NCLEX Questions-Pharmacology (with
rationales)
1.A nurse is caring for a client with hyperparathyroidism and notes that the
client's serum calcium level is 13 mg/dL. Which medication should the nurse
prepare to administer as prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D
ANS: 3. Calcitonin (Miacalcin) Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is
experiencing hypercalcemia. Calcium gluconate and calcium chloride
are medications used for the treatment of tetany, which occurs as a
result of acute hypocalcemia. In hypercal- cemia, large doses of vitamin
D need to be avoided. Calcitonin, a thyroid hormone, decreases the
plasma calcium level by inhibiting bone resorption and lowering the
serum calcium concentration.
2.Oral iron supplements are prescribed for a 6-year-old child with iron de-
ficiency anemia. The nurse instructs the mother to administer the iron with
which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice
ANS: 4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother
should be instructed to administer the medication with a citrus fruit or a
juice that is high in vitamin C. Milk may affect absorption of the iron.
Water will not assist in absorption. Orange juice contains a greater
,amount of vitamin C than apple juice.
3.Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse
monitors the client, knowing that which of the following would indicate the
presence of systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations
ANS: 1. Tinnitus Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity
(salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea,
and psychological disturbances. Constipation and diarrhea are not
associated with salicylism.
4.A client with severe acne is seen in the clinic and the health care provider
(HCP) prescribes isotretinoin. The nurse reviews the client's medication
record and would contact the (HCP) if the client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin)
ANS: 1. Vitamin A Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized
intensification of isotretinoin toxicity. Because of the potential for
increased toxicity, vitamin A supplements should be discontinued before
isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the
use of isotretinoin.
5.The nurse is applying a topical corticosteroid to a client with eczema. The nurse
would monitor for the potential for increased systemic absorption of the
medication if the medication were being applied to which of the following body
areas?
,1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands
ANS: 2. Axilla Rationale:
Topical corticosteroids can be absorbed into the systemic circulation.
Absorption is higher from regions where the skin is especially
permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and
lower from regions in which permeability is poor (back, palms, soles).
6.The health care provider has prescribed silver sulfadiazine (Silvadene) for
the client with a partial-thickness burn, which has cultured positive for gram-
negative bacteria. The nurse is reinforcing information to the client
about the medication. Which statement made by the client indicates a lack of
understanding about the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."
ANS: 3. "The medica- tion will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad
spectrum of activity against gram-negative bacteria, gram-positive
bacteria, and yeast. It is applied directly to the wound to assist in
healing. It does not stain the skin.
7.The client with metastatic breast cancer is receiving tamoxifen. The nurse
specifically monitors which laboratory value while the client is taking this
medication?
1. Glucose level
2. Calcium level
3. Potassium level
4. Prothrombin time
, ANS: 2. Calcium level Rationale:
Tamoxifen may increase calcium, cholesterol, and triglyceride levels.
Before the initiation of therapy, a complete blood count, platelet count,
and serum calcium levels should be assessed. These blood levels, along
with cholesterol and triglyceride levels, should be monitored periodically
during therapy. The nurse should assess for hypercalcemia while the
client is taking this medication. Signs of hypercalcemia include
increased urine volume, excessive thirst, nausea, vomiting,
constipation, hypotonicity of muscles, and deep bone and flank pain.
8.A nurse is caring for a client after thyroidectomy and notes that calcium glu-
conate is prescribed for the client. The nurse determines that this medication has
been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.
ANS: 3. Treat hypocalcemic tetany. Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands
are acci- dentally removed or injured during surgery. Manifestations
develop 1 to 7 days after surgery. If the client develops numbness and
tingling around the mouth, fingertips, or toes or muscle spasms or
twitching, the health care provider is notified immediately. Calcium
gluconate should be kept at the bedside.
9.A client who has been newly diagnosed with diabetes mellitus has been
stabilized with daily insulin injections. Which information should the nurse teach
when carrying out plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage.
