NSG 124 Exam 4 Actual Exam V2 | NSG 124 Pharmacology (NSG124
Exam 4) | Herzing University PDF
1. A patient who has been taking fluoxetine for depression for several weeks presents with
agitation, tremors, and hyperreflexia. The nurse discovers the patient recently started taking
an over-the-counter herbal supplement for sleep. What is the priority nursing action?
A. Administer an extra dose of fluoxetine to stabilize the patient’s mood.
B. Hold the medication and notify the healthcare provider immediately.
C. Encourage the patient to drink more water to flush out the supplement.
D. Instruct the patient to wait for the symptoms to subside naturally.
Answer: B
Rationale: The patient’s symptoms are highly suggestive of serotonin syndrome, which is a
potentially life-threatening condition caused by excessive serotonin levels. This often
occurs when SSRIs are combined with other serotonergic substances like St. John’s Wort.
Immediate cessation of the causative agents and provider notification are essential to
ensure patient safety and begin supportive care.
2. A nurse is preparing to administer the first dose of cephalexin to a patient who has a
documented history of severe anaphylaxis to penicillin. What should the nurse do?
A. Withhold the medication and contact the provider for an alternative antibiotic.
B. Premedicate the patient with diphenhydramine before administration.
C. Administer the cephalexin and monitor the patient closely for 30 minutes.
D. Administer the medication at a slower rate to minimize reaction risk.
Answer: A
Rationale: There is a known cross-sensitivity between penicillins and cephalosporins due
to their similar beta-lactam ring structures. While the risk is generally low, a history of
severe anaphylaxis to penicillin is a contraindication for cephalosporin use in many clinical
guidelines. The nurse must prioritize patient safety by advocating for an alternative class of
antibiotics, such as macrolides.
3. A patient is prescribed oral tetracycline for the treatment of acne. What educational point
is most important for the nurse to include?
A. Take the medication with a full glass of milk to prevent GI upset.
B. Stop taking the medication as soon as the skin clear up to avoid resistance.
C. Avoid sun exposure and use high-SPF sunscreen due to photosensitivity.
,D. Take an iron supplement at the same time to prevent anemia.
Answer: C
Rationale: Tetracyclines are known to cause significant photosensitivity, increasing the
risk of severe sunburn even with minimal exposure. Patients should also be taught to avoid
dairy products and antacids at the time of administration because they interfere with drug
absorption. Completing the entire course of therapy is necessary, and iron should not be
taken concurrently as it chelates the drug.
4. A patient receiving intravenous vancomycin develops sudden hypotension, flushing, and a
red rash on the face and neck. What is the nurse’s first action?
A. Stop the infusion immediately and prepare for epinephrine administration.
B. Slow the infusion rate and monitor the patient’s blood pressure.
C. Notify the pharmacy that the patient is allergic to the medication.
D. Document the findings as a normal side effect of the drug.
Answer: B
Rationale: These symptoms are characteristic of Red Man Syndrome, which is a rate-
dependent infusion reaction rather than a true IgE-mediated allergy. The standard
intervention is to slow the rate of the infusion and potentially administer antihistamines.
Stopping the infusion entirely is only necessary if the reaction is severe or if anaphylaxis is
suspected, but slowing the rate is the primary management strategy for this specific
syndrome.
5. A nurse is providing discharge instructions to a patient starting phenytoin for a seizure
disorder. Which statement by the patient indicates a need for further teaching?
A. ‘I can stop taking the medication if I haven’t had a seizure for a month.’
B. ‘I should use a backup form of birth control while on this medication.’
C. ‘I will visit my dentist regularly and brush my teeth twice a day.’
D. ‘I need to have my blood drawn periodically to check my drug levels.’
Answer: A
Rationale: Antiepileptic drugs like phenytoin must never be stopped abruptly, as this can
precipitate status epilepticus, a life-threatening medical emergency. Phenytoin also carries
a risk of gingival hyperplasia, necessitating strict oral hygiene and dental follow-up.
Furthermore, it is a known teratogen and enzyme inducer that can decrease the
effectiveness of hormonal contraceptives.
