Grade A+ PHARM NCLEX-style (with rationales) REVIEWS 2025
3. Calcitonin (Miacalcin)
Rationale:
1) A RN is caring for a client with hyperparathyroidism and notes
that the client's serum calcium level is 13 mg/dL. Which meds
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client
should the RN prepare to administer as prescribed to the client?
is experiencing hypercalcemia. Calcium gluconate and calcium
1. Calcium chloride
chloride are medications used to treat tetany, which occurs as
2. Calcium gluconate
a result of acute hypocalcemia. In hypercalcemia, large doses
3. Calcitonin Miacalcin
of vitamin D need to be avoided. Calcitonin, a thyroid hormone,
4. Large doses of vitamin D
decreases the plasma calcium level by inhibiting bone resorption
and lowering the serum calcium concentration.
2.) Oral iron supplements are prescribed for a 6-year-old child 4. Orange juice
with iron deficiency anemia. The nurse instructs the mother to Rationale:
administer the iron with which best food item? Vitamin C increases the absorption of iron by the body. The mother
1. Milk should be instructed to administer the medication with a citrus fruit
2. Water or a juice that is high in vitamin C. Milk may affect absorption of
3. Apple juice the iron. Water will not assist in absorption. Orange juice contains
4. Orange juice a greater amount of vitamin C than apple juice.
3.) Salicylic acid is prescribed for a client with a diagnosis of
psoriasis. The nurse monitors the client, knowing that which of the 1. Tinnitus
following would indicate the presence of systemic toxicity from this Rationale:
medication? Salicylic acid is absorbed readily through the skin, and systemic
1. Tinnitus toxicity (salicylism) can result. Symptoms include tinnitus, dizzi-
2. Diarrhea ness, hyperpnea, and psychological disturbances. Constipation
3. Constipation and diarrhea are not associated with salicylism.
4. Decreased respirations
4.) The camp RN asks the children preparing to swim in the lake
if they have applied sunscreen. The RN reminds the children that 4. At least 30 minutes before exposure to the sun
chemical sunscreens are most effective when applied: Rationale:
1. Immediately before swimming Sunscreens are most effective when applied at least 30 minutes
2. 15 min before exposure to the sun before exposure to the sun so that they can penetrate the skin. All
3. Immediately before exposure to the sun sunscreens should be reapplied after swimming or sweating.
4. At least 30 min before exposure to the sun
5.) Mafenide acetate Sulfamylon is prescribed for the client with 3. Informing the client that this is normal
a burn injury. When applying the medication, the client complains Rationale:
of local discomfort and burning. Which of the following is the most Mafenide acetate is bacteriostatic for gram-negative and
appropriate nursing action?
gram-positive organisms and is used to treat burns to reduce bac-
teria present in avascular tissues. The client should be informed
1. Notifying the registered nurse
that the medication will cause local discomfort and burning and
2. Discontinuing the medication
that this is a normal reaction; therefore options 1, 2, and 4 are
3. Informing the client that this is normal
incorrect
4. Applying a thinner film than prescribed to the burn site
1. Hyperventilation
6.) The burn client is receiving treatments of topical mafenide
Rationale:
acetate (Sulfamylon) site of injury. The RN monitors the client,
Mafenide acetate is a carbonic anhydrase inhibitor and can sup-
knowing that which of the following indicates that a systemic effect
press renal excretion of acid, thereby causing acidosis. Clients
has occurred?
receiving this treatment should be monitored for signs of an
1 .Hyperventilation
acid-base imbalance hyperventilation. If this occurs, the medica-
2 .Elevated BP
tion should be discontinued for 1 to 2 days. Options 3 and 4
3 .Local pain at the burn site
describe local rather than systemic effects. Elevated BP may be
4 .Local rash at the burn site
expected from the pain that occurs with a burn injury.
7.) Isotretinoin is prescribed for a client with severe acne. Before 2. Triglyceride level
the administration of this medication, the nurse anticipates that Rationale:
which laboratory test will be prescribed? Isotretinoin can elevate triglyceride levels. Blood triglyceride levels
1. Platelet count should be measured before treatment and periodically thereafter
2. Triglyceride level until the effect on the triglycerides has been evaluated. Options
3. Complete blood count 1, 3, and 4 do not need to be monitored specifically during this
4. White blood cell count treatment.
8.) A client with severe acne is seen in the clinic and HCP pre- 1. Vitamin A
scribes isotretinoin. The RN reviews the client's medication record Rationale:
and contacts the (HCP) if the client is taking which MEDS. Isotretinoin is a metabolite of vitamin A and can produce general-
,Grade A+ PHARM NCLEX-style (with rationales) REVIEWS 2025
1. Vitamin A ized intensification of isotretinoin toxicity. Because of the potential
2. Digoxin (Lanoxin) for increased toxicity, vitamin A supplements should be DC before
3. Furosemide (Lasix) isotretinoin therapy. Options 2, 3, and 4 are not contraindicated
4. Phenytoin (Dilantin) with the use of isotretinoin.
9.) The RN is applying a topical corticosteroid to a client with
2. Axilla
eczema. The RN would monitor for the potential for increased
Rationale:
systemic absorption of the medication if the medication were
Topical corticosteroids can be absorbed into the systemic circula-
being applied to which of the following body areas?
