Pharmacy Assistant Licensure Exam preparation SET 2

Q1

pH of human blood is:

A

6.4

B

7.0

C

7.4

D

8.0

Q2

Which is a proton pump inhibitor?

A

Ranitidine

B

Omeprazole

C

Domperidone

D

Metoclopramide

Q3

Clinical Pharmacy focuses on:

A

Drug manufacturing

B

Patient care and optimal drug therapy

C

Quality control

D

Drug marketing

Q4

Drug disposal should follow:

A

Dumping in river

B

Proper pharmaceutical waste management guidelines

C

Burning openly

D

Throwing in trash

Q5

Nebulizers convert liquid into:

A

Solid particles

B

Fine mist or aerosol

C

Gel

D

Cream

Q6

Parenteral solutions inspected for:

A

Color change

B

Particulate matter

C

Both A and B

D

Neither A nor B

Q7

Condoms are classified as:

A

Prescription drugs

B

OTC health products

C

Controlled substances

D

Banned

Q8

Counseling about drug-food interactions important because:

A

To increase drug cost

B

To optimize therapeutic effect and avoid adverse reactions

C

To make counseling longer

D

Not necessary

Q9

Essential health services package includes:

A

All possible treatments

B

Priority health interventions for all citizens

C

Only emergency care

D

Only surgical services

Q10

Pharmacy-based blood pressure monitoring helps:

A

No benefit

B

Early detection and management of hypertension

C

Increasing blood pressure

D

Not relevant

Q11

CAPA in pharmacy means:

A

No action needed

B

Actions to correct existing problems and prevent recurrence

C

Only punishing staff

D

Ignoring problems

Q12

Under chemical classification, which group includes drugs such as digitalis and strophanthus?

A

Alkaloids

B

Cardiac glycosides

C

Tannins

D

Volatile oils

Q13

Which pharmacopoeial test is performed to assess the degree of pulverization of a powdered drug?

A

Loss on drying test

B

Particle size analysis by sieve method

C

Microscopic examination for starch granules

D

Ash value determination

Q14

Which of the following is NOT a typical pharmacological activity of tannins?

A

Astringency

B

Antimicrobial effect

C

Sedative effect

D

Antioxidant activity

Q15

The traditional decoction of Amalaki (Phyllanthus emblica) is most useful for:

A

Boosting immunity

B

Reducing fever

C

Relieving constipation

D

Treating skin infections

Q16

Anthraquinone glycosides are present in all of the following except:

A

Senna leaves

B

Aloe vera leaf exudate

C

Rhubarb rhizome

D

Cinchona bark

Q17

Which of the following statements about alcohol-based hand rubs is correct?

A

They are ineffective against bacterial spores

B

They must contain at least 70% ethanol to be effective

C

They are contraindicated on damaged skin

D

They preserve viral nucleic acids

Q18

Which of the following is a structural feature of Ibuprofen?

A

A benzene ring with a propionic acid side chain

B

A heterocyclic indole ring

C

A pyrazolone ring

D

A salicylic acid ester

Q19

Which sulphonamide is commonly used as an ophthalmic solution for eye infections?

A

Sulfacetamide

B

Sulfasalazine

C

Sulfadoxine

D

Sulfaguanidine

Q20

The active coenzyme form of thiamine is:

A

Thiamine pyrophosphate

B

Flavin adenine dinucleotide

C

Pyridoxal phosphate

D

Tetrahydrofolate

Q21

Which of the following is an example of a 'semi-solid' dosage form?

A

Liniment

B

Ointment

C

Emulsion

D

Tincture

Q22

Which of the following storage conditions is most appropriate for a moisture-sensitive dusting powder?

