 – surgical anesthesia with muscle relaxation and loss of reflexes.

Stage 4 anesthesia is characterized by: A) Mild sedation B) Perfect surgical depth C) Medullary paralysis and severe CNS depression D) REM sleep C) Medullary paralysis – loss of respiratory and vasomotor center; this is dangerous.

The main purpose of balanced anesthesia is to: A) Shorten induction time only B) Use one very high-dose anesthetic C) Combine several drugs to achieve analgesia

amnesia

Nitrous oxide carries which risk? A) Bradycardia B) Hypoxia C) Hyperkalemia D) Renal failure B) Hypoxia – given with oxygen to prevent low O₂ levels.

Malignant hyperthermia is treated with: A) Naloxone B) Dantrolene C) Flumazenil D) Atropine B) Dantrolene – skeletal muscle relaxant used in malignant hyperthermia crisis.

Local anesthetics work primarily by blocking: A) Calcium channels B) Sodium channels C) Potassium channels D) Glucose uptake B) Sodium channels – prevents depolarization and nerve impulse conduction.

Which best describes a nerve block with local anesthesia? A) Topical cream on the skin B) Tourniquet application C) Injection around a specific nerve or nerve group D) IV infusion in a large vein C) Injection near the nerve – blocks impulse transmission from that region.

Which anxiolytic is associated with minimal sedation and low abuse potential? A) Diazepam B) Temazepam C) Buspirone D) Zolpidem C) Buspirone – anxiolytic that does not cause significant sedation.

Barbiturates may be used clinically for: A) Mild situational anxiety only B) Hypertension C) Seizure disorders D) Asthma C) Seizures – phenobarbital is often used as an anticonvulsant.

The black box warning for benzodiazepines is related to: A) Liver failure B) Renal toxicity C) Respiratory depression when combined with opioids/sedatives D) Cardiac arrest C) Respiratory depression – especially when combined with other CNS depressants.

Which agent is an inhaled anesthetic gas? A) Methohexital B) Midazolam C) Nitrous oxide D) Promethazine C) Nitrous oxide – inhaled anesthetic gas.

Zolpidem is most appropriately prescribed for: A) Anxiety B) Chronic pain C) Insomnia D) Seizure control C) Insomnia – hypnotic used to induce sleep.

Sevoflurane is commonly used to: A) Treat chronic pain B) Induce anesthesia rapidly C) Reverse hypoxia D) Prevent infection B) Induce anesthesia – rapid onset and recovery.

Which is a common CNS effect of barbiturates? A) Excitation B) Drowsiness and lethargy C) Euphoria D) Hyperactivity B) Drowsiness and lethargy – CNS depression.

Benzodiazepines primarily act on which neurotransmitter system? A) Dopamine B) Serotonin C) GABA D) Norepinephrine C) GABA – they enhance the inhibitory effect of GABA.

A key risk of local anesthetics

especially if absorbed systemically

Which is a volatile liquid anesthetic? A) Nitrous oxide B) Desflurane C) Diazepam D) Dantrolene B) Desflurane – a volatile inhaled anesthetic.

The primary purpose of preoperative antiemetic medications is to: A) Sedate the patient B) Reduce nausea and vomiting C) Increase heart rate D) Decrease urine output B) Reduce nausea and vomiting during and after anesthesia.

Which benzodiazepine is often used IV for status epilepticus? A) Alprazolam B) Diazepam C) Temazepam D) Zaleplon B) Diazepam – rapid IV onset for seizure control.

Hypnosis from sedative-hypnotics is best described as: A) Light sleep B) Deep CNS depression with loss of response to stimuli C) Mild anxiety D) Muscle contraction B) Deep CNS depression – patient is not aware of or responsive to stimuli.

Which of the following is NOT a typical barbiturate adverse effect? A) Hallucinations B) Ataxia C) Respiratory depression D) Hyperactivity D) Hyperactivity – barbiturates are CNS depressants.

