1.

An employee of a company engaged in clearing vegetation from country roadsides

accidentally ingested a small quantity of a herbicidal solution that contained paraquat.
Within 2 hours, he was admitted to the emergency room of a nearby hospital. Which of
the following best describes his probable signs and symptoms in the emergency room?

a. Diarrhea, vomiting, sweating, and profound skeletal muscle weakness

b. Dizziness, nausea, agitation, and hyperreflexia
c. Dyspnea, pulmonary dysfunction, and elevated body temperature
d. Gastrointestinal irritation with hematemesis and bloody stools.

2. Correct pairings of toxic agent with the best method of treatment include all of the
following EXCEPT

a. Carbon monoxide: 100% or hyperbaric oxygen

b. Carbon tetrachloride: Support of vital signs
c. Nitrogen dioxide: Nonspecific treatment of non-cardiogenic pulmonary edema
d. Paraquat: Hemodialysis

3. The light brownish colour of smog often apparent in the Riverton City area on a hot
summer day is mainly due to

a. Nitrogen dioxide
b. Hydrocarbons
c. Carbon monoxide
d. Ozone

4. Parkinson’s disease reflects an imbalance between inhibitory and stimulating activity of

nerves in the

a. reticular activating system.

b. cerebellum.
c. basal ganglia
d. limbic system

5. The main, underlying problem with Parkinson’s disease seems to be a decrease in the
neurotransmitter

a. acetylcholine
b. dopamine
c. norepinephrine
d. serotonin

6. Drugs that are used to alter a patient’s response to the environment are called

a. hypnotics.
b. sedatives.
 c. antiepileptics.
d. anxiolytics.

7. The benzodiazepines are the most frequently used anxiolytic drugs because

a. they are anxiolytic at doses much lower than those needed for sedation or hypnosis
b. they can also be stimulating
c. they are more likely to cause physical dependence than older anxiolytic drugs
d. they do not affect any neurotransmitters

8. Which of the following effects is most likely after acute ingestion of ethanol resulting in a
blood level of 80 mg/dL?

a. Cirrhosis
b. Hypertension
c. Increased activity of liver microsomal drug-metabolizing enzymes.
d. relaxation of uterine smooth muscle

Item 10: A homeless middle-aged male patient presents in the emergency room in a state of
intoxication. You note that he is behaviorally disinhibited and rowdy. He tells you that he has
recently consumed about a pint of a red-colored liquid that his friends were using to “get
high.” He complains that his vision is blurred and that it is “like being in a snowstorm.” His
breath smells a bit like formaldehyde.

9. The most likely cause of this patient’s intoxicated state is the ingestion of

a. Ethanol
b. Ethylene glycol
c. Methanol
d. Isopropanol

10. All of the following are topical skin treatment used as antiseptic agents EXCEPT:

a. Potassium permanganate
b. Silver nitrate
c. Albendazole
d. Aluminium diacetate

11. Bethamethasone is a topical skin ointment which has all the following precautions
EXCEPT:

a. avoid prolonged treatment of large areas of the skin as adrenal suppression can
occur
b. bethamethasone should not be used on the face for more than seven (7) consecutive
days
c. It should be withdrawn and an appropriate antimicrobial given if secondary infection
occurs during treatment
 d. It should be used in large amounts or for more than 2 weeks during pregnancy

12. Which of the following actions or properties is most closely associated with estradiol?

a. increases the production of thick cervical mucus

b. stimulates progesterone receptor biosynthesis in the uterus
c. is transported in the blood bound mainly to albumin
d. can be reversibly metabolized to testosterone

13. Nandrolone esters may be useful adjuncts for the treatment of which one of the following
conditions?

a. prostatic cancer
b. precocious puberty
c. threatened spontaneous abortion
d. hypogonadism

14. Potential adverse effects of testosterone administration include all of the following
EXCEPT:

a. precocious puberty
b. virilization
c. decreased sperm production
d. hepatotoxicity

15. Health teaching for the patient receiving digitalis and diuretics should include the
instructions to increase dietary intake of:

a. iron rich animal protein

b. potassium-rich foods
c. foods high in soluble fibre
d. foods high in a vitamin K.