tion. Absorption is higher from regions where the skin is especially
1. Back
permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia),
2. Axilla
3. Soles of the feet and lower from regions in which permeability is poor (back, palms,
soles).
4. Palms of the hands
10.) The clinic RN is performing an admission assessment on a
client. The RN notes that the client is taking azelaic acid Azelex. 1. Acne
Because of the MEDS prescription, the RN would suspect that the Rationale:
client is being treated for: Azelaic acid is a topical medication used to treat mild to moder-
1. Acne ate acne. The acid appears to work by suppressing the growth
2. Eczema of Propionibacterium acnes and decreasing the proliferation of
3. Hair loss keratinocytes. Options 2, 3, and 4 are incorrect.
4. Herpes simplex
11.) The HCP prescribed silver sulfadiazine (Silvadene) for the
client with a partial-thickness burn, which has cultured positive for 3. "The medication will permanently stain my skin."
gram-negative bacteria. The RN is reinforcing info. to the client
Rationale:
about the meds. Which statement made by the client indicates a
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad
lack of understanding about the treatments?
spectrum of activity against gram-negative bacteria, gram-positive
1. "The medication is an antibacterial."
2. "The medication will help heal the burn." bacteria, and yeast. It is applied directly to the wound to assist in
healing. It does not stain the skin.
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."
12.) An RN is caring for a client who is receiving IV infusion 1. Notify RN.
of an antineoplastic medication. During the infusion, the client Rationale:
complains of pain at the insertion site. During an inspection of When antineoplastic meds Chemotherapeutic Agents are admin-
the site, the RN notes redness and swelling and that the rate of istered via IV, great care must be taken to prevent the medica-
infusion of the medication has slowed. The RN should take which tion from escaping into the tissues surrounding the injection site,
appropriate action? because pain, tissue damage, and necrosis can result. The RN
1. Notify the RN. monitors for signs of extravasation, such as redness or swelling at
2. Administer pain medication to reduce the discomfort. the insertion site and a decreased infusion rate. If extravasation
3. Apply ice and maintain the infusion rate, as prescribed. occurs, the RN needs to be notified; he or she will then contact
4. Elevate the extremity of the IV site, and slow the infusion. HCP.
4. Pulmonary function studies
Rationale:
13.) The client with squamous cell carcinoma of the larynx is
Bleomycin is an antineoplastic meds Chemotherapeutic Agents
receiving bleomycin IV. The RN caring for the client anticipates
that can cause interstitial pneumonitis, which can progress to pul-
which diagnostic study will be prescribed.
monary fibrosis. Pulmonary function studies along with hemato-
1. Echocardiography
logical, hepatic, and renal function tests need to be monitored. The
2. Electrocardiography
RN needs to monitor lung sounds for dyspnea and crackles, which
3. Cervical radiography
indicate pulmonary toxicity. The meds needs to be DC immediately
4. Pulmonary function studies
if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to
the specific use of this medication.
14.) The client with acute myelocytic leukemia is being treated with
2. Uric acid level
busulfan Myleran. Which lab value would the nurse specifically
Rationale:
monitor during treatment with this medication?
Busulfan Myleran can cause an increase in the uric acid level.
1. Clotting time
Hyperuricemia can produce uric acid nephropathy, renal stones,
2. Uric acid level
and acute renal failure. Options 1, 3, and 4 are not specifically
3. Potassium level
related to this medication.
4. Blood glucose level
15.) The client with small cell lung cancer is being treated with
4. Orthostatic hypotension
etoposide (VePesid). The nurse who is assisting in caring for the Rationale:
client during its administration understands that which side effect
A side effect specific to etoposide is orthostatic hypotension. The
is specifically associated with this medication?
,Grade A+ PHARM NCLEX-style (with rationales) REVIEWS 2025
1. Alopecia
client's blood pressure is monitored during the infusion. Hair loss
2. Chest pain
occurs with nearly all the antineoplastic medications. Chest pain
3. Pulmonary fibrosis
and pulmonary fibrosis are unrelated to this medication.