Why is the induction phase of general anesthesia considered a danger period? A) Risk of hypoglycemia B) Sympathetic stimulation with tachycardia

tachypnea

When possible

the preferred route for benzodiazepine administration is: A) IV B) SQ C) PO D) IM C) PO – safer with fewer acute adverse effects than IV.

Epilepsy is defined as: A) One single seizure B) Chronic tendency toward recurrent seizures C) A psychiatric disorder D) A metabolic syndrome

B) Chronic disorder with repeated unprovoked seizures.

Which antiepileptic works by increasing GABA levels? A) Gabapentin B) Lamotrigine C) Carbamazepine D) Phenytoin

A) Gabapentin – increases GABA activity.

Valproic acid is contraindicated in: A) Pregnancy B) Diabetes C) Asthma D) GERD

A) Pregnancy – significant teratogenicity.

Which antiepileptic causes visual field narrowing as a unique adverse effect? A) Vigabatrin B) Levetiracetam C) Phenytoin D) Carbamazepine

A) Vigabatrin – irreversible vision loss possible.

T/F: Seizure medications should be taken consistently at the same time each day.

True – maintains stable levels.

Which agent is most associated with hyponatremia? A) Carbamazepine B) Gabapentin C) Clonazepam D) Lamotrigine

A) Carbamazepine – SIADH risk.

Patients should avoid alcohol with antiepileptics because it: A) Has no effect B) Increases seizure threshold C) Lowers seizure threshold and causes CNS depression

D) Makes medications ineffective

Which type of seizure involves brief staring spells? A) Tonic seizures B) Atonic seizures C) Absence seizures D) Myoclonic

C) Absence seizures – typical in children.

Lorazepam is preferred for status epilepticus because: A) Oral dosing works best B) Long action and strong effect C) Short action D) It is not sedating

B) Long duration and strong benzodiazepine effect.

Which antiepileptic carries risk of SJS especially when titrated quickly? A) Lamotrigine B) Valproate C) Phenytoin D) Diazepam

A) Lamotrigine – titrate slowly.

T/F: Levetiracetam can cause mood changes or irritability.

True – behavioral effects possible.

Vocab: “Tonic-clonic” seizure refers to: A) Only tonic stiffening B) Only clonic jerking C) Stiffening then rhythmic jerking D) Brief staring

C) Stiffening followed by jerking.

NMJ blockers must be administered: A) Only orally B) IM C) IV only D) SubQ

C) IV – require rapid controlled onset.

Which is a nondepolarizing NMJ blocker? A) Succinylcholine B) Rocuronium C) Diazepam D) Ketamine

B) Rocuronium – competitive antagonist.

Succinylcholine onset is typically: A) 10 minutes B) 60 seconds C) 30 minutes D) 1 hour

B) About 1 minute – rapid sequence intubation.

A contraindication to succinylcholine is: A) Anxiety B) Hyperkalemia C) Hypokalemia D) Mild infection

B) Hyperkalemia – can worsen and cause arrhythmias.

Paralyzed patients may appear awake because: A) They are awake B) Paralytics do not sedate C) They have no consciousness D) Paralytics induce coma

B) Paralytics do NOT sedate – must give sedation.

Which class of drug reverses nondepolarizing blockers? A) Opioids B) Cholinesterase inhibitors C) Beta-blockers D) Dopamine agonists

B) Cholinesterase inhibitors such as neostigmine.

Benefit of rocuronium over succinylcholine: A) Faster onset B) No paralysis C) Fewer adverse effects like hyperkalemia D) Causes analgesia

C) Fewer adverse effects – safer in hyperkalemia.

Which antiepileptic is associated with weight gain? A) Topiramate B) Valproic acid C) Lamotrigine D) Lacosamide

B) Valproic acid – common metabolic effect.

Topiramate commonly causes: A) Weight gain B) Cognitive slowing (“Dopamax”) C) Hyperreflexia D) Rash

B) Cognitive slowing.

T/F: Many antiepileptics require periodic bloodwork.

