PHARMACOLOGY NURS 251 MODULE 4 EXAM 2026/2027
| Portage Learning ABCnursing Geneva College | Verified
Edition Questions & Answers | Pass Guaranteed - A+
Graded
Section 1: Pain Management & Analgesics (Questions 1-30)
Q1: A patient with severe cancer pain is transitioning from oral morphine to intravenous (IV)
hydromorphone. The nurse knows that when calculating equianalgesic dosing conversions,
which of the following principles is most critical to prevent respiratory depression?
A. Divide the IV dose by 2 to account for first-pass metabolism
B. Calculate the exact equianalgesic dose and administer the full IV dose immediately
C. Reduce the calculated equianalgesic dose by 25% to 50% due to incomplete cross-tolerance
D. Increase the calculated dose by 25% because IV administration has lower bioavailability
Correct Answer: C
Rationale: When converting opioids, incomplete cross-tolerance means the patient may be less
tolerant to the new opioid, so the calculated equianalgesic dose must be reduced by 25% to
50% to prevent fatal respiratory depression. Option A is incorrect because IV routes bypass
first-pass metabolism entirely. Option B is dangerous as it ignores cross-tolerance risks. Option
D is incorrect as IV bioavailability is 100%, requiring a dose decrease, not an increase, from the
oral route. Module 4 Exam Insight: Portage Learning heavily tests the concept of incomplete
cross-tolerance and dose reduction during opioid rotation.
Q2: A post-operative patient is receiving morphine via Patient-Controlled Analgesia (PCA). The
nurse enters the room and finds the patient unresponsive with a respiratory rate of 6
breaths/min and pinpoint pupils. Which intervention should the nurse implement first?
A. Administer flumazenil IV push
B. Administer naloxone (Narcan) IV push
C. Perform chest compressions
D. Apply a 100% non-rebreather mask
Correct Answer: B
Rationale: The patient exhibits classic signs of opioid overdose: respiratory depression, pinpoint
pupils (miosis), and altered consciousness. Naloxone is a competitive mu-opioid antagonist that
rapidly reverses respiratory depression. Flumazenil is for benzodiazepines, not opioids. Chest
compressions are not indicated as the patient has a pulse. Oxygen alone will not reverse the
opioid-induced respiratory center depression. Module 4 Exam Insight: ABCnursing questions
frequently pair pinpoint pupils and decreased respiratory rate as the prime triggers for naloxone
administration.
,Q3: A nurse is educating a patient prescribed acetaminophen (Tylenol) for chronic osteoarthritis
pain. Which statement by the patient indicates a need for further teaching?
A. "I should not drink alcohol while taking this medication."
B. "I can take up to 4,000 mg a day to manage my pain."
C. "This medication works by blocking pain signals in my brain."
D. "I will monitor my skin for yellowing because this can affect my liver."
Correct Answer: B
Rationale: While 4,000 mg is the absolute maximum daily dose for healthy adults, current
guidelines recommend lowering the maximum to 3,000 mg per day, especially for chronic use or
in those with risk factors, to prevent hepatotoxicity. Acetaminophen acts centrally to inhibit COX
pathways and does not have peripheral anti-inflammatory effects. Alcohol increases
hepatotoxicity risk. Jaundice is a sign of liver damage. Module 4 Exam Insight: Geneva College
exams often test the 3,000 mg vs 4,000 mg daily limit nuance, specifically in the context of
chronic pain patients.
Q4: A patient with a history of peptic ulcer disease and stage 3 chronic kidney disease presents
with acute low back pain. Which of the following medications is the safest initial choice for this
patient?
A. Ibuprofen (Motrin)
B. Naproxen (Aleve)
C. Celecoxib (Celebrex)
D. Acetaminophen (Tylenol)
Correct Answer: D
Rationale: Acetaminophen is the analgesic of choice for patients with renal impairment and GI
bleeding risks because it lacks peripheral anti-inflammatory effects, does not decrease renal
blood flow, and does not irritate the gastric mucosa. Ibuprofen and naproxen are non-selective
NSAIDs that cause GI bleeding and nephrotoxicity. Celecoxib is a COX-2 inhibitor that spares
the GI tract but still carries significant nephrotoxicity and cardiovascular risks, making it
contraindicated in stage 3 CKD. Module 4 Exam Insight: NURS 251 expects students to
automatically rule out all NSAIDs (including COX-2 inhibitors) when a patient has impaired renal
function.