4. Orthostatic hypotension
16.) The clinic nurse is reviewing a teaching plan for the client 3. Consult with health care providers (HCPs) before receiving
receiving an antineoplastic medication. When implementing the immunizations
plan, the nurse tells the client: Rationale:
1. To take aspirin (acetylsalicylic acid) as needed for headache Because antineoplastic medications lower the resistance of the
2. Drink beverages containing alcohol in moderate amounts each body, clients must be informed not to receive immunizations with-
evening out a HCP's approval. Clients also need to avoid contact with
3. Consult with health care providers (HCPs) before receiving individuals who have recently received a live virus vaccine. Clients
immunizations need to avoid aspirin and aspirin-containing products to minimize
4. That it is not necessary to consult HCPs before receiving a flu the risk of bleeding, and they need to avoid alcohol to minimize
vaccine at the local health fair the risk of toxicity and side effects.
4. Numbness and tingling in the fingers and toes
Rationale:
17.) The client with ovarian cancer is being treated with vincristine A side effect specific to vincristine is peripheral neuropathy, which
(Oncovin). The nurse monitors the client, knowing that which of occurs in almost every client. Peripheral neuropathy can be man-
the following indicates a side effect specific to this medication? ifested as numbness and tingling in the fingers and toes. De-
1. Diarrhea pression of the Achilles tendon reflex may be the first clinical
2. Hair loss sign indicating peripheral neuropathy. Constipation rather than
3. Chest pain diarrhea is most likely to occur with this medication, although
4. Numbness and tingling in the fingers and toes diarrhea may occur occasionally. Hair loss occurs with nearly all
the antineoplastic medications. Chest pain is unrelated to this
medication.
1. Pancreatitis
18.) The RN is reviewing the H&P exam of a client who will Rationale:
be receiving asparaginase Elspar, an antineoplastic agent. The Asparaginase (Elspar) is contraindicated if hypersensitivity exists,
nurse consults with the RN regarding the administration of the in pancreatitis, or if the client has a history of pancreatitis. The
medication if which of the following is documented in the client's medication impairs pancreatic function and pancreatic function
HX? tests should be performed before therapy begins and when a
1. Pancreatitis week or more has elapsed between administration of the doses.
2. Diabetes mellitus The client needs to be monitored for signs of pancreatitis, which
3. Myocardial infarction include nausea, vomiting, and abdominal pain. The conditions
4. Chronic obstructive pulmonary disease noted in options 2, 3, and 4 are not contraindicated with this
medication.
4. Compete with estradiol for binding to estrogen in tissues con-
19.) Tamoxifen is prescribed for the client with metastatic breast
taining high concentrations of receptors.
carcinoma. The nurse understands that the primary action of this Rationale:
medication is to:
Tamoxifen is an antineoplastic medication that competes with
1. Increase DNA and RNA synthesis.
estradiol for binding to estrogen in tissues containing high concen-
2. Promote the biosynthesis of nucleic acids.
trations of receptors. Tamoxifen is used to treat metastatic breast
3. Increase estrogen concentration and estrogen response.
carcinoma in women and men. Tamoxifen is also effective in de-
4. Compete with estradiol for binding to estrogen in tissues
laying the recurrence of cancer following mastectomy. Tamoxifen
containing high concentrations of receptors.
reduces DNA synthesis and estrogen response.
2. Calcium level
Rationale:
20.) The client with metastatic breast cancer is receiving tamox-
Tamoxifen may increase calcium, cholesterol, and triglyceride lev-
ifen. The nurse specifically monitors which laboratory value while
els. Before the initiation of therapy, a CBC, platelet count, and
the client is taking this medication?
serum calcium levels should be assessed. These blood levels,
1. Glucose level
along with cholesterol and triglyceride levels, should be monitored
2. Calcium level
periodically during therapy. The RN should assess for hypercal-
3. Potassium level
cemia while the client is taking this med. Signs of hypercalcemia
4. Prothrombin time
include increased urine volume, excessive thirst, N/V, constipa-
tion, hypotonicity of muscles, and deep bone and flank pain.
