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NNC NLEN BSc study materials
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NNC NLEN BSc practice questions

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Question 1Fundamentals of Nursing and Nursing Practice Foundations

A nurse is preparing to insert a peripheral IV cannula. Which action best demonstrates the principle of asepsis during this procedure?

  1. Re-palpating the insertion site with a gloved finger immediately before puncture
  2. Cleaning the skin with an alcohol swab in a circular motion from the centre outward and allowing it to dry Correct answer.
  3. Applying the tourniquet directly over the prepared insertion site
  4. Wearing sterile gloves while palpating the vein after skin antisepsis

Explanation

Skin antisepsis for peripheral cannulation requires friction in a circular motion from the centre outward, and the antiseptic must be allowed to dry to achieve its full antimicrobial effect. Palpation after antisepsis contaminates the site and should be avoided or performed with sterile technique.

Question 2Fundamentals of Nursing and Nursing Practice Foundations

When measuring a patient's blood pressure manually, which finding indicates that the cuff size is too small for the patient's arm?

  1. The cuff deflates more slowly than expected
  2. The systolic reading is lower than the patient's usual baseline
  3. The reading is consistently higher than readings taken with an appropriately sized cuff Correct answer.
  4. The Korotkoff sounds are unusually clear and loud

Explanation

An undersized cuff requires higher inflation pressure to occlude the brachial artery, producing falsely elevated readings. Correct cuff size is based on arm circumference, with the bladder encircling roughly 80 percent of the arm.

Question 3Fundamentals of Nursing and Nursing Practice Foundations

A patient is prescribed oxygen at 2 L/min via nasal cannula. Which nursing action is most appropriate before starting therapy?

  1. Placing the patient in the prone position
  2. Setting the flow rate to 6 L/min to ensure adequate oxygenation
  3. Applying petroleum jelly to the nares to prevent drying
  4. Checking the prescription for the flow rate and target oxygen saturation range Correct answer.

Explanation

Oxygen is a medication and must be administered according to a prescription that specifies flow rate and target saturation. Verifying these parameters allows the nurse to titrate safely and evaluate effectiveness.

Question 4Fundamentals of Nursing and Nursing Practice Foundations

Which statement best describes the purpose of the nursing process?

  1. It documents only medical diagnoses and treatments
  2. It is used exclusively during the discharge planning phase
  3. It replaces clinical judgement with standardised checklists
  4. It provides a systematic, cyclical framework for delivering individualised patient care Correct answer.

Explanation

The nursing process comprises assessment, diagnosis, planning, implementation and evaluation, forming a continuous cycle that guides individualised care. It supports, rather than replaces, clinical judgement and applies across all phases of care.

Question 5Fundamentals of Nursing and Nursing Practice Foundations

A nurse receives a verbal prescription from a physician for a controlled drug. What is the most appropriate action?

  1. Ask another nurse to confirm the dose from memory
  2. Refuse to accept any verbal prescription under all circumstances
  3. Read back the prescription to the prescriber and document it according to local policy Correct answer.
  4. Administer the drug immediately and document later

Explanation

Verbal prescriptions carry a high risk of error, so the nurse should write down the order, read it back for confirmation, and document it promptly per policy. Controlled drugs usually require additional safeguards such as countersignature within a specified timeframe.

Question 6Fundamentals of Nursing and Nursing Practice Foundations

Which of the following is the most reliable indicator that a patient's fluid resuscitation is adequate?

  1. Urine output of at least 0.5 mL/kg/hour with improving haemodynamic parameters Correct answer.
  2. Absence of thirst
  3. Warm peripheries alone
  4. A single systolic blood pressure reading above 100 mmHg

Explanation

Urine output reflects renal perfusion and, combined with haemodynamic trends, is a reliable marker of adequate resuscitation. Single measurements and isolated signs are less dependable than trends.

Question 7Fundamentals of Nursing and Nursing Practice Foundations

A patient with a new ileostomy has liquid output. Which nursing intervention best protects the surrounding skin?