True – LFTs, CBC, drug levels.

Long-term phenytoin use affects: A) Teeth/gums B) Thyroid C) Lungs D) Skin only

A) Gingival hyperplasia and dental issues.

Which NMJ blocker is preferred for rapid sequence intubation if succinylcholine is contraindicated? A) Rocuronium B) Diazepam C) Haloperidol D) Fluoxetine

A) Rocuronium – fastest non-depolarizer.

Neuromuscular blockers should NOT be used in patients lacking: A) IV access B) Sedation capability C) Reflexes D) Insurance

B) Sedation capability – paralysis without sedation is dangerous.

Vocab: “Flaccid paralysis” means: A) Spasms B) Rigid muscles C) Limp muscles unable to contract D) Seizure activity

C) Limp muscle paralysis due to NMJ blockade.

Which antiepileptic requires folic acid supplementation in pregnancy? A) Levetiracetam B) Lamotrigine C) Valproic acid D) Diazepam

B) Lamotrigine – safest option but folate recommended.

Major risk of succinylcholine in trauma/burn patients: A) Hypoglycemia B) Severe hyperkalemia C) Weight gain D) Rash

B) Severe hyperkalemia due to upregulated receptors.

T/F: NMJ blockers must be titrated while monitoring nerve stimulator “train-of-four.”

True – ensures correct paralysis depth.

Which neurotransmitter imbalance is most associated with depression? A) Dopamine B) Serotonin C) Acetylcholine D) GABA

B) Serotonin – low serotonin levels are strongly linked to depressive symptoms.

Which medication class includes sertraline and fluoxetine? A) Tricyclics B) MAOIs C) SSRIs D) Atypicals

C) SSRIs – selective serotonin reuptake inhibitors.

SSRIs typically take how long to show therapeutic effect? A) Immediately B) 1–2 days C) 1–4 weeks D) 2 months

C) 1–4 weeks – due to gradual receptor changes.

A dangerous reaction combining SSRIs with MAOIs is called: A) Neuroleptic syndrome B) Serotonin syndrome C) Akathisia D) EPS

B) Serotonin syndrome – results from excess serotonin.

Which symptom is characteristic of serotonin syndrome? A) Bradycardia B) Hypothermia C) Agitation and hyperreflexia D) Constipation

C) Agitation, hyperreflexia, fever.

TCAs (tricyclic antidepressants) are contraindicated with which condition? A) Diabetes B) Recent MI C) Asthma D) GERD

B) Recent MI – TCAs cause cardiac conduction effects.

Common adverse effect of TCAs: A) Diarrhea B) Orthostatic hypotension C) Hyperthermia D) Mydriasis

B) Orthostatic hypotension – due to alpha blockade.

MAOIs require avoidance of foods high in: A) Sodium B) Potassium C) Tyramine D) Calcium

C) Tyramine – risk of hypertensive crisis.

Hypertensive crisis may occur with MAOIs when consuming: A) Lettuce B) Aged cheeses C) Bananas D) Saltines

B) Aged cheeses – high tyramine content.

Which antidepressant is most activating (energizing)? A) Paroxetine B) Fluoxetine C) Amitriptyline D) Phenelzine

B) Fluoxetine – tends to be activating.

Best time to administer an activating SSRI like fluoxetine: A) At bedtime B) With dinner C) In the morning D) Middle of night

C) Morning – avoids insomnia.

Bupropion is useful for depression and also for: A) Weight gain B) Smoking cessation C) Hypertension D) Seizure disorder

B) Smoking cessation – reduces nicotine cravings.

Which antidepressant lowers seizure threshold? A) Sertraline B) Bupropion C) Mirtazapine D) Fluoxetine

B) Bupropion – dose-dependent seizure risk.

T/F: St. John’s Wort should NOT be combined with SSRIs.

True – increases serotonin → serotonin syndrome risk.

Which antipsychotic carries high EPS risk? A) Olanzapine B) Clozapine C) Haloperidol D) Quetiapine

C) Haloperidol – high-potency typical antipsychotic.