1. Tinnitus
21.) A nurse is assisting with caring for a client with cancer who 2. Ototoxicity
is receiving cisplatin. Select the adverse effects that the nurse 5. Nephrotoxicity
monitors for that are associated with this medication. Select all 6. Hypomagnesemia
that apply. Rationale:
,Grade A+ PHARM NCLEX-style (with rationales) REVIEWS 2025
Cisplatin is an alkylating medication. Alkylating medications are
1. Tinnitus
cell cycle phase-nonspecific medications that affect the synthesis
2. Ototoxicity
of DNA by causing the cross-linking of DNA to inhibit cell re-
3. Hyperkalemia
production. Cisplatin may cause ototoxicity, tinnitus, hypokalemia,
4. Hypercalcemia
hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine
5. Nephrotoxicity
(Ethyol) may be administered before cisplatin to reduce the po-
6. Hypomagnesemia
tential for renal toxicity.
3. Treat hypocalcemic tetany.
22.) A nurse is caring for a client after thyroidectomy and notes
Rationale:
that calcium gluconate is prescribed for the client. The nurse
Hypocalcemia can develop after thyroidectomy if the parathyroid
determines that this medication has been prescribed to:
glands are accidentally removed or injured during surgery. Mani-
1. Treat thyroid storm.
festations develop 1 to 7 days after surgery. If the client develops
2. Prevent cardiac irritability.
numbness and tingling around the mouth, fingertips, or toes or
3. Treat hypocalcemic tetany.
muscle spasms or twitching, the health care provider is notified
4. Stimulate the release of parathyroid hormone.
immediately. Calcium gluconate should be kept at the bedside.
2. Rotate the insulin injection sites systematically.
Rationale:
23.) A client who has been newly diagnosed with diabetes mellitus Insulin dosages should not be adjusted or increased before un-
has been stabilized with daily insulin injections. Which information usual exercise. If acetone is found in the urine, it may possibly
should the nurse teach when carrying out plans for discharge? indicate the need for additional insulin. To minimize the discomfort
1. Keep insulin vials refrigerated at all times. associated with insulin injections, the insulin should be adminis-
2. Rotate the insulin injection sites systematically. tered at room temperature. Injection sites should be systematically
3. Increase the amount of insulin before unusual exercise. rotated from one area to another. The client should be instructed to
4. Monitor the urine acetone level to determine the insulin dosage. give injections in one area, about 1 inch apart, until the whole area
has been used and then to change to another site. This prevents
dramatic changes in daily insulin absorption.
24.) A nurse is reinforcing teaching for a client regarding how to
mix regular insulin and NPH insulin in the same syringe. Which of 1. Withdraws the NPH insulin first
the following actions, if performed by the client, indicates the need Rationale:
for further teaching? When preparing a mixture of regular insulin with another insulin
1. Withdraws the NPH insulin first preparation, the regular insulin is drawn into the syringe first. This
2. Withdraws the regular insulin first sequence will avoid contaminating the vial of regular insulin with
3. Injects air into NPH insulin vial first insulin of another type. Options 2, 3, and 4 identify the correct
4. Injects an amount of air equal to the desired dose of insulin into actions for preparing NPH and regular insulin.
the vial
25.) A home care nurse visits a client recently diagnosed with
diabetes mellitus who is taking Humulin NPH insulin daily. The 2. Refrigerate the insulin.
client asks the nurse how to store the unopened vials of insulin. Rationale:
The nurse tells the client to: Insulin in unopened vials should be stored under refrigeration until
1. Freeze the insulin. needed. Vials should not be frozen. When stored unopened under
2. Refrigerate the insulin. refrigeration, insulin can be used up to the expiration date on the
3. Store the insulin in a dark, dry place. vial. Options 1, 3, and 4 are incorrect.
4. Keep the insulin at room temperature.
26.) Glimepiride (Amaryl) is prescribed for a client with diabetes 1. Alcohol
Rationale:
mellitus. A nurse reinforces instructions for the client and tells the When alcohol is combined with glimepiride (Amaryl), a disul-
client to avoid which of the following while taking this medication?
firam-like reaction may occur. This syndrome includes flushing,
1. Alcohol
palpitations, and nausea. Alcohol can also potentiate the hypo-
2. Organ meats
glycemic effects of the medication. Clients need to be instructed to
3. Whole-grain cereals
avoid alcohol consumption while taking this medication. The items
4. Carbonated beverages
in options 2, 3, and 4 do not need to be avoided.
27.) Sildenafil (Viagra) is prescribed to treat a client with erectile 3. Use of nitroglycerin
dysfunction. A nurse reviews the client's medical record and would Rationale:
question the prescription if which of the following is noted in the Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide
client's history? in the corpus cavernosum of the penis, thus sustaining an erection.
