NURS 305 Exam 4 V3 | NURS 305 Pharmacology | Actual Q&A with
Rationale (NURS305 Exam 4) | Liberty University
1. A nurse is teaching a patient with Type 1 Diabetes about insulin lispro. When should the
nurse instruct the patient to administer this medication?
A. 30 to 60 minutes before a meal
B. At bedtime to provide basal coverage
C. Immediately after finishing a meal
D. 15 to 30 minutes before a meal
Answer: D
Explanation: Insulin lispro is a rapid-acting insulin that has an onset of action within 15 to
30 minutes. Because of this quick onset, the patient must have food ready to eat shortly
after administration to avoid hypoglycemia. Administering it 30 to 60 minutes before a
meal would result in the insulin peaking before the glucose from the food enters the
bloodstream.
2. Which of the following instructions is most important for a patient newly prescribed
levothyroxine for hypothyroidism?
A. Take the medication on an empty stomach 30 to 60 minutes before breakfast.
B. Take the medication with the evening meal.
C. Take the medication on an empty stomach in the morning.
D. Take the medication with a full glass of milk.
Answer: A
Explanation: Levothyroxine absorption is significantly decreased when taken with food or
certain minerals like calcium. To ensure consistent blood levels, it must be taken on an
empty stomach, ideally 30 to 60 minutes before breakfast. Taking it at night or with milk
would interfere with its therapeutic efficacy in managing hypothyroidism.
3. A patient is scheduled for a CT scan with intravenous contrast. Which medication should
the nurse expect to be held for 48 hours after the procedure?
A. Glyburide
B. Pioglitazone
C. Metformin
D. Sitagliptin
,Answer: C
Explanation: Metformin can interact with iodinated contrast media used in imaging,
potentially causing acute renal failure and lactic acidosis. Clinical guidelines suggest
holding metformin on the day of the procedure and for 48 hours afterward. The medication
is only resumed once renal function has been verified as normal.
4. What is the primary mechanism of action for the medication Omeprazole?
A. Irreversibly inhibiting the H+/K+ ATPase pump
B. Blocking H2 receptors on parietal cells
C. Neutralizing gastric acid through a chemical reaction
D. Providing a protective coating over gastric ulcers
Answer: A
Explanation: Omeprazole is a proton pump inhibitor (PPI) that works by irreversibly
binding to the hydrogen-potassium ATPase enzyme system. This system is the final step in
acid secretion by parietal cells. By inhibiting this pump, PPIs provide more profound acid
suppression than H2 receptor antagonists.
5. A patient with asthma is prescribed albuterol and beclomethasone inhalers. Which
instruction should the nurse provide?
A. Use the beclomethasone first to open the airways.
B. Use the albuterol first, wait 5 minutes, then use the beclomethasone.
C. Mix both inhalers together for faster administration.
D. Only use the albuterol if the beclomethasone fails to work.
Answer: B
Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that causes rapid
bronchodilation. Using the bronchodilator first allows the airways to open, ensuring that
the corticosteroid (beclomethasone) can penetrate deeper into the lung tissue. Waiting five
minutes between medications is essential for optimal drug delivery.
6. Which adverse effect should the nurse monitor for in a patient taking chronic high-dose
prednisone therapy?
A. Hypoglycemia
B. Hyperglycemia and fluid retention
C. Hypotension
D. Weight loss and anorexia
Answer: B
, Explanation: Corticosteroids like prednisone increase gluconeogenesis and decrease
glucose use, leading to hyperglycemia. They also cause sodium and water retention while
promoting potassium loss. Long-term use requires careful monitoring of blood sugar levels
and signs of fluid volume excess.
7. A nurse is preparing to administer insulin glargine to a patient who also has a dose of
regular insulin scheduled. How should the nurse proceed?
A. Draw up the regular insulin first, then the glargine in one syringe.
B. Draw up the medications in two separate syringes.
C. Draw up the glargine first, then the regular insulin in one syringe.
D. Mix the two together and let them sit for 10 minutes before giving.
Answer: B
Explanation: Insulin glargine is a long-acting insulin with a low pH that causes it to
precipitate if mixed with other insulins. Mixing it can alter its onset and duration of action,
leading to unpredictable glycemic control. Therefore, glargine must always be
administered as a separate injection.
8. What is the priority assessment for a patient receiving intravenous magnesium sulfate for
preeclampsia?
A. Body temperature
B. Serum glucose levels
C. Bowel sounds
D. Deep tendon reflexes and respiratory rate
Answer: D
Explanation: Magnesium toxicity can lead to neuromuscular blockade and respiratory
depression. The loss of deep tendon reflexes (DTRs) is often the first sign of rising
magnesium levels. The nurse must monitor DTRs and respirations closely to ensure the
patient does not reach toxic concentrations.
9. A patient is prescribed Sucralfate for the treatment of a duodenal ulcer. When should the
nurse instruct the patient to take this medication?
