NUR 2474 PHARMACOLOGY FINAL EXAM NCLEX-STYLE PRACTICE |
COMPREHENSIVE STUDY GUIDE, PRACTICE QUESTIONS & ANSWERS
2026/2027
a.The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin
insulin - ANS ✔✔The nurse working on a high-acuity medical-surgical unit is prioritizing care for four
patients who were just admitted. Which patient should the nurse assess first?
a.The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin
insulin
b.The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin)
c.The patient with a blood pressure of 136/92 mm Hg who complains of having a headache
d.The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin)
d.Lispro (Humalog) - ANS ✔✔A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars
are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is
317 mg/dL. Which formulation of insulin should the nurse prepare to administer?
a.No insulin should be administered.
b.NPH
c.70/30 mix
d.Lispro (Humalog)
c.Six or seven times a day - ANS ✔✔A patient with type 1 diabetes recently became pregnant. The nurse
plans a blood glucose testing schedule for her. What is the recommended monitoring schedule?
a.Before each meal and before bed
b.In the morning for a fasting level and at 4 PM for the peak level
c.Six or seven times a day
d.Three times a day, along with urine glucose testing
a."Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." -
ANS ✔✔An adolescent patient recently attended a health fair and had a serum glucose test. The patient
telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the
nurse's most accurate response?
a."Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes."
b."At this level, you probably have diabetes. You will need an oral glucose tolerance test this week."
c."This level is conclusive evidence that you have diabetes."
d."This level is conclusive evidence that you do not have diabetes."
c.Once daily at bedtime - ANS ✔✔Insulin glargine is prescribed for a hospitalized patient who is diabetic.
When will the nurse administer this drug?
a.Approximately 15 to 30 minutes before each meal
,b.In the morning and at 4 PM
c.Once daily at bedtime
d.After meals and at bedtime
d.The beta blocker can mask the symptoms of hypoglycemia. - ANS ✔✔A patient with type 1 diabetes
who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned?
a.The beta blocker can cause insulin resistance.
b.Using the two agents together increases the risk of ketoacidosis.
c.Propranolol increases insulin requirements because of receptor blocking.
d.The beta blocker can mask the symptoms of hypoglycemia.
a.Miglitol has not been associated with hepatic dysfunction. - ANS ✔✔Which statement is correct about
the contrast between acarbose and miglitol?
a.Miglitol has not been associated with hepatic dysfunction.
b.With miglitol, sucrose can be used to treat hypoglycemia.
c.Miglitol is less effective in African Americans.
d.Miglitol has no gastrointestinal side effects.
b.Flatulence
e.Diarrhea - ANS ✔✔A nurse counsels a patient with diabetes who is starting therapy with an alpha-
glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions?
(Select all that apply.)
a.Hypoglycemia
b.Flatulence
c.Elevated iron levels in the blood
d.Fluid retention
e.Diarrhea
b.Neuropsychologic deficits in the fetus can occur if the condition is not treated. - ANS ✔✔The nurse is
caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she
does not want to take medications while she is pregnant. What will the nurse explain to this patient?
a.Hypothyroidism is a normal effect of pregnancy and usually is of no consequence.
b.Neuropsychologic deficits in the fetus can occur if the condition is not treated.
c.No danger to the fetus exists until the third trimester.
d.Treatment is required only if the patient is experiencing symptoms.
d."If I take calcium supplements, I may need to decrease my dose of Synthroid." - ANS ✔✔A nurse is
teaching a patient who has been diagnosed with hypothyroidism about levothyroxine (Synthroid). Which
statement by the patient indicates a need for further teaching?
a."I should not take heartburn medication without consulting my provider."
b."I should report insomnia, tremors, and an increased heart rate to my provider."
c."If I take a multivitamin with iron, I should take it 4 hours after the Synthroid."
d."If I take calcium supplements, I may need to decrease my dose of Synthroid."
