NUR 2474 Pharmacology Exam 2 Test Bank|
NCLEX-Style Questions & Verified Answers |
Exam Prep
Set 1: Prioritization & Diabetes Management (Questions 1-10)
1. The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who
were just admitted. Which patient should the nurse assess first?
a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin
insulin.
b. The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin).
c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache.
d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin).
Correct Answer: a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units
of 70/30 Novolin insulin.
Rationale: This patient has a low/normal blood glucose level and just received intermediate-acting
insulin (70/30 Novolin), which will continue to lower glucose. The patient is NPO, increasing the risk of
severe hypoglycemia. This is a priority safety concern.
2. A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale
and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which
formulation of insulin should the nurse prepare to administer?
a. No insulin should be administered.
b. NPH
c. 70/30 mix
d. Lispro (Humalog)
Correct Answer: d. Lispro (Humalog)
Rationale: Lispro is a rapid-acting insulin with an onset of about 15 minutes. It is used to cover mealtime
glucose spikes. A blood sugar of 317 mg/dL requires rapid correction before eating.
3. A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing
schedule for her. What is the recommended monitoring schedule?
a. Before each meal and before bed
b. In the morning for a fasting level and at 4 PM for the peak level
c. Six or seven times a day
d. Three times a day, along with urine glucose testing
,Correct Answer: c. Six or seven times a day.
Rationale: Pregnancy affects glucose levels significantly. Frequent monitoring (6-7 times daily) is
required to maintain tight glycemic control and prevent complications for both mother and fetus.
4. A patient with type 1 diabetes reports mixing NPH and regular insulin to prepare for injection. What
action by the nurse is appropriate?
a. Remind the patient to draw up the regular insulin first.
b. Ask the provider if the two insulins can be mixed.
c. Tell the patient that insulins should not be mixed.
d. Have the patient draw up the NPH insulin first.
Correct Answer: a. Remind the patient to draw up the regular insulin first.
Rationale: When mixing regular insulin (clear) with NPH (cloudy), the regular insulin should always be
drawn up first to prevent contamination of the vial. "Clear before cloudy."
5. A patient will begin taking the long-acting insulin glargine (Lantus). The nurse scheduling
administration of this medication will coordinate the timing of the glargine dose with which other
medication or meal?
a. With the patient's first meal of the day
b. In the morning and at 4 PM
c. Once daily at bedtime
d. After meals and at bedtime
Correct Answer: c. Once daily at bedtime.
Rationale: Glargine (Lantus) is a long-acting, peakless insulin typically administered once daily at
bedtime to provide baseline glucose coverage for 24 hours.
6. A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why
is the nurse concerned?
a. The beta blocker can cause insulin resistance.
b. Using the two agents together increases the risk of ketoacidosis.
c. Propranolol increases insulin requirements.
d. The beta blocker can mask the symptoms of hypoglycemia.
Correct Answer: d. The beta blocker can mask the symptoms of hypoglycemia.
Rationale: Beta-blockers (especially non-selective like propranolol) block sympathetic nervous system
responses, masking key warning signs of hypoglycemia such as tachycardia and tremors. The patient
may not recognize low blood sugar symptoms.
,7. Which statement is correct about the contrast between acarbose and miglitol?
a. Miglitol has not been associated with hepatic dysfunction.
b. With miglitol, sucrose can be used to treat hypoglycemia.
c. Miglitol is less effective in African Americans.
d. Miglitol has no gastrointestinal side effects.
Correct Answer: a. Miglitol has not been associated with hepatic dysfunction.
Rationale: While both are alpha-glucosidase inhibitors, acarbose has been associated with rare cases of
hepatic dysfunction; miglitol has not shown this adverse effect.
8. A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase
inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all
that apply.)
a. Hypoglycemia
b. Flatulence
c. Elevated iron levels in the blood
d. Fluid retention
e. Diarrhea
Correct Answer: b. Flatulence, e. Diarrhea.
Rationale: Alpha-glucosidase inhibitors work by delaying carbohydrate absorption in the intestines,
leading to undigested carbohydrates reaching the colon. This causes gas buildup (flatulence) and an
osmotic effect (diarrhea).
9. The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells
the nurse she does not want to take medications while she is pregnant. The nurse explains that
thyroid hormone is critical for which reason?
a. A decrease in oxygen demand for the fetus
b. Promotion of neurologic development in the fetus
c. Regulation of the formation of the fetal muscle mass
d. Stimulation of the fetal gastrointestinal system
Correct Answer: b. Promotion of neurologic development in the fetus.
Rationale: Maternal thyroid hormone is essential for fetal neurologic development, especially during the
first trimester. Untreated hypothyroidism during pregnancy can lead to cognitive impairment in the
child.
10. A nurse provides teaching for a patient with hypothyroidism who is taking levothyroxine
(Synthroid). Which statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my provider."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
, c. "If I take a multivitamin with iron, I should take it 4 hours after the Synthroid."
d. "If I take calcium supplements, I may need to decrease my dose of Synthroid."
Correct Answer: d. "If I take calcium supplements, I may need to decrease my dose of Synthroid."
Rationale: Calcium interferes with the absorption of levothyroxine. The dose of Synthroid may need to
be increased, not decreased, when taking calcium supplements. This statement indicates
misunderstanding.
Set 2: Thyroid & Myxedema (Questions 11-20)
11. A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The nurse assesses the
patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature
of 97.2° F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to
request an order for which drug?
a. Beta blocker
b. Increased dose of PO levothyroxine
c. Intravenous levothyroxine
d. Methimazole (Tapazole)
Correct Answer: c. Intravenous levothyroxine.
Rationale: The patient is showing signs of myxedema coma (lethargy, hypothermia, difficult to
arouse)—a medical emergency. IV levothyroxine allows for rapid correction of thyroid hormone levels;
oral administration is ineffective due to poor GI absorption in this state.
12. A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). The nurse
learns that the patient also takes warfarin (Coumadin). The nurse will notify the provider to discuss
_____ the _____ dose.
a. reducing, levothyroxine
b. reducing, warfarin
c. increasing, levothyroxine
d. increasing, warfarin
Correct Answer: b. reducing, warfarin.
Rationale: Levothyroxine can increase the effects of warfarin, leading to an increased risk of bleeding.
The warfarin dose may need to be reduced to maintain a safe INR.
13. An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dL, and
the TSH level is 8 microunits/mL. The prescriber orders levothyroxine (Levothroid) 100 mcg/day PO.
What will the nurse do?
a. Administer the medication as ordered.
b. Contact the provider to discuss giving the levothyroxine IV.
NCLEX-Style Questions & Verified Answers |
Exam Prep
Set 1: Prioritization & Diabetes Management (Questions 1-10)
1. The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who
were just admitted. Which patient should the nurse assess first?
a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin
insulin.
b. The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin).
c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache.
d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin).
Correct Answer: a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units
of 70/30 Novolin insulin.
Rationale: This patient has a low/normal blood glucose level and just received intermediate-acting
insulin (70/30 Novolin), which will continue to lower glucose. The patient is NPO, increasing the risk of
severe hypoglycemia. This is a priority safety concern.
2. A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale
and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which
formulation of insulin should the nurse prepare to administer?
a. No insulin should be administered.
b. NPH
c. 70/30 mix
d. Lispro (Humalog)
Correct Answer: d. Lispro (Humalog)
Rationale: Lispro is a rapid-acting insulin with an onset of about 15 minutes. It is used to cover mealtime
glucose spikes. A blood sugar of 317 mg/dL requires rapid correction before eating.
3. A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing
schedule for her. What is the recommended monitoring schedule?
a. Before each meal and before bed
b. In the morning for a fasting level and at 4 PM for the peak level
c. Six or seven times a day
d. Three times a day, along with urine glucose testing
,Correct Answer: c. Six or seven times a day.
Rationale: Pregnancy affects glucose levels significantly. Frequent monitoring (6-7 times daily) is
required to maintain tight glycemic control and prevent complications for both mother and fetus.
4. A patient with type 1 diabetes reports mixing NPH and regular insulin to prepare for injection. What
action by the nurse is appropriate?
a. Remind the patient to draw up the regular insulin first.
b. Ask the provider if the two insulins can be mixed.
c. Tell the patient that insulins should not be mixed.
d. Have the patient draw up the NPH insulin first.
Correct Answer: a. Remind the patient to draw up the regular insulin first.
Rationale: When mixing regular insulin (clear) with NPH (cloudy), the regular insulin should always be
drawn up first to prevent contamination of the vial. "Clear before cloudy."
5. A patient will begin taking the long-acting insulin glargine (Lantus). The nurse scheduling
administration of this medication will coordinate the timing of the glargine dose with which other
medication or meal?
a. With the patient's first meal of the day
b. In the morning and at 4 PM
c. Once daily at bedtime
d. After meals and at bedtime
Correct Answer: c. Once daily at bedtime.
Rationale: Glargine (Lantus) is a long-acting, peakless insulin typically administered once daily at
bedtime to provide baseline glucose coverage for 24 hours.
6. A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why
is the nurse concerned?
a. The beta blocker can cause insulin resistance.
b. Using the two agents together increases the risk of ketoacidosis.
c. Propranolol increases insulin requirements.
d. The beta blocker can mask the symptoms of hypoglycemia.
Correct Answer: d. The beta blocker can mask the symptoms of hypoglycemia.
Rationale: Beta-blockers (especially non-selective like propranolol) block sympathetic nervous system
responses, masking key warning signs of hypoglycemia such as tachycardia and tremors. The patient
may not recognize low blood sugar symptoms.
,7. Which statement is correct about the contrast between acarbose and miglitol?
a. Miglitol has not been associated with hepatic dysfunction.
b. With miglitol, sucrose can be used to treat hypoglycemia.
c. Miglitol is less effective in African Americans.
d. Miglitol has no gastrointestinal side effects.
Correct Answer: a. Miglitol has not been associated with hepatic dysfunction.
Rationale: While both are alpha-glucosidase inhibitors, acarbose has been associated with rare cases of
hepatic dysfunction; miglitol has not shown this adverse effect.
8. A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase
inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all
that apply.)
a. Hypoglycemia
b. Flatulence
c. Elevated iron levels in the blood
d. Fluid retention
e. Diarrhea
Correct Answer: b. Flatulence, e. Diarrhea.
Rationale: Alpha-glucosidase inhibitors work by delaying carbohydrate absorption in the intestines,
leading to undigested carbohydrates reaching the colon. This causes gas buildup (flatulence) and an
osmotic effect (diarrhea).
9. The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells
the nurse she does not want to take medications while she is pregnant. The nurse explains that
thyroid hormone is critical for which reason?
a. A decrease in oxygen demand for the fetus
b. Promotion of neurologic development in the fetus
c. Regulation of the formation of the fetal muscle mass
d. Stimulation of the fetal gastrointestinal system
Correct Answer: b. Promotion of neurologic development in the fetus.
Rationale: Maternal thyroid hormone is essential for fetal neurologic development, especially during the
first trimester. Untreated hypothyroidism during pregnancy can lead to cognitive impairment in the
child.
10. A nurse provides teaching for a patient with hypothyroidism who is taking levothyroxine
(Synthroid). Which statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my provider."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
, c. "If I take a multivitamin with iron, I should take it 4 hours after the Synthroid."
d. "If I take calcium supplements, I may need to decrease my dose of Synthroid."
Correct Answer: d. "If I take calcium supplements, I may need to decrease my dose of Synthroid."
Rationale: Calcium interferes with the absorption of levothyroxine. The dose of Synthroid may need to
be increased, not decreased, when taking calcium supplements. This statement indicates
misunderstanding.
Set 2: Thyroid & Myxedema (Questions 11-20)
11. A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The nurse assesses the
patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature
of 97.2° F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to
request an order for which drug?
a. Beta blocker
b. Increased dose of PO levothyroxine
c. Intravenous levothyroxine
d. Methimazole (Tapazole)
Correct Answer: c. Intravenous levothyroxine.
Rationale: The patient is showing signs of myxedema coma (lethargy, hypothermia, difficult to
arouse)—a medical emergency. IV levothyroxine allows for rapid correction of thyroid hormone levels;
oral administration is ineffective due to poor GI absorption in this state.
12. A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). The nurse
learns that the patient also takes warfarin (Coumadin). The nurse will notify the provider to discuss
_____ the _____ dose.
a. reducing, levothyroxine
b. reducing, warfarin
c. increasing, levothyroxine
d. increasing, warfarin
Correct Answer: b. reducing, warfarin.
Rationale: Levothyroxine can increase the effects of warfarin, leading to an increased risk of bleeding.
The warfarin dose may need to be reduced to maintain a safe INR.
13. An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dL, and
the TSH level is 8 microunits/mL. The prescriber orders levothyroxine (Levothroid) 100 mcg/day PO.
What will the nurse do?
a. Administer the medication as ordered.
b. Contact the provider to discuss giving the levothyroxine IV.
