Question 1

Why are chemotherapeutic agents such as methotrexate and cyclophosphamide sometimes used to treat JIA?

Accepted Answer

Answer reason: Methotrexate is a conventional DMARD that suppresses lymphocyte proliferation and inflammatory cytokine activity, reducing synovitis and preventing joint damage. Cyclophosphamide is a potent immunosuppressant reserved for severe, refractory autoimmune inflammation due to toxicity. The rationale is not that JIA is “cancer-like,” nor are these drugs NSAID-equivalents; their therapeutic effect comes from immunomodulation.

Question 2

The older adult woman’s current medication includes alendronate. Which outcome would be successful therapy?

Accepted Answer

Answer reason: A successful therapeutic outcome is therefore objective improvement in bone mass/strength rather than symptom-only changes. Tumor spread and infection resolution are unrelated to its mechanism and indications. Pain relief may occur if fractures are prevented, but it is not the primary expected direct outcome used to evaluate efficacy.

Question 3

Antiretroviral agents, such as AZT, are used in the management of AIDS. Which of the following is NOT an action expected of these drugs.?

Accepted Answer

Answer reason:  Antiretroviral therapy suppresses HIV replication to reduce viral load and slow immune system destruction, but it does not eradicate latent virus reservoirs. Because of this, treatment can prolong survival and improve quality of life when adherence is maintained. Viral suppression also lowers transmission risk, but it does not equate to eliminating communicability in all circumstances or curing infection. The claim that these drugs can cure AIDS is therefore the only statement that is not an expected action.

Question 4

A woman, 6 months pregnant, came to the center for consultation. Which of the following substances is contraindicated?

Accepted Answer

Answer reason: A 200,000 IU dose is far above routine prenatal requirements and resembles high-dose supplementation used in deficiency programs that is avoided during pregnancy. In contrast, tetanus toxoid is recommended in pregnancy to prevent maternal/neonatal tetanus, and iron supplementation is commonly indicated due to increased maternal iron needs. Iodine is generally beneficial in pregnancy at appropriate doses, whereas excessive vitamin A poses a clearer fetal risk.

Question 5

Which biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer?

Accepted Answer

Answer reason: Diphtheria-tetanus-pertussis–containing vaccines are classic freeze-sensitive products and are stored at 2–8°C, not in the freezer. In contrast, live attenuated viral vaccines (e.g., OPV; and many measles/MMR formulations depending on program guidance) are generally more tolerant of freezing and are often stored frozen at higher levels of the cold chain. Therefore, among the listed EPI biologics, the one that should not be stored in the freezer is the diphtheria-tetanus-pertussis combination.

Question 6

Following injection is ______ medicine?

Accepted Answer

Answer reason: This mechanism places it in the anticholinergic drug class rather than agents primarily used to treat vomiting, psychosis, or cough. Clinically it is used as an antispasmodic for colicky abdominal pain, and typical anticholinergic adverse effects include dry mouth, tachycardia, urinary retention, and blurred vision. Antiemetics have varied mechanisms (e.g., dopamine/serotonin antagonism), which is not the primary pharmacologic identity of hyoscine butylbromide.

Question 7

Mefenamic acid tablets belongs to which of the following class ?

Accepted Answer

Answer reason: It is commonly used for dysmenorrhea and other mild-to-moderate pain states, which aligns with typical NSAID indications. Diuretics act on renal tubular electrolyte/water handling, which is unrelated to mefenamic acid’s mechanism. Cytotoxic agents are anticancer drugs, and coagulants promote clotting—neither matches the pharmacologic class or clinical use profile of mefenamic acid.

Question 8

Ruling 40(Omeprazole) is use for..?

Accepted Answer

Answer reason: Acid suppression promotes healing of peptic ulcer disease and is a core therapy for duodenal ulcers, including as part of H. pylori eradication regimens. “Pain relief” is too nonspecific because PPIs are not analgesics; they treat acid-related pathology that may secondarily reduce pain. “Meningitis” is unrelated to acid suppression, and “stomach” is vague rather than naming a specific acid-mediated indication.

Question 9

Atropine works on?

