NR565/565 ADVANCED PHARMACOLOGY
TESTBANK 2026/2027 NEW ADVANCED
VERSIONS/ TESTED and GRADED A+/ HIGLY
RATED and VERIFIED
1. A nurse is caring for a client with an indwelling urinary catheter. Which action best
prevents catheter-associated urinary tract infection?
A. Routine catheter irrigation
B. Daily catheter replacement
C. Maintaining a closed drainage system
D. Elevating the drainage bag
Rationale: A closed drainage system prevents microorganisms from entering the urinary
tract, significantly reducing infection risk. Routine irrigation or frequent replacement is not
recommended unless obstruction occurs, as these interventions can introduce pathogens.
Elevating the drainage bag prevents backflow but does not replace the infection prevention
provided by a closed system.
2. A 68-year-old client with chronic heart failure is prescribed furosemide for fluid overload.
The nurse notes that the client’s potassium level is 3.0 mEq/L. Which nursing action is most
appropriate before administering the medication?
A. Administer the medication as prescribed
B. Hold the medication and notify the provider
C. Administer the medication with a potassium-sparing supplement
D. Increase the client’s fluid intake
Rationale: Loop diuretics such as furosemide promote potassium excretion, increasing the
risk of hypokalemia. Administering furosemide when potassium is critically low (3.0 mEq/L)
may precipitate life-threatening arrhythmias. The nurse should hold the medication, notify
the provider, and anticipate potassium replacement. Administering with a potassium-sparing
supplement without provider approval is not safe.
,3. A client with Type 2 diabetes mellitus is prescribed metformin. Which instruction is most
important to prevent lactic acidosis?
A. Take the medication only with meals
B. Hold the medication before procedures involving contrast dye
C. Limit carbohydrate intake
D. Take an extra dose if blood sugar is high
Rationale: Metformin reduces hepatic glucose production and improves insulin sensitivity.
A rare but serious adverse effect is lactic acidosis, which is more likely to occur in clients
undergoing contrast imaging or with renal impairment. Holding metformin 48 hours before
and after contrast procedures is standard. Taking extra doses or limiting carbohydrate intake
does not prevent this complication.
4. A nurse is teaching a client about warfarin therapy following a DVT. Which statement
indicates understanding of the therapy?
A. I will take the medication only when my legs feel swollen
B. I should take extra vitamin K if my INR is low
C. I will have my blood tested regularly to monitor INR
D. I will stop the medication once I feel better
Rationale: Warfarin inhibits vitamin K–dependent clotting factors, requiring careful
monitoring of INR to ensure therapeutic anticoagulation and prevent bleeding or clotting
complications. Clients should never adjust their dose without provider guidance. Adherence
is critical even if symptoms resolve.
5. A client receiving vancomycin intravenously reports flushing and itching during the
infusion. Which action should the nurse take first?
A. Stop the infusion and notify the provider
B. Administer antihistamines after the infusion is complete
C. Slow the infusion rate and monitor for hypotension
D. Document the reaction and continue as usual
Rationale: Red man syndrome is an infusion-related reaction characterized by flushing,
itching, and hypotension, usually caused by rapid administration of vancomycin. Slowing the
infusion rate and monitoring vital signs can prevent progression while allowing treatment
continuation. Stopping the infusion may be required in severe reactions, but first slowing is
standard.
,6. A nurse is preparing to administer digoxin to a client with heart failure. Which finding
would require holding the medication and notifying the provider?
A. Apical pulse 70 bpm
B. Blood pressure 120/78 mmHg
C. Apical pulse 48 bpm
D. Respiratory rate 18 breaths/min
Rationale: Digoxin slows AV nodal conduction and enhances myocardial contractility.
Bradycardia (apical pulse <60 bpm in adults) is a common sign of digoxin toxicity.
Administering the medication under these conditions could precipitate severe arrhythmias.
Blood pressure, respiration, and normal heart rate do not independently indicate holding
digoxin.
7. A client with asthma is prescribed albuterol. Which instruction is essential to include in
client teaching?
A. Take this medication only when symptoms occur and ignore scheduled doses
B. Avoid using this medication more than once per week
C. Use the inhaler 5–10 minutes before activities that trigger asthma
D. This medication will prevent long-term airway inflammation
Rationale: Albuterol is a short-acting beta-2 agonist that provides rapid bronchodilation.