  1. Applying a thick layer of powder to intact skin
  2. Cleaning the skin with alcohol before applying the pouch
  3. Fitting the pouching system so the opening is 1–2 mm larger than the stoma and using a skin barrier Correct answer.
  4. Changing the pouch only when it leaks

Explanation

A correctly sized opening with a skin barrier prevents effluent from contacting the peristomal skin. The opening should closely match the stoma, typically 1–2 mm larger, to avoid both leakage and constriction.

Question 8Fundamentals of Nursing and Nursing Practice Foundations

Which finding should a nurse report immediately in a patient receiving a blood transfusion?

  1. Sudden onset of fever, flank pain and dark urine Correct answer.
  2. A heart rate of 88 beats per minute
  3. Mild itching at the cannula site
  4. A haemoglobin level of 8 g/dL before transfusion

Explanation

Fever, flank pain and haemoglobinuria suggest an acute haemolytic transfusion reaction, which requires stopping the transfusion immediately and reporting urgently. Prompt recognition prevents serious harm.

Question 9Fundamentals of Nursing and Nursing Practice Foundations

A nurse is assessing a patient's risk of falls. Which factor is the strongest independent predictor of inpatient falls?

  1. Receiving a low-sodium diet
  2. Male sex
  3. A body mass index above 30
  4. A history of falls in the previous 12 months Correct answer.

Explanation

A previous fall is consistently identified as one of the strongest predictors of future falls and is a core element of validated risk assessment tools. It reflects cumulative intrinsic and environmental risk.

Question 10Fundamentals of Nursing and Nursing Practice Foundations

A patient is receiving enteral feeding via a nasogastric tube. Which action best reduces the risk of aspiration?

  1. Checking residual volume only once daily
  2. Elevating the head of the bed to 30–45 degrees during and after feeding Correct answer.
  3. Flushing the tube with 10 mL of water every hour
  4. Positioning the patient supine during feeding

Explanation

Head-of-bed elevation of 30–45 degrees during feeding and for a period afterwards reduces reflux and aspiration risk. This is a cornerstone of safe enteral feeding practice.

Question 11Fundamentals of Nursing and Nursing Practice Foundations

A nurse documents a pressure injury as stage 2. Which description matches this classification?

  1. Full-thickness loss with visible subcutaneous fat
  2. Partial-thickness loss of skin with exposed dermis Correct answer.
  3. Intact skin with non-blanchable erythema
  4. Full-thickness loss with exposed fascia, muscle or bone

Explanation

Stage 2 pressure injury involves partial-thickness skin loss with exposed dermis, presenting as a shallow open ulcer or a serum-filled blister. Deeper structures are not visible at this stage.

Question 12Fundamentals of Nursing and Nursing Practice Foundations

Which action demonstrates correct technique when performing a surgical hand scrub?

  1. Rinsing from the elbows toward the hands
  2. Scrubbing the hands and forearms with a brush for at least 10 minutes
  3. Keeping the hands above the elbows throughout the scrub and rinse Correct answer.
  4. Drying the hands with a shared cloth towel

Explanation

During surgical hand antisepsis, the hands are held above the elbows so water runs from the cleaner area to the less clean area. This prevents contamination of the hands during the procedure.

Question 13Fundamentals of Nursing and Nursing Practice Foundations

A patient with chronic obstructive pulmonary disease has an oxygen saturation of 88 percent. Which approach is most appropriate?

  1. Withhold oxygen entirely because of the risk of carbon dioxide retention
  2. Titrate oxygen to a prescribed target range, commonly 88–92 percent, and monitor closely Correct answer.
  3. Encourage hyperventilation to raise saturation
  4. Administer high-flow oxygen to achieve 100 percent saturation

Explanation

In COPD with chronic hypercapnia, oxygen is titrated to a target range, often 88–92 percent, to maintain oxygenation while avoiding hyperoxia-related hypercapnia. Monitoring allows early detection of deterioration.

Question 14Fundamentals of Nursing and Nursing Practice Foundations

Which principle underlies the use of standard precautions in nursing practice?

  1. Precautions are applied only to patients with a known infectious disease
  2. Gloves are required for all patient contact
  3. Masks are required for every patient interaction
  4. All blood and body fluids are treated as potentially infectious regardless of diagnosis Correct answer.

