Comprehensive Pharmacology & Nursing Quiz

1) General Pharmacology & Therapeutic Effects

1.1 Mechanisms of Action

Q: Why don’t antibiotics work against viruses?

Antibiotics only work in the bloodstream, not inside cells.
Viruses replicate inside host cells & lack bacterial structures, so antibiotics don’t target them.
Viruses are too large to be affected by antibiotics.

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Q: Antiemetics for motion sickness typically work by...

Coating the stomach lining so acids don’t irritate the GI tract.
Blocking or modulating neurotransmitters in the vomiting center or CTZ.
Speeding up gastric emptying so food doesn’t stay in the stomach.

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1.2 Prophylaxis & Preventive Therapy

Q: A patient frequently gets UTIs and is given an antibiotic "just in case" before a long flight. This is called?

Prophylactic therapy
Empiric therapy
Definitive therapy

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Q: Select all that apply regarding prophylactic antibiotic teaching:

Complete the entire prescribed course
Stop taking them as soon as you feel better
Watch for possible GI upset or allergic reactions
Overuse can lead to antibiotic resistance

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1.3 Drug Tolerance & Dosage Adjustments

Q: An 80-year-old on levothyroxine for 30 years may need dose changes because:

Older adults typically need higher doses of thyroid meds.
Metabolic rate changes with age; lower doses may be needed to avoid hyperthyroid effects.
Levothyroxine is not safe after age 70, so it’s discontinued.

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1.4 Patient Instruction & Lifestyle Considerations

Q: A patient on an over-the-counter PPI also has chronic kidney disease. Which statement is most accurate?

PPIs are always safe for kidneys; no issue using them long-term.
High-dose or long-term PPI use can affect kidney function & should be monitored in CKD.
CKD patients should just switch to antacids instead.

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Q: A patient on antacids + other oral meds. Best teaching about timing?

Take all meds together so you only have to do it once.
Separate antacids by 1–2 hours from other meds to avoid absorption issues.
Take antacids only at bedtime, other meds in the morning.

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2) Antibiotics: Therapeutic & Adverse Effects

2.1 Cross-Sensitivity & Allergies

Q: A patient severely allergic to penicillin might also react to carbapenems. Which symptom suggests cross-sensitivity?

Rash, hives, or anaphylaxis
Bitter taste in mouth
Constipation

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2.2 Medication Instructions & GI Upset

Q: A patient on tetracycline has nausea. Which is the best dietary instruction?

Take with milk or dairy to settle the stomach.
Avoid dairy because calcium can reduce tetracycline absorption.
No special dietary considerations.

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Q: A patient on azithromycin has GI upset. Should they take it with food?

Typically best on empty stomach, but can take with light food if severe upset.
Always take azithromycin with a large meal to increase absorption.
Azithromycin is never given orally due to GI side effects.

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2.3 Initial/Broad vs. Narrow Spectrum

Q: Why start a broad-spectrum antibiotic for suspected pneumonia before culture results are in?

Broad-spectrum drugs are cheaper than narrow-spectrum options.
To cover a wide range of possible bacteria; then switch to narrow-spectrum once organism is identified.
No real reason; it’s just standard practice.

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2.4 Adverse Reactions & Monitoring

Q: A patient on gentamicin complains of ringing in the ears. What might this indicate?

Ototoxicity; nurse should hold the drug & notify provider.
It’s normal, continue the infusion.
Tetanus infection

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2.5 Timing of Cultures

Q: Why obtain cultures before starting IV antibiotics?

Antibiotics must always be started after cultures to avoid skewing results.
Actually it’s best to start antibiotics first, then do cultures later.
If antibiotics are given first, the cultures can be false negative or inaccurate.

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3) Dosage Calculations & IV Infusion

3.1 Practice with Drop Factors:
500 mL of D₅W over 5 hours, drop factor 15 gtt/mL. Calculate the flow rate (gtt/min).

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3.2 mL/hr Calculation:
750 mL over 6 hours. Rate in mL/hr?

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3.3 IV Piggyback Example:
50 mL over 30 minutes. What rate (mL/hr)?

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3.4 Shorter Infusion:
50 mL over 15 minutes. Rate (mL/hr)?

