COLLEGE OF NURSING

MIDTERM EXAMINATION
NCM 106 (PHARMACOLOGY)
1st Semester, SY 2019-2020
October , 2019

General Instructions:
1. Use the official answer sheet only.
2. Shade only one box for each question on your answer sheet.
3. Erasure or superimposition will invalid your answer.
4. Questions or clarifications must be directed to your instructor only.
5. Cheating in any form will automatically fail in this exam.

Choose the correct letter that corresponds to your answer.

Situation: A 35 year old driver is brought to the Emergency Room due to moderate to
severe chest pain after taking his breakfast with cold clammy perspiration and
peripheral edema. Initial VS taken and recorded as BP 170/100mmhg, PR 96bpm, RR
20cpm. ICU admission is advised. Nitro Dur patch is applied by ER Nurse on duty, Gg.
per doctor’s order. Questions 1-15 refer to this situation
1. Which of the following observations by nurse Gg, indicates that a Nitro-Dur patch is
achieving its desired effect?
A. Chest pain is relieved..
B. Tolerates minimal activity without pain.
C. Performs activities of daily living without chest pain.
D. Able to control pain with frequent change of patch.

2. Nurse Gino instructed Dado about the use of a nitrate patch. Which of the following
would prevent nitrates tolerance?
A. Do not remove the patches.
B. Have a 12-hour “no nitrate” time.
C. Have a 24-hour “no nitrate” time.
D. Keep nitrates on 24 hours, then off 24 hours.

3. Which among these vital signs is most likely to reflect an adverse effect of
nitroglycerin?
A. Heart rate. C. Blood pressure
B. Temperature. D. Respiratory rate

4. A nitroglycerine IV was prescribed to Dado. Nurse Gino understands that the

therapeutic action of this drug is to
A. produce an immediate analgesic effect and relieve the chest pain.
B. increase the coronary blood supply and decrease the afterload.
C. increase diuresis and glomerular filtration which results in decreased venous
return.
D. increase the force of contraction of the myocardium, thereby increasing oxygen
delivery.

5. Which of the following statements of Dado indicates that this drug is producing
its therapeutic effect?
A. "I have a bad headache."
B. "My chest pain is decreasing."
C. "I feel a tingling sensation around my mouth."
D. "My blood pressure must be high because my vision is blurred."
6. Dado is known hypertensive and has a maintenance medication, a beta blocker.
Which among these options is classified as beta blocker?
A. Clonidine. C. Betanechol
B. Metropolol. D. Losartan.

7. Digoxin ( lanoxin ) is also prescribed for Dado. Which of the following side
effects should be observed?
A. GI bleeding. C. Ringing in the ears
B. Signs of bruising D. Visual disturbances

8. During digoxin therapy, nurse Gino should closely monitor Dado for
A. urine glucose and ketones.
B. serum potassium and magnesium levels.
C. serum potassium and creatine kinase levels.
D. urine potassium and creatine kinase levels.

9. When attached to cardiac monitor, Dado is having dysrhythmias. Nurse Gino is

expecting that the physician will order which medication?
A. Digoxin.. C. Propanolol

B. Captopril. D. Procainamide

10. During the night, Dado becomes restless and diaphoretic. Which of the following
nursing actions should be performed initially by Gino?
A. Call the physician to obtain an order for sedation.
B. Check his temperature and determine his serum blood glucose level.
C. Turn the alarms low and decrease the number of times you interrupt sleep.
D. Check the monitor to determine his cardiac rhythm and evaluate vital signs.

11. Which of the following nursing interventions is not appropriate when

administering vasodilator?
A. Implement seizure precaution.
B. Withhold the drug if BP is 90/60.
C. Encourage patient to change position slowly.
D. Tell patient that headache and dizziness may occur.

12. Which statement by the client indicates that the Nitroglycerine IV is producing its
therapeutic effect?
A. "I have a bad headache."
B. "My chest pain is decreasing."
C. "I feel a tingling sensation around my mouth."
D. "My blood pressure must be up because my vision is blurred."

