Orris

MUHS university bsc nursing 4th sem pharmacology mcq practice

Reading File
Searching the Web

MUHS BSc Nursing 4th semester pharmacology syllabus topics 2024

Finding Sources
Reading Web Page

https://www.muhsonline.com/papers/bsc-nursing-4-sem-pharmaco…

Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
I now have enough solid content to produce a high-quality MCQ set. Let me compile the full response covering all major MUHS BSc Nursing 4th semester pharmacology units.
Here is a comprehensive set of MUHS BSc Nursing 4th Semester Pharmacology MCQs covering all major exam units, with answers and brief explanations.

MUHS BSc Nursing 4th Semester - Pharmacology MCQ Practice

Covers: Cardiovascular drugs | Respiratory drugs | GI drugs | Endocrine/Hormonal drugs | Antimicrobials | CNS drugs | Antineoplastic drugs

UNIT 1 - Cardiovascular Drugs

Q1. The mechanism of action of digoxin is:
  • A. Inhibition of Na⁺/K⁺ ATPase pump
  • B. Activation of adenylyl cyclase
  • C. Blockade of calcium channels
  • D. Inhibition of beta-1 receptors
Answer: A Digoxin inhibits the Na⁺/K⁺ ATPase pump on myocardial cells, leading to increased intracellular Na⁺, which then increases intracellular Ca²⁺ via the Na⁺/Ca²⁺ exchanger, increasing cardiac contractility. (Goodman & Gilman's)
Q2. Which of the following is the drug of choice for ventricular arrhythmia associated with digoxin toxicity?
  • A. Quinidine
  • B. Atropine
  • C. Digoxin-specific antibody fragments (Fab)
  • D. Verapamil
Answer: C Digoxin-specific antibody (Fab) fragments are the antidote for severe digoxin toxicity. Quinidine actually increases digoxin levels; verapamil worsens bradycardia.
Q3. A patient on furosemide develops hypokalemia. This increases the risk of toxicity with which drug?
  • A. Metoprolol
  • B. Digoxin
  • C. Amlodipine
  • D. Ramipril
Answer: B Hypokalemia potentiates digoxin toxicity because K⁺ and digoxin compete for the same binding site on Na⁺/K⁺ ATPase. A nurse must monitor potassium levels closely.
Q4. The drug of choice for hypertensive emergency is:
  • A. Oral nifedipine
  • B. IV sodium nitroprusside
  • C. Oral amlodipine
  • D. IV digoxin
Answer: B Sodium nitroprusside (IV) causes rapid vasodilation - both arterial and venous - and is used in hypertensive emergencies. Blood pressure must be monitored continuously.
Q5. Which diuretic is potassium-sparing?
  • A. Furosemide
  • B. Hydrochlorothiazide
  • C. Spironolactone
  • D. Ethacrynic acid
Answer: C Spironolactone is an aldosterone antagonist - it blocks aldosterone receptors in the collecting duct, reducing Na⁺ reabsorption while retaining K⁺.
Q6. The site of action of loop diuretics (e.g., furosemide) is:
  • A. Proximal convoluted tubule
  • B. Thick ascending limb of loop of Henle
  • C. Distal convoluted tubule
  • D. Collecting duct
Answer: B Furosemide inhibits the Na⁺-K⁺-2Cl⁻ cotransporter (NKCC2) in the thick ascending limb of the loop of Henle.
Q7. Beta-blockers are contraindicated in:
  • A. Angina pectoris
  • B. Bronchial asthma
  • C. Post-MI patients
  • D. Hypertension
Answer: B Beta-blockers (especially non-selective ones like propranolol) can cause bronchoconstriction by blocking beta-2 receptors in the lungs, worsening asthma. (Katzung's, 16th ed.)
Q8. Which calcium channel blocker is used specifically for supraventricular tachycardia (SVT)?
  • A. Amlodipine
  • B. Nifedipine
  • C. Verapamil
  • D. Felodipine
Answer: C Verapamil (non-dihydropyridine CCB) slows conduction through the AV node and is used to terminate SVT. Amlodipine and nifedipine are dihydropyridines with no AV node effect.
Q9. The first-line drug for heart failure with reduced ejection fraction (HFrEF) from the following is:
  • A. Digoxin
  • B. ACE inhibitor (e.g., enalapril)
  • C. Amlodipine
  • D. Amiodarone
Answer: B ACE inhibitors reduce mortality in HFrEF by reducing afterload and preventing cardiac remodeling. Digoxin improves symptoms but does not reduce mortality.
Q10. Nitroglycerin (GTN) works by:
  • A. Blocking beta-1 receptors
  • B. Releasing nitric oxide → increasing cGMP → vasodilation
  • C. Blocking calcium channels
  • D. Inhibiting Na⁺/K⁺ ATPase
Answer: B Nitroglycerin is an organic nitrate that releases nitric oxide (NO), which activates guanylyl cyclase → increases cGMP → smooth muscle relaxation → venodilation (primarily) → reduced preload → relief of angina.

