NUR 2474 Pharmacology Final Exam NCLEX Style Pract

Name: NUR 2474 Pharmacology Final Exam NCLEX Style Pract
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High-yield pharmacology questions covering insulin types, diabetes management, hypothyroidism in pregnancy, and med safety. Perfect for med-surg and NCLEX prep. Sharpen your clinical judgment now.

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NUR 2474 / NUR 2474 Pharmacology
Final Exam NCLEX Style Practice
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four
patients who were just admitted. Which patient should the nurse assess first?
a.The NPO patientwith a blood glucose level of 80 mg/dL who just received 20 units of
70/30 Novolin insulin
b.The patient with a pulse of 58 beats per minute who is about to receive digoxin
(Lanoxin)
c.The patient with a blood pressure of 136/92 mm Hg who complains of having a
headache
d.The patient with an allergy to penicillin who is receiving an infusion of vancomycin
(Vancocin) - ANSWER-a.The NPO patient with a blood glucose level of 80 mg/dL who
just received 20 units of 70/30 Novolin insulin
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a
sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar
level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer?
a.No insulin should be administered.
b.NPH
c.70/30 mix
d.Lispro (Humalog) - ANSWER-d.Lispro (Humalog)
A patient with type 1 diabetes recently became pregnant. The nurse plans a blood
glucose testing schedule for her. What is the recommended monitoring schedule?
a.Before each meal and before bed
b.lnthe morning for a fasting level and at 4 PM for the peak level
c.Six or seven times a day
d .Three times a day, along with urine glucose testing - ANSWER-c.Six or seven times a
day
An adolescent patient recently attended a health fair and had a serum glucose test.
The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I
have diabetes?' What is the nurse's most accurate response?
a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean
you have diabetes.”
b. "At this level, you probably have diabetes. You will need an oral glucose tolerance
test this week."
c. 'This level is conclusive evidence that you have diabetes."

d. "This level is conclusive evidence that you do not have diabetes." - ANSWER-
a."Unlessyou were fasting for longer than 8 hours, this does not necessarily mean
you have diabetes.''
Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the
nurse administer this drug?
a.Approximately 15 to 30 minutes before each meal
b ln the morning and at 4 PM
c.Once daily at bedtime
d.After meals and at bedtime - ANSWER-c.Once daily at bedtime
A patient with type 1 diabetes who takes insulin reports taking propranolol for
hypertension. Why is the nurse concerned?
a.The beta blocker can cause insulin resistance.
b.Using the two agents together increases the risk of ketoacidosis.
c.Propranolol increases insulin requirements because of receptor blocking.
d.The beta blocker can mask the symptoms of hypoglycemia. - ANSWER-d.The beta
blocker can mask the symptoms of hypoglycemia.
Which statement is correct about the contrast between acarbose and miglitol?
a.Miglitol has not been associated with hepatic dysfunction.
b.With miglitol, sucrose can be used to treat hypoglycemia.
c.Miglitol is less effective in African Americans.
d.Miglitol has no gastrointestinal side effects. - ANSWER -a.Miglitol has not been
associated with hepatic dysfunction.
A nurse counsels a patient with diabetes who is starting therapy with an alpha-
glucosidase inhibitor. The patient should be educated about the potential for which
adverse reactions? (Select all that apply.)
a.Hypoglycemia
b.Flatulence
c.Elevated iron levels in the blood
d.Fluid retention
e.Diarrhea - ANSWER-b.Flatulence
e.Diarrhea
The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The
patient tells the nurse she does not want to take medications while she is pregnant.
What will the nurse explain to this patient?
a.Hypothyroidism is a normal effect of pregnancy and usually is of no
consequence, b.Neuropsychologic deficits in the fetus can occur if the condition is
not treated. c.No danger to the fetus exists until the third trimester.

