NGN HESI RN Pharmacology practice questions and
Answers | latest Update | TEST BANK
1. A nurse is preparing to administer metformin to a client with type 2 diabetes. Which
laboratory value should the nurse assess before administration?
A. Serum potassium B. Serum creatinine (correct answer) C. Serum calcium D. Complete blood
count
Rationale: Metformin is contraindicated in renal impairment because it can accumulate
and cause lactic acidosis. Serum creatinine reflects kidney function and must be assessed
before administration.
2. A client receiving warfarin has an INR of 4.8. Which action should the nurse take first?
A. Administer vitamin K as ordered (correct answer) B. Draw a repeat INR in 4 hours C. Hold
the next scheduled dose only D. Notify dietary to restrict green vegetables
Rationale: An INR of 4.8 is significantly above the therapeutic range of 2–3, indicating a
high bleeding risk. Vitamin K is the antidote for warfarin toxicity and should be
administered as ordered while the prescriber is notified.
3. A nurse is teaching a client about atorvastatin. Which statement by the client requires
follow-up?
A. "I will report any muscle pain immediately." B. "I can take this medication with grapefruit
juice." (correct answer) C. "I will have periodic liver function tests." D. "I should take this
medication in the evening."
Rationale: Grapefruit juice inhibits CYP3A4 enzymes, increasing statin blood levels and
the risk of myopathy and rhabdomyolysis. The client must avoid grapefruit juice while
taking atorvastatin.
4. A client with a penicillin allergy is prescribed cephalexin. What is the nurse's priority
action?
,A. Administer the medication as prescribed B. Contact the prescriber to clarify the order (correct
answer) C. Administer diphenhydramine before giving the medication D. Substitute amoxicillin
instead
Rationale: There is a potential cross-reactivity between penicillins and cephalosporins
(approximately 1–10%). The nurse must notify the prescriber before administering
cephalexin to a client with a known penicillin allergy.
5. A nurse is administering IV vancomycin. The client develops flushing, erythema, and
hypotension. What is the most likely cause?
A. Anaphylactic reaction B. Red Man Syndrome (correct answer) C. Clostridium difficile
infection D. Nephrotoxicity
Rationale: Red Man Syndrome is a non-immune-mediated reaction caused by rapid
infusion of vancomycin. It presents with flushing, erythema of the neck and face, and
hypotension. Slowing the infusion rate prevents and treats this reaction.
6. A nurse is caring for a client receiving morphine via PCA pump. Which finding requires
immediate intervention?
A. Respiratory rate of 10 breaths/min (correct answer) B. Pain rating of 4/10 C. Mild nausea D.
Drowsiness
Rationale: Respiratory depression is the most serious adverse effect of opioid analgesics. A
respiratory rate of 10 or below indicates significant CNS depression requiring immediate
intervention, including naloxone administration.
7. A client is prescribed lithium for bipolar disorder. Which instruction is most important
for the nurse to include?
A. "Avoid caffeine-containing beverages." B. "Maintain a consistent sodium intake." (correct
answer) C. "Take the medication on an empty stomach." D. "Report any weight gain
immediately."
Rationale: Sodium and lithium compete for renal reabsorption. Low sodium intake causes
the kidneys to retain lithium, leading to toxicity. Clients must maintain a consistent,
adequate daily sodium intake.
,8. A nurse is preparing to administer digoxin to a client. The apical pulse is 54 beats/min.
What should the nurse do?
A. Administer the dose and document the finding B. Hold the dose and notify the prescriber
(correct answer) C. Administer half the prescribed dose D. Recheck the pulse in 30 minutes
Rationale: Digoxin should be withheld if the apical pulse is below 60 beats/min in adults.
Bradycardia is a sign of digoxin toxicity. The nurse must hold the dose and notify the
prescriber.
9. A client taking isoniazid (INH) for tuberculosis should receive which supplement to
prevent peripheral neuropathy?
A. Vitamin C B. Vitamin B12 C. Pyridoxine (Vitamin B6) (correct answer) D. Folic acid
Rationale: Isoniazid interferes with pyridoxine (Vitamin B6) metabolism. Supplementation
with B6 prevents INH-induced peripheral neuropathy, a common adverse effect.
10. A nurse is reviewing orders for a client with a sulfa allergy. Which medication should
the nurse question?
A. Furosemide B. Hydrochlorothiazide (correct answer) C. Spironolactone D. Bumetanide
Rationale: Hydrochlorothiazide is a sulfonamide-derived diuretic and may cause cross-
sensitivity in clients with sulfa allergies. The nurse should clarify this order with the
prescriber.
11. A client is receiving heparin infusion. The aPTT result is 120 seconds (therapeutic
range 60–100 seconds). What should the nurse do?
A. Increase the infusion rate by 2 units/kg/hr B. Decrease the infusion rate or hold per protocol
(correct answer) C. Administer protamine sulfate immediately D. Continue the infusion and
recheck in 6 hours
Rationale: An aPTT of 120 seconds is above the therapeutic range, indicating excessive
anticoagulation and increased bleeding risk. The infusion should be decreased or
temporarily held per the institutional protocol.
, 12. A client taking spironolactone should avoid which of the following?
A. Sodium-containing foods B. Potassium-rich foods (correct answer) C. High-fat meals D.
Antacids
Rationale: Spironolactone is a potassium-sparing diuretic that causes potassium retention.
Consuming potassium-rich foods concurrently increases the risk of hyperkalemia, which
can cause dangerous cardiac arrhythmias.
13. A nurse administers too much regular insulin to a client. Which intervention is the
priority?
A. Prepare for intubation B. Administer 50% dextrose IV (correct answer) C. Administer
glucagon intramuscularly D. Provide a high-carbohydrate meal
Rationale: IV dextrose 50% is the fastest-acting intervention for severe hypoglycemia when
IV access is available. It raises blood glucose rapidly, which is critical in insulin overdose.
14. A client prescribed sildenafil reports taking isosorbide mononitrate. What is the nurse's
priority action?
A. Administer sildenafil as ordered B. Hold sildenafil and notify the prescriber (correct answer)
C. Stagger the administration of both medications D. Monitor the client's blood pressure closely
Rationale: Sildenafil combined with nitrates causes severe, potentially fatal hypotension.
This combination is absolutely contraindicated, and the prescriber must be notified
immediately.
15. A client receiving IV amphotericin B begins to develop chills, fever, and rigors during
the infusion. What is the nurse's best action?
A. Stop the infusion immediately and call a rapid response B. Slow the infusion rate and
premedicate per protocol (correct answer) C. Discontinue amphotericin B and switch to
fluconazole D. Obtain blood cultures and restart the infusion
Rationale: Infusion-related reactions (fever, chills, rigors) are common with amphotericin
B. Slowing the infusion rate and premedication with acetaminophen, diphenhydramine,
and/or meperidine are standard management strategies.
Answers | latest Update | TEST BANK
1. A nurse is preparing to administer metformin to a client with type 2 diabetes. Which
laboratory value should the nurse assess before administration?
A. Serum potassium B. Serum creatinine (correct answer) C. Serum calcium D. Complete blood
count
Rationale: Metformin is contraindicated in renal impairment because it can accumulate
and cause lactic acidosis. Serum creatinine reflects kidney function and must be assessed
before administration.
2. A client receiving warfarin has an INR of 4.8. Which action should the nurse take first?
A. Administer vitamin K as ordered (correct answer) B. Draw a repeat INR in 4 hours C. Hold
the next scheduled dose only D. Notify dietary to restrict green vegetables
Rationale: An INR of 4.8 is significantly above the therapeutic range of 2–3, indicating a
high bleeding risk. Vitamin K is the antidote for warfarin toxicity and should be
administered as ordered while the prescriber is notified.
3. A nurse is teaching a client about atorvastatin. Which statement by the client requires
follow-up?
A. "I will report any muscle pain immediately." B. "I can take this medication with grapefruit
juice." (correct answer) C. "I will have periodic liver function tests." D. "I should take this
medication in the evening."
Rationale: Grapefruit juice inhibits CYP3A4 enzymes, increasing statin blood levels and
the risk of myopathy and rhabdomyolysis. The client must avoid grapefruit juice while
taking atorvastatin.
4. A client with a penicillin allergy is prescribed cephalexin. What is the nurse's priority
action?
,A. Administer the medication as prescribed B. Contact the prescriber to clarify the order (correct
answer) C. Administer diphenhydramine before giving the medication D. Substitute amoxicillin
instead
Rationale: There is a potential cross-reactivity between penicillins and cephalosporins
(approximately 1–10%). The nurse must notify the prescriber before administering
cephalexin to a client with a known penicillin allergy.
5. A nurse is administering IV vancomycin. The client develops flushing, erythema, and
hypotension. What is the most likely cause?
A. Anaphylactic reaction B. Red Man Syndrome (correct answer) C. Clostridium difficile
infection D. Nephrotoxicity
Rationale: Red Man Syndrome is a non-immune-mediated reaction caused by rapid
infusion of vancomycin. It presents with flushing, erythema of the neck and face, and
hypotension. Slowing the infusion rate prevents and treats this reaction.
6. A nurse is caring for a client receiving morphine via PCA pump. Which finding requires
immediate intervention?
A. Respiratory rate of 10 breaths/min (correct answer) B. Pain rating of 4/10 C. Mild nausea D.
Drowsiness
Rationale: Respiratory depression is the most serious adverse effect of opioid analgesics. A
respiratory rate of 10 or below indicates significant CNS depression requiring immediate
intervention, including naloxone administration.
7. A client is prescribed lithium for bipolar disorder. Which instruction is most important
for the nurse to include?
A. "Avoid caffeine-containing beverages." B. "Maintain a consistent sodium intake." (correct
answer) C. "Take the medication on an empty stomach." D. "Report any weight gain
immediately."
Rationale: Sodium and lithium compete for renal reabsorption. Low sodium intake causes
the kidneys to retain lithium, leading to toxicity. Clients must maintain a consistent,
adequate daily sodium intake.
,8. A nurse is preparing to administer digoxin to a client. The apical pulse is 54 beats/min.
What should the nurse do?
A. Administer the dose and document the finding B. Hold the dose and notify the prescriber
(correct answer) C. Administer half the prescribed dose D. Recheck the pulse in 30 minutes
Rationale: Digoxin should be withheld if the apical pulse is below 60 beats/min in adults.
Bradycardia is a sign of digoxin toxicity. The nurse must hold the dose and notify the
prescriber.
9. A client taking isoniazid (INH) for tuberculosis should receive which supplement to
prevent peripheral neuropathy?
A. Vitamin C B. Vitamin B12 C. Pyridoxine (Vitamin B6) (correct answer) D. Folic acid
Rationale: Isoniazid interferes with pyridoxine (Vitamin B6) metabolism. Supplementation
with B6 prevents INH-induced peripheral neuropathy, a common adverse effect.
10. A nurse is reviewing orders for a client with a sulfa allergy. Which medication should
the nurse question?
A. Furosemide B. Hydrochlorothiazide (correct answer) C. Spironolactone D. Bumetanide
Rationale: Hydrochlorothiazide is a sulfonamide-derived diuretic and may cause cross-
sensitivity in clients with sulfa allergies. The nurse should clarify this order with the
prescriber.
11. A client is receiving heparin infusion. The aPTT result is 120 seconds (therapeutic
range 60–100 seconds). What should the nurse do?
A. Increase the infusion rate by 2 units/kg/hr B. Decrease the infusion rate or hold per protocol
(correct answer) C. Administer protamine sulfate immediately D. Continue the infusion and
recheck in 6 hours
Rationale: An aPTT of 120 seconds is above the therapeutic range, indicating excessive
anticoagulation and increased bleeding risk. The infusion should be decreased or
temporarily held per the institutional protocol.
, 12. A client taking spironolactone should avoid which of the following?
A. Sodium-containing foods B. Potassium-rich foods (correct answer) C. High-fat meals D.
Antacids
Rationale: Spironolactone is a potassium-sparing diuretic that causes potassium retention.
Consuming potassium-rich foods concurrently increases the risk of hyperkalemia, which
can cause dangerous cardiac arrhythmias.
13. A nurse administers too much regular insulin to a client. Which intervention is the
priority?
A. Prepare for intubation B. Administer 50% dextrose IV (correct answer) C. Administer
glucagon intramuscularly D. Provide a high-carbohydrate meal
Rationale: IV dextrose 50% is the fastest-acting intervention for severe hypoglycemia when
IV access is available. It raises blood glucose rapidly, which is critical in insulin overdose.
14. A client prescribed sildenafil reports taking isosorbide mononitrate. What is the nurse's
priority action?
A. Administer sildenafil as ordered B. Hold sildenafil and notify the prescriber (correct answer)
C. Stagger the administration of both medications D. Monitor the client's blood pressure closely
Rationale: Sildenafil combined with nitrates causes severe, potentially fatal hypotension.
This combination is absolutely contraindicated, and the prescriber must be notified
immediately.
15. A client receiving IV amphotericin B begins to develop chills, fever, and rigors during
the infusion. What is the nurse's best action?
A. Stop the infusion immediately and call a rapid response B. Slow the infusion rate and
premedicate per protocol (correct answer) C. Discontinue amphotericin B and switch to
fluconazole D. Obtain blood cultures and restart the infusion
Rationale: Infusion-related reactions (fever, chills, rigors) are common with amphotericin
B. Slowing the infusion rate and premedication with acetaminophen, diphenhydramine,
and/or meperidine are standard management strategies.