UNIT 2 - Respiratory Drugs

Q11. The drug of choice for acute severe bronchial asthma is:
  • A. Theophylline IV
  • B. Inhaled short-acting beta-2 agonist (salbutamol)
  • C. Oral prednisolone
  • D. Ipratropium bromide
Answer: B Salbutamol (albuterol) - a short-acting beta-2 agonist (SABA) - is the first-line bronchodilator for acute asthma. It relaxes bronchial smooth muscle rapidly.
Q12. Theophylline's mechanism of action is:
  • A. Beta-2 receptor agonism
  • B. Muscarinic receptor antagonism
  • C. Inhibition of phosphodiesterase → increased cAMP
  • D. Leukotriene receptor blockade
Answer: C Theophylline inhibits phosphodiesterase, preventing the breakdown of cAMP, leading to bronchial smooth muscle relaxation. It has a narrow therapeutic index.
Q13. A nurse notices a patient on theophylline develops nausea, vomiting, and seizures. This indicates:
  • A. Allergic reaction
  • B. Theophylline toxicity
  • C. Normal side effects at therapeutic levels
  • D. Drug interaction with salbutamol
Answer: B Theophylline has a narrow therapeutic window (10-20 mcg/mL). Toxic levels cause nausea, vomiting, tremor, palpitations, and seizures. Serum levels must be monitored.
Q14. Ipratropium bromide belongs to which drug class?
  • A. Beta-2 agonist
  • B. Anticholinergic (muscarinic antagonist)
  • C. Corticosteroid
  • D. Mast cell stabilizer
Answer: B Ipratropium bromide is an inhaled anticholinergic that blocks muscarinic receptors in bronchial smooth muscle, causing bronchodilation. It is used especially in COPD.
Q15. Cromolyn sodium (sodium cromoglicate) acts by:
  • A. Bronchodilation via beta-2 receptors
  • B. Stabilizing mast cells, preventing mediator release
  • C. Inhibiting leukotriene synthesis
  • D. Blocking histamine H1 receptors
Answer: B Cromolyn sodium is a mast cell stabilizer - it prevents degranulation and release of histamine, leukotrienes, and prostaglandins. It is used for prophylaxis, not acute attacks.

UNIT 3 - Gastrointestinal Drugs

Q16. Omeprazole belongs to which drug class?
  • A. H2 receptor blocker
  • B. Proton pump inhibitor (PPI)
  • C. Antacid
  • D. Prostaglandin analogue
Answer: B Omeprazole irreversibly inhibits the H⁺/K⁺ ATPase (proton pump) on parietal cells, producing the most potent acid suppression available.
Q17. Which H2 blocker has the most drug interactions due to CYP450 inhibition?
  • A. Ranitidine
  • B. Famotidine
  • C. Cimetidine
  • D. Nizatidine
Answer: C Cimetidine is a potent inhibitor of CYP450 enzymes, increasing plasma levels of warfarin, phenytoin, theophylline, and many other drugs. It is the most commonly tested for drug interactions.
Q18. Misoprostol is used to protect the gastric mucosa from NSAID injury. It is a:
  • A. H2 blocker
  • B. PPI
  • C. Synthetic prostaglandin E1 analogue
  • D. Antacid
Answer: C Misoprostol is a prostaglandin E1 analogue that increases mucus secretion, bicarbonate production, and blood flow to the gastric mucosa. It is also used to induce labor.
Q19. Ondansetron's mechanism of antiemetic action is:
  • A. Dopamine D2 receptor blockade
  • B. 5-HT3 receptor blockade
  • C. H1 receptor blockade
  • D. Muscarinic receptor blockade
Answer: B Ondansetron is a 5-HT3 receptor antagonist. It blocks serotonin receptors both peripherally (vagal afferents in gut) and centrally (chemoreceptor trigger zone), making it very effective for chemotherapy-induced nausea.
Q20. Which laxative works by increasing osmotic pressure in the bowel?
  • A. Bisacodyl
  • B. Liquid paraffin
  • C. Lactulose
  • D. Senna
Answer: C Lactulose is an osmotic laxative - it is not absorbed from the gut and draws water into the intestinal lumen by osmosis. Also used in hepatic encephalopathy to reduce ammonia.