,c.Intravenous levothyroxine - ANS ✔✔A patient with hypothyroidism begins taking PO levothyroxine
(Synthroid). The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62
beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to arouse. The nurse
will contact the provider to request an order for which drug?
a.Beta blocker
b.Increased dose of PO levothyroxine
c.Intravenous levothyroxine
d.Methimazole (Tapazole)
b.reducing; warfarin - ANS ✔✔A patient is admitted to the hospital and will begin taking levothyroxine
(Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The nurse will notify the
provider to discuss _____ the _____ dose.
a.reducing levothyroxine
b.reducing warfarin
c.increasing levothyroxine
d.increasing warfarin
d.Suggest that the provider lower the dose. - ANS ✔✔An older adult patient is diagnosed with
hypothyroidism. The initial free T4 level is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The
prescriber orders levothyroxine (Levothroid) 100 mcg/day PO. What will the nurse do?
a.Administer the medication as ordered.
b.Contact the provider to discuss giving the levothyroxine IV.
c.Request an order to give desiccated thyroid (Armour Thyroid).
d.Suggest that the provider lower the dose.
a.change the dose of levothyroxine to 6 mcg/kg/day. - ANS ✔✔A 1-year-old child with cretinism has
been receiving 8 mcg/kg/day of levothyroxine (Synthroid). The child comes to the clinic for a well-child
check up. The nurse will expect the provider to:
a.change the dose of levothyroxine to 6 mcg/kg/day.
b.discontinue the drug if the child's physical and mental development is normal.
c.increase the dose to accommodate the child's increased growth.
d.stop the drug for 4 weeks and check the child's TSH level.
c.Select an alternate intravenous site and administer the infusion more slowly. - ANS ✔✔A patient who
is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the
infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. What is the
nurse's priority action?
a.Apply warm packs to the arm, and infuse the medication at a slower rate.
b.Continue the infusion while elevating the arm.
c.Select an alternate intravenous site and administer the infusion more slowly.
d.Request central venous access.
, b."Cephalosporins have increased activity against gram-negative bacteria with each generation." - ANS
✔✔A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which
statement by the student indicates understanding of the teaching?
a."Cephalosporins are assigned to generations based on their relative costs to administer."
b."Cephalosporins have increased activity against gram-negative bacteria with each generation."
c."First-generation cephalosporins have better penetration of the cerebrospinal fluid."
d."Later generations of cephalosporins have lower resistance to destruction by beta-lactamases."
a.Administer the medication as prescribed. - ANS ✔✔A provider has ordered ceftriaxone 4 gm once daily
for a patient with renal impairment. What will the nurse do?
a.Administer the medication as prescribed.
b.Contact the provider to ask about giving the drug in divided doses.
c.Discuss increasing the interval between doses with the provider.
d.Discuss reducing the dose with the provider.
a.Abstain from alcohol consumption during therapy. - ANS ✔✔A patient will be discharged home to
complete treatment with intravenous cefotetan with the assistance of a home nurse. The home care
nurse will include which instruction when teaching the patient about this drug treatment?
a.Abstain from alcohol consumption during therapy.
b.Avoid dairy products while taking this drug.
c.Take an antihistamine if a rash occurs.
d.Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain.
b.red man syndrome. - ANS ✔✔The nurse is caring for a patient who is receiving vancomycin (Vancocin).
The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart
rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these
findings are consistent with:
a.allergic reaction.
b.red man syndrome.
c.rhabdomyolysis.
d.Stevens-Johnson syndrome.
a.First-generation cephalosporin - ANS ✔✔A patient is to undergo orthopedic surgery, and the prescriber
will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects
the provider to order which cephalosporin?
a.First-generation cephalosporin
b.Second-generation cephalosporin
c.Third-generation cephalosporin
d.Fourth-generation cephalosporin
b.Discontinuing the cephalosporin and beginning metronidazole (Flagyl) - ANS ✔✔A patient receiving a
cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an
appropriate treatment for this patient?