16. Which of the following laboratory tests results should the nurse expect to monitor
periodically in the patient taking atorvastatin (Lipitor)?

a. liver function tests

b. bleeding time
c. thyroid hormone levels
d. magnesium levels

17. Captopril (Capoten) is an antihypertensive drug that is classified as:

 a. an alpha-adrenergic blocker
b. a sympathetic ganglionic blocker
c. a direct acting peripheral vasodilator
b. an angiotensin converting enzyme Inhibitor

18. Mr. Dixon, asks you the Nurse on duty if he should be taking potassium supplementation
while he is taking his Spironolactone (Aldactone). Your answer to him is:

a. “Yes, you will need a source of potassium supplementation.”

b. “No, the diuretic that you are taking does not pull potassium from your body.”
c. “That idea sounds like a good one; I’ll get an order for potassium for you.”
d. “No, don’t worry about that unless your physician decides you need
supplementation.”

19. The most common gastrointestinal side effect experienced by women taking oral
contraceptive agents is:
a. abdominal cramps
b. diarrhea
c. flatulence
d. nausea

20. As single agents, or in combination with another drug, all the following are used to
stimulate ovulation EXCEPT:

a. Clomiphene
b. Medroxyprogesterone
c. Cyclofentanyl
d. Gonadorelin acetate

21. A common vaginal problem that occurs during both oestrogen and progestin therapy is:

a. Monilia
b. pruritus
c. candida
d. increased dryness

22. All of the following drugs are used to decrease uterine motility EXCEPT:

a. Terbutaline (Bricanyl)
b. Nifedipine (Adalat)
c. Salbutamol (Ventolin)
d. Noradrenaline
23. Your instructions to your patient taking progestin would include:

a. “Report any changes in your vision to your physician.”

b. “You can expect your weight to fluctuate quite a bit until your body adjusts to this
medication.”
c. “Report any urticarial around the injection site immediately.”
d. “You need to eat foods high in potassium.”

24. As you take your patient’s history, what would alert you that her oestrogen is
contraindicated for her?

a. Severe episodes of diaphoresis at nights

b. The presence of polycystic breast disease
c. A history of thromboembolic disease
d. Complaints of excessive bleeding during menstruation

25. Hypercalcemia can become a problem for those on anabolic steroids. The symptoms of
hypercalcemia include all the following EXCEPT:

a. Anorexia
b. Constipation
c. Loss of muscle tone
d. Polyuria

26. The efficacy of oral contraceptives may be decreased by all the following agents
EXCEPT:

a. mineral oil
b. chloramphenicol
c. bromcriptine (Parlodel)
d. dihydroergotamine

27. Periodic lab function tests that are important for the patient taking anabolic steroids
include:

a. Liver function tests and serum cholesterol

b. glucose tolerance and electrolytes
c. T4 and pTT
d. Renal function tests and BUN

28. In the patient experiencing severe pain being treated with opiate analgesics, the primary objective
of nursing care is to:
a. provide comforting measures
 b. prevent or alleviate pain
c. prevent physical dependence
d. facilitate coping behavior

29. Opiate analgesics are contraindicated or used cautiously in all of the following EXCEPT
in
those patients:

a. Who express a fear of drug addiction

b. Known to have hepatic cirrhosis
c. With undiagnosed acute abdominal pain
d. With increased intracranial pressure.

30. In a patient taking an NSAID and anticoagulant concurrently, the nurse would expect to
monitor the:

a. prothrombin time
b. total albumin
c. platelet level
d. amylase level

31. In the patient taking an NSAID, which of the following conditions reported in the past
medical history indicates a possible contraindication?

a. Recurrent cholecystitis
b. Hiatal hernia
c. A bleeding ulcer episode
d. diverticulitis

32. The most common current indication for the use of barbiturates is for:

a. seizure control
b. anxiety control
c. hypnosis
d. pain control

33. The largest and most widely used group of antipsychotic drugs are the:
a. benzodiazepines
b. Phenothiazines
c. Tricyclic antidepressants
d. MAO Inhibitors
34. Health teaching for the patient taking benzodiazepines includes advice to eliminate
smoking
because, in individuals that smoke, drug effects may be:

a. lessened
b. potentiated
c. reach toxic levels
d. cancelled

35. In teaching the patient about his prescribed medication of Chlordiazepoxide (Librium),
the nurse should explain that common side-effects experienced in the early stages of
therapy is:

a. daytime drowsiness
b. memory impairment
c. vivid dreaming
d. urinary retention