UNIT 4 - Endocrine / Hormonal Drugs

Q21. The drug of choice for type 2 diabetes mellitus (first-line oral hypoglycemic) is:
  • A. Glibenclamide
  • B. Metformin
  • C. Insulin glargine
  • D. Acarbose
Answer: B Metformin (biguanide) is the first-line drug for T2DM. It works by reducing hepatic glucose production (gluconeogenesis) and improving peripheral insulin sensitivity. It does NOT cause hypoglycemia.
Q22. Which insulin preparation has the longest duration of action?
  • A. Regular insulin
  • B. NPH insulin
  • C. Insulin glargine
  • D. Insulin lispro
Answer: C Insulin glargine is a long-acting (basal) insulin with duration up to 24 hours and no pronounced peak (peakless), mimicking basal insulin secretion.
Q23. A diabetic patient develops sweating, trembling, palpitation, and confusion. The nurse's first priority action is:
  • A. Give subcutaneous insulin
  • B. Check blood glucose and give oral glucose if conscious
  • C. Call the physician immediately and wait
  • D. Administer IV glucagon always
Answer: B These are signs of hypoglycemia. If the patient is conscious and can swallow, oral glucose (15g rule) is given first. Glucagon IM/IV is reserved for unconscious patients.
Q24. Sulfonylureas (e.g., glibenclamide) lower blood glucose by:
  • A. Inhibiting gluconeogenesis in the liver
  • B. Stimulating insulin secretion from pancreatic beta cells
  • C. Blocking glucose absorption in the gut
  • D. Increasing peripheral glucose uptake without insulin
Answer: B Sulfonylureas close ATP-sensitive K⁺ channels on pancreatic beta cells → depolarization → Ca²⁺ influx → insulin secretion. They can cause hypoglycemia.
Q25. Which thyroid drug is used in thyrotoxicosis (hyperthyroidism)?
  • A. Levothyroxine (T4)
  • B. Propylthiouracil (PTU)
  • C. Liothyronine (T3)
  • D. Thyroxine injection
Answer: B PTU inhibits thyroid peroxidase (blocking T3/T4 synthesis) AND inhibits peripheral conversion of T4 to T3. It is especially preferred in thyroid storm and in pregnancy (1st trimester).

