Question 1

Which of the following sympathomimetics is preferable for the emergency therapy of cardiogenic shock?

Accepted Answer

Answer reason: Dobutamine is a beta-1 agonist that increases myocardial contractility and cardiac output with limited effects on heart rate and peripheral resistance, making it preferred in cardiogenic shock.

Question 2

Indicate the sympathomimetic agent, which is combined with a local anesthetic to prolong the duration of infiltration nerve block?

Accepted Answer

Answer reason: Epinephrine causes local alpha-1–mediated vasoconstriction, reducing systemic absorption of the anesthetic and prolonging the duration of infiltration nerve block. The other agents are not used for this purpose.

Question 3

Beta-blocking drugs-induced chronically lower blood pressure may be associated with theirs effects on?

Accepted Answer

Answer reason: Beta-blockers lower BP by decreasing cardiac output via beta1 blockade in the heart, reducing peripheral vascular resistance via decreased sympathetic tone, and suppressing renin release from the kidney, thus reducing RAAS activity—therefore all listed mechanisms contribute.

Question 4

Which of the following beta receptor antagonists is preferable in patients with asthma, diabetes or peripheral vascular diseases?

Accepted Answer

Answer reason: Metoprolol is a cardioselective beta-1 blocker, preferred in asthma, diabetes, and peripheral vascular disease because it minimizes beta-2 blockade that can cause bronchoconstriction, mask hypoglycemia, and worsen peripheral vasoconstriction. Propranolol, nadolol, and timolol are nonselective.

Question 5

Beta-receptor blocking drugs are used in the treatment all of the following diseases EXCEPT?

Accepted Answer

Answer reason: Beta blockers treat hypertension, angina, and arrhythmias; timolol is used for glaucoma; and propranolol controls thyrotoxic symptoms. In pheochromocytoma, beta blockade alone is contraindicated and not a primary therapy—alpha blockade is required first—so it is the exception.

Question 6

Which of the following hypnotic drugs is more likely to cause cumulative and residual effects?

Accepted Answer

Answer reason: Phenobarbital is a long-acting barbiturate with a long half-life and enzyme induction, leading to drug accumulation and residual daytime sedation. Zolpidem, temazepam, and triazolam are shorter acting with less residual effects.

Question 7

Which of the following hypnotics is preferred in patients with limited hepatic function?

Accepted Answer

Answer reason: Compared with barbiturates and long-acting benzodiazepines like flurazepam, zolpidem lacks active metabolites and has a shorter half-life, resulting in less accumulation in hepatic impairment (dose reduction may still be needed). Thus it is preferred among the listed options.

Question 8

Barbiturates are being replaced by hypnotic benzodiazepines because of?

Accepted Answer

Answer reason: Barbiturates have a narrow therapeutic index, suppress REM sleep, and carry a high risk of dependence and abuse, so benzodiazepines are preferred; thus all statements are correct.

Question 9

Indicate the hypnotic drug, which binds selectively to the BZ1 receptor subtype, facilitating GABAergic inhibition?

Accepted Answer

Answer reason: Zolpidem is a non-benzodiazepine hypnotic that selectively binds to the BZ1 subtype of the GABA-A receptor to enhance GABAergic inhibition. Thiopental and phenobarbital are barbiturates, and flurazepam is a benzodiazepine that is not BZ1-selective.

Question 10

Toxic doses of hypnotics may cause a circulatory collapse as a result of?

Accepted Answer

Answer reason: In overdose, CNS-depressant hypnotics suppress the medullary vasomotor center, leading to loss of sympathetic tone, vasodilation, hypotension, and circulatory collapse.

Question 11

Which of the following antiseizure drugs produces enhancement of GABA-mediated inhibition?

Accepted Answer

Answer reason: Phenobarbital enhances GABA-A–mediated chloride influx, increasing inhibitory neurotransmission. Ethosuximide blocks T-type calcium channels; carbamazepine and lamotrigine primarily block voltage-gated sodium channels.

Question 12

Which of the following antiseizure drugs produces a voltage-dependent inactivation of sodium channels?

Accepted Answer

Answer reason: Lamotrigine, carbamazepine, and phenytoin all block voltage-gated sodium channels by stabilizing the inactivated state; therefore all are correct.