13. Dado is being discharged with take home meds of Nitroglycerin tablet. Home
instructions should include
A. keep the nitroglycerin in a clear container.
B. keep the nitroglycerin in a breathable container.
C. take nitroglycerin at the first onset of chest pain.
D. take two nitroglycerin tablets together for severe chest pain.

14. Nurse Gino should also instruct Dado to

A. replenish his supply every month.
B. keep the medication in the brown bottle..
C. take one every 15 minutes if pain occurs.
D. crush the medication and take with water.
 15. Which statement by Dado indicates that he understands how to take the
nitroglycerin sublingual?
A. " I'll chew the tablet then let it dissolve in my mouth."
B. " I'll take only one dose. If the pain persisted I'll call the doctor."
C. " If I have chest pain, I'll call the doctor and put two tablets under my tongue."
D. " If I have a chest pain, I will take a rest, sit down and take the medication."

Situation: Mr. X,a 65 year old male known hypertensive was brought to
emergency room by his grandaughter due to elevated BP and nape pain. His vital
signs upon admission were taken as BP 170/100mmHg, HR 110 bpm, RR 30cpm.
He is taking beta blockers as his maintenance drug. Nurse Cd is assigned to his
care Questions 16- 25, please refer to the situation.

16. The nurse knows that beta-blockers should be used cautiously to patient with
A. UTI C. Urolithiasis
B. Asthma D. Normoactive bowel sound

17. Nurse Cd is monitoring Mr. X .Which of the following assessment data would
indicate a potential serious complication associated with propranolol?
A. Complaints of insomnia
B. The presence of audible expiratory wheezes upon auscultation.
C. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of
138/72 mm Hg after two doses of the medication
D. A baseline resting heart rate of 88 beats per minute followed by a resting
heart rate of 72 beats per minute after two doses of the medication

18. Mr.X is for discharge. In developing a medication teaching plan, nurse Cd would
include which of the following instructions?
A. Exercise will prevent orthostatic hypotension
B. Hot baths and showers are advised, to increase vasodilation
C. Medication should be taken on an empty stomach to enhance absorption
D. Medication should be withheld if the pulse rate drops below 60 beats per
minute.

19. .A common beta blocker used in the treatment of hypertension is

A. Atenolol C. Betanechol
B. Captopril D. Edrophonium

20. 20. Which of the following medications is clasiified as beta adrenergic blocking
agent?
A. Metaraminal C. Propanolol
B. Phenylephrine D. Levarterenol

21. Nurse Cindy must be aware of the action, indication and side effects of the
adrenergic blocking drugs which are also known as
A. Anticholinergics C. Sympatholytics
B. Sympathomimetics D. Parasympatholytics

22. Mr.X should be cautioned to

A. avoid exposure to sun.
B. avoid exposure to infection.
C. stop the drug if he experience flu like symptom.
D. never stop the drug abruptly because it needs to be tapered slowly.

23. Sympathomimetics are classified into direct acting and indirect acting drugs. A
drug that directly stimulate adrenergic receptor is
 A. Epinephrine. C. Amphetamine.
B. Ephedrine. D. Albuterol.

24. Which of the following drugs control supraventricular tachycardia by decreasing

cardiac impulse conduction through its mechanism of action?
A. ACE inhibitors C. Anti-hypertensive
B. Cardiac stimulant. D. Beta-adrenergic blockers

25. The following are the major side effects of anti-hypertensive drugs except
A. Skin rash C. Sexual disturbance
B. Dizziness D. Orthostatic hypotension

26. Which of the following drugs elevates the blood pressure by constricting the
peripheral blood vessels through alpha-adrenergic stimulation?
A. Diuretics C. Cardiac stimulants
B. Vasopressors D. Antihypertensive drugs

27. A nurse provides discharge instructions to a postoperative patient who is taking

warfarin sodium (Coumadin). Which statement, if made by the client, reflects the
need for further teaching?
A. “ I will take my pills every day at the same time.”
B. “ I will be certain to limit my alcohol consumption.”
C. “ I will take Aspirin for my headache because it is coated.”
D. “ I have already called my family to pick up a Medic-Alert bracelet.”

