BSN 315 Pharmacology Drug Classifications Exam | Nursing
Medication Management Questions with Rationales
Question 1
A nurse is providing discharge instructions to a client newly prescribed
atorvastatin (an HMG-CoA reductase inhibitor) for hyperlipidemia.
Which client statement indicates a correct understanding of the
medication management?
• A. "I should take this medication first thing in the morning with a
glass of grapefruit juice."
• B. "I will take this medication in the evening, as cholesterol
synthesis in the liver peaks at night."
• C. "If I develop mild muscle aches, I can ignore them because they
are completely harmless."
• D. "I should stop taking this medication immediately if my total
cholesterol drops below 200 mg/dL."
Correct Answer: B. "I will take this medication in the evening, as
cholesterol synthesis in the liver peaks at night."
Detailed Rationale: HMG-CoA reductase inhibitors (statins) with a
shorter half-life are most effective when taken in the evening or at
bedtime because hepatic cholesterol synthesis reaches its peak
overnight. Grapefruit juice must be avoided because it inhibits CYP3A4
enzymes, raising statin blood levels and increasing the risk of myopathy
and rhabdomyolysis. Muscle aches must be reported promptly, as they
can indicate rhabdomyolysis.
Question 2
,A client with chronic heart failure is prescribed furosemide (a loop
diuretic). Which laboratory value should the nurse monitor most closely
as a direct class-specific adverse effect?
• A. Serum sodium and potassium levels
• B. Serum blood urea nitrogen alone
• C. Serum total bilirubin levels
• D. Activated partial thromboplastin time (aPTT)
Correct Answer: A. Serum sodium and potassium levels
Detailed Rationale: Loop diuretics inhibit sodium and chloride
reabsorption in the ascending limb of the loop of Henle, leading to
significant excretion of water, sodium, potassium, calcium, and
magnesium. Hypokalemia and hyponatremia are hallmark class-specific
electrolyte imbalances that require close monitoring and often
replacement therapy.
Question 3
A client with type 2 diabetes mellitus is scheduled to receive
intravenous iodinated radiocontrast media for a computed tomography
(CT) scan. The client takes metformin (a biguanide). What is the
essential nursing medication management action regarding this drug?
• A. Double the metformin dose prior to the procedure to prevent
hyperglycemia.
• B. Discontinue metformin at the time of or prior to the procedure
and withhold it for 48 hours afterward, resuming only after renal
function is confirmed normal.
, • C. Switch the client to sliding-scale regular insulin permanently.
• D. Administer metformin with the contrast dye to protect renal
tubules.
Correct Answer: B. Discontinue metformin at the time of or prior to the
procedure and withhold it for 48 hours afterward, resuming only after
renal function is confirmed normal.
Detailed Rationale: Iodinated contrast media can cause acute kidney
injury, which impairs the renal excretion of metformin. Accumulation of
metformin significantly increases the risk of life-threatening lactic
acidosis. Therefore, metformin must be temporarily withheld around
the time of iodinated contrast procedures.
Question 4
A client with a history of bronchial asthma is admitted for hypertension.
The physician considers starting a beta-blocker. Which classification of
beta-blockers is strictly contraindicated or requires extreme caution in
this client?
• A. Cardioselective beta-1 blockers (e.g., metoprolol)
• B. Non-selective beta blockers (e.g., propranolol)
• C. Third-generation vasodilating beta blockers (e.g., carvedilol)
• D. Intrinsic sympathomimetic activity beta blockers
Correct Answer: B. Non-selective beta blockers (e.g., propranolol)
Detailed Rationale: Non-selective beta blockers block both beta-1
receptors (heart) and beta-2 receptors (bronchi and blood vessels).
Blocking beta-2 receptors in the lungs triggers bronchoconstriction,
, which can precipitate a severe, life-threatening asthma attack.
Cardioselective beta-1 blockers are safer but still require caution in
severe reactive airway disease.
Question 5
A client with a severe gram-negative infection is receiving intravenous
gentamicin (an aminoglycoside). Which nursing action is most
important to prevent nephrotoxicity and ototoxicity?
• A. Monitoring peak and trough serum drug levels alongside
baseline and serial serum creatinine
• B. Administering the infusion rapidly over 5 minutes to maintain
peak concentration
• C. Restricting fluid intake to 1,000 mL per day
• D. Combining gentamicin with other nephrotoxic drugs like NSAIDs
to enhance efficacy
Correct Answer: A. Monitoring peak and trough serum drug levels
alongside baseline and serial serum creatinine
Detailed Rationale: Aminoglycosides have a narrow therapeutic index
and accumulate in the renal cortex and inner ear, causing acute tubular
necrosis and eighth cranial nerve damage. Serial monitoring of trough
levels ensures the drug is clearing properly between doses, while peak
levels ensure efficacy. Serum creatinine must be monitored closely.
Question 6
A client taking digoxin (a cardiac glycoside) for heart failure reports
seeing yellowish-green halos around lights, persistent nausea, and
profound fatigue. What is the priority nursing action?