ANS: 2. Rotate the insulin injection sites systematically.
rationales)
1.A nurse is caring for a client with hyperparathyroidism and notes that the
client's serum calcium level is 13 mg/dL. Which medication should the nurse
prepare to administer as prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D
ANS: 3. Calcitonin (Miacalcin) Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is
experiencing hypercalcemia. Calcium gluconate and calcium chloride
are medications used for the treatment of tetany, which occurs as a
result of acute hypocalcemia. In hypercal- cemia, large doses of vitamin
D need to be avoided. Calcitonin, a thyroid hormone, decreases the
plasma calcium level by inhibiting bone resorption and lowering the
serum calcium concentration.
2.Oral iron supplements are prescribed for a 6-year-old child with iron de-
ficiency anemia. The nurse instructs the mother to administer the iron with
which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice
ANS: 4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother
should be instructed to administer the medication with a citrus fruit or a
juice that is high in vitamin C. Milk may affect absorption of the iron.
Water will not assist in absorption. Orange juice contains a greater
,amount of vitamin C than apple juice.
3.Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse
monitors the client, knowing that which of the following would indicate the
presence of systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations
ANS: 1. Tinnitus Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity
(salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea,
and psychological disturbances. Constipation and diarrhea are not
associated with salicylism.
4.A client with severe acne is seen in the clinic and the health care provider
(HCP) prescribes isotretinoin. The nurse reviews the client's medication
record and would contact the (HCP) if the client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin)
ANS: 1. Vitamin A Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized
intensification of isotretinoin toxicity. Because of the potential for
increased toxicity, vitamin A supplements should be discontinued before
isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the
use of isotretinoin.
5.The nurse is applying a topical corticosteroid to a client with eczema. The nurse
would monitor for the potential for increased systemic absorption of the
medication if the medication were being applied to which of the following body
areas?
,1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands
ANS: 2. Axilla Rationale:
Topical corticosteroids can be absorbed into the systemic circulation.
Absorption is higher from regions where the skin is especially
permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and
lower from regions in which permeability is poor (back, palms, soles).
6.The health care provider has prescribed silver sulfadiazine (Silvadene) for
the client with a partial-thickness burn, which has cultured positive for gram-
negative bacteria. The nurse is reinforcing information to the client
about the medication. Which statement made by the client indicates a lack of
understanding about the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."
ANS: 3. "The medica- tion will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad
spectrum of activity against gram-negative bacteria, gram-positive
bacteria, and yeast. It is applied directly to the wound to assist in
healing. It does not stain the skin.
7.The client with metastatic breast cancer is receiving tamoxifen. The nurse
specifically monitors which laboratory value while the client is taking this
medication?
1. Glucose level
2. Calcium level
3. Potassium level
4. Prothrombin time
, ANS: 2. Calcium level Rationale:
Tamoxifen may increase calcium, cholesterol, and triglyceride levels.
Before the initiation of therapy, a complete blood count, platelet count,
and serum calcium levels should be assessed. These blood levels, along
with cholesterol and triglyceride levels, should be monitored periodically
during therapy. The nurse should assess for hypercalcemia while the
client is taking this medication. Signs of hypercalcemia include
increased urine volume, excessive thirst, nausea, vomiting,
constipation, hypotonicity of muscles, and deep bone and flank pain.
8.A nurse is caring for a client after thyroidectomy and notes that calcium glu-
conate is prescribed for the client. The nurse determines that this medication has
been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.
ANS: 3. Treat hypocalcemic tetany. Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands
are acci- dentally removed or injured during surgery. Manifestations
develop 1 to 7 days after surgery. If the client develops numbness and
tingling around the mouth, fingertips, or toes or muscle spasms or
twitching, the health care provider is notified immediately. Calcium
gluconate should be kept at the bedside.
9.A client who has been newly diagnosed with diabetes mellitus has been
stabilized with daily insulin injections. Which information should the nurse teach
when carrying out plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage.
ANS: 2. Rotate the insulin injection sites systematically.
