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WorksheetsPharm Final Part 2
Total questions: 72
Worksheet time: 36mins
Which statement about tuberculosis treatment is accurate?
Monotherapy is preferred to reduce side effects
At least two or more drugs should be used to prevent resistance
Therapy is usually completed within 7–10 days
Drug resistance is rare in TB organisms
The most common adverse effect of isoniazid therapy is:
Optic neuritis
Peripheral neuropathy in hands and feet
Polyarthralgia
Severe photosensitivity
A patient taking rifampin should be taught to:
Stop the drug immediately if urine turns reddish-orange
Use an additional non-hormonal form of contraception
Expect increased effectiveness of warfarin therapy
Avoid all foods containing calcium
Which first-line antitubercular drug is most commonly associated with optic neuritis and visual disturbances?
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
A nurse is reviewing liver function monitoring for a patient on isoniazid and pyrazinamide. Which teaching is most appropriate?
“Liver tests are not needed unless you feel ill.”
“Hepatotoxicity does not occur with TB medications.”
“Alcohol use has no effect on your TB medicines.”
“You should report anorexia, fatigue, or jaundice immediately.”
Which statement best explains why antivirals are generally less effective than antibiotics?
Viruses replicate more slowly than bacteria
Viruses are parasitic and rely on host cells, limiting selective toxicity
Antivirals are rapidly eliminated by the kidneys
Antibiotics are always given IV while antivirals are oral only
Acyclovir must first be activated before it can inhibit viral DNA polymerase. Which viral enzyme is required for its activation?
Reverse transcriptase
Protease
Thymidine kinase
Integrase
Which viral infections are primary indications for acyclovir therapy?
Influenza A and B
Hepatitis B and C
Herpes simplex and varicella-zoster viruses
Rotavirus and norovirus
A patient is receiving IV acyclovir for herpes zoster. Which nursing action is most appropriate to reduce the risk of nephrotoxicity?
Infuse the drug over at least 1 hour
Restrict oral fluids
Administer IM instead of IV
Give with a high-protein meal
Which finding is used to define progression from HIV infection to AIDS?
Positive HIV antibody test alone
Any viral load above detectable limits
CD4 T-cell count < 200 cells/mL or presence of an AIDS-defining illness
Presence of flu-like symptoms for more than 2 weeks
Which of the following is an example of an AIDS-defining condition?
Acute otitis media
Recurrent bacterial pneumonia or Pneumocystis pneumonia
Uncomplicated urinary tract infection
Seasonal allergic rhinitis
Which statement correctly distinguishes NRTIs from NNRTIs?
NRTIs directly bind reverse transcriptase; NNRTIs are nucleoside analogues
NRTIs require intracellular activation; NNRTIs do not
NRTIs only treat HIV-1; NNRTIs treat HIV-1 and HIV-2
NRTIs are non-toxic to mitochondria; NNRTIs cause lactic acidosis
A major adverse effect associated with NRTIs such as abacavir is:
Severe hypertension
Profound hypoglycemia
Lactic acidosis and hepatomegaly
Irreversible nephrotoxicity
Which adverse effect is most commonly associated with protease inhibitors such as darunavir?
Severe hypothyroidism
Profound neutropenia
Bradycardia requiring pacemaker placement
Hyperlipidemia and fat redistribution
Which statement best describes the primary mechanism of action of most diuretics?
Increasing glomerular filtration rate
Blocking sodium and chloride reabsorption in the nephron
Stimulating aldosterone release
Inhibiting urea production in the liver
Filtration in the kidney is:
A nonselective process occurring at the glomerulus
A selective process occurring in the distal convoluted tubule
A selective process occurring in the collecting duct
Responsible for reabsorbing 99% of water and electrolytes
Which site of action is correct for furosemide (Lasix)?
Proximal convoluted tubule
Early segment of distal convoluted tubule
Thick ascending limb of the loop of Henle
Collecting duct only
A patient is receiving IV furosemide for pulmonary edema. Which electrolyte imbalance is the nurse most concerned about?