A

Room temperature in a glass jar with a rubber stopper

B

Refrigerated at 4°C in a plastic bag

C

In a desiccator or airtight container at ambient temperature

D

In a freezer at - 20°C

Q23

During the evaluation of tablet hardness, a value of 12 kp (kilopond) is considered:

A

Very low hardness, indicating a soft tablet

B

Adequate hardness for most immediate release tablets

C

Excessively high hardness, risking poor disintegration

D

Irrelevant, as hardness is measured in Newtons

Q24

Syrup BPC is an example of:

A

Simple syrup

B

Concentrated syrup

C

Neutral syrup

D

Double-strength syrup

Q25

Which statement about the solubility of drugs in suppository bases is correct?

A

Lipophilic drugs have higher solubility in PEG bases than in cocoa butter

B

Hydrophilic drugs dissolve better in hydrophobic bases

C

Drug solubility in the base affects release rate

D

All drugs have equal solubility in fatty and water-soluble bases

Q26

A prescription contains both triamterene and furosemide. What incompatibility concern exists with concurrent administration?

A

Furosemide increases renal excretion of triamterene

B

Triamterene reduces gastrointestinal absorption of furosemide

C

Furosemide enhances hepatic metabolism of triamterene

D

Both drugs compete for the same renal tubular secretion mechanisms

Q27

For storing vaccines requiring cold chain, which temperature range is standard for most refrigerated vaccines in a primary healthcare pharmacy?

A

-15°C to -50°C

B

2°C to 8°C

C

15°C to 25°C

D

-2°C to -8°C

Q28

Which sterilization method uses low-temperature hydrogen peroxide plasma?

A

Steam sterilization

B

Dry heat sterilization

C

Radiation sterilization

D

Plasma sterilization

Q29

Which statement about protein binding is correct?

A

Only unbound drug is pharmacologically active

B

Bound drug is readily filtered by glomerulus

C

Increased protein binding increases volume of distribution

D

Protein binding does not affect half-life

Q30

A drug with a high clearance rate requires frequent dosing to maintain therapeutic levels. Which route would reduce dosing frequency by providing sustained release?

A

Oral immediate-release tablet

B

Intravenous bolus

C

Transdermal patch

D

Sublingual tablet

Q31

The term 'anaphylactoid' refers to:

A

IgE-mediated reactions only

B

Non-IgE mediated reactions with similar clinical features

C

Type III hypersensitivity reactions

D

Autoimmune reactions

Q32

In a patient with acute postoperative pain, which opioid analgesic has the shortest duration of action?

A

Morphine

B

Buprenorphine

C

Fentanyl

D

Methadone

Q33

Which antibiotic is contraindicated during the first trimester of pregnancy due to teratogenic effects?

A

Penicillin G

B

Erythromycin

C

Tetracycline

D

Cephalexin

Q34

A patient with peptic ulcer disease requires an H2 receptor antagonist. Which drug is most appropriate?

A

Omeprazole

B

Cimetidine

C

Antacid

D

Misoprostol

Q35

A 45-year-old man with type 2 diabetes mellitus is started on insulin therapy. Which insulin preparation has the fastest onset of action and shortest duration of action?

A

Regular human insulin

B

Neutral protamine Hagedorn (NPH) insulin

C

Insulin glargine

D

Insulin lispro

Q36

Which oral anticancer drug functions by inhibiting dihydrofolate reductase?

A

Capecitabine

B

Methotrexate

C

Fluorouracil

D

Gemcitabine

Q37

A patient presents with a suspected adverse drug reaction (ADR) to an antibiotic. Which of the following is the responsibility of the clinical pharmacist?

A

Report the ADR to the national pharmacovigilance center and assess causality

B

Treat the infection with a different class of antibiotic

C

Prescribe corticosteroids for the reaction

D

Perform skin biopsy

Q38

In the Nepalese ADR reporting form, which of the following patient identifiers is mandatory?

A

Full name

B

Citizenship number

C

Age and sex

D

Phone number

Q39

A patient with newly diagnosed type 2 diabetes is prescribed a sulfonylurea. The pharmacist should warn about which adverse effect that may impair adherence?

A

Weight loss

B

Hypoglycaemia, especially if meals are skipped

C

Metallic taste

D

Photosensitivity

Q40

The WHO-Uppsala Monitoring Centre maintains the global database of adverse event reports. What is the name of this database?

