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WorksheetsPharma 1
Total questions: 60
Worksheet time: 30mins
Select all that are among the six "rights" of medication administration.
Right patient
Right medication
Right dose
Right route
Right time
Which route has the fastest medication absorption?
Intravenous (IV)
Intramuscular (IM)
Subcutaneous
Oral
What does sublingual administration mean?
Placing medication under the tongue where it dissolves and is absorbed through mucous membranes
Delivering medication into a vein for immediate distribution
Inserting medication rectally for absorption through the colon
Swallowing medication to be digested and absorbed in the stomach and intestines
Which route of administration involves breathing medication directly into the lungs?
Inhalation (e.g., inhaler or nebulizer)
Oral
Intravenous (IV)
Subcutaneous
Which statement best describes the difference between parenteral and enteral routes?
Parenteral routes bypass the digestive system; enteral routes use the digestive system
Parenteral routes use the digestive system; enteral routes bypass it
Both parenteral and enteral routes use the digestive system
Both parenteral and enteral routes bypass the digestive system
When is oxygen administration indicated?
For any patient with suspected hypoxia, respiratory distress, or SpO2 below 94% (or below 90% for COPD)
Only when cyanosis is present
Only when SpO2 is above 94%
Only in cases of head injury without respiratory symptoms
What is a primary concern about giving high-flow oxygen to some COPD patients?
They may have hypoxic drive, and excessive oxygen can reduce their respiratory drive
High-flow oxygen causes immediate bronchoconstriction in all COPD patients
COPD patients cannot tolerate any supplemental oxygen
High-flow oxygen always eliminates the need for medications
What is the normal flow rate for a nasal cannula?
1–6 liters per minute (providing approximately 24–44% oxygen)
8–15 liters per minute (providing 60–100% oxygen)
0.5–1 liter per minute (providing 5–10% oxygen)
10–20 liters per minute (providing 80–100% oxygen)
What is nitroglycerin's mechanism of action?
It dilates blood vessels, reducing cardiac workload and improving blood flow to the heart muscle
It constricts blood vessels to raise blood pressure
It increases heart rate and contractility directly
It reduces lung secretions to improve oxygenation
Select all contraindications for nitroglycerin.
Systolic blood pressure below 100 mmHg
Use of erectile dysfunction medications within the prior 24–48 hours
Head injury
Patient has already taken the maximum dose
Active gastrointestinal bleeding
What is the typical nitroglycerin dose and repetition schedule?
0.4 mg sublingual tablet or spray; may repeat every 3–5 minutes up to 3 doses if blood pressure remains adequate
1 mg oral tablet; repeat hourly as needed
0.1 mg subcutaneous injection; one-time dose only
0.8 mg inhaled dose; may repeat every minute without limit
What position should a patient be in when taking nitroglycerin to reduce the risk of hypotension and syncope?
Sitting or lying down
Standing upright and walking
Trendelenburg position
Kneeling with the head between the knees
Which common side effect should patients be warned about when taking nitroglycerin due to vasodilation and potential drop in blood pressure?
Headache with dizziness
Constipation
Skin rash
Urinary retention
In cardiac emergencies, what is aspirin’s mechanism of action that helps prevent blood clots from growing larger?
It inhibits platelet aggregation (antiplatelet)
It acts as a bronchodilator
It increases blood pressure
It causes vasodilation of coronary arteries
For suspected acute coronary syndrome, what is the standard aspirin dose administered and how should it be taken?
81 mg swallowed whole
160–325 mg chewed
500 mg crushed and mixed with water
1,000 mg swallowed with food
Which conditions are contraindications for administering aspirin? Select all that apply.
Known aspirin allergy
Active gastrointestinal bleeding
Recent stroke
Asthma triggered by aspirin
Inability to swallow
Why should aspirin be chewed rather than swallowed in an emergency?