Q5: A patient is receiving epidural morphine for post-surgical pain management. The nurse
knows that compared to IV opioids, epidural administration carries a specific risk for which
adverse effect?
A. Immediate respiratory depression upon injection
B. Delayed respiratory depression occurring 6 to 12 hours after administration
C. Severe localized itching at the injection site only
D. Tachycardia due to systemic absorption
Correct Answer: B
Rationale: Epidural and intrathecal opioids bypass the blood-brain barrier initially, allowing
cerebrospinal fluid to distribute the drug to the brainstem respiratory center. This causes a risk
of delayed respiratory depression (often 6 to 24 hours later) as the drug rostrally migrates.
,Pruritus is common but not limited to the injection site. Opioids cause bradycardia, not
tachycardia. Module 4 Exam Insight: Recognizing the timeline of "delayed respiratory
depression" is a classic Module 4 pharmacokinetics testing point for neuraxial opioids.
Q6: A nurse is assessing a patient receiving ketorolac (Toradol) IV for acute renal colic. Which
nursing intervention is most critical?
A. Assessing the patient's bowel sounds
B. Monitoring strict intake and output and daily BUN/creatinine
C. Checking the patient's pupils for dilation
D. Evaluating the patient for signs of physical dependence
Correct Answer: B
Rationale: Ketorolac is a potent non-selective NSAID that inhibits prostaglandins responsible for
maintaining renal blood flow, posing a high risk of acute kidney injury. It is limited to 5 days of
use. Bowel sounds are not primarily affected by NSAIDs. Pupil changes and physical
dependence are adverse effects of opioids, not NSAIDs. Module 4 Exam Insight: The 5-day
maximum use limit and nephrotoxicity monitoring for IV ketorolac are highly tested Portage
Learning concepts.
Q7: A patient with diabetic neuropathy reports burning, shooting pain in their feet that wakes
them up at night. The provider prescribes gabapentin (Neurontin). The nurse explains that this
medication works by which mechanism?
A. Blocking sodium channels in the peripheral nerves
B. Inhibiting cyclooxygenase in the central nervous system
C. Modulating voltage-gated calcium channels to reduce excitatory neurotransmitter release
D. Inhibiting the reuptake of serotonin and norepinephrine in the synaptic cleft
Correct Answer: C
Rationale: Gabapentin and pregabalin are first-line adjuvant analgesics for neuropathic pain.
They bind to the alpha-2-delta subunit of voltage-gated calcium channels in the CNS,
decreasing the release of excitatory neurotransmitters like glutamate. Sodium channel blockade
is the mechanism of local anesthetics and carbamazepine. COX inhibition is the mechanism of
NSAIDs/acetaminophen. SNRIs (duloxetine) inhibit serotonin and norepinephrine reuptake.
Module 4 Exam Insight: ABCnursing frequently distinguishes between gabapentin (calcium
channel) and carbamazepine (sodium channel) mechanisms for neuropathic pain.
Q8: A patient arrives at the emergency department experiencing a migraine with aura. Their
medical history includes uncontrolled hypertension and coronary artery disease. Which of the
following abortive migraine medications is contraindicated for this patient?
A. Metoclopramide (Reglan)
B. Sumatriptan (Imitrex)
C. Ibuprofen (Motrin)
D. Ubrogepant (Ubrelvy)
Correct Answer: B
Rationale: Triptans like sumatriptan are 5-HT1B/1D receptor agonists that cause
vasoconstriction. In patients with coronary artery disease or uncontrolled hypertension, this can
, precipitate severe cardiac ischemia or stroke, making them strictly contraindicated.
Metoclopramide is an antiemetic. Ibuprofen is an NSAID. Ubrogepant is a CGRP antagonist that
does not cause vasoconstriction and is safe for cardiovascular patients. Module 4 Exam Insight:
Triptan contraindications (CAD, HTN, hemiplegic migraine) are a staple analysis-level question
in NURS 251.
Q9: A nurse is caring for an opioid-naive patient who is prescribed oxycodone 5 mg orally every
4 hours as needed for acute pain. The patient requests pain medication at 0200. Which
assessment finding would cause the nurse to hold the dose?
