NCLEX PHARMACOLOGY VATI, RN VATI PHARMACOLOGY, ATI VIRTUAL- PHARM ASSESSMENT,
RN PHARMACOLOGY VATI
Question 1
A nurse is caring for a client who ingested a toxic amount of acetaminophen 36 hours ago.
Which of the following findings should the nurse monitor for?
A) Elevated troponin levels
B) Hyperglycemia
C) Decreased alanine aminotransferase (ALT) level
D) Diaphoresis and abdominal discomfort
E) Decreased prothrombin time (PT)
Correct Answer: D) Diaphoresis and abdominal discomfort
Rationale: Acetaminophen toxicity occurs in stages. In the first 24 hours, clients often
experience non-specific symptoms such as diaphoresis, nausea, vomiting, and abdominal
discomfort. After 24 to 48 hours, signs of liver injury appear, characterized by increased
levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Elevated
troponin is associated with cardiac injury, and acetaminophen specifically targets the liver,
not the myocardium. Antidote therapy with acetylcysteine is essential to convert the toxic
metabolite to a nontoxic form.
Question 2
A nurse is assessing a client who has a new prescription for oral albuterol for the long-term
management of asthma. For which of the following adverse effects should the nurse monitor?
A) Nystagmus
B) Tachycardia
C) Drowsiness
D) Oral fungal infections
E) Constipation
Correct Answer: B) Tachycardia
Rationale: Albuterol is a beta2-adrenergic agonist. While it primarily targets the lungs, it
can also stimulate beta1 receptors in the heart, leading to tachycardia, palpitations, and
dysrhythmias. Drowsiness is not expected; instead, tremors and nervousness are common.
Oral fungal infections (candidiasis) are an adverse effect associated with inhaled
corticosteroids, such as beclomethasone, not bronchodilators like albuterol.
Question 3
A nurse is planning care for a client who has asthma and a prescription for methylprednisolone.
Which of the following laboratory values should the nurse plan to monitor?
A) Aspartate aminotransferase (AST)
B) Fibrin split products
C) Blood urea nitrogen (BUN)
D) Serum Glucose
, 2
E) Serum Sodium
Correct Answer: D) Serum Glucose
Rationale: Methylprednisolone is a glucocorticoid. Glucocorticoids increase glucose
production (gluconeogenesis) and decrease glucose uptake in the periphery, frequently
leading to hyperglycemia. This is especially important in clients with diabetes or those on
long-term steroid therapy. While steroids can cause sodium retention, glucose is the most
frequently affected and monitored metabolic lab value in the acute setting.
Question 4
A nurse is planning care for a client who has a new prescription for acetazolamide. Which of the
following findings should the nurse monitor for as an adverse effect of this medication?
A) Bronchospasm
B) Constipation
C) Diplopia
D) Electrolyte imbalance
E) Hypertension
Correct Answer: D) Electrolyte imbalance
Rationale: Acetazolamide is a carbonic anhydrase inhibitor used for glaucoma and edema.
It promotes the excretion of sodium, potassium, and bicarbonate. This can lead to
metabolic acidosis and significant electrolyte imbalances, particularly hypokalemia. Nurses
must monitor for signs of potassium depletion, such as muscle weakness and cardiac
dysrhythmias.
Question 5
A nurse is reviewing a client's medical history to determine if sumatriptan is safe for migraine
management. Which of the following conditions is a contraindication for this medication?
A) Gastrointestinal reflux
B) Angina pectoris
C) Routine acetylsalicylic acid use
D) Eczema
E) Hypothyroidism
Correct Answer: B) Angina pectoris
Rationale: Sumatriptan is a triptan that works by causing vasoconstriction of cranial
arteries. However, it can also cause coronary vasospasm. Therefore, it is strictly
contraindicated in clients with a history of ischemic heart disease, angina pectoris, or
uncontrolled hypertension. Swelling of the eyelids and lips during therapy may indicate a
serious allergic reaction and should be reported immediately.
Question 6
A nurse is preparing to administer digoxin to a client on a telemetry unit. Which of the following
cardiac rhythms should the nurse identify as a contraindication for this medication?
, 3
A) Atrial flutter
B) Second-degree heart block
C) Atrial fibrillation
D) Narrow QRS complexes
E) Sinus tachycardia
Correct Answer: B) Second-degree heart block
Rationale: Digoxin slows conduction through the AV node (negative dromotropic effect).
Administering it to a client who already has a conduction delay, such as second-degree or
third-degree heart block, can lead to complete heart block or cardiac arrest. If toxicity
occurs, the antidote is Digoxin immune Fab (Fab antibody fragments), which binds to the
drug and prevents its action.
Question 7
A nurse is caring for a postoperative client receiving IV ketorolac following orthopedic surgery.
Which of the following findings is the priority to report to the provider?
A) Dry mouth
B) Oliguria
C) Nausea
D) Altered taste
E) Sleepiness
Correct Answer: B) Oliguria
Rationale: Ketorolac is a potent NSAID. A major adverse effect of NSAIDs is renal
impairment due to the inhibition of prostaglandins that maintain renal blood flow. Oliguria
(low urine output) can indicate acute kidney injury. While nausea and dry mouth are side
effects, they are not as life-threatening or systemically critical as potential renal failure.
Question 8
A nurse is reviewing the laboratory results for a client who has been taking sodium polystyrene
sulfonate. Which of the following findings indicates a therapeutic response?
A) Magnesium 1.5 mEq/L
B) Calcium 9.2 mg/dL
C) Sodium 140 mEq/L
D) Potassium 4.8 mEq/L
E) Phosphorus 3.0 mg/dL
Correct Answer: D) Potassium 4.8 mEq/L
Rationale: Sodium polystyrene sulfonate is a cation-exchange resin used to treat
hyperkalemia. It works in the intestines by exchanging sodium ions for potassium ions,
which are then excreted. A potassium level of 4.8 mEq/L is within the normal reference
range (3.5–5.0 mEq/L), indicating the medication has effectively lowered the client's
previously high potassium level.
RN PHARMACOLOGY VATI
Question 1
A nurse is caring for a client who ingested a toxic amount of acetaminophen 36 hours ago.
Which of the following findings should the nurse monitor for?
A) Elevated troponin levels
B) Hyperglycemia
C) Decreased alanine aminotransferase (ALT) level
D) Diaphoresis and abdominal discomfort
E) Decreased prothrombin time (PT)
Correct Answer: D) Diaphoresis and abdominal discomfort
Rationale: Acetaminophen toxicity occurs in stages. In the first 24 hours, clients often
experience non-specific symptoms such as diaphoresis, nausea, vomiting, and abdominal
discomfort. After 24 to 48 hours, signs of liver injury appear, characterized by increased
levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Elevated
troponin is associated with cardiac injury, and acetaminophen specifically targets the liver,
not the myocardium. Antidote therapy with acetylcysteine is essential to convert the toxic
metabolite to a nontoxic form.
Question 2
A nurse is assessing a client who has a new prescription for oral albuterol for the long-term
management of asthma. For which of the following adverse effects should the nurse monitor?
A) Nystagmus
B) Tachycardia
C) Drowsiness
D) Oral fungal infections
E) Constipation
Correct Answer: B) Tachycardia
Rationale: Albuterol is a beta2-adrenergic agonist. While it primarily targets the lungs, it
can also stimulate beta1 receptors in the heart, leading to tachycardia, palpitations, and
dysrhythmias. Drowsiness is not expected; instead, tremors and nervousness are common.
Oral fungal infections (candidiasis) are an adverse effect associated with inhaled
corticosteroids, such as beclomethasone, not bronchodilators like albuterol.
Question 3
A nurse is planning care for a client who has asthma and a prescription for methylprednisolone.
Which of the following laboratory values should the nurse plan to monitor?
A) Aspartate aminotransferase (AST)
B) Fibrin split products
C) Blood urea nitrogen (BUN)
D) Serum Glucose
, 2
E) Serum Sodium
Correct Answer: D) Serum Glucose
Rationale: Methylprednisolone is a glucocorticoid. Glucocorticoids increase glucose
production (gluconeogenesis) and decrease glucose uptake in the periphery, frequently
leading to hyperglycemia. This is especially important in clients with diabetes or those on
long-term steroid therapy. While steroids can cause sodium retention, glucose is the most
frequently affected and monitored metabolic lab value in the acute setting.
Question 4
A nurse is planning care for a client who has a new prescription for acetazolamide. Which of the
following findings should the nurse monitor for as an adverse effect of this medication?
A) Bronchospasm
B) Constipation
C) Diplopia
D) Electrolyte imbalance
E) Hypertension
Correct Answer: D) Electrolyte imbalance
Rationale: Acetazolamide is a carbonic anhydrase inhibitor used for glaucoma and edema.
It promotes the excretion of sodium, potassium, and bicarbonate. This can lead to
metabolic acidosis and significant electrolyte imbalances, particularly hypokalemia. Nurses
must monitor for signs of potassium depletion, such as muscle weakness and cardiac
dysrhythmias.
Question 5
A nurse is reviewing a client's medical history to determine if sumatriptan is safe for migraine
management. Which of the following conditions is a contraindication for this medication?
A) Gastrointestinal reflux
B) Angina pectoris
C) Routine acetylsalicylic acid use
D) Eczema
E) Hypothyroidism
Correct Answer: B) Angina pectoris
Rationale: Sumatriptan is a triptan that works by causing vasoconstriction of cranial
arteries. However, it can also cause coronary vasospasm. Therefore, it is strictly
contraindicated in clients with a history of ischemic heart disease, angina pectoris, or
uncontrolled hypertension. Swelling of the eyelids and lips during therapy may indicate a
serious allergic reaction and should be reported immediately.
Question 6
A nurse is preparing to administer digoxin to a client on a telemetry unit. Which of the following
cardiac rhythms should the nurse identify as a contraindication for this medication?
, 3
A) Atrial flutter
B) Second-degree heart block
C) Atrial fibrillation
D) Narrow QRS complexes
E) Sinus tachycardia
Correct Answer: B) Second-degree heart block
Rationale: Digoxin slows conduction through the AV node (negative dromotropic effect).
Administering it to a client who already has a conduction delay, such as second-degree or
third-degree heart block, can lead to complete heart block or cardiac arrest. If toxicity
occurs, the antidote is Digoxin immune Fab (Fab antibody fragments), which binds to the
drug and prevents its action.
Question 7
A nurse is caring for a postoperative client receiving IV ketorolac following orthopedic surgery.
Which of the following findings is the priority to report to the provider?
A) Dry mouth
B) Oliguria
C) Nausea
D) Altered taste
E) Sleepiness
Correct Answer: B) Oliguria
Rationale: Ketorolac is a potent NSAID. A major adverse effect of NSAIDs is renal
impairment due to the inhibition of prostaglandins that maintain renal blood flow. Oliguria
(low urine output) can indicate acute kidney injury. While nausea and dry mouth are side
effects, they are not as life-threatening or systemically critical as potential renal failure.
Question 8
A nurse is reviewing the laboratory results for a client who has been taking sodium polystyrene
sulfonate. Which of the following findings indicates a therapeutic response?
A) Magnesium 1.5 mEq/L
B) Calcium 9.2 mg/dL
C) Sodium 140 mEq/L
D) Potassium 4.8 mEq/L
E) Phosphorus 3.0 mg/dL
Correct Answer: D) Potassium 4.8 mEq/L
Rationale: Sodium polystyrene sulfonate is a cation-exchange resin used to treat
hyperkalemia. It works in the intestines by exchanging sodium ions for potassium ions,
which are then excreted. A potassium level of 4.8 mEq/L is within the normal reference
range (3.5–5.0 mEq/L), indicating the medication has effectively lowered the client's
previously high potassium level.