Explanation

Standard precautions assume that all blood, body fluids, secretions and non-intact skin may carry transmissible pathogens. This universal approach protects both patients and staff without relying on known diagnosis.

Question 15Fundamentals of Nursing and Nursing Practice Foundations

A nurse is caring for a patient with an indwelling urinary catheter. Which intervention best reduces the risk of catheter-associated urinary tract infection?

  1. Maintaining a closed drainage system and dependent drainage below bladder level Correct answer.
  2. Disconnecting the tubing to obtain urine samples
  3. Changing the catheter every 48 hours
  4. Irrigating the catheter routinely with antiseptic solution

Explanation

A closed system with unobstructed, dependent drainage limits retrograde migration of microorganisms. Routine irrigation and frequent changes increase infection risk rather than reduce it.

Question 16Fundamentals of Nursing and Nursing Practice Foundations

Which statement accurately reflects the principle of informed consent?

  1. The patient must receive adequate information and give consent voluntarily and without coercion Correct answer.
  2. Consent obtained from a relative is always valid for an adult patient
  3. A signature alone proves that consent was informed
  4. Consent can be presumed for any procedure in hospitalised patients

Explanation

Valid informed consent requires capacity, adequate disclosure, comprehension, voluntariness and authorisation. A signature documents consent but does not by itself establish that it was informed.

Question 17Fundamentals of Nursing and Nursing Practice Foundations

A patient reports pain scored 8 out of 10 one hour after receiving an opioid. Which action should the nurse take first?

  1. Document the pain score and wait for the next scheduled dose
  2. Reassess the pain and observe for signs of sedation and respiratory depression Correct answer.
  3. Encourage the patient to distract themselves
  4. Administer a second dose immediately

Explanation

After opioid administration the nurse must reassess pain and monitor for sedation and respiratory depression, the most serious adverse effects. Assessment guides whether further analgesia is safe.

Question 18Fundamentals of Nursing and Nursing Practice Foundations

Which of the following best describes the role of the nurse in evidence-based practice?

  1. Implementing every published study finding immediately
  2. Integrating the best available evidence with clinical expertise and patient preferences Correct answer.
  3. Relying solely on textbook knowledge from initial training
  4. Applying research findings only when they match personal experience

Explanation

Evidence-based practice combines research evidence, clinical expertise and patient values to inform decisions. This triad ensures care is both scientifically sound and individualised.

Question 19Fundamentals of Nursing and Nursing Practice Foundations

A patient is confused and repeatedly attempts to climb out of bed. Which intervention should the nurse implement first?

  1. Administer a sedative without a prescription
  2. Assess for reversible causes such as pain, hypoxia or urinary retention Correct answer.
  3. Apply physical restraints immediately
  4. Raise all four side rails and leave the patient unattended

Explanation

Delirium and agitation often have treatable causes such as pain, hypoxia, constipation or urinary retention. Identifying and correcting these causes is the first step before considering restrictive measures.

Question 20Fundamentals of Nursing and Nursing Practice Foundations

Which technique is correct when administering a subcutaneous injection into the abdomen?

  1. Massaging the site vigorously after injection
  2. Injecting directly into the umbilicus
  3. Inserting the needle at a 45- to 90-degree angle into tissue at least 5 cm from the umbilicus Correct answer.
  4. Inserting the needle at a 15-degree angle

Explanation

Subcutaneous tissue in the abdomen is accessed at 45 to 90 degrees depending on tissue thickness, avoiding the umbilicus and scars. Rotating sites prevents lipohypertrophy.

Question 21Fundamentals of Nursing and Nursing Practice Foundations

A nurse observes a colleague failing to perform hand hygiene before patient contact. What is the most appropriate initial response?

  1. Report the colleague to the regulatory body immediately
  2. Speak to the colleague privately and respectfully about the observation Correct answer.
  3. Ignore the incident to avoid conflict
  4. Discuss the incident with other staff in the break room

Explanation

The first step in addressing a professional concern is a respectful, private conversation aimed at improving practice. Escalation follows if the behaviour persists or poses ongoing risk.

