NURS 180 | NURS180 Exam 4: Pharmacology - WCU
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with epilepsy is prescribed Phenytoin. Which finding should the nurse prioritize
during the assessment to ensure safe administration?
A. Reports of mild nausea after taking the medication
B. Evidence of mild gingival hyperplasia
C. Blood serum level of 25 mcg/mL
D. Occasional constipation
Correct Answer: C
Expert Explanation: The therapeutic range for phenytoin is 10 to 20 mcg/mL, meaning a
level of 25 mcg/mL indicates toxicity. The nurse must prioritize this finding because
toxicity can lead to serious neurological issues like ataxia or encephalopathy. While
gingival hyperplasia is a known side effect, it is not an acute priority compared to toxic
serum levels. Nausea and constipation are minor side effects that do not require immediate
intervention. Promptly notifying the provider and holding the dose is the standard nursing
action for toxic levels.
2. A patient taking Levodopa/Carbidopa for Parkinson’s disease complains that the
medication is less effective. What dietary instruction should the nurse provide?
A. Increase intake of leafy green vegetables
B. Avoid high-protein meals during the day
C. Drink at least 3 liters of water daily
D. Take the medication with a glass of milk
Correct Answer: B
Expert Explanation: High-protein foods can reduce the absorption of levodopa because
amino acids compete with the drug for transport across the blood-brain barrier. The nurse
should instruct the patient to spread protein intake throughout the day or avoid high-
protein meals near dosing times. This dietary adjustment helps maintain steady drug levels
and symptom control. While hydration is important for general health, it does not directly
affect the efficacy of levodopa. Milk contains protein and should not be used as a primary
vehicle for taking the drug if efficacy is decreasing.
3. A patient is receiving an IV infusion of Vancomycin. The nurse observes the patient’s face
and neck becoming bright red and itchy. What is the priority action?
A. Stop the infusion immediately
,B. Administer STAT epinephrine
C. Apply a cold compress to the face
D. Slow the rate of the infusion
Correct Answer: D
Expert Explanation: The patient is experiencing ‘Red Man Syndrome,’ which is a rate-
dependent reaction rather than a true allergic response. The priority nursing action is to
slow the infusion rate to see if the symptoms subside. If the reaction is severe or evolves
into anaphylaxis, then stopping and giving epinephrine would be necessary, but Red Man
Syndrome is usually managed by rate adjustment. The nurse should also monitor blood
pressure as hypotension can occur. Teaching the patient that this is a common side effect of
rapid infusion is part of the follow-up care.
4. A nurse is caring for a patient on Lithium for Bipolar Disorder. The patient has been
vomiting and has diarrhea. Which lab value is most concerning?
A. Sodium level of 128 mEq/L
B. Potassium level of 3.8 mEq/L
C. Lithium level of 0.8 mEq/L
D. White blood cell count of 8,000/mm3
Correct Answer: A
Expert Explanation: Hyponatremia is a major risk factor for lithium toxicity because the
kidneys conserve lithium when sodium levels are low. A sodium level of 128 mEq/L is
significantly below the normal range and increases the risk of toxic lithium accumulation.
The patient’s symptoms of vomiting and diarrhea further exacerbate sodium loss. The
nurse must monitor for signs of toxicity such as tremors, confusion, or seizures.
Encouraging fluid and salt intake is a standard intervention to stabilize lithium excretion.
5. A patient recently started on Sertraline (an SSRI) arrives at the clinic with shivering,
sweating, and hyperreflexia. What does the nurse suspect?
A. Anticholinergic crisis
B. Neuroleptic malignant syndrome
C. Serotonin syndrome
D. Tardive dyskinesia
Correct Answer: C
Expert Explanation: Serotonin syndrome is a potentially life-threatening condition caused
by excess serotonin, often occurring when starting or increasing doses of SSRIs. Symptoms
include autonomic instability, neuromuscular hyperactivity like hyperreflexia, and mental
, status changes. The nurse should immediately hold the medication and notify the
healthcare provider. Unlike neuroleptic malignant syndrome, which is associated with
antipsychotics and ‘lead-pipe’ rigidity, serotonin syndrome involves hyperreflexia.
Emergency supportive care and benzodiazepines are often used to manage symptoms.
6. Which lab test is most critical for a patient receiving long-term Gentamicin therapy?
A. Serum glucose
B. Amylase
C. Prothrombin time
D. Creatinine and BUN
Correct Answer: D
Expert Explanation: Gentamicin is an aminoglycoside known for its nephrotoxic and
ototoxic potential. Monitoring serum creatinine and BUN is essential to evaluate renal
function and prevent permanent kidney damage. If these levels rise, the dosage may need
adjustment or the drug may need to be discontinued. Aminoglycosides are cleared by the
kidneys, making renal status the primary safety concern. The nurse should also assess for
tinnitus or hearing loss as signs of ototoxicity.
7. A patient is prescribed the MAOI Phenelzine. Which food choice indicates the patient
needs further teaching?
A. Grilled chicken and rice
B. Pepperoni pizza and a glass of red wine
C. Fresh salad with vinaigrette
D. Scrambled eggs and toast
Correct Answer: B
Expert Explanation: MAOIs interact with tyramine-rich foods, which can trigger a
hypertensive crisis. Pepperoni (cured meat) and red wine are both high in tyramine and
must be avoided. The nurse must educate the patient on a low-tyramine diet to ensure
safety while taking Phenelzine. Symptoms of a hypertensive crisis include severe headache,
palpitations, and stiff neck. This interaction is critical because the reaction can be rapid and
fatal if not managed.
8. A nurse is preparing to administer Morphine sulfate to a patient. Which assessment data
would cause the nurse to hold the medication?
A. Blood pressure 110/70 mmHg
B. Respiratory rate 9 breaths/min
C. Pain level 8 out of 10
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with epilepsy is prescribed Phenytoin. Which finding should the nurse prioritize
during the assessment to ensure safe administration?
A. Reports of mild nausea after taking the medication
B. Evidence of mild gingival hyperplasia
C. Blood serum level of 25 mcg/mL
D. Occasional constipation
Correct Answer: C
Expert Explanation: The therapeutic range for phenytoin is 10 to 20 mcg/mL, meaning a
level of 25 mcg/mL indicates toxicity. The nurse must prioritize this finding because
toxicity can lead to serious neurological issues like ataxia or encephalopathy. While
gingival hyperplasia is a known side effect, it is not an acute priority compared to toxic
serum levels. Nausea and constipation are minor side effects that do not require immediate
intervention. Promptly notifying the provider and holding the dose is the standard nursing
action for toxic levels.
2. A patient taking Levodopa/Carbidopa for Parkinson’s disease complains that the
medication is less effective. What dietary instruction should the nurse provide?
A. Increase intake of leafy green vegetables
B. Avoid high-protein meals during the day
C. Drink at least 3 liters of water daily
D. Take the medication with a glass of milk
Correct Answer: B
Expert Explanation: High-protein foods can reduce the absorption of levodopa because
amino acids compete with the drug for transport across the blood-brain barrier. The nurse
should instruct the patient to spread protein intake throughout the day or avoid high-
protein meals near dosing times. This dietary adjustment helps maintain steady drug levels
and symptom control. While hydration is important for general health, it does not directly
affect the efficacy of levodopa. Milk contains protein and should not be used as a primary
vehicle for taking the drug if efficacy is decreasing.
3. A patient is receiving an IV infusion of Vancomycin. The nurse observes the patient’s face
and neck becoming bright red and itchy. What is the priority action?
A. Stop the infusion immediately
,B. Administer STAT epinephrine
C. Apply a cold compress to the face
D. Slow the rate of the infusion
Correct Answer: D
Expert Explanation: The patient is experiencing ‘Red Man Syndrome,’ which is a rate-
dependent reaction rather than a true allergic response. The priority nursing action is to
slow the infusion rate to see if the symptoms subside. If the reaction is severe or evolves
into anaphylaxis, then stopping and giving epinephrine would be necessary, but Red Man
Syndrome is usually managed by rate adjustment. The nurse should also monitor blood
pressure as hypotension can occur. Teaching the patient that this is a common side effect of
rapid infusion is part of the follow-up care.
4. A nurse is caring for a patient on Lithium for Bipolar Disorder. The patient has been
vomiting and has diarrhea. Which lab value is most concerning?
A. Sodium level of 128 mEq/L
B. Potassium level of 3.8 mEq/L
C. Lithium level of 0.8 mEq/L
D. White blood cell count of 8,000/mm3
Correct Answer: A
Expert Explanation: Hyponatremia is a major risk factor for lithium toxicity because the
kidneys conserve lithium when sodium levels are low. A sodium level of 128 mEq/L is
significantly below the normal range and increases the risk of toxic lithium accumulation.
The patient’s symptoms of vomiting and diarrhea further exacerbate sodium loss. The
nurse must monitor for signs of toxicity such as tremors, confusion, or seizures.
Encouraging fluid and salt intake is a standard intervention to stabilize lithium excretion.
5. A patient recently started on Sertraline (an SSRI) arrives at the clinic with shivering,
sweating, and hyperreflexia. What does the nurse suspect?
A. Anticholinergic crisis
B. Neuroleptic malignant syndrome
C. Serotonin syndrome
D. Tardive dyskinesia
Correct Answer: C
Expert Explanation: Serotonin syndrome is a potentially life-threatening condition caused
by excess serotonin, often occurring when starting or increasing doses of SSRIs. Symptoms
include autonomic instability, neuromuscular hyperactivity like hyperreflexia, and mental
, status changes. The nurse should immediately hold the medication and notify the
healthcare provider. Unlike neuroleptic malignant syndrome, which is associated with
antipsychotics and ‘lead-pipe’ rigidity, serotonin syndrome involves hyperreflexia.
Emergency supportive care and benzodiazepines are often used to manage symptoms.
6. Which lab test is most critical for a patient receiving long-term Gentamicin therapy?
A. Serum glucose
B. Amylase
C. Prothrombin time
D. Creatinine and BUN
Correct Answer: D
Expert Explanation: Gentamicin is an aminoglycoside known for its nephrotoxic and
ototoxic potential. Monitoring serum creatinine and BUN is essential to evaluate renal
function and prevent permanent kidney damage. If these levels rise, the dosage may need
adjustment or the drug may need to be discontinued. Aminoglycosides are cleared by the
kidneys, making renal status the primary safety concern. The nurse should also assess for
tinnitus or hearing loss as signs of ototoxicity.
7. A patient is prescribed the MAOI Phenelzine. Which food choice indicates the patient
needs further teaching?
A. Grilled chicken and rice
B. Pepperoni pizza and a glass of red wine
C. Fresh salad with vinaigrette
D. Scrambled eggs and toast
Correct Answer: B
Expert Explanation: MAOIs interact with tyramine-rich foods, which can trigger a
hypertensive crisis. Pepperoni (cured meat) and red wine are both high in tyramine and
must be avoided. The nurse must educate the patient on a low-tyramine diet to ensure
safety while taking Phenelzine. Symptoms of a hypertensive crisis include severe headache,
palpitations, and stiff neck. This interaction is critical because the reaction can be rapid and
fatal if not managed.
8. A nurse is preparing to administer Morphine sulfate to a patient. Which assessment data
would cause the nurse to hold the medication?
A. Blood pressure 110/70 mmHg
B. Respiratory rate 9 breaths/min
C. Pain level 8 out of 10