d.Treatment is required only if the patient is experiencing symptoms. - ANSWER-
b.Neuropsychologic deficits in the fetus can occur if the condition is not treated.
A nurse is teaching a patient who has been diagnosed with hypothyroidism about
levothyroxine (Synthroid). Which statement by the patient indicates a need forfurther
teaching?
a. "I should not take heartburn medication without consulting my provider."
b."| should report insomnia, tremors, and an increased heart rate to my provider."
c "If I take a multivitamin with iron, I should take it 4 hours after the Synthroid.”
d."lf I take calcium supplements, I may need to decrease my dose of Synthroid." -
ANSWER-d."lf I take calcium supplements, I may need to decrease my dose of
Synthroid."
A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The nurse
assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per
minute and a temperature of 97.27F. The patient is lethargic and difficult to arouse. The
nurse will contact the provider to request an order for which drug?
a.Beta blocker
b.Increased dose of PO levothyroxine
c.Intravenous levothyroxine
d.Methimazole (Tapazole) - ANSWER-c.Intravenous levothyroxine
A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). The
nurse learns that the patient also takes warfarin (Coumadin). The nurse will notify the
provider to discuss the dose.
a.reducing levothyroxine
b.reducing warfarin
c.increasing levothyroxine
d.increasing warfarin - ANSWER-b.reducing; warfarin
An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5
mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine
(Levothroid) 100 mcg/day PO. What will the nurse do?
a.Administer the medication as ordered.
b.Contact the provider to discuss giving the levothyroxine IV.
c.Re quest an order to give desiccated thyroid (Armour Thyroid).
d.Suggest that the provider lower the dose. - ANSWER-d.Suggest that the provider
lower the dose.
A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of levothyroxine
(Synthroid). The child comes to the clinic for a well-chiId check up. The nurse will expect
the provider to:

a.change the dose of levothyroxine to 6 mcg/kg/day.
b.discontinue the drug if the child's physical and mental development is normal.
c.increase the dose to accommodate the child's increased growth.
d.stop the drug for 4 weeks and check the child's TSH level. - ANSWER-a.change the
dose of levothyroxine to 6 mcg/kg/day.
A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to
complain of pain and irritation at the infusion site. The nurse observes signs of redness
at the IV insertion site and along the vein. What is the nurse's priority action?
a.Apply warm packs to the arm, and infuse the medication at a slower rate.
b.Continue the infusion while elevating the arm.
c.Select an alternate intravenous site and administer the infusion more slowly.
d.Request central venous access. - ANSWER-c.Select an alternate intravenous site and
administer the infusion more slowly.
A nurse is teaching a nursing student what is meant by ''generations” of cephalosporins.
Which statement by the student indicates understanding of the teaching?
a. "Cephalosporins are assigned to generations based on their relative costs
to administer."
b. "Cephalosporins have increased activity against gram-negative bacteria with
each generation."
c."First- generation cephalosporins have better penetration of the cerebrospinal
fluid." d."Later generations of cephalosporins have lower resistance to destruction by
beta- lactamases." - ANSWER -b."Cephalosporins have increased activity against
gram- negative bacteria with each generation."
A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment.
What will the nurse do?
a.Administer the medication as prescribed.
b.Contact the provider to ask about giving the drug in divided doses.
c.Discuss increasing the interval between doses with the provider.
d. Discuss reducing the dose with the provider. - ANSWER-a.Administer the medication
as prescribed.
A patient will be discharged home to complete treatment with intravenous cefotetan with
the assistance of a home nurse. The home care nurse will include which instruction
when teaching the patient about this drug treatment?
a.Abstain from alcohol consumption during therapy.
b.Avoid dairy products while taking this drug.
c.Take an antihistamine if a rash occurs.

