Nr341 QUESTION BANK for Pharmacology cje
benchmark All topics fully covered
1. A client with heart failure is prescribed digoxin. 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
Answer: B Hypokalemia (<3.5 mEq/L) increases digoxin binding to the Na⁺/K⁺-ATPase pump,
enhancing toxicity. Potassium and digoxin compete for the same binding site.
2. A client with type 2 diabetes is prescribed metformin. Which instruction is most important to
prevent a life-threatening adverse effect?
A) Take with food to prevent nausea
B) Monitor blood glucose daily
C) Hold for 48 hours before and after IV contrast dye
D) Report any weight gain to the provider
Answer: C IV contrast can cause acute kidney injury, increasing metformin levels and the risk of lactic
acidosis. Metformin must be held before and after contrast.
3. A client receiving warfarin has an INR of 4.8 with no signs of bleeding. Which action should the
nurse anticipate?
A) Administer vitamin K subcutaneously
B) Hold the next dose and notify the provider
C) Increase the warfarin dose
D) Administer fresh frozen plasma
Answer: B INR 4.8 is above therapeutic range (2-3 for most indications) but without bleeding, holding
the dose and monitoring is standard. Vitamin K is for active bleeding or very high INR (>10).
1|Page SUCCESS!!!
,4. A client is prescribed lisinopril for hypertension. The nurse should teach the client to report which
symptom that is most characteristic of angioedema?
A) Dry, persistent cough
B) Swelling of the lips, tongue, or face
C) Dizziness upon standing
D) Metallic taste in the mouth
Answer: B Angioedema is a life-threatening ACE inhibitor reaction presenting as swelling of the face,
lips, or tongue, which can compromise the airway. Dry cough is common but not life-threatening.
5. A client with a history of anaphylaxis to penicillin is being treated for a UTI. Which antibiotic should
the nurse question?
A) Ciprofloxacin
B) Nitrofurantoin
C) Cephalexin
D) Trimethoprim-sulfamethoxazole
Answer: C Cephalosporins (cephalexin) have 1-10% cross-sensitivity with penicillins. In true
anaphylaxis, an alternative class (fluoroquinolone, macrolide) is preferred.
6. A client with atrial fibrillation is prescribed apixaban (Eliquis). The nurse knows that this
medication:
A) Requires routine INR monitoring
B) Is a warfarin derivative
C) Is a direct factor Xa inhibitor that does not require routine monitoring
D) Has an antidote of vitamin K
Answer: C Apixaban is a DOAC with predictable pharmacokinetics; it does not require INR monitoring.
Andexanet alfa is the antidote, not vitamin K.
7. A client is prescribed albuterol via MDI for asthma. The nurse should instruct the client to:
A) Use the inhaler daily to prevent exacerbations
B) Rinse the mouth immediately after use to prevent thrush
C) Wait 60 seconds between puffs
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,D) Use the inhaler as a rescue medication for acute symptoms
Answer: D Albuterol is a short-acting beta-2 agonist (SABA) used as a rescue medication. Daily use
indicates poor control. Mouth rinsing is for inhaled corticosteroids.
8. A client is prescribed clopidogrel after a coronary stent placement. The nurse understands that this
medication:
A) Should be stopped 7 days before any surgery
B) Is an antiplatelet agent that irreversibly inhibits the P2Y12 receptor
C) Replaces aspirin as monotherapy
D) Has a rapid onset and short duration of action
Answer: B Clopidogrel irreversibly inhibits the P2Y12 ADP receptor on platelets. It is used with aspirin
(DAPT) after stents. Duration is the life of the platelet (7-10 days).
9. A client with opioid use disorder is prescribed buprenorphine/naloxone (Suboxone). The nurse
explains that naloxone is included to:
A) Enhance the analgesic effect of buprenorphine
B) Prevent diversion by injection (precipitates withdrawal if injected)
C) Reduce the risk of constipation
D) Increase the duration of action of buprenorphine
Answer: B Naloxone has poor sublingual absorption but if injected, it precipitates withdrawal,
deterring misuse. Naloxone does not enhance analgesia or duration.
10. A client prescribed metoprolol for heart failure reports dizziness and a heart rate of 52 bpm. What
is the nurse’s priority action?
A) Administer the dose as ordered
B) Hold the dose and notify the provider
C) Give the dose with food
D) Increase the dose to improve heart rate
Answer: B Metoprolol is a beta-blocker that can cause bradycardia. A heart rate <60 bpm typically
requires holding the dose and notifying the provider for adjustment.
3|Page SUCCESS!!!
, 11. A client is prescribed insulin glargine (Lantus). Which statement by the client indicates correct
understanding?
A) “I will take this insulin 30 minutes before meals.”
B) “This insulin peaks in 2-4 hours.”
C) “It is a long-acting basal insulin with no pronounced peak.”
D) “I can mix it with regular insulin in the same syringe.”
Answer: C Insulin glargine is long-acting with a duration of 20-24 hours and no pronounced peak. It
should not be mixed with other insulins.
12. A client is prescribed spironolactone for heart failure. Which laboratory finding requires
immediate intervention?
A) Serum potassium 5.2 mEq/L
B) Serum sodium 138 mEq/L
C) Serum creatinine 0.9 mg/dL
D) Blood glucose 110 mg/dL
Answer: A Spironolactone is a potassium-sparing diuretic. Hyperkalemia (K >5.0) can cause fatal
dysrhythmias and requires dose reduction or discontinuation.
13. A client receiving furosemide (Lasix) reports muscle cramps and weakness. Which electrolyte
imbalance is most likely?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
Answer: B Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia presents with
muscle cramps, weakness, and fatigue.
14. A client is prescribed amlodipine (Norvasc). Which side effect should the nurse include in patient
teaching?
A) Dry cough
B) Peripheral edema
4|Page SUCCESS!!!
benchmark All topics fully covered
1. A client with heart failure is prescribed digoxin. 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
Answer: B Hypokalemia (<3.5 mEq/L) increases digoxin binding to the Na⁺/K⁺-ATPase pump,
enhancing toxicity. Potassium and digoxin compete for the same binding site.
2. A client with type 2 diabetes is prescribed metformin. Which instruction is most important to
prevent a life-threatening adverse effect?
A) Take with food to prevent nausea
B) Monitor blood glucose daily
C) Hold for 48 hours before and after IV contrast dye
D) Report any weight gain to the provider
Answer: C IV contrast can cause acute kidney injury, increasing metformin levels and the risk of lactic
acidosis. Metformin must be held before and after contrast.
3. A client receiving warfarin has an INR of 4.8 with no signs of bleeding. Which action should the
nurse anticipate?
A) Administer vitamin K subcutaneously
B) Hold the next dose and notify the provider
C) Increase the warfarin dose
D) Administer fresh frozen plasma
Answer: B INR 4.8 is above therapeutic range (2-3 for most indications) but without bleeding, holding
the dose and monitoring is standard. Vitamin K is for active bleeding or very high INR (>10).
1|Page SUCCESS!!!
,4. A client is prescribed lisinopril for hypertension. The nurse should teach the client to report which
symptom that is most characteristic of angioedema?
A) Dry, persistent cough
B) Swelling of the lips, tongue, or face
C) Dizziness upon standing
D) Metallic taste in the mouth
Answer: B Angioedema is a life-threatening ACE inhibitor reaction presenting as swelling of the face,
lips, or tongue, which can compromise the airway. Dry cough is common but not life-threatening.
5. A client with a history of anaphylaxis to penicillin is being treated for a UTI. Which antibiotic should
the nurse question?
A) Ciprofloxacin
B) Nitrofurantoin
C) Cephalexin
D) Trimethoprim-sulfamethoxazole
Answer: C Cephalosporins (cephalexin) have 1-10% cross-sensitivity with penicillins. In true
anaphylaxis, an alternative class (fluoroquinolone, macrolide) is preferred.
6. A client with atrial fibrillation is prescribed apixaban (Eliquis). The nurse knows that this
medication:
A) Requires routine INR monitoring
B) Is a warfarin derivative
C) Is a direct factor Xa inhibitor that does not require routine monitoring
D) Has an antidote of vitamin K
Answer: C Apixaban is a DOAC with predictable pharmacokinetics; it does not require INR monitoring.
Andexanet alfa is the antidote, not vitamin K.
7. A client is prescribed albuterol via MDI for asthma. The nurse should instruct the client to:
A) Use the inhaler daily to prevent exacerbations
B) Rinse the mouth immediately after use to prevent thrush
C) Wait 60 seconds between puffs
2|Page SUCCESS!!!
,D) Use the inhaler as a rescue medication for acute symptoms
Answer: D Albuterol is a short-acting beta-2 agonist (SABA) used as a rescue medication. Daily use
indicates poor control. Mouth rinsing is for inhaled corticosteroids.
8. A client is prescribed clopidogrel after a coronary stent placement. The nurse understands that this
medication:
A) Should be stopped 7 days before any surgery
B) Is an antiplatelet agent that irreversibly inhibits the P2Y12 receptor
C) Replaces aspirin as monotherapy
D) Has a rapid onset and short duration of action
Answer: B Clopidogrel irreversibly inhibits the P2Y12 ADP receptor on platelets. It is used with aspirin
(DAPT) after stents. Duration is the life of the platelet (7-10 days).
9. A client with opioid use disorder is prescribed buprenorphine/naloxone (Suboxone). The nurse
explains that naloxone is included to:
A) Enhance the analgesic effect of buprenorphine
B) Prevent diversion by injection (precipitates withdrawal if injected)
C) Reduce the risk of constipation
D) Increase the duration of action of buprenorphine
Answer: B Naloxone has poor sublingual absorption but if injected, it precipitates withdrawal,
deterring misuse. Naloxone does not enhance analgesia or duration.
10. A client prescribed metoprolol for heart failure reports dizziness and a heart rate of 52 bpm. What
is the nurse’s priority action?
A) Administer the dose as ordered
B) Hold the dose and notify the provider
C) Give the dose with food
D) Increase the dose to improve heart rate
Answer: B Metoprolol is a beta-blocker that can cause bradycardia. A heart rate <60 bpm typically
requires holding the dose and notifying the provider for adjustment.
3|Page SUCCESS!!!
, 11. A client is prescribed insulin glargine (Lantus). Which statement by the client indicates correct
understanding?
A) “I will take this insulin 30 minutes before meals.”
B) “This insulin peaks in 2-4 hours.”
C) “It is a long-acting basal insulin with no pronounced peak.”
D) “I can mix it with regular insulin in the same syringe.”
Answer: C Insulin glargine is long-acting with a duration of 20-24 hours and no pronounced peak. It
should not be mixed with other insulins.
12. A client is prescribed spironolactone for heart failure. Which laboratory finding requires
immediate intervention?
A) Serum potassium 5.2 mEq/L
B) Serum sodium 138 mEq/L
C) Serum creatinine 0.9 mg/dL
D) Blood glucose 110 mg/dL
Answer: A Spironolactone is a potassium-sparing diuretic. Hyperkalemia (K >5.0) can cause fatal
dysrhythmias and requires dose reduction or discontinuation.
13. A client receiving furosemide (Lasix) reports muscle cramps and weakness. Which electrolyte
imbalance is most likely?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
Answer: B Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia presents with
muscle cramps, weakness, and fatigue.
14. A client is prescribed amlodipine (Norvasc). Which side effect should the nurse include in patient
teaching?
A) Dry cough
B) Peripheral edema
4|Page SUCCESS!!!