1. Neuralgia Because of the effect of the medication, it is contraindicated with
2. Insomnia concurrent use of organic nitrates and nitroglycerin. Sildenafil
3. Use of nitroglycerin is not contraindicated with the use of vitamins. Neuralgia and
4. Use of multivitamins insomnia are side effects of the medication.
3. Calcitonin (Miacalcin)
Rationale:
1) A RN is caring for a client with hyperparathyroidism and notes
that the client's serum calcium level is 13 mg/dL. Which meds
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client
should the RN prepare to administer as prescribed to the client?
is experiencing hypercalcemia. Calcium gluconate and calcium
1. Calcium chloride
chloride are medications used to treat tetany, which occurs as
2. Calcium gluconate
a result of acute hypocalcemia. In hypercalcemia, large doses
3. Calcitonin Miacalcin
of vitamin D need to be avoided. Calcitonin, a thyroid hormone,
4. Large doses of vitamin D
decreases the plasma calcium level by inhibiting bone resorption
and lowering the serum calcium concentration.
2.) Oral iron supplements are prescribed for a 6-year-old child 4. Orange juice
with iron deficiency anemia. The nurse instructs the mother to Rationale:
administer the iron with which best food item? Vitamin C increases the absorption of iron by the body. The mother
1. Milk should be instructed to administer the medication with a citrus fruit
2. Water or a juice that is high in vitamin C. Milk may affect absorption of
3. Apple juice the iron. Water will not assist in absorption. Orange juice contains
4. Orange juice a greater amount of vitamin C than apple juice.
3.) Salicylic acid is prescribed for a client with a diagnosis of
psoriasis. The nurse monitors the client, knowing that which of the 1. Tinnitus
following would indicate the presence of systemic toxicity from this Rationale:
medication? Salicylic acid is absorbed readily through the skin, and systemic
1. Tinnitus toxicity (salicylism) can result. Symptoms include tinnitus, dizzi-
2. Diarrhea ness, hyperpnea, and psychological disturbances. Constipation
3. Constipation and diarrhea are not associated with salicylism.
4. Decreased respirations
4.) The camp RN asks the children preparing to swim in the lake
if they have applied sunscreen. The RN reminds the children that 4. At least 30 minutes before exposure to the sun
chemical sunscreens are most effective when applied: Rationale:
1. Immediately before swimming Sunscreens are most effective when applied at least 30 minutes
2. 15 min before exposure to the sun before exposure to the sun so that they can penetrate the skin. All
3. Immediately before exposure to the sun sunscreens should be reapplied after swimming or sweating.
4. At least 30 min before exposure to the sun
5.) Mafenide acetate Sulfamylon is prescribed for the client with 3. Informing the client that this is normal
a burn injury. When applying the medication, the client complains Rationale:
of local discomfort and burning. Which of the following is the most Mafenide acetate is bacteriostatic for gram-negative and
appropriate nursing action?
gram-positive organisms and is used to treat burns to reduce bac-
teria present in avascular tissues. The client should be informed
1. Notifying the registered nurse
that the medication will cause local discomfort and burning and
2. Discontinuing the medication
that this is a normal reaction; therefore options 1, 2, and 4 are
3. Informing the client that this is normal
incorrect
4. Applying a thinner film than prescribed to the burn site
1. Hyperventilation
6.) The burn client is receiving treatments of topical mafenide
Rationale:
acetate (Sulfamylon) site of injury. The RN monitors the client,
Mafenide acetate is a carbonic anhydrase inhibitor and can sup-
knowing that which of the following indicates that a systemic effect
press renal excretion of acid, thereby causing acidosis. Clients
has occurred?
receiving this treatment should be monitored for signs of an
1 .Hyperventilation
acid-base imbalance hyperventilation. If this occurs, the medica-
2 .Elevated BP
tion should be discontinued for 1 to 2 days. Options 3 and 4
3 .Local pain at the burn site
describe local rather than systemic effects. Elevated BP may be
4 .Local rash at the burn site
expected from the pain that occurs with a burn injury.
7.) Isotretinoin is prescribed for a client with severe acne. Before 2. Triglyceride level
the administration of this medication, the nurse anticipates that Rationale:
which laboratory test will be prescribed? Isotretinoin can elevate triglyceride levels. Blood triglyceride levels
1. Platelet count should be measured before treatment and periodically thereafter
2. Triglyceride level until the effect on the triglycerides has been evaluated. Options
3. Complete blood count 1, 3, and 4 do not need to be monitored specifically during this
4. White blood cell count treatment.
8.) A client with severe acne is seen in the clinic and HCP pre- 1. Vitamin A
scribes isotretinoin. The RN reviews the client's medication record Rationale:
and contacts the (HCP) if the client is taking which MEDS. Isotretinoin is a metabolite of vitamin A and can produce general-
,Grade A+ PHARM NCLEX-style (with rationales) REVIEWS 2025
1. Vitamin A ized intensification of isotretinoin toxicity. Because of the potential
2. Digoxin (Lanoxin) for increased toxicity, vitamin A supplements should be DC before
3. Furosemide (Lasix) isotretinoin therapy. Options 2, 3, and 4 are not contraindicated
4. Phenytoin (Dilantin) with the use of isotretinoin.
9.) The RN is applying a topical corticosteroid to a client with
2. Axilla
eczema. The RN would monitor for the potential for increased
Rationale:
systemic absorption of the medication if the medication were
Topical corticosteroids can be absorbed into the systemic circula-
being applied to which of the following body areas?