28. .A client is being treated with procainamide hydrochloride (Pronestyl) for cardiac
dysrhythmia. Following intravenous administration of the medication, the client
complains of dizziness. Which intervention should the nurse do first?
A. Obtain a 12 lead ECG immediately
B. Administer ordered nitroglycerin tablets.
C. Measure heart rate and rhythm on the rhythm strip.
D. Auscultate the client’s apical pulse and obtain a blood pressure

29. A nurse is caring for a client receiving a heparin IV infusion. The nurse
anticipates that which laboratory study will be prescribed to monitor the
therapeutic effect of heparin?
A. Hematocrit. C. Prothrombin time.
B. Hemoglobin. D. Activated partial thromboplastin time.

30. A client is diagnosed with an acute myocardial infarction (MI) and is receiving
thrombolytic, which of the following is a priority nursing intervention?
A. Monitor for renal failure.
B. Monitor psychosocial status.
C. Monitor for signs of bleeding.
D. Have heparin sodium available.

31. A male client is admitted in the medical ward with diagnosis of Transient
Ischemic Attack. He is currently taking Enalapril (Vasotec), atenolol (Tenormin),
and aspirin (ASA) daily .prescribed by his family physician. The admitting
phycisian wrote in the doctor’s order sheet, “Administer maintenance
medications.” Which of the following is the most appropriate action for the nurse
to take?
A. Administer the medications as ordered by the phycisian
B. Call the phycisian, describe the medications, and request order clarification
C. Send the client’s medication bottles to the pharmacy for identification and
then administer the medications as ordered
 D. Refuse to give any medications, and wait until the phycisian makes rounds to
clarify the order

32. A 66-year-old female client consulted the clinic due loss of appetite and
nauseated. She is taking Atenolol (Tenormin), Digoxin (Lanoxin) and
Chlorothiazide (Diuril). Initial diagnosis of digoxin toxicity is made. Which of the
following assessment data would support this diagnosis?
A. Dyspnea, edema, and palpitations
B. Chest pain, hypotension and parethesia
C. Double vision, loss of appetite and nausea
D. Constipation, dry mouth, and sleep disorder

33. A nurse is giving information about the effects of ACE inhibitor. Which of the
following statements made by the nurse is correct?
A. ACE inhibitor increases blood pressure.
B. ACE inhibitor reduces the need to urinate.
C. ACE inhibitor reduces potassium level in the blood.
D. ACE inhibitor increases potassium level in the blood.

34. An adult patient is taking cardiovascular drug that increases the force of
myocardial contraction. Which of the following drugs has a positive inotropic
effect?
A. Nitrates C. Antiarryhthmic
B. Diuretics D. Cardiac glycosides

35. Which of the following drugs is an example of cardiac glycoside?

A. Lidocaine C. Digoxin
B. Atropine D. Propranolol

36. A nurse is about to administer cardiac glycoside. Which nursing action is most
appropriate prior to administration of cardiac glycoside?
A. Assess apical pulse C. Evaluate eye movements
B. Check mental status D. Monitor urine specific gravity

37. The doctor prescribed digoxin (lanoxin) once a day to a patient with CHF. The
nurse takes the apical pulse and the result is 51 bpm and the patient complains
of nausea. Which nursing action is important at this point?
A. Withhold the digoxin and notify the physician.
B. Administer the digoxin and notify the physician.
C. Administer the digoxin and medicate for nausea.
D. Withhold digoxin and obtain a serum digoxin level.