Using it before triggers can prevent bronchospasm. Overuse can cause tachycardia, tremors,
and reduced effectiveness. Long-term airway inflammation is managed by inhaled
corticosteroids, not albuterol.
8. A client taking levothyroxine reports palpitations and insomnia. Which action should the
nurse take first?
A. Advise the client to take the next dose at night
B. Assess for signs of overreplacement and notify the provider
C. Recommend doubling the dose for faster effect
D. Instruct the client to stop the medication immediately
Rationale: Symptoms such as palpitations and insomnia suggest overreplacement of thyroid
hormone. The nurse should assess for other signs of hyperthyroidism, review recent lab
results, and notify the provider to adjust the dose. Doubling or stopping medication without
guidance is unsafe.
, 9. A nurse is preparing to administer insulin lispro to a client with diabetes. When is the
optimal time to give this medication?
A. 30 minutes after breakfast
B. Within 15 minutes before meals
C. At bedtime
D. Once daily in the morning
Rationale: Insulin lispro is a rapid-acting insulin with an onset of 10–15 minutes and peak
effect at 1–2 hours. Administering it 15 minutes before meals matches insulin activity with
postprandial glucose rise. Administering at bedtime or 30 minutes after meals increases risk
for hyperglycemia.
10. A client is receiving corticosteroids for rheumatoid arthritis. Which long-term
complication should the nurse monitor?
A. Hyperkalemia
B. Hypotension
C. Osteoporosis
D. Hyperthyroidism
Rationale: Long-term corticosteroid therapy can cause bone demineralization, leading to
osteoporosis and increased fracture risk. Other complications include hyperglycemia,
immunosuppression, and adrenal suppression. Monitoring bone density, calcium, and
vitamin D intake is essential.
11. A nurse is caring for a client taking an ACE inhibitor for hypertension. Which symptom
requires immediate reporting?
A. Mild headache
B. Slight dizziness on standing
C. Swelling of lips, tongue, or throat
D. Occasional dry cough
Rationale: ACE inhibitors can cause angioedema, a rare but potentially life-threatening
adverse effect. Swelling of the lips, tongue, or throat requires immediate intervention. A mild
headache or dry cough is common and generally not urgent.
12. A client with chronic kidney disease is prescribed epoetin alfa. Which intervention is
critical to monitor for complications?
A. Blood glucose
TESTBANK 2026/2027 NEW ADVANCED
VERSIONS/ TESTED and GRADED A+/ HIGLY
RATED and VERIFIED
1. A nurse is caring for a client with an indwelling urinary catheter. Which action best
prevents catheter-associated urinary tract infection?
A. Routine catheter irrigation
B. Daily catheter replacement
C. Maintaining a closed drainage system
D. Elevating the drainage bag
Rationale: A closed drainage system prevents microorganisms from entering the urinary
tract, significantly reducing infection risk. Routine irrigation or frequent replacement is not
recommended unless obstruction occurs, as these interventions can introduce pathogens.
Elevating the drainage bag prevents backflow but does not replace the infection prevention
provided by a closed system.
2. A 68-year-old client with chronic heart failure is prescribed furosemide for fluid overload.
The nurse notes that the client’s potassium level is 3.0 mEq/L. Which nursing action is most
appropriate before administering the medication?
A. Administer the medication as prescribed
B. Hold the medication and notify the provider
C. Administer the medication with a potassium-sparing supplement
D. Increase the client’s fluid intake
Rationale: Loop diuretics such as furosemide promote potassium excretion, increasing the
risk of hypokalemia. Administering furosemide when potassium is critically low (3.0 mEq/L)
may precipitate life-threatening arrhythmias. The nurse should hold the medication, notify
the provider, and anticipate potassium replacement. Administering with a potassium-sparing
supplement without provider approval is not safe.
,3. A client with Type 2 diabetes mellitus is prescribed metformin. Which instruction is most
important to prevent lactic acidosis?
A. Take the medication only with meals
B. Hold the medication before procedures involving contrast dye
C. Limit carbohydrate intake
D. Take an extra dose if blood sugar is high
Rationale: Metformin reduces hepatic glucose production and improves insulin sensitivity.
A rare but serious adverse effect is lactic acidosis, which is more likely to occur in clients
undergoing contrast imaging or with renal impairment. Holding metformin 48 hours before
and after contrast procedures is standard. Taking extra doses or limiting carbohydrate intake
does not prevent this complication.
4. A nurse is teaching a client about warfarin therapy following a DVT. Which statement
indicates understanding of the therapy?