tion. Absorption is higher from regions where the skin is especially
1. Back
permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia),
2. Axilla
3. Soles of the feet and lower from regions in which permeability is poor (back, palms,
soles).
4. Palms of the hands
10.) The clinic RN is performing an admission assessment on a
client. The RN notes that the client is taking azelaic acid Azelex. 1. Acne
Because of the MEDS prescription, the RN would suspect that the Rationale:
client is being treated for: Azelaic acid is a topical medication used to treat mild to moder-
1. Acne ate acne. The acid appears to work by suppressing the growth
2. Eczema of Propionibacterium acnes and decreasing the proliferation of
3. Hair loss keratinocytes. Options 2, 3, and 4 are incorrect.
4. Herpes simplex
11.) The HCP prescribed silver sulfadiazine (Silvadene) for the
client with a partial-thickness burn, which has cultured positive for 3. "The medication will permanently stain my skin."
gram-negative bacteria. The RN is reinforcing info. to the client
Rationale:
about the meds. Which statement made by the client indicates a
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad
lack of understanding about the treatments?
spectrum of activity against gram-negative bacteria, gram-positive
1. "The medication is an antibacterial."
2. "The medication will help heal the burn." bacteria, and yeast. It is applied directly to the wound to assist in
healing. It does not stain the skin.
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."
12.) An RN is caring for a client who is receiving IV infusion 1. Notify RN.
of an antineoplastic medication. During the infusion, the client Rationale:
complains of pain at the insertion site. During an inspection of When antineoplastic meds Chemotherapeutic Agents are admin-
the site, the RN notes redness and swelling and that the rate of istered via IV, great care must be taken to prevent the medica-
infusion of the medication has slowed. The RN should take which tion from escaping into the tissues surrounding the injection site,
appropriate action? because pain, tissue damage, and necrosis can result. The RN
1. Notify the RN. monitors for signs of extravasation, such as redness or swelling at
2. Administer pain medication to reduce the discomfort. the insertion site and a decreased infusion rate. If extravasation
3. Apply ice and maintain the infusion rate, as prescribed. occurs, the RN needs to be notified; he or she will then contact
4. Elevate the extremity of the IV site, and slow the infusion. HCP.
4. Pulmonary function studies
Rationale:
13.) The client with squamous cell carcinoma of the larynx is
Bleomycin is an antineoplastic meds Chemotherapeutic Agents
receiving bleomycin IV. The RN caring for the client anticipates
that can cause interstitial pneumonitis, which can progress to pul-
which diagnostic study will be prescribed.
monary fibrosis. Pulmonary function studies along with hemato-
1. Echocardiography
logical, hepatic, and renal function tests need to be monitored. The
2. Electrocardiography
RN needs to monitor lung sounds for dyspnea and crackles, which
3. Cervical radiography
indicate pulmonary toxicity. The meds needs to be DC immediately
4. Pulmonary function studies
if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to
the specific use of this medication.
14.) The client with acute myelocytic leukemia is being treated with
2. Uric acid level
busulfan Myleran. Which lab value would the nurse specifically
Rationale:
monitor during treatment with this medication?
Busulfan Myleran can cause an increase in the uric acid level.
1. Clotting time
Hyperuricemia can produce uric acid nephropathy, renal stones,
2. Uric acid level
and acute renal failure. Options 1, 3, and 4 are not specifically
3. Potassium level
related to this medication.
4. Blood glucose level
15.) The client with small cell lung cancer is being treated with
4. Orthostatic hypotension
etoposide (VePesid). The nurse who is assisting in caring for the Rationale:
client during its administration understands that which side effect
A side effect specific to etoposide is orthostatic hypotension. The
is specifically associated with this medication?
,Grade A+ PHARM NCLEX-style (with rationales) REVIEWS 2025
1. Alopecia
client's blood pressure is monitored during the infusion. Hair loss
2. Chest pain
occurs with nearly all the antineoplastic medications. Chest pain
3. Pulmonary fibrosis
and pulmonary fibrosis are unrelated to this medication.