Question 22Fundamentals of Nursing and Nursing Practice Foundations

Which finding most strongly suggests that a patient is experiencing hypovolaemic shock?

  1. Polyuria with clear urine
  2. Tachycardia, hypotension, cool clammy skin and reduced urine output Correct answer.
  3. Bradycardia, hypertension and warm flushed skin
  4. Bounding pulses with widened pulse pressure

Explanation

Hypovolaemic shock reduces circulating volume, producing compensatory tachycardia, falling blood pressure, cool clammy peripheries and oliguria. Recognising this cluster enables timely intervention.

Question 23Fundamentals of Nursing and Nursing Practice Foundations

Which action best demonstrates respect for patient autonomy during a bed bath?

  1. Closing the curtains and leaving the patient alone without checking
  2. Explaining each step and asking the patient which areas they prefer to wash themselves Correct answer.
  3. Proceeding quickly without explanation to save time
  4. Washing the patient without asking whether they consent

Explanation

Respecting autonomy involves providing information, seeking consent and supporting the patient's participation in their own care. This preserves dignity and control.

Question 24Fundamentals of Nursing and Nursing Practice Foundations

A nurse is preparing to administer a medication through a nasogastric tube. Which action is correct?

  1. Administering medications with the patient supine
  2. Crushing extended-release tablets and administering them together
  3. Mixing all medications together in one syringe
  4. Using liquid formulations where possible and flushing the tube before and after each medication Correct answer.

Explanation

Liquid formulations reduce tube blockage, and flushing before and after each medication prevents interactions and occlusion. Medications should be given separately to avoid incompatibility.

Question 25Anatomy, Physiology, and Pathophysiology

Which structure separates the left ventricle from the left atrium?

  1. The aortic valve
  2. The mitral valve Correct answer.
  3. The pulmonary valve
  4. The tricuspid valve

Explanation

The mitral (bicuspid) valve lies in the left atrioventricular orifice and prevents backflow from the left ventricle into the left atrium during systole. The tricuspid valve occupies the right atrioventricular orifice, while the aortic and pulmonary valves are semilunar valves at ventricular outflow tracts.

Question 26Anatomy, Physiology, and Pathophysiology

A patient has a lesion of the left recurrent laryngeal nerve after thoracic surgery. Which nerve does this branch arise from, and which structure does it loop around?

  1. The vagus nerve, looping under the aortic arch Correct answer.
  2. The phrenic nerve, looping under the left pulmonary artery
  3. The glossopharyngeal nerve, looping under the left subclavian artery
  4. The sympathetic trunk, looping under the left main bronchus

Explanation

The left recurrent laryngeal nerve branches from the left vagus nerve and hooks beneath the aortic arch lateral to the ligamentum arteriosum. This long course through the mediastinum makes it vulnerable during thoracic and thyroid surgery, producing hoarseness from vocal fold weakness.

Question 27Anatomy, Physiology, and Pathophysiology

Which segment of the nephron is the principal site of regulated water reabsorption under the influence of antidiuretic hormone?

  1. The ascending limb of the loop of Henle
  2. The collecting duct Correct answer.
  3. The proximal convoluted tubule
  4. The macula densa

Explanation

Antidiuretic hormone inserts aquaporin-2 channels in the principal cells of the collecting duct, allowing water reabsorption down the medullary osmotic gradient. The proximal tubule reabsorbs most filtered water but does so constitutively, largely independent of ADH.

Question 28Anatomy, Physiology, and Pathophysiology

A patient with chronic obstructive pulmonary disease retains carbon dioxide. Which change in arterial blood gases is most consistent with uncompensated respiratory acidosis?

  1. Raised bicarbonate with raised pH
  2. Normal carbon dioxide with lowered bicarbonate
  3. Lowered partial pressure of carbon dioxide with raised pH
  4. Raised partial pressure of carbon dioxide with lowered pH Correct answer.

Explanation

Alveolar hypoventilation raises the arterial partial pressure of carbon dioxide, and because carbon dioxide forms carbonic acid, the pH falls. This defines respiratory acidosis; renal bicarbonate retention would be a later compensatory response.