Question 13

Dose-related adverse effect caused by phenytoin is?

Accepted Answer

Answer reason: Phenytoin commonly causes gingival hyperplasia with chronic/dose-related exposure; the other options are not characteristic adverse effects of phenytoin.

Question 14

Granulocytopenia, gastrointestinal irritation, gingival hyperplasia, and facial hirsutism are possible adverse effects of?

Accepted Answer

Answer reason: Phenytoin characteristically causes gingival hyperplasia and hirsutism; it can also produce GI irritation and hematologic dyscrasias such as granulocytopenia. The other options do not combine these hallmark effects.

Question 15

Which of the following antiseizure drugs acts directly on the GABA receptor-chloride channel complex?

Accepted Answer

Answer reason: Benzodiazepines like diazepam bind directly to the GABA-A receptor–chloride channel complex to enhance Cl− influx. Vigabatrin and valproate increase GABA levels (e.g., via GABA transaminase inhibition), and gabapentin modulates calcium channels, not the GABA receptor.

Question 16

Which of the following opioid receptor types is responsible for euphoria and respiratory depression?

Accepted Answer

Answer reason: Mu (μ) receptors mediate euphoria and cause respiratory depression; kappa and delta do not produce both of these effects.

Question 17

Indicate the opioid receptor type, which is responsible for dysphoria and vasomotor stimulation?

Accepted Answer

Answer reason: Kappa receptor activation is linked to dysphoria and psychotomimetic/vasomotor effects, whereas mu produces euphoria and delta has less association with dysphoria.

Question 18

Fentanyl can produce significant respiratory depression by?

Accepted Answer

Answer reason: Fentanyl directly depresses brainstem respiratory centers and can cause chest/truncal rigidity that impedes ventilation; cough suppression is not the primary mechanism of significant respiratory depression.

Question 19

Which of the following opioid analgesics can produce an increase in the pulmonary arterial pressure and myocardial work?

Accepted Answer

Answer reason: Pentazocine (a kappa agonist, weak mu antagonist) increases sympathetic outflow, raising heart rate, blood pressure, and pulmonary arterial pressure, thereby increasing myocardial work. The others generally do not increase myocardial workload.

Question 20

In contrast to morphine, methadone?

Accepted Answer

Answer reason: Methadone has high oral effectiveness, develops tolerance and physical dependence more slowly than morphine, and produces a less intense but more prolonged withdrawal due to its long half-life—so all statements are correct.

Question 21

Which of the following opioid analgesics is a strong kappa receptor agonist and a mu receptor antagonist?

Accepted Answer

Answer reason: Nalbuphine is a mixed opioid agonist–antagonist: it acts as a strong kappa agonist and a mu receptor antagonist. Naltrexone is a pure antagonist, methadone is a mu agonist, and buprenorphine is a partial mu agonist and kappa antagonist.

Question 22

Which one of the following non-narcotic agents inhibits mainly cyclooxygenase (COX) in CNS?

Accepted Answer

Answer reason: Paracetamol (acetaminophen) acts predominantly in the CNS, inhibiting central COX activity, which explains its analgesic and antipyretic effects with minimal peripheral anti-inflammatory action. NSAIDs like ketorolac, aspirin, and ibuprofen inhibit peripheral COX more prominently.

Question 23

Indicate the antipsychotic drug having significant peripheral alpha-adrenergic blocking activity?

Accepted Answer

Answer reason: Chlorpromazine, a low-potency typical antipsychotic (phenothiazine), has strong peripheral alpha-1 adrenergic blockade, causing marked orthostatic hypotension. Haloperidol has minimal alpha blockade; risperidone and clozapine are less pronounced.

Question 24

The mechanism of haloperidol antipsychotic action is?

Accepted Answer

Answer reason: Haloperidol is a high-potency typical antipsychotic whose primary mechanism is D2 receptor antagonism in the mesolimbic pathway. It is not an inhibitor of norepinephrine reuptake; alpha-adrenergic blockade is not the main mechanism of its antipsychotic effect.

Question 25

Which of the following adverse effects is associated with lithium treatment?

