ARIZONA COLLEGE OF NURSING
NUR 354 - Pharmacology II
FINAL EXAM 4 FALL 2026
1. A client has a low serum calcium level. Which hormone response is expected according to the
study guide?
A. Insulin increases to release calcium from bone.
B. Parathyroid hormone increases to raise serum calcium.
C. Calcitonin increases to raise serum calcium.
D. Thyroid-stimulating hormone increases to lower serum calcium.
✓ Correct Answer: B. Parathyroid hormone increases to raise serum calcium.
Rationale: The study guide states that falling serum calcium stimulates parathyroid hormone, which
raises calcium through bone and gastrointestinal effects.
2. Which assessment finding is most concerning for thyroid storm?
A. Mild nausea after dulaglutide
B. High fever with severe tachycardia and agitation
C. Dark stools with constipation
D. Bradycardia with cold intolerance
✓ Correct Answer: B. High fever with severe tachycardia and agitation
Rationale: Thyroid storm is described as a life-threatening hyperthyroid crisis with high fever,
tachycardia, agitation/restlessness, and cardiovascular complications.
3. A client receiving blood develops fever, chills, low back pain, and dark urine. Which reaction is
most consistent with these findings?
A. Expected response to iron therapy
B. Thyroid storm
C. Mild dehydration
D. Acute hemolytic transfusion reaction
✓ Correct Answer: D. Acute hemolytic transfusion reaction
Rationale: The transfusion review associates low back pain, fever/chills, oliguria, and dark urine with a
hemolytic reaction.
4. Which item should be avoided in the room of a neutropenic client according to the review?
A. A blood pressure cuff
B. Fresh flowers or plants
C. A call light
D. A clean blanket
✓ Correct Answer: B. Fresh flowers or plants
Rationale: Neutropenic precautions include strict hygiene, no fresh flowers/plants, no raw foods, and
limiting infection exposure.
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,5. Which complication should the nurse monitor for in a client taking dapagliflozin?
A. Genital yeast infection or urinary tract infection
B. Cardiotoxicity from anthracyclines
C. Uterine cancer
D. Agranulocytosis from iodine blockade
✓ Correct Answer: A. Genital yeast infection or urinary tract infection
Rationale: The review links SGLT2-related glucosuria with genital yeast infections and urinary tract
infections.
6. A client receiving filgrastim reports left upper abdominal and shoulder pain. What is the nurse's
priority concern?
A. Expected iron-related constipation
B. Normal thyroid replacement response
C. Possible splenic complication that requires prompt reporting
D. Expected dark urine from doxorubicin
✓ Correct Answer: C. Possible splenic complication that requires prompt
reporting Rationale: The review identifies splenomegaly/splenic rupture as a rare serious
filgrastim risk and says left upper abdominal or shoulder pain should be reported immediately.
7. Why should iron supplementation generally be continued when a client receives epoetin alfa?
A. Iron prevents water intoxication.
B. Iron reduces TSH.
C. Adequate iron stores are needed for effective red blood cell production.
D. Iron reverses neutropenia directly.
✓ Correct Answer: C. Adequate iron stores are needed for effective
red blood cell production.
Rationale: The review explains that adequate iron stores are required for epoetin alfa to stimulate
effective erythropoiesis.
8. A client with Addison disease takes hydrocortisone. Which teaching is most important?
A. Skip doses during illness or surgery.
B. Avoid taking the medication with food.
C. Stop the medication as soon as symptoms improve.
D. Do not stop the medication abruptly.
✓ Correct Answer: D. Do not stop the medication abruptly.
Rationale: Abrupt corticosteroid withdrawal can precipitate life-threatening adrenal insufficiency; the
sources stress tapering rather than sudden discontinuation.
9. Which electrolyte pattern is consistent with Addison disease according to the review?
A. Normal sodium with severe hypercalcemia
B. Hypernatremia and hypokalemia
C. Hypercalcemia and hypophosphatemia
D. Hyponatremia and hyperkalemia
✓ Correct Answer: D. Hyponatremia and hyperkalemia
Rationale: The review identifies hyponatremia and hyperkalemia as characteristic of Addison disease.
10. Which factors are identified as contributors to iron-deficiency anemia in the notes?
A. Heavy menstrual bleeding and frequent antacid use
B. Levothyroxine and calcium deficiency
C. Excess vitamin C and high iron intake
D. Desmopressin use and high sodium intake
✓ Correct Answer: A. Heavy menstrual bleeding and frequent antacid use
Rationale: The notes identify heavy menstrual periods and repeated antacid use as contributors to iron-
deficiency anemia.