38. During digoxin therapy, the nurse should closely monitor the patient’s:
A. Urine glucose and ketones
B. Serum potassium and magnesium levels
C. Serum potassium and creatine kinase levels
D. Urine potassium and creatine kinase levels

39. Which of the following nursing actions would be most important when caring for
a patient who is receiving nifedipine (calcibloc )?
A. Palpating pedal pulses C. Auscultating heart sound
B. Assessing capillary refill D. Monitoring blood pressure

40. Nifedipine is ordered for the client with a ruptured cerebral aneurysm. The nurse
recognizes that the desired effect of this drug is to
A. Prevent the inflammatory process
B. Dissolve the clot that has formed
 C. Prevent the influx of calcium into cells
D. Restore the client’s blood pressure to a normal reading

41. Which of the following side effects the nurse would expect when administering
Atropine SO4?
A. Dry mouth C. Teary eyes
B. Salivation D. Bronchospasm

42. Which of the following medications is used to decrease oropharyngeal secretions

prior to surgery?
A. Cholinergic C. Sympatholytics
B. Anticholinergics D. Parasympathomimetics

43. . Cholinergic agonists stimulate which of the following receptors?

A. Beta2 C. Adrenergic
B. Alpha1 D. Cholinergic

44. Which statement describes the action of Atropine as pre anesthetic agent?
A. Atropine reduces hyperreflexia during surgery
B. Atropine minimizes the risk of post operative ileus
C. Atropine prevents respiratory depression during surgery
D. Atropine reduces excess salivation and gastric secretions

45. A client is receiving heparin sodium by continuous intravenous infusion. Which

adverse effect should be monitored?
A. decreased blood pressure C. ecchymoses
B. increased pulse rate D. tinnitus

46. Which action should the nurse perform while the patient is on heparin IV
therapy?
A. Protect the medication from light
B. Use IM route if there are frequent IV site changes
C. Attach the IV heparin to an infusion pump
D. Regulate IV flow with macrotubing

47. Which among these options should be prepared by the nurse if the patient
develops a heparin overdose?
A. Platelets C. Vitamin K
B. Urokinase D. Protamine sulfate

48. The nurse is teaching the patient about warfarin (Coumadin) therapy. Which
statement by the nurse is incorrect?
A. If you miss your daily dose of Coumadin, take 2 tablets the next day.
B. Use electric razor when shaving while on Coumadin therapy.
C. Notify your physician before taking any other medication.
D. Avoid drinking alcohol in any form while on Coumadin therapy.

49. A patient is on coumadin therapy. Which statement when made by the client will
concern the nurse?
A. I will use soft-bristled toothbrush
B. I will drink 8-10 glasses of water everyday
C. I will refrain from taking aspirin for my headache
D. I'm glad I'll be able to eat lettuce, spinach and other green vegetables

Concept: The clinical instructor is discussing drugs affecting the Central Nervous
System. A brief review of the anatomy and physiology of the CNS was done to
fully understand how these drugs act in the system. Questions 50 – 58,refer to
this concept.

50. Which of the following does not belong to a neurotransmitter?

A. Calcitonin which involved in the calcium production
B. Acetylcholine which is involved in with memory and learning
C. Norepinephrine Which is involved with mania depression and emotions
D. Serotonin which is involved with biological rhythms, sleep, emotion and pain.

51. Which drug hinders movement of the impulses from the thalamus to the brain
cortex, thus creating depression in the CNS?
A. Procaine C. Amphetamines
B. Ibupropen D. Thiopental Sodium

52. When the drug prevents dissemination of electrical discharges in the motor
cortex area of the brain it is known as
A. Sedatives C. Anticonvulsants
B. Narcotics D. Muscle relaxant

53. All but one is a Non-Steroidal Anti-Inflammatory Drug.

A. Piroxicam C. Prednisone
B. Naproxen D.Indomethacin

54. Non-Steroidal Anti- Inflammatory Drugs should not be given together with
antacids because
A. It may cause GI distress
B. It increases blood pressure
C. it decreases the potency of the drug
D. it increase higher incidence of bleeding

55. .The nurse is caring a 70 year old client with sleep disturbance problem. When
treating an elderly person with a sedative, the dose may need to be
A. Increased C. Unchanged

B. Decreased D. Combined with another drug

56. Which information should be included in the teaching plan for patient taking
hypnotic medication for insomnia?
A. At bedtime, put medication on bedside table with a glass of water in case a
pill is needed
B. Avoid eating high protein foods between supper and bedtime
C. Keep a night-light on for patient safety in case they need to get out bed.
D. Go to bed 30 minutes earlier than usual to allow the hypnotic to work.

