Grade A+ NCLEX Questions-Pharmacology (with rationales) 2025
3. Calcitonin (Miacalcin)
A nurse is caring for a client with hyperparathyroidism and notes Rationale:
that the client's serum calcium level is 13 mg/dL. Which medication The normal serum calcium level is 8.6 to 10.0 mg/dL. This client
should the nurse prepare to administer as prescribed to the client? is experiencing hypercalcemia. Calcium gluconate and calcium
1. Calcium chloride chloride are medications used for the treatment of tetany, which
2. Calcium gluconate occurs as a result of acute hypocalcemia. In hypercalcemia, large
3. Calcitonin (Miacalcin) doses of vitamin D need to be avoided. Calcitonin, a thyroid
4. Large doses of vitamin D hormone, decreases the plasma calcium level by inhibiting bone
resorption and lowering the serum calcium concentration.
Oral iron supplements are prescribed for a 6-year-old child with 4. Orange juice
iron deficiency anemia. The nurse instructs the mother to admin- Rationale:
ister the iron with which best food item? Vitamin C increases the absorption of iron by the body. The mother
1. Milk should be instructed to administer the medication with a citrus fruit
2. Water or a juice that is high in vitamin C. Milk may affect absorption of
3. Apple juice the iron. Water will not assist in absorption. Orange juice contains
4. Orange juice a greater amount of vitamin C than apple juice.
Salicylic acid is prescribed for a client with a diagnosis of psoriasis.
The nurse monitors the client, knowing that which of the following 1. Tinnitus
would indicate the presence of systemic toxicity from this med- Rationale:
ication? Salicylic acid is absorbed readily through the skin, and systemic
1. Tinnitus toxicity (salicylism) can result. Symptoms include tinnitus, dizzi-
2. Diarrhea ness, hyperpnea, and psychological disturbances. Constipation
3. Constipation and diarrhea are not associated with salicylism.
4. Decreased respirations
A client with severe acne is seen in the clinic and the health 1. Vitamin A
care provider (HCP) prescribes isotretinoin. The nurse reviews the
client's medication record and would contact the (HCP) if the client Rationale:
Isotretinoin is a metabolite of vitamin A and can produce general-
is taking which medication?
ized intensification of isotretinoin toxicity. Because of the potential
1. Vitamin A
for increased toxicity, vitamin A supplements should be discon-
2. Digoxin (Lanoxin)
tinued before isotretinoin therapy. Options 2, 3, and 4 are not
3. Furosemide (Lasix)
contraindicated with the use of isotretinoin.
4. Phenytoin (Dilantin)
The nurse is applying a topical corticosteroid to a client with
2. Axilla
eczema. The nurse would monitor for the potential for increased
Rationale:
systemic absorption of the medication if the medication were
Topical corticosteroids can be absorbed into the systemic circula-
being applied to which of the following body areas?
tion. Absorption is higher from regions where the skin is especially
1. Back
permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia),
2. Axilla
and lower from regions in which permeability is poor (back, palms,
3. Soles of the feet
soles).
4. Palms of the hands
The health care provider has prescribed silver sulfadiazine (Sil-
vadene) for the client with a partial-thickness burn, which has cul-
tured positive for gram-negative bacteria. The nurse is reinforcing 3. "The medication will permanently stain my skin."
information to the client about the medication. Which statement Rationale:
made by the client indicates a lack of understanding about the Silver sulfadiazine (Silvadene) is an antibacterial that has a broad
treatments? spectrum of activity against gram-negative bacteria, gram-positive
1. "The medication is an antibacterial." bacteria, and yeast. It is applied directly to the wound to assist in
2. "The medication will help heal the burn." healing. It does not stain the skin.
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."
2. Calcium level
The client with metastatic breast cancer is receiving tamoxifen. Rationale:
The nurse specifically monitors which laboratory value while the Tamoxifen may increase calcium, cholesterol, and triglyceride lev-
client is taking this medication? els. Before the initiation of therapy, a complete blood count, platelet
1. Glucose level count, and serum calcium levels should be assessed. These blood
2. Calcium level levels, along with cholesterol and triglyceride levels, should be
3. Potassium level monitored periodically during therapy. The nurse should assess
4. Prothrombin time for hypercalcemia while the client is taking this medication. Signs
of hypercalcemia include increased urine volume, excessive thirst,
, Grade A+ NCLEX Questions-Pharmacology (with rationales) 2025
nausea, vomiting, constipation, hypotonicity of muscles, and deep
bone and flank pain.