d.Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain. -
ANSWER -a.Abstain from alcohol consumption during therapy.
The nurse is caring for a patient who is receiving vancomycin (Vancocin). The nurse
notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's
heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse
understands that these findings are consistent with:
a.allergic reaction.
b.red man syndrome.
c.rhabdomyolysis.
d.Stevens-Johnson syndrome. - ANSWER-b.red man syndrome.
A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporin
to be given preoperatively as prophylaxis against infection. The nurse expects the
provider to order which cephalosporin?
a.First-generation cephalosporin
b.Second-generation cephalosporin
c.Third-generation cephalosporin
d.Fourth-generation cephalosporin - ANSWER- a.First- generation cephalosporin
A patient receiving a cephalosporin develops a secondary intestinal infection caused by
Clostridium difficile. What is an appropriate treatment for this patient?
a.Adding an antibiotic, such as vancomycin (Vancocin), to the patient's regimen
b.Discontinuing the cephalosporin and beginning metronidazole (Flagyl)
c.Discontinuing all antibiotics and providing fluid replacement
d.Increasing the dose of the cephalosporin and providing isolation measures -
ANSWER-b.Discontinuing the cephalosporin and beginning metronidazole
(Flagyl)
Besides the cost of administering a given drug, which are considerations when a
provider selects a cephalosporin to treat an infection? (Select all that apply.)
a.Adverse effects
b.Antimicrobial spectrum
c.Brand name
d.Manufacturer
e.Pharmacokinetics - ANSWER-a.Adverse effects
b.Antimicrobial spectrum
e.Pharmacokinetics
A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has
ordered piperacillin and amikacin, both to be given intravenously. What will the nurse
do?

a.Make sure to administer the drugs at different times using different IV tubing.
b.Suggest giving larger doses of piperacillin and discontinuing the amikacin.
c.Suggest that a fixed-dose combination of piperacillin and tazobactam (Zosyn) be
used.
d.Watch the patient closely for allergic reactions, because this risk is increased with this
combination. - ANSWER-a.Make sure to administer the drugs at different times using
different IV tubing.
A nurse assisting a nursing student with medications asks the student to describe how
penicillins (PCNs) work to treat bacterial infections. The student is correct in responding
that penicillins:
a.disinhibit transpeptidases.
b.disrupt bacterial cell wall synthesis.
c.inhibit autolysins.
d.inhibit host cell wall function. - ANSWER- b.disrupt bacterial cell wall synthesis.
A patient is about to receive penicillin G for an infection that is highly sensitive to this
drug. While obtaining the patient's medication history, the nurse learns that the patient
experienced a rash when given amoxicillin (Amoxil) as a child 20 years earlier. What will
the nurse do?
a.Ask the provider to order a cephalosporin.
b.Reassure the patient that allergic responses diminish over time.
c.Re quest an order for a skin test to assess the current risk.
d.Suggest using a desensitization schedule to administer the drug. - ANSWER-
c.Request an order for a skin test to assess the current risk.
A patient with no known drug allergies is receiving amoxicillin (Amoxil) IPO twice daily.
Twenty minutes after being given a dose, the patient complains of shortness of breath.
The patients blood pressure is 100/58 mm Hg. What will the nurse do?
a.Contact the provider and prepare to administer epinephrine.
b.Notify the provider if the patient develops a rash.
c.Re quest an order for a skin test to evaluate possible PCN allergy.
d.Withhold the next dose until symptoms subside. - ANSWER-a.Contact the provider
and prepare to administer epinephrine.
A patient with an infection caused by Pseudomonas aeruginosa is being treated with
piperacillin. The nurse providing care reviews the patient's laboratory reports and notes
that the patient's blood urea nitrogen and serum creatinine levels are elevated. The
nurse will contact the provider to discuss:
a.adding an aminoglycoside.
b.changing to penicillin G.
c.reducing the dose of piperacillin.