A

VigiBase

B

VigiLyze

C

VigiFlow

D

VigiShare

Q41

The 'Economic Order Quantity (EOQ)' model minimizes the sum of:

A

Purchase price and transportation cost

B

Ordering cost and holding cost

C

Stockout cost and expiry loss

D

Insurance and taxes

Q42

Which of the following is a key performance indicator (KPI) for hospital pharmacy dispensing services in Nepal?

A

Percentage of prescriptions dispensed within the target turnaround time (e.g., 30 minutes for outpatients)

B

Number of pharmacists on duty

C

Total drug procurement cost

D

Number of drug brands stocked

Q43

What should be done immediately after a patient returns unused portions of a narcotic drug to the hospital pharmacy?

A

Return it directly to the patient's bedside

B

Count, re-weigh or re-count, and make a corresponding entry in the narcotic register

C

Place it back into general stock after visual inspection

D

Discard it in ordinary waste

Q44

During TPN preparation, a pharmacist must perform a final microbial sterility test. Which of the following methods is recommended?

A

Direct plating on agar

B

Membrane filtration technique

C

Turbidity measurement

D

pH indicator test

Q45

Which of the following OTC medications is most likely to cause drowsiness?

A

Loratadine

B

Fexofenadine

C

Chlorpheniramine

D

Cetirizine

Q46

Which of the following statements about the role of community pharmacies in the National Tuberculosis Control Program (DOTS) in Nepal is correct?

A

Pharmacies can dispense anti-TB drugs without a prescription

B

Pharmacies are responsible for directly observing therapy daily

C

Pharmacies can refer suspected TB patients to designated DOTS centers

D

Pharmacies conduct sputum smear microscopy on site

Q47

In a community pharmacy setting, which of the following scenarios most urgently requires an immediate referral to a physician?

A

A patient requesting a refill of a chronic hypertension medication

B

A patient presenting with sudden onset of facial drooping and slurred speech

C

A patient asking for a recommendation for a mild cough syrup

D

A patient inquiring about the storage conditions of insulin

Q48

What is the legal term for the unauthorized transfer of a prescription drug from a lawful channel to an unlawful channel?

A

Adulteration

B

Diversion

C

Substitution

D

Contraindication

Q49

Which harm-reduction strategy is recommended for opioid users in Nepal?

A

Needle-syringe exchange programs

B

Mandatory imprisonment for possession

C

Prohibition of all opioid prescribing

D

Public shaming of users

Q50

The principle of 'pharmaceutical equivalence' is required for which of the following legal actions?

A

Brand substitution without patient consent

B

Changing a prescription to a generic drug with the same therapeutic effect

C

Selling expired medicines at a reduced price

D

Dispensing a higher dose to a patient with tolerance

Q51

In the context of social pharmacy, what does the term 'Health Equity' specifically refer to?

A

Providing the same health services to every citizen

B

Distributing healthcare resources equally among all districts

C

Absence of avoidable or remediable differences in health among groups

D

Ensuring all pharmacies have the same stock of essential medicines

Q52

In Nepal's National Drug Policy, the term "essential medicines" is defined as:

A

All medicines that generate the highest revenue for the pharmaceutical industry

B

Medicines that satisfy the priority health care needs of the population and should be available at all times

C

Only those medicines imported from WHO-prequalified manufacturers

D

All over-the-counter products

Q53

A pharmacy assistant is counseling a mother about the national immunization program. Which vaccine is administered at birth according to Nepal's schedule?

A

Measles vaccine

B

BCG vaccine

C

Polio vaccine (IPV)

D

DPT vaccine

Q54

The 'null hypothesis' in most epidemiologic studies states that:

A

The exposure has no effect on the outcome

B

The exposure increases the risk of the outcome

C

The exposure decreases the risk of the outcome

D

There is a dose-response relationship

Q55

When a pharmacist explains both the benefits and the risks of a medication to a patient, they are supporting:

A

Paternalism

B

Informed Decision Making

C

Medical Hegemony

D

Pharmaceutical Marketing

Q56

The enzyme alkaline phosphatase (ALP) is most active at which pH range?

