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NUR 283 COMP 1–3: Essential
Medications You Need to Pass
Exam Structure:
Subject: Pharmacology & Medication Safety
Source: Nursing Licensure & Advanced Pharmacology Review
Format: Multiple Choice & Fill-in-the-Blank
1. A nurse is educating a patient who has been prescribed lisinopril,
metoprolol, and valsartan. What is the most important safety
instruction to prevent orthostatic hypotension?
Correct Answer: Dangle the patient on the side of the bed before rising and
instruct them to change positions slowly.
Rationale:
1. Orthostatic hypotension is a common adverse effect of antihypertensive
medications like ACE inhibitors (lisinopril), beta-blockers (metoprolol), and
ARBs (valsartan).
2. Dangling and slow position changes allow the cardiovascular system to
adjust to postural changes, reducing the risk of falls and syncope.
3. This is a standard safety measure for patients on any medication that
affects blood pressure regulation.
2. A patient receiving Epoetin Alfa for chemotherapy-induced anemia
should be monitored for which serious adverse effects? Select all that
apply.
A. Hypertension
B. Stroke
C. Blood clots
D. Myocardial infarction
Correct Answer: A, B, C, D
Rationale:
1. Epoetin Alfa stimulates red blood cell production, which increases
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hematocrit and blood viscosity.
2. This elevated viscosity can lead to hypertension and increase the risk of
thrombotic events such as stroke, blood clots, and myocardial infarction.
3. Routine monitoring of blood pressure and hemoglobin levels is essential to
mitigate these risks.
3. A patient's WBC count was 2.6 k/uL. After administration of
Neupogen (filgrastim), the nurse expects the count to:
Correct Answer: Increase (e.g., to 6 k/uL or higher).
Rationale:
1. Neupogen is a granulocyte colony-stimulating factor that stimulates the
bone marrow to produce white blood cells.
2. An increase in WBC count is the desired therapeutic effect, especially in
patients with neutropenia from chemotherapy.
3. Monitoring the CBC is crucial to assess response and prevent excessive
leukocytosis.
4. A patient on lithium therapy goes for a long run on a hot day. The
nurse should be concerned about:
Correct Answer: Dehydration leading to decreased sodium levels and
increased risk of lithium toxicity.
Rationale:
1. Lithium is a salt, and its excretion is closely tied to sodium and water
balance.
2. Dehydration from strenuous exercise reduces renal lithium clearance,
causing serum levels to rise.
3. Hyponatremia further exacerbates this risk because the kidneys reabsorb
lithium when sodium is low.
4. Toxicity can occur at levels ≥2.0 mEq/L and presents with neurological,
GI, and renal symptoms.
5. A patient with a multi-drug resistant organism (MDRO) is
prescribed vancomycin. Which MDRO is this medication most likely
treating?
Correct Answer: MRSA (Methicillin-resistant Staphylococcus aureus).
Rationale:
1. Vancomycin is a first-line treatment for serious MRSA infections.
, 3|Page
2. Rifampin may be used in combination but is not typically used alone due
to rapid resistance.
3. Understanding common drug-organism pairings is key for effective
infection control and antibiotic stewardship.
6. When teaching a patient about transdermal patch application,
which instruction is correct?
A. Dispose of used patches in the trash.
B. Cover the patch with plastic while showering.
C. Apply over bruised or abraded skin.
D. Fold the patch in half and flush it down the toilet.
Correct Answer: D
Rationale:
1. Transdermal patches contain residual medication and must be disposed
of safely to prevent accidental exposure (e.g., to children or pets).
2. Folding the patch adhesive-side together and flushing it is a
recommended disposal method for many opioid and nitroglycerin patches.
3. Patches are waterproof and do not need covering; they should be applied
to clean, intact skin for optimal absorption.
7. A patient reports chest pain rated 6/10 and takes a sublingual
nitroglycerin tablet. The pain decreases to 3/10. What should the
patient do next?
Correct Answer: Take another nitroglycerin tablet as directed (usually
every 5 minutes, up to 3 doses).
Rationale:
1. Nitroglycerin is used for acute relief of angina. If pain is not fully relieved
after one dose, additional doses may be taken at 5-minute intervals.
2. If pain persists after three doses, the patient should seek emergency
medical attention, as this may indicate an acute coronary syndrome.
3. Patients should rest while taking nitroglycerin to minimize dizziness
from vasodilation.
8. A patient is prescribed hydrochlorothiazide. The nurse should
monitor for which electrolyte imbalance?
Correct Answer: Hypokalemia.
, 4|Page
Rationale:
1. Hydrochlorothiazide is a potassium-wasting diuretic that increases renal
excretion of potassium.
2. Hypokalemia can lead to muscle weakness, cramps, and dangerous
cardiac arrhythmias.
3. Patients may require potassium supplements or increased dietary
potassium intake while on this medication.
9. A patient with diabetes insipidus is started on desmopressin. Which
outcome indicates the medication is effective?
Correct Answer: Urine output decreases from 500 mL/hr to 125 mL/hr.
Rationale:
1. Desmopressin is a synthetic vasopressin analog that promotes water
reabsorption in the kidneys.
2. In diabetes insipidus, the patient has excessive urine output due to a lack of
ADH.
3. A significant reduction in urine output and an increase in urine specific
gravity are expected therapeutic effects.
10. When drawing levels for gentamicin, the trough should be drawn:
Correct Answer: Immediately before the next scheduled dose.
Rationale:
1. The trough level represents the lowest concentration of the drug in the
bloodstream and is drawn just prior to the next dose.
2. Monitoring trough levels helps prevent toxicity (nephrotoxicity and
ototoxicity) by ensuring the drug is not accumulating.
3. The peak level, drawn 30 minutes after infusion, assesses therapeutic
efficacy.
11. A patient taking allopurinol for gout should be instructed to:
Correct Answer: Increase fluid intake to prevent kidney stones.
Rationale:
1. Allopurinol reduces uric acid production, which can lead to uric acid
crystals forming in the kidneys.
2. Adequate hydration helps flush uric acid through the renal system and
reduces the risk of nephrolithiasis.
NUR 283 COMP 1–3: Essential
Medications You Need to Pass
Exam Structure:
Subject: Pharmacology & Medication Safety
Source: Nursing Licensure & Advanced Pharmacology Review
Format: Multiple Choice & Fill-in-the-Blank
1. A nurse is educating a patient who has been prescribed lisinopril,
metoprolol, and valsartan. What is the most important safety
instruction to prevent orthostatic hypotension?
Correct Answer: Dangle the patient on the side of the bed before rising and
instruct them to change positions slowly.
Rationale:
1. Orthostatic hypotension is a common adverse effect of antihypertensive
medications like ACE inhibitors (lisinopril), beta-blockers (metoprolol), and
ARBs (valsartan).
2. Dangling and slow position changes allow the cardiovascular system to
adjust to postural changes, reducing the risk of falls and syncope.
3. This is a standard safety measure for patients on any medication that
affects blood pressure regulation.
2. A patient receiving Epoetin Alfa for chemotherapy-induced anemia
should be monitored for which serious adverse effects? Select all that
apply.
A. Hypertension
B. Stroke
C. Blood clots
D. Myocardial infarction
Correct Answer: A, B, C, D
Rationale:
1. Epoetin Alfa stimulates red blood cell production, which increases
, 2|Page
hematocrit and blood viscosity.
2. This elevated viscosity can lead to hypertension and increase the risk of
thrombotic events such as stroke, blood clots, and myocardial infarction.
3. Routine monitoring of blood pressure and hemoglobin levels is essential to
mitigate these risks.
3. A patient's WBC count was 2.6 k/uL. After administration of
Neupogen (filgrastim), the nurse expects the count to:
Correct Answer: Increase (e.g., to 6 k/uL or higher).
Rationale:
1. Neupogen is a granulocyte colony-stimulating factor that stimulates the
bone marrow to produce white blood cells.
2. An increase in WBC count is the desired therapeutic effect, especially in
patients with neutropenia from chemotherapy.
3. Monitoring the CBC is crucial to assess response and prevent excessive
leukocytosis.
4. A patient on lithium therapy goes for a long run on a hot day. The
nurse should be concerned about:
Correct Answer: Dehydration leading to decreased sodium levels and
increased risk of lithium toxicity.
Rationale:
1. Lithium is a salt, and its excretion is closely tied to sodium and water
balance.
2. Dehydration from strenuous exercise reduces renal lithium clearance,
causing serum levels to rise.
3. Hyponatremia further exacerbates this risk because the kidneys reabsorb
lithium when sodium is low.
4. Toxicity can occur at levels ≥2.0 mEq/L and presents with neurological,
GI, and renal symptoms.
5. A patient with a multi-drug resistant organism (MDRO) is
prescribed vancomycin. Which MDRO is this medication most likely
treating?
Correct Answer: MRSA (Methicillin-resistant Staphylococcus aureus).
Rationale:
1. Vancomycin is a first-line treatment for serious MRSA infections.
, 3|Page
2. Rifampin may be used in combination but is not typically used alone due
to rapid resistance.
3. Understanding common drug-organism pairings is key for effective
infection control and antibiotic stewardship.
6. When teaching a patient about transdermal patch application,
which instruction is correct?
A. Dispose of used patches in the trash.
B. Cover the patch with plastic while showering.
C. Apply over bruised or abraded skin.
D. Fold the patch in half and flush it down the toilet.
Correct Answer: D
Rationale:
1. Transdermal patches contain residual medication and must be disposed
of safely to prevent accidental exposure (e.g., to children or pets).
2. Folding the patch adhesive-side together and flushing it is a
recommended disposal method for many opioid and nitroglycerin patches.
3. Patches are waterproof and do not need covering; they should be applied
to clean, intact skin for optimal absorption.
7. A patient reports chest pain rated 6/10 and takes a sublingual
nitroglycerin tablet. The pain decreases to 3/10. What should the
patient do next?
Correct Answer: Take another nitroglycerin tablet as directed (usually
every 5 minutes, up to 3 doses).
Rationale:
1. Nitroglycerin is used for acute relief of angina. If pain is not fully relieved
after one dose, additional doses may be taken at 5-minute intervals.
2. If pain persists after three doses, the patient should seek emergency
medical attention, as this may indicate an acute coronary syndrome.
3. Patients should rest while taking nitroglycerin to minimize dizziness
from vasodilation.
8. A patient is prescribed hydrochlorothiazide. The nurse should
monitor for which electrolyte imbalance?
Correct Answer: Hypokalemia.
, 4|Page
Rationale:
1. Hydrochlorothiazide is a potassium-wasting diuretic that increases renal
excretion of potassium.
2. Hypokalemia can lead to muscle weakness, cramps, and dangerous
cardiac arrhythmias.
3. Patients may require potassium supplements or increased dietary
potassium intake while on this medication.
9. A patient with diabetes insipidus is started on desmopressin. Which
outcome indicates the medication is effective?
Correct Answer: Urine output decreases from 500 mL/hr to 125 mL/hr.
Rationale:
1. Desmopressin is a synthetic vasopressin analog that promotes water
reabsorption in the kidneys.
2. In diabetes insipidus, the patient has excessive urine output due to a lack of
ADH.
3. A significant reduction in urine output and an increase in urine specific
gravity are expected therapeutic effects.
10. When drawing levels for gentamicin, the trough should be drawn:
Correct Answer: Immediately before the next scheduled dose.
Rationale:
1. The trough level represents the lowest concentration of the drug in the
bloodstream and is drawn just prior to the next dose.
2. Monitoring trough levels helps prevent toxicity (nephrotoxicity and
ototoxicity) by ensuring the drug is not accumulating.
3. The peak level, drawn 30 minutes after infusion, assesses therapeutic
efficacy.
11. A patient taking allopurinol for gout should be instructed to:
Correct Answer: Increase fluid intake to prevent kidney stones.
Rationale:
1. Allopurinol reduces uric acid production, which can lead to uric acid
crystals forming in the kidneys.
2. Adequate hydration helps flush uric acid through the renal system and
reduces the risk of nephrolithiasis.