Hyperkalemia
Hypokalemia
Hypercalcemia
Hypermagnesemia
A serum potassium level of 3.2 mEq/L in a patient taking furosemide indicates:
Hypokalemia
Hyperkalemia
Normal potassium level
Laboratory error, repeat test unnecessary
Which teaching point is most appropriate for a patient newly prescribed hydrochlorothiazide (HCTZ)?
Take the medication at bedtime
Restrict all fluid intake
Expect ankle swelling to increase
Take the medication with food to reduce GI upset
Which statement about thiazide diuretics is correct?
They remain effective even when urine flow is very low
They cause diuresis that is greater than loop diuretics
They can increase uric acid and glucose levels
They are usually the first choice for acute pulmonary edema
What is the primary therapeutic goal of using spironolactone (Aldactone) with loop or thiazide diuretics?
Counterbalance potassium loss from other diuretics
Increase sodium excretion and blood pressure
Reduce the need for electrolyte monitoring
Prevent dehydration
Which adverse effect is specifically associated with spironolactone due to its endocrine actions?
Bradycardia
Ototoxicity
Gynecomastia and hirsutism
Severe constipation
You are caring for a patient receiving spironolactone. Which finding should be reported to the provider immediately?
Serum sodium 144 mEq/L
Urine output 120 mL in 4 hours
Serum potassium 5.2 mEq/L
Blood pressure 138/90 mm Hg
Which statement best defines osmolality?
The total volume of body water
The concentration of dissolved particles in a solution
The amount of sodium in extracellular fluid
The pressure created by plasma proteins
Isotonic volume contraction is characterized by:
Loss of water exceeding loss of sodium
Loss of sodium exceeding loss of water
Sodium and water loss in equal (isotonic) proportions
Increased total volume with no change in osmolality
Which fluid is most appropriate to treat isotonic contraction due to vomiting and diarrhea?
3% sodium chloride
D5W
0.45% sodium chloride (½ NS)
0.9% normal saline (NS)
Hypertonic contraction is best described as:
Loss of sodium greater than water with decreased osmolality
Gain of water only, causing cells to swell
Loss of water greater than sodium with increased osmolality
Gain of sodium only, with no change in osmolality
A patient with hypotonic contraction from diuretic overuse and lack of aldosterone has severe symptoms. Which treatment is most appropriate?
Rapid infusion of D5W
Hypertonic (3%) sodium chloride solution
Oral water intake only
Stopping all sodium intake
Respiratory alkalosis is most commonly caused by:
Chronic renal failure
Hyperventilation leading to decreased PCO₂
Hypoventilation with CO₂ retention
Hypoventilation with CO₂ retention
A patient has been vomiting for several days and is diagnosed with metabolic alkalosis. Which treatment is typically indicated?
Rebreathing into a paper bag
IV sodium bicarbonate
Infusion of sodium chloride with potassium chloride
Rapid infusion of 3% sodium chloride
Which statement about potassium regulation is correct?
Potassium excretion by the kidney is decreased by aldosterone
Most diuretics decrease potassium excretion
Alkalosis enhances potassium uptake into cells
Insulin has little effect on serum potassium levels
Which nursing action is correct when administering IV potassium chloride for hypokalemia?
Give undiluted IV push in a central line only
Infuse no faster than about 10 mEq/hour in adults
Avoid diluting the solution below 60 mEq/L
Stop cardiac monitoring once the infusion has started
A patient with renal insufficiency is taking magnesium-containing antacids and has signs of muscle weakness and hypotension. Which electrolyte disturbance is the likely culprit?
Hypokalemia
Hyperkalemia
Hypomagnesemia
Hypermagnesemia
Which statement best describes the primary defect in type 1 diabetes mellitus (T1DM)?
Insulin resistance in target tissues
Autoimmune destruction of pancreatic beta cells
Overproduction of insulin by the pancreas
Temporary decrease in insulin during pregnancy
Type 2 diabetes mellitus (T2DM) is characterized primarily by:
Absolute absence of insulin production
Autoimmune beta cell destruction only
Insulin resistance with impaired insulin secretion
Complete normalization with diet alone in all patients
Which laboratory value is diagnostic for diabetes mellitus?
