A severely undernourished 40-year-old (BMI 14) is started on full-calorie tube feeds. On day 3 he becomes weak and confused, with serum phosphate 1.2 mg/dL (normal 2.5-4.5). The most likely explanation is:

Hyperosmolar hyperglycaemic state

Vitamin K is given intramuscularly to every newborn at birth to prevent:

Physiological neonatal jaundice

Chloramphenicol given to a newborn in adult-type doses can cause grey baby syndrome mainly because the neonate has:

Deficient hepatic glucuronide conjugation

A greater fat store that holds the drug

Low plasma albumin that binds less drug

High gastric pH that increases absorption

Pharmacology and nutrition

20 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Pharmacology and nutrition, part of Basic Sciences. The first 20 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
A severely undernourished 40-year-old (BMI 14) is started on full-calorie tube feeds. On day 3 he becomes weak and confused, with serum phosphate 1.2 mg/dL (normal 2.5-4.5). The most likely explanation is:
1. ATube feed aspiration pneumonia
2. BRefeeding syndrome
3. CHyperosmolar hyperglycaemic state
4. DWernicke encephalopathy alone
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Answer: B · Refeeding syndrome
When a starved patient is fed, insulin rises and drives phosphate, potassium and magnesium into cells, so their plasma levels crash. Low phosphate causes weakness, confusion, respiratory failure and heart failure. The risk is managed by starting at low calories, correcting electrolytes and giving thiamine before feeding. Levels are checked daily for the first few days.
- A: Aspiration causes fever, cough and hypoxia, not this electrolyte fall.
- C: HHS needs very high glucose, which is not described.
- D: Wernicke encephalopathy can occur, but it does not explain the very low phosphate.
Question 2 · Hard
A youth who ate datura seeds has hot, dry, flushed skin, dilated pupils, pulse 140/min, urinary retention and agitated delirium. Which drug acts as the specific antidote?
1. AAtropine
2. BNaloxone
3. CPhysostigmine
4. DPralidoxime
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Answer: C · Physostigmine
Datura contains atropine-like alkaloids, giving the anticholinergic picture: dry as a bone, red as a beet, hot as a hare, blind as a bat and mad as a hatter. Physostigmine, a tertiary-amine anticholinesterase, raises acetylcholine and crosses into the brain, so it reverses both the central and peripheral effects. Neostigmine does not enter the brain. Care is supportive with cooling and sedation.
- A: Atropine would worsen an anticholinergic poisoning.
- B: Naloxone reverses opioids, which cause pinpoint pupils.
- D: Pralidoxime reactivates cholinesterase after organophosphate poisoning.
Question 3 · Easy
Vitamin K is given intramuscularly to every newborn at birth to prevent:
1. APhysiological neonatal jaundice
2. BVitamin K deficiency bleeding
3. CNeonatal hypoglycaemia
4. DNeonatal hypocalcaemic tetany
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Answer: B · Vitamin K deficiency bleeding
Newborns have low vitamin K stores, because little crosses the placenta, breast milk contains little and the gut has no bacteria yet to make it. Clotting factors II, VII, IX and X are therefore low, and bleeding can occur from the cord, gut or brain. A single IM dose of 1 mg (0.5 mg in preterm babies) prevents it. Exclusively breastfed babies are most at risk.
- A: Physiological jaundice is from immature bilirubin conjugation, not vitamin K lack.
- C: Hypoglycaemia is prevented by early feeding, not vitamin K.
- D: Tetany relates to calcium and vitamin D, not vitamin K.
Question 4 · Medium
Chloramphenicol given to a newborn in adult-type doses can cause grey baby syndrome mainly because the neonate has:
1. ADeficient hepatic glucuronide conjugation
2. BA greater fat store that holds the drug
3. CLow plasma albumin that binds less drug
4. DHigh gastric pH that increases absorption
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Answer: A · Deficient hepatic glucuronide conjugation
Newborns, especially preterm ones, have low glucuronyl transferase activity and immature kidneys, so chloramphenicol accumulates. High levels block mitochondrial function, giving vomiting, cyanosis, an ashen grey colour, hypothermia and circulatory collapse. The drug is avoided in neonates or given in reduced doses with level monitoring. Similar immaturity explains neonatal jaundice.
- B: Neonates have little body fat, and fat stores are not the cause.
- C: Albumin binding is linked with sulphonamide kernicterus, not grey baby syndrome.
- D: Absorption differences do not explain the toxic accumulation.
Question 5 · Hard
A snack contains 50 g carbohydrate, 20 g protein and 10 g fat. Using the usual energy values, how many kilocalories does it provide?
1. A470 kcal
2. B320 kcal
3. C370 kcal
4. D350 kcal
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Answer: C · 370 kcal
Carbohydrate and protein each give 4 kcal per gram and fat gives 9 kcal per gram. So 50 x 4 = 200, 20 x 4 = 80 and 10 x 9 = 90, a total of 370 kcal. Fat is the most energy-dense nutrient, which is why small amounts of oil raise the energy of therapeutic feeds. Alcohol gives 7 kcal per gram.
- A: 470 kcal counts protein at 9 kcal per gram.
- B: 320 kcal counts fat at 4 kcal per gram.
- D: 350 kcal counts fat at 7 kcal per gram, the value for alcohol.
Question 6 · Easy
The bioavailability of a drug given as an intravenous injection is:
1. A100%
2. B75%
3. CVariable with first-pass loss
4. D50%
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Question 7 · Medium
At higher doses phenytoin follows zero-order kinetics. The practical consequence for the patient is that:
1. AA small dose rise can cause a large rise in level
2. BIt is eliminated faster as the dose increases
3. CIts half-life stays the same at every dose
4. DIts plasma level can no longer be measured
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Question 8 · Medium
To prevent dumping syndrome after a partial gastrectomy, the nurse advises the patient to:
1. AWalk briskly straight after each meal
2. BTake fluids between meals, not with them
3. CDrink sweet fluids along with each meal
4. DEat three large high-carbohydrate meals
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Question 9 · Medium
A man with recurrent gouty arthritis and high serum uric acid is advised to limit which foods?
1. AFresh fruits and green vegetables
2. BMilk, curd and buttermilk
3. CRice, wheat and other cereals
4. DOrgan meats such as liver and kidney
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Question 10 · Hard
A farmer with organophosphate poisoning is being given repeated IV atropine. Which finding best shows that atropinisation is adequate?
1. APupils dilated to 6 mm or more
2. BClear chest with heart rate above 80/min
3. CFull return of muscle power
4. DA dry mouth with thirst
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Question 11 · Medium
The oedema that distinguishes kwashiorkor from marasmus is classically attributed to:
1. AHeart failure from anaemia
2. BExcess dietary salt
3. CLow serum albumin
4. DKidney damage from infection
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Question 12 · Easy
Confusion, ataxia and ophthalmoplegia in a man with chronic alcohol dependence point to deficiency of:
1. ANiacin
2. BThiamine
3. CPyridoxine
4. DFolic acid
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Question 13 · Medium
Glyceryl trinitrate tablets for angina are placed under the tongue rather than swallowed, mainly because the sublingual route:
1. APrevents the headache caused by nitrates
2. BProtects the drug from stomach acid
3. CAvoids extensive first-pass liver metabolism
4. DGives a longer duration of action
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Question 14 · Easy
The elimination half-life of a drug is the time taken for:
1. AHalf the dose to be absorbed
2. BIts plasma level to reach its peak
3. CHalf its receptors to be occupied
4. DIts plasma level to fall by half
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Question 15 · Medium
A vegetarian woman with iron deficiency is taught how to improve absorption of iron from her meals. Taking her meals with which item helps most?
1. AA cup of strong tea
2. BA calcium tablet
3. CA glass of lemon juice
4. DA glass of milk
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Question 16 · Easy
Swollen, bleeding gums and tiny haemorrhages around hair follicles in an elderly man living alone point to deficiency of:
1. AVitamin C
2. BRiboflavin
3. CVitamin K
4. DVitamin D
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Question 17 · Medium
The size of a loading dose needed to reach a target plasma concentration quickly depends mainly on the drug's:
1. ASpeed of onset
2. BElimination half-life
3. CVolume of distribution
4. DRenal clearance
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Question 18 · Medium
In paracetamol overdose, N-acetylcysteine protects the liver mainly because it:
1. ABlocks the absorption of paracetamol
2. BReplenishes glutathione that detoxifies NAPQI
3. CInhibits the liver enzymes that make NAPQI
4. DIncreases the excretion of paracetamol
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Question 19 · Hard
A drug with a half-life of 8 hours is started as regular doses with no loading dose. About when will it reach steady state?
1. AAfter about 32-40 hours
2. BAfter about 16 hours
3. CAfter about 8 hours
4. DAfter about 4 days
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Question 20 · Hard
A drug with first-order kinetics and a half-life of 6 hours has a plasma level of 80 mg/L. If no more is given, what will the level be after 18 hours?
1. A10 mg/L
2. B20 mg/L
3. C26.7 mg/L
4. D40 mg/L
Answer and explanation in LearnFree account