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cl.ordering nafcillin. -ANSWER-c.reducing the dose of piperacillin.
A patient recently began receiving clindamycin (Cleocin) to treat an infection. After 8
days of treatment, the patient reports having 10 to 15 watery stools per day. What will
the nurse telI this patient?
a.The provider may increase the clindamycin dose to treat this infection.
b.This is a known side effect of clindamycin, and the patient should consume extra
fluids.
c.The patient should stop taking the clindamycin now and contact the provider
immediately.
d.The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal
symptoms. - ANSWER -c.The patient should stop taking the clindamycin now and
contact the provider immediately.
Which side effect of clindamycin (Cleocin) causes the most concern and may warrant
discontinuation of the drug?
a.Diarrhea
b.Headache
c.Nausea
d.Vomiting - ANSWER-a.Diarrhea
A patient develops CDAD. Which antibiotic is recommended for treating this infection?
a.Chloramphenicol
b.Clindamycin (Cleocin)
c.Linezolid (Zyvox)
d.Vancomycin - ANSWER-d.Vancomycin
A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) (Bactrim)
for a urinary tract infection at 34 weeks' gestation. A week later, the woman delivers her
infant prematurely. The nurse will expect to monitor the infant for:
a.birth defects.
b.hypoglycemia.
c.rash.
d.scleral jaundice. - ANSWER-d.scleral jaundice.
A patient who is taking immunosuppressants develops a urinary tract infection. The
causative organism is sensitive to sulfonamides and to another, more expensive
antibiotic. The prescriber orders the more expensive antibiotic. The nursing student
assigned to this patient asks the nurse why the more expensive antibiotic is being
used. Which response by the nurse is correct?
a. "Immunosuppressed patients are folate deficient."

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b. "Patients who are immunosuppressed are more likely to develop
resistance." c."Sulfonamides are bacteriostatic and depend on host immunity
to work."
d."Sulfonamides intensify the effects of immunosuppression." - ANSWER-
c."Sulfonamides are bacteriostatic and depend on host immunity to work."
A nurse teaches a patient about sulfonamides. Which statement by the patient indicates
a need for further teaching?
a."l need to drink extra fluids while taking this medication."
b."l need to use sunscreen when taking this drug."
c."l should call my provider if I develop a rash while taking this drug."
d."l should stop taking this drug when my symptoms are gone." - ANSWER-d."l should
stop taking this drug when my symptoms are gone."
A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary
tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient?
a.Patients with diabetes have an increased risk of an allergic reaction.
b.Patients taking TMP/SMZ may need increased doses of glipizide.
c.The patient should check the blood glucose level more often while taking TMP/SMZ.
d.The patient should stop taking the glipizide while taking the TMP/SMZ. - ANSWER -
c.The patient should check the blood glucose level more often while taking TMP/SMZ.
A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The
nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on
this assessment, the nurse will expect the provider to:
a.change the antibiotic to TMP/SMZ.
b.increase the dose of the glipizide.
c .monitor the patient's el e ct rolytes close ly.
d.monitor the patient's coagulation levels. - ANSWER-d.monitor the patient's
coagulation levels.
A patient will be discharged from the hospital with a prescription for TMP/SMZ
(Bactrim). When providing teaching for this patient, the nurse will tell the patient that it
will be important to:
a.drink 8 to 10 glasses of water each day.
b.eat foods that are high in potassium.
c.take the medication with food.
d.take folic acid supplements. - ANSWER-a.drink 8 to 10 glasses of water each day.
A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a
nursing student. Which statement by the student indicates a need for further teaching?
a. "Bacterial resistance to trimethoprim is relatively uncommon.

