NSG 3253 Pharm II Comprehensive Review
Bundle | Final Exam Practice Questions with
Verified Answers
Question 1
A nurse is preparing to administer intravenous amiodarone to a client
with recurrent ventricular fibrillation. Which baseline assessment is
most critical to document before and during therapy?
• A. Baseline chest radiograph and pulmonary function tests for
pulmonary toxicity
• B. Complete blood count for white blood cell suppression
• C. Serum amylase and lipase levels for acute pancreatitis
• D. Fasting blood glucose and HbA1c levels
Correct Answer: A. Baseline chest radiograph and pulmonary function
tests for pulmonary toxicity
Detailed Rationale: Amiodarone can cause severe pulmonary toxicity,
including interstitial lung disease and pulmonary fibrosis. Baseline and
ongoing respiratory assessments, chest x-rays, and pulmonary function
tests are crucial.
Question 2
A client taking warfarin for deep vein thrombosis has an International
Normalized Ratio (INR) of 4.5 and mild epistaxis. What is the priority
nursing action?
, • A. Hold the scheduled dose of warfarin and notify the provider for
potential vitamin K administration
• B. Administer the scheduled dose of warfarin and encourage iron-
rich foods
• C. Discontinue warfarin permanently without notifying the
provider
• D. Administer protamine sulfate intravenously immediately
Correct Answer: A. Hold the scheduled dose of warfarin and notify the
provider for potential vitamin K administration
Detailed Rationale: An INR of 4.5 exceeds the therapeutic range (2.0 to
3.0) and is accompanied by minor bleeding (epistaxis). Holding the dose
and notifying the provider for possible reversal with vitamin K prevents
major hemorrhage.
Question 3
A client with heart failure is prescribed sacubitril/valsartan. Which
medication must be discontinued at least 36 hours prior to initiating this
new therapy to prevent severe angioedema?
• A. Lisinopril
• B. Metoprolol
• C. Furosemide
• D. Digoxin
Correct Answer: A. Lisinopril
Detailed Rationale: Combining an ACE inhibitor (like lisinopril) with
neprilysin inhibitors (sacubitril) increases the risk of life-threatening
,angioedema due to concurrent bradykinin accumulation. A strict 36-
hour washout period is required.
Question 4
A client with type 1 diabetes mellitus is prescribed regular insulin and
NPH insulin. What is the correct technique for drawing these insulins
into a single syringe?
• A. Draw up the clear regular insulin first, followed by the cloudy
NPH insulin
• B. Draw up the cloudy NPH insulin first, followed by the clear
regular insulin
• C. Mix the two insulins in a separate container 12 hours before
administration
• D. Regular insulin and NPH insulin can never be mixed in the same
syringe
Correct Answer: A. Draw up the clear regular insulin first, followed by
the cloudy NPH insulin
Detailed Rationale: Following the "Clear to Cloudy" rule prevents
contaminating the regular insulin vial with the suspension proteins
found in NPH insulin, ensuring the purity and rapid onset of regular
insulin.
Question 5
A nurse is monitoring a client taking levothyroxine for hypothyroidism.
Which finding indicates potential medication overdose and
hyperthyroidism?
, • A. Tachycardia, heat intolerance, weight loss, and insomnia
• B. Bradycardia, cold intolerance, weight gain, and lethargy
• C. Constipation, dry skin, and facial puffiness
• D. Hypoactive bowel sounds and somnolence
Correct Answer: A. Tachycardia, heat intolerance, weight loss, and
insomnia
Detailed Rationale: Excessive thyroid hormone replacement speeds up
metabolism, manifesting as signs of hyperthyroidism including
tachycardia, palpitations, heat intolerance, weight loss, nervousness,
and insomnia.
Question 6
A client receiving long-term oral prednisone asks why the dose must be
tapered gradually rather than stopped abruptly. What is the best
nursing explanation?
• A. "Gradual tapering allows your adrenal glands time to resume
natural cortisol production and prevents Addisonian crisis."
• B. "Stopping abruptly causes immediate rebound hypertension
and heart attack."
• C. "Tapering prevents the development of sudden antibiotic
resistance."
• D. "Sudden cessation causes severe acute hypoglycemia and
shock."
Correct Answer: A. "Gradual tapering allows your adrenal glands time
to resume natural cortisol production and prevents Addisonian crisis."
Bundle | Final Exam Practice Questions with
Verified Answers
Question 1
A nurse is preparing to administer intravenous amiodarone to a client
with recurrent ventricular fibrillation. Which baseline assessment is
most critical to document before and during therapy?
• A. Baseline chest radiograph and pulmonary function tests for
pulmonary toxicity
• B. Complete blood count for white blood cell suppression
• C. Serum amylase and lipase levels for acute pancreatitis
• D. Fasting blood glucose and HbA1c levels
Correct Answer: A. Baseline chest radiograph and pulmonary function
tests for pulmonary toxicity
Detailed Rationale: Amiodarone can cause severe pulmonary toxicity,
including interstitial lung disease and pulmonary fibrosis. Baseline and
ongoing respiratory assessments, chest x-rays, and pulmonary function
tests are crucial.
Question 2
A client taking warfarin for deep vein thrombosis has an International
Normalized Ratio (INR) of 4.5 and mild epistaxis. What is the priority
nursing action?
, • A. Hold the scheduled dose of warfarin and notify the provider for
potential vitamin K administration
• B. Administer the scheduled dose of warfarin and encourage iron-
rich foods
• C. Discontinue warfarin permanently without notifying the
provider
• D. Administer protamine sulfate intravenously immediately
Correct Answer: A. Hold the scheduled dose of warfarin and notify the
provider for potential vitamin K administration
Detailed Rationale: An INR of 4.5 exceeds the therapeutic range (2.0 to
3.0) and is accompanied by minor bleeding (epistaxis). Holding the dose
and notifying the provider for possible reversal with vitamin K prevents
major hemorrhage.
Question 3
A client with heart failure is prescribed sacubitril/valsartan. Which
medication must be discontinued at least 36 hours prior to initiating this
new therapy to prevent severe angioedema?
• A. Lisinopril
• B. Metoprolol
• C. Furosemide
• D. Digoxin
Correct Answer: A. Lisinopril
Detailed Rationale: Combining an ACE inhibitor (like lisinopril) with
neprilysin inhibitors (sacubitril) increases the risk of life-threatening
,angioedema due to concurrent bradykinin accumulation. A strict 36-
hour washout period is required.
Question 4
A client with type 1 diabetes mellitus is prescribed regular insulin and
NPH insulin. What is the correct technique for drawing these insulins
into a single syringe?
• A. Draw up the clear regular insulin first, followed by the cloudy
NPH insulin
• B. Draw up the cloudy NPH insulin first, followed by the clear
regular insulin
• C. Mix the two insulins in a separate container 12 hours before
administration
• D. Regular insulin and NPH insulin can never be mixed in the same
syringe
Correct Answer: A. Draw up the clear regular insulin first, followed by
the cloudy NPH insulin
Detailed Rationale: Following the "Clear to Cloudy" rule prevents
contaminating the regular insulin vial with the suspension proteins
found in NPH insulin, ensuring the purity and rapid onset of regular
insulin.
Question 5
A nurse is monitoring a client taking levothyroxine for hypothyroidism.
Which finding indicates potential medication overdose and
hyperthyroidism?
, • A. Tachycardia, heat intolerance, weight loss, and insomnia
• B. Bradycardia, cold intolerance, weight gain, and lethargy
• C. Constipation, dry skin, and facial puffiness
• D. Hypoactive bowel sounds and somnolence
Correct Answer: A. Tachycardia, heat intolerance, weight loss, and
insomnia
Detailed Rationale: Excessive thyroid hormone replacement speeds up
metabolism, manifesting as signs of hyperthyroidism including
tachycardia, palpitations, heat intolerance, weight loss, nervousness,
and insomnia.
Question 6
A client receiving long-term oral prednisone asks why the dose must be
tapered gradually rather than stopped abruptly. What is the best
nursing explanation?
• A. "Gradual tapering allows your adrenal glands time to resume
natural cortisol production and prevents Addisonian crisis."
• B. "Stopping abruptly causes immediate rebound hypertension
and heart attack."
• C. "Tapering prevents the development of sudden antibiotic
resistance."
• D. "Sudden cessation causes severe acute hypoglycemia and
shock."
Correct Answer: A. "Gradual tapering allows your adrenal glands time
to resume natural cortisol production and prevents Addisonian crisis."