COMPREHENSIVE STUDY GUIDE, PRACTICE QUESTIONS & ANSWERS
2026/2027
a.The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin
insulin - ANS ✔✔The nurse working on a high-acuity medical-surgical unit is prioritizing care for four
patients who were just admitted. Which patient should the nurse assess first?
a.The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin
insulin
b.The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin)
c.The patient with a blood pressure of 136/92 mm Hg who complains of having a headache
d.The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin)
d.Lispro (Humalog) - ANS ✔✔A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars
are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is
317 mg/dL. Which formulation of insulin should the nurse prepare to administer?
a.No insulin should be administered.
b.NPH
c.70/30 mix
d.Lispro (Humalog)
c.Six or seven times a day - ANS ✔✔A patient with type 1 diabetes recently became pregnant. The nurse
plans a blood glucose testing schedule for her. What is the recommended monitoring schedule?
a.Before each meal and before bed
b.In the morning for a fasting level and at 4 PM for the peak level
c.Six or seven times a day
d.Three times a day, along with urine glucose testing
a."Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." -
ANS ✔✔An adolescent patient recently attended a health fair and had a serum glucose test. The patient
telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the
nurse's most accurate response?
a."Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes."
b."At this level, you probably have diabetes. You will need an oral glucose tolerance test this week."
c."This level is conclusive evidence that you have diabetes."
d."This level is conclusive evidence that you do not have diabetes."
c.Once daily at bedtime - ANS ✔✔Insulin glargine is prescribed for a hospitalized patient who is diabetic.
When will the nurse administer this drug?
a.Approximately 15 to 30 minutes before each meal
,b.In the morning and at 4 PM
c.Once daily at bedtime
d.After meals and at bedtime
d.The beta blocker can mask the symptoms of hypoglycemia. - ANS ✔✔A patient with type 1 diabetes
who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned?
a.The beta blocker can cause insulin resistance.
b.Using the two agents together increases the risk of ketoacidosis.
c.Propranolol increases insulin requirements because of receptor blocking.
d.The beta blocker can mask the symptoms of hypoglycemia.
a.Miglitol has not been associated with hepatic dysfunction. - ANS ✔✔Which statement is correct about
the contrast between acarbose and miglitol?
a.Miglitol has not been associated with hepatic dysfunction.
b.With miglitol, sucrose can be used to treat hypoglycemia.
c.Miglitol is less effective in African Americans.
d.Miglitol has no gastrointestinal side effects.
b.Flatulence
e.Diarrhea - ANS ✔✔A nurse counsels a patient with diabetes who is starting therapy with an alpha-
glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions?
(Select all that apply.)
a.Hypoglycemia
b.Flatulence
c.Elevated iron levels in the blood
d.Fluid retention
e.Diarrhea
b.Neuropsychologic deficits in the fetus can occur if the condition is not treated. - ANS ✔✔The nurse is
caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she
does not want to take medications while she is pregnant. What will the nurse explain to this patient?
a.Hypothyroidism is a normal effect of pregnancy and usually is of no consequence.
b.Neuropsychologic deficits in the fetus can occur if the condition is not treated.
c.No danger to the fetus exists until the third trimester.
d.Treatment is required only if the patient is experiencing symptoms.
d."If I take calcium supplements, I may need to decrease my dose of Synthroid." - ANS ✔✔A nurse is
teaching a patient who has been diagnosed with hypothyroidism about levothyroxine (Synthroid). Which
statement by the patient indicates a need for further teaching?
a."I should not take heartburn medication without consulting my provider."
b."I should report insomnia, tremors, and an increased heart rate to my provider."
c."If I take a multivitamin with iron, I should take it 4 hours after the Synthroid."
d."If I take calcium supplements, I may need to decrease my dose of Synthroid."
