CMS PHARMACOLOGY PROCTORED EXAM QUESTIONS AND ANSWERS
{VERIFIED ANSWERS}
Question 1
A nurse is teaching a client with a new prescription for clozapine. Which statement is a priority
to include in the teaching?
A) "This medication can cause significant weight gain."
B) "You should avoid eating aged cheeses and cured meats."
C) "Notify your provider immediately if you develop a fever or sore throat."
D) "Take this medication with food to increase its absorption."
Correct Answer: C) "Notify your provider if you develop a fever while taking this
medication"
Rationale: Clozapine has a black box warning for severe neutropenia/agranulocytosis, a life-
threatening drop in white blood cells. A fever and sore throat are early signs of an infection,
which could indicate the onset of this dangerous adverse effect. Regular WBC monitoring is
also required.
Question 2
A nurse is reviewing the medication list of a client with erectile dysfunction who is requesting a
prescription for sildenafil. The nurse should identify that concurrent use of which medication is
an absolute contraindication?
A) Metformin
B) Atorvastatin
C) Lisinopril
D) Nitroglycerin
Correct Answer: D) nitroglycerin
Rationale: Sildenafil is a phosphodiesterase-5 (PDE5) inhibitor. Both sildenafil and organic
nitrates like nitroglycerin cause significant vasodilation. When taken together, they can
produce a synergistic effect, leading to a profound and potentially fatal drop in blood
pressure (hypotension).
Question 3
A client scheduled to receive an influenza vaccine tells the nurse, "I've changed my mind and I
,[Type here]
don't want the vaccine right now." Which response by the nurse is most appropriate?
A) "You need to take this vaccine to prevent getting sick."
B) "The influenza vaccine is strongly encouraged, but I respect your right to decline it at this
time."
C) "Why are you refusing the vaccine? It's very safe."
D) "I will need to document your refusal in your medical record."
Correct Answer: B) the influenza vaccine this strongly and coverage but I understand you
would like to decline right now
Rationale: A competent adult has the right to refuse any medical treatment, including
vaccinations. This response respects the client's autonomy while also reinforcing the
professional recommendation. It is non-coercive and acknowledges the client's decision.
Question 4
When discussing pain medication risks in older adults with a new nurse, which of the following
should be included as risk factors for an adverse drug reaction? (Select all that apply.)
A) Multiple health problems (comorbidities)
B) Increased percentage of body fat
C) Decreased renal function
D) Increased liver function
E) Decreased gastric pH
Correct Answer: A, C) multiple health problems, decreased renal function
Rationale: Older adults often have multiple comorbidities (polypharmacy), and age-related
decline in renal function impairs drug excretion. A decreased percentage of body fat (not
increased) and decreased liver function also contribute. These factors alter the
pharmacokinetics and pharmacodynamics of drugs, increasing the risk of adverse
reactions.
Question 5
A nurse is reviewing a client's medical record before administering acetaminophen 650 mg.
Which finding in the client's history would prompt the nurse to notify the provider?
A) A history of hypertension.
B) A history of alcohol use disorder.
, [Type here]
C) A history of asthma.
D) A history of peptic ulcer disease.
Correct Answer: B) history of alcohol use disorder
Rationale: Acetaminophen is metabolized by the liver. Chronic, heavy alcohol use can also
damage the liver and deplete glutathione stores, which are necessary to detoxify a harmful
metabolite of acetaminophen. This combination significantly increases the risk of severe
hepatotoxicity, even at therapeutic doses.
Question 6
A nurse is caring for a client with severe hyponatremia who is receiving a prescribed infusion of
3% sodium chloride (a hypertonic solution). Which finding indicates that the treatment is
effective?
A) Increased urinary output.
B) Peripheral edema.
C) A decrease in heart rate.
D) Improved cognition.
Correct Answer: D) Improved cognition
Rationale: Hyponatremia causes cerebral edema, which leads to neurological symptoms
such as confusion, lethargy, and disorientation. An improvement in the client's cognitive
status and level of consciousness is a key indicator that the serum sodium level is correcting
and the cerebral edema is resolving.
Question 7
A nurse is reviewing the laboratory results of a client receiving gentamicin. Which of the
following findings should the nurse report to the provider immediately?
A) Hemoglobin 14 g/dL
B) Serum creatinine 2.5 mg/dL
C) Fasting blood glucose 130 mg/dL
D) White blood cell count 8,000/mm³
Correct Answer: B) Serum creatinine 2.5 mg/dL
Rationale: Gentamicin is an aminoglycoside antibiotic with a high risk of nephrotoxicity
{VERIFIED ANSWERS}
Question 1
A nurse is teaching a client with a new prescription for clozapine. Which statement is a priority
to include in the teaching?