Question 29Anatomy, Physiology, and Pathophysiology

Which type of epithelium lines the alveoli of the lung, and why is it suited to gas exchange?

  1. Pseudostratified ciliated epithelium, because it clears particles
  2. Stratified squamous epithelium, because it resists abrasion
  3. Simple columnar epithelium, because it secretes mucus
  4. Simple squamous epithelium, because it minimises diffusion distance Correct answer.

Explanation

The alveolar wall is formed mainly by type I pneumocytes, which are simple squamous cells. Their extreme thinness, combined with the thin capillary endothelium, creates a short diffusion barrier for oxygen and carbon dioxide.

Question 30Anatomy, Physiology, and Pathophysiology

During the cardiac cycle, which event produces the first heart sound?

  1. Opening of the atrioventricular valves
  2. Closure of the semilunar valves
  3. Atrial contraction
  4. Closure of the atrioventricular valves Correct answer.

Explanation

The first heart sound arises when the mitral and tricuspid valves close at the onset of ventricular systole. The second sound follows semilunar valve closure at the end of systole, while valve opening and atrial contraction are normally silent.

Question 31Anatomy, Physiology, and Pathophysiology

A patient has a tumour compressing the pituitary gland. Which hormone deficiency would most directly impair the production of cortisol by the adrenal cortex?

  1. Aldosterone
  2. Insulin
  3. Adrenocorticotropic hormone Correct answer.
  4. Thyroxine

Explanation

Adrenocorticotropic hormone from the anterior pituitary stimulates the zona fasciculata to secrete cortisol. Loss of ACTH therefore reduces cortisol output even though the adrenal cortex itself is intact.

Question 32Anatomy, Physiology, and Pathophysiology

Which structure forms the blood-brain barrier at the level of the cerebral capillaries?

  1. Gaps between astrocytes
  2. Openings in the pia mater
  3. Fenestrations within the capillary endothelium
  4. Tight junctions between capillary endothelial cells Correct answer.

Explanation

Cerebral capillary endothelial cells are joined by continuous tight junctions that restrict paracellular movement of solutes. Astrocyte end-feet provide inductive and supportive signals but the physical barrier is the endothelial tight junction.

Question 33Anatomy, Physiology, and Pathophysiology

Which cells of the gastric mucosa secrete intrinsic factor, and what is the consequence of their loss?

  1. Parietal cells, causing vitamin B12 malabsorption Correct answer.
  2. Mucous neck cells, causing mucosal ulceration
  3. G cells, causing hypergastrinaemia
  4. Chief cells, causing protein maldigestion

Explanation

Parietal cells secrete hydrochloric acid and intrinsic factor, which is required for ileal absorption of vitamin B12. Their destruction in autoimmune atrophic gastritis leads to pernicious anaemia.

Question 34Anatomy, Physiology, and Pathophysiology

Which change in the lung describes a restrictive pattern on spirometry?

  1. Increased residual volume with a reduced forced expiratory ratio
  2. Reversible airflow obstruction after bronchodilator use
  3. Increased total lung capacity with air trapping
  4. Reduced total lung capacity with a preserved or raised forced expiratory ratio Correct answer.

Explanation

Restrictive lung disease reduces total lung capacity, but the forced expiratory ratio is typically normal or even elevated because airflow is not primarily obstructed. Fibrosis and chest wall disease are typical causes.

Question 35Anatomy, Physiology, and Pathophysiology

A patient with type 1 diabetes develops deep, rapid breathing with a fruity odour to the breath. Which acid-base disturbance best explains this presentation?

  1. Respiratory alkalosis with hyperventilation
  2. Respiratory acidosis with hypoventilation
  3. Metabolic alkalosis with compensatory hypoventilation
  4. Metabolic acidosis with compensatory hyperventilation Correct answer.

Explanation

Ketone bodies accumulate in diabetic ketoacidosis and lower plasma bicarbonate, producing a metabolic acidosis. The respiratory centre responds with deep, rapid breathing (Kussmaul respiration) to blow off carbon dioxide and partially correct the pH.