A major risk of clozapine is: A) Liver failure B) Agranulocytosis C) Hypertension D) Weight loss

B) Agranulocytosis – requires frequent CBC monitoring.

Which symptom is part of EPS (extrapyramidal symptoms)? A) Diarrhea B) Dystonia C) Hyperglycemia D) Diplopia

B) Dystonia – muscle spasms and rigidity.

Neuroleptic malignant syndrome (NMS) includes: A) Hypotension B) Muscle rigidity & high fever C) Bradycardia D) Constipation

B) Severe rigidity, fever, autonomic instability.

Which drug class has black box for increased suicidality in youth? A) SSRIs B) Calcium-channel blockers C) Diuretics D) Beta-blockers

A) SSRIs – monitor mood changes.

Which atypical antipsychotic is most sedating and causes weight gain? A) Risperidone B) Olanzapine C) Aripiprazole D) Haloperidol

B) Olanzapine – strong metabolic side effects.

Risperidone can cause increases in which hormone? A) Cortisol B) TSH C) Prolactin D) Estrogen

C) Prolactin – may cause galactorrhea.

Vocab: “Akathisia” means: A) Muscle stiffness B) Restlessness/inability to sit still C) Tremors D) Paralysis

B) Restlessness – common EPS manifestation.

Which antidepressant is safest in elderly? A) TCA B) MAOI C) SSRI D) Haloperidol

C) SSRI – better tolerated, fewer cardiac effects.

T/F: MAOIs should be discontinued for 2 weeks before starting an SSRI.

True – washout required.

Mirtazapine is known to cause: A) Weight loss B) Sedation & weight gain C) Arrhythmias D) Insomnia

B) Sedation and increased appetite.

Which medication is considered a mood stabilizer? A) Lithium B) Sertraline C) Haloperidol D) Fluoxetine

A) Lithium – used in bipolar disorder.

Lithium toxicity risk increases with: A) Low sodium B) High protein C) Low glucose D) High calcium

A) Low sodium – causes lithium retention.

Which lab must be monitored closely with lithium? A) LFTs B) Lithium level (0.6–1.2) C) Hemoglobin D) Calcium

B) Lithium blood levels – narrow therapeutic index.

T/F: Atypical antipsychotics may cause metabolic syndrome.

True – includes weight gain, hyperglycemia, dyslipidemia.

The sympathetic nervous system is also known as the: A) Cholinergic system B) Rest-and-digest system C) Adrenergic system D) Serotonergic system

C) Adrenergic system – SNS uses norepinephrine and epinephrine.

SNS activation typically causes: A) Decreased HR B) Bronchoconstriction C) Pupil dilation D) Increased GI motility

C) Pupil dilation – part of “fight or flight.”

Which receptor causes vasoconstriction and increased peripheral resistance? A) Beta1 B) Beta2 C) Alpha1 D) Alpha2

C) Alpha1 – increases BP and constricts vessels.

Which receptor helps prevent overstimulation of norepinephrine? A) Alpha1 B) Alpha2 C) Beta1 D) Beta3

B) Alpha2 – provides negative feedback control.

Stimulation of Beta1 receptors results in: A) Decreased heart rate B) Increased heart rate C) Bronchoconstriction D) Decreased fat breakdown

B) Increased HR and enhanced energy production.

Stimulation of Beta2 receptors causes: A) Increased GI motility B) Constricted bronchioles C) Bronchodilation D) Decreased glucagon release

C) Bronchodilation and vasodilation.

The parasympathetic nervous system is also known as the: A) Fight or Flight system B) Adrenergic system C) Rest and Digest system D) Hypothalamic system

C) Rest and Digest – promotes digestion, urination, secretion.

PNS activation causes: A) Increased HR B) Dilated pupils C) Decreased secretions D) Increased GI motility and secretions

D) Increased GI activity – cholinergic effects.