UNIT 5 - Antimicrobials / Antibiotics

Q26. The mechanism of action of penicillin is:
  • A. Inhibition of protein synthesis at 50S ribosome
  • B. Inhibition of bacterial cell wall synthesis (peptidoglycan cross-linking)
  • C. Disruption of bacterial cell membrane
  • D. Inhibition of DNA gyrase
Answer: B Penicillins bind to penicillin-binding proteins (PBPs) and block transpeptidase, inhibiting cross-linking of peptidoglycan in the bacterial cell wall. (Katzung's, 16th ed.; Lippincott Pharmacology)
Q27. Before administering the first dose of penicillin, the most important nursing action is:
  • A. Check blood pressure
  • B. Take allergy history and perform sensitivity test
  • C. Draw blood for CBC
  • D. Ensure IV line is in place
Answer: B Penicillin can cause severe anaphylaxis. A thorough allergy history and sensitivity test are mandatory before the first dose.
Q28. Which antibiotic is nephrotoxic and ototoxic?
  • A. Amoxicillin
  • B. Erythromycin
  • C. Gentamicin (aminoglycoside)
  • D. Ciprofloxacin
Answer: C Aminoglycosides (gentamicin, streptomycin, amikacin) are nephrotoxic (tubular damage) and ototoxic (auditory + vestibular damage). Trough and peak serum levels must be monitored.
Q29. Tetracyclines are contraindicated in:
  • A. Adults with urinary tract infection
  • B. Children under 8 years and pregnant women
  • C. Patients with COPD
  • D. Diabetic patients
Answer: B Tetracyclines chelate calcium in developing teeth and bones, causing permanent yellow-brown discoloration and impaired bone growth. They are contraindicated in children <8 years and during pregnancy.
Q30. Metronidazole is the drug of choice for:
  • A. Pulmonary tuberculosis
  • B. Amoebic dysentery and anaerobic infections
  • C. Malaria
  • D. Fungal infections
Answer: B Metronidazole is a nitroimidazole active against anaerobic bacteria and protozoa (Entamoeba histolytica, Trichomonas vaginalis, Giardia lamblia). Patients must avoid alcohol (disulfiram-like reaction).
Q31. Cotrimoxazole (trimethoprim + sulfamethoxazole) inhibits:
  • A. Cell wall synthesis
  • B. Protein synthesis at 30S
  • C. Folate synthesis at two sequential steps
  • D. DNA gyrase
Answer: C Sulfamethoxazole inhibits dihydropteroate synthase (DHPS) and trimethoprim inhibits dihydrofolate reductase (DHFR) - sequential steps in folate synthesis. The combination is synergistic.
Q32. Rifampicin (rifampin) is used in tuberculosis. It causes:
  • A. Orange-red discoloration of urine, tears, and sweat
  • B. Yellow discoloration of skin only
  • C. Nephrotoxicity
  • D. Peripheral neuropathy
Answer: A Rifampicin turns body fluids (urine, saliva, tears, sweat, semen) orange-red. Patients must be counseled about this harmless but alarming side effect. It also induces CYP450 enzymes strongly.

UNIT 6 - CNS Drugs

Q33. Morphine's primary mechanism of action is:
  • A. Inhibition of COX enzyme
  • B. Agonism at opioid receptors (mu, kappa, delta)
  • C. Blocking NMDA receptors
  • D. Inhibiting serotonin reuptake
Answer: B Morphine acts on opioid receptors (primarily mu-opioid receptors) in the CNS and periphery to produce analgesia, sedation, euphoria, respiratory depression, and constipation.
Q34. The antidote for morphine/opioid overdose is:
  • A. Flumazenil
  • B. Atropine
  • C. Naloxone
  • D. N-acetylcysteine
Answer: C Naloxone is a competitive opioid receptor antagonist. It rapidly reverses respiratory depression in opioid overdose. Flumazenil reverses benzodiazepine overdose.
Q35. Which benzodiazepine is used for status epilepticus?
  • A. Alprazolam
  • B. IV diazepam or IV lorazepam
  • C. Nitrazepam
  • D. Temazepam
Answer: B IV diazepam or lorazepam are first-line for status epilepticus. They enhance GABA-A receptor activity, increasing Cl⁻ influx and hyperpolarizing neurons.
Q36. Chlorpromazine belongs to which drug class?
  • A. Benzodiazepine
  • B. Tricyclic antidepressant
  • C. Typical (first-generation) antipsychotic - phenothiazine
  • D. SSRI
Answer: C Chlorpromazine is a phenothiazine - a typical antipsychotic. It blocks dopamine D2 receptors. Side effects include extrapyramidal symptoms (EPS), tardive dyskinesia, and anticholinergic effects.
Q37. Which antiepileptic drug causes gingival hyperplasia and hirsutism as characteristic side effects?
  • A. Valproate
  • B. Carbamazepine
  • C. Phenytoin
  • D. Phenobarbitone
Answer: C Phenytoin's long-term side effects include gingival hyperplasia, hirsutism, coarsening of facial features, and megaloblastic anemia. It blocks voltage-gated Na⁺ channels.

