Nursing Pharmacology | Comprehensive Study
Guide, Practice Exam, Questions & Answers,
Pharmacology Exam Prep Test Bank, Medication
Classifications, Drug Calculations, Safe Medication
Administration, Pharmacokinetics,
Pharmacodynamics, Drug Interactions, NCLEX-RN
& NCLEX-PN Review, Clinical Judgment, Detailed
Rationales, Complete Review
Question 1: A patient with a history of a severe anaphylactic reaction to
penicillin is prescribed a cephalosporin for a surgical prophylaxis. Which
nursing action is the highest priority?
A. Administer the cephalosporin with an antihistamine to prevent a reaction.
B. Administer a small test dose of the cephalosporin to assess for a reaction.
C. Hold the medication and notify the healthcare provider of the patient's allergy.
D. Proceed with administration as cross-reactivity is a myth.
CORRECT ANSWER: C. Hold the medication and notify the healthcare provider
of the patient's allergy.
Rationale:While the overall cross-reactivity between penicillins and cephalosporins is
lower than once thought (approximately 1-3%), it remains a significant risk, especially in
patients with a history of severe, immediate (Type I) hypersensitivity reactions to
penicillin. The priority is patient safety; the nurse should hold the drug and consult the
prescriber to consider an alternative antibiotic.
Question 2: A client is prescribed digoxin and furosemide for heart failure. The
nurse should monitor the client for which electrolyte imbalance that could
precipitate digoxin toxicity?
A. Hyperkalemia
B. Hyponatremia
C. Hypokalemia
D. Hypercalcemia
CORRECT ANSWER: C. Hypokalemia
Rationale:Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
(low serum potassium) increases the risk of digoxin toxicity by making the cardiac
muscle more sensitive to the drug's effects, potentially leading to life-threatening
dysrhythmias.
Question 3: A nurse is providing education to a patient starting on an ACE
inhibitor (lisinopril). Which adverse effect should the patient be instructed to
report immediately?
A. Dry cough
B. Dizziness when standing
,C. Angioedema (swelling of the lips, tongue, or throat)
D. Hyperkalemia
CORRECT ANSWER: C. Angioedema (swelling of the lips, tongue, or throat)
Rationale:Angioedema is a rare but serious, potentially life-threatening adverse effect of
ACE inhibitors characterized by rapid swelling of the deep layers of the skin and mucous
membranes, particularly the face, lips, tongue, and airway. While a dry cough and
dizziness are common side effects, angioedema requires immediate emergency medical
attention.
Question 4: A patient on warfarin therapy has an International Normalized
Ratio (INR) of 5.2. Which of the following is the most appropriate nursing
action?
A. Administer a dose of vitamin K as prescribed.
B. Administer a dose of protamine sulfate as prescribed.
C. Hold the warfarin and monitor the patient for signs of bleeding.
D. Increase the next dose of warfarin to lower the INR.
CORRECT ANSWER: A. Administer a dose of vitamin K as prescribed.
Rationale:The therapeutic INR range for most indications is 2.0-3.0. An INR of 5.2 is
significantly elevated and indicates a high risk of bleeding. The standard reversal agent
for warfarin-induced anticoagulation is vitamin K. Protamine sulfate is the antidote for
heparin.
Question 5: Which of the following is the primary mechanism of action for the
biguanide class of antidiabetic drugs, such as metformin?
A. Stimulating the pancreas to release more insulin.
B. Increasing the sensitivity of peripheral tissues to insulin.
C. Inhibiting the breakdown of starch and complex carbohydrates.
D. Increasing the excretion of glucose in the urine.
CORRECT ANSWER: B. Increasing the sensitivity of peripheral tissues to
insulin.
Rationale:Metformin's primary mechanism is to decrease hepatic glucose production
(gluconeogenesis) and increase insulin sensitivity at peripheral receptor sites (muscle
and fat), thereby improving glucose uptake and utilization. It does not directly stimulate
insulin release from the pancreas.
Question 6: A nurse is preparing to administer an IV infusion of potassium
chloride (KCl). Which of the following is the most important safety
consideration?
A. Administer the infusion via rapid IV push.
B. Dilute the KCl and infuse at a rate no greater than 10 mEq/hour.
,C. Monitor the patient's blood glucose level closely.