A. The patient reports pain as an 8 out of 10
B. The patient's respiratory rate is 10 breaths per minute
C. The patient states they feel slightly nauseous
D. The patient's blood pressure is 110/70 mmHg
Correct Answer: B
Rationale: A respiratory rate of 10 breaths per minute in an opioid-naive patient indicates
respiratory depression, the most serious adverse effect of opioids, requiring the nurse to hold
the dose and potentially administer naloxone. A pain score of 8 indicates the need for the
analgesic. Nausea is a common side effect but not a reason to withhold the medication. A BP of
110/70 is within normal limits. Module 4 Exam Insight: Geneva College exams test the absolute
threshold for holding opioids: respiratory rate limits (typically <12 or significant drop from
baseline) override the patient's subjective pain score.
Q10: A patient is prescribed aspirin 81 mg daily for cardiovascular protection. The nurse
understands that at this low dose, aspirin works by which mechanism?
A. Reversibly inhibiting COX-2 in inflamed tissues
B. Irreversibly inhibiting COX-1, preventing thromboxane A2 synthesis
C. Stimulating the production of prostacyclin in endothelial cells
D. Blocking calcium channels in the vascular smooth muscle
Correct Answer: B
Rationale: Low-dose aspirin irreversibly acetylates COX-1 in platelets, preventing the synthesis
of thromboxane A2, a potent platelet aggregator and vasoconstrictor. Because platelets lack
nuclei, they cannot regenerate COX-1, so the antiplatelet effect lasts the lifespan of the platelet
(7-10 days). COX-2 inhibition requires higher doses. Aspirin actually inhibits endothelial
prostacyclin at low doses slightly, but the anti-thrombotic effect dominates. Module 4 Exam
Insight: The distinction between COX-1 (platelets/thromboxane) and COX-2
(endothelium/prostacyclin) at low vs. high aspirin doses is a fundamental NURS 251 recall
question.
Q11: A patient taking duloxetine (Cymbalta) for fibromyalgia and diabetic neuropathy reports
new-onset dizziness and a blood pressure reading of 160/100 mmHg. The nurse recognizes this
as an adverse effect related to which mechanism?
A. Dopamine receptor blockade
B. Norepinephrine reuptake inhibition
C. Serotonin receptor antagonism
| Portage Learning ABCnursing Geneva College | Verified
Edition Questions & Answers | Pass Guaranteed - A+
Graded
Section 1: Pain Management & Analgesics (Questions 1-30)
Q1: A patient with severe cancer pain is transitioning from oral morphine to intravenous (IV)
hydromorphone. The nurse knows that when calculating equianalgesic dosing conversions,
which of the following principles is most critical to prevent respiratory depression?
A. Divide the IV dose by 2 to account for first-pass metabolism
B. Calculate the exact equianalgesic dose and administer the full IV dose immediately
C. Reduce the calculated equianalgesic dose by 25% to 50% due to incomplete cross-tolerance
D. Increase the calculated dose by 25% because IV administration has lower bioavailability
Correct Answer: C
Rationale: When converting opioids, incomplete cross-tolerance means the patient may be less
tolerant to the new opioid, so the calculated equianalgesic dose must be reduced by 25% to
50% to prevent fatal respiratory depression. Option A is incorrect because IV routes bypass
first-pass metabolism entirely. Option B is dangerous as it ignores cross-tolerance risks. Option
D is incorrect as IV bioavailability is 100%, requiring a dose decrease, not an increase, from the
oral route. Module 4 Exam Insight: Portage Learning heavily tests the concept of incomplete
cross-tolerance and dose reduction during opioid rotation.
Q2: A post-operative patient is receiving morphine via Patient-Controlled Analgesia (PCA). The
nurse enters the room and finds the patient unresponsive with a respiratory rate of 6
breaths/min and pinpoint pupils. Which intervention should the nurse implement first?
A. Administer flumazenil IV push
B. Administer naloxone (Narcan) IV push
C. Perform chest compressions
D. Apply a 100% non-rebreather mask
Correct Answer: B
Rationale: The patient exhibits classic signs of opioid overdose: respiratory depression, pinpoint
pupils (miosis), and altered consciousness. Naloxone is a competitive mu-opioid antagonist that
rapidly reverses respiratory depression. Flumazenil is for benzodiazepines, not opioids. Chest
compressions are not indicated as the patient has a pulse. Oxygen alone will not reverse the
opioid-induced respiratory center depression. Module 4 Exam Insight: ABCnursing questions
frequently pair pinpoint pupils and decreased respiratory rate as the prime triggers for naloxone
administration.