4. Orthostatic hypotension
16.) The clinic nurse is reviewing a teaching plan for the client 3. Consult with health care providers (HCPs) before receiving
receiving an antineoplastic medication. When implementing the immunizations
plan, the nurse tells the client: Rationale:
1. To take aspirin (acetylsalicylic acid) as needed for headache Because antineoplastic medications lower the resistance of the
2. Drink beverages containing alcohol in moderate amounts each body, clients must be informed not to receive immunizations with-
evening out a HCP's approval. Clients also need to avoid contact with
3. Consult with health care providers (HCPs) before receiving individuals who have recently received a live virus vaccine. Clients
immunizations need to avoid aspirin and aspirin-containing products to minimize
4. That it is not necessary to consult HCPs before receiving a flu the risk of bleeding, and they need to avoid alcohol to minimize
vaccine at the local health fair the risk of toxicity and side effects.
4. Numbness and tingling in the fingers and toes
Rationale:
17.) The client with ovarian cancer is being treated with vincristine A side effect specific to vincristine is peripheral neuropathy, which
(Oncovin). The nurse monitors the client, knowing that which of occurs in almost every client. Peripheral neuropathy can be man-
the following indicates a side effect specific to this medication? ifested as numbness and tingling in the fingers and toes. De-
1. Diarrhea pression of the Achilles tendon reflex may be the first clinical
2. Hair loss sign indicating peripheral neuropathy. Constipation rather than
3. Chest pain diarrhea is most likely to occur with this medication, although
4. Numbness and tingling in the fingers and toes diarrhea may occur occasionally. Hair loss occurs with nearly all
the antineoplastic medications. Chest pain is unrelated to this
medication.
1. Pancreatitis
18.) The RN is reviewing the H&P exam of a client who will Rationale:
be receiving asparaginase Elspar, an antineoplastic agent. The Asparaginase (Elspar) is contraindicated if hypersensitivity exists,
nurse consults with the RN regarding the administration of the in pancreatitis, or if the client has a history of pancreatitis. The
medication if which of the following is documented in the client's medication impairs pancreatic function and pancreatic function
HX? tests should be performed before therapy begins and when a
1. Pancreatitis week or more has elapsed between administration of the doses.
2. Diabetes mellitus The client needs to be monitored for signs of pancreatitis, which
3. Myocardial infarction include nausea, vomiting, and abdominal pain. The conditions
4. Chronic obstructive pulmonary disease noted in options 2, 3, and 4 are not contraindicated with this
medication.
4. Compete with estradiol for binding to estrogen in tissues con-
19.) Tamoxifen is prescribed for the client with metastatic breast
taining high concentrations of receptors.
carcinoma. The nurse understands that the primary action of this Rationale:
medication is to:
Tamoxifen is an antineoplastic medication that competes with
1. Increase DNA and RNA synthesis.
estradiol for binding to estrogen in tissues containing high concen-
2. Promote the biosynthesis of nucleic acids.
trations of receptors. Tamoxifen is used to treat metastatic breast
3. Increase estrogen concentration and estrogen response.
carcinoma in women and men. Tamoxifen is also effective in de-
4. Compete with estradiol for binding to estrogen in tissues
laying the recurrence of cancer following mastectomy. Tamoxifen
containing high concentrations of receptors.
reduces DNA synthesis and estrogen response.
2. Calcium level
Rationale:
20.) The client with metastatic breast cancer is receiving tamox-
Tamoxifen may increase calcium, cholesterol, and triglyceride lev-
ifen. The nurse specifically monitors which laboratory value while
els. Before the initiation of therapy, a CBC, platelet count, and
the client is taking this medication?
serum calcium levels should be assessed. These blood levels,
1. Glucose level
along with cholesterol and triglyceride levels, should be monitored
2. Calcium level
periodically during therapy. The RN should assess for hypercal-
3. Potassium level
cemia while the client is taking this med. Signs of hypercalcemia
4. Prothrombin time
include increased urine volume, excessive thirst, N/V, constipa-
tion, hypotonicity of muscles, and deep bone and flank pain.
1. Tinnitus
21.) A nurse is assisting with caring for a client with cancer who 2. Ototoxicity
is receiving cisplatin. Select the adverse effects that the nurse 5. Nephrotoxicity
monitors for that are associated with this medication. Select all 6. Hypomagnesemia
that apply. Rationale:
,Grade A+ PHARM NCLEX-style (with rationales) REVIEWS 2025
Cisplatin is an alkylating medication. Alkylating medications are
1. Tinnitus
cell cycle phase-nonspecific medications that affect the synthesis
2. Ototoxicity
of DNA by causing the cross-linking of DNA to inhibit cell re-
3. Hyperkalemia
production. Cisplatin may cause ototoxicity, tinnitus, hypokalemia,
4. Hypercalcemia
hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine
5. Nephrotoxicity
(Ethyol) may be administered before cisplatin to reduce the po-
6. Hypomagnesemia
tential for renal toxicity.
