CJE PRACTICE EXAM 1
COMPREHENSIVE
STUDY GUIDE
SECTION 1: PHARMACOLOGY & MEDICATION ADMINISTRATION
QUESTION 1
The nurse is caring for a client with tuberculosis who is receiving isoniazid and rifampin.
Which adverse effect should the nurse be most concerned with? 1. Blurred vision 2.
Yellowish sclera 3. Nausea and vomiting 4. Decreased urine output
ANSWER
2. Yellowish sclera
RATIONALE / EXPLANATION
Yellowish sclera indicates jaundice, a sign of hepatotoxicity (liver damage). Both isoniazid and
rifampin are hepatotoxic. Monitor liver function tests and assess for jaundice.
QUESTION 2
The nurse is assessing a client who is receiving warfarin (Coumadin). Assessment findings
include increased drowsiness, BP 90/57, pulse 108, respirations 22. What medication should
the nurse prepare to administer? 1. Vitamin K 2. Metoprolol 3. Protamine sulfate 4.
Amiodarone
ANSWER
1. Vitamin K
RATIONALE / EXPLANATION
These symptoms indicate warfarin toxicity with internal bleeding. Vitamin K is the antidote for
warfarin overdose. Protamine sulfate is for heparin overdose.
QUESTION 3
The nurse is providing discharge instructions for a client prescribed prednisone for
pneumonia. Which response indicates the need for further teaching? 1. "I may eat more food
than usual." 2. "I need to take the medication on an empty stomach." 3. "I need to gradually
Page 1 of 29
,decrease the dose." 4. "I should notify my doctor if my urine has a foul odor."
ANSWER
2. "I need to take the medication on an empty stomach."
RATIONALE / EXPLANATION
Prednisone should be taken WITH food to minimize gastric irritation. Corticosteroids can cause
GI upset and ulcers. Taking with meals provides protection.
QUESTION 4
The nurse completes medication reconciliation with an older adult admitted with Parkinson's
disease. Which medication should the nurse question? 1. Docusate 2. Benztropine 3.
Amantadine 4. Levodopa-carbidopa
ANSWER
2. Benztropine
RATIONALE / EXPLANATION
Benztropine (anticholinergic) should be avoided in older adults due to risk of acute confusion,
urinary retention, constipation, dry mouth, and blurred vision. It's on the Beers Criteria list.
QUESTION 5
Which lab finding concerns the nurse the most in the care of a client receiving Lisinopril
(Prinivil) for heart failure? 1. Potassium of 6.0 2. Sodium of 150 3. Microalbuminuria 4.
Elevated BNP
ANSWER
1. Potassium of 6.0
RATIONALE / EXPLANATION
ACE inhibitors like Lisinopril cause potassium retention, leading to hyperkalemia. K+ of 6.0
mEq/L is dangerously high and can cause fatal dysrhythmias. Normal K+ is 3.5-5.0 mEq/L.
QUESTION 6
The nurse is teaching a client about verapamil. Which statement indicates understanding? 1.
"I need to throw away my grapefruit juice." 2. "I will have to stop eating a banana for
breakfast." 3. "I should report any problems with sex to my doctor." 4. "I should look for lip
swelling and report to my doctor."
Page 2 of 29
, ANSWER
1. "I need to throw away my grapefruit juice."
RATIONALE / EXPLANATION
Grapefruit and grapefruit juice inhibit CYP3A4 enzyme, increasing verapamil levels and risk of
toxicity. Patients should avoid grapefruit products while taking calcium channel blockers.
QUESTION 7
The nurse cares for four clients prescribed atorvastatin. Which client requires further
evaluation before delivery of the medication? 1. Older adult female with muscle pain from
previous doses 2. Older adult male with constipation 3. Young adult male with type 1
diabetes 4. Young adult female who plans to become pregnant this year
ANSWER
4. A young adult female who plans to become pregnant this year.
RATIONALE / EXPLANATION
Statins are Category X drugs - absolutely contraindicated in pregnancy. They can cause fetal
harm. The nurse must verify the client is using contraception or hold the medication.
QUESTION 8
The nurse is caring for a client receiving lactulose for hepatic encephalopathy. What is an
unexpected finding of this drug? Select all that apply. 1. Ca 8.5 2. Na 155 3. Urine positive
for ketones 4. Potassium level 3.0 5. Urine specific gravity 1.038
ANSWER
• Na 155 (hypernatremia)
• Potassium level 3.0 (hypokalemia)
• Urine specific gravity 1.038 (concentrated urine)
RATIONALE / EXPLANATION
Lactulose causes diarrhea (therapeutic effect), which can lead to dehydration, hypernatremia,
hypokalemia, and concentrated urine. Monitor electrolytes and hydration status.
Page 3 of 29
COMPREHENSIVE
STUDY GUIDE
SECTION 1: PHARMACOLOGY & MEDICATION ADMINISTRATION
QUESTION 1
The nurse is caring for a client with tuberculosis who is receiving isoniazid and rifampin.
Which adverse effect should the nurse be most concerned with? 1. Blurred vision 2.
Yellowish sclera 3. Nausea and vomiting 4. Decreased urine output
ANSWER
2. Yellowish sclera
RATIONALE / EXPLANATION
Yellowish sclera indicates jaundice, a sign of hepatotoxicity (liver damage). Both isoniazid and
rifampin are hepatotoxic. Monitor liver function tests and assess for jaundice.
QUESTION 2
The nurse is assessing a client who is receiving warfarin (Coumadin). Assessment findings
include increased drowsiness, BP 90/57, pulse 108, respirations 22. What medication should
the nurse prepare to administer? 1. Vitamin K 2. Metoprolol 3. Protamine sulfate 4.
Amiodarone
ANSWER
1. Vitamin K
RATIONALE / EXPLANATION
These symptoms indicate warfarin toxicity with internal bleeding. Vitamin K is the antidote for
warfarin overdose. Protamine sulfate is for heparin overdose.
QUESTION 3
The nurse is providing discharge instructions for a client prescribed prednisone for
pneumonia. Which response indicates the need for further teaching? 1. "I may eat more food
than usual." 2. "I need to take the medication on an empty stomach." 3. "I need to gradually
Page 1 of 29
,decrease the dose." 4. "I should notify my doctor if my urine has a foul odor."
ANSWER
2. "I need to take the medication on an empty stomach."
RATIONALE / EXPLANATION
Prednisone should be taken WITH food to minimize gastric irritation. Corticosteroids can cause
GI upset and ulcers. Taking with meals provides protection.
QUESTION 4
The nurse completes medication reconciliation with an older adult admitted with Parkinson's
disease. Which medication should the nurse question? 1. Docusate 2. Benztropine 3.
Amantadine 4. Levodopa-carbidopa
ANSWER
2. Benztropine
RATIONALE / EXPLANATION
Benztropine (anticholinergic) should be avoided in older adults due to risk of acute confusion,
urinary retention, constipation, dry mouth, and blurred vision. It's on the Beers Criteria list.
QUESTION 5
Which lab finding concerns the nurse the most in the care of a client receiving Lisinopril
(Prinivil) for heart failure? 1. Potassium of 6.0 2. Sodium of 150 3. Microalbuminuria 4.
Elevated BNP
ANSWER
1. Potassium of 6.0
RATIONALE / EXPLANATION
ACE inhibitors like Lisinopril cause potassium retention, leading to hyperkalemia. K+ of 6.0
mEq/L is dangerously high and can cause fatal dysrhythmias. Normal K+ is 3.5-5.0 mEq/L.
QUESTION 6
The nurse is teaching a client about verapamil. Which statement indicates understanding? 1.
"I need to throw away my grapefruit juice." 2. "I will have to stop eating a banana for
breakfast." 3. "I should report any problems with sex to my doctor." 4. "I should look for lip
swelling and report to my doctor."
Page 2 of 29
, ANSWER
1. "I need to throw away my grapefruit juice."
RATIONALE / EXPLANATION
Grapefruit and grapefruit juice inhibit CYP3A4 enzyme, increasing verapamil levels and risk of
toxicity. Patients should avoid grapefruit products while taking calcium channel blockers.
QUESTION 7
The nurse cares for four clients prescribed atorvastatin. Which client requires further
evaluation before delivery of the medication? 1. Older adult female with muscle pain from
previous doses 2. Older adult male with constipation 3. Young adult male with type 1
diabetes 4. Young adult female who plans to become pregnant this year
ANSWER
4. A young adult female who plans to become pregnant this year.
RATIONALE / EXPLANATION
Statins are Category X drugs - absolutely contraindicated in pregnancy. They can cause fetal
harm. The nurse must verify the client is using contraception or hold the medication.
QUESTION 8
The nurse is caring for a client receiving lactulose for hepatic encephalopathy. What is an
unexpected finding of this drug? Select all that apply. 1. Ca 8.5 2. Na 155 3. Urine positive
for ketones 4. Potassium level 3.0 5. Urine specific gravity 1.038
ANSWER
• Na 155 (hypernatremia)
• Potassium level 3.0 (hypokalemia)
• Urine specific gravity 1.038 (concentrated urine)
RATIONALE / EXPLANATION
Lactulose causes diarrhea (therapeutic effect), which can lead to dehydration, hypernatremia,
hypokalemia, and concentrated urine. Monitor electrolytes and hydration status.
Page 3 of 29
