NSG 1540 PHARMACOTHERAPEUTICS FINAL EXAM COMPREHENSIVE
EXAM QUESTIONS COMPLETE WITH 100% VERIFIED ANSWERS
1. A patient with liver cirrhosis is prescribed a medication with
extensive first-pass metabolism. The nurse should anticipate which of
the following effects?
A. Decreased bioavailability and reduced therapeutic effect
B. Increased bioavailability and higher risk of toxicity
C. No change in drug metabolism or absorption
D. Faster drug elimination through renal excretion
CORRECT ANSWER: B. Increased bioavailability and higher risk of
toxicity
Rationale: Liver cirrhosis impairs hepatic function, reducing the liver's
ability to metabolize drugs during first-pass metabolism. When a drug
with extensive first-pass metabolism is given orally to a patient with
cirrhosis, more of the drug escapes metabolism and reaches systemic
circulation unchanged, leading to increased bioavailability. This places
the patient at higher risk for toxicity, requiring dose adjustment.
2. The nurse is caring for a patient prescribed gentamicin. Which
laboratory value should be prioritized for monitoring to prevent
toxicity?
A. Serum creatinine
B. Serum potassium
,C. Serum sodium
D. Serum albumin
CORRECT ANSWER: A. Serum creatinine
Rationale: Gentamicin is an aminoglycoside antibiotic with significant
nephrotoxic potential. Serum creatinine is the most important
laboratory value to monitor as it reflects kidney function. Elevated
creatinine indicates impaired renal clearance, increasing the risk of drug
accumulation and toxicity. Peak and trough levels should also be
monitored to maintain therapeutic concentrations and minimize
nephrotoxicity.
3. A patient prescribed warfarin asks about dietary restrictions. Which
food should the nurse advise the patient to consume consistently?
A. Foods high in vitamin K
B. Foods high in potassium
C. Foods high in calcium
D. Foods high in magnesium
CORRECT ANSWER: A. Foods high in vitamin K
Rationale: Warfarin is a vitamin K antagonist that inhibits vitamin K-
dependent clotting factors. Sudden changes in vitamin K intake can alter
the INR and affect anticoagulation control. Patients should be advised to
maintain consistent intake of vitamin K-rich foods (such as green leafy
vegetables) rather than avoiding them completely. This consistency
allows for stable anticoagulation and reduces the risk of bleeding or
clotting complications.
,4. The nurse is preparing to administer digoxin. Which assessment
finding would indicate the need to hold the medication and notify the
healthcare provider?
A. Apical pulse of 72 beats per minute
B. Apical pulse of 88 beats per minute
C. Apical pulse of 52 beats per minute
D. Blood pressure of 118/76 mmHg
CORRECT ANSWER: C. Apical pulse of 52 beats per minute
Rationale: Digoxin has a positive inotropic effect and negative
chronotropic effect, meaning it slows the heart rate. The standard
practice is to hold digoxin and notify the healthcare provider if the
apical pulse is below 60 beats per minute in adults. A pulse of 52 bpm
indicates significant bradycardia, putting the patient at risk for
decreased cardiac output, dizziness, and syncope.
5. A patient is prescribed metronidazole for trichomoniasis. Which
instruction is most important for the nurse to include in patient
teaching?
A. Take the medication with food to prevent nausea
B. Avoid alcohol consumption during and for 48 hours after therapy
C. Monitor for signs of hyperglycemia
D. Take the medication at bedtime to reduce drowsiness
CORRECT ANSWER: B. Avoid alcohol consumption during and for 48
hours after therapy
, Rationale: Metronidazole can cause a disulfiram-like reaction when
combined with alcohol, characterized by severe nausea, vomiting,
flushing, headache, and tachycardia. Patients must be instructed to
avoid alcohol during treatment and for at least 48 hours after the last
dose to prevent this potentially serious adverse reaction. A metallic
taste is another common side effect of metronidazole.
6. The nurse is caring for a patient receiving vancomycin infusion. The
patient develops flushing and rash on the face and trunk. What is the
appropriate nursing action?
A. Stop the infusion immediately and administer diphenhydramine
B. Slow the infusion rate and continue monitoring
C. Administer epinephrine 1:1000 intramuscularly
D. Discontinue the medication and notify the prescriber
CORRECT ANSWER: B. Slow the infusion rate and continue monitoring
Rationale: Red Man Syndrome (also known as Red Neck Syndrome) is a
non-allergic reaction to rapid vancomycin infusion, characterized by
flushing and rash on the face, neck, and upper torso. It is caused by
histamine release related to rapid infusion rate. The appropriate nursing
intervention is to slow the infusion rate; this is not an anaphylactic
reaction requiring epinephrine. The reaction typically resolves with
slower infusion.
7. A patient with asthma is prescribed a beta-blocker for hypertension.
Which medication should the nurse question?
EXAM QUESTIONS COMPLETE WITH 100% VERIFIED ANSWERS
1. A patient with liver cirrhosis is prescribed a medication with
extensive first-pass metabolism. The nurse should anticipate which of
the following effects?
A. Decreased bioavailability and reduced therapeutic effect
B. Increased bioavailability and higher risk of toxicity
C. No change in drug metabolism or absorption
D. Faster drug elimination through renal excretion
CORRECT ANSWER: B. Increased bioavailability and higher risk of
toxicity
Rationale: Liver cirrhosis impairs hepatic function, reducing the liver's
ability to metabolize drugs during first-pass metabolism. When a drug
with extensive first-pass metabolism is given orally to a patient with
cirrhosis, more of the drug escapes metabolism and reaches systemic
circulation unchanged, leading to increased bioavailability. This places
the patient at higher risk for toxicity, requiring dose adjustment.
2. The nurse is caring for a patient prescribed gentamicin. Which
laboratory value should be prioritized for monitoring to prevent
toxicity?
A. Serum creatinine
B. Serum potassium
,C. Serum sodium
D. Serum albumin
CORRECT ANSWER: A. Serum creatinine
Rationale: Gentamicin is an aminoglycoside antibiotic with significant
nephrotoxic potential. Serum creatinine is the most important
laboratory value to monitor as it reflects kidney function. Elevated
creatinine indicates impaired renal clearance, increasing the risk of drug
accumulation and toxicity. Peak and trough levels should also be
monitored to maintain therapeutic concentrations and minimize
nephrotoxicity.
3. A patient prescribed warfarin asks about dietary restrictions. Which
food should the nurse advise the patient to consume consistently?
A. Foods high in vitamin K
B. Foods high in potassium
C. Foods high in calcium
D. Foods high in magnesium
CORRECT ANSWER: A. Foods high in vitamin K
Rationale: Warfarin is a vitamin K antagonist that inhibits vitamin K-
dependent clotting factors. Sudden changes in vitamin K intake can alter
the INR and affect anticoagulation control. Patients should be advised to
maintain consistent intake of vitamin K-rich foods (such as green leafy
vegetables) rather than avoiding them completely. This consistency
allows for stable anticoagulation and reduces the risk of bleeding or
clotting complications.
,4. The nurse is preparing to administer digoxin. Which assessment
finding would indicate the need to hold the medication and notify the
healthcare provider?
A. Apical pulse of 72 beats per minute
B. Apical pulse of 88 beats per minute
C. Apical pulse of 52 beats per minute
D. Blood pressure of 118/76 mmHg
CORRECT ANSWER: C. Apical pulse of 52 beats per minute
Rationale: Digoxin has a positive inotropic effect and negative
chronotropic effect, meaning it slows the heart rate. The standard
practice is to hold digoxin and notify the healthcare provider if the
apical pulse is below 60 beats per minute in adults. A pulse of 52 bpm
indicates significant bradycardia, putting the patient at risk for
decreased cardiac output, dizziness, and syncope.
5. A patient is prescribed metronidazole for trichomoniasis. Which
instruction is most important for the nurse to include in patient
teaching?
A. Take the medication with food to prevent nausea
B. Avoid alcohol consumption during and for 48 hours after therapy
C. Monitor for signs of hyperglycemia
D. Take the medication at bedtime to reduce drowsiness
CORRECT ANSWER: B. Avoid alcohol consumption during and for 48
hours after therapy
, Rationale: Metronidazole can cause a disulfiram-like reaction when
combined with alcohol, characterized by severe nausea, vomiting,
flushing, headache, and tachycardia. Patients must be instructed to
avoid alcohol during treatment and for at least 48 hours after the last
dose to prevent this potentially serious adverse reaction. A metallic
taste is another common side effect of metronidazole.
6. The nurse is caring for a patient receiving vancomycin infusion. The
patient develops flushing and rash on the face and trunk. What is the
appropriate nursing action?
A. Stop the infusion immediately and administer diphenhydramine
B. Slow the infusion rate and continue monitoring
C. Administer epinephrine 1:1000 intramuscularly
D. Discontinue the medication and notify the prescriber
CORRECT ANSWER: B. Slow the infusion rate and continue monitoring
Rationale: Red Man Syndrome (also known as Red Neck Syndrome) is a
non-allergic reaction to rapid vancomycin infusion, characterized by
flushing and rash on the face, neck, and upper torso. It is caused by
histamine release related to rapid infusion rate. The appropriate nursing
intervention is to slow the infusion rate; this is not an anaphylactic
reaction requiring epinephrine. The reaction typically resolves with
slower infusion.
7. A patient with asthma is prescribed a beta-blocker for hypertension.
Which medication should the nurse question?