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3.5 Combination Order (Explain briefly)

1,000 mL LR from 0700–1100 (4 hours) + 100 mL antibiotic at 0900 on the same line. How do you handle the rates?

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4) Insulin & Diabetes Management

4.1 Onset and Peak Times

Q: A patient is to eat at 0800. When should rapid-acting insulin lispro be administered?

Exactly at 0800 or slightly after
15 minutes before the meal (e.g., ~0745)
2 hours before the meal

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Q: If a patient takes NPH insulin at 0800, when might they be at highest risk for hypoglycemia?

Around 0900 (1 hr later)
Approximately 4–8 hours later (late morning to mid-afternoon)
Never; NPH has no peak

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4.2 Mixing Insulins

Q: How do you correctly draw up short-acting (Regular) and NPH in the same syringe?

Cloudy before clear
Clear before cloudy (Regular first, then NPH)
Doesn’t matter; mix in any order

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4.3 Sliding Scale with NPO

Q: A patient’s glucose is 250 mg/dL. The sliding scale says 4 units. Patient is NPO. What’s the biggest concern?

Risk of hypoglycemia since the patient isn’t eating
Not enough insulin for BG 250
The nurse should give double the dose

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4.4 Opposite Scenario: Hyperglycemia Management

Q: A patient’s BG is 520 mg/dL with ketones, and they’re on IV regular insulin. Which is most important for the nurse to monitor?

Potassium and frequent BG checks
Whether the patient can tolerate large meals
Bowel sounds

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4.5 Lab Tests & Monitoring

Q: A patient’s HbA1c is 9.0%. How does this guide therapy?

9.0% is excellent control; no changes needed
9.0% indicates poor control over ~3 months; intensify therapy
9.0% means blood sugar has been low

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5) GI / Laxatives & Bowel Prep

5.1 Different Laxatives

Q: Which statement is true about bulk-forming vs. stimulant laxatives?

Bulk-forming irritate the bowel lining; stimulants only add fiber.
Bulk-forming absorb water to increase stool bulk; stimulants directly irritate the mucosa.
Neither affects stool consistency; both just reduce gas.

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Q: When might you discourage a stimulant laxative?

If the patient has undiagnosed abdominal pain or possible obstruction
Only if the patient is lactose intolerant
Never discourage; stimulant laxatives are always fine

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5.2 Bowel Prep Effectiveness

Q: A patient on polyethylene glycol for colonoscopy is considered “ready” when...

They have had only one formed stool in the past 24 hours
Bowel movements are clear, watery, and free of solid stool
The patient reports no GI cramping

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5.3 Diarrhea from Laxatives

Q: A patient on an osmotic laxative develops severe diarrhea. The first intervention is:

Tell them to continue the laxative until the diarrhea subsides
Stop/hold the laxative and monitor fluid/electrolyte status
Add a stimulant laxative

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5.4 Antiemetics in Various Routes

Q: If a patient is actively vomiting, which antiemetic route is typically preferred?

Oral only
IV or rectal suppository
Sublingual is the only route for antiemetics

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6) Other Endocrine & Metformin Considerations

6.1 Metformin & Imaging Contrast

Q: Why might metformin be held before IV contrast?

IV contrast neutralizes metformin so it won’t lower blood sugar
Risk of lactic acidosis if renal function is compromised by contrast
There’s no reason; it’s an outdated practice

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6.2 Metformin + CKD

Q: Why might a nurse question metformin for a patient with chronic kidney disease?

Metformin has no effect on blood sugar if kidneys are diseased
Reduced renal clearance can lead to metformin accumulation & lactic acidosis
CKD patients don’t need diabetes meds

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6.3 Long-Term Monitoring

Q: A type 2 diabetic on metformin complains of fatigue & numb feet. Which deficiency might be suspected?

Vitamin B12 deficiency
Iron deficiency
Vitamin C deficiency

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6.4 Thyroid Replacement in Special Populations

Q: A younger adult wants to stop levothyroxine after normal labs. The best response is:

“Yes, once levels normalize you can discontinue.”
“Hypothyroidism is typically lifelong; normal labs mean the med is working.”
“We’ll switch you to an oral antibiotic instead.”

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All Sections Complete!

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