Pharmacology Essentials Sample

Question 1

A client is prescribed metoprolol for hypertension. Which assessment finding would the nurse address before administering the next dose?

Accepted Answer

Metoprolol is a beta 1 selective blocker that slows heart rate and lowers myocardial workload. An apical pulse of 52 puts the client at risk for symptomatic bradycardia and hypotension if another dose is given. Standard practice is to hold the dose for a heart rate below 60 and notify the provider for guidance.

The other findings are mild and do not contraindicate the next dose. Routine vital signs before each beta blocker dose protect against this exact problem.

Question 2

A client receiving IV vancomycin develops red, flushed skin on the upper body during the infusion. The most likely cause is:

Accepted Answer

Vancomycin infusion reaction (formerly called red man syndrome) is caused by direct histamine release when vancomycin runs in too quickly. Slowing the infusion and pretreating with diphenhydramine usually resolves it. The reaction is rate dependent, not a true allergy.

Anaphylaxis would include hypotension, bronchospasm, or angioedema. Stevens Johnson presents with mucosal involvement and skin sloughing. Acetaminophen does not cause this pattern.

Question 3

Which lab finding is the most useful for monitoring heparin therapy?

Accepted Answer

The activated partial thromboplastin time tracks the intrinsic clotting pathway, which is where unfractionated heparin acts. Goal range is usually 1.5 to 2.5 times the control value. INR is for warfarin therapy, hemoglobin reflects red cell mass, and bleeding time is rarely used clinically.

Knowing which lab matches which drug is one of the highest yield distinctions in pharmacology because the wrong lab can hide a dangerous bleed or clot.

Question 4

A client takes lisinopril for hypertension and reports a persistent dry cough. The nurse recognizes this is most likely caused by:

Accepted Answer

ACE inhibitors block the enzyme that breaks down bradykinin. The buildup of bradykinin in the lungs irritates airways and causes a dry, nagging cough in roughly 10 to 20 percent of clients. Switching to an ARB usually resolves the cough because ARBs do not affect bradykinin.

The other choices are unrelated. Hypokalemia and ACE inhibitors do not classically pair; ACE inhibitors actually tend to raise potassium. Reflex tachycardia and first dose hypotension are not the cough mechanism.

Question 5

A client is starting digoxin for heart failure. Which teaching point is most important?

Accepted Answer

Digoxin has a narrow therapeutic window. Early signs of toxicity include nausea, anorexia, blurred or yellow tinged vision, and halos around lights. Teaching the client to report these symptoms early prevents arrhythmias and hospitalizations.

Dietary timing, dairy avoidance, and fluid restrictions are not the leading safety teaching points for digoxin. Potassium status, kidney function, and drug interactions matter more.

Question 6

A client is prescribed ondansetron for nausea. Which assessment is most important before administration?

Accepted Answer

Ondansetron is a 5 HT3 antagonist that can prolong the QT interval, particularly in clients on other QT prolonging drugs or with electrolyte disturbances. Reviewing a recent ECG and the QT interval is the safety check that prevents torsades de pointes.

Other tests listed are not specific to ondansetron safety. The combination of QT prolonging drugs is a frequent NCLEX target, and the antiemetic family is one of the most commonly missed culprits.

Question 7

A client taking metformin is scheduled for a CT scan with IV contrast. The nurse anticipates the provider will:

Accepted Answer

Iodinated contrast can transiently impair kidney function. Metformin is renally cleared, and accumulation can rarely cause lactic acidosis. Standard practice is to hold metformin around the time of the scan and restart only after kidney function is confirmed to be unchanged.

Continuing the drug, doubling it, or switching to permanent insulin are all incorrect responses to a single imaging study.

Question 8

Which finding suggests acetaminophen toxicity in a client who took an unknown amount yesterday?

Accepted Answer

Acetaminophen toxicity injures hepatocytes through a reactive metabolite when normal pathways are saturated. Rising AST and ALT are early markers of that liver injury. The antidote, N acetylcysteine, works best within 8 to 10 hours but still helps later in many cases.

Kidney, sodium, and pancreatic markers are not the primary signal of acetaminophen damage in the early window.

Question 9

A nurse is administering levothyroxine. Which instruction supports best absorption?

Accepted Answer

Levothyroxine absorption is reduced by food, calcium, iron, and many supplements. The standard rule is to take it 30 to 60 minutes before breakfast on an empty stomach with plain water. Spacing other supplements by at least four hours preserves the dose.

Incorrect timing is one of the most common reasons clients show up with persistent hypothyroid symptoms despite a stable prescribed dose.

Question 10

A client is receiving IV potassium chloride 20 mEq in 100 mL of normal saline over one hour. Which action is most important for safe administration?

Accepted Answer

IV potassium chloride is never given as a push and must run on a pump at a controlled rate. Most institutions cap peripheral infusions at 10 mEq per hour and central infusions at 20 mEq per hour, with continuous cardiac monitoring for higher rates. Going faster causes lethal arrhythmias.

Mixing potassium with calcium in the same line creates precipitates. Cardiac monitoring is required, not optional.