6. A patient is being treated with lithium carbonate for bipolar disorder. The nurse should
monitor which laboratory value most closely to prevent toxicity?
A. Serum potassium
, B. Serum calcium
C. Serum sodium
D. Serum magnesium
Answer: C
Rationale: Lithium is handled by the kidneys in a manner very similar to sodium, meaning
that low sodium levels can lead to decreased lithium excretion and toxicity. The nurse must
educate the patient to maintain consistent salt and fluid intake to avoid imbalances.
Monitoring serum lithium levels and sodium levels is critical for maintaining the narrow
therapeutic index of this drug.
7. A patient is prescribed levodopa-carbidopa for Parkinson’s disease. What is the primary
purpose of combining these two drugs?
A. Carbidopa increases the transport of levodopa across the blood-brain barrier.
B. The combination allows for a higher dose of levodopa to be used safely.
C. Levodopa reduces the side effects associated with carbidopa therapy.
D. Carbidopa prevents the peripheral breakdown of levodopa, making more available for
the brain.
Answer: D
Rationale: Levodopa is the precursor to dopamine, but it is easily metabolized in the
periphery before reaching the brain. Carbidopa inhibits the enzyme dopa decarboxylase in
the periphery, which prevents this breakdown without crossing the blood-brain barrier
itself. This allows for lower doses of levodopa to be effective and reduces systemic side
effects like nausea and vomiting.
8. A patient who has been taking a monoamine oxidase inhibitor (MAOI) for three weeks
arrives at the emergency department with a severe headache and a blood pressure of
210/110 mmHg. Which question should the nurse ask first?
A. ‘Have you been experiencing any unusual stress lately?’
B. ‘When was the last time you exercised?’
C. ‘Did you double your dose of medication this morning?’
D. ‘Have you eaten any aged cheeses, cured meats, or red wine recently?’
Answer: D
Rationale: MAOIs interact dangerously with tyramine-rich foods, which can cause a
massive release of norepinephrine, leading to a hypertensive crisis. Foods such as aged
cheese, salami, and red wine are high in tyramine and must be strictly avoided by patients
Exam 4) | Herzing University PDF
1. A patient who has been taking fluoxetine for depression for several weeks presents with
agitation, tremors, and hyperreflexia. The nurse discovers the patient recently started taking
an over-the-counter herbal supplement for sleep. What is the priority nursing action?
A. Administer an extra dose of fluoxetine to stabilize the patient’s mood.
B. Hold the medication and notify the healthcare provider immediately.
C. Encourage the patient to drink more water to flush out the supplement.
D. Instruct the patient to wait for the symptoms to subside naturally.
Answer: B
Rationale: The patient’s symptoms are highly suggestive of serotonin syndrome, which is a
potentially life-threatening condition caused by excessive serotonin levels. This often
occurs when SSRIs are combined with other serotonergic substances like St. John’s Wort.
Immediate cessation of the causative agents and provider notification are essential to
ensure patient safety and begin supportive care.
2. A nurse is preparing to administer the first dose of cephalexin to a patient who has a
documented history of severe anaphylaxis to penicillin. What should the nurse do?
A. Withhold the medication and contact the provider for an alternative antibiotic.
B. Premedicate the patient with diphenhydramine before administration.
C. Administer the cephalexin and monitor the patient closely for 30 minutes.
D. Administer the medication at a slower rate to minimize reaction risk.
Answer: A
Rationale: There is a known cross-sensitivity between penicillins and cephalosporins due
to their similar beta-lactam ring structures. While the risk is generally low, a history of
severe anaphylaxis to penicillin is a contraindication for cephalosporin use in many clinical
guidelines. The nurse must prioritize patient safety by advocating for an alternative class of
antibiotics, such as macrolides.
3. A patient is prescribed oral tetracycline for the treatment of acne. What educational point
is most important for the nurse to include?
A. Take the medication with a full glass of milk to prevent GI upset.
B. Stop taking the medication as soon as the skin clear up to avoid resistance.
C. Avoid sun exposure and use high-SPF sunscreen due to photosensitivity.
,D. Take an iron supplement at the same time to prevent anemia.