Chewing increases surface area for faster absorption through oral mucosa
Chewing prevents nausea in most patients
Chewing improves taste compared with tablets
Chewing reduces tooth pain during administration
What is the primary indication for using an epinephrine auto‑injector?
Minor allergic rash without breathing difficulty
Severe allergic reaction (anaphylaxis) with respiratory distress or signs of shock
Fever with sore throat
Mild cold symptoms
What is the typical adult dose for an EpiPen and route of administration?
0.15 mg intramuscular
0.3 mg intramuscular
1 mg intravenous
5 mg oral
Where should an epinephrine auto‑injector be administered to ensure proper delivery?
Deltoid muscle of the upper arm
Lateral mid‑thigh muscle (vastus lateralis), through clothing if needed
Abdominal subcutaneous tissue
Gluteal muscle
Following manufacturer instructions, how long should you hold the epinephrine auto‑injector in place after activation?
1 second
3 seconds
30 seconds
Until bleeding stops
Which are common side effects of epinephrine? Select all that apply.
Tachycardia
Tremors
Pallor
Dizziness
Bradycardia
What is albuterol’s primary action in the airways?
Beta‑2 agonist bronchodilator that relaxes smooth muscle
Platelet inhibitor that prevents clot formation
Antihistamine that blocks H1 receptors
Alpha‑1 vasoconstrictor that raises blood pressure
Which scenario indicates assisting a patient with albuterol?
Chest pain consistent with acute coronary syndrome
Wheezing and respiratory distress due to asthma or COPD bronchospasm
Low blood sugar with diaphoresis
Allergic rash without wheezing
What is a common side effect of albuterol?
Tachycardia (increased heart rate)
Tremors
Nervousness
Bradycardia
Severe hypertension
How is albuterol typically administered in the field?
Via metered-dose inhaler (MDI)
Via small-volume nebulizer
Oral tablet
Intramuscular injection
What is the indication for oral glucose administration?
Altered mental status with suspected hypoglycemia in a patient who can swallow and protect the airway
Any altered mental status regardless of cause
Hyperglycemia with polyuria and polydipsia
Unconscious patient who cannot protect the airway
What is the contraindication for oral glucose?
Decreased level of consciousness with inability to swallow or protect the airway
Mild hypoglycemia with intact airway reflexes
Patient reports hunger but has normal blood glucose
History of diabetes without symptoms
What is the typical dose of oral glucose?
15–20 grams (one tube) between the cheek and gum; may repeat if needed
5 grams once, do not repeat
30–40 grams all at once
10 grams intravenously
What blood glucose level typically indicates hypoglycemia requiring treatment?
Below 60–70 mg/dL with symptoms
Above 200 mg/dL
Exactly 100 mg/dL
Below 30 mg/dL only
What is naloxone's mechanism of action?
Opioid antagonist that reverses opioid effects by binding to opioid receptors
Cholinergic agonist that increases secretions
Beta-adrenergic blocker that slows heart rate
Diuretic that increases urine output
What are signs of opioid overdose requiring naloxone?
Respiratory depression
Decreased level of consciousness
Pinpoint pupils
Dilated pupils
What routes can naloxone be administered?
Intranasal (IN)
Intramuscular (IM)
Intravenous (IV)
Subcutaneous
Oral
What is the typical intranasal naloxone dose?
2–4 mg (typically one spray per nostril)
0.2 mg total
10 mg per nostril
1 mg orally
What should you be prepared for after naloxone administration?
Possible aggressive behavior
Vomiting
Withdrawal symptoms as the patient regains consciousness
Immediate long-lasting sedation
What is the action of beta-blockers (e.g., metoprolol, atenolol)?
They slow heart rate and reduce blood pressure by blocking beta-adrenergic receptors
They increase heart rate by stimulating beta receptors
They act as opioid antagonists
They primarily increase blood glucose levels
What are common side effects of beta-blockers?