A) "This medication can cause significant weight gain."
B) "You should avoid eating aged cheeses and cured meats."
C) "Notify your provider immediately if you develop a fever or sore throat."
D) "Take this medication with food to increase its absorption."
Correct Answer: C) "Notify your provider if you develop a fever while taking this
medication"
Rationale: Clozapine has a black box warning for severe neutropenia/agranulocytosis, a life-
threatening drop in white blood cells. A fever and sore throat are early signs of an infection,
which could indicate the onset of this dangerous adverse effect. Regular WBC monitoring is
also required.
Question 2
A nurse is reviewing the medication list of a client with erectile dysfunction who is requesting a
prescription for sildenafil. The nurse should identify that concurrent use of which medication is
an absolute contraindication?
A) Metformin
B) Atorvastatin
C) Lisinopril
D) Nitroglycerin
Correct Answer: D) nitroglycerin
Rationale: Sildenafil is a phosphodiesterase-5 (PDE5) inhibitor. Both sildenafil and organic
nitrates like nitroglycerin cause significant vasodilation. When taken together, they can
produce a synergistic effect, leading to a profound and potentially fatal drop in blood
pressure (hypotension).
Question 3
A client scheduled to receive an influenza vaccine tells the nurse, "I've changed my mind and I
,[Type here]
don't want the vaccine right now." Which response by the nurse is most appropriate?
A) "You need to take this vaccine to prevent getting sick."
B) "The influenza vaccine is strongly encouraged, but I respect your right to decline it at this
time."
C) "Why are you refusing the vaccine? It's very safe."
D) "I will need to document your refusal in your medical record."
Correct Answer: B) the influenza vaccine this strongly and coverage but I understand you
would like to decline right now
Rationale: A competent adult has the right to refuse any medical treatment, including
vaccinations. This response respects the client's autonomy while also reinforcing the
professional recommendation. It is non-coercive and acknowledges the client's decision.
Question 4
When discussing pain medication risks in older adults with a new nurse, which of the following
should be included as risk factors for an adverse drug reaction? (Select all that apply.)
A) Multiple health problems (comorbidities)
B) Increased percentage of body fat
C) Decreased renal function
D) Increased liver function
E) Decreased gastric pH
Correct Answer: A, C) multiple health problems, decreased renal function
Rationale: Older adults often have multiple comorbidities (polypharmacy), and age-related
decline in renal function impairs drug excretion. A decreased percentage of body fat (not
increased) and decreased liver function also contribute. These factors alter the
pharmacokinetics and pharmacodynamics of drugs, increasing the risk of adverse
reactions.
Question 5
A nurse is reviewing a client's medical record before administering acetaminophen 650 mg.
Which finding in the client's history would prompt the nurse to notify the provider?
A) A history of hypertension.
B) A history of alcohol use disorder.
, [Type here]
C) A history of asthma.
D) A history of peptic ulcer disease.
Correct Answer: B) history of alcohol use disorder
Rationale: Acetaminophen is metabolized by the liver. Chronic, heavy alcohol use can also
damage the liver and deplete glutathione stores, which are necessary to detoxify a harmful
metabolite of acetaminophen. This combination significantly increases the risk of severe
hepatotoxicity, even at therapeutic doses.
Question 6
A nurse is caring for a client with severe hyponatremia who is receiving a prescribed infusion of
3% sodium chloride (a hypertonic solution). Which finding indicates that the treatment is
effective?
A) Increased urinary output.
B) Peripheral edema.
C) A decrease in heart rate.
D) Improved cognition.
Correct Answer: D) Improved cognition
Rationale: Hyponatremia causes cerebral edema, which leads to neurological symptoms
such as confusion, lethargy, and disorientation. An improvement in the client's cognitive
status and level of consciousness is a key indicator that the serum sodium level is correcting
and the cerebral edema is resolving.
Question 7
A nurse is reviewing the laboratory results of a client receiving gentamicin. Which of the
following findings should the nurse report to the provider immediately?
A) Hemoglobin 14 g/dL
B) Serum creatinine 2.5 mg/dL
C) Fasting blood glucose 130 mg/dL
D) White blood cell count 8,000/mm³
Correct Answer: B) Serum creatinine 2.5 mg/dL
Rationale: Gentamicin is an aminoglycoside antibiotic with a high risk of nephrotoxicity