Muscarinic receptor stimulation results in: A) Increased HR B) Pupil dilation C) Increased bladder contraction D) Bronchodilation

C) Increased bladder contraction and GI motility.

Nicotinic receptors primarily cause: A) Sedation B) Muscle contraction C) Decreased ACh release D) Fever

B) Muscle contraction and norepinephrine release.

Adrenergic agonists mimic: A) Acetylcholine B) Dopamine C) Histamine D) Sympathetic nervous system

D) SNS – they are sympathomimetics.

Which medication is a mixed alpha/beta adrenergic agonist? A) Atropine B) Epinephrine C) Lorazepam D) Propranolol

B) Epinephrine – activates multiple adrenergic receptors.

A major adverse effect of adrenergic agonists is: A) Hypotension B) Bradycardia C) Arrhythmias D) Hypoglycemia

C) Arrhythmias – excessive SNS stimulation.

Why must extravasation of dopamine or norepinephrine be avoided? A) Causes sedation B) Causes bronchospasm C) Causes tissue necrosis D) Causes diarrhea

C) Tissue necrosis due to intense vasoconstriction.

Which beta-agonist is used in asthma? A) Epinephrine B) Salmeterol C) Atropine D) Prazosin

B) Salmeterol – beta2 agonist bronchodilator.

Common adverse effect of beta-agonists: A) Bradycardia B) Tremor C) Sedation D) Constipation

B) Tremor – due to beta2 stimulation.

Anticholinergic drugs produce which effect? A) Increased salivation B) Pupil constriction C) Dry mouth D) Increased urination

C) Dry mouth – “can't see, can't spit, can't pee…”

Which anticholinergic is used for COPD maintenance? A) Atropine B) Ipratropium C) Pilocarpine D) Bethanechol

B) Ipratropium – inhaled bronchodilator.

Scopolamine is used mainly for: A) Diarrhea B) Motion sickness C) Hypertension D) Depression

B) Motion sickness – anticholinergic patch.

Cholinergic agonists mimic which neurotransmitter? A) GABA B) Serotonin C) Acetylcholine D) Dopamine

C) Acetylcholine – parasympathomimetics.

Which direct-acting cholinergic is used to increase bladder tone? A) Atropine B) Bethanechol C) Salmeterol D) Epinephrine

B) Bethanechol – increases bladder contraction.

Indirect-acting cholinergic agonists act by: A) Blocking receptors B) Breaking down ACh C) Inhibiting acetylcholinesterase D) Blocking dopamine

C) Inhibiting ACh breakdown → increases ACh.

Which drug treats myasthenia gravis by increasing ACh at neuromuscular junctions? A) Neostigmine B) Atropine C) Propranolol D) Phenylephrine

A) Neostigmine – indirect cholinergic.

A key adverse effect of cholinergic agonists: A) Tachycardia B) Hypertension C) Bradycardia & hypotension D) Hyperglycemia

C) Bradycardia and hypotension – excess parasympathetic effect.

What is the antidote for overdose of cholinergic agents? A) Flumazenil B) Atropine C) Naloxone D) Dopamine

B) Atropine – anticholinergic.

Adrenergic antagonists (beta-blockers) cause: A) Increased HR B) Decreased HR C) Pupil dilation D) Increased BP

B) Decreased HR – blocks beta1 effects.

Which beta-blocker is beta1 selective? A) Propranolol B) Timolol C) Metoprolol D) Nadolol

C) Metoprolol – cardioselective.

Alpha1 blockers (like prazosin) commonly cause: A) Reflex hypertension B) Orthostatic hypotension C) Tachycardia D) Constipation

B) Orthostatic hypotension – due to vasodilation.

T/F: Beta-blockers should be tapered, not abruptly discontinued.

True – to avoid rebound tachycardia/hypertension.

Vocab: “Sympatholytic” means: A) Enhances SNS B) Blocks SNS response C) Enhances PNS D) Blocks PNS

B) Blocks SNS activity – adrenergic antagonist.

Final Exam Summary Study Flashcards

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