3. Treat hypocalcemic tetany.
A nurse is caring for a client after thyroidectomy and notes that
Rationale:
calcium gluconate is prescribed for the client. The nurse deter-
Hypocalcemia can develop after thyroidectomy if the parathyroid
mines that this medication has been prescribed to:
glands are accidentally removed or injured during surgery. Mani-
1. Treat thyroid storm.
festations develop 1 to 7 days after surgery. If the client develops
2. Prevent cardiac irritability.
numbness and tingling around the mouth, fingertips, or toes or
3. Treat hypocalcemic tetany.
muscle spasms or twitching, the health care provider is notified
4. Stimulate the release of parathyroid hormone.
immediately. Calcium gluconate should be kept at the bedside.
2. Rotate the insulin injection sites systematically.
Rationale:
A client who has been newly diagnosed with diabetes mellitus Insulin dosages should not be adjusted or increased before un-
has been stabilized with daily insulin injections. Which information usual exercise. If acetone is found in the urine, it may possibly
should the nurse teach when carrying out plans for discharge? indicate the need for additional insulin. To minimize the discomfort
1. Keep insulin vials refrigerated at all times. associated with insulin injections, the insulin should be adminis-
2. Rotate the insulin injection sites systematically. tered at room temperature. Injection sites should be systematically
3. Increase the amount of insulin before unusual exercise. rotated from one area to another. The client should be instructed to
4. Monitor the urine acetone level to determine the insulin dosage. give injections in one area, about 1 inch apart, until the whole area
has been used and then to change to another site. This prevents
dramatic changes in daily insulin absorption.
A nurse is reinforcing teaching for a client regarding how to mix
regular insulin and NPH insulin in the same syringe. Which of the 1. Withdraws the NPH insulin first
following actions, if performed by the client, indicates the need for Rationale:
further teaching? When preparing a mixture of regular insulin with another insulin
1. Withdraws the NPH insulin first preparation, the regular insulin is drawn into the syringe first. This
2. Withdraws the regular insulin first sequence will avoid contaminating the vial of regular insulin with
3. Injects air into NPH insulin vial first insulin of another type. Options 2, 3, and 4 identify the correct
4. Injects an amount of air equal to the desired dose of insulin into actions for preparing NPH and regular insulin.
the vial
1. Alcohol
Glimepiride (Amaryl) is prescribed for a client with diabetes melli-
Rationale:
tus. A nurse reinforces instructions for the client and tells the client
When alcohol is combined with glimepiride (Amaryl), a disul-
to avoid which of the following while taking this medication?
firam-like reaction may occur. This syndrome includes flushing,
1. Alcohol
palpitations, and nausea. Alcohol can also potentiate the hypo-
2. Organ meats
glycemic effects of the medication. Clients need to be instructed to
3. Whole-grain cereals
avoid alcohol consumption while taking this medication. The items
4. Carbonated beverages
in options 2, 3, and 4 do not need to be avoided.
Sildenafil (Viagra) is prescribed to treat a client with erectile dys- 3. Use of nitroglycerin
function. A nurse reviews the client's medical record and would Rationale:
question the prescription if which of the following is noted in the Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide
client's history? in the corpus cavernosum of the penis, thus sustaining an erection.
1. Neuralgia Because of the effect of the medication, it is contraindicated with
2. Insomnia concurrent use of organic nitrates and nitroglycerin. Sildenafil
3. Use of nitroglycerin is not contraindicated with the use of vitamins. Neuralgia and
4. Use of multivitamins insomnia are side effects of the medication.
A client is taking Humulin NPH insulin daily every morning. The
2. 4 to 12 hours after administration
nurse reinforces instructions for the client and tells the client that
Rationale:
the most likely time for a hypoglycemic reaction to occur is:
Humulin NPH is an intermediate-acting insulin. The onset of action
1. 2 to 4 hours after administration
is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is
2. 4 to 12 hours after administration
24 hours. Hypoglycemic reactions most likely occur during peak
3. 16 to 18 hours after administration
time.
4. 18 to 24 hours after administration
A client with diabetes mellitus visits a health care clinic. The 1. Prednisone
client's diabetes mellitus previously had been well controlled with Rationale:
glyburide (DiaBeta) daily, but recently the fasting blood glucose Prednisone may decrease the effect of oral hypoglycemics,
level has been 180 to 200 mg/dL. Which medication, if added to insulin, diuretics, and potassium supplements. Option 2, a
the client's regimen, may have contributed to the hyperglycemia?
monoamine oxidase inhibitor, and option 3, a ² b- locker, have their
1. Prednisone
own intrinsic hypoglycemic activity. Option 4 decreases urinary
2. Phenelzine (Nardil)
3. Calcitonin (Miacalcin)
A nurse is caring for a client with hyperparathyroidism and notes Rationale:
that the client's serum calcium level is 13 mg/dL. Which medication The normal serum calcium level is 8.6 to 10.0 mg/dL. This client
should the nurse prepare to administer as prescribed to the client? is experiencing hypercalcemia. Calcium gluconate and calcium
1. Calcium chloride chloride are medications used for the treatment of tetany, which
2. Calcium gluconate occurs as a result of acute hypocalcemia. In hypercalcemia, large
3. Calcitonin (Miacalcin) doses of vitamin D need to be avoided. Calcitonin, a thyroid
4. Large doses of vitamin D hormone, decreases the plasma calcium level by inhibiting bone
resorption and lowering the serum calcium concentration.
Oral iron supplements are prescribed for a 6-year-old child with 4. Orange juice
iron deficiency anemia. The nurse instructs the mother to admin- Rationale:
ister the iron with which best food item? Vitamin C increases the absorption of iron by the body. The mother
1. Milk should be instructed to administer the medication with a citrus fruit
2. Water or a juice that is high in vitamin C. Milk may affect absorption of
3. Apple juice the iron. Water will not assist in absorption. Orange juice contains
4. Orange juice a greater amount of vitamin C than apple juice.
Salicylic acid is prescribed for a client with a diagnosis of psoriasis.
The nurse monitors the client, knowing that which of the following 1. Tinnitus
would indicate the presence of systemic toxicity from this med- Rationale:
ication? Salicylic acid is absorbed readily through the skin, and systemic
1. Tinnitus toxicity (salicylism) can result. Symptoms include tinnitus, dizzi-
2. Diarrhea ness, hyperpnea, and psychological disturbances. Constipation
3. Constipation and diarrhea are not associated with salicylism.
4. Decreased respirations
A client with severe acne is seen in the clinic and the health 1. Vitamin A
care provider (HCP) prescribes isotretinoin. The nurse reviews the
client's medication record and would contact the (HCP) if the client Rationale:
Isotretinoin is a metabolite of vitamin A and can produce general-
is taking which medication?
ized intensification of isotretinoin toxicity. Because of the potential
1. Vitamin A
for increased toxicity, vitamin A supplements should be discon-
2. Digoxin (Lanoxin)
tinued before isotretinoin therapy. Options 2, 3, and 4 are not
3. Furosemide (Lasix)
contraindicated with the use of isotretinoin.
4. Phenytoin (Dilantin)
The nurse is applying a topical corticosteroid to a client with
2. Axilla
eczema. The nurse would monitor for the potential for increased
Rationale:
systemic absorption of the medication if the medication were
Topical corticosteroids can be absorbed into the systemic circula-
being applied to which of the following body areas?
tion. Absorption is higher from regions where the skin is especially
1. Back
permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia),
2. Axilla
and lower from regions in which permeability is poor (back, palms,
3. Soles of the feet
soles).
4. Palms of the hands
The health care provider has prescribed silver sulfadiazine (Sil-
vadene) for the client with a partial-thickness burn, which has cul-
tured positive for gram-negative bacteria. The nurse is reinforcing 3. "The medication will permanently stain my skin."
information to the client about the medication. Which statement Rationale:
made by the client indicates a lack of understanding about the Silver sulfadiazine (Silvadene) is an antibacterial that has a broad
treatments? spectrum of activity against gram-negative bacteria, gram-positive
1. "The medication is an antibacterial." bacteria, and yeast. It is applied directly to the wound to assist in
2. "The medication will help heal the burn." healing. It does not stain the skin.
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."
2. Calcium level
The client with metastatic breast cancer is receiving tamoxifen. Rationale:
The nurse specifically monitors which laboratory value while the Tamoxifen may increase calcium, cholesterol, and triglyceride lev-
client is taking this medication? els. Before the initiation of therapy, a complete blood count, platelet
1. Glucose level count, and serum calcium levels should be assessed. These blood
2. Calcium level levels, along with cholesterol and triglyceride levels, should be
3. Potassium level monitored periodically during therapy. The nurse should assess
4. Prothrombin time for hypercalcemia while the client is taking this medication. Signs
of hypercalcemia include increased urine volume, excessive thirst,
, Grade A+ NCLEX Questions-Pharmacology (with rationales) 2025
nausea, vomiting, constipation, hypotonicity of muscles, and deep
bone and flank pain.