Accepted Answer

Answer reason: Lithium exposure can cause congenital cardiac defects (e.g., Ebstein anomaly) in newborns, can enlarge the thyroid causing hypothyroidism, and commonly induces nephrogenic diabetes insipidus via renal ADH resistance—therefore all listed effects are associated.

Question 26

Which of the following agents is related to the third-generation heterocyclic antidepressants?

Accepted Answer

Answer reason: Nefazodone is one of the newer (third-generation) heterocyclic/atypical antidepressants, whereas amitriptyline is a TCA, maprotiline is a tetracyclic second-generation agent, and tranylcypromine is an MAOI.

Question 27

Which of the following antidepressant agents is a selective inhibitor of norepinephrine reuptake?

Accepted Answer

Answer reason: Maprotiline is a tetracyclic antidepressant that selectively inhibits norepinephrine reuptake. Fluvoxamine is an SSRI, amitriptyline is a TCA affecting both NE and 5-HT, and tranylcypromine is an MAOI.

Question 28

Which of the following MAO inhibitors has amphetamine-like activity and is related to nonhydrazide derivatives?

Accepted Answer

Answer reason: Tranylcypromine is a nonhydrazide MAOI structurally related to amphetamine and exhibits amphetamine-like activity. Phenelzine is a hydrazine derivative, and moclobemide is a reversible MAO-A inhibitor, not amphetamine-like.

Question 29

Monoamine Oxydase A?

Accepted Answer

Answer reason: MAO-A preferentially deaminates norepinephrine and serotonin and is chiefly responsible for gut/liver metabolism of tyramine. Dopamine is more selectively metabolized by MAO-B.

Question 30

Block of which type of Monoamine Oxydase might be more selective for depression?

Accepted Answer

Answer reason: MAO-A primarily metabolizes serotonin and norepinephrine; inhibiting MAO-A increases these monoamines and is used for depression. MAO-B inhibition is more associated with Parkinson's disease.

Question 31

Which of the following autonomic nervous system effects is common for tricyclic antidepressants?

Accepted Answer

Answer reason: Tricyclic antidepressants commonly exhibit antimuscarinic effects, H1 antihistamine activity, and alpha-1 adrenoreceptor blockade, so all listed effects apply.

Question 32

The choice of benzodiazepines for anxiety is based on?

Accepted Answer

Answer reason: Benzodiazepines are preferred partly because they have a wide therapeutic index. While flumazenil exists for overdose reversal, benzodiazepines carry a significant risk of physiologic dependence, so 'All of the above' is incorrect.

Question 33

Which of the following benzodiazepines is less likely to cause cumulative and residual effects with multiple doses?

Accepted Answer

Answer reason: Lorazepam has no active metabolites and is cleared by glucuronidation (LOT drugs), so it shows minimal accumulation with repeated dosing. Clorazepate, quazepam, and prazepam have long-acting active metabolites leading to residual effects.

Question 34

Which drugs may be used as antianxiety agents?

Accepted Answer

Answer reason: Beta-blockers can reduce autonomic symptoms of performance anxiety; clonidine decreases sympathetic outflow and can alleviate anxiety symptoms; tricyclic antidepressants are effective for some anxiety disorders. Therefore all listed can be used.

Question 35

The limitation of sevoflurane is?

Accepted Answer

Answer reason: Sevoflurane is non-pungent (low risk of cough/laryngospasm), does not cause sympathetic activation with hypertension/tachycardia, and is not known for hepatotoxicity. Its key limitation is chemical instability with CO2 absorbents, degrading to Compound A.

Question 36

Which of the following inhaled anesthetics is an induction agent of choice in patient with airway problems?

Accepted Answer

Answer reason: Halothane is non-pungent and a bronchodilator, allowing smooth inhalational induction while maintaining spontaneous ventilation—useful in airway problems. Desflurane is an airway irritant, and nitrous oxide is insufficiently potent for induction alone.

Question 37

Which of the following inhaled anesthetics decreases methionine synthase activity and causes megaloblastic anemia?

Accepted Answer

Answer reason: Nitrous oxide oxidizes vitamin B12, inhibiting methionine synthase and impairing DNA synthesis, which can lead to megaloblastic anemia.

