NR 293 PHARMACOLOGY EXAM 1
Spring–Summer 2026 | 140 Questions |
Answers| Rationales
1. A client with multiple sclerosis is receiving ACTH (Acthar) IV for an acute
exacerbation. What is the therapeutic action of Acthar?
A. It stimulates new growth in affected nerve fibers.
B. It stimulates cortisol secretion, which has potent anti-inflammatory effects.
C. It rebuilds the myelin sheath.
D. It reduces painful muscle spasms.
Rationale: ACTH (corticotropin) stimulates the adrenal cortex to release cortisol,
reducing inflammation during MS exacerbations. It does not directly affect myelin
or spasticity.
2. Which symptom would the nurse expect to see in a client prior to starting
levothyroxine (Synthroid) for hypothyroidism?
A. Tremor, headache
B. Diarrhea, abdominal cramping
C. Dry skin, constipation
D. Exophthalmos, tachycardia
Rationale: Hypothyroidism causes decreased metabolic rate → dry skin,
constipation, fatigue, cold intolerance. Tremor and tachycardia are
hyperthyroidism signs.
3. The nurse suspects a client with diabetes is hypoglycemic. What is the priority
action?
A. Notify the physician immediately.
B. Give crackers and juice, then monitor blood sugar.
,C. Check the client’s blood sugar using a glucometer.
D. Administer insulin immediately.
Rationale: Always confirm hypoglycemia with a blood glucose reading before
treating, unless the client is unconscious or cannot swallow.
4. A patient takes 6 units of Novolog insulin at 0730 and has only coffee for
breakfast. By 1000, blood sugar is 54 mg/dL. Which symptoms of low blood
sugar should the patient be alerted to?
A. Extreme thirst
B. Tremors, cold sweat
C. Polyuria, polyphagia
D. Deep, rapid breathing
Rationale: Hypoglycemia triggers autonomic (tremors, diaphoresis) and
neuroglycopenic symptoms. Thirst and polyuria are hyperglycemia signs.
5. Before breakfast, how should the nurse prepare 15 units of Lantus insulin and
10 units of Humalog insulin?
A. Draw 15 units of Lantus first, then add 10 units of Humalog, give IM.
B. Draw 10 units of Humalog first, then add 15 units of Lantus, give IM.
C. Draw 15 units of Lantus first, add 10 units of Humalog, give IV.
D. Draw 15 units of Lantus into one syringe and 10 units of Humalog into
another syringe; give both subcutaneously.
Rationale: Lantus (insulin glargine) cannot be mixed with any other insulin in the
same syringe because pH differences cause precipitation. Separate syringes are
required.
6. A client on long-term warfarin (Coumadin) is started on levothyroxine
(Synthroid). Both are highly protein-bound. What is most important for the
client to do?
A. Take Synthroid at least 2 hours before warfarin.
B. Limit protein in diet.
,C. Obtain daily weight.
D. Regularly monitor INR results.
Rationale: Levothyroxine increases metabolism of vitamin K-dependent clotting
factors, potentially altering INR. Close INR monitoring is essential, especially when
starting or stopping thyroid medication.
7. Somatropin (Humatrope) is most likely administered to a 6-year-old child for
which reason?
A. ADH deficiency
B. GH deficiency
C. The child is 62 inches tall
D. Hyperglycemia
Rationale: Somatropin is recombinant human growth hormone (GH) used for
documented GH deficiency in children. ADH deficiency requires desmopressin.
8. A client has racing heart and weight loss. The nurse expects the physician to
test for which disorder?
A. Hyperthyroidism
B. Hypothyroidism
C. Hyperglycemia
D. Hypoglycemia
Rationale: Hyperthyroidism increases metabolic rate → tachycardia, weight loss,
heat intolerance, tremors.
9. A nurse is administering medications. Which action is most essential for safe
administration?
A. Understanding how the drug works biochemically
B. Knowing the half-life of the drug
C. Assessing patient allergies before giving drugs
D. Giving every medication at precisely the ordered time
, Rationale: Allergy assessment prevents life-threatening anaphylaxis. It is the
priority safety action.
10. A drug is ordered to be given OU. To avoid errors, how should the nurse
indicate the administration site?
A. Both eyes
B. Both ears
C. Right ear
D. Right eye
Rationale: “OU” (oculus uterque) means both eyes. The safest practice is to write
“both eyes” instead of abbreviations.
11. A client is prescribed digoxin. Which finding warrants holding the dose?
A. Heart rate 72 bpm
B. Apical pulse 52 bpm in an adult
C. Serum potassium 4.0 mEq/L
D. Blood pressure 130/80 mm Hg
Rationale: Digoxin is held for heart rate <60 bpm in adults (or <90–100 in infants).
Bradycardia increases risk of toxicity and heart block.
12. A nurse teaches a client about rifampin. Which harmless adverse effect
should the client expect?
A. Grayish-blue skin discoloration
B. Orange-colored urine
C. Green-tinted saliva
D. Black tongue
Rationale: Rifampin causes harmless orange-red discoloration of urine, sweat,
and tears. This should not be mistaken for blood.
Spring–Summer 2026 | 140 Questions |
Answers| Rationales
1. A client with multiple sclerosis is receiving ACTH (Acthar) IV for an acute
exacerbation. What is the therapeutic action of Acthar?
A. It stimulates new growth in affected nerve fibers.
B. It stimulates cortisol secretion, which has potent anti-inflammatory effects.
C. It rebuilds the myelin sheath.
D. It reduces painful muscle spasms.
Rationale: ACTH (corticotropin) stimulates the adrenal cortex to release cortisol,
reducing inflammation during MS exacerbations. It does not directly affect myelin
or spasticity.
2. Which symptom would the nurse expect to see in a client prior to starting
levothyroxine (Synthroid) for hypothyroidism?
A. Tremor, headache
B. Diarrhea, abdominal cramping
C. Dry skin, constipation
D. Exophthalmos, tachycardia
Rationale: Hypothyroidism causes decreased metabolic rate → dry skin,
constipation, fatigue, cold intolerance. Tremor and tachycardia are
hyperthyroidism signs.
3. The nurse suspects a client with diabetes is hypoglycemic. What is the priority
action?
A. Notify the physician immediately.
B. Give crackers and juice, then monitor blood sugar.
,C. Check the client’s blood sugar using a glucometer.
D. Administer insulin immediately.
Rationale: Always confirm hypoglycemia with a blood glucose reading before
treating, unless the client is unconscious or cannot swallow.
4. A patient takes 6 units of Novolog insulin at 0730 and has only coffee for
breakfast. By 1000, blood sugar is 54 mg/dL. Which symptoms of low blood
sugar should the patient be alerted to?
A. Extreme thirst
B. Tremors, cold sweat
C. Polyuria, polyphagia
D. Deep, rapid breathing
Rationale: Hypoglycemia triggers autonomic (tremors, diaphoresis) and
neuroglycopenic symptoms. Thirst and polyuria are hyperglycemia signs.
5. Before breakfast, how should the nurse prepare 15 units of Lantus insulin and
10 units of Humalog insulin?
A. Draw 15 units of Lantus first, then add 10 units of Humalog, give IM.
B. Draw 10 units of Humalog first, then add 15 units of Lantus, give IM.
C. Draw 15 units of Lantus first, add 10 units of Humalog, give IV.
D. Draw 15 units of Lantus into one syringe and 10 units of Humalog into
another syringe; give both subcutaneously.
Rationale: Lantus (insulin glargine) cannot be mixed with any other insulin in the
same syringe because pH differences cause precipitation. Separate syringes are
required.
6. A client on long-term warfarin (Coumadin) is started on levothyroxine
(Synthroid). Both are highly protein-bound. What is most important for the
client to do?
A. Take Synthroid at least 2 hours before warfarin.
B. Limit protein in diet.
,C. Obtain daily weight.
D. Regularly monitor INR results.
Rationale: Levothyroxine increases metabolism of vitamin K-dependent clotting
factors, potentially altering INR. Close INR monitoring is essential, especially when
starting or stopping thyroid medication.
7. Somatropin (Humatrope) is most likely administered to a 6-year-old child for
which reason?
A. ADH deficiency
B. GH deficiency
C. The child is 62 inches tall
D. Hyperglycemia
Rationale: Somatropin is recombinant human growth hormone (GH) used for
documented GH deficiency in children. ADH deficiency requires desmopressin.
8. A client has racing heart and weight loss. The nurse expects the physician to
test for which disorder?
A. Hyperthyroidism
B. Hypothyroidism
C. Hyperglycemia
D. Hypoglycemia
Rationale: Hyperthyroidism increases metabolic rate → tachycardia, weight loss,
heat intolerance, tremors.
9. A nurse is administering medications. Which action is most essential for safe
administration?
A. Understanding how the drug works biochemically
B. Knowing the half-life of the drug
C. Assessing patient allergies before giving drugs
D. Giving every medication at precisely the ordered time
, Rationale: Allergy assessment prevents life-threatening anaphylaxis. It is the
priority safety action.
10. A drug is ordered to be given OU. To avoid errors, how should the nurse
indicate the administration site?
A. Both eyes
B. Both ears
C. Right ear
D. Right eye
Rationale: “OU” (oculus uterque) means both eyes. The safest practice is to write
“both eyes” instead of abbreviations.
11. A client is prescribed digoxin. Which finding warrants holding the dose?
A. Heart rate 72 bpm
B. Apical pulse 52 bpm in an adult
C. Serum potassium 4.0 mEq/L
D. Blood pressure 130/80 mm Hg
Rationale: Digoxin is held for heart rate <60 bpm in adults (or <90–100 in infants).
Bradycardia increases risk of toxicity and heart block.
12. A nurse teaches a client about rifampin. Which harmless adverse effect
should the client expect?
A. Grayish-blue skin discoloration
B. Orange-colored urine
C. Green-tinted saliva
D. Black tongue
Rationale: Rifampin causes harmless orange-red discoloration of urine, sweat,
and tears. This should not be mistaken for blood.