A

Acidic (pH 4-5)

B

Neutral (pH 6-7)

C

Alkaline (pH 9-10)

D

Variable, independent of pH

Q57

Which parameter is most reliable for assessing the renal clearance of a drug that is freely filtered, not secreted, and not reabsorbed?

A

Serum creatinine concentration

B

Urine drug concentration

C

Urine flow rate

D

Drug plasma half-life

Q58

Which of the following foods is a good source of calcium but low in phosphorus?

A

Cheddar cheese

B

Almonds

C

Canned sardines with bone

D

Soy milk

Q59

In morphological classification, which of the following is an example of a balsam drug?

A

Myrrh

B

Benzoin

C

Tolu balsam

D

Both B and C

Q60

Under the Narcotic Drugs (Control) Act of Nepal, which document must a pharmacy retain for a period of at least two years after the last transaction of a controlled substance?

A

Prescription register

B

Narcotic drug inventory log

C

Patient counseling record

D

Pharmacy annual financial statement

Q61

Which vaccine is administered to pregnant women in Nepal to prevent neonatal tetanus?

A

BCG

B

Tetanus Toxoid (TT)

C

Hepatitis B

D

DTP

Q62

In the treatment of hypertension, which drug is most likely to cause gingival hyperplasia as a side effect?

A

Amlodipine

B

Atenolol

C

Hydrochlorothiazide

D

Spironolactone

Q63

Which organizational structure is most common in a large hospital to ensure that pharmacy services are integrated into patient care?

A

Independent operation

B

Decentralized pharmacy services

C

Single-room pharmacy model

D

External contracting only

Q64

Which of the following is considered a violation of the 'misbranding' provisions of Nepal's drug regulations?

A

Displaying the drug's generic name alongside the brand name

B

Printing the correct expiry date but in a small font

C

Providing false therapeutic claims on the label

D

Including the manufacturer's contact information

Q65

Which of the following is a chemical property of the drug Meloxicam?

A

It is a selective COX-1 inhibitor

B

It is an oxicam derivative with preferential COX-2 inhibition

C

It is a salicylate derivative

D

It is a non-steroidal steroid

Q66

A 9-year-old child presents with a mild earache due to external otitis. Which OTC ear drop is appropriate?

A

Acetic acid 2% otic solution

B

Hydrocortisone 1% otic suspension

C

Phenylephrine nasal spray

D

Lidocaine 2% gel

Q67

Which molecule is the primary regulator of the rate of glycolysis by inhibiting phosphofructokinase-1 (PFK-1)?

A

AMP

B

Fructose-2,6-bisphosphate

C

ATP

D

Pyruvate

Q68

Which of the following is an example of a physical incompatibility in an IV admixture?

A

Drug A causing an allergic reaction

B

Formation of crystals upon mixing two compatible solvents

C

Drug A inhibiting the enzyme that metabolizes Drug B

D

Drug A increasing the blood pressure while Drug B decreases it

Q69

What is the mechanism of action of the drug Benzonatate in the treatment of cough?

A

Central suppression of the medulla

B

Anesthesia of stretch receptors in the lungs

C

Reduction of mucus viscosity

D

Activation of the mu-opioid receptor

Q70

Which of the following is the drug of choice for the treatment of absence (petit mal) seizures?

A

Phenytoin

B

Carbamazepine

C

Ethosuximide

D

Phenobarbital

Q71

Which of the following tasks is part of the clinical pharmacist's role in implementing a hospital's antimicrobial stewardship program?

A

Conducting prospective audit with feedback to prescribers on antibiotic use

B

Managing the hospital's laundry services

C

Operating the central sterile supply department

D

Providing nutritional counseling to post-operative patients

Q72

A hydrolyzable tannin, when treated with acid, yields:

A

Gallic acid

B

Flavan-3-ol units

C

Non-phenolic polymers

D

Volatile terpenes

Q73

Which of the following biological indicators is specifically used to validate the efficiency of a Dry Heat Sterilizer?