UNIT 7 - Antineoplastic / Other Drugs

Q38. Which antineoplastic agent causes hemorrhagic cystitis?
  • A. Methotrexate
  • B. Cyclophosphamide
  • C. Vincristine
  • D. 5-Fluorouracil
Answer: B Cyclophosphamide (alkylating agent) is metabolized to acrolein, which irritates the bladder mucosa causing hemorrhagic cystitis. Mesna is given to prevent this. (Katzung's, 16th ed.)
Q39. Methotrexate acts by:
  • A. Alkylating DNA
  • B. Inhibiting dihydrofolate reductase (DHFR) → blocking folate metabolism
  • C. Intercalating into DNA
  • D. Blocking tubulin polymerization
Answer: B Methotrexate inhibits DHFR, blocking the reduction of dihydrofolate to tetrahydrofolate, thus preventing nucleotide synthesis. Leucovorin (folinic acid) rescue is used to reduce toxicity.
Q40. The nurse's most important assessment before administering chemotherapy is:
  • A. Blood glucose level
  • B. Absolute neutrophil count (ANC) and blood counts
  • C. Blood pressure
  • D. Urine output only
Answer: B Chemotherapy is myelosuppressive. Checking ANC before each cycle is essential - most protocols hold chemotherapy if ANC <1000/mm³ or WBC is critically low to prevent life-threatening infections.

UNIT 8 - General Pharmacology Concepts

Q41. The volume of distribution (Vd) of a drug that is highly bound to plasma proteins would be:
  • A. Large
  • B. Small
  • C. Zero
  • D. Equal to blood volume
Answer: B Drugs highly bound to plasma proteins remain in the vascular compartment and have a small Vd. Drugs that distribute widely into tissues have a large Vd.
Q42. First-pass metabolism occurs in the:
  • A. Kidneys
  • B. Lungs
  • C. Liver and gut wall (after oral administration)
  • D. Plasma
Answer: C After oral administration, drugs are absorbed from the gut and pass through the portal circulation to the liver, where they undergo first-pass (presystemic) metabolism, reducing bioavailability.
Q43. Aspirin's antiplatelet effect is due to:
  • A. Reversible inhibition of COX-1
  • B. Irreversible inhibition of COX-1 → blocks thromboxane A2 synthesis
  • C. Inhibition of ADP receptors on platelets
  • D. Activation of protein C
Answer: B Aspirin irreversibly acetylates COX-1, blocking thromboxane A2 (TXA2) production in platelets for their entire lifespan (~7-10 days). Low-dose aspirin (75-150 mg/day) is used as an antiplatelet agent.
Q44. Which route of drug administration has 100% bioavailability?
  • A. Oral
  • B. Subcutaneous
  • C. Intravenous (IV)
  • D. Sublingual
Answer: C IV administration delivers drug directly into systemic circulation, bypassing absorption and first-pass metabolism entirely - bioavailability is always 100%.
Q45. A loading dose is given to:
  • A. Maintain steady-state concentration
  • B. Rapidly achieve therapeutic plasma concentration
  • C. Reduce toxicity
  • D. Increase half-life
Answer: B A loading dose is a larger initial dose given to quickly reach therapeutic levels, especially for drugs with long half-lives (e.g., digoxin, amiodarone) where waiting for steady state would take too long.

Quick Summary Table - High-Yield Antidotes

Poisoning/OverdoseAntidote
Opioid (morphine)Naloxone
BenzodiazepineFlumazenil
OrganophosphateAtropine + Pralidoxime
Paracetamol (acetaminophen)N-acetylcysteine (NAC)
DigoxinDigoxin-specific Fab fragments
HeparinProtamine sulfate
WarfarinVitamin K + Fresh Frozen Plasma
Iron poisoningDeferoxamine
CyanideHydroxocobalamin / Sodium thiosulfate

High-Yield Rules for MUHS Exams

  1. Penicillin - always take allergy history before giving
  2. Aminoglycosides - monitor renal function + hearing (nephrotoxic + ototoxic)
  3. Tetracyclines - avoid in children <8 yrs and pregnancy (dental staining)
  4. Metronidazole - avoid alcohol (disulfiram-like reaction)
  5. Rifampicin - orange-red discoloration of body fluids; strong CYP inducer
  6. Digoxin - monitor K⁺; narrow therapeutic index; antidote = Fab fragments
  7. Morphine - respiratory depression; antidote = naloxone
  8. Metformin - first-line T2DM; no hypoglycemia; lactic acidosis risk
  9. Furosemide - loop diuretic; site = thick ascending limb of loop of Henle
  10. Cyclophosphamide - hemorrhagic cystitis; prevent with Mesna
These 45 MCQs are mapped to the standard MUHS BSc Nursing 4th semester pharmacology syllabus. Focus especially on drug mechanisms, nursing implications, contraindications, antidotes, and common side effects - these are the most frequently tested areas in MUHS pattern exams.
This is a shared conversation. Sign in to Orris to start your own chat.