Question 38

Indicate the side effect of Theophylline?

Accepted Answer

Answer reason: Theophylline (a methylxanthine) has positive chronotropic/inotropic and CNS-stimulating effects, leading to tachycardia and increased myocardial oxygen demand. It does not cause bradycardia or respiratory center depression; BP elevation is not typical.

Question 39

Tick the main approach of peptic ulcer treatment?

Accepted Answer

Answer reason: Peptic ulcer therapy includes neutralizing existing acid (antacids), suppressing acid secretion (H2 blockers/PPIs), and eradicating H. pylori when present; therefore all listed approaches are correct.

Question 40

Indicate the laxative drug belonging to osmotic laxatives?

Accepted Answer

Answer reason: Sodium phosphate is a saline osmotic laxative; the others are not (docusate is a stool softener, bisacodyl and phenolphthalein are stimulant laxatives).

Question 41

The mechanism of stimulant purgatives is?

Accepted Answer

Answer reason: Stimulant laxatives act by irritating the intestinal mucosa and activating enteric nerves, increasing peristalsis and fluid/electrolyte secretion. Other options describe bulk-forming (a), stool softeners (c), or osmotic agents (d).

Question 42

Fibrinolytic drugs are used for following EXCEPT?

Accepted Answer

Answer reason: Fibrinolytics lyse blood clots; they are indicated for thrombotic conditions such as DVT, massive PE, and acute MI, but not for heart failure which is not primarily thrombotic.

Question 43

All of the following are recommended at the initial stages of treating patients with heart failure EXCEPT?

Accepted Answer

Answer reason: Verapamil, a non-dihydropyridine calcium channel blocker, depresses myocardial contractility and is contraindicated in systolic heart failure, so it is not recommended initially. Salt restriction, ACE inhibitors, and diuretics are standard first-line measures.

Question 44

The calcium channel blockers have direct negative inotropic effects because they reduce the inward movement of calcium during the action potential. This consideration is?

Accepted Answer

Answer reason: CCBs block L-type Ca2+ channels, decreasing Ca2+ influx during the plateau of the cardiac action potential, which lowers intracellular calcium available for contraction and produces a negative inotropic effect.

Question 45

Tick the adverse reactions characteristic for lidocaine?

Accepted Answer

Answer reason: Lidocaine (local anesthetic/class Ib antiarrhythmic) commonly causes CNS toxicity such as paresthesias and seizures and cardiovascular depression with hypotension. The other options are not typical adverse effects of lidocaine.

Question 46

Which of the following nitrates and nitrite drugs are long-acting?

Accepted Answer

Answer reason: Sustac is a sustained-release nitroglycerin preparation and thus long-acting. Sublingual nitroglycerin, sublingual isosorbide dinitrate, and amyl nitrite inhalant act rapidly with short duration.

Question 47

Choose the unwanted effects of clonidine?

Accepted Answer

Answer reason: Clonidine is a centrally acting alpha-2 agonist; common adverse effects include sedation/drowsiness and dry mouth. The other options correspond to adverse effects of other drugs (e.g., ACE inhibitors cause dry cough; parkinsonism with dopamine-blocking/depleting drugs; agranulocytosis/aplastic anemia not typical for clonidine).

Question 48

Which neurological side effect is anticipated in an elderly patient on NSAIDs?

Accepted Answer

Answer reason: NSAIDs, especially indomethacin, can cause confusion and cognitive impairment in older adults; tremors, ataxia, and pseudoparkinsonism are not typical NSAID adverse effects.

Question 49

What is Artemether injection used for?

Accepted Answer

Answer reason: Artemether is an artemisinin derivative used to treat acute/severe malaria, particularly Plasmodium falciparum; it is not indicated for fever or pain relief.

Question 50

Ondansetron is used for which condition?

Accepted Answer

Answer reason: Ondansetron is a 5-HT3 receptor antagonist antiemetic used to prevent and treat nausea and vomiting (e.g., postoperative or chemotherapy-induced).

Train with a large NCLEX question bank and jump into a full exam-style simulator

Pharmacology NCLEX Practice Test

Continue Learning