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b. "Resistance among gonococci, streptococci, and meningococci to sulfonamides is
high.1
'
c."Resistance to both agents can occur by spontaneous mutation of organisms."
d."Resistance to sulfonamides is less than resistance to trimethoprim." - ANSWER-
d."Resistance to sulfonamides is less than resistance to trimethoprim."
A patient with bronchitis is taking TMP/SMZ, 106/80 mg orally, twice daily. Before
administering the third dose, the nurse notesthat the patient has a widespread rash, a
temperature of 103?? F, and a heart rate of 100 beats per minute. The patient looks ill
and reports not feeling well. What will the nurse do?
a.Administer the dose and request an order for an antipyretic medication.
b.Withhold the dose and request an order for an antihistamine to treat the rash.
c.Withhold the dose and notify the provider of the symptoms.
d.Request an order for intravenous TMP/SMZ, because the patient is getting worse. -
ANSWER -c.Withhold the dose and notify the provider of the symptoms.
A patient with histoplasmosis is being treated with itraconazole (Sporanox). The nurse
will teach this patient to report which symptoms?
a.Gynecomastia and decreased libido
b.Headache and rash
c.Nausea, vomiting, and anorexia
d. Visual disturbances - ANSWER-c.Nausea, vomiting, and anorexia
A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The
patient asks the nurse what will be done to suppress an outbreak when she is
near term. The nurse will tell the patient that:
a.antiviral medications are not safe during pregnancy.
b.intravenous antiviral agents will be used if an outbreak occurs.
c.oral acyclovir (Zovirax) may be used during pregnancy.
d.topical acyclovir (Zovirax) must be used to control outbreaks - ANSWER-c.oral
acyclovir (Zovirax) may be used during pregnancy.
The nurse is caring fora patient receiving intravenous acyclovir (Zovirax). To prevent
nephrotoxicity associated with intravenous acyclovir, the nurse will:
a.hydratethe patient during the infusion and for 2 hours after the infusion.
b.increase the patient's intake of foods rich in vitamin C.
c.monitor urinary output every 30 minutes.
d.provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. -
ANSWER -a.hydrate the patient during the infusion and for 2 hours after the
infusion.

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A nurse is performing a pre operative drug history on a patient who is admitted to the
hospital for surgery. To evaluate the risk of hemorrhage, the nurse will ask the patient
about antiplatelet and anticoagulant medications as well as which dietary supplement?
a.Coenzyme Q-10
b.Ginkgo biloba
c.Ma Huang (ephedra)
d.St. John's wort - ANSWER-b.Ginkgo biloba
A patient will begin taking immunosuppressant drugs for rheumatoid arthritis. The nurse
will caution this patient to avoid which dietary supplement?
a.Black cohosh
b.Echinacea
c.Feverfew
d.Glucosamine - ANSWER-b.Echinacea
An infant has allergies and often develops a pruritic rash when exposed to allergens.
The infant's parents ask the nurse about using a topical antihistamine. What does
the nurse tell them?
a.Antihistamines given by this route are not absorbed as well in children.
b.Applying this medication to the skin can cause toxicity in this age group.
c.The child will also need oral medication to achieve effective results.
d.Topical medications have fewer side effects than those given by other routes. -
ANSWER-b.Applying this medication to the skin can cause toxicity in this age group.
The parents of a child with asthma ask the nurse why their child cannot use oral
corticosteroids more often, because they are so effective. The nurse will offer which
information that is true for children?
a.Chronic steroid use can inhibit growth.
b.Frequent use of this drug may lead to a decreased response.
c.A hypersensitivity reaction to this drug may occur.
d.Systemic steroids can be toxic. - ANSWER-a.Chronic steroid use can inhibit growth.
Parents ask the nurse why an over-the-counter cough suppressant with sedative side
effects is not recommended for infants. Which response by the nurse is correct?
a/'Babies have a more rapid gastric emptying time and don't absorb drugs well.''
b."Cough medicine tastes bad, and infants usually won't take it."
c."Infants are more susceptible to central nervous system effects than are adults."
d."Infants metabolize drugs too rapidly, so drugs aren't as effective." - ANSWER-
c."Infants are more susceptible to central nervous system effects than are adults."
A nurse is caring for an infant after a surgical procedure. After ensuring that the ordered
dose is appropriate for the infant's age and weight, the nurse administers a narcotic
analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes

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respirations of 22 breaths per minute and a heart rate of 110 beats per minute. The
infant is asleep in the parent’s arms and does not awaken when vital signs are
assessed. The nurse understands that these findings are the result of:
a.an allergic reaction to the medication.
b.immaturity of the blood-brain barrier in the infant.
c.toxic effects of the narcotic, requiring naloxone (Narcan) as an antidote.
d.unexpected side effects of medications in infants. - ANSWER-b.immaturity of the
blood-brain barrier in the infant.
An infant is receiving a medication that has a narrow therapeutic range. The nurse
reviews the medication information and learns that the drug is excreted by the kidneys.
When giving the medication, the nurse will assess the infant for:
a.decreased effectiveness of the drug.
b.shorter period of the drug's effects.
c.signs of drug toxicity.
d.unusual CNS effects. - ANSWER-c.signs of drug toxicity.
A prescriber has ordered medication fora newborn. The medication is eliminated
primarily by hepatic metabolism. The nurse expects the prescriber to:
a.order a dose that is lower than an adult dose.
b.order a dose that is higher than an adult dose.
c.increase the frequency of medication dosing.
d.discontinue the drug after one or two doses. - ANSWER -a.order a dose that is lower
than an adult dose.
A nurse caring for a 5-year-old child notesthat the child has discoloration of several
teeth. When taking a medication history, the nurse will ask about which group of
medications?
a.Glucocorticoids
b.Salicylates
c.Sulfonamides
d.Tetracyc lines - ANSWER-d.TetracycIines
A nurse is caring for a patient and her newborn immediately after delivery. The patient's
medication history includes prenatal vitamins throughout pregnancy, one or two glasses
of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her
last trimester, and intravenous morphine during labor. What will the nurse expect to do?
a.Administer opioids to the infant to prevent withdrawal syndrome.
b.Monitor the infant's respirations closely and prepare to administer
oxygen. c.Note a high-pitched cry and irritability in the infant.

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d.Prep are the patient for motor delays in the infant caused by the alcohol use. -
ANSWER-b.Monitor the infant's respirations closely and prepareto administer
oxygen.
A patient who has just learned she is pregnant has stopped using a prescription
medication that she takes for asthma because she doesn't want to harm her baby. What
will the nurse tell her?
a.That asthma medications will not affect the fetus
b.That her baby's health is dependent on hers
c.Toavoid taking medications during her pregnancy
d.To resume the medication in her second trimester - ANSWER-b.That her baby's
health is dependent on hers
A pregnant patient asks the nurse about the safe use of medications during the third
trimester. What will the nurse tell her about drugs taken at this stage?
a.They may need to be given in higher doses if they undergo renal clearance.
b.They require lower doses ifthey are metabolized by the liver.
c.They are less likely to cross the placenta and affect the fetus.
d.They are more likely to cause anatomical defects if they are teratogenic. - ANSWER -
a.They may need to be given in higher doses if they undergo renal clearance.
A breast-feeding patient must take a prescription medication for 2 weeks. The
medication is safe, but the patient wants to make sure her baby receives as little of the
drug as possible. What will the nurse tell the patient?
a.Togive the baby formula as long as the mother is taking the medication
b.To take the medication immediately after breast-feeding
c.To pump breast milk and feed the baby by bottle
d.To take the medication 1 hour before breast-feeding - ANSWER -b.To take the
medication immediately after breast-feeding
Which type of drug taken by a pregnant patient is more likely to have effects on a fetus?
a.Drug that is highly polar
b.lonized drug
c.Lipid-soluble drug
d.Protein-bound drug - ANSWER-c.Lipid-soluble drug
A nurse is concerned about renal function in an 84-year-old patient who is taking
several medications. What should the nurse assess?
a.Creatinine clearance
b.Sodium levels
c.Potassium levels
d.Serum creatinine - ANSWER- a.Creatinine clearance

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NUR 2474 Pharmacology Final Exam NCLEX Style Pract

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