Fasting plasma glucose of 115 mg/dL
2-hour OGTT result of 160 mg/dL
Hemoglobin A1c of 6.8%
Casual plasma glucose of 180 mg/dL with no symptoms
Hemoglobin A1c is most useful clinically because it:
Reflects the fasting glucose level only
Reflects average glucose over the previous 2–3 months
Measures insulin production directly
Is unaffected by changes in blood glucose
For most nonpregnant adults with diabetes, an appropriate A1c goal is:
Below 5%
Below 6%
Below 7%
Below 10%
Which insulin preparation has a prolonged duration of action up to 24 hours and is used once daily for basal control?
Insulin lispro (Humalog)
Regular insulin (Humulin R)
NPH insulin (Humulin N)
Insulin glargine (Lantus)
A patient is prescribed a rapid‑acting insulin to be given with meals. Which insulin fits this description?
Insulin detemir (Levemir)
NPH insulin (Humulin N)
Insulin aspart (NovoLog)
Regular insulin (Novolin R)
Which insulin is the only one that can be mixed with NPH insulin in the same syringe?
Insulin glargine (Lantus)
Insulin detemir (Levemir)
Short‑acting regular insulin (Humulin R)
No insulins can be mixed with NPH
Which statement about insulin appearance and handling is correct?
NPH insulin is a cloudy suspension that must be gently agitated before use
All insulins should appear cloudy
Opened insulin vials must be discarded after 24 hours
Insulin may be safely frozen to prolong shelf life
Tight glycemic control may be inappropriate for which patient?
Newly diagnosed 25‑year‑old with type 1 diabetes and no complications
Middle‑aged patient with type 2 diabetes and good support/resources
Patient with long‑standing type 2 diabetes and advanced macrovascular disease
Pregnant patient with gestational diabetes
Which statement best describes the principal therapeutic use of insulin?
Treatment of type 2 diabetes only
Treatment of type 1 diabetes only
Required for all patients with type 1 diabetes and many with type 2 diabetes
Reserved for use only in diabetic ketoacidosis (DKA)
In continuous subcutaneous insulin infusion (CSII) via an insulin pump:
Only NPH insulin can be used
Insulin is given once daily as a large basal dose
Regular, lispro, aspart, or glulisine insulin is delivered at a basal rate with patient‑controlled boluses
Blood glucose monitoring is unnecessary
A conscious patient with blood glucose of 55 mg/dL is sweaty, shaky, and confused. The most appropriate initial nursing action is to:
Start an IV and give IV glucagon
Administer a fast‑acting oral carbohydrate such as juice or glucose tablets
Give the scheduled dose of insulin
Have the patient lie flat and withhold all intake
Which patient scenario represents a contraindicated way to treat hypoglycemia?
IV dextrose in an unconscious patient
IM glucagon in a patient without IV access
Orange juice given to a patient with absent gag reflex
Glucose tablets for a patient who is awake and able to swallow
A major potentially life‑threatening adverse effect of insulin therapy is:
Hypertension
Hypernatremia
Thrombocytopenia
Hypoglycemia
Which drug is the first‑line oral agent for most patients with newly diagnosed type 2 diabetes?
Glyburide
Metformin
Pioglitazone
Acarbose
The primary mechanisms of action of metformin include:
Stimulating pancreatic insulin secretion
Reducing hepatic glucose production and increasing insulin sensitivity in muscle
Blocking intestinal fat absorption
Directly increasing renal glucose reabsorption
Which important adverse effect is associated with sulfonylureas such as glipizide and glyburide?
Severe diarrhea and weight loss
Lactic acidosis
Hypoglycemia and weight gain
Ketoacidosis
Which statement about glucagon for treatment of severe hypoglycemia is correct?
It raises blood glucose by stimulating glycogen breakdown in the liver
It is the preferred treatment in all cases of hypoglycemia
It is effective even in patients with no hepatic glycogen stores (severe starvation)
It should never be given outside of a hospital setting
Which statement best describes the primary goal of long‑term asthma management?
Cure the underlying disease
Eliminate the need for all medications
Reduce impairment and reduce risk of exacerbations
Maintain oxygen saturation above 90% only during exercise
Which class of drugs is considered first‑line for prophylactic treatment of persistent asthma?
