NCLEX Pharmacology Practice Questions – Complete Exam
Preparation with Answers and Explanations
1. Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol)
overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which
of the following organs?
a. Lungs
b. Liver
c. Kidney
d. Adrenal Glands
---Correct---Answer B. Acetaminophen is extensively metabolized by pathways in the liver. Toxic
doses of acetaminophen deplete hepatic glutathione, resulting in accumulation of the
intermediate agent, quinine, which leads to hepatic necrosis. Prolonged use of acetaminophen
may result in an increased risk of renal dysfunction, but a single overdose does not precipitate
life-threatening problems in the respiratory system, renal system, or adrenal glands.
2. A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis
(eczema) is:
a. Parasite infection.
b. Viral infection.
c. Bacterial infection.
d. Spirochete infection.
---Correct---Answer B. Topical agents produce a localized, rather than systemic effect. When
treating atopic dermatitis with a steroidal preparation, the site is vulnerable to invasion by
organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of disseminated
infection. Educate the patient using topical corticosteroids to avoid crowds or people known to
have infections and to report even minor signs of an infection. Topical corticosteroid usage
results in little danger of concurrent infection with these agents.
3. In infants and children, the side effects of first generation over-the-counter (OTC)
antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:
,a. Reye's syndrome.
b. Cholinergic effects.
c. Paradoxical CNS stimulation.
d. Nausea and diarrhea.
---Correct---Answer C. Typically, first generation OTC antihistamines have a sedating effect
because of passage into the CNS. However, in some individuals, especially infants and children,
paradoxical CNS stimulation occurs and is manifested by excitement, euphoria, restlessness, and
confusion. For this reason, use of first generation OTC antihistamines has declined, and second
generation product usage has increased. Reye's syndrome is a systemic response to a virus. First
generation OTC antihistamines do not exhibit a cholinergic effect. Nausea and diarrhea are
uncommon when first generation OTC antihistamines are taken.
4. Reye's syndrome, a potentially fatal illness associated with liver failure and encephalopathy is
associated with the administration of which over-the-counter (OTC) medication?
a. acetaminophen (Tylenol)
b. ibuprofen (Motrin)
c. aspirin
d. brompheniramine/psudoephedrine (Dimetapp)
---Correct---Answer C. Virus-infected children who are given aspirin to manage pain, fever, and
inflammation are at an increased risk of developing Reye's syndrome. Use of acetaminophen
has not been associated with Reye's syndrome and can be safely given to patients with fever
due to viral illnesses. Ibuprofen adverse effects include GI irritation and bleeding, and in toxic
doses, both renal and hepatic failure are reported. However, ibuprofen has not been associated
with the onset of Reye's disease. Brompheniramine/psudoephedrine contains a first generation
OTC antihistamine and a decongestant. Neither agent has been associated with the
development of Reye's syndrome.
5. The nurse is aware that the patients who are allergic to intravenous contrast media are
usually also allergic to which of the following products?
a. Eggs
b. Shellfish
,c. Soy
d. acidic fruits
---Correct---Answer B. Some types of contrast media contain iodine as an ingredient. Shellfish
also contain significant amounts of iodine. Therefore, a patient who is allergic to iodine will
exhibit an allergic response to both iodine containing contrast media and shellfish. These
products do not contain iodine.
6. A 13-month-old child recently arrived in the United States from a foreign country with his
parents and needs childhood immunizations. His mother reports that he is allergic to eggs.
Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the
following vaccines should he not receive?
a. Hepatitis B
b. inactivated polio
c. diphtheria, acellular pertussis, tetanus (DTaP)
d. mumps, measles, rubella (MMR)
---Correct---Answer D. The measles portion of the MMR vaccine is grown in chick embryo cells.
The current MMR vaccine does not contain a significant amount of egg proteins, and even
children with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction.
However, patients that do respond to egg contact with anaphylaxis should be in a medically
controlled setting where full resuscitation efforts can be administered if anaphylaxis results. The
vaccines in options a,b and c do not contain egg protein.
7. The cell and Coombs classification system categorizes allergic reactions and is useful in
describing and classifying patient reactions to drugs. Type I reactions are immediate
hypersensitivity reactions and are mediated by:
a. immunoglobulin E (IgE).
b. immunoglobulin G (IgG).
c. immunoglobulin A (IgA).
d. immunoglobulin M (IgM).
