NEW JERSEY CERTIFIED ASSISTED LIVING
ADMINISTRATOR (CALA) EXAMINATION
This comprehensive collection of 320 multiple-choice exam questions spans essential
nursing domains, including Pharmacology, Fundamentals, Medical-Surgical,
Pediatrics, Obstetrics, Mental Health, and Critical Care. Each question is
meticulously crafted with four plausible options, a definitive correct answer, and a
detailed rationale that explains the underlying clinical reasoning and
pathophysiological principles. The questions are designed to test critical thinking,
prioritization, and application of evidence-based practice, mimicking the complexity
of actual nursing licensure and certification examinations. Covering topics from
medication antidotes and electrolyte imbalances to emergency interventions and
developmental milestones, this resource serves as an invaluable study tool for
nursing students and professionals seeking to enhance their clinical knowledge,
reinforce key concepts, and prepare effectively for high-stakes testing scenarios.
PHARMACOLOGY (Questions 1-50)
1. A client is prescribed Digoxin. Which of the following is a therapeutic effect of
this medication?
A) Decreased heart rate and increased force of contraction
B) Increased heart rate and decreased force of contraction
C) Vasodilation of peripheral arteries
D) Inhibition of platelet aggregation
Correct Answer: A
Rationale: Digoxin is a cardiac glycoside that works by inhibiting the Na+/K+
ATPase pump, leading to increased intracellular calcium in cardiac myocytes. This
,results in a positive inotropic effect (increased force of contraction) and a negative
chronotropic effect (decreased heart rate). Options B, C, and D describe other
medication classes (e.g., beta-blockers, vasodilators, antiplatelets).
2. A nurse is preparing to administer Heparin subcutaneously. Which action is
correct?
A) Aspirate for blood return before injecting
B) Massage the site vigorously after injection
C) Administer in the abdomen, 2 inches away from the umbilicus
D) Use a 21-gauge needle for administration
Correct Answer: C
Rationale: Heparin is administered subcutaneously in the abdominal fatty tissue, at
least 2 inches from the umbilicus to avoid the vasculature and ensure absorption.
Aspiration is not recommended as it can cause hematoma formation. Massaging can
cause bruising or hematoma. A smaller gauge needle (25-27 gauge) is typically
used.
3. A patient on Warfarin has an INR of 5.5. What is the priority nursing action?
A) Administer Vitamin K (Phytonadione) as prescribed
B) Administer Protamine Sulfate
C) Increase the Warfarin dose
D) Monitor for signs of bleeding and continue the current dose
Correct Answer: A
Rationale: The therapeutic INR for most indications is 2.0-3.0. An INR of 5.5 is
critically high and indicates a significant bleeding risk. Vitamin K is the antidote for
Warfarin and should be administered to reverse the anticoagulant effect.
Protamine Sulfate is the antidote for Heparin, not Warfarin.
4. Which side effect is specific to the loop diuretic Furosemide?
A) Hyperkalemia
,B) Ototoxicity
C) Gynecomastia
D) Orange discoloration of urine
Correct Answer: B
Rationale: Furosemide is a potent loop diuretic that can cause ototoxicity (tinnitus
and hearing loss), especially when given rapidly IV or in high doses. It causes
hypokalemia, not hyperkalemia. Gynecomastia is associated with Spironolactone.
Orange urine is associated with Rifampin.
5. A client is prescribed an ACE inhibitor, Lisinopril. What adverse effect should the
nurse monitor for?
A) Dry cough
B) Tachycardia
C) Hypoglycemia
D) Weight gain
Correct Answer: A
Rationale: A persistent, dry cough is a hallmark adverse effect of ACE inhibitors due
to the accumulation of bradykinin in the lungs. If this occurs, the medication is usually
switched to an ARB. ACE inhibitors typically cause bradycardia (not tachycardia)
and can improve insulin sensitivity (not cause hypoglycemia).
6. The nurse is administering a beta-blocker, Metoprolol. What is the priority
assessment before administration?
A) Respiratory rate
B) Blood pressure and heart rate
C) Blood glucose level
D) Level of consciousness
Correct Answer: B
, Rationale: Beta-blockers work by blocking beta-1 receptors in the heart, leading to
decreased heart rate and decreased blood pressure. The priority assessment is to
check heart rate (hold if <60 bpm) and blood pressure (hold if systolic <90 mmHg)
to prevent profound bradycardia and hypotension.
7. What medication requires the nurse to monitor serum levels for toxicity, with a
therapeutic range of 10-20 mcg/mL?
A) Lithium
B) Phenytoin
C) Gentamicin
D) Digoxin
Correct Answer: B
Rationale: Phenytoin (Dilantin) has a narrow therapeutic range of 10-20 mcg/mL.
Levels above 20 mcg/mL lead to toxicity, presenting with nystagmus, ataxia, and
slurred speech. Lithium (0.6-1.2 mEq/L), Gentamicin (peak 5-10 mcg/mL), and
Digoxin (0.8-2.0 ng/mL) have different therapeutic ranges.
8. A client is receiving Morphine IV push. The nurse notes a respiratory rate of 8
breaths/min. Which medication should the nurse prepare to administer?
A) Naloxone
B) Flumazenil
C) Atropine
D) Epinephrine
Correct Answer: A
Rationale: Morphine is an opioid agonist. Respiratory depression is a severe
adverse effect. Naloxone (Narcan) is a pure opioid antagonist that reverses the
effects of opioids, including respiratory depression. Flumazenil is for
benzodiazepines, Atropine is for bradycardia/cholinergic toxicity, and Epinephrine
is for anaphylaxis.
ADMINISTRATOR (CALA) EXAMINATION
This comprehensive collection of 320 multiple-choice exam questions spans essential
nursing domains, including Pharmacology, Fundamentals, Medical-Surgical,
Pediatrics, Obstetrics, Mental Health, and Critical Care. Each question is
meticulously crafted with four plausible options, a definitive correct answer, and a
detailed rationale that explains the underlying clinical reasoning and
pathophysiological principles. The questions are designed to test critical thinking,
prioritization, and application of evidence-based practice, mimicking the complexity
of actual nursing licensure and certification examinations. Covering topics from
medication antidotes and electrolyte imbalances to emergency interventions and
developmental milestones, this resource serves as an invaluable study tool for
nursing students and professionals seeking to enhance their clinical knowledge,
reinforce key concepts, and prepare effectively for high-stakes testing scenarios.
PHARMACOLOGY (Questions 1-50)
1. A client is prescribed Digoxin. Which of the following is a therapeutic effect of
this medication?
A) Decreased heart rate and increased force of contraction
B) Increased heart rate and decreased force of contraction
C) Vasodilation of peripheral arteries
D) Inhibition of platelet aggregation
Correct Answer: A
Rationale: Digoxin is a cardiac glycoside that works by inhibiting the Na+/K+
ATPase pump, leading to increased intracellular calcium in cardiac myocytes. This
,results in a positive inotropic effect (increased force of contraction) and a negative
chronotropic effect (decreased heart rate). Options B, C, and D describe other
medication classes (e.g., beta-blockers, vasodilators, antiplatelets).
2. A nurse is preparing to administer Heparin subcutaneously. Which action is
correct?
A) Aspirate for blood return before injecting
B) Massage the site vigorously after injection
C) Administer in the abdomen, 2 inches away from the umbilicus
D) Use a 21-gauge needle for administration
Correct Answer: C
Rationale: Heparin is administered subcutaneously in the abdominal fatty tissue, at
least 2 inches from the umbilicus to avoid the vasculature and ensure absorption.
Aspiration is not recommended as it can cause hematoma formation. Massaging can
cause bruising or hematoma. A smaller gauge needle (25-27 gauge) is typically
used.
3. A patient on Warfarin has an INR of 5.5. What is the priority nursing action?
A) Administer Vitamin K (Phytonadione) as prescribed
B) Administer Protamine Sulfate
C) Increase the Warfarin dose
D) Monitor for signs of bleeding and continue the current dose
Correct Answer: A
Rationale: The therapeutic INR for most indications is 2.0-3.0. An INR of 5.5 is
critically high and indicates a significant bleeding risk. Vitamin K is the antidote for
Warfarin and should be administered to reverse the anticoagulant effect.
Protamine Sulfate is the antidote for Heparin, not Warfarin.
4. Which side effect is specific to the loop diuretic Furosemide?
A) Hyperkalemia
,B) Ototoxicity
C) Gynecomastia
D) Orange discoloration of urine
Correct Answer: B
Rationale: Furosemide is a potent loop diuretic that can cause ototoxicity (tinnitus
and hearing loss), especially when given rapidly IV or in high doses. It causes
hypokalemia, not hyperkalemia. Gynecomastia is associated with Spironolactone.
Orange urine is associated with Rifampin.
5. A client is prescribed an ACE inhibitor, Lisinopril. What adverse effect should the
nurse monitor for?
A) Dry cough
B) Tachycardia
C) Hypoglycemia
D) Weight gain
Correct Answer: A
Rationale: A persistent, dry cough is a hallmark adverse effect of ACE inhibitors due
to the accumulation of bradykinin in the lungs. If this occurs, the medication is usually
switched to an ARB. ACE inhibitors typically cause bradycardia (not tachycardia)
and can improve insulin sensitivity (not cause hypoglycemia).
6. The nurse is administering a beta-blocker, Metoprolol. What is the priority
assessment before administration?
A) Respiratory rate
B) Blood pressure and heart rate
C) Blood glucose level
D) Level of consciousness
Correct Answer: B
, Rationale: Beta-blockers work by blocking beta-1 receptors in the heart, leading to
decreased heart rate and decreased blood pressure. The priority assessment is to
check heart rate (hold if <60 bpm) and blood pressure (hold if systolic <90 mmHg)
to prevent profound bradycardia and hypotension.
7. What medication requires the nurse to monitor serum levels for toxicity, with a
therapeutic range of 10-20 mcg/mL?
A) Lithium
B) Phenytoin
C) Gentamicin
D) Digoxin
Correct Answer: B
Rationale: Phenytoin (Dilantin) has a narrow therapeutic range of 10-20 mcg/mL.
Levels above 20 mcg/mL lead to toxicity, presenting with nystagmus, ataxia, and
slurred speech. Lithium (0.6-1.2 mEq/L), Gentamicin (peak 5-10 mcg/mL), and
Digoxin (0.8-2.0 ng/mL) have different therapeutic ranges.
8. A client is receiving Morphine IV push. The nurse notes a respiratory rate of 8
breaths/min. Which medication should the nurse prepare to administer?
A) Naloxone
B) Flumazenil
C) Atropine
D) Epinephrine
Correct Answer: A
Rationale: Morphine is an opioid agonist. Respiratory depression is a severe
adverse effect. Naloxone (Narcan) is a pure opioid antagonist that reverses the
effects of opioids, including respiratory depression. Flumazenil is for
benzodiazepines, Atropine is for bradycardia/cholinergic toxicity, and Epinephrine
is for anaphylaxis.