Bradycardia
Hypotension
Fatigue
Masking hypoglycemia symptoms in diabetics
Severe hyperglycemia
What is warfarin (Coumadin) and what is a major risk associated with its use?
An anticoagulant that prevents clots; major risk is bleeding/hemorrhage
An antiplatelet drug; major risk is severe hypertension
An antibiotic; major risk is opportunistic infections
A diuretic; major risk is dehydration and electrolyte loss
What do ACE inhibitors (medications ending in "-pril") do?
Lower blood pressure by preventing formation of angiotensin II
Increase heart rate to improve cardiac output
Raise blood pressure by stimulating vasoconstriction
Lower cholesterol by inhibiting hepatic synthesis
What is metformin and what emergency can it cause?
An oral diabetes medication that can cause lactic acidosis
A thyroid hormone that can cause thyrotoxicosis
An antihypertensive that can cause hypertensive crisis
An antibiotic that can cause anaphylaxis
What are statins used for?
To lower cholesterol and reduce cardiovascular risk
To increase heart rate in bradycardia
To treat acute infections
To reduce fluid overload in heart failure
What is digoxin and which effect indicates toxicity?
A cardiac glycoside; toxicity may cause nausea, vision changes (yellow halos), and dysrhythmias
A beta-blocker; toxicity may cause severe hypertension and tremors
An anticoagulant; toxicity may cause excessive clotting and stroke
A diuretic; toxicity may cause hyperhydration and edema
What does furosemide (Lasix) do?
It is a loop diuretic that increases urine output to reduce fluid overload
It is an analgesic that reduces pain perception
It is a vasoconstrictor that raises blood pressure
It is an antipyretic that lowers fever only
What are SSRIs and what syndrome can occur with overdose?
Selective serotonin reuptake inhibitors (antidepressants); overdose can cause serotonin syndrome with agitation, hyperthermia, and muscle rigidity
Dopamine antagonists (antipsychotics); overdose can cause neuroleptic malignant syndrome only
Monoamine oxidase inhibitors; overdose can cause hypothermia and bradykinesia
Tricyclic antidepressants; overdose can cause iron-deficiency anemia
What is the danger of combining erectile dysfunction medications with nitroglycerin?
Both cause vasodilation, leading to severe life-threatening hypotension
They cancel each other, causing no hemodynamic effect
They cause vasoconstriction, leading to hypertensive crisis
They primarily cause tachycardia without blood pressure changes
Before assisting with any medication, which actions must you verify? Select all that apply.
The medication is prescribed to the patient
The medication has not expired
You have permission from medical direction
No contraindications exist
What does "PRN" mean on a medication label?
As needed—taken only when necessary, not on a regular schedule
Every day—taken on a fixed schedule
Before meals—taken prior to eating
At bedtime—taken nightly
What should you do with all medication containers when transporting or documenting a patient’s medications?
Bring them to the hospital or document all medications the patient takes (bring the "brown bag")
Discard them to avoid confusion during transport
Return them to the pharmacy immediately
Leave them at the patient’s home and rely on memory
If a patient has altered mental status, how should you assess their medications? Select all actions that are appropriate.
Check the scene for pill bottles and medication packaging
Ask family members and caregivers about recent medication use
Look for medical alert tags
Ignore medications until the patient regains normal mentation
Ask the patient what they have taken today if possible
Which statements accurately describe polypharmacy and its concerns? Select all that apply.
Taking multiple medications simultaneously
Increases risk of drug interactions and adverse effects
Decreases the likelihood of medication errors in elderly patients
Refers only to using herbal supplements
Often raises the risk of medication mistakes
You arrive on scene to find a 62-year-old male with crushing chest pain radiating to his left arm. He took one nitroglycerin tablet 10 minutes ago with no relief. His blood pressure is 118/76, pulse 88, respirations 20. What actions should you take? Select all that apply.