Accepted Answer

Answer reason: By blocking muscarinic receptors, it increases heart rate (useful in symptomatic bradycardia) and decreases secretions and vagal tone. Beta-adrenergic receptors are targeted by beta-agonists/antagonists (e.g., epinephrine, propranolol), not atropine. Dopamine receptors are targeted by agents like dopamine, bromocriptine, or antipsychotics, which is a different receptor system entirely.

Question 10

What Is The Ideal Dose Of Tetanus Toxoid Vaccine ???

Accepted Answer

Answer reason: 0.5 ML Standard tetanus toxoid–containing vaccines (e.g., TT, Td, Tdap) are supplied and administered as a fixed-dose 0.5 mL intramuscular injection for immunization. This volume is the established formulation used across routine schedules and wound prophylaxis, ensuring delivery of the intended antigen content. Larger volumes (e.g., 1 mL or 5 mL) would represent overdosing and are not standard vaccine presentations. A very small volume like 0.05 mL would be subtherapeutic and would not deliver the required antigen dose for reliable immunity.

Question 11

Which of the following is a preparation of choice for a patient who has been admitted in ED open contaminated injury & no recent history of tetanus immunization?

Accepted Answer

Answer reason: Human tetanus immune globulin provides rapid, ready-made antibodies and is the preferred preparation for post-exposure prophylaxis in this high-risk scenario. Tetanus toxoid is an active vaccine that takes time to generate protective antibodies, so it cannot provide immediate protection by itself. Older equine antitoxin is less preferred due to higher risk of hypersensitivity reactions, and DPT is primarily a pediatric combination vaccine rather than the immediate post-exposure product of choice in adults.

Question 12

Which of the following syringe used for BCG vaccination?

Accepted Answer

Answer reason: 05 mL in neonates or 0.1 mL in older infants/children), which requires a syringe with fine graduations for accurate dosing. A tuberculin syringe (typically 1 mL with 0.01 mL markings) is designed for precise small-volume intradermal injections and is paired with a fine short needle. Larger syringes like 2, 5, or 10 cc have less precise small-volume calibration and increase risk of dosing error and improper intradermal technique. Therefore, the syringe type that best matches the route and dose requirements for BCG is the tuberculin syringe.

Question 13

Vaccine (s) which should not be frozen include?

Accepted Answer

Answer reason: DPT and TT are classic freeze-sensitive toxoid/adsorbed vaccines that must be stored at +2 to +8°C and discarded if frozen. Many typhoid vaccines used in immunization programs are also stored refrigerated and are not meant to be frozen, as freezing can affect stability and effectiveness. Because each listed vaccine is considered freeze-sensitive in standard cold-chain teaching, the best single answer is the combined option.

Question 14

The client is discharged from the unit with a prescription for Evista (raloxifene HCl). Which of the following is a side effect of this medication?

Accepted Answer

Answer reason: As a result, menopausal-type flushing is a common adverse effect seen with this medication. This aligns with typical counseling points for patients taking raloxifene for osteoporosis risk reduction. A key safety-associated adverse effect to remember (not listed here) is increased risk of venous thromboembolism, which helps distinguish it from unrelated options.

Question 15

Statins reduce....?

Accepted Answer

Answer reason: This increases clearance of LDL from the bloodstream and reduces total cholesterol and LDL levels. The primary clinical use is dyslipidemia management and cardiovascular risk reduction, not direct fever control or blood pressure lowering. Although statins can be associated with a slight increase in blood glucose in some patients, their therapeutic effect is not to reduce it.

Question 16

Heparin sodium injection are ?

Accepted Answer

Answer reason: Clinically it is used for prevention and treatment of venous thromboembolism and for anticoagulation in acute coronary syndromes and during procedures. The expected major adverse effect is bleeding, and a key immune-mediated complication is heparin-induced thrombocytopenia. The other options do not match heparin’s mechanism: antihistamines block histamine receptors, antioxidants reduce oxidative stress, and antivirals target viral replication.

Question 17

What is the mechanism of action of sildenafil?

Accepted Answer

Answer reason: Higher cGMP levels promote vasodilation in the corpus cavernosum (and pulmonary vasculature), facilitating erection with sexual stimulation. This mechanism also explains the major safety issue of profound hypotension when combined with nitrates due to additive cGMP-mediated vasodilation. The other options reflect different drug classes (e.g., cyclooxygenase inhibition for NSAIDs or sodium-channel blockade for certain antiarrhythmics/local anesthetics) and do not match sildenafil’s pathway.

