NR293 Exam 4 Actual Exam Style V3 | NR
293 Pharmacology for Nursing Practice |
Chamberlain
1. A patient is prescribed phenytoin (Dilantin) for the treatment of generalized tonic-clonic
seizures. Which physical assessment finding is most likely associated with a known long-term
adverse effect of this medication?
A. Swollen and bleeding gums
B. Auditory hallucinations
C. Increased urinary frequency
D. Significant weight loss
Correct Answer: A
Expert Explanation: Gingival hyperplasia, or the overgrowth of gum tissue, is a common
adverse effect of long-term phenytoin therapy. Patients should be instructed to maintain
meticulous oral hygiene and see a dentist regularly. The nurse must assess the oral cavity
frequently to monitor for signs of swelling or bleeding.
2. A patient with Parkinson’s disease is starting therapy with levodopa-carbidopa. What is the
primary purpose of combining these two medications?
A. The combination allows for a higher dose of levodopa to be used safely.
B. Carbidopa increases the patient’s tolerance to gastrointestinal upset.
C. Levodopa prevents carbidopa from crossing the blood-brain barrier.
,D. Carbidopa prevents the conversion of levodopa in the periphery.
Correct Answer: D
Expert Explanation: Carbidopa acts as a decarboxylase inhibitor that prevents the
breakdown of levodopa in the peripheral tissues. This mechanism ensures that a higher
concentration of levodopa reaches the brain to be converted into dopamine. By inhibiting
peripheral conversion, carbidopa also reduces systemic side effects like nausea and cardiac
arrhythmias.
3. A nurse is monitoring a patient receiving Lithium for bipolar disorder. The patient’s serum
lithium level is 1.8 mEq/L. Which action should the nurse take first?
A. Administer the next dose as scheduled.
B. Document the result as within the therapeutic range.
C. Hold the dose and notify the healthcare provider.
D. Request a repeat lab draw in 24 hours.
Correct Answer: C
Expert Explanation: The therapeutic range for lithium is generally 0.6 to 1.2 mEq/L, and a
level of 1.8 mEq/L indicates toxicity. The nurse must hold the medication to prevent
further elevation of blood levels and potential organ damage. Immediate notification of the
provider is necessary to manage the patient’s symptoms and adjust the treatment plan.
,4. Which laboratory value is most important for a nurse to monitor in a patient receiving
Clozapine (Clozaril)?
A. Serum potassium levels
B. Prothrombin time (PT)
C. Glomerular filtration rate (GFR)
D. White blood cell (WBC) count
Correct Answer: D
Expert Explanation: Clozapine is associated with a risk of agranulocytosis, which is a
dangerous decrease in the white blood cell count. Because of this risk, mandatory weekly
or bi-weekly blood monitoring is required for patients on this medication. If the WBC count
falls below a specific threshold, the drug must be discontinued immediately to prevent life-
threatening infections.
5. A patient is experiencing an acute asthma attack. Which medication should the nurse
expect to administer as a rescue treatment?
A. Salmeterol
B. Fluticasone
C. Albuterol
D. Montelukast
Correct Answer: C
, Expert Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid
bronchodilation during acute respiratory distress. Other medications like salmeterol are
long-acting and not appropriate for emergency rescue use. The nurse should prioritize
rapid-acting medications to ensure the patient’s airway remains patent.
6. A patient has been taking an MAOI (Monoamine Oxidase Inhibitor) for depression. Which
food item must the nurse instruct the patient to avoid?
A. Whole grain bread
B. Fresh apples
C. Grilled chicken breast
D. Aged cheddar cheese
Correct Answer: D
Expert Explanation: Patients taking MAOIs must avoid foods high in tyramine, such as
aged cheeses, cured meats, and red wine. Consumption of tyramine while on an MAOI can
lead to a hypertensive crisis, which is a medical emergency. The nurse must provide a
comprehensive list of restricted foods to ensure patient safety.
7. A nurse is preparing to administer Regular insulin and NPH insulin in the same syringe.
Which action is correct?
A. Draw up the NPH insulin first.
B. Draw up the Regular insulin first.
C. Shake the NPH vial vigorously before drawing.
293 Pharmacology for Nursing Practice |
Chamberlain
1. A patient is prescribed phenytoin (Dilantin) for the treatment of generalized tonic-clonic
seizures. Which physical assessment finding is most likely associated with a known long-term
adverse effect of this medication?
A. Swollen and bleeding gums
B. Auditory hallucinations
C. Increased urinary frequency
D. Significant weight loss
Correct Answer: A
Expert Explanation: Gingival hyperplasia, or the overgrowth of gum tissue, is a common
adverse effect of long-term phenytoin therapy. Patients should be instructed to maintain
meticulous oral hygiene and see a dentist regularly. The nurse must assess the oral cavity
frequently to monitor for signs of swelling or bleeding.
2. A patient with Parkinson’s disease is starting therapy with levodopa-carbidopa. What is the
primary purpose of combining these two medications?
A. The combination allows for a higher dose of levodopa to be used safely.
B. Carbidopa increases the patient’s tolerance to gastrointestinal upset.
C. Levodopa prevents carbidopa from crossing the blood-brain barrier.
,D. Carbidopa prevents the conversion of levodopa in the periphery.
Correct Answer: D
Expert Explanation: Carbidopa acts as a decarboxylase inhibitor that prevents the
breakdown of levodopa in the peripheral tissues. This mechanism ensures that a higher
concentration of levodopa reaches the brain to be converted into dopamine. By inhibiting
peripheral conversion, carbidopa also reduces systemic side effects like nausea and cardiac
arrhythmias.
3. A nurse is monitoring a patient receiving Lithium for bipolar disorder. The patient’s serum
lithium level is 1.8 mEq/L. Which action should the nurse take first?
A. Administer the next dose as scheduled.
B. Document the result as within the therapeutic range.
C. Hold the dose and notify the healthcare provider.
D. Request a repeat lab draw in 24 hours.
Correct Answer: C
Expert Explanation: The therapeutic range for lithium is generally 0.6 to 1.2 mEq/L, and a
level of 1.8 mEq/L indicates toxicity. The nurse must hold the medication to prevent
further elevation of blood levels and potential organ damage. Immediate notification of the
provider is necessary to manage the patient’s symptoms and adjust the treatment plan.
,4. Which laboratory value is most important for a nurse to monitor in a patient receiving
Clozapine (Clozaril)?
A. Serum potassium levels
B. Prothrombin time (PT)
C. Glomerular filtration rate (GFR)
D. White blood cell (WBC) count
Correct Answer: D
Expert Explanation: Clozapine is associated with a risk of agranulocytosis, which is a
dangerous decrease in the white blood cell count. Because of this risk, mandatory weekly
or bi-weekly blood monitoring is required for patients on this medication. If the WBC count
falls below a specific threshold, the drug must be discontinued immediately to prevent life-
threatening infections.
5. A patient is experiencing an acute asthma attack. Which medication should the nurse
expect to administer as a rescue treatment?
A. Salmeterol
B. Fluticasone
C. Albuterol
D. Montelukast
Correct Answer: C
, Expert Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid
bronchodilation during acute respiratory distress. Other medications like salmeterol are
long-acting and not appropriate for emergency rescue use. The nurse should prioritize
rapid-acting medications to ensure the patient’s airway remains patent.
6. A patient has been taking an MAOI (Monoamine Oxidase Inhibitor) for depression. Which
food item must the nurse instruct the patient to avoid?
A. Whole grain bread
B. Fresh apples
C. Grilled chicken breast
D. Aged cheddar cheese
Correct Answer: D
Expert Explanation: Patients taking MAOIs must avoid foods high in tyramine, such as
aged cheeses, cured meats, and red wine. Consumption of tyramine while on an MAOI can
lead to a hypertensive crisis, which is a medical emergency. The nurse must provide a
comprehensive list of restricted foods to ensure patient safety.
7. A nurse is preparing to administer Regular insulin and NPH insulin in the same syringe.
Which action is correct?
A. Draw up the NPH insulin first.
B. Draw up the Regular insulin first.
C. Shake the NPH vial vigorously before drawing.
