Four results come back on a medical ward (potassium reference 3.5-5.0 mmol/L). Which should the nurse report first?

Ramipril and spironolactone: potassium 6.4 mmol/L

Hydrochlorothiazide: glucose 7.4 mmol/L (133 mg/dL)

Furosemide: potassium 3.4 mmol/L

Mannitol: sodium 146 mmol/L (135-145)

An 80-year-old patient on digoxin reports loss of appetite, nausea and yellow-green halos around lights. What should the nurse do?

Withhold the dose and report possible digoxin toxicity

Reassure the patient that these are expected effects of digoxin

Give the dose with food to settle the nausea

Give an antiemetic, then give the dose as usual

Major drug groups, adverse effects and antidotes

60 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Major drug groups, adverse effects and antidotes, part of Pharmacology and Medication Safety. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
Four results come back on a medical ward (potassium reference 3.5-5.0 mmol/L). Which should the nurse report first?
1. AHydrochlorothiazide: glucose 7.4 mmol/L (133 mg/dL)
2. BFurosemide: potassium 3.4 mmol/L
3. CRamipril and spironolactone: potassium 6.4 mmol/L
4. DMannitol: sodium 146 mmol/L (135-145)
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Answer: C · Ramipril and spironolactone: potassium 6.4 mmol/L
A potassium of 6.4 mmol/L in a patient on an ACE inhibitor with spironolactone is a dangerous hyperkalaemia that can cause sudden arrhythmias and cardiac arrest. It needs an urgent report, an ECG and treatment. A potassium of 3.4 mmol/L is only slightly low and needs replacement but is not immediately life-threatening. Mild hyperglycaemia on a thiazide and a sodium just above range on mannitol need review but are not the priority.
- A: Mild hyperglycaemia is an expected thiazide effect and not an emergency.
- B: A potassium of 3.4 mmol/L is mildly low and less urgent.
- D: A sodium of 146 mmol/L is only slightly high and less urgent.
Question 2 · Medium
A patient has serum potassium 7.1 mmol/L (3.5-5.0) and peaked T waves. The drug given first to protect the heart is:
1. ANebulised salbutamol
2. BOral sodium polystyrene
3. CIV calcium gluconate
4. DIV insulin with dextrose
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Answer: C · IV calcium gluconate
Calcium stabilises the cardiac cell membrane within minutes and reduces the risk of arrhythmia, although it does not lower potassium. Insulin with dextrose and salbutamol then shift potassium into the cells, and binders, diuretics or dialysis remove it from the body. Continuous ECG monitoring is used throughout. Glucose is monitored after insulin because hypoglycaemia is common.
- A: Salbutamol shifts potassium but is not the first, protective step.
- B: Resins remove potassium over hours and do not protect the heart.
- D: Insulin shifts potassium but does not protect the heart as quickly.
Question 3 · Medium
An 80-year-old patient on digoxin reports loss of appetite, nausea and yellow-green halos around lights. What should the nurse do?
1. AReassure the patient that these are expected effects of digoxin
2. BWithhold the dose and report possible digoxin toxicity
3. CGive the dose with food to settle the nausea
4. DGive an antiemetic, then give the dose as usual
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Answer: B · Withhold the dose and report possible digoxin toxicity
Anorexia, nausea and visual changes such as yellow-green halos or blurred vision are classic early signs of digoxin toxicity. Older adults are at higher risk because of reduced kidney function and smaller body mass. The dose is held, the apical pulse and rhythm are checked, and the prescriber is told so that the level, potassium and creatinine can be measured. Giving the dose would add to the toxicity.
- A: These are toxicity signs, not expected effects.
- C: Food does not treat the cause, and the dose would worsen toxicity.
- D: Masking the nausea hides an early warning sign of toxicity.
Question 4 · Medium
A patient takes digoxin and furosemide. Which laboratory finding most increases the risk of digoxin toxicity?
1. ALow serum potassium
2. BLow serum sodium
3. CHigh serum phosphate
4. DHigh serum potassium
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Answer: A · Low serum potassium
Digoxin and potassium compete for the same binding site on the sodium-potassium ATPase. When potassium is low, more digoxin binds and toxicity occurs even at normal serum levels. Furosemide commonly causes hypokalaemia, so potassium is checked regularly in patients on both drugs. Low magnesium and high calcium also raise the risk.
- B: Sodium does not directly change digoxin binding.
- C: Phosphate has no direct effect on digoxin toxicity.
- D: High potassium reduces digoxin binding; it is a feature of severe toxicity, not a cause.
Question 5 · Easy
By the ADA definition, level 1 hypoglycaemia in a person with diabetes is a blood glucose below:
1. A3.9 mmol/L (70 mg/dL)
2. B5.6 mmol/L (100 mg/dL)
3. C7.0 mmol/L (126 mg/dL)
4. D2.2 mmol/L (40 mg/dL)
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Answer: A · 3.9 mmol/L (70 mg/dL)
The ADA defines level 1 hypoglycaemia as glucose below 3.9 mmol/L (70 mg/dL) and level 2 as below 3.0 mmol/L (54 mg/dL). Level 3 is any low glucose with altered mental or physical state needing help from another person. At level 1 the patient should take 15-20 g of fast-acting glucose and recheck after 15 minutes. Waiting for lower values delays treatment and risks seizures.
- B: 5.6 mmol/L is the upper limit of a normal fasting glucose, not a hypoglycaemia threshold.
- C: 7.0 mmol/L is the fasting threshold for diagnosing diabetes.
- D: 2.2 mmol/L is dangerously low and far below the level at which treatment should start.
Question 6 · Easy
Which electrolyte disturbance is most common in patients taking furosemide?
1. AHypernatraemia
2. BHypokalaemia
3. CHypercalcaemia
4. DHyperkalaemia
Answer and explanation in LearnFree account
Question 7 · Medium
On a surgical ward, which finding is the earliest reliable warning of opioid-induced respiratory depression?
1. AIncreasing sedation
2. BA fall in blood pressure
3. CPinpoint pupils
4. DA low SpO2 on oxygen
Answer and explanation in LearnFree account
Question 8 · Hard
A patient accidentally receives 5,000 units of unfractionated heparin as an IV bolus and starts oozing from the cannula site 10 minutes later. Using 1 mg of protamine per 100 units of heparin, what dose of protamine is needed?
1. A50 mg
2. B5 mg
3. C25 mg
4. D100 mg
Answer and explanation in LearnFree account
Question 9 · Medium
Two hours after a first dose of lisinopril, a patient's lips and tongue become swollen and the voice is hoarse. What is the priority?
1. ARecord it as a minor side effect in the notes
2. BApply a cold compress and recheck in one hour
3. CAssess the airway urgently and summon emergency help
4. DGive the next dose together with an oral antihistamine tablet
Answer and explanation in LearnFree account
Question 10 · Medium
A woman with pre-eclampsia on a magnesium sulfate infusion has absent patellar reflexes and a respiratory rate of 10/min. After stopping the infusion, which antidote should be ready?
1. ACalcium gluconate
2. BPotassium chloride
3. CProtamine sulfate
4. DNaloxone
Answer and explanation in LearnFree account
Question 11 · Easy
The blood test most often used to adjust the rate of a continuous IV unfractionated heparin infusion is the:
1. AActivated partial thromboplastin time
2. BPlatelet count
3. CInternational normalised ratio
4. DBleeding time
Answer and explanation in LearnFree account
Question 12 · Easy
The classic triad of signs of opioid overdose is:
1. ADilated pupils, agitation and fast breathing
2. BPinpoint pupils, agitation and high fever
3. CDilated pupils, coma and fast breathing
4. DPinpoint pupils, coma and slow breathing
Answer and explanation in LearnFree account
Question 13 · Hard
A man arrives in the ER after taking a large overdose of propranolol. HR is 36/min and BP 72/40 mmHg despite atropine and IV fluids. Which drug is used as a specific treatment?
1. ADigoxin immune Fab
2. BIV glucagon
3. CIV naloxone
4. DIV flumazenil
Answer and explanation in LearnFree account
Question 14 · Easy
A blood sample for a serum digoxin level is most accurate when it is taken:
1. AThirty minutes after an IV dose
2. BAt any time, as timing does not matter
3. CJust before the next dose is due
4. DOne hour after an oral dose
Answer and explanation in LearnFree account
Question 15 · Hard
A patient on insulin is found unresponsive, sweating and pale at 03:00. Capillary glucose is 2.4 mmol/L (43 mg/dL). The IV cannula has just tissued and cannot be used. What should the nurse give first?
1. AA sweet drink through a straw
2. BThe next insulin dose at half strength
3. CGlucagon 1 mg by IM injection
4. DGlucose gel squeezed into the mouth
Answer and explanation in LearnFree account
Question 16 · Medium
A patient using an inhaled corticosteroid twice daily for asthma should rinse the mouth and spit after each dose, to prevent:
1. ATooth decay
2. BOral thrush
3. CAdrenal crisis
4. DRebound bronchospasm
Answer and explanation in LearnFree account
Question 17 · Easy
Before giving digoxin to an adult, the nurse counts the apical pulse for a full minute. By the usual rule in nursing texts, the dose is withheld and reported if the rate is below:
1. A60 beats/min
2. B100 beats/min
3. C80 beats/min
4. D70 beats/min
Answer and explanation in LearnFree account
Question 18 · Easy
IV phenytoin is compatible for dilution only with:
1. A0.9% sodium chloride
2. B5% dextrose in water
3. C10% dextrose in water
4. DLactated Ringer's solution
Answer and explanation in LearnFree account
Question 19 · Easy
Long-term oral prednisolone must be tapered rather than stopped suddenly, mainly to prevent:
1. AA rebound rise in blood glucose levels
2. BWithdrawal seizures
3. CSevere fluid retention
4. DAcute adrenal insufficiency
Answer and explanation in LearnFree account
Question 20 · Medium
A patient has had a generalised tonic-clonic seizure for 6 minutes. An IV cannula is in place and capillary glucose is 5.8 mmol/L (104 mg/dL). The drug given first is:
1. AIV magnesium sulfate
2. BIV phenytoin
3. CIV levetiracetam
4. DIV lorazepam
Answer and explanation in LearnFree account
Question 21 · Easy
The drug used to neutralise an overdose of unfractionated heparin is:
1. AFresh frozen plasma
2. BProtamine sulfate
3. CIdarucizumab
4. DPhytomenadione (vitamin K)
Answer and explanation in LearnFree account
Question 22 · Easy
For IM injection in anaphylaxis, the adrenaline concentration used is:
1. A1 mg/mL (1:1,000)
2. B0.1 mg/mL (1:10,000)
3. C0.01 mg/mL (1:100,000)
4. D10 mg/mL (1:100)
Answer and explanation in LearnFree account
Question 23 · Medium
A patient is taking metronidazole for a C. difficile infection. Which teaching point is most important?
1. ATake each dose with a full glass of milk to improve absorption
2. BStop the tablets as soon as the diarrhoea settles
3. CAvoid alcohol during treatment and for at least two days after
4. DExpect the urine to turn orange-red during the course
Answer and explanation in LearnFree account
Question 24 · Hard
A boy weighing 15 kg is stung by a bee and develops wheeze, hives and a weak pulse. The order is adrenaline 0.01 mg/kg IM from the 1 mg/mL (1:1,000) ampoule. The volume to give is:
1. A1.5 mL
2. B0.5 mL
3. C0.15 mL
4. D0.015 mL
Answer and explanation in LearnFree account
Question 25 · Easy
A patient starting rifampicin for tuberculosis should be told to expect:
1. AA blue tint to vision for some hours
2. BYellowing of the skin and the whites of the eyes
3. COrange-red colour in urine, sweat and tears
4. DBlack, tarry discolouration of the stools
Answer and explanation in LearnFree account

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Major drug groups, adverse effects and antidotes

Four results come back on a medical ward (potassium reference 3.5-5.0 mmol/L). Which should the nurse report first?

A patient has serum potassium 7.1 mmol/L (3.5-5.0) and peaked T waves. The drug given first to protect the heart is:

An 80-year-old patient on digoxin reports loss of appetite, nausea and yellow-green halos around lights. What should the nurse do?

A patient takes digoxin and furosemide. Which laboratory finding most increases the risk of digoxin toxicity?

By the ADA definition, level 1 hypoglycaemia in a person with diabetes is a blood glucose below:

Which electrolyte disturbance is most common in patients taking furosemide?

On a surgical ward, which finding is the earliest reliable warning of opioid-induced respiratory depression?

A patient accidentally receives 5,000 units of unfractionated heparin as an IV bolus and starts oozing from the cannula site 10 minutes later. Using 1 mg of protamine per 100 units of heparin, what dose of protamine is needed?

Two hours after a first dose of lisinopril, a patient's lips and tongue become swollen and the voice is hoarse. What is the priority?

A woman with pre-eclampsia on a magnesium sulfate infusion has absent patellar reflexes and a respiratory rate of 10/min. After stopping the infusion, which antidote should be ready?

The blood test most often used to adjust the rate of a continuous IV unfractionated heparin infusion is the:

The classic triad of signs of opioid overdose is:

A man arrives in the ER after taking a large overdose of propranolol. HR is 36/min and BP 72/40 mmHg despite atropine and IV fluids. Which drug is used as a specific treatment?

A blood sample for a serum digoxin level is most accurate when it is taken:

A patient on insulin is found unresponsive, sweating and pale at 03:00. Capillary glucose is 2.4 mmol/L (43 mg/dL). The IV cannula has just tissued and cannot be used. What should the nurse give first?

A patient using an inhaled corticosteroid twice daily for asthma should rinse the mouth and spit after each dose, to prevent:

Before giving digoxin to an adult, the nurse counts the apical pulse for a full minute. By the usual rule in nursing texts, the dose is withheld and reported if the rate is below:

IV phenytoin is compatible for dilution only with:

Long-term oral prednisolone must be tapered rather than stopped suddenly, mainly to prevent:

A patient has had a generalised tonic-clonic seizure for 6 minutes. An IV cannula is in place and capillary glucose is 5.8 mmol/L (104 mg/dL). The drug given first is:

The drug used to neutralise an overdose of unfractionated heparin is:

For IM injection in anaphylaxis, the adrenaline concentration used is:

A patient is taking metronidazole for a C. difficile infection. Which teaching point is most important?

A boy weighing 15 kg is stung by a bee and develops wheeze, hives and a weak pulse. The order is adrenaline 0.01 mg/kg IM from the 1 mg/mL (1:1,000) ampoule. The volume to give is:

A patient starting rifampicin for tuberculosis should be told to expect: