NSG 3253 Pharm II ATI/NCLEX Preparation |
Pharmacology Practice Questions & Detailed
Rationales
Question 1
What is the priority nursing assessment before administering a dose of
digoxin to an adult client?
• A. Check the client's apical pulse for a full minute and withhold if
less than 60/min
• B. Measure the client's blood pressure for orthostatic hypotension
• C. Assess the client's deep tendon reflexes
• D. Evaluate the client's breath sounds for wheezing
Correct Answer: A. Check the client's apical pulse for a full minute and
withhold if less than 60/min
Detailed Rationale: Digoxin slows the heart rate by decreasing AV nodal
conduction. If the apical heart rate is below 60/min in an adult, the
nurse must withhold the medication and notify the provider to prevent
worsening bradycardia or toxicity.
Question 2
A nurse is reviewing laboratory results for a client receiving warfarin
therapy for deep vein thrombosis. Which INR value indicates the
therapeutic range for this client?
• A. 0.8 to 1.2
, • B. 2.0 to 3.0
• C. 3.5 to 5.0
• D. 6.0 to 8.0
Correct Answer: B. 2.0 to 3.0
Detailed Rationale: For standard warfarin therapy used in conditions
like deep vein thrombosis, atrial fibrillation, or pulmonary embolism,
the therapeutic International Normalized Ratio (INR) range is typically
2.0 to 3.0.
Question 3
A client prescribed lisinopril for hypertension reports a persistent, dry,
hacking cough. What is the most appropriate nursing response?
• A. "This is a common, harmless side effect caused by bradykinin
accumulation; discuss changing to an ARB with your provider."
• B. "You should stop taking the medication immediately and call
911 for anaphylaxis."
• C. "This indicates your blood pressure is too low, so you should
double your fluid intake."
• D. "Take an over-the-counter cough suppressant because this
symptom will resolve in two days."
Correct Answer: A. "This is a common, harmless side effect caused by
bradykinin accumulation; discuss changing to an ARB with your
provider."
Detailed Rationale: ACE inhibitors inhibit the breakdown of bradykinin,
leading to a dry cough in up to 20% of clients. If intolerable, the
,provider often switches the client to an Angiotensin II Receptor Blocker
(ARB), which does not affect bradykinin levels.
Question 4
A nurse is preparing to administer metoprolol to a client with heart
failure. Which finding requires the nurse to withhold the medication
and contact the provider?
• A. Heart rate of 52/min and blood pressure of 92/58 mmHg
• B. Respiratory rate of 16/min and clear lung sounds
• C. Serum potassium level of 4.2 mEq/L
• D. Fasting blood glucose of 110 mg/dL
Correct Answer: A. Heart rate of 52/min and blood pressure of 92/58
mmHg
Detailed Rationale: Beta-blockers decrease heart rate and myocardial
contractility, lowering blood pressure. A heart rate below 60/min or
systolic blood pressure below 100 mmHg warrants withholding the dose
and notifying the provider.
Question 5
A client taking atorvastatin for hyperlipidemia reports new-onset
muscle aches and generalized weakness. Which laboratory test should
the nurse monitor?
• A. Creatine kinase (CK)
• B. Complete blood count (CBC)
• C. Serum creatinine and blood urea nitrogen
, • D. Fasting lipid panel
Correct Answer: A. Creatine kinase (CK)
Detailed Rationale: Statins can cause myopathy, which can progress to
rhabdomyolysis. Monitoring creatine kinase (CK) levels helps evaluate
muscle injury and determines whether the statin must be discontinued.
Question 6
A nurse is educating a client newly diagnosed with type 1 diabetes
mellitus about recognizing hypoglycemia. Which symptom should the
nurse include in the teaching plan?
• A. Diaphoresis, tremors, tachycardia, and confusion
• B. Extreme thirst, fruity breath odor, and polyuria
• C. Warm, flushed dry skin and slow respirations
• D. Right upper quadrant abdominal pain and jaundice
Correct Answer: A. Diaphoresis, tremors, tachycardia, and confusion
Detailed Rationale: Hypoglycemia triggers a sympathetic nervous
response (sweating, tremors, tachycardia, anxiety) and neuroglycopenic
symptoms (confusion, headache, blurred vision), requiring rapid
ingestion of fast-acting carbohydrates.
Question 7
A nurse is monitoring a client taking levothyroxine for hypothyroidism.
Which finding indicates potential medication overdose
(hyperthyroidism)?