D. Ensure the patient is on a cardiac monitor only if they have a history of heart disease.
CORRECT ANSWER: B. Dilute the KCl and infuse at a rate no greater than 10
mEq/hour.
Rationale:IV potassium is a high-alert medication. It must never be given as a bolus or
IV push due to the risk of fatal cardiac dysrhythmias. It must be diluted and infused at a
controlled rate, generally not exceeding 10 mEq/hour through a peripheral line (up to 20
mEq/hour via central line), to prevent hyperkalemia and cardiac arrest.
Question 7: A client is prescribed morphine sulfate for severe post-operative
pain. The nurse should anticipate that which medication will be ordered to
counteract the most common and dangerous adverse effect of morphine?
A. Naloxone
B. Naltrexone
C. Methylnaltrexone
D. Ondansetron
CORRECT ANSWER: A. Naloxone
Rationale:The most dangerous adverse effect of morphine is respiratory depression.
Naloxone (Narcan) is a pure opioid antagonist that rapidly reverses this life-threatening
effect. Naltrexone is used for opioid dependence and alcoholism, while
methylnaltrexone is used for opioid-induced constipation. Ondansetron is an antiemetic.
Question 8: A patient is taking sertraline for depression. Which of the
following over-the-counter (OTC) medications should the nurse warn the
patient to avoid due to the risk of serotonin syndrome?
A. Acetaminophen
B. Ibuprofen
C. St. John's Wort
D. Diphenhydramine
CORRECT ANSWER: C. St. John's Wort
Rationale:Sertraline is a Selective Serotonin Reuptake Inhibitor (SSRI). Combining it
with other serotonergic agents, such as the herbal supplement St. John's Wort,
significantly increases the risk of serotonin syndrome, a potentially life-threatening
condition characterized by agitation, confusion, diaphoresis, and tremors.
Question 9: The nurse is caring for a patient receiving heparin via continuous
IV infusion. Which laboratory value is the most important to monitor to assess
the therapeutic effect of the drug?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
, C. Activated Partial Thromboplastin Time (aPTT)
D. Platelet count
CORRECT ANSWER: C. Activated Partial Thromboplastin Time (aPTT)
Rationale:Heparin's therapeutic effect is monitored by the aPTT, which measures the
intrinsic pathway of the coagulation cascade. The therapeutic goal for a patient on
continuous IV heparin is typically an aPTT that is 1.5 to 2.5 times the normal control
value. PT and INR monitor warfarin's effect, and platelet count is monitored to detect
heparin-induced thrombocytopenia (HIT).
Question 10: Which antibiotic class has a mechanism of action that involves
inhibiting bacterial protein synthesis by binding to the 30S ribosomal subunit?
A. Penicillins
B. Cephalosporins
C. Aminoglycosides
D. Fluoroquinolones
CORRECT ANSWER: C. Aminoglycosides
Rationale:Aminoglycosides (e.g., gentamicin, tobramycin) bind to the 30S ribosomal
subunit of susceptible bacteria, disrupting protein synthesis. Penicillins and
cephalosporins inhibit cell wall synthesis, and fluoroquinolones inhibit DNA gyrase.
Question 11: A patient on isoniazid (INH) for tuberculosis should be educated
to monitor for which adverse effect?
A. Peripheral neuropathy
B. Ototoxicity
C. Hepatotoxicity
D. Red-orange discoloration of body fluids
CORRECT ANSWER: A. Peripheral neuropathy
Rationale:Isoniazid can interfere with the metabolism of vitamin B6 (pyridoxine),
leading to a deficiency that causes peripheral neuropathy (numbness and tingling of the
hands and feet). Patients are often prescribed pyridoxine supplements to prevent this.
Hepatotoxicity is also a risk but is not as specific to INH alone. Red-orange discoloration
is a classic side effect of rifampin.
Question 12: The nurse is educating a patient on self-administration of insulin.
The patient is prescribed NPH insulin and regular insulin. What is the correct
procedure for mixing these insulins in one syringe?
A. Draw up the NPH insulin first, then the regular insulin.
B. Draw up the regular insulin first, then the NPH insulin.
C. Draw them into two separate syringes.
D. The order does not matter.
CORRECT ANSWER: B. Draw up the regular insulin first, then the NPH insulin.