Question 18

The nurse instructs the client taking dexamethasone (Decadron) to take it with food or milk. What is the physiological basis for this instruction?

Accepted Answer

Answer reason: Taking the medication with food or milk helps buffer gastric acid and decreases direct irritation of the gastric lining. This instruction is therefore based on the drug’s tendency to promote an acidic gastric environment rather than suppress it. Options suggesting reduced acid or altered gastric emptying do not explain why co-administration with food specifically protects against steroid-related GI irritation.

Question 19

When teaching a client about the use of sublingual nitroglycerin, the nurse should emphasize that which of these is the most common side effect?

Accepted Answer

Answer reason:  Nitrates increase nitric oxide leading to venous and arterial vasodilation, and dilation of cerebral vessels commonly produces headache. This effect is dose-related and is one of the most frequently reported adverse effects with sublingual nitroglycerin, especially when initiating therapy. Patients should be taught that this can occur even when the medication is working appropriately for angina. Dry mouth, depression, and anorexia are not typical common adverse effects of nitrates compared with headache and hypotension/lightheadedness.

Question 20

While teaching a client about their medications, the client asks how long it will take before the effects of lithium take place. What is the best response of the nurse?

Accepted Answer

Answer reason: A typical teaching point is that therapeutic benefit for acute mania may take about 1–2 weeks after reaching a therapeutic serum level. This makes a same-day effect unlikely and helps set expectations to support adherence while monitoring for toxicity. “Several days” is often too short for meaningful symptom control, whereas “1 month” overstates the usual onset timeframe taught in nursing pharmacology.

Question 21

A client diagnosed with cirrhosis of the liver and ascites is receiving Spironolactone (Aldactone). The nurse understands that this medication spares elimination of which element?

Accepted Answer

Answer reason: By blocking aldosterone-mediated potassium secretion, it decreases renal potassium loss, so potassium is “spared.” This property makes it useful for ascites related to cirrhosis, where aldosterone levels are often elevated and sodium/water retention predominates. A key safety implication is the risk of hyperkalemia, especially with renal impairment or concurrent ACE inhibitors/ARBs. Sodium is not spared; it is excreted more readily with this therapy.

Question 22

A client receiving chlorpromazine HCL (Thorazine) is in psychiatric home care. During a home visit the nurse observes the client smacking her lips alternately with grinding her teeth. The nurse recognizes this assessment finding as what?

Accepted Answer

Answer reason: Lip smacking and teeth grinding fit the characteristic pattern of abnormal involuntary movements that may persist even after the medication is reduced or stopped. This distinguishes it from acute dystonia, which presents with sustained muscle contractions (e.g., torticollis, oculogyric crisis) shortly after starting or increasing the drug. Recognizing this adverse effect is important because it warrants prompt prescriber notification and reevaluation of antipsychotic therapy to limit potential irreversibility.

Question 23

A client has been taking alprazolam (Xanax) for 3 days. Nursing assessment should reveal which expected effect of the drug?

Accepted Answer

Answer reason: After several days of alprazolam use, a key expected assessment finding is reduced anxiety symptoms such as tremor and palpitations/tachycardia. It is not an analgesic, so pain relief should not be expected as a primary effect. While sedation can occur as an adverse/secondary effect, the best expected therapeutic outcome in an anxious client is reduction of somatic anxiety signs.

Question 24

Which of the following conditions assessed by the nurse would contraindicate the use of benztropine (Cogentin)?

Accepted Answer

Answer reason: Its antimuscarinic effects also reduce detrusor contraction and increase urinary retention risk, making it unsafe in patients with prostatic enlargement. By contrast, acute extrapyramidal reactions are a common indication for this medication rather than a contraindication. The key safety screen is for conditions worsened by anticholinergic effects, especially narrow-angle glaucoma and bladder outlet obstruction.

Question 25

To prevent drug resistance common to tubercle bacilli, the nurse is aware that which of the following agents are usually added to drug therapy?

Accepted Answer

Answer reason: Using multiple active anti-TB agents simultaneously reduces the probability that the organism is resistant to all drugs at once. This is why standard regimens include several first-line drugs during the initial phase rather than adding non-specific adjuncts. Vitamins may be used to reduce specific adverse effects (e.g., pyridoxine with isoniazid) but they do not prevent resistance, and adding a single additional antibiotic class without an appropriate multi-drug TB regimen does not address the primary resistance mechanism.