• A. Tachycardia, heat intolerance, weight loss, and insomnia
Pharmacology Practice Questions & Detailed
Rationales
Question 1
What is the priority nursing assessment before administering a dose of
digoxin to an adult client?
• A. Check the client's apical pulse for a full minute and withhold if
less than 60/min
• B. Measure the client's blood pressure for orthostatic hypotension
• C. Assess the client's deep tendon reflexes
• D. Evaluate the client's breath sounds for wheezing
Correct Answer: A. Check the client's apical pulse for a full minute and
withhold if less than 60/min
Detailed Rationale: Digoxin slows the heart rate by decreasing AV nodal
conduction. If the apical heart rate is below 60/min in an adult, the
nurse must withhold the medication and notify the provider to prevent
worsening bradycardia or toxicity.
Question 2
A nurse is reviewing laboratory results for a client receiving warfarin
therapy for deep vein thrombosis. Which INR value indicates the
therapeutic range for this client?
• A. 0.8 to 1.2
, • B. 2.0 to 3.0
• C. 3.5 to 5.0
• D. 6.0 to 8.0
Correct Answer: B. 2.0 to 3.0
Detailed Rationale: For standard warfarin therapy used in conditions
like deep vein thrombosis, atrial fibrillation, or pulmonary embolism,
the therapeutic International Normalized Ratio (INR) range is typically
2.0 to 3.0.
Question 3
A client prescribed lisinopril for hypertension reports a persistent, dry,
hacking cough. What is the most appropriate nursing response?
• A. "This is a common, harmless side effect caused by bradykinin
accumulation; discuss changing to an ARB with your provider."
• B. "You should stop taking the medication immediately and call
911 for anaphylaxis."
• C. "This indicates your blood pressure is too low, so you should
double your fluid intake."
• D. "Take an over-the-counter cough suppressant because this
symptom will resolve in two days."
Correct Answer: A. "This is a common, harmless side effect caused by
bradykinin accumulation; discuss changing to an ARB with your
provider."
Detailed Rationale: ACE inhibitors inhibit the breakdown of bradykinin,
leading to a dry cough in up to 20% of clients. If intolerable, the
,provider often switches the client to an Angiotensin II Receptor Blocker
(ARB), which does not affect bradykinin levels.
Question 4
A nurse is preparing to administer metoprolol to a client with heart
failure. Which finding requires the nurse to withhold the medication
and contact the provider?
• A. Heart rate of 52/min and blood pressure of 92/58 mmHg
• B. Respiratory rate of 16/min and clear lung sounds
• C. Serum potassium level of 4.2 mEq/L
• D. Fasting blood glucose of 110 mg/dL
Correct Answer: A. Heart rate of 52/min and blood pressure of 92/58
mmHg
Detailed Rationale: Beta-blockers decrease heart rate and myocardial
contractility, lowering blood pressure. A heart rate below 60/min or
systolic blood pressure below 100 mmHg warrants withholding the dose
and notifying the provider.
Question 5
A client taking atorvastatin for hyperlipidemia reports new-onset
muscle aches and generalized weakness. Which laboratory test should
the nurse monitor?
• A. Creatine kinase (CK)
• B. Complete blood count (CBC)
• C. Serum creatinine and blood urea nitrogen
, • D. Fasting lipid panel
Correct Answer: A. Creatine kinase (CK)
Detailed Rationale: Statins can cause myopathy, which can progress to
rhabdomyolysis. Monitoring creatine kinase (CK) levels helps evaluate
muscle injury and determines whether the statin must be discontinued.
Question 6
A nurse is educating a client newly diagnosed with type 1 diabetes
mellitus about recognizing hypoglycemia. Which symptom should the
nurse include in the teaching plan?
• A. Diaphoresis, tremors, tachycardia, and confusion
• B. Extreme thirst, fruity breath odor, and polyuria
• C. Warm, flushed dry skin and slow respirations
• D. Right upper quadrant abdominal pain and jaundice
Correct Answer: A. Diaphoresis, tremors, tachycardia, and confusion
Detailed Rationale: Hypoglycemia triggers a sympathetic nervous
response (sweating, tremors, tachycardia, anxiety) and neuroglycopenic
symptoms (confusion, headache, blurred vision), requiring rapid
ingestion of fast-acting carbohydrates.
Question 7
A nurse is monitoring a client taking levothyroxine for hypothyroidism.
Which finding indicates potential medication overdose
(hyperthyroidism)?
• A. Tachycardia, heat intolerance, weight loss, and insomnia