3. Treat hypocalcemic tetany.
A nurse is caring for a client after thyroidectomy and notes that
Rationale:
calcium gluconate is prescribed for the client. The nurse deter-
Hypocalcemia can develop after thyroidectomy if the parathyroid
mines that this medication has been prescribed to:
glands are accidentally removed or injured during surgery. Mani-
1. Treat thyroid storm.
festations develop 1 to 7 days after surgery. If the client develops
2. Prevent cardiac irritability.
numbness and tingling around the mouth, fingertips, or toes or
3. Treat hypocalcemic tetany.
muscle spasms or twitching, the health care provider is notified
4. Stimulate the release of parathyroid hormone.
immediately. Calcium gluconate should be kept at the bedside.
2. Rotate the insulin injection sites systematically.
Rationale:
A client who has been newly diagnosed with diabetes mellitus Insulin dosages should not be adjusted or increased before un-
has been stabilized with daily insulin injections. Which information usual exercise. If acetone is found in the urine, it may possibly
should the nurse teach when carrying out plans for discharge? indicate the need for additional insulin. To minimize the discomfort
1. Keep insulin vials refrigerated at all times. associated with insulin injections, the insulin should be adminis-
2. Rotate the insulin injection sites systematically. tered at room temperature. Injection sites should be systematically
3. Increase the amount of insulin before unusual exercise. rotated from one area to another. The client should be instructed to
4. Monitor the urine acetone level to determine the insulin dosage. give injections in one area, about 1 inch apart, until the whole area
has been used and then to change to another site. This prevents
dramatic changes in daily insulin absorption.
A nurse is reinforcing teaching for a client regarding how to mix
regular insulin and NPH insulin in the same syringe. Which of the 1. Withdraws the NPH insulin first
following actions, if performed by the client, indicates the need for Rationale:
further teaching? When preparing a mixture of regular insulin with another insulin
1. Withdraws the NPH insulin first preparation, the regular insulin is drawn into the syringe first. This
2. Withdraws the regular insulin first sequence will avoid contaminating the vial of regular insulin with
3. Injects air into NPH insulin vial first insulin of another type. Options 2, 3, and 4 identify the correct
4. Injects an amount of air equal to the desired dose of insulin into actions for preparing NPH and regular insulin.
the vial
1. Alcohol
Glimepiride (Amaryl) is prescribed for a client with diabetes melli-
Rationale:
tus. A nurse reinforces instructions for the client and tells the client
When alcohol is combined with glimepiride (Amaryl), a disul-
to avoid which of the following while taking this medication?
firam-like reaction may occur. This syndrome includes flushing,
1. Alcohol
palpitations, and nausea. Alcohol can also potentiate the hypo-
2. Organ meats
glycemic effects of the medication. Clients need to be instructed to
3. Whole-grain cereals
avoid alcohol consumption while taking this medication. The items
4. Carbonated beverages
in options 2, 3, and 4 do not need to be avoided.
Sildenafil (Viagra) is prescribed to treat a client with erectile dys- 3. Use of nitroglycerin
function. A nurse reviews the client's medical record and would Rationale:
question the prescription if which of the following is noted in the Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide
client's history? in the corpus cavernosum of the penis, thus sustaining an erection.
1. Neuralgia Because of the effect of the medication, it is contraindicated with
2. Insomnia concurrent use of organic nitrates and nitroglycerin. Sildenafil
3. Use of nitroglycerin is not contraindicated with the use of vitamins. Neuralgia and
4. Use of multivitamins insomnia are side effects of the medication.
A client is taking Humulin NPH insulin daily every morning. The
2. 4 to 12 hours after administration
nurse reinforces instructions for the client and tells the client that
Rationale:
the most likely time for a hypoglycemic reaction to occur is:
Humulin NPH is an intermediate-acting insulin. The onset of action
1. 2 to 4 hours after administration
is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is
2. 4 to 12 hours after administration
24 hours. Hypoglycemic reactions most likely occur during peak
3. 16 to 18 hours after administration
time.
4. 18 to 24 hours after administration
A client with diabetes mellitus visits a health care clinic. The 1. Prednisone
client's diabetes mellitus previously had been well controlled with Rationale:
glyburide (DiaBeta) daily, but recently the fasting blood glucose Prednisone may decrease the effect of oral hypoglycemics,
level has been 180 to 200 mg/dL. Which medication, if added to insulin, diuretics, and potassium supplements. Option 2, a
the client's regimen, may have contributed to the hyperglycemia?
monoamine oxidase inhibitor, and option 3, a ² b- locker, have their
1. Prednisone
own intrinsic hypoglycemic activity. Option 4 decreases urinary
2. Phenelzine (Nardil)