Guide, Practice Exam, Questions & Answers,
Pharmacology Exam Prep Test Bank, Medication
Classifications, Drug Calculations, Safe Medication
Administration, Pharmacokinetics,
Pharmacodynamics, Drug Interactions, NCLEX-RN
& NCLEX-PN Review, Clinical Judgment, Detailed
Rationales, Complete Review
Question 1: A patient with a history of a severe anaphylactic reaction to
penicillin is prescribed a cephalosporin for a surgical prophylaxis. Which
nursing action is the highest priority?
A. Administer the cephalosporin with an antihistamine to prevent a reaction.
B. Administer a small test dose of the cephalosporin to assess for a reaction.
C. Hold the medication and notify the healthcare provider of the patient's allergy.
D. Proceed with administration as cross-reactivity is a myth.
CORRECT ANSWER: C. Hold the medication and notify the healthcare provider
of the patient's allergy.
Rationale:While the overall cross-reactivity between penicillins and cephalosporins is
lower than once thought (approximately 1-3%), it remains a significant risk, especially in
patients with a history of severe, immediate (Type I) hypersensitivity reactions to
penicillin. The priority is patient safety; the nurse should hold the drug and consult the
prescriber to consider an alternative antibiotic.
Question 2: A client is prescribed digoxin and furosemide for heart failure. The
nurse should monitor the client for which electrolyte imbalance that could
precipitate digoxin toxicity?
A. Hyperkalemia
B. Hyponatremia
C. Hypokalemia
D. Hypercalcemia
CORRECT ANSWER: C. Hypokalemia
Rationale:Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
(low serum potassium) increases the risk of digoxin toxicity by making the cardiac
muscle more sensitive to the drug's effects, potentially leading to life-threatening
dysrhythmias.
Question 3: A nurse is providing education to a patient starting on an ACE
inhibitor (lisinopril). Which adverse effect should the patient be instructed to
report immediately?
A. Dry cough
B. Dizziness when standing
,C. Angioedema (swelling of the lips, tongue, or throat)
D. Hyperkalemia
CORRECT ANSWER: C. Angioedema (swelling of the lips, tongue, or throat)
Rationale:Angioedema is a rare but serious, potentially life-threatening adverse effect of
ACE inhibitors characterized by rapid swelling of the deep layers of the skin and mucous
membranes, particularly the face, lips, tongue, and airway. While a dry cough and
dizziness are common side effects, angioedema requires immediate emergency medical
attention.
Question 4: A patient on warfarin therapy has an International Normalized
Ratio (INR) of 5.2. Which of the following is the most appropriate nursing
action?
A. Administer a dose of vitamin K as prescribed.
B. Administer a dose of protamine sulfate as prescribed.
C. Hold the warfarin and monitor the patient for signs of bleeding.
D. Increase the next dose of warfarin to lower the INR.
CORRECT ANSWER: A. Administer a dose of vitamin K as prescribed.
Rationale:The therapeutic INR range for most indications is 2.0-3.0. An INR of 5.2 is
significantly elevated and indicates a high risk of bleeding. The standard reversal agent
for warfarin-induced anticoagulation is vitamin K. Protamine sulfate is the antidote for
heparin.
Question 5: Which of the following is the primary mechanism of action for the
biguanide class of antidiabetic drugs, such as metformin?
A. Stimulating the pancreas to release more insulin.
B. Increasing the sensitivity of peripheral tissues to insulin.
C. Inhibiting the breakdown of starch and complex carbohydrates.
D. Increasing the excretion of glucose in the urine.
CORRECT ANSWER: B. Increasing the sensitivity of peripheral tissues to
insulin.
Rationale:Metformin's primary mechanism is to decrease hepatic glucose production
(gluconeogenesis) and increase insulin sensitivity at peripheral receptor sites (muscle
and fat), thereby improving glucose uptake and utilization. It does not directly stimulate
insulin release from the pancreas.
Question 6: A nurse is preparing to administer an IV infusion of potassium
chloride (KCl). Which of the following is the most important safety
consideration?
A. Administer the infusion via rapid IV push.
B. Dilute the KCl and infuse at a rate no greater than 10 mEq/hour.
,C. Monitor the patient's blood glucose level closely.