A. I will take the medication only when my legs feel swollen
B. I should take extra vitamin K if my INR is low
C. I will have my blood tested regularly to monitor INR
D. I will stop the medication once I feel better
Rationale: Warfarin inhibits vitamin K–dependent clotting factors, requiring careful
monitoring of INR to ensure therapeutic anticoagulation and prevent bleeding or clotting
complications. Clients should never adjust their dose without provider guidance. Adherence
is critical even if symptoms resolve.
5. A client receiving vancomycin intravenously reports flushing and itching during the
infusion. Which action should the nurse take first?
A. Stop the infusion and notify the provider
B. Administer antihistamines after the infusion is complete
C. Slow the infusion rate and monitor for hypotension
D. Document the reaction and continue as usual
Rationale: Red man syndrome is an infusion-related reaction characterized by flushing,
itching, and hypotension, usually caused by rapid administration of vancomycin. Slowing the
infusion rate and monitoring vital signs can prevent progression while allowing treatment
continuation. Stopping the infusion may be required in severe reactions, but first slowing is
standard.
,6. A nurse is preparing to administer digoxin to a client with heart failure. Which finding
would require holding the medication and notifying the provider?
A. Apical pulse 70 bpm
B. Blood pressure 120/78 mmHg
C. Apical pulse 48 bpm
D. Respiratory rate 18 breaths/min
Rationale: Digoxin slows AV nodal conduction and enhances myocardial contractility.
Bradycardia (apical pulse <60 bpm in adults) is a common sign of digoxin toxicity.
Administering the medication under these conditions could precipitate severe arrhythmias.
Blood pressure, respiration, and normal heart rate do not independently indicate holding
digoxin.
7. A client with asthma is prescribed albuterol. Which instruction is essential to include in
client teaching?
A. Take this medication only when symptoms occur and ignore scheduled doses
B. Avoid using this medication more than once per week
C. Use the inhaler 5–10 minutes before activities that trigger asthma
D. This medication will prevent long-term airway inflammation
Rationale: Albuterol is a short-acting beta-2 agonist that provides rapid bronchodilation.
Using it before triggers can prevent bronchospasm. Overuse can cause tachycardia, tremors,
and reduced effectiveness. Long-term airway inflammation is managed by inhaled
corticosteroids, not albuterol.
8. A client taking levothyroxine reports palpitations and insomnia. Which action should the
nurse take first?
A. Advise the client to take the next dose at night
B. Assess for signs of overreplacement and notify the provider
C. Recommend doubling the dose for faster effect
D. Instruct the client to stop the medication immediately
Rationale: Symptoms such as palpitations and insomnia suggest overreplacement of thyroid
hormone. The nurse should assess for other signs of hyperthyroidism, review recent lab
results, and notify the provider to adjust the dose. Doubling or stopping medication without
guidance is unsafe.
, 9. A nurse is preparing to administer insulin lispro to a client with diabetes. When is the
optimal time to give this medication?
A. 30 minutes after breakfast
B. Within 15 minutes before meals
C. At bedtime
D. Once daily in the morning
Rationale: Insulin lispro is a rapid-acting insulin with an onset of 10–15 minutes and peak
effect at 1–2 hours. Administering it 15 minutes before meals matches insulin activity with
postprandial glucose rise. Administering at bedtime or 30 minutes after meals increases risk
for hyperglycemia.
10. A client is receiving corticosteroids for rheumatoid arthritis. Which long-term
complication should the nurse monitor?
A. Hyperkalemia
B. Hypotension
C. Osteoporosis
D. Hyperthyroidism
Rationale: Long-term corticosteroid therapy can cause bone demineralization, leading to
osteoporosis and increased fracture risk. Other complications include hyperglycemia,
immunosuppression, and adrenal suppression. Monitoring bone density, calcium, and
vitamin D intake is essential.
11. A nurse is caring for a client taking an ACE inhibitor for hypertension. Which symptom
requires immediate reporting?
A. Mild headache
B. Slight dizziness on standing
C. Swelling of lips, tongue, or throat
D. Occasional dry cough
Rationale: ACE inhibitors can cause angioedema, a rare but potentially life-threatening
adverse effect. Swelling of the lips, tongue, or throat requires immediate intervention. A mild
headache or dry cough is common and generally not urgent.
12. A client with chronic kidney disease is prescribed epoetin alfa. Which intervention is
critical to monitor for complications?
A. Blood glucose