3. Treat hypocalcemic tetany.
22.) A nurse is caring for a client after thyroidectomy and notes
Rationale:
that calcium gluconate is prescribed for the client. The nurse
Hypocalcemia can develop after thyroidectomy if the parathyroid
determines that this medication has been prescribed to:
glands are accidentally removed or injured during surgery. Mani-
1. Treat thyroid storm.
festations develop 1 to 7 days after surgery. If the client develops
2. Prevent cardiac irritability.
numbness and tingling around the mouth, fingertips, or toes or
3. Treat hypocalcemic tetany.
muscle spasms or twitching, the health care provider is notified
4. Stimulate the release of parathyroid hormone.
immediately. Calcium gluconate should be kept at the bedside.
2. Rotate the insulin injection sites systematically.
Rationale:
23.) A client who has been newly diagnosed with diabetes mellitus Insulin dosages should not be adjusted or increased before un-
has been stabilized with daily insulin injections. Which information usual exercise. If acetone is found in the urine, it may possibly
should the nurse teach when carrying out plans for discharge? indicate the need for additional insulin. To minimize the discomfort
1. Keep insulin vials refrigerated at all times. associated with insulin injections, the insulin should be adminis-
2. Rotate the insulin injection sites systematically. tered at room temperature. Injection sites should be systematically
3. Increase the amount of insulin before unusual exercise. rotated from one area to another. The client should be instructed to
4. Monitor the urine acetone level to determine the insulin dosage. give injections in one area, about 1 inch apart, until the whole area
has been used and then to change to another site. This prevents
dramatic changes in daily insulin absorption.
24.) A nurse is reinforcing teaching for a client regarding how to
mix regular insulin and NPH insulin in the same syringe. Which of 1. Withdraws the NPH insulin first
the following actions, if performed by the client, indicates the need Rationale:
for further teaching? When preparing a mixture of regular insulin with another insulin
1. Withdraws the NPH insulin first preparation, the regular insulin is drawn into the syringe first. This
2. Withdraws the regular insulin first sequence will avoid contaminating the vial of regular insulin with
3. Injects air into NPH insulin vial first insulin of another type. Options 2, 3, and 4 identify the correct
4. Injects an amount of air equal to the desired dose of insulin into actions for preparing NPH and regular insulin.
the vial
25.) A home care nurse visits a client recently diagnosed with
diabetes mellitus who is taking Humulin NPH insulin daily. The 2. Refrigerate the insulin.
client asks the nurse how to store the unopened vials of insulin. Rationale:
The nurse tells the client to: Insulin in unopened vials should be stored under refrigeration until
1. Freeze the insulin. needed. Vials should not be frozen. When stored unopened under
2. Refrigerate the insulin. refrigeration, insulin can be used up to the expiration date on the
3. Store the insulin in a dark, dry place. vial. Options 1, 3, and 4 are incorrect.
4. Keep the insulin at room temperature.
26.) Glimepiride (Amaryl) is prescribed for a client with diabetes 1. Alcohol
Rationale:
mellitus. A nurse reinforces instructions for the client and tells the When alcohol is combined with glimepiride (Amaryl), a disul-
client to avoid which of the following while taking this medication?
firam-like reaction may occur. This syndrome includes flushing,
1. Alcohol
palpitations, and nausea. Alcohol can also potentiate the hypo-
2. Organ meats
glycemic effects of the medication. Clients need to be instructed to
3. Whole-grain cereals
avoid alcohol consumption while taking this medication. The items
4. Carbonated beverages
in options 2, 3, and 4 do not need to be avoided.
27.) Sildenafil (Viagra) is prescribed to treat a client with erectile 3. Use of nitroglycerin
dysfunction. A nurse reviews the client's medical record and would Rationale:
question the prescription if which of the following is noted in the Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide
client's history? in the corpus cavernosum of the penis, thus sustaining an erection.
1. Neuralgia Because of the effect of the medication, it is contraindicated with
2. Insomnia concurrent use of organic nitrates and nitroglycerin. Sildenafil
3. Use of nitroglycerin is not contraindicated with the use of vitamins. Neuralgia and
4. Use of multivitamins insomnia are side effects of the medication.