Pharmacology and nutrition

A severely undernourished 40-year-old (BMI 14) is started on full-calorie tube feeds. On day 3 he becomes weak and confused, with serum phosphate 1.2 mg/dL (normal 2.5-4.5). The most likely explanation is:

A youth who ate datura seeds has hot, dry, flushed skin, dilated pupils, pulse 140/min, urinary retention and agitated delirium. Which drug acts as the specific antidote?

Vitamin K is given intramuscularly to every newborn at birth to prevent:

Chloramphenicol given to a newborn in adult-type doses can cause grey baby syndrome mainly because the neonate has:

A snack contains 50 g carbohydrate, 20 g protein and 10 g fat. Using the usual energy values, how many kilocalories does it provide?

The bioavailability of a drug given as an intravenous injection is:

At higher doses phenytoin follows zero-order kinetics. The practical consequence for the patient is that:

To prevent dumping syndrome after a partial gastrectomy, the nurse advises the patient to:

A man with recurrent gouty arthritis and high serum uric acid is advised to limit which foods?

A farmer with organophosphate poisoning is being given repeated IV atropine. Which finding best shows that atropinisation is adequate?

The oedema that distinguishes kwashiorkor from marasmus is classically attributed to:

Confusion, ataxia and ophthalmoplegia in a man with chronic alcohol dependence point to deficiency of:

Glyceryl trinitrate tablets for angina are placed under the tongue rather than swallowed, mainly because the sublingual route:

The elimination half-life of a drug is the time taken for:

A vegetarian woman with iron deficiency is taught how to improve absorption of iron from her meals. Taking her meals with which item helps most?

Swollen, bleeding gums and tiny haemorrhages around hair follicles in an elderly man living alone point to deficiency of:

The size of a loading dose needed to reach a target plasma concentration quickly depends mainly on the drug's:

In paracetamol overdose, N-acetylcysteine protects the liver mainly because it:

A drug with a half-life of 8 hours is started as regular doses with no loading dose. About when will it reach steady state?

A drug with first-order kinetics and a half-life of 6 hours has a plasma level of 80 mg/L. If no more is given, what will the level be after 18 hours?