Short‑acting beta₂ agonists (SABAs)
Long‑acting beta₂ agonists (LABAs) alone
Inhaled glucocorticoids such as beclomethasone
Oral methylxanthines such as theophylline
A common local adverse effect of inhaled glucocorticoids such as beclomethasone is:
Severe hypotension
Oropharyngeal candidiasis and dysphonia
Renal failure
Hypoglycemia
Which nursing teaching is most appropriate for a patient using an inhaled glucocorticoid?
Rinse the mouth and gargle with water after each use
Use the inhaler only when having an acute asthma attack
Stop the medication abruptly when symptoms improve
Take extra doses on days you feel well
Montelukast (Singulair), a leukotriene receptor antagonist, is best described as:
A rescue medication for acute asthma attacks
A second‑line oral agent for prophylaxis of asthma and exercise‑induced bronchospasm
An inhaled corticosteroid for short‑term use only
A bronchodilator used to treat COPD exacerbations only
Which statement about short‑acting beta₂ agonists (SABAs) such as albuterol is correct?
They are used on a fixed schedule for long‑term control only
They are “rescue inhalers” used PRN for acute symptoms and exercise‑induced bronchospasm
They must always be combined with a glucocorticoid
They directly reduce airway inflammation
Long‑acting beta₂ agonists (LABAs) such as salmeterol should be used in asthma:
As monotherapy for all patients
Only during acute severe attacks
On a fixed schedule and always in combination with an inhaled glucocorticoid
Only in children under 12 years of age
Which statement from a patient taking oral theophylline for chronic stable asthma indicates a need for further teaching?
“I will have my blood levels checked regularly.”
“I should avoid drinks and medications that contain caffeine.”
“It’s okay if I keep smoking; it won’t affect this medication.”
“I will take my doses at the same time every day.”
What is the primary mechanism of action of ipratropium when used as an inhaled bronchodilator?
Blockade of muscarinic receptors in the bronchi, reducing bronchoconstriction
Direct stimulation of beta₂ receptors in bronchial smooth muscle
Inhibition of leukotriene synthesis
Suppression of histamine release from mast cells
Initial management of an acute severe asthma exacerbation typically includes all of the following EXCEPT:
Oxygen
Systemic glucocorticoid
High‑dose nebulized SABA
Long‑acting beta₂ agonist (LABA) alone
Which definition best reflects the current understanding of pain?
A purely physical sensation caused by tissue damage
A subjective sensation that cannot be assessed
A response only to objective evidence of injury
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
Which statement about opioids is correct?
Opioids are only synthetic drugs and do not include natural compounds
Opioids are less effective than NSAIDs for severe pain
Opioids are any drugs, natural or synthetic, with actions similar to morphine
Opiates and opioids are completely unrelated terms
hich endogenous opioid peptide families are produced by the body and have opioid‑like properties?
Histamine, serotonin, dopamine
Endorphins, enkephalins, dynorphins
GABA, glutamate, glycine
Acetylcholine, norepinephrine, epinephrine
Activation of which opioid receptor is primarily responsible for respiratory depression, euphoria, and physical dependence?
Alpha
Beta
Delta
Mu
Pure opioid agonists such as morphine are best described as:
Drugs that activate both mu and kappa receptors, producing analgesia and euphoria
Drugs that have receptor affinity but no efficacy
Drugs that block all opioid receptors
Drugs that only activate kappa receptors
Which adverse effect of morphine is related to suppression of propulsive intestinal contractions and increased sphincter tone?
Respiratory depression
Constipation
Miosis
Cough suppression
A nurse is preparing to administer an IV dose of morphine. Which assessment finding requires the nurse to withhold the dose and contact the provider?
Pain rated 8/10
Respiratory rate of 8 breaths/min
Blood pressure 128/76 mm Hg
Sedation score of 1 (awake and alert)
The classic triad of acute opioid toxicity includes:
Hypertension, tachycardia, dilated pupils
Bradycardia, hypotension, miosis
Coma, respiratory depression, pinpoint pupils
Fever, seizures, flushing
What is the primary therapeutic use of naloxone (Narcan)?
Providing long‑term analgesia for chronic pain
Preventing the development of opioid tolerance
Reversing opioid overdose and opioid‑induced respiratory depression
Treating neuropathic pain unresponsive to opioids
