NCLEX-RN Pharmacology Exam 2025 | 150
Q&A with Rationales | All Drug Classes |
Verified Answers
1. 1. Question
An infection in a central venous access device is not eliminated by giving
antibiotics through the catheter. How would bacterial glycocalyx contribute to
this?
A. It protects the bacteria from antibiotic and immunologic destruction.
B. Glycocalyx neutralizes the antibiotic rendering it ineffective.
C. It competes with the antibiotic for binding sites on the microbe.
D. Glycocalyx provides nutrients for microbial growth.
Correct Answer: C. It competes with the antibiotic for binding sites on the
microbe.
Glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes.
It enhances adherence to surfaces, resists phagocytic engulfment by the white
blood cells, and prevents antibiotics from contacting the microbe.
Option A: The first identified function of the glycocalyx was probably
protection. The glycocalyx is a dense, gel-like meshwork that surrounds the
cell, constituting a physical barrier for any object to enter the cell. For example,
the glycocalyx was identified to play an important role to prevent the entry of
pathogens into the cell.
Option B: The endothelial glycocalyx is continuously in contact with the
bloodstream and acts as a vital mechanosensor on endothelial cells.
Specifically, long proteoglycans with strong glycosylation such as heparan
sulfate or chondroitin sulfate are involved in this process. Often, the image of
wind brushing through trees is used: In this analogy, the “wind” of the
bloodstream acts on the proteoglycan “trees” of the glycocalyx, bending them,
which creates a torque that is transferred to the inside of the cells. This leads
to various intracellular responses such as the release of the vasodilator nitric
oxide, actin cytoskeleton rearrangement, and cell polarization.
, Option D: Considering that galectins are both glycocalyx organizing proteins
and involved in a variety of cellular processes, it appears as if the glycocalyx
can act as a “storage compartment” for galectins and potentially other
proteins. Upon triggering events, they are released and translocated into the
cell, where they fulfill their respective function.
2. 2. Question
Central venous access devices are beneficial in pediatric therapy because:
A. They don’t frighten children.
B. Use of the arms is not restricted.
C. They cannot be dislodged.
D. They are difficult to see.
Correct Answer: B. Use of the arms is not restricted.
The child can move his extremities and function in a normal fashion. This lessens
stress associated with position restriction and promotes normal activity. After the
decision has been made to place a CVAD, a suitable approach is chosen. A clear
understanding of the anatomy is needed for each of the different approaches.
The four main approaches to central venous access include the internal jugular,
subclavian, femoral, and PICC techniques.
Option A: Fear may not be eliminated. Central venous access devices (CVADs)
are used to deliver larger volumes of irritating solutions, such as antibiotics,
blood products, parenteral nutrition media, and sclerosing chemotherapeutic
agents. If patients need prolonged intravenous (IV) access, a CVAD is preferred
to a peripheral IV line. Central access is also indicated when peripheral access
cannot be achieved; however, in an emergency situation (e.g., trauma), when
peripheral and central access cannot be expeditiously obtained, the
intraosseous route is the next best choice for obtaining vascular access.
Option C: All lines can be dislodged. CVADs improve the quality of life and
patients’ safety. However, these catheters may lead to severe complications,
e.g., infection, thrombosis, and dislodgement. Dislodgement was defined as
the displacement of the tip of the CVAD into a non-central portion of the
venous system.
Option D: Even small catheters can be readily seen. Central venous catheters
(CVCs) are inserted at femoral, subclavian, and internal jugular sites. These
devices are preferred in children who have no peripheral access and in those
, who require long-term IV access. The subclavian route has been the preferred
route for many years and affords the patient the greatest mobility. The internal
jugular vein (IJV), either via cut down or via percutaneous access, is also a
popular site in children that is amenable to placement under ultrasonographic
(US) guidance.
3. 3. Question
How can central venous access devices (CVADs) be of value in a patient receiving
chemotherapy who has stomatitis and severe diarrhea?
A. The chemotherapy can be rapidly completed allowing the stomatitis and
diarrhea to resolve.
B. Crystalloid can be administered to prevent dehydration.
C. Concentrated hyperalimentation fluid can be administered through the
CVAD.
D. The chemotherapy dose can be reduced.
Correct Answer: C. Concentrated hyper alimentation fluid can be
administered through the CVAD.
For patients who are unable to take oral nutrition, a parenteral hyperalimentation
is an option for providing nutritional support. High concentrations of dextrose,
protein, minerals, vitamins and trace elements can be provided. Dosing is not
affected in options a and d. Hyperalimentation can provide free water and
considerable nutritional benefits.
Option A: The outcome and prognosis of patients with a CVAD directly
depend on the complications. If complications are minimized, the outcome
related to the placement of these lines is excellent. In addition, meticulous and
sterile care of the CVAD can also prevent line infections.
Option B: Crystalloid can provide free water but has very little nutritional
benefits. Crystalloid fluids are a subset of intravenous solutions that find
frequent use in the clinical setting. Crystalloid fluids are the first-line choice for
fluid resuscitation in the presence of hypovolemia, hemorrhage, sepsis, and
dehydration. Further clinical applications include acting as a solution for
intravenous medication delivery, delivering maintenance fluid in patients with
limited or no enteral nutrition, blood pressure management, and increasing
diuresis to avoid nephrotoxic drug or toxin-mediated end-organ damage.
, Option D: There is a possibility that decreasing the dose would decrease the
effectiveness of the drug, no matter what genotype a patient had.
Chemotherapy is a type of treatment that targets and kills rapidly dividing
cells, such as cancer, and is a hallmark of cancer treatment. Unfortunately, this
type of medicine also kills rapidly dividing cells that are not cancerous, such as
blood and skin cells and the lining of the intestine. This toxicity causes serious
side effects, leaving patients ill and bedridden. Many patients are reluctant to
start potent chemotherapy regimens, no matter how effective, because they
are concerned about the toll the side effects will take on daily living.
4. 4. Question
Some central venous access devices (CVAD) have more than one lumen. These
multi-lumen catheters:
A. Have an increased risk of infiltration.
B. Only work a short time because the small-bore clots off.
C. Are beneficial to patient care but are prohibitively expensive.
D. Allow different medications or solutions to be administered
simultaneously.
Correct
Correct
Correct Answer: D. Allow different medications or solutions to be
administered simultaneously.
A multi-lumen catheter contains separate ports and means to administer agents.
An agent infusing in one port cannot mix with an agent infusing into another
port. Thus, agents that would be incompatible if given together can be given in
separate ports simultaneously.
Option A: Multi-lumen CVADs are available and these can be from dual lumen
PICCs and tunneled catheters to triple, quad, and quin lumen Central venous
catheters (CVCs). The advantage of a multi-lumen catheter is the ability to
infuse incompatible mediations and solutions at the same time. The catheters
are designed to ensure that there is no mixing of medications either within the
catheter OR once they exit from the tip (located in the superior vena cava or
right atrium) into the rapid blood flow.
Q&A with Rationales | All Drug Classes |
Verified Answers
1. 1. Question
An infection in a central venous access device is not eliminated by giving
antibiotics through the catheter. How would bacterial glycocalyx contribute to
this?
A. It protects the bacteria from antibiotic and immunologic destruction.
B. Glycocalyx neutralizes the antibiotic rendering it ineffective.
C. It competes with the antibiotic for binding sites on the microbe.
D. Glycocalyx provides nutrients for microbial growth.
Correct Answer: C. It competes with the antibiotic for binding sites on the
microbe.
Glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes.
It enhances adherence to surfaces, resists phagocytic engulfment by the white
blood cells, and prevents antibiotics from contacting the microbe.
Option A: The first identified function of the glycocalyx was probably
protection. The glycocalyx is a dense, gel-like meshwork that surrounds the
cell, constituting a physical barrier for any object to enter the cell. For example,
the glycocalyx was identified to play an important role to prevent the entry of
pathogens into the cell.
Option B: The endothelial glycocalyx is continuously in contact with the
bloodstream and acts as a vital mechanosensor on endothelial cells.
Specifically, long proteoglycans with strong glycosylation such as heparan
sulfate or chondroitin sulfate are involved in this process. Often, the image of
wind brushing through trees is used: In this analogy, the “wind” of the
bloodstream acts on the proteoglycan “trees” of the glycocalyx, bending them,
which creates a torque that is transferred to the inside of the cells. This leads
to various intracellular responses such as the release of the vasodilator nitric
oxide, actin cytoskeleton rearrangement, and cell polarization.
, Option D: Considering that galectins are both glycocalyx organizing proteins
and involved in a variety of cellular processes, it appears as if the glycocalyx
can act as a “storage compartment” for galectins and potentially other
proteins. Upon triggering events, they are released and translocated into the
cell, where they fulfill their respective function.
2. 2. Question
Central venous access devices are beneficial in pediatric therapy because:
A. They don’t frighten children.
B. Use of the arms is not restricted.
C. They cannot be dislodged.
D. They are difficult to see.
Correct Answer: B. Use of the arms is not restricted.
The child can move his extremities and function in a normal fashion. This lessens
stress associated with position restriction and promotes normal activity. After the
decision has been made to place a CVAD, a suitable approach is chosen. A clear
understanding of the anatomy is needed for each of the different approaches.
The four main approaches to central venous access include the internal jugular,
subclavian, femoral, and PICC techniques.
Option A: Fear may not be eliminated. Central venous access devices (CVADs)
are used to deliver larger volumes of irritating solutions, such as antibiotics,
blood products, parenteral nutrition media, and sclerosing chemotherapeutic
agents. If patients need prolonged intravenous (IV) access, a CVAD is preferred
to a peripheral IV line. Central access is also indicated when peripheral access
cannot be achieved; however, in an emergency situation (e.g., trauma), when
peripheral and central access cannot be expeditiously obtained, the
intraosseous route is the next best choice for obtaining vascular access.
Option C: All lines can be dislodged. CVADs improve the quality of life and
patients’ safety. However, these catheters may lead to severe complications,
e.g., infection, thrombosis, and dislodgement. Dislodgement was defined as
the displacement of the tip of the CVAD into a non-central portion of the
venous system.
Option D: Even small catheters can be readily seen. Central venous catheters
(CVCs) are inserted at femoral, subclavian, and internal jugular sites. These
devices are preferred in children who have no peripheral access and in those
, who require long-term IV access. The subclavian route has been the preferred
route for many years and affords the patient the greatest mobility. The internal
jugular vein (IJV), either via cut down or via percutaneous access, is also a
popular site in children that is amenable to placement under ultrasonographic
(US) guidance.
3. 3. Question
How can central venous access devices (CVADs) be of value in a patient receiving
chemotherapy who has stomatitis and severe diarrhea?
A. The chemotherapy can be rapidly completed allowing the stomatitis and
diarrhea to resolve.
B. Crystalloid can be administered to prevent dehydration.
C. Concentrated hyperalimentation fluid can be administered through the
CVAD.
D. The chemotherapy dose can be reduced.
Correct Answer: C. Concentrated hyper alimentation fluid can be
administered through the CVAD.
For patients who are unable to take oral nutrition, a parenteral hyperalimentation
is an option for providing nutritional support. High concentrations of dextrose,
protein, minerals, vitamins and trace elements can be provided. Dosing is not
affected in options a and d. Hyperalimentation can provide free water and
considerable nutritional benefits.
Option A: The outcome and prognosis of patients with a CVAD directly
depend on the complications. If complications are minimized, the outcome
related to the placement of these lines is excellent. In addition, meticulous and
sterile care of the CVAD can also prevent line infections.
Option B: Crystalloid can provide free water but has very little nutritional
benefits. Crystalloid fluids are a subset of intravenous solutions that find
frequent use in the clinical setting. Crystalloid fluids are the first-line choice for
fluid resuscitation in the presence of hypovolemia, hemorrhage, sepsis, and
dehydration. Further clinical applications include acting as a solution for
intravenous medication delivery, delivering maintenance fluid in patients with
limited or no enteral nutrition, blood pressure management, and increasing
diuresis to avoid nephrotoxic drug or toxin-mediated end-organ damage.
, Option D: There is a possibility that decreasing the dose would decrease the
effectiveness of the drug, no matter what genotype a patient had.
Chemotherapy is a type of treatment that targets and kills rapidly dividing
cells, such as cancer, and is a hallmark of cancer treatment. Unfortunately, this
type of medicine also kills rapidly dividing cells that are not cancerous, such as
blood and skin cells and the lining of the intestine. This toxicity causes serious
side effects, leaving patients ill and bedridden. Many patients are reluctant to
start potent chemotherapy regimens, no matter how effective, because they
are concerned about the toll the side effects will take on daily living.
4. 4. Question
Some central venous access devices (CVAD) have more than one lumen. These
multi-lumen catheters:
A. Have an increased risk of infiltration.
B. Only work a short time because the small-bore clots off.
C. Are beneficial to patient care but are prohibitively expensive.
D. Allow different medications or solutions to be administered
simultaneously.
Correct
Correct
Correct Answer: D. Allow different medications or solutions to be
administered simultaneously.
A multi-lumen catheter contains separate ports and means to administer agents.
An agent infusing in one port cannot mix with an agent infusing into another
port. Thus, agents that would be incompatible if given together can be given in
separate ports simultaneously.
Option A: Multi-lumen CVADs are available and these can be from dual lumen
PICCs and tunneled catheters to triple, quad, and quin lumen Central venous
catheters (CVCs). The advantage of a multi-lumen catheter is the ability to
infuse incompatible mediations and solutions at the same time. The catheters
are designed to ensure that there is no mixing of medications either within the
catheter OR once they exit from the tip (located in the superior vena cava or
right atrium) into the rapid blood flow.