A. With meals and at bedtime
B. One hour before meals and at bedtime
C. Only when pain is present
D. Immediately after meals
Answer: B
Rationale (NURS305 Exam 4) | Liberty University
1. A nurse is teaching a patient with Type 1 Diabetes about insulin lispro. When should the
nurse instruct the patient to administer this medication?
A. 30 to 60 minutes before a meal
B. At bedtime to provide basal coverage
C. Immediately after finishing a meal
D. 15 to 30 minutes before a meal
Answer: D
Explanation: Insulin lispro is a rapid-acting insulin that has an onset of action within 15 to
30 minutes. Because of this quick onset, the patient must have food ready to eat shortly
after administration to avoid hypoglycemia. Administering it 30 to 60 minutes before a
meal would result in the insulin peaking before the glucose from the food enters the
bloodstream.
2. Which of the following instructions is most important for a patient newly prescribed
levothyroxine for hypothyroidism?
A. Take the medication on an empty stomach 30 to 60 minutes before breakfast.
B. Take the medication with the evening meal.
C. Take the medication on an empty stomach in the morning.
D. Take the medication with a full glass of milk.
Answer: A
Explanation: Levothyroxine absorption is significantly decreased when taken with food or
certain minerals like calcium. To ensure consistent blood levels, it must be taken on an
empty stomach, ideally 30 to 60 minutes before breakfast. Taking it at night or with milk
would interfere with its therapeutic efficacy in managing hypothyroidism.
3. A patient is scheduled for a CT scan with intravenous contrast. Which medication should
the nurse expect to be held for 48 hours after the procedure?
A. Glyburide
B. Pioglitazone
C. Metformin
D. Sitagliptin
,Answer: C
Explanation: Metformin can interact with iodinated contrast media used in imaging,
potentially causing acute renal failure and lactic acidosis. Clinical guidelines suggest
holding metformin on the day of the procedure and for 48 hours afterward. The medication
is only resumed once renal function has been verified as normal.
4. What is the primary mechanism of action for the medication Omeprazole?
A. Irreversibly inhibiting the H+/K+ ATPase pump
B. Blocking H2 receptors on parietal cells
C. Neutralizing gastric acid through a chemical reaction
D. Providing a protective coating over gastric ulcers
Answer: A
Explanation: Omeprazole is a proton pump inhibitor (PPI) that works by irreversibly
binding to the hydrogen-potassium ATPase enzyme system. This system is the final step in
acid secretion by parietal cells. By inhibiting this pump, PPIs provide more profound acid
suppression than H2 receptor antagonists.
5. A patient with asthma is prescribed albuterol and beclomethasone inhalers. Which
instruction should the nurse provide?
A. Use the beclomethasone first to open the airways.
B. Use the albuterol first, wait 5 minutes, then use the beclomethasone.
C. Mix both inhalers together for faster administration.
D. Only use the albuterol if the beclomethasone fails to work.
Answer: B
Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that causes rapid
bronchodilation. Using the bronchodilator first allows the airways to open, ensuring that
the corticosteroid (beclomethasone) can penetrate deeper into the lung tissue. Waiting five
minutes between medications is essential for optimal drug delivery.
6. Which adverse effect should the nurse monitor for in a patient taking chronic high-dose
prednisone therapy?
A. Hypoglycemia
B. Hyperglycemia and fluid retention
C. Hypotension
D. Weight loss and anorexia
Answer: B
, Explanation: Corticosteroids like prednisone increase gluconeogenesis and decrease
glucose use, leading to hyperglycemia. They also cause sodium and water retention while
promoting potassium loss. Long-term use requires careful monitoring of blood sugar levels
and signs of fluid volume excess.
7. A nurse is preparing to administer insulin glargine to a patient who also has a dose of
regular insulin scheduled. How should the nurse proceed?
A. Draw up the regular insulin first, then the glargine in one syringe.
B. Draw up the medications in two separate syringes.
C. Draw up the glargine first, then the regular insulin in one syringe.
D. Mix the two together and let them sit for 10 minutes before giving.
Answer: B
Explanation: Insulin glargine is a long-acting insulin with a low pH that causes it to
precipitate if mixed with other insulins. Mixing it can alter its onset and duration of action,
leading to unpredictable glycemic control. Therefore, glargine must always be
administered as a separate injection.
8. What is the priority assessment for a patient receiving intravenous magnesium sulfate for
preeclampsia?
A. Body temperature
B. Serum glucose levels
C. Bowel sounds
D. Deep tendon reflexes and respiratory rate
Answer: D
Explanation: Magnesium toxicity can lead to neuromuscular blockade and respiratory
depression. The loss of deep tendon reflexes (DTRs) is often the first sign of rising
magnesium levels. The nurse must monitor DTRs and respirations closely to ensure the
patient does not reach toxic concentrations.
9. A patient is prescribed Sucralfate for the treatment of a duodenal ulcer. When should the
nurse instruct the patient to take this medication?
A. With meals and at bedtime
B. One hour before meals and at bedtime
C. Only when pain is present
D. Immediately after meals
Answer: B