Contact medical direction and, if approved, assist with a second nitroglycerin dose (systolic BP adequate above 100)
Apply oxygen
Administer aspirin if not contraindicated
Withhold transport until pain fully resolves
Avoid nitroglycerin due to adequate blood pressure
A 28-year-old female is experiencing severe difficulty breathing after a bee sting. She has hives on her chest and her blood pressure is 88/60. She has her own epinephrine auto-injector but is hesitant to use it because "it makes her heart race." What is the best action?
Assist with the epinephrine auto-injector immediately; tachycardia is expected and benefits outweigh side effects
Wait and monitor until hives resolve, then consider epinephrine
Administer antihistamines only and avoid epinephrine due to tachycardia
Provide fluids and transport without epinephrine
You are assisting a patient with his metered-dose inhaler. After the first puff, he immediately inhales deeply and holds his breath. What instruction should you give for the next puff? Select all correct steps.
Exhale completely before the next inhalation
Press the inhaler during inhalation, then inhale slowly and deeply
Hold the breath for 5–10 seconds after inhalation
Take the next puff immediately with no wait
Wait 1–2 minutes between puffs
A 45-year-old diabetic patient is confused with cool, clammy skin. Family states he took his insulin this morning but did not eat breakfast. His blood glucose reads 52 mg/dL. He keeps pushing your hand away and will not cooperate. What is the best course of action?
Administer oral glucose despite his mental status
Offer small sips of juice and reassess
Do not give oral glucose due to aspiration risk; request ALS for IV dextrose or consider glucagon
Administer insulin to correct hypoglycemia
A 70-year-old male with chest pain tells you he took Viagra yesterday afternoon. It is now 10 AM the next day (approximately 19 hours later). His blood pressure is 106/70. Can you assist with nitroglycerin?
Yes, nitroglycerin is safe 12 hours after erectile dysfunction medication
Contact medical direction; nitroglycerin is likely still contraindicated at 19 hours based on most protocols
Administer aspirin only and avoid contacting medical direction
Withhold all medications and transport without consultation
You administered naloxone to an unresponsive patient with slow, shallow respirations. Two minutes later, the patient becomes combative and tries to leave. Vital signs are now blood pressure 160/92, pulse 110, respirations 18. What is your primary concern?
Naloxone will wear off in 30–60 minutes while the opioid may last longer, causing possible re-sedation; the patient requires transport and monitoring
The patient is cured and can be released at the scene
Naloxone permanently blocks all opioid effects for 24 hours
Combative behavior indicates stroke rather than opioid involvement
A 55-year-old COPD patient on home oxygen at 2 LPM is now in severe respiratory distress with SpO2 of 76%. What oxygen delivery should you provide?
Continue home oxygen at 2 LPM via nasal cannula
Increase to 4 LPM via nasal cannula
Apply high-flow oxygen via non-rebreather mask at 10–15 LPM
Withhold oxygen to avoid respiratory depression
You are transporting a patient who took aspirin for chest pain. He suddenly complains of severe upper abdominal pain and vomits bright red blood. What is the likely complication?
Allergic reaction to aspirin causing hives
Pulmonary embolism
Gastrointestinal bleeding, potentially from a gastric ulcer exacerbated by aspirin
Kidney failure
A patient with asthma used his albuterol inhaler 4 times in the last hour before calling 911. He is still wheezing with moderate distress. Can you assist with another dose?
Yes, immediately administer another dose without consultation
Contact medical direction; frequent recent use suggests possible overuse or severe bronchospasm, and typical dosing allows every 4–6 hours
Advise the patient to stop all medications and wait for symptoms to pass
Administer epinephrine instead of consulting
An elderly patient's daughter brings you a bag with 15 different medication bottles. The patient is confused and cannot tell you what she took today. What actions should you take? Select all that apply.
Bring all medications to the hospital and document names if possible
Check for empty bottles suggesting overdose
Look for medications that could cause altered mental status (sedatives, opioids, insulin)
Discard unknown medications at the scene
Report findings to the receiving facility and consider polypharmacy complications