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, 11. Which laboratory value requires close monitoring in a client receiving desmopressin?
A. Serum troponin
B. Serum bilirubin
C. Serum sodium
D. Serum amylase
✓ Correct Answer: C. Serum sodium
Rationale: The notes repeatedly emphasize sodium monitoring because desmopressin can cause water
intoxication and hyponatremia.
12. A client with Graves disease is prescribed methimazole. Which adverse effect requires the
most focused teaching?
A. Peripheral neuropathy from vincristine
B. Dark stools from iron therapy
C. Red urine for 1 to 2 days
D. Agranulocytosis
✓ Correct Answer: D. Agranulocytosis
Rationale: Agranulocytosis is identified as a serious risk of methimazole; fever, chills, or sore throat
should be reported promptly.
13. What is the first action if a transfusion reaction is suspected?
A. Wait for the provider before taking any action.
B. Remove the IV catheter immediately without saline access.
C. Administer the remaining blood rapidly.
D. Stop the transfusion immediately.
✓ Correct Answer: D. Stop the transfusion immediately.
Rationale: The review gives stopping the transfusion as the first priority whenever a reaction is suspected.
14. A client receiving doxorubicin develops redness and swelling at the infusion site. What should
the nurse do first?
A. Increase the infusion rate.
B. Continue the infusion and reassess after completion.
C. Stop the infusion.
D. Massage the site.
✓ Correct Answer: C. Stop the infusion.
Rationale: The notes state that redness and swelling may indicate extravasation and the doxorubicin
infusion should be stopped.
15. Which description best matches Addison disease in the provided materials?
A. Primary adrenal insufficiency with deficient corticosteroids and mineralocorticoids
B. Excess cortisol caused by prolonged corticosteroid exposure
C. Excess antidiuretic hormone with fluid retention
D. Autoimmune destruction of pancreatic beta cells
✓ Correct Answer: A. Primary adrenal insufficiency with deficient
corticosteroids and mineralocorticoids
Rationale: Addison disease is defined in the notes as primary adrenocortical insufficiency with deficient
corticosteroids and mineralocorticoids.
Page 3
NUR 354 - Pharmacology II
FINAL EXAM 4 FALL 2026
1. A client has a low serum calcium level. Which hormone response is expected according to the
study guide?
A. Insulin increases to release calcium from bone.
B. Parathyroid hormone increases to raise serum calcium.
C. Calcitonin increases to raise serum calcium.
D. Thyroid-stimulating hormone increases to lower serum calcium.
✓ Correct Answer: B. Parathyroid hormone increases to raise serum calcium.
Rationale: The study guide states that falling serum calcium stimulates parathyroid hormone, which
raises calcium through bone and gastrointestinal effects.
2. Which assessment finding is most concerning for thyroid storm?
A. Mild nausea after dulaglutide
B. High fever with severe tachycardia and agitation
C. Dark stools with constipation
D. Bradycardia with cold intolerance
✓ Correct Answer: B. High fever with severe tachycardia and agitation
Rationale: Thyroid storm is described as a life-threatening hyperthyroid crisis with high fever,
tachycardia, agitation/restlessness, and cardiovascular complications.
3. A client receiving blood develops fever, chills, low back pain, and dark urine. Which reaction is
most consistent with these findings?
A. Expected response to iron therapy
B. Thyroid storm
C. Mild dehydration
D. Acute hemolytic transfusion reaction
✓ Correct Answer: D. Acute hemolytic transfusion reaction
Rationale: The transfusion review associates low back pain, fever/chills, oliguria, and dark urine with a
hemolytic reaction.
4. Which item should be avoided in the room of a neutropenic client according to the review?
A. A blood pressure cuff
B. Fresh flowers or plants
C. A call light
D. A clean blanket
✓ Correct Answer: B. Fresh flowers or plants
Rationale: Neutropenic precautions include strict hygiene, no fresh flowers/plants, no raw foods, and
limiting infection exposure.
Page 1
,5. Which complication should the nurse monitor for in a client taking dapagliflozin?
A. Genital yeast infection or urinary tract infection
B. Cardiotoxicity from anthracyclines
C. Uterine cancer
D. Agranulocytosis from iodine blockade
✓ Correct Answer: A. Genital yeast infection or urinary tract infection
Rationale: The review links SGLT2-related glucosuria with genital yeast infections and urinary tract
infections.