36. A typical antidepressant exhibiting selective inhibition of serotonin uptake in the brain
and having comparatively fewer sedative and anticholinergic effects than do other
antidepressants include all the following EXCEPT:

a. Imipramine (Tofranil)
b. Paroxetine (Paxil)
c. Sertraline (Zoloft)
d. Fluoxetine (Prozac)

37. The principal indication for the use of Diazepam (Valium) is:

a. Status epilepticus
b. Lennox-Gastaut Seizures
c. Petit-Mal seizures
d. Grand Mal Seizures

38. The symptoms of Parkinsonism are caused by:

a. low dopamine activity and high cholinergic action

b. Excessive parasympathomimetic stimulation
c. Interuptions in cholinergic neural pathways
d. Autonomic hypoactivity and decreased response to the peripheral system

39. David Allen suffers from recurrent attacks of drowsiness and sleep during the daytime
and falls asleep in the middle of conversations. He is diagnosed with narcolepsy. As an
adjunct to therapy, his physician is most likely to prescribe:

a. Methaphetamine
 b. Dextroamphetamine (Dexadrine)
c. Caffeine
d. Doxapram (Dopram)

40. All of the following could be potential side effects of the androgens except:

a. salt and water retention

b. liver damage
c. drowsiness and dizziness
d. adenocarcinoma

41. The mechanism of action of the combination oestrogen-progestin oral contraceptives

include all the following EXCEPT:

a. inhibition of the process of ovulation

b. interference with follicular maturation
c. increased fallopian tube peristaltic activity
d. make the endometrium unfavourable to implantation

42. Bactericidal antibiotics are capable of:

a. Weakening the cell walls of the microbes.
b. Inhabitation of nucleic acid metabolism.
c. Interference with cell metabolism.
d. Interference with cell division

43. An organism frequently responsible for super infections during antibiotic therapy is:

a. Streptococcus
b. Candida
c. E. Coli
d. Klebsiella

44. Antibiotics are divided into broad spectrum and narrow spectrum ranges of antimicrobial
activity. Which statement best describes the activity of a wide spectrum antibiotic?

a. The antibiotic primarily affects one group of microorganisms.

b. Organisms affected are primarily gram negative organisms plus a number of others,
such
as Neisseria.
c. The agent is effective against gram-positive and gram negative organisms.
d. The most effective antibiotic has a wide spectrum of activity.

45. A frequently used, natural penincillin that is a first-line treatment for infections caused by
gram positive bacteria is:
 a. Amocixillin
b. Carbenicillin
c. Penicillin
d. Methicillin

46. A major untoward reaction associated with use of the penicillin is:

a. Blood dyscrasias
b. Ototoxicity
c. Hypersensitivity
d. Renal damage

47. If your patient is allergic to penicillin, she/he may also be allergic to:

a. Tetracyclines
b. Cephalosporins
c. Erythromycin
d. Sulfonamides

48. An important difference between first , second, and third generation cephalosporins is
that:

a. The spectrum of antibacterial action is narrower in the third generation than in the
first
and second generations.
b. Third generation drugs are less active against gram negative microorganisms.
c. The first generation drugs are most effective against gram positive infections .
d. First generation drugs are the most expensive of the three.

49. The cephalosporin often added to dialysis fluid is :

a. Cefaclor (Ceclor)
b. Cefadroxil (Duricef)
c. Cefazolin (Ancef)
d. Cephalothin (Keeflin)

50. An important lab to obtain before starting an antimicrobial medication on a patient with
an infection is:

a. Sodium levels
b. Culture and sensitivities
c. Calcium levels
d. Prothrombin times

END OF SECTION I

SECTION II [30 marks]