57. .A client taking a barbiturate should be taught to

A. Decrease the drug gradually rather than stop it abruptly
B. Decrease dose when drowsiness occurs
C. Drink alcohol only with medication
D. Operate of machinery or drive a car

58. When administering Phenobarbital, a nurse should have

A. Emergency resuscitation equipment readily available
B. An indwelling urinary catheter or straight catheter on hand
C. The practitioner at the client’s bedside
D. A signed consent form for the drug
Situation; Mr.Z a 25 year old working student was driving a car when suddenly
ahit by a ten wheeler truck which resulted to head injury. He was rushed to the
hospital and a subdural hematoma was determined after CT scan, the doctor
prescribed Mannitol 75cc every 6hours. Questions 59-

59. The physician ordered Mannitol for which of the following indications?
A. Cataract C. Normal Renal function
B. Heart failure D. Increased intracranial pressure

60. Which of the following results would indicate the therapeutic effect of Mannitol ?
A. Urine output increases
B. Pupils are 8 mm and nonreactive
C. Systolic blood pressure remains at 150 mm Hg.
D. Blood urea nitrogen (BUN) and creatinine levels return to normal.

61. Which of the following nursing interventions should be prioritized prior to

administration of mannitol?
A. Check for presence of hematuria
B. Asses the pupil reaction of the client.
C. Cautiously check the blood pressure of the client.
D. Check the renal and the liver function test of the client.
.
62. A patient who is suffering from cerebral edema is given with Mannitol. The
patient develops renal failure, what will be the initial action of the nurse?
A. Assess vital sign of the patients
B. Discontinue immediately Mannitol
C. Record the response of the patient
D. Refer to the head nurse

63. Dexamethasone IV is prescribed for a client with cerebral edema. The nurse
prepares the medication for administration and plans to
A. Mix the medication in 1000 ml of 5% dextrose
B. Prepare an undiluted direct injection of the medication
C. Mix the medication in 100 ml of lactated Ringer’s solution
D. Dilute the medication in diluted lactated Ringer’s solution and administer as a
direct injection

64. A patient who is known to be a narcotic abuser is involved in an automobile

accident and has extensive surgery. In planning for analgesia post-surgery, the
nurse should be aware that this patient is likely to
A. tolerate pain than a patient who is not a drug abuser.
B. refuse medication to prove addiction is not a problem
C. tolerate oral medication better than intravenous doses
D. require greater doses of medication before pain is relieved

65. A nurse is planning care for a client in spinal shock. Which of the following
actions would be least helpful in minimizing the effects of vasodilatation below
the level of the injury?
A. Moving the client quickjy as one unit
B. Applying TED’s or compression stockings
C. Using vasopressor medications as prescribed
D. Monitoring vital signs before and during positions changes

66. What is the difference between epidural analgesia and IV analgesia?

A. Epidural analgesia has fewer side effects
B. Epidural analgesia has more sedative effect
C. Epidural analgesia has longer effect in the body.
 D. Epidural analgesia is more effective in relieving pain

67. Which statement is appropriate for a nurse to make to a client who’s about to
have a surgery using an inhalation anesthetics?
A. “It’s normal for you to shiver after surgery.”
B. “I’ll monitor the area for a rash after surgery.”
C. “You may not have feeling in the surgical area when you wake up.”
D. “Your sense of touch will decrease and then you’ll lose motor function.”