Question 36Anatomy, Physiology, and Pathophysiology

Which factor most increases the oxygen affinity of haemoglobin in the pulmonary capillaries?

  1. A rise in pH Correct answer.
  2. A rise in 2,3-diphosphoglycerate
  3. A rise in temperature
  4. A rise in carbon dioxide

Explanation

Alkalosis strengthens the binding of oxygen to haemoglobin, shifting the dissociation curve to the left and promoting loading in the lungs. The other listed changes weaken affinity and favour unloading in tissues.

Question 37Anatomy, Physiology, and Pathophysiology

Which artery supplies the sinoatrial node in most individuals?

  1. The posterior descending artery
  2. The left anterior descending artery
  3. The right coronary artery Correct answer.
  4. The left circumflex artery

Explanation

In the majority of people the sinoatrial node receives its blood supply from a branch of the right coronary artery. Occlusion of this vessel can therefore produce sinus node ischaemia and arrhythmia.

Question 38Anatomy, Physiology, and Pathophysiology

Which mechanism best explains why a patient with nephrotic syndrome develops peripheral oedema?

  1. Increased capillary hydrostatic pressure from left ventricular failure
  2. Lymphatic obstruction by tumour infiltration
  3. Sodium retention caused by primary hyperaldosteronism
  4. Reduced plasma oncotic pressure from urinary protein loss Correct answer.

Explanation

Heavy proteinuria lowers plasma albumin, reducing the oncotic pressure that normally holds fluid within the capillaries. Fluid shifts into the interstitium, producing oedema; secondary sodium retention further expands the extracellular volume.

Question 39Anatomy, Physiology, and Pathophysiology

Which muscle group is the principal inspiratory muscle at rest?

  1. The internal intercostal muscles
  2. The transversus thoracis
  3. The diaphragm Correct answer.
  4. The rectus abdominis

Explanation

Contraction of the diaphragm lowers the dome and increases the vertical dimension of the thoracic cavity during quiet inspiration. The external intercostals assist, while the abdominal and internal intercostal muscles act mainly in forced expiration.

Question 40Anatomy, Physiology, and Pathophysiology

A patient has damage to the upper motor neurons of the corticospinal tract. Which finding is most characteristic?

  1. Flaccid paralysis with absent reflexes
  2. Spasticity with hyperreflexia Correct answer.
  3. Fasciculations with muscle wasting
  4. Loss of pain and temperature sensation

Explanation

Upper motor neuron lesions remove descending inhibition, producing increased muscle tone, exaggerated reflexes and an extensor plantar response. Lower motor neuron lesions instead cause flaccidity, atrophy, fasciculation and areflexia.

Question 41Anatomy, Physiology, and Pathophysiology

Which change occurs in the juxtaglomerular apparatus when renal perfusion pressure falls?

  1. Increased atrial natriuretic peptide release
  2. Increased renin release from granular cells Correct answer.
  3. Decreased sympathetic stimulation of the afferent arteriole
  4. Increased sodium delivery to the macula densa

Explanation

Reduced stretch in the afferent arteriole and increased sympathetic tone stimulate granular cells to release renin. Renin initiates the angiotensin-aldosterone cascade, which raises blood pressure and conserves sodium.

Question 42Anatomy, Physiology, and Pathophysiology

Which feature distinguishes cardiac muscle from skeletal muscle at the level of the intercalated disc?

  1. Absence of striations
  2. Voluntary control by somatic motor neurons
  3. Multiple peripheral nuclei
  4. Gap junctions permitting electrical coupling between cells Correct answer.

Explanation

Intercalated discs contain gap junctions that allow action potentials to pass directly between cardiomyocytes, so the heart behaves as a functional syncytium. Skeletal muscle fibres are electrically isolated and require somatic motor innervation.

Question 43Anatomy, Physiology, and Pathophysiology

Which hormone is released from the posterior pituitary, and what is its main renal action?