,Q3: A nurse is educating a patient prescribed acetaminophen (Tylenol) for chronic osteoarthritis
pain. Which statement by the patient indicates a need for further teaching?
A. "I should not drink alcohol while taking this medication."
B. "I can take up to 4,000 mg a day to manage my pain."
C. "This medication works by blocking pain signals in my brain."
D. "I will monitor my skin for yellowing because this can affect my liver."
Correct Answer: B
Rationale: While 4,000 mg is the absolute maximum daily dose for healthy adults, current
guidelines recommend lowering the maximum to 3,000 mg per day, especially for chronic use or
in those with risk factors, to prevent hepatotoxicity. Acetaminophen acts centrally to inhibit COX
pathways and does not have peripheral anti-inflammatory effects. Alcohol increases
hepatotoxicity risk. Jaundice is a sign of liver damage. Module 4 Exam Insight: Geneva College
exams often test the 3,000 mg vs 4,000 mg daily limit nuance, specifically in the context of
chronic pain patients.
Q4: A patient with a history of peptic ulcer disease and stage 3 chronic kidney disease presents
with acute low back pain. Which of the following medications is the safest initial choice for this
patient?
A. Ibuprofen (Motrin)
B. Naproxen (Aleve)
C. Celecoxib (Celebrex)
D. Acetaminophen (Tylenol)
Correct Answer: D
Rationale: Acetaminophen is the analgesic of choice for patients with renal impairment and GI
bleeding risks because it lacks peripheral anti-inflammatory effects, does not decrease renal
blood flow, and does not irritate the gastric mucosa. Ibuprofen and naproxen are non-selective
NSAIDs that cause GI bleeding and nephrotoxicity. Celecoxib is a COX-2 inhibitor that spares
the GI tract but still carries significant nephrotoxicity and cardiovascular risks, making it
contraindicated in stage 3 CKD. Module 4 Exam Insight: NURS 251 expects students to
automatically rule out all NSAIDs (including COX-2 inhibitors) when a patient has impaired renal
function.
Q5: A patient is receiving epidural morphine for post-surgical pain management. The nurse
knows that compared to IV opioids, epidural administration carries a specific risk for which
adverse effect?
A. Immediate respiratory depression upon injection
B. Delayed respiratory depression occurring 6 to 12 hours after administration
C. Severe localized itching at the injection site only
D. Tachycardia due to systemic absorption
Correct Answer: B
Rationale: Epidural and intrathecal opioids bypass the blood-brain barrier initially, allowing
cerebrospinal fluid to distribute the drug to the brainstem respiratory center. This causes a risk
of delayed respiratory depression (often 6 to 24 hours later) as the drug rostrally migrates.
,Pruritus is common but not limited to the injection site. Opioids cause bradycardia, not
tachycardia. Module 4 Exam Insight: Recognizing the timeline of "delayed respiratory
depression" is a classic Module 4 pharmacokinetics testing point for neuraxial opioids.
Q6: A nurse is assessing a patient receiving ketorolac (Toradol) IV for acute renal colic. Which
nursing intervention is most critical?
A. Assessing the patient's bowel sounds
B. Monitoring strict intake and output and daily BUN/creatinine
C. Checking the patient's pupils for dilation
D. Evaluating the patient for signs of physical dependence
Correct Answer: B
Rationale: Ketorolac is a potent non-selective NSAID that inhibits prostaglandins responsible for
maintaining renal blood flow, posing a high risk of acute kidney injury. It is limited to 5 days of
use. Bowel sounds are not primarily affected by NSAIDs. Pupil changes and physical
dependence are adverse effects of opioids, not NSAIDs. Module 4 Exam Insight: The 5-day
maximum use limit and nephrotoxicity monitoring for IV ketorolac are highly tested Portage
Learning concepts.
Q7: A patient with diabetic neuropathy reports burning, shooting pain in their feet that wakes
them up at night. The provider prescribes gabapentin (Neurontin). The nurse explains that this
medication works by which mechanism?
