, RN Pharmacology Relias A Exam
Advanced Prep: Master Clinical
Pharmacology & Medication Safety Practice
Questions
Subject: RN Pharmacology – Advanced Clinical Pharmacotherapeutics and
Medication Safety
Question 1: A patient with a history of heart failure is prescribed lisinopril. The nurse notes the
patient’s serum potassium is 5.4 mEq/L. What is the most appropriate action?
A) Administer the lisinopril and continue monitoring.
B) Hold the dose and notify the healthcare provider of the hyperkalemia.
C) Administer the dose but suggest a potassium-sparing diuretic be added.
D) Instruct the patient to increase dietary sodium intake to lower potassium.
Correct Answer: B) Hold the dose and notify the healthcare provider of the hyperkalemia.
Explanation: Lisinopril is an ACE inhibitor, which functions by inhibiting the conversion of
angiotensin I to angiotensin II, leading to decreased aldosterone levels and subsequent
potassium retention. A potassium level of 5.4 mEq/L is above the normal range (3.5–5.0 mEq/L).
Administering the drug would exacerbate hyperkalemia, risking life-threatening cardiac
arrhythmias. Increasing sodium intake (Option D) is contraindicated in heart failure patients
due to fluid retention risks.
Question 2: A nurse is preparing to administer vancomycin to a patient. Which assessment
finding requires immediate clinical intervention?
A) A blood pressure of 110/70 mmHg.
B) Presence of a central venous access device.
C) Flushing, pruritus, and hypotension shortly after the infusion begins.
D) A creatinine level increase from 0.8 mg/dL to 0.9 mg/dL.
Correct Answer: C) Flushing, pruritus, and hypotension shortly after the infusion begins.
,Explanation: These symptoms are characteristic of Red Man Syndrome, an infusion-related
reaction caused by the rapid release of histamine associated with overly rapid administration of
vancomycin. The nurse must stop the infusion immediately, notify the provider, and likely restart
it at a slower rate or initiate antihistamine premedication. While creatinine monitoring is
important for nephrotoxicity, a minor shift of 0.1 mg/dL is less acutely critical than an infusion
reaction.
Question 3: A patient receiving heparin therapy has an aPTT of 120 seconds. What is the priority
nursing action?
A) Continue the current infusion rate.
B) Prepare for potential administration of protamine sulfate.
C) Increase the infusion rate to reach the therapeutic window.
D) Draw blood for a platelet count to check for HIT.
Correct Answer: B) Prepare for potential administration of protamine sulfate.
Explanation: A normal aPTT is typically 25–35 seconds; therapeutic range for heparin is usually
1.5 to 2 times the control (approx. 45–70 seconds). A value of 120 seconds indicates significant
anticoagulation and a high risk for spontaneous hemorrhage. Protamine sulfate is the specific
antidote for heparin overdose. While HIT is a concern with heparin, the immediate priority for
an aPTT of 120 seconds is reversing the anticoagulation effect to prevent bleeding.
Question 4: Which of the following drug-drug interactions represents a significant risk for a
patient taking warfarin?
A) Warfarin and acetaminophen (occasional).
B) Warfarin and amiodarone.
C) Warfarin and iron supplements.
D) Warfarin and metformin.
Correct Answer: B) Warfarin and amiodarone.
Explanation: Amiodarone is a potent inhibitor of the CYP2C9 and CYP3A4 enzymes, which are
responsible for metabolizing warfarin. Co-administration can significantly increase warfarin
plasma levels, drastically raising the INR and the risk of severe bleeding. Patients starting
amiodarone usually require a 30–50% reduction in their warfarin dose.
Question 5: A patient is prescribed gentamicin. Which assessment data is most critical to monitor
for early detection of adverse effects?
, A) Serum creatinine and BUN.
B) Peak and trough levels and audiometry.
C) Liver function tests (AST/ALT).
D) Complete blood count (CBC).
Correct Answer: B) Peak and trough levels and audiometry.
Explanation: Aminoglycosides like gentamicin are known for both nephrotoxicity and ototoxicity.
Ototoxicity, which can be irreversible, is often preceded by tinnitus, vertigo, or high-frequency
hearing loss. Monitoring trough levels ensures the drug does not accumulate to toxic
concentrations, and audiometry/baseline hearing assessment is vital for monitoring for
ototoxicity.
Question 6: A patient with type 2 diabetes is scheduled for a CT scan with contrast. Which
medication must be held 48 hours before and after the procedure?
A) Glipizide.
B) Metformin.
C) Insulin glargine.
D) Sitagliptin.
Correct Answer: B) Metformin.
Explanation: Metformin, in the presence of iodinated contrast media, carries a high risk of lactic
acidosis, particularly if the contrast induces acute kidney injury. The drug must be held for 48
hours post-procedure to ensure that the patient’s renal function is stable, as lactic acidosis is a
rare but highly lethal metabolic complication.
Question 7: A patient is receiving phenytoin for seizure control. Which clinical observation
warrants immediate contact with the provider?
A) Gingival hyperplasia.
B) Mild drowsiness.
C) Ataxia and nystagmus.
D) Dark-colored urine.
Correct Answer: C) Ataxia and nystagmus.
Advanced Prep: Master Clinical
Pharmacology & Medication Safety Practice
Questions
Subject: RN Pharmacology – Advanced Clinical Pharmacotherapeutics and
Medication Safety
Question 1: A patient with a history of heart failure is prescribed lisinopril. The nurse notes the
patient’s serum potassium is 5.4 mEq/L. What is the most appropriate action?
A) Administer the lisinopril and continue monitoring.
B) Hold the dose and notify the healthcare provider of the hyperkalemia.
C) Administer the dose but suggest a potassium-sparing diuretic be added.
D) Instruct the patient to increase dietary sodium intake to lower potassium.
Correct Answer: B) Hold the dose and notify the healthcare provider of the hyperkalemia.
Explanation: Lisinopril is an ACE inhibitor, which functions by inhibiting the conversion of
angiotensin I to angiotensin II, leading to decreased aldosterone levels and subsequent
potassium retention. A potassium level of 5.4 mEq/L is above the normal range (3.5–5.0 mEq/L).
Administering the drug would exacerbate hyperkalemia, risking life-threatening cardiac
arrhythmias. Increasing sodium intake (Option D) is contraindicated in heart failure patients
due to fluid retention risks.
Question 2: A nurse is preparing to administer vancomycin to a patient. Which assessment
finding requires immediate clinical intervention?
A) A blood pressure of 110/70 mmHg.
B) Presence of a central venous access device.
C) Flushing, pruritus, and hypotension shortly after the infusion begins.
D) A creatinine level increase from 0.8 mg/dL to 0.9 mg/dL.
Correct Answer: C) Flushing, pruritus, and hypotension shortly after the infusion begins.
,Explanation: These symptoms are characteristic of Red Man Syndrome, an infusion-related
reaction caused by the rapid release of histamine associated with overly rapid administration of
vancomycin. The nurse must stop the infusion immediately, notify the provider, and likely restart
it at a slower rate or initiate antihistamine premedication. While creatinine monitoring is
important for nephrotoxicity, a minor shift of 0.1 mg/dL is less acutely critical than an infusion
reaction.
Question 3: A patient receiving heparin therapy has an aPTT of 120 seconds. What is the priority
nursing action?
A) Continue the current infusion rate.
B) Prepare for potential administration of protamine sulfate.
C) Increase the infusion rate to reach the therapeutic window.
D) Draw blood for a platelet count to check for HIT.
Correct Answer: B) Prepare for potential administration of protamine sulfate.
Explanation: A normal aPTT is typically 25–35 seconds; therapeutic range for heparin is usually
1.5 to 2 times the control (approx. 45–70 seconds). A value of 120 seconds indicates significant
anticoagulation and a high risk for spontaneous hemorrhage. Protamine sulfate is the specific
antidote for heparin overdose. While HIT is a concern with heparin, the immediate priority for
an aPTT of 120 seconds is reversing the anticoagulation effect to prevent bleeding.
Question 4: Which of the following drug-drug interactions represents a significant risk for a
patient taking warfarin?
A) Warfarin and acetaminophen (occasional).
B) Warfarin and amiodarone.
C) Warfarin and iron supplements.
D) Warfarin and metformin.
Correct Answer: B) Warfarin and amiodarone.
Explanation: Amiodarone is a potent inhibitor of the CYP2C9 and CYP3A4 enzymes, which are
responsible for metabolizing warfarin. Co-administration can significantly increase warfarin
plasma levels, drastically raising the INR and the risk of severe bleeding. Patients starting
amiodarone usually require a 30–50% reduction in their warfarin dose.
Question 5: A patient is prescribed gentamicin. Which assessment data is most critical to monitor
for early detection of adverse effects?
, A) Serum creatinine and BUN.
B) Peak and trough levels and audiometry.
C) Liver function tests (AST/ALT).
D) Complete blood count (CBC).
Correct Answer: B) Peak and trough levels and audiometry.
Explanation: Aminoglycosides like gentamicin are known for both nephrotoxicity and ototoxicity.
Ototoxicity, which can be irreversible, is often preceded by tinnitus, vertigo, or high-frequency
hearing loss. Monitoring trough levels ensures the drug does not accumulate to toxic
concentrations, and audiometry/baseline hearing assessment is vital for monitoring for
ototoxicity.
Question 6: A patient with type 2 diabetes is scheduled for a CT scan with contrast. Which
medication must be held 48 hours before and after the procedure?
A) Glipizide.
B) Metformin.
C) Insulin glargine.
D) Sitagliptin.
Correct Answer: B) Metformin.
Explanation: Metformin, in the presence of iodinated contrast media, carries a high risk of lactic
acidosis, particularly if the contrast induces acute kidney injury. The drug must be held for 48
hours post-procedure to ensure that the patient’s renal function is stable, as lactic acidosis is a
rare but highly lethal metabolic complication.
Question 7: A patient is receiving phenytoin for seizure control. Which clinical observation
warrants immediate contact with the provider?
A) Gingival hyperplasia.
B) Mild drowsiness.
C) Ataxia and nystagmus.
D) Dark-colored urine.
Correct Answer: C) Ataxia and nystagmus.