Instruction: Answer all questions in this section

1. Indicate whether the following statements are TRUE or FALSE [6 marks]

a. The use of the combined oral contraceptive preparation may lead

to an increase in the patient’s blood pressure. T F
 b. The progestin only contraceptives have many more side effects
than the combined OCPs. T F

c. Bromocriptine (Parlodel) is contraindicated in patients less

than 15 years old. T F

d. Cardiovascular side effects of contraceptives are increased in

women under 35 who do not smoke. T F

e. Abrupt withdrawal of the antipsychotics may precipitate

rebound reactions.
T F
f. Phenytoin (Dilantin) can be used in the treatment of
Petit mal seizures. T F

2. Match the following drugs with their Pharmacologic Class [12 marks].

1. Tobramycin _____ antidepressant

2. Fluoxetine _____ fluoroquinolone

3. Valproic acid _____ Aminoglycoside

4. Ofloxacin ______ Cephalosporin

5. Morphine ______ Potassium Sparing Diuretic

6. Chlomiphene _____ Anticonvulsant

7. Gemfibrozil _____ Anti-oestrogen

8. Spironolactone ______ Anti-lipidemic

9. Cefaclor _____ Opioid analgesic

10. Tamoxifen _____ Ovarian Stimulant

11. Chloroquine _____ Anti-viral

12. Zidovudine ______ Anti-malaria

Anti-fungal
3. Match the following drug with the associated side effects [ 4 marks]

1. Vincristine_____ Hemorrhagic cystitis

2. Cyclophosphamide _____ Neurotoxicity

3. Methotrexate _____ Cardio toxicity

4. Doxorubicin ______ Leucovovin rescue

Stomatitis

4. Define the following terminologies [8 marks]

a. HAART

b. Opportunistic infections

c. Doubling time

d. CCS Chemotherapy

END OF SECTION II
 SECTION III – [20 marks]

Answer ANY TWO (2) questions from this section in the Booklet provided

QUESTION 1

Estradiol is a the prototype drug of the estrogens;

a. Briefly state four (4) areas in the human body where the endogenous form of this

drug is synthesized. [2 marks]

b. Describe briefly the mechanism of action of estradiol. [3 marks]

c. State one (1) therapeutic action, and two (2) uses of estradiol. [3 marks]

d. Briefly describe two (2) pharmacokinetic properties of estradiol. [2 marks]

QUESTION 2

a.Give a definition for Environmental toxicity. [2 marks]

b. Lead and its compounds are toxic substances. They can be found in the drinking

water of some individuals or found in dust particles. Describe the route by which

inorganic metallic lead compounds and organic lead compounds enter the body of an

individual [3 marks]

c.Briefly describe the mechanism of action of inorganic lead [2 marks]

d. State two (2) primary signs of acute lead toxicity [2 marks]

e.Identify two (2) drugs used in treating lead poisoning [1 mark]

QUESTION 3

Monica Lewinsky, a 50 year old attendant in the Matron’s office is admitted to the clinic for
hip and knee pain. Ms. Lewinsky’s drug history reveals that she takes Chlorpropamide
(Diabenese), Atenolol (Tenormin), Hydrochlorthiazide, and Warfarin. A diagnosis of
degenerative arthritis is made and the physician prescribes Ibuprofen (Brufen) 400 mg tds.

a.What class of drug is Ibuprofen? [1 mark]

b. Give five (5) side effects that you would inform Ms. Lewinsky to be on the lookout
for.
[5 mark]

c.State four (4) health teachings that would be included in your plan for Ms. Lewinsky.
[4mark]

QUESTION 4

SA is a 6 yrs old child with otitis media. The physician ordered amoxicillin 250 mg. The
nurse asked SA mother if SA is allergic to any drugs and her mother says she is allergic to
penicillin.

a. What type of drug is amoxicillin? Is it similar to penicillin? Give an explanation for your
answer. [3 marks]

b. What nursing action should the nurse take? [1 mark]

The physician changed the amoxicillin order to cefaclor 250 mg q8h. The therapeutic dosage
for children is 20-40 mg/kg/day in three divided doses. SA weighs 40lbs.

c. What type of drug is cefaclor? [1 mark]

d. Is the prescribed cefaclor dose for SA within the safe parameters? Give an explanation for
your answer [3 mark]

e. Could SA be allergic to cefaclor?