A

Bacillus stearothermophilus

B

Bacillus subtilis

C

Clostridium sporogenes

D

Pseudomonas aeruginosa

Q74

Which inorganic salt is used as a source of fluoride in community water fluoridation programs?

A

Sodium fluoride

B

Calcium fluoride

C

Potassium fluoride

D

Magnesium fluoride

Q75

A pharmacist is compounding a dusting powder containing 2% chlorhexidine gluconate. Which pH adjustment is most important for stability?

A

pH 4.5-5.5

B

pH 6.5-7.5

C

pH 8.5-9.5

D

pH 2.5-3.5

Q76

Which receptor family primarily utilizes the JAK-STAT signaling pathway as its main transduction mechanism?

A

G protein-coupled receptors

B

Ion channel receptors

C

Enzyme-linked receptors (cytokine receptors)

D

Nuclear receptors

Q77

When a pharmacist is acting as an expert witness in a forensic investigation regarding a medication error, their primary legal responsibility is to:

A

Defend the pharmacy regardless of the error

B

Provide an unbiased, evidence-based professional opinion

C

Suggest a settlement to avoid court proceedings

D

Hide errors to protect the reputation of the profession

Q78

A 78-year-old man with Parkinson's disease experiences motor fluctuations and dyskinesias despite optimized oral levodopa/carbidopa therapy. His neurologist considers continuous dopaminergic stimulation to stabilize plasma levels. Which route of administration offers the most consistent and controlled delivery?

A

Oral controlled-release levodopa tablets

B

Transdermal rotigotine patch applied to the abdomen

C

Intravenous bolus injections of apomorphine

D

Inhalation of ipodemastat powder via dry powder inhaler

Q79

Which metric most directly reflects the timeliness of drug information service responses?

A

Percentage of queries answered within the defined turnaround time

B

Number of citations used per response

C

User satisfaction score from a post-response survey

D

Total number of queries received per month

Q80

In the context of narcotic drug storage in hospital pharmacy, which of the following is a mandatory requirement under Nepal NPC guidelines?

A

Storage in a wooden cabinet with lock

B

Storage in a steel almirah with double lock system

C

Storage in a glass display case with key

D

Storage in a plastic container with combination lock

Q81

Which vitamin is primarily stored in the liver and has a biological half-life of approximately 3 - 4 weeks?

A

Vitamin B12

B

Vitamin C

C

Vitamin K

D

Vitamin B6

Q82

For a suspected adverse reaction following immunisation, which specific form is used in Nepal to report the event?

A

Yellow Card

B

Vaccine Adverse Event Reporting Form (AEFI form)

C

Standard ADR Form

D

Immunisation Safety Checklist

Q83

For pediatric patients, the PIC recommends which of the following adjustments for the dose of atropine used in organophosphate poisoning?

A

Same adult dose irrespective of weight

B

0.02 mg/kg IV every 5-15 min

C

0.1 mg/kg IM once

D

0.5 mg/kg oral

Q84

Which class of antidiabetic drugs enhances insulin sensitivity by activating peroxisome proliferator-activated receptor gamma (PPARγ)?

A

thiazolidinediones

B

sulfonylureas

C

meglitinides

D

SGLT2 inhibitors

Q85

The scope of pharmacognosy includes 'biogenetic pathways', which refers to:

A

The way drugs are transported in the blood

B

The biological steps by which a plant synthesizes a compound

C

The legal pathways for importing drugs

D

The process of drug excretion from the body

Q86

To curb antimicrobial resistance, the National Drug Policy recommends which of the following measures?

A

Banning all antibiotic sales

B

Restricting over-the-counter sale of antibiotics

C

Encouraging prophylactic use of antibiotics

D

Promoting universal use of broad-spectrum antibiotics

Q87

Which plant is the natural source of the anthraquinone emodin, used historically as a laxative?

A

Rheum emodi

B

Cassia senna

C

Aloe vera

D

Cascara sagrada

Q88

A patient with chronic kidney disease develops metabolic bone disease due to impaired renal hydroxylation. Which of the following enzymes is directly affected by reduced renal function?

A

25-hydroxyvitamin D3 1-alpha-hydroxylase

B

11-beta-hydroxysteroid dehydrogenase

C

25-hydroxyvitamin D3 24-hydroxylase

D

Cholesterol side-chain cleavage enzyme

Q89

A community pharmacy participates in a program that collects discarded medication containers for incineration. This activity primarily addresses which aspect of drug-abuse prevention?

A

Reducing availability of diverted medicines

B

Educating the public about risks

C

Monitoring prescription trends

D

Providing counseling services

Q90

When a community pharmacist collaborates with local schools, municipal water boards, and NGOs to launch a hand-washing promotion campaign, this reflects which public health principle?

A

Intersectoral action

B

Vertical programming

C

Biomedical model

D

Individual behavior change

Q91

Which of the following chemical groups is present in the structure of Indomethacin, contributing to its potency as an NSAID?

A

Indole ring

B

Pyrazole ring

C

Imidazole ring

D

Thiazole ring

Q92

What is the minimum frequency required for recording temperature of vaccines stored in a community pharmacy's cold chain in Nepal?

A

Once a month

B

Every 12 hours (twice daily)

C

Only when a temperature excursion occurs

D

Every 6 hours

Q93

In a cohort study the incidence rate ratio (IRR) is calculated as:

A

Incidence rate in exposed ÷ incidence rate in unexposed

B

Incidence proportion in exposed ÷ incidence proportion in unexposed

C

Number of cases in exposed ÷ total exposed

D

Odds of disease in exposed ÷ odds in unexposed

Q94

Which statistical measure is most commonly used to assess the strength of association between a drug and an adverse event in disproportionality analysis?

A

Reporting Odds Ratio

B

Relative Risk

C

Number Needed to Treat

D

Hazard Ratio

Q95

In tablet formulation, the addition of a superdisintegrant is critical for proper tablet performance. Which of the following agents functions by both swelling and wicking mechanisms to promote water penetration?

A

Starch 1500

B

Croscarmellose sodium

C

Magnesium stearate

D

Hydroxypropyl methylcellulose

Q96

Which of the following best describes the role of a community pharmacist in the National Tuberculosis Elimination Program (NTEP) in Nepal?

A

Directly observe patients taking anti-TB drugs at the DOT center

B

Provide Directly Observed Treatment (DOT) services at the community pharmacy

C

Distribute fixed-dose combination (FDC) TB drugs to patients

D

Maintain central records of all TB treatment outcomes in the district

Q97

Which of the following is the PRIMARY mechanism by which ethanol metabolism contributes to fatty liver in chronic alcoholics?

A

Direct stimulation of fatty acid synthase by acetaldehyde leading to increased lipogenesis

B

Inhibition of carnitine palmitoyltransferase I preventing mitochondrial fatty acid oxidation

C

NADH accumulation from alcohol dehydrogenase activity inhibiting fatty acid oxidation and gluconeogenesis

D

Increased VLDL secretion due to enhanced apolipoprotein synthesis

Q98

Why is sodium thiosulfate added after using a chlorine-based disinfectant for wound irrigation?

A

To neutralize residual chlorine

B

To increase antimicrobial activity

C

To lower the pH of the solution

D

To enhance tissue penetration

Q99

The therapeutic range for serum lithium is:

A

0.2–0.6 mmol/L

B

0.6–1.2 mmol/L

C

1.2–1.8 mmol/L

D

1.8–2.4 mmol/L

Q100

What is the most appropriate health-promotion message for adolescent girls (12–19 years) to prevent iron-deficiency anemia in Nepal?

A

Consume a cup of milk daily

B

Increase intake of leafy green vegetables and meat

C

Avoid all fried foods

D

Limit tea consumption to after meals