Medication Management Questions with Rationales
Question 1
A nurse is providing discharge instructions to a client newly prescribed
atorvastatin (an HMG-CoA reductase inhibitor) for hyperlipidemia.
Which client statement indicates a correct understanding of the
medication management?
• A. "I should take this medication first thing in the morning with a
glass of grapefruit juice."
• B. "I will take this medication in the evening, as cholesterol
synthesis in the liver peaks at night."
• C. "If I develop mild muscle aches, I can ignore them because they
are completely harmless."
• D. "I should stop taking this medication immediately if my total
cholesterol drops below 200 mg/dL."
Correct Answer: B. "I will take this medication in the evening, as
cholesterol synthesis in the liver peaks at night."
Detailed Rationale: HMG-CoA reductase inhibitors (statins) with a
shorter half-life are most effective when taken in the evening or at
bedtime because hepatic cholesterol synthesis reaches its peak
overnight. Grapefruit juice must be avoided because it inhibits CYP3A4
enzymes, raising statin blood levels and increasing the risk of myopathy
and rhabdomyolysis. Muscle aches must be reported promptly, as they
can indicate rhabdomyolysis.
Question 2
,A client with chronic heart failure is prescribed furosemide (a loop
diuretic). Which laboratory value should the nurse monitor most closely
as a direct class-specific adverse effect?
• A. Serum sodium and potassium levels
• B. Serum blood urea nitrogen alone
• C. Serum total bilirubin levels
• D. Activated partial thromboplastin time (aPTT)
Correct Answer: A. Serum sodium and potassium levels
Detailed Rationale: Loop diuretics inhibit sodium and chloride
reabsorption in the ascending limb of the loop of Henle, leading to
significant excretion of water, sodium, potassium, calcium, and
magnesium. Hypokalemia and hyponatremia are hallmark class-specific
electrolyte imbalances that require close monitoring and often
replacement therapy.
Question 3
A client with type 2 diabetes mellitus is scheduled to receive
intravenous iodinated radiocontrast media for a computed tomography
(CT) scan. The client takes metformin (a biguanide). What is the
essential nursing medication management action regarding this drug?
• A. Double the metformin dose prior to the procedure to prevent
hyperglycemia.
• B. Discontinue metformin at the time of or prior to the procedure
and withhold it for 48 hours afterward, resuming only after renal
function is confirmed normal.
, • C. Switch the client to sliding-scale regular insulin permanently.
• D. Administer metformin with the contrast dye to protect renal
tubules.
Correct Answer: B. Discontinue metformin at the time of or prior to the
procedure and withhold it for 48 hours afterward, resuming only after
renal function is confirmed normal.
Detailed Rationale: Iodinated contrast media can cause acute kidney
injury, which impairs the renal excretion of metformin. Accumulation of
metformin significantly increases the risk of life-threatening lactic
acidosis. Therefore, metformin must be temporarily withheld around
the time of iodinated contrast procedures.
Question 4
A client with a history of bronchial asthma is admitted for hypertension.
The physician considers starting a beta-blocker. Which classification of
beta-blockers is strictly contraindicated or requires extreme caution in
this client?
• A. Cardioselective beta-1 blockers (e.g., metoprolol)
• B. Non-selective beta blockers (e.g., propranolol)
• C. Third-generation vasodilating beta blockers (e.g., carvedilol)
• D. Intrinsic sympathomimetic activity beta blockers
Correct Answer: B. Non-selective beta blockers (e.g., propranolol)
Detailed Rationale: Non-selective beta blockers block both beta-1
receptors (heart) and beta-2 receptors (bronchi and blood vessels).
Blocking beta-2 receptors in the lungs triggers bronchoconstriction,
, which can precipitate a severe, life-threatening asthma attack.
Cardioselective beta-1 blockers are safer but still require caution in
severe reactive airway disease.
Question 5
A client with a severe gram-negative infection is receiving intravenous
gentamicin (an aminoglycoside). Which nursing action is most
important to prevent nephrotoxicity and ototoxicity?
• A. Monitoring peak and trough serum drug levels alongside
baseline and serial serum creatinine
• B. Administering the infusion rapidly over 5 minutes to maintain
peak concentration
• C. Restricting fluid intake to 1,000 mL per day
• D. Combining gentamicin with other nephrotoxic drugs like NSAIDs
to enhance efficacy
Correct Answer: A. Monitoring peak and trough serum drug levels
alongside baseline and serial serum creatinine
Detailed Rationale: Aminoglycosides have a narrow therapeutic index
and accumulate in the renal cortex and inner ear, causing acute tubular
necrosis and eighth cranial nerve damage. Serial monitoring of trough
levels ensures the drug is clearing properly between doses, while peak
levels ensure efficacy. Serum creatinine must be monitored closely.
Question 6
A client taking digoxin (a cardiac glycoside) for heart failure reports
seeing yellowish-green halos around lights, persistent nausea, and
profound fatigue. What is the priority nursing action?