Question 26

When teaching a client about the side effects of fluoxetine (Prozac), which of the following will be included?

Accepted Answer

Answer reason: The listed symptoms align with typical serotonergic effects, including diarrhea and reduced libido, and fluoxetine can be associated with decreased appetite/weight loss in some patients. Reactions to tyramine-rich foods are characteristic of MAO inhibitors, not SSRIs, making that distractor incorrect. The other option clusters effects more consistent with anticholinergic or other medication classes rather than fluoxetine’s expected profile.

Question 27

A client is being discharged home today, and will be taking K-dur 20mEq per day by mouth. The nurse should reinforce that potassium levels will be decreased by?

Accepted Answer

Answer reason: This leads to hypokalemia, which is particularly important to recognize in a patient taking oral potassium supplementation. By contrast, salt substitutes commonly contain potassium chloride and tend to raise potassium, not lower it. Potassium-sparing diuretics and many NSAIDs reduce renal potassium excretion and can increase potassium levels, making them the opposite of what the question asks.

Question 28

The nurse is caring for a child receiving albuterol (Proventil) for asthma. The parents ask the nurse why their child is receiving this medication. Which explanation is correct?

Accepted Answer

Answer reason: Albuterol is a short-acting beta2-adrenergic agonist that produces bronchodilation by relaxing bronchial smooth muscle. This directly counteracts the acute bronchospasm that narrows airways during an asthma exacerbation, improving airflow and relieving wheeze and dyspnea. Decreasing airway swelling is primarily the role of corticosteroids, which address inflammation rather than immediate smooth-muscle constriction. It does not primarily thin secretions or stimulate the brain’s respiratory center; its key therapeutic effect is peripheral airway smooth-muscle relaxation.

Question 29

A 42 year-old male client refuses to take propranolol hydrochloride (Inderal) as prescribed. Which client statements from the assessment data is likely to explain his noncompliance?

Accepted Answer

Answer reason: " Beta-blockers can cause sexual dysfunction (decreased libido and erectile dysfunction), which is a common and impactful adverse effect that leads to intentional nonadherence. This statement directly reflects a known propranolol side effect that patients may be reluctant to tolerate or disclose. Diarrhea and jitteriness are not typical propranolol adverse effects (beta-blockers more often cause bradycardia, fatigue, and can mask hypoglycemia). While sleep disturbance can occur with some beta-blockers, sexual dysfunction is a more classic and frequent reason for refusal in practice.

Question 30

ANTIDOTE FOR INSECTICIDE POISONING IS ..?

Accepted Answer

Answer reason: The key immediate pharmacologic reversal is muscarinic blockade to dry secretions and improve airway and hemodynamics. One common distractor is physostigmine, which is an acetylcholinesterase inhibitor and would worsen cholinergic toxicity. Diazepam may be used as adjunct for seizures, and EDTA is a chelator for heavy metals, not insecticides.

Question 31

Tramadol drug is used for..?

Accepted Answer

Answer reason: It works primarily via weak μ-opioid receptor agonism and by inhibiting reuptake of serotonin and norepinephrine, which enhances descending inhibitory pain pathways. This mechanism is consistent with pain control, not antimicrobial activity. A common distractor is “Antibiotic,” but tramadol has no bactericidal or bacteriostatic effect and does not treat infections. Key safety concerns with tramadol include sedation/respiratory depression (especially with other CNS depressants) and increased seizure or serotonin syndrome risk with certain interacting drugs.

Question 32

Propranolol is contraindicated in?

Accepted Answer

Answer reason: This makes their use unsafe in asthma, where maintaining bronchodilation is critical. In contrast, variant (Prinzmetal) angina is typically treated with calcium channel blockers/nitrates, but the key absolute clinical contraindication tested for this drug is asthma due to beta-2 blockade. Even small doses can worsen wheeze and reduce response to rescue beta-agonists.

Question 33

The most severe adverse effect of morphine sulfate is?