6. A client receiving filgrastim reports left upper abdominal and shoulder pain. What is the nurse's
priority concern?
A. Expected iron-related constipation
B. Normal thyroid replacement response
C. Possible splenic complication that requires prompt reporting
D. Expected dark urine from doxorubicin
✓ Correct Answer: C. Possible splenic complication that requires prompt
reporting Rationale: The review identifies splenomegaly/splenic rupture as a rare serious
filgrastim risk and says left upper abdominal or shoulder pain should be reported immediately.
7. Why should iron supplementation generally be continued when a client receives epoetin alfa?
A. Iron prevents water intoxication.
B. Iron reduces TSH.
C. Adequate iron stores are needed for effective red blood cell production.
D. Iron reverses neutropenia directly.
✓ Correct Answer: C. Adequate iron stores are needed for effective
red blood cell production.
Rationale: The review explains that adequate iron stores are required for epoetin alfa to stimulate
effective erythropoiesis.
8. A client with Addison disease takes hydrocortisone. Which teaching is most important?
A. Skip doses during illness or surgery.
B. Avoid taking the medication with food.
C. Stop the medication as soon as symptoms improve.
D. Do not stop the medication abruptly.
✓ Correct Answer: D. Do not stop the medication abruptly.
Rationale: Abrupt corticosteroid withdrawal can precipitate life-threatening adrenal insufficiency; the
sources stress tapering rather than sudden discontinuation.
9. Which electrolyte pattern is consistent with Addison disease according to the review?
A. Normal sodium with severe hypercalcemia
B. Hypernatremia and hypokalemia
C. Hypercalcemia and hypophosphatemia
D. Hyponatremia and hyperkalemia
✓ Correct Answer: D. Hyponatremia and hyperkalemia
Rationale: The review identifies hyponatremia and hyperkalemia as characteristic of Addison disease.
10. Which factors are identified as contributors to iron-deficiency anemia in the notes?
A. Heavy menstrual bleeding and frequent antacid use
B. Levothyroxine and calcium deficiency
C. Excess vitamin C and high iron intake
D. Desmopressin use and high sodium intake
✓ Correct Answer: A. Heavy menstrual bleeding and frequent antacid use
Rationale: The notes identify heavy menstrual periods and repeated antacid use as contributors to iron-
deficiency anemia.
Page 2
, 11. Which laboratory value requires close monitoring in a client receiving desmopressin?
A. Serum troponin
B. Serum bilirubin
C. Serum sodium
D. Serum amylase
✓ Correct Answer: C. Serum sodium
Rationale: The notes repeatedly emphasize sodium monitoring because desmopressin can cause water
intoxication and hyponatremia.
12. A client with Graves disease is prescribed methimazole. Which adverse effect requires the
most focused teaching?
A. Peripheral neuropathy from vincristine
B. Dark stools from iron therapy
C. Red urine for 1 to 2 days
D. Agranulocytosis
✓ Correct Answer: D. Agranulocytosis
Rationale: Agranulocytosis is identified as a serious risk of methimazole; fever, chills, or sore throat
should be reported promptly.
13. What is the first action if a transfusion reaction is suspected?
A. Wait for the provider before taking any action.
B. Remove the IV catheter immediately without saline access.
C. Administer the remaining blood rapidly.
D. Stop the transfusion immediately.
✓ Correct Answer: D. Stop the transfusion immediately.
Rationale: The review gives stopping the transfusion as the first priority whenever a reaction is suspected.
14. A client receiving doxorubicin develops redness and swelling at the infusion site. What should
the nurse do first?
A. Increase the infusion rate.
B. Continue the infusion and reassess after completion.
C. Stop the infusion.
D. Massage the site.
✓ Correct Answer: C. Stop the infusion.
Rationale: The notes state that redness and swelling may indicate extravasation and the doxorubicin
infusion should be stopped.
15. Which description best matches Addison disease in the provided materials?
A. Primary adrenal insufficiency with deficient corticosteroids and mineralocorticoids
B. Excess cortisol caused by prolonged corticosteroid exposure
C. Excess antidiuretic hormone with fluid retention
D. Autoimmune destruction of pancreatic beta cells
✓ Correct Answer: A. Primary adrenal insufficiency with deficient
corticosteroids and mineralocorticoids
Rationale: Addison disease is defined in the notes as primary adrenocortical insufficiency with deficient
corticosteroids and mineralocorticoids.
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