68. An intubated, mechanically ventilated patient in the intensive care unit is

becoming increasingly restless and anxious. The nurse prepares which of the
following intravenous anesthetic drug?
A. Halothane C. Propofol (Diprivan)
B. Nitrous Oxide D. Isoflurane (Forane)

69. A client with generalized anxiety disorder is prescribed an antianxiety drug, such
as Alprazolam (Xanax), the nurse should instruct the patient to
A. take it before meals
B. avoid alcoholic beverages
C. increase potassium intake
D. discontinue use of drugs like tylenol

70. The nurse would question the use of benzodiazepines to which of the following
clients?
A. CVA C. Anxious
B. Pregnant D. Chronic glaucoma

71. Which drugs are thought to work by stimulating the inhibitory neurotransmitter
GABA?
A. Barbiturates
B. Benzodiazepines
C. Tricyclic Antidepressants
D. Selective Serotonin Reuptake Inhibitors

72. A nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist
regularly and perform frequent oral hygiene based on the knowledge that a
common side effect of this drug is
A. oral candidiasis C. increased risk of dental abscesses
B. gingival hyperplasia D. increased incidence of dental caries

73. Which of the following assessment indicates the need for Dilantin (phenytoin)
administration after dialysis?
A. headache, nausea, vomiting
B. twitching, vomiting, restlessness
C. dizziness, headache, restlessness
D. hypertension, headache, restlessness

74. .A client with seizures asks the nurse how phenytoin sodium (Dilantin) will help.
Based on the knowledge of the drug’s action, what is the nurse’s best response?
A. Reduces motor cortex activity by altering transport of ions.
B. It corrects the abnormal synthesis of norepinephrine in the body.
C. Transmission of abnormal impulses in the spinal cord is depressed.
D. It interrupts the flow of abnormal impulses from peripheral neurons in the
viscera to the brain.
75. When preparing to teach a client about phenytoin sodium (Dilantin) therapy, the
nurse would urge not to stop the drug suddenly because
A. Heart block is likely to develop
B. Status epilepticus may develop
C. A hypoglycemic reactions develops
D. Physical dependency on the drug develops over time

76. Gabapentin (Neurontin) may be ordered for a client with which disorder?
A. Tonic-clonic seizures C. Postherpetic neuralgia
B. Parkinson’s disease D. A history of pancreatitis

77. Which of the following is a plant alkaloid derived from Belladona plant that blocks
acetylcholine and inhibits parasympathetic action?
A. Atropine C. Epinephrine
B. Dopamine D. Nitroglycerine

78. Mr. Jessie Ray, a newly admitted patient, has a seizure disorder which is being
treated with medication. Which of the following drugs would the nurse question if
ordered for him?
A. Phenobarbitol, 150 mg hs
B. Amitriptylene (Elavil), 10 mg QID.
C. Phenytoin (Dilantin), 100 mg TID
D. Valproic acid (Depakote), 150 mg BID

79. A hospitalized client had a tonic-clonic seizure while walking in the hall way.
During the seizure the nurse priority intervention should be:
A. Hold the clients arms and leg firmly
B. Protects the client’s head from injury
C. Place the client immediately to soft surface
D. Attempt to insert a tongue depressor between the client’s teeth

80. Nurse Mayette is caring for client who begins to have seizure while on bed.
Which action should the nurse implement to prevent aspiration?
A. Elevate the head
B. Loosen restrictive clothing
C. Use tongue depressor between teeth
D. Position the client on the side with head flexed forward

81. John suddenly experiences a seizure, and Nurse Gina notice that John exhibits
uncontrollable jerking movements. Nurse Gina documents that John experienced
which type of seizure?
A. Clonic seizure
B. Tonic seizure
C. Absence seizure
D. Myoclonic seizure

82. Nurse Carol is assessing a client with Parkinson’s disease. The nurse recognize
bradykinesia when the client exhibits
A. Muscle spasm
B. Paralysis of limbs
C. Intentional tremor
D. Lack of spontaneous movement

83. Karina a client with myasthenia gravis is to receive immunosuppressive therapy.

The nurse understands that this therapy is effective because it
 A. Stimulates the production of acetylcholine at the neuromuscular junction.
B. Stimulates the production of acetylcholine at the neuromuscular junction.
C. Promotes the removal of antibodies that impair the transmission of impulses
D. Decreases the production of autoantibodies that attack the acetylcholine
receptors.

Prepared by:

Ma.Analita L.Bergado RN, MN

Reviewed and Validated by

Dr. Mario R. Marasigan,RN

Approved by:

Dr. Cecilia C. Pring, RN

Dean/VPAR