,c.Intravenous levothyroxine - ANS ✔✔A patient with hypothyroidism begins taking PO levothyroxine
(Synthroid). The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62
beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to arouse. The nurse
will contact the provider to request an order for which drug?
a.Beta blocker
b.Increased dose of PO levothyroxine
c.Intravenous levothyroxine
d.Methimazole (Tapazole)
b.reducing; warfarin - ANS ✔✔A patient is admitted to the hospital and will begin taking levothyroxine
(Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The nurse will notify the
provider to discuss _____ the _____ dose.
a.reducing levothyroxine
b.reducing warfarin
c.increasing levothyroxine
d.increasing warfarin
d.Suggest that the provider lower the dose. - ANS ✔✔An older adult patient is diagnosed with
hypothyroidism. The initial free T4 level is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The
prescriber orders levothyroxine (Levothroid) 100 mcg/day PO. What will the nurse do?
a.Administer the medication as ordered.
b.Contact the provider to discuss giving the levothyroxine IV.
c.Request an order to give desiccated thyroid (Armour Thyroid).
d.Suggest that the provider lower the dose.
a.change the dose of levothyroxine to 6 mcg/kg/day. - ANS ✔✔A 1-year-old child with cretinism has
been receiving 8 mcg/kg/day of levothyroxine (Synthroid). The child comes to the clinic for a well-child
check up. The nurse will expect the provider to:
a.change the dose of levothyroxine to 6 mcg/kg/day.
b.discontinue the drug if the child's physical and mental development is normal.
c.increase the dose to accommodate the child's increased growth.
d.stop the drug for 4 weeks and check the child's TSH level.
c.Select an alternate intravenous site and administer the infusion more slowly. - ANS ✔✔A patient who
is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the
infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. What is the
nurse's priority action?
a.Apply warm packs to the arm, and infuse the medication at a slower rate.
b.Continue the infusion while elevating the arm.
c.Select an alternate intravenous site and administer the infusion more slowly.
d.Request central venous access.
, b."Cephalosporins have increased activity against gram-negative bacteria with each generation." - ANS
✔✔A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which
statement by the student indicates understanding of the teaching?
a."Cephalosporins are assigned to generations based on their relative costs to administer."
b."Cephalosporins have increased activity against gram-negative bacteria with each generation."
c."First-generation cephalosporins have better penetration of the cerebrospinal fluid."
d."Later generations of cephalosporins have lower resistance to destruction by beta-lactamases."
a.Administer the medication as prescribed. - ANS ✔✔A provider has ordered ceftriaxone 4 gm once daily
for a patient with renal impairment. What will the nurse do?
a.Administer the medication as prescribed.
b.Contact the provider to ask about giving the drug in divided doses.
c.Discuss increasing the interval between doses with the provider.
d.Discuss reducing the dose with the provider.
a.Abstain from alcohol consumption during therapy. - ANS ✔✔A patient will be discharged home to
complete treatment with intravenous cefotetan with the assistance of a home nurse. The home care
nurse will include which instruction when teaching the patient about this drug treatment?
a.Abstain from alcohol consumption during therapy.
b.Avoid dairy products while taking this drug.
c.Take an antihistamine if a rash occurs.
d.Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain.
b.red man syndrome. - ANS ✔✔The nurse is caring for a patient who is receiving vancomycin (Vancocin).
The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart
rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these
findings are consistent with:
a.allergic reaction.
b.red man syndrome.
c.rhabdomyolysis.
d.Stevens-Johnson syndrome.
a.First-generation cephalosporin - ANS ✔✔A patient is to undergo orthopedic surgery, and the prescriber
will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects
the provider to order which cephalosporin?
a.First-generation cephalosporin
b.Second-generation cephalosporin
c.Third-generation cephalosporin
d.Fourth-generation cephalosporin
b.Discontinuing the cephalosporin and beginning metronidazole (Flagyl) - ANS ✔✔A patient receiving a
cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an
appropriate treatment for this patient?