  1. Oxytocin, increasing sodium reabsorption in the proximal tubule
  2. Growth hormone, increasing glucose filtration at the glomerulus
  3. Antidiuretic hormone, increasing water permeability of the collecting duct Correct answer.
  4. Prolactin, increasing calcium reabsorption in the distal tubule

Explanation

Antidiuretic hormone and oxytocin are stored and released by the posterior pituitary. ADH acts on collecting duct principal cells to insert aquaporin-2 channels and increase water reabsorption, concentrating the urine.

Question 44Anatomy, Physiology, and Pathophysiology

A patient with a lesion of the right optic tract will show which visual field defect?

  1. Complete blindness of the right eye only
  2. Right homonymous hemianopia
  3. Left homonymous hemianopia Correct answer.
  4. Bitemporal hemianopia

Explanation

The right optic tract carries fibres from the temporal retina of the right eye and the nasal retina of the left eye, both representing the left visual field. A lesion therefore causes loss of the left half of the visual field in both eyes.

Question 45Pharmacology and Medication Management

A patient is prescribed a drug with a narrow therapeutic index. Which monitoring approach best reflects this property?

  1. Annual review of renal function only
  2. Review of the patient's vaccination status
  3. Routine therapeutic drug monitoring of plasma concentrations Correct answer.
  4. Assessment of the patient's dietary habits

Explanation

A narrow therapeutic index means the difference between therapeutic and toxic plasma concentrations is small, so small changes in absorption, distribution or clearance can cause toxicity or treatment failure. Therapeutic drug monitoring of plasma levels is therefore used to keep concentrations within the target range.

Question 46Pharmacology and Medication Management

Which route of administration completely avoids first-pass hepatic metabolism?

  1. Oral tablet swallowed with water
  2. Enteric-coated oral capsule
  3. Sublingual tablet Correct answer.
  4. Oral solution

Explanation

Sublingual absorption drains into the venous system before reaching the portal circulation, so the drug bypasses the liver on its first pass. All swallowed oral formulations, including solutions and enteric-coated capsules, are absorbed into the portal circulation and are subject to first-pass metabolism.

Question 47Pharmacology and Medication Management

A patient taking warfarin is started on a drug that inhibits CYP2C9. What is the most appropriate initial action?

  1. Increase the warfarin dose to compensate
  2. Expect no interaction because warfarin is renally cleared
  3. Anticipate raised INR and monitor clotting closely Correct answer.
  4. Stop warfarin permanently without substitution

Explanation

Warfarin is metabolised mainly by CYP2C9, so inhibiting this enzyme reduces clearance and raises plasma levels and INR. Close INR monitoring with dose adjustment is the appropriate response; simply stopping warfarin without a plan risks thrombosis.

Question 48Pharmacology and Medication Management

Which statement best describes a competitive antagonist at a receptor?

  1. It binds a site distinct from the agonist site and reduces maximal response
  2. It irreversibly binds and lowers the maximal agonist response
  3. It shifts the agonist dose-response curve to the right without reducing maximal response Correct answer.
  4. It mimics the agonist and produces the same maximal effect

Explanation

A competitive antagonist binds reversibly at the same site as the agonist, so higher agonist concentrations can overcome the block. This produces a parallel rightward shift of the dose-response curve while the maximal response remains achievable.

Question 49Pharmacology and Medication Management

A drug is eliminated with first-order kinetics. What happens to the rate of elimination as plasma concentration rises?

  1. It decreases as concentration rises
  2. It increases in proportion to concentration Correct answer.
  3. It stays constant regardless of concentration
  4. It becomes zero once a threshold is reached

Explanation

In first-order kinetics the amount eliminated per unit time is proportional to plasma concentration, so the fraction removed per unit time is constant. Clearance therefore remains constant while the absolute elimination rate rises with concentration.

Question 50Pharmacology and Medication Management

Which adverse effect is most characteristic of aminoglycoside antibiotics such as gentamicin?

  1. Photosensitivity rash
  2. Nephrotoxicity and ototoxicity Correct answer.
  3. Aplastic anaemia
  4. Hepatotoxicity with jaundice

Explanation

Aminoglycosides accumulate in the proximal tubule and inner ear, producing dose-related nephrotoxicity and vestibulocochlear toxicity. Monitoring renal function and drug levels, and limiting duration, reduces these risks.