NR 341 PHARMACOLOGY CJE EXAM NEWEST 2026
ACTUAL EXAM TEST BANK| COMPLETE 450 REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
1. A client is prescribed digoxin for heart failure with reduced
ejection fraction. Which laboratory value places the client at
highest risk for digoxin toxicity?
A) Serum sodium 135 mEq/L
B) Serum potassium 3.1 mEq/L
C) Serum calcium 9.5 mg/dL
D) Serum magnesium 2.2 mg/dL
Correct Answer: B
Rationale: Hypokalemia (potassium <3.5 mEq/L) increases the
risk of digoxin toxicity because digoxin binds to the same site on
the Na⁺/K⁺-ATPase pump as potassium. Low potassium enhances
digoxin binding, leading to increased toxicity. Normal sodium
(135–145), normal calcium (8.5–10.2), and normal magnesium
(1.5–2.5) do not potentiate digoxin toxicity to the same degree.
1
,2. A client with type 2 diabetes is prescribed metformin. Which
instruction is most important to prevent a life-threatening
adverse effect?
A) Take the medication with food to prevent nausea
B) Monitor blood glucose daily
C) Hold the medication for 48 hours before and after IV
contrast dye administration
D) Report any weight gain to the provider
Correct Answer: C
Rationale: Metformin carries a risk of lactic acidosis, especially
in the setting of renal impairment. IV contrast dye can cause
acute kidney injury. Holding metformin for 48 hours before and
after contrast administration reduces the risk of lactic acidosis.
Option A addresses GI side effects but is not life-threatening.
Option B is routine. Option D is not associated with metformin.
3. A client receiving warfarin has an international normalized
ratio (INR) of 4.8. The client has no signs of bleeding. Which
action should the nurse anticipate?
A) Administer vitamin K subcutaneously
2
, B) Administer fresh frozen plasma
C) Hold the next dose of warfarin and monitor INR
D) Increase the warfarin dose to achieve therapeutic range
Correct Answer: C
Rationale: For an asymptomatic INR of 4.5–10.0 without
bleeding, current guidelines recommend holding warfarin
(withholding the next dose) and repeating INR. Oral vitamin K
may be used if the patient is at high bleeding risk. FFP is for
active bleeding or life-threatening elevation. Option D would
worsen the INR.
4. A client is prescribed furosemide 40 mg IV push. Which
laboratory finding requires the most immediate intervention?
A) Serum sodium 132 mEq/L
B) Serum potassium 2.9 mEq/L
C) Blood glucose 140 mg/dL
D) Serum creatinine 1.2 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant
3
, potassium wasting. Hypokalemia (K <3.5) increases the risk of
cardiac dysrhythmias, especially in patients on digoxin. A
potassium of 2.9 mEq/L is severe and requires prompt
replacement. Mild hyponatremia (132) is less urgent. Glucose
elevation is expected. Creatinine 1.2 is near normal.
5. A client with a history of anaphylaxis to penicillin is being
treated for a urinary tract infection. Which antibiotic should the
nurse question?
A) Ciprofloxacin
B) Nitrofurantoin
C) Cephalexin
D) Trimethoprim-sulfamethoxazole
Correct Answer: C
Rationale: Cephalosporins (cephalexin) have cross-sensitivity with
penicillins in approximately 1–10% of patients with a history of
penicillin anaphylaxis. While not absolutely contraindicated,
caution is required, and an alternative is preferred if a true
anaphylactic reaction occurred. Options A, B, and D have no
cross-reactivity.
4
ACTUAL EXAM TEST BANK| COMPLETE 450 REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
1. A client is prescribed digoxin for heart failure with reduced
ejection fraction. Which laboratory value places the client at
highest risk for digoxin toxicity?
A) Serum sodium 135 mEq/L
B) Serum potassium 3.1 mEq/L
C) Serum calcium 9.5 mg/dL
D) Serum magnesium 2.2 mg/dL
Correct Answer: B
Rationale: Hypokalemia (potassium <3.5 mEq/L) increases the
risk of digoxin toxicity because digoxin binds to the same site on
the Na⁺/K⁺-ATPase pump as potassium. Low potassium enhances
digoxin binding, leading to increased toxicity. Normal sodium
(135–145), normal calcium (8.5–10.2), and normal magnesium
(1.5–2.5) do not potentiate digoxin toxicity to the same degree.
1
,2. A client with type 2 diabetes is prescribed metformin. Which
instruction is most important to prevent a life-threatening
adverse effect?
A) Take the medication with food to prevent nausea
B) Monitor blood glucose daily
C) Hold the medication for 48 hours before and after IV
contrast dye administration
D) Report any weight gain to the provider
Correct Answer: C
Rationale: Metformin carries a risk of lactic acidosis, especially
in the setting of renal impairment. IV contrast dye can cause
acute kidney injury. Holding metformin for 48 hours before and
after contrast administration reduces the risk of lactic acidosis.
Option A addresses GI side effects but is not life-threatening.
Option B is routine. Option D is not associated with metformin.
3. A client receiving warfarin has an international normalized
ratio (INR) of 4.8. The client has no signs of bleeding. Which
action should the nurse anticipate?
A) Administer vitamin K subcutaneously
2
, B) Administer fresh frozen plasma
C) Hold the next dose of warfarin and monitor INR
D) Increase the warfarin dose to achieve therapeutic range
Correct Answer: C
Rationale: For an asymptomatic INR of 4.5–10.0 without
bleeding, current guidelines recommend holding warfarin
(withholding the next dose) and repeating INR. Oral vitamin K
may be used if the patient is at high bleeding risk. FFP is for
active bleeding or life-threatening elevation. Option D would
worsen the INR.
4. A client is prescribed furosemide 40 mg IV push. Which
laboratory finding requires the most immediate intervention?
A) Serum sodium 132 mEq/L
B) Serum potassium 2.9 mEq/L
C) Blood glucose 140 mg/dL
D) Serum creatinine 1.2 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant
3
, potassium wasting. Hypokalemia (K <3.5) increases the risk of
cardiac dysrhythmias, especially in patients on digoxin. A
potassium of 2.9 mEq/L is severe and requires prompt
replacement. Mild hyponatremia (132) is less urgent. Glucose
elevation is expected. Creatinine 1.2 is near normal.
5. A client with a history of anaphylaxis to penicillin is being
treated for a urinary tract infection. Which antibiotic should the
nurse question?
A) Ciprofloxacin
B) Nitrofurantoin
C) Cephalexin
D) Trimethoprim-sulfamethoxazole
Correct Answer: C
Rationale: Cephalosporins (cephalexin) have cross-sensitivity with
penicillins in approximately 1–10% of patients with a history of
penicillin anaphylaxis. While not absolutely contraindicated,
caution is required, and an alternative is preferred if a true
anaphylactic reaction occurred. Options A, B, and D have no
cross-reactivity.
4