D. Ensure the patient is on a cardiac monitor only if they have a history of heart disease.
CORRECT ANSWER: B. Dilute the KCl and infuse at a rate no greater than 10
mEq/hour.
Rationale:IV potassium is a high-alert medication. It must never be given as a bolus or
IV push due to the risk of fatal cardiac dysrhythmias. It must be diluted and infused at a
controlled rate, generally not exceeding 10 mEq/hour through a peripheral line (up to 20
mEq/hour via central line), to prevent hyperkalemia and cardiac arrest.
Question 7: A client is prescribed morphine sulfate for severe post-operative
pain. The nurse should anticipate that which medication will be ordered to
counteract the most common and dangerous adverse effect of morphine?
A. Naloxone
B. Naltrexone
C. Methylnaltrexone
D. Ondansetron
CORRECT ANSWER: A. Naloxone
Rationale:The most dangerous adverse effect of morphine is respiratory depression.
Naloxone (Narcan) is a pure opioid antagonist that rapidly reverses this life-threatening
effect. Naltrexone is used for opioid dependence and alcoholism, while
methylnaltrexone is used for opioid-induced constipation. Ondansetron is an antiemetic.
Question 8: A patient is taking sertraline for depression. Which of the
following over-the-counter (OTC) medications should the nurse warn the
patient to avoid due to the risk of serotonin syndrome?
A. Acetaminophen
B. Ibuprofen
C. St. John's Wort
D. Diphenhydramine
CORRECT ANSWER: C. St. John's Wort
Rationale:Sertraline is a Selective Serotonin Reuptake Inhibitor (SSRI). Combining it
with other serotonergic agents, such as the herbal supplement St. John's Wort,
significantly increases the risk of serotonin syndrome, a potentially life-threatening
condition characterized by agitation, confusion, diaphoresis, and tremors.
Question 9: The nurse is caring for a patient receiving heparin via continuous
IV infusion. Which laboratory value is the most important to monitor to assess
the therapeutic effect of the drug?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
, C. Activated Partial Thromboplastin Time (aPTT)
D. Platelet count
CORRECT ANSWER: C. Activated Partial Thromboplastin Time (aPTT)
Rationale:Heparin's therapeutic effect is monitored by the aPTT, which measures the
intrinsic pathway of the coagulation cascade. The therapeutic goal for a patient on
continuous IV heparin is typically an aPTT that is 1.5 to 2.5 times the normal control
value. PT and INR monitor warfarin's effect, and platelet count is monitored to detect
heparin-induced thrombocytopenia (HIT).
Question 10: Which antibiotic class has a mechanism of action that involves
inhibiting bacterial protein synthesis by binding to the 30S ribosomal subunit?
A. Penicillins
B. Cephalosporins
C. Aminoglycosides
D. Fluoroquinolones
CORRECT ANSWER: C. Aminoglycosides
Rationale:Aminoglycosides (e.g., gentamicin, tobramycin) bind to the 30S ribosomal
subunit of susceptible bacteria, disrupting protein synthesis. Penicillins and
cephalosporins inhibit cell wall synthesis, and fluoroquinolones inhibit DNA gyrase.
Question 11: A patient on isoniazid (INH) for tuberculosis should be educated
to monitor for which adverse effect?
A. Peripheral neuropathy
B. Ototoxicity
C. Hepatotoxicity
D. Red-orange discoloration of body fluids
CORRECT ANSWER: A. Peripheral neuropathy
Rationale:Isoniazid can interfere with the metabolism of vitamin B6 (pyridoxine),
leading to a deficiency that causes peripheral neuropathy (numbness and tingling of the
hands and feet). Patients are often prescribed pyridoxine supplements to prevent this.
Hepatotoxicity is also a risk but is not as specific to INH alone. Red-orange discoloration
is a classic side effect of rifampin.
Question 12: The nurse is educating a patient on self-administration of insulin.
The patient is prescribed NPH insulin and regular insulin. What is the correct
procedure for mixing these insulins in one syringe?
A. Draw up the NPH insulin first, then the regular insulin.
B. Draw up the regular insulin first, then the NPH insulin.
C. Draw them into two separate syringes.
D. The order does not matter.
CORRECT ANSWER: B. Draw up the regular insulin first, then the NPH insulin.