, ---Correct---Answer A. IgE, the least common serum immunoglobulin (Ig) binds very tightly to
receptors on basophils and mast cells and is involved in allergic reactions. Binding of the
allergen to the IgE on the cells results in the release of various pharmacological mediators that
result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most versatile Ig
because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class of
Ig that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the
second most common serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is
important in local (mucosal) immunity. IgM, the third most common serum Ig, is the first Ig to
be made by the fetus and the first Ig to be made by a virgin B cell when it is stimulated by
antigen. IgM antibodies are very efficient in leading to the lysis of microorganisms.
8. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most
frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is:
a. aplastic anemia.
b. thrombocytosis.
c. leukocytosis.
d. granulocytosis.
---Correct---Answer A. Aplastic anemia is the result of a hypersensitivity reaction and is often
irreversible. It leads to pancytopenia, a severe decrease in all cell types: red blood cells, white
blood cells, and platelets. A reduced number of red blood cells causes hemoglobin to drop. A
reduced number of white blood cells make the patient susceptible to infection. And, a reduced
number of platelets cause the blood not to clot as easily. Treatment for mild cases is supportive.
Transfusions may be necessary. Severe cases require a bone marrow transplant. Option 2 is an
elevated platelet count. Option 3 is an elevated white count. Option 4 is an elevated granulocyte
count. A granulocyte is a type of white blood cell.
9. Serious adverse effects of oral contraceptives include:
a. Increase in skin oil followed by acne.
b. Headache and dizziness.
c. Early or mid-cycle bleeding.
d. Thromboembolic complications.
Preparation with Answers and Explanations
1. Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol)
overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which
of the following organs?
a. Lungs
b. Liver
c. Kidney
d. Adrenal Glands
---Correct---Answer B. Acetaminophen is extensively metabolized by pathways in the liver. Toxic
doses of acetaminophen deplete hepatic glutathione, resulting in accumulation of the
intermediate agent, quinine, which leads to hepatic necrosis. Prolonged use of acetaminophen
may result in an increased risk of renal dysfunction, but a single overdose does not precipitate
life-threatening problems in the respiratory system, renal system, or adrenal glands.
2. A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis
(eczema) is:
a. Parasite infection.
b. Viral infection.
c. Bacterial infection.
d. Spirochete infection.
---Correct---Answer B. Topical agents produce a localized, rather than systemic effect. When
treating atopic dermatitis with a steroidal preparation, the site is vulnerable to invasion by
organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of disseminated
infection. Educate the patient using topical corticosteroids to avoid crowds or people known to
have infections and to report even minor signs of an infection. Topical corticosteroid usage
results in little danger of concurrent infection with these agents.
3. In infants and children, the side effects of first generation over-the-counter (OTC)
antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:
,a. Reye's syndrome.
b. Cholinergic effects.
c. Paradoxical CNS stimulation.
d. Nausea and diarrhea.
---Correct---Answer C. Typically, first generation OTC antihistamines have a sedating effect
because of passage into the CNS. However, in some individuals, especially infants and children,
paradoxical CNS stimulation occurs and is manifested by excitement, euphoria, restlessness, and
confusion. For this reason, use of first generation OTC antihistamines has declined, and second
generation product usage has increased. Reye's syndrome is a systemic response to a virus. First
generation OTC antihistamines do not exhibit a cholinergic effect. Nausea and diarrhea are
uncommon when first generation OTC antihistamines are taken.
4. Reye's syndrome, a potentially fatal illness associated with liver failure and encephalopathy is
associated with the administration of which over-the-counter (OTC) medication?
a. acetaminophen (Tylenol)
b. ibuprofen (Motrin)
c. aspirin
d. brompheniramine/psudoephedrine (Dimetapp)
---Correct---Answer C. Virus-infected children who are given aspirin to manage pain, fever, and
inflammation are at an increased risk of developing Reye's syndrome. Use of acetaminophen
has not been associated with Reye's syndrome and can be safely given to patients with fever
due to viral illnesses. Ibuprofen adverse effects include GI irritation and bleeding, and in toxic
doses, both renal and hepatic failure are reported. However, ibuprofen has not been associated
with the onset of Reye's disease. Brompheniramine/psudoephedrine contains a first generation
OTC antihistamine and a decongestant. Neither agent has been associated with the
development of Reye's syndrome.
5. The nurse is aware that the patients who are allergic to intravenous contrast media are
usually also allergic to which of the following products?
a. Eggs
b. Shellfish
,c. Soy
d. acidic fruits
---Correct---Answer B. Some types of contrast media contain iodine as an ingredient. Shellfish
also contain significant amounