NUR 354 Final Exam: Pharmacology II V3 - Arizona College
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory result must the
nurse monitor most closely to prevent life-threatening complications?
A. Serum Potassium levels
B. Hemoglobin and Hematocrit
C. Absolute Neutrophil Count (ANC)
D. Liver Function Tests (LFTs)
Ans: C
Explanation: Clozapine is associated with a high risk of agranulocytosis, which is a dangerous decrease
in white blood cell counts. The Absolute Neutrophil Count must be monitored weekly initially to ensure
the patient’s immune system remains functional. While other labs are important for general health, they
are not the primary safety concern for this specific medication. Patients must be educated to report any
signs of infection like fever or sore throat immediately. Treatment must be discontinued if the ANC falls
below a certain threshold to prevent sepsis.
2. A nurse is caring for a patient receiving Lithium Carbonate for bipolar disorder. The patient’s serum
lithium level is 1.8 mEq/L. What is the priority nursing action?
A. Withhold the dose and notify the healthcare provider
B. Increase oral fluid intake to 3 liters per day
C. Administer the next scheduled dose as ordered
D. Request a repeat lithium level in 24 hours
,Ans: A
Explanation: The therapeutic range for lithium is generally 0.6 to 1.2 mEq/L, and a level of 1.8 mEq/L
indicates toxicity. Symptoms of lithium toxicity can include coarse tremors, confusion, and cardiovascular
collapse. The nurse must immediately stop the medication to prevent further accumulation and toxicity
symptoms. Providing fluids is helpful but does not take priority over stopping the offending agent.
Continuous monitoring of the patient’s neurological status and electrolyte balance is essential.
3. A patient on Warfarin therapy has an International Normalized Ratio (INR) of 5.5 and is experiencing
active gingival bleeding. Which reversal agent should the nurse anticipate administering?
A. Vitamin K (Phytonadione)
B. Protamine Sulfate
C. Idarucizumab
D. Glucagon
Ans: A
Explanation: Vitamin K is the specific antagonist for Warfarin and helps the liver synthesize clotting
factors. An INR of 5.5 is significantly above the therapeutic range, placing the patient at high risk for
hemorrhage. Protamine sulfate is used for heparin reversal, not warfarin, and idarucizumab is for
dabigatran. The nurse should prepare to administer Vitamin K either orally or intravenously depending
on the severity of bleeding. Monitoring the INR daily is necessary until the levels return to the desired
therapeutic range.
4. A nurse is preparing to administer Digoxin to a patient with heart failure. Which assessment finding
would cause the nurse to hold the medication?
A. Serum Potassium level of 3.2 mEq/L
,B. Apical heart rate of 72 beats per minute
C. Blood pressure of 110/70 mmHg
D. Serum Digoxin level of 0.8 ng/mL
Ans: A
Explanation: Hypokalemia significantly increases the risk of digoxin toxicity because potassium
competes for the same binding sites on the sodium-potassium ATPase pump. A potassium level of 3.2
mEq/L is low and predisposes the patient to life-threatening arrhythmias. The apical heart rate and blood
pressure provided are within normal limits and do not require withholding the drug. The digoxin level of
0.8 ng/mL is within the therapeutic range of 0.5 to 2.0 ng/mL. The nurse must prioritize correcting the
potassium imbalance before continuing digoxin therapy.
5. A patient is prescribed Phenytoin for a seizure disorder. What specific oral health education should the
nurse provide?
A. Avoid using dental floss to prevent bleeding
B. Perform frequent oral hygiene and gum massage
C. Rinse with an alcohol-based mouthwash twice daily
D. Expect the gums to turn a dark blue color
Ans: B
Explanation: Phenytoin is known to cause gingival hyperplasia, which is an overgrowth of gum tissue.
Proper oral hygiene, including brushing and flossing, can help minimize the severity of this side effect.
Alcohol-based mouthwashes may dry the oral mucosa and are not specifically indicated for phenytoin
users. Gingival hyperplasia can lead to infection and tooth loss if not managed aggressively with dental
care. The nurse should also remind the patient to schedule regular dental checkups every six months.
, 6. A patient taking Phenelzine, an MAO inhibitor, is at risk for a hypertensive crisis if they consume which of
the following foods?
A. Aged cheddar cheese and red wine
B. Fresh chicken and steamed broccoli
C. Whole grain bread and cottage cheese
D. Apples and orange juice
Ans: A
Explanation: Phenelzine prevents the breakdown of tyramine, an amino acid found in fermented and
aged foods. High levels of tyramine cause the release of excessive norepinephrine, leading to dangerous
vasoconstriction and hypertensive crisis. Aged cheeses, red wines, and smoked meats are high in
tyramine and must be strictly avoided. Symptoms of a hypertensive crisis include a severe headache,
palpitations, and stiff neck. The nurse should provide a comprehensive list of safe and unsafe foods to the
patient before discharge.
7. A nurse is educating a patient who has just started taking Lisinopril. Which side effect is a common reason
for patients to discontinue this medication?
A. Weight gain of 5 pounds
B. Excessive hair loss
C. Increased urinary frequency
D. Persistent dry cough
Ans: D
Explanation: Lisinopril is an ACE inhibitor that can cause a buildup of bradykinin in the lungs, leading to
a dry, hacking cough. This cough does not typically resolve with time and often requires a switch to an
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory result must the
nurse monitor most closely to prevent life-threatening complications?
A. Serum Potassium levels
B. Hemoglobin and Hematocrit
C. Absolute Neutrophil Count (ANC)
D. Liver Function Tests (LFTs)
Ans: C
Explanation: Clozapine is associated with a high risk of agranulocytosis, which is a dangerous decrease
in white blood cell counts. The Absolute Neutrophil Count must be monitored weekly initially to ensure
the patient’s immune system remains functional. While other labs are important for general health, they
are not the primary safety concern for this specific medication. Patients must be educated to report any
signs of infection like fever or sore throat immediately. Treatment must be discontinued if the ANC falls
below a certain threshold to prevent sepsis.
2. A nurse is caring for a patient receiving Lithium Carbonate for bipolar disorder. The patient’s serum
lithium level is 1.8 mEq/L. What is the priority nursing action?
A. Withhold the dose and notify the healthcare provider
B. Increase oral fluid intake to 3 liters per day
C. Administer the next scheduled dose as ordered
D. Request a repeat lithium level in 24 hours
,Ans: A
Explanation: The therapeutic range for lithium is generally 0.6 to 1.2 mEq/L, and a level of 1.8 mEq/L
indicates toxicity. Symptoms of lithium toxicity can include coarse tremors, confusion, and cardiovascular
collapse. The nurse must immediately stop the medication to prevent further accumulation and toxicity
symptoms. Providing fluids is helpful but does not take priority over stopping the offending agent.
Continuous monitoring of the patient’s neurological status and electrolyte balance is essential.
3. A patient on Warfarin therapy has an International Normalized Ratio (INR) of 5.5 and is experiencing
active gingival bleeding. Which reversal agent should the nurse anticipate administering?
A. Vitamin K (Phytonadione)
B. Protamine Sulfate
C. Idarucizumab
D. Glucagon
Ans: A
Explanation: Vitamin K is the specific antagonist for Warfarin and helps the liver synthesize clotting
factors. An INR of 5.5 is significantly above the therapeutic range, placing the patient at high risk for
hemorrhage. Protamine sulfate is used for heparin reversal, not warfarin, and idarucizumab is for
dabigatran. The nurse should prepare to administer Vitamin K either orally or intravenously depending
on the severity of bleeding. Monitoring the INR daily is necessary until the levels return to the desired
therapeutic range.
4. A nurse is preparing to administer Digoxin to a patient with heart failure. Which assessment finding
would cause the nurse to hold the medication?
A. Serum Potassium level of 3.2 mEq/L
,B. Apical heart rate of 72 beats per minute
C. Blood pressure of 110/70 mmHg
D. Serum Digoxin level of 0.8 ng/mL
Ans: A
Explanation: Hypokalemia significantly increases the risk of digoxin toxicity because potassium
competes for the same binding sites on the sodium-potassium ATPase pump. A potassium level of 3.2
mEq/L is low and predisposes the patient to life-threatening arrhythmias. The apical heart rate and blood
pressure provided are within normal limits and do not require withholding the drug. The digoxin level of
0.8 ng/mL is within the therapeutic range of 0.5 to 2.0 ng/mL. The nurse must prioritize correcting the
potassium imbalance before continuing digoxin therapy.
5. A patient is prescribed Phenytoin for a seizure disorder. What specific oral health education should the
nurse provide?
A. Avoid using dental floss to prevent bleeding
B. Perform frequent oral hygiene and gum massage
C. Rinse with an alcohol-based mouthwash twice daily
D. Expect the gums to turn a dark blue color
Ans: B
Explanation: Phenytoin is known to cause gingival hyperplasia, which is an overgrowth of gum tissue.
Proper oral hygiene, including brushing and flossing, can help minimize the severity of this side effect.
Alcohol-based mouthwashes may dry the oral mucosa and are not specifically indicated for phenytoin
users. Gingival hyperplasia can lead to infection and tooth loss if not managed aggressively with dental
care. The nurse should also remind the patient to schedule regular dental checkups every six months.
, 6. A patient taking Phenelzine, an MAO inhibitor, is at risk for a hypertensive crisis if they consume which of
the following foods?
A. Aged cheddar cheese and red wine
B. Fresh chicken and steamed broccoli
C. Whole grain bread and cottage cheese
D. Apples and orange juice
Ans: A
Explanation: Phenelzine prevents the breakdown of tyramine, an amino acid found in fermented and
aged foods. High levels of tyramine cause the release of excessive norepinephrine, leading to dangerous
vasoconstriction and hypertensive crisis. Aged cheeses, red wines, and smoked meats are high in
tyramine and must be strictly avoided. Symptoms of a hypertensive crisis include a severe headache,
palpitations, and stiff neck. The nurse should provide a comprehensive list of safe and unsafe foods to the
patient before discharge.
7. A nurse is educating a patient who has just started taking Lisinopril. Which side effect is a common reason
for patients to discontinue this medication?
A. Weight gain of 5 pounds
B. Excessive hair loss
C. Increased urinary frequency
D. Persistent dry cough
Ans: D
Explanation: Lisinopril is an ACE inhibitor that can cause a buildup of bradykinin in the lungs, leading to
a dry, hacking cough. This cough does not typically resolve with time and often requires a switch to an