A. Blocking sodium channels in the peripheral nerves
B. Inhibiting cyclooxygenase in the central nervous system
C. Modulating voltage-gated calcium channels to reduce excitatory neurotransmitter release
D. Inhibiting the reuptake of serotonin and norepinephrine in the synaptic cleft
Correct Answer: C
Rationale: Gabapentin and pregabalin are first-line adjuvant analgesics for neuropathic pain.
They bind to the alpha-2-delta subunit of voltage-gated calcium channels in the CNS,
decreasing the release of excitatory neurotransmitters like glutamate. Sodium channel blockade
is the mechanism of local anesthetics and carbamazepine. COX inhibition is the mechanism of
NSAIDs/acetaminophen. SNRIs (duloxetine) inhibit serotonin and norepinephrine reuptake.
Module 4 Exam Insight: ABCnursing frequently distinguishes between gabapentin (calcium
channel) and carbamazepine (sodium channel) mechanisms for neuropathic pain.
Q8: A patient arrives at the emergency department experiencing a migraine with aura. Their
medical history includes uncontrolled hypertension and coronary artery disease. Which of the
following abortive migraine medications is contraindicated for this patient?
A. Metoclopramide (Reglan)
B. Sumatriptan (Imitrex)
C. Ibuprofen (Motrin)
D. Ubrogepant (Ubrelvy)
Correct Answer: B
Rationale: Triptans like sumatriptan are 5-HT1B/1D receptor agonists that cause
vasoconstriction. In patients with coronary artery disease or uncontrolled hypertension, this can
, precipitate severe cardiac ischemia or stroke, making them strictly contraindicated.
Metoclopramide is an antiemetic. Ibuprofen is an NSAID. Ubrogepant is a CGRP antagonist that
does not cause vasoconstriction and is safe for cardiovascular patients. Module 4 Exam Insight:
Triptan contraindications (CAD, HTN, hemiplegic migraine) are a staple analysis-level question
in NURS 251.
Q9: A nurse is caring for an opioid-naive patient who is prescribed oxycodone 5 mg orally every
4 hours as needed for acute pain. The patient requests pain medication at 0200. Which
assessment finding would cause the nurse to hold the dose?
A. The patient reports pain as an 8 out of 10
B. The patient's respiratory rate is 10 breaths per minute
C. The patient states they feel slightly nauseous
D. The patient's blood pressure is 110/70 mmHg
Correct Answer: B
Rationale: A respiratory rate of 10 breaths per minute in an opioid-naive patient indicates
respiratory depression, the most serious adverse effect of opioids, requiring the nurse to hold
the dose and potentially administer naloxone. A pain score of 8 indicates the need for the
analgesic. Nausea is a common side effect but not a reason to withhold the medication. A BP of
110/70 is within normal limits. Module 4 Exam Insight: Geneva College exams test the absolute
threshold for holding opioids: respiratory rate limits (typically <12 or significant drop from
baseline) override the patient's subjective pain score.
Q10: A patient is prescribed aspirin 81 mg daily for cardiovascular protection. The nurse
understands that at this low dose, aspirin works by which mechanism?
A. Reversibly inhibiting COX-2 in inflamed tissues
B. Irreversibly inhibiting COX-1, preventing thromboxane A2 synthesis
C. Stimulating the production of prostacyclin in endothelial cells
D. Blocking calcium channels in the vascular smooth muscle
Correct Answer: B
Rationale: Low-dose aspirin irreversibly acetylates COX-1 in platelets, preventing the synthesis
of thromboxane A2, a potent platelet aggregator and vasoconstrictor. Because platelets lack
nuclei, they cannot regenerate COX-1, so the antiplatelet effect lasts the lifespan of the platelet
(7-10 days). COX-2 inhibition requires higher doses. Aspirin actually inhibits endothelial
prostacyclin at low doses slightly, but the anti-thrombotic effect dominates. Module 4 Exam
Insight: The distinction between COX-1 (platelets/thromboxane) and COX-2
(endothelium/prostacyclin) at low vs. high aspirin doses is a fundamental NURS 251 recall
question.
Q11: A patient taking duloxetine (Cymbalta) for fibromyalgia and diabetic neuropathy reports
new-onset dizziness and a blood pressure reading of 160/100 mmHg. The nurse recognizes this
as an adverse effect related to which mechanism?
A. Dopamine receptor blockade
B. Norepinephrine reuptake inhibition
C. Serotonin receptor antagonism