Answer: C
Rationale: Tetracyclines are known to cause significant photosensitivity, increasing the
risk of severe sunburn even with minimal exposure. Patients should also be taught to avoid
dairy products and antacids at the time of administration because they interfere with drug
absorption. Completing the entire course of therapy is necessary, and iron should not be
taken concurrently as it chelates the drug.
4. A patient receiving intravenous vancomycin develops sudden hypotension, flushing, and a
red rash on the face and neck. What is the nurse’s first action?
A. Stop the infusion immediately and prepare for epinephrine administration.
B. Slow the infusion rate and monitor the patient’s blood pressure.
C. Notify the pharmacy that the patient is allergic to the medication.
D. Document the findings as a normal side effect of the drug.
Answer: B
Rationale: These symptoms are characteristic of Red Man Syndrome, which is a rate-
dependent infusion reaction rather than a true IgE-mediated allergy. The standard
intervention is to slow the rate of the infusion and potentially administer antihistamines.
Stopping the infusion entirely is only necessary if the reaction is severe or if anaphylaxis is
suspected, but slowing the rate is the primary management strategy for this specific
syndrome.
5. A nurse is providing discharge instructions to a patient starting phenytoin for a seizure
disorder. Which statement by the patient indicates a need for further teaching?
A. ‘I can stop taking the medication if I haven’t had a seizure for a month.’
B. ‘I should use a backup form of birth control while on this medication.’
C. ‘I will visit my dentist regularly and brush my teeth twice a day.’
D. ‘I need to have my blood drawn periodically to check my drug levels.’
Answer: A
Rationale: Antiepileptic drugs like phenytoin must never be stopped abruptly, as this can
precipitate status epilepticus, a life-threatening medical emergency. Phenytoin also carries
a risk of gingival hyperplasia, necessitating strict oral hygiene and dental follow-up.
Furthermore, it is a known teratogen and enzyme inducer that can decrease the
effectiveness of hormonal contraceptives.
6. A patient is being treated with lithium carbonate for bipolar disorder. The nurse should
monitor which laboratory value most closely to prevent toxicity?
A. Serum potassium
, B. Serum calcium
C. Serum sodium
D. Serum magnesium
Answer: C
Rationale: Lithium is handled by the kidneys in a manner very similar to sodium, meaning
that low sodium levels can lead to decreased lithium excretion and toxicity. The nurse must
educate the patient to maintain consistent salt and fluid intake to avoid imbalances.
Monitoring serum lithium levels and sodium levels is critical for maintaining the narrow
therapeutic index of this drug.
7. A patient is prescribed levodopa-carbidopa for Parkinson’s disease. What is the primary
purpose of combining these two drugs?
A. Carbidopa increases the transport of levodopa across the blood-brain barrier.
B. The combination allows for a higher dose of levodopa to be used safely.
C. Levodopa reduces the side effects associated with carbidopa therapy.
D. Carbidopa prevents the peripheral breakdown of levodopa, making more available for
the brain.
Answer: D
Rationale: Levodopa is the precursor to dopamine, but it is easily metabolized in the
periphery before reaching the brain. Carbidopa inhibits the enzyme dopa decarboxylase in
the periphery, which prevents this breakdown without crossing the blood-brain barrier
itself. This allows for lower doses of levodopa to be effective and reduces systemic side
effects like nausea and vomiting.
8. A patient who has been taking a monoamine oxidase inhibitor (MAOI) for three weeks
arrives at the emergency department with a severe headache and a blood pressure of
210/110 mmHg. Which question should the nurse ask first?
A. ‘Have you been experiencing any unusual stress lately?’
B. ‘When was the last time you exercised?’
C. ‘Did you double your dose of medication this morning?’
D. ‘Have you eaten any aged cheeses, cured meats, or red wine recently?’
Answer: D
Rationale: MAOIs interact dangerously with tyramine-rich foods, which can cause a
massive release of norepinephrine, leading to a hypertensive crisis. Foods such as aged
cheese, salami, and red wine are high in tyramine and must be strictly avoided by patients