Accepted Answer

Answer reason: This can rapidly compromise organ perfusion and become life-threatening, making it a severe adverse effect requiring urgent recognition and support. In contrast, acute renal or hepatic failure are not typical direct toxicities of morphine at therapeutic dosing; morphine is primarily associated with CNS and respiratory effects rather than primary end-organ failure. Increased intracranial pressure may occur due to CO2 retention from hypoventilation, but it is not as broadly immediate and common a life-threatening effect as profound hypotension in susceptible patients.

Question 34

Tramadol is used for?

Accepted Answer

Answer reason: This directly matches the therapeutic indication being asked. While its monoamine effects can influence mood, it is not prescribed as a primary treatment for anxiety or depressive disorders. A key clinical consideration is avoiding unsafe combinations (e.g., other serotonergic drugs) due to risks like serotonin syndrome and seizures, but the core use remains pain control.

Question 35

A resident is taking warfarin therapy for embolus prophylaxis after a left hip replacement. This morning her INR was 7.2. Which of the following would you expect the provider to order?

Accepted Answer

Answer reason: Vitamin K is the specific antidote that restores hepatic synthesis of vitamin K–dependent clotting factors (II, VII, IX, X). Protamine reverses heparin (and partially LMWH), not warfarin, so it would not correct an INR elevation from warfarin. Aspirin and enoxaparin would further increase bleeding risk and do not address warfarin toxicity.

Question 36

Commonly used medications for cholera include all of the following except:

Accepted Answer

Answer reason: Macrolides (e.g., azithromycin) and tetracyclines are well-established effective options in appropriate patients and settings. A corticosteroid does not treat the infection or the toxin-mediated secretory diarrhea and can increase risk of adverse effects such as immunosuppression and hyperglycemia. Therefore the steroid is the best “except” choice among the listed medications.

Question 37

The reason for using the parenteral route to administer medications includes

Accepted Answer

Answer reason: This makes onset of action faster and more predictable, especially with IV (immediate) and often IM/SC compared with oral dosing. Cost is generally higher for parenteral therapy due to supplies, sterility, and skilled administration, making the “least expensive” choice incorrect. Duration is not inherently longer than oral and depends on formulation and pharmacokinetics, not simply the route.

Question 38

Which of the following is true about verapamil ?

Accepted Answer

Answer reason: This hemodynamic effect is clinically important because it can precipitate hypotension, especially with IV dosing, volume depletion, or concomitant beta-blockers. It is not used for wide-complex tachycardia because that rhythm may represent ventricular tachycardia where AV-nodal blockers can worsen outcomes. In PEA, the first-line medication is epinephrine with CPR and treatment of reversible causes, not verapamil.

Question 39

The first choice of drug for treating MI?

Accepted Answer

Answer reason: Nitrates provide prompt venodilation and some coronary vasodilation, lowering preload and wall stress, which can quickly improve chest pain and ischemia. Anticoagulants like heparin help prevent thrombus propagation but do not provide immediate symptom relief and are adjuncts to reperfusion/antiplatelet therapy. Streptokinase is a fibrinolytic used for reperfusion when PCI is unavailable and has important timing/contraindication considerations, so it is not the universal first drug given at presentation; streptomycin is an antibiotic and is unrelated.

Question 40

The drug commonly used to manage the cardiac arrhythmias is?

Accepted Answer

Answer reason: This medication increases vagal tone and reduces conduction through the AV node, helping control ventricular rate. It is also used in heart failure to improve contractility, which can be relevant when tachyarrhythmias coexist with reduced cardiac output. A common distractor here is a beta-agonist bronchodilator, which can actually precipitate tachycardia rather than treat arrhythmias.

Question 41

Drug of choice for the prevention of Mother to Child HIV infection:

Accepted Answer

Answer reason: Nevirapine is a non-nucleoside reverse transcriptase inhibitor that has been historically used as intrapartum and neonatal prophylaxis in PMTCT protocols, especially in resource-limited settings. The other options do not target HIV replication: tamoxifen is an anti-estrogen for breast cancer, indinavir is an HIV protease inhibitor but is not the classic single-dose PMTCT prophylaxis choice, and amikacin is an aminoglycoside antibiotic. Therefore, among the listed options, the antiretroviral most directly associated with PMTCT prophylaxis is nevirapine.

Question 42

Which one of the following antihypertensive medications is NOT safe in pregnancy?

