NURSING 2451
PHARMACOLOGY
EXAM Q & A
2024
1. A patient with hypertension is prescribed lisinopril, an angiotensin-converting enzyme
(ACE) inhibitor. The nurse should monitor the patient for which of the following adverse
effects of this drug?
a) Hyperkalemia*
b) Hypoglycemia
c) Hypocalcemia
d) Hyponatremia
Rationale: ACE inhibitors can cause hyperkalemia by inhibiting the secretion of
aldosterone, which regulates potassium excretion. Hypoglycemia, hypocalcemia, and
hyponatremia are not common side effects of ACE inhibitors.
2. A patient with type 2 diabetes mellitus is prescribed metformin, a biguanide that lowers
blood glucose levels by decreasing hepatic glucose production and increasing insulin
sensitivity. The nurse should instruct the patient to avoid which of the following
substances while taking this drug?
a) Alcohol*
b) Caffeine
c) Grapefruit juice
d) Milk
Rationale: Alcohol can increase the risk of lactic acidosis, a rare but serious complication of
metformin therapy. Lactic acidosis is characterized by nausea, vomiting, abdominal pain,
hyperventilation, and hypothermia. Caffeine, grapefruit juice, and milk do not interact
significantly with metformin.
,3. A patient with schizophrenia is prescribed clozapine, an atypical antipsychotic that
blocks dopamine and serotonin receptors in the brain. The nurse should inform the
patient about the need for regular blood tests to monitor which of the following
parameters?
a) White blood cell count*
b) Liver function tests
c) Blood urea nitrogen
d) Serum creatinine
Rationale: Clozapine can cause agranulocytosis, a potentially fatal condition that involves a
severe reduction in white blood cells. Patients taking clozapine should have their white
blood cell count checked weekly for the first six months of therapy and every two weeks
thereafter. Liver function tests, blood urea nitrogen, and serum creatinine are not
routinely monitored for clozapine therapy.
4. A patient with depression is prescribed fluoxetine, a selective serotonin reuptake
inhibitor (SSRI) that increases the availability of serotonin in the synaptic cleft. The nurse
should advise the patient to report any signs of which of the following conditions that
may occur as a result of excessive serotonin levels?
a) Serotonin syndrome*
b) Neuroleptic malignant syndrome
c) Tardive dyskinesia
d) Extrapyramidal symptoms
Rationale: Serotonin syndrome is a potentially life-threatening condition that occurs when
serotonin levels become too high due to the use of SSRIs or other serotonergic drugs.
Serotonin syndrome is characterized by agitation, confusion, tremor, hyperreflexia,
diaphoresis, tachycardia, and fever. Neuroleptic malignant syndrome, tardive dyskinesia,
and extrapyramidal symptoms are associated with antipsychotic drugs, not SSRIs.
5. A patient with asthma is prescribed albuterol, a beta-2 adrenergic agonist that relaxes
bronchial smooth muscle and improves airflow. The nurse should instruct the patient to
use the drug as needed for which of the following purposes?
a) Prevention of bronchospasm
b) Treatment of acute bronchospasm*
c) Maintenance of bronchodilation
d) Reduction of inflammation
Rationale: Albuterol is a short-acting beta-2 agonist that is used to treat acute
bronchospasm in patients with asthma or chronic obstructive pulmonary disease
(COPD). It is not used for prevention or maintenance of bronchodilation or for reduction
of inflammation. For these purposes, other drugs such as inhaled corticosteroids or long-
, acting beta-2 agonists are used.
6. A patient with rheumatoid arthritis is prescribed methotrexate, a disease-modifying
antirheumatic drug (DMARD) that inhibits dihydrofolate reductase and interferes with
DNA synthesis and cell division. The nurse should caution the patient to avoid which of
the following substances while taking this drug?
a) Folic acid supplements
b) Nonsteroidal anti-inflammatory drugs (NSAIDs)*
c) Calcium supplements
d) Vitamin C supplements
Rationale: NSAIDs can increase the risk of hepatotoxicity and bone marrow suppression
when taken with methotrexate. Patients taking methotrexate should have their liver
function tests and complete blood count monitored regularly. Folic acid supplements can
reduce the toxicity of methotrexate without affecting its efficacy. Calcium and vitamin C
supplements do not interact significantly with methotrexate.
7. A patient with bipolar disorder is prescribed lithium, a mood stabilizer that affects the
reuptake and release of neurotransmitters such as norepinephrine, serotonin, and
dopamine. The nurse should educate the patient about the importance of maintaining a
consistent intake of which of the following electrolytes while taking this drug?
a) Sodium*
b) Potassium
c) Magnesium
d) Calcium
Rationale: Sodium levels can affect the renal clearance and serum concentration of lithium.
A low sodium intake can increase the risk of lithium toxicity, while a high sodium intake
can decrease the effectiveness of lithium. Patients taking lithium should maintain a
normal sodium intake and avoid sudden changes in their diet or fluid intake. Potassium,
magnesium, and calcium do not affect lithium levels.
8. A patient with chronic pain is prescribed morphine, an opioid analgesic that binds to mu
receptors in the central nervous system and produces analgesia, sedation, and euphoria.
The nurse should assess the patient for which of the following signs of opioid overdose?
a) Pinpoint pupils*
b) Dilated pupils
c) Flushed skin
d) Diarrhea
PHARMACOLOGY
EXAM Q & A
2024
1. A patient with hypertension is prescribed lisinopril, an angiotensin-converting enzyme
(ACE) inhibitor. The nurse should monitor the patient for which of the following adverse
effects of this drug?
a) Hyperkalemia*
b) Hypoglycemia
c) Hypocalcemia
d) Hyponatremia
Rationale: ACE inhibitors can cause hyperkalemia by inhibiting the secretion of
aldosterone, which regulates potassium excretion. Hypoglycemia, hypocalcemia, and
hyponatremia are not common side effects of ACE inhibitors.
2. A patient with type 2 diabetes mellitus is prescribed metformin, a biguanide that lowers
blood glucose levels by decreasing hepatic glucose production and increasing insulin
sensitivity. The nurse should instruct the patient to avoid which of the following
substances while taking this drug?
a) Alcohol*
b) Caffeine
c) Grapefruit juice
d) Milk
Rationale: Alcohol can increase the risk of lactic acidosis, a rare but serious complication of
metformin therapy. Lactic acidosis is characterized by nausea, vomiting, abdominal pain,
hyperventilation, and hypothermia. Caffeine, grapefruit juice, and milk do not interact
significantly with metformin.
,3. A patient with schizophrenia is prescribed clozapine, an atypical antipsychotic that
blocks dopamine and serotonin receptors in the brain. The nurse should inform the
patient about the need for regular blood tests to monitor which of the following
parameters?
a) White blood cell count*
b) Liver function tests
c) Blood urea nitrogen
d) Serum creatinine
Rationale: Clozapine can cause agranulocytosis, a potentially fatal condition that involves a
severe reduction in white blood cells. Patients taking clozapine should have their white
blood cell count checked weekly for the first six months of therapy and every two weeks
thereafter. Liver function tests, blood urea nitrogen, and serum creatinine are not
routinely monitored for clozapine therapy.
4. A patient with depression is prescribed fluoxetine, a selective serotonin reuptake
inhibitor (SSRI) that increases the availability of serotonin in the synaptic cleft. The nurse
should advise the patient to report any signs of which of the following conditions that
may occur as a result of excessive serotonin levels?
a) Serotonin syndrome*
b) Neuroleptic malignant syndrome
c) Tardive dyskinesia
d) Extrapyramidal symptoms
Rationale: Serotonin syndrome is a potentially life-threatening condition that occurs when
serotonin levels become too high due to the use of SSRIs or other serotonergic drugs.
Serotonin syndrome is characterized by agitation, confusion, tremor, hyperreflexia,
diaphoresis, tachycardia, and fever. Neuroleptic malignant syndrome, tardive dyskinesia,
and extrapyramidal symptoms are associated with antipsychotic drugs, not SSRIs.
5. A patient with asthma is prescribed albuterol, a beta-2 adrenergic agonist that relaxes
bronchial smooth muscle and improves airflow. The nurse should instruct the patient to
use the drug as needed for which of the following purposes?
a) Prevention of bronchospasm
b) Treatment of acute bronchospasm*
c) Maintenance of bronchodilation
d) Reduction of inflammation
Rationale: Albuterol is a short-acting beta-2 agonist that is used to treat acute
bronchospasm in patients with asthma or chronic obstructive pulmonary disease
(COPD). It is not used for prevention or maintenance of bronchodilation or for reduction
of inflammation. For these purposes, other drugs such as inhaled corticosteroids or long-
, acting beta-2 agonists are used.
6. A patient with rheumatoid arthritis is prescribed methotrexate, a disease-modifying
antirheumatic drug (DMARD) that inhibits dihydrofolate reductase and interferes with
DNA synthesis and cell division. The nurse should caution the patient to avoid which of
the following substances while taking this drug?
a) Folic acid supplements
b) Nonsteroidal anti-inflammatory drugs (NSAIDs)*
c) Calcium supplements
d) Vitamin C supplements
Rationale: NSAIDs can increase the risk of hepatotoxicity and bone marrow suppression
when taken with methotrexate. Patients taking methotrexate should have their liver
function tests and complete blood count monitored regularly. Folic acid supplements can
reduce the toxicity of methotrexate without affecting its efficacy. Calcium and vitamin C
supplements do not interact significantly with methotrexate.
7. A patient with bipolar disorder is prescribed lithium, a mood stabilizer that affects the
reuptake and release of neurotransmitters such as norepinephrine, serotonin, and
dopamine. The nurse should educate the patient about the importance of maintaining a
consistent intake of which of the following electrolytes while taking this drug?
a) Sodium*
b) Potassium
c) Magnesium
d) Calcium
Rationale: Sodium levels can affect the renal clearance and serum concentration of lithium.
A low sodium intake can increase the risk of lithium toxicity, while a high sodium intake
can decrease the effectiveness of lithium. Patients taking lithium should maintain a
normal sodium intake and avoid sudden changes in their diet or fluid intake. Potassium,
magnesium, and calcium do not affect lithium levels.
8. A patient with chronic pain is prescribed morphine, an opioid analgesic that binds to mu
receptors in the central nervous system and produces analgesia, sedation, and euphoria.
The nurse should assess the patient for which of the following signs of opioid overdose?
a) Pinpoint pupils*
b) Dilated pupils
c) Flushed skin
d) Diarrhea