Accepted Answer

Answer reason: This can lead to oligohydramnios with resultant pulmonary hypoplasia, limb contractures, and neonatal renal failure. Labetalol, nifedipine, and methyldopa are commonly used, evidence-supported antihypertensives in pregnancy. A common test trap is assuming all chronic hypertension drugs are acceptable, but ACE inhibitors/ARBs are specifically avoided due to fetal toxicity.

Question 43

A 5-year-old child came to the emergency room with a broken arm. While the nurse was reviewing the child's medical record, she saw that the child was prescribed Doxepin (Sinequan). Besides a broken arm, what medical condition does this child most likely have?

Accepted Answer

Answer reason: A recognized nonpsychiatric use is treating nocturnal enuresis by reducing nighttime awakenings and increasing bladder outlet tone via anticholinergic activity. In a 5-year-old, a prescription for doxepin is therefore more suggestive of nighttime urinary problems than severe psychiatric disorders like schizophrenia. While doxepin can be used for anxiety-related conditions, the classic pediatric association tested is nocturnal enuresis/nocturia rather than phobias or “neurosis.”.

Question 44

Epinephrine is given to counteract anaphylaxis. What is the mechanism of action of epinephrine?

Accepted Answer

Answer reason: Alpha-1 stimulation causes peripheral vasoconstriction, raising systemic vascular resistance and reducing mucosal edema, which counteracts hypotension from vasodilation. Beta-1 stimulation increases heart rate and contractility, improving cardiac output and perfusion. Beta-2 stimulation relaxes bronchial smooth muscle to relieve bronchospasm and also helps inhibit further mediator release from mast cells. Options that claim decreased cardiac output or constricted smooth muscle contradict these receptor-mediated effects in anaphylaxis.

Question 45

Antipyretic drugs reduce –

Accepted Answer

Answer reason: This directly treats the core feature of pyrexia rather than primarily altering hemodynamics or glucose. While many antipyretics (e.g., acetaminophen, NSAIDs) also provide analgesia, their defining effect as a class is fever reduction. Blood pressure and blood sugar are not primary therapeutic targets of antipyretic drugs.

Question 46

Which of the following drug is extracted from the parts of Foxglove plant?

Accepted Answer

Answer reason: The drug class extracted from foxglove includes digoxin/digitoxin, commonly referred to as digitalis. Morphine is derived from the opium poppy (Papaver somniferum), and cinchona alkaloids (e.g., quinine) come from Cinchona tree bark, so they do not match the plant in the stem. Therefore the best single answer is the option naming digitalis.

Question 47

Mifepristone tablets is used for ?

Accepted Answer

Answer reason: It is used as part of a medication abortion regimen, typically followed by misoprostol to induce uterine contractions and complete expulsion. The other options do not match its mechanism or standard indications; for example, diarrhea is not treated with an antiprogestin and would more likely be a potential adverse effect rather than a therapeutic use. Understanding drug mechanism and clinical indication is the key discriminator in this item.

Question 48

Indomethacin is used for?

Accepted Answer

Answer reason: This makes it primarily used as an analgesic/anti-inflammatory agent in conditions such as acute gout and inflammatory arthritides. While NSAIDs can also lower temperature, antipyresis is not the best single descriptor of its common clinical use compared with analgesia/anti-inflammation. It is not an antihistamine for allergic reactions and has no antihelminthic activity for worm infections.

Question 49

Which drug is the first-line treatment for acute angina (chest pain)?

Accepted Answer

Answer reason: Sublingual nitrates provide the fastest symptomatic relief by venodilation (reducing preload and wall stress) and coronary vasodilation, typically improving pain within minutes. Beta-blockers and calcium channel blockers are important for chronic angina prophylaxis but are not the quickest first-step agent for an acute episode. Aspirin is essential in suspected acute coronary syndrome to reduce thrombosis risk, but it does not provide rapid chest-pain relief like a nitrate does.

Question 50

Nystatin is given for..?

Accepted Answer

Answer reason: It is primarily used for Candida infections, especially mucocutaneous disease such as oral thrush and cutaneous candidiasis, where its minimal systemic absorption is advantageous. It does not treat endocrine disorders like diabetes or cardiovascular conditions such as hypertension. While it may be formulated for topical use on various body sites, its therapeutic target is fungal (Candida) infection rather than an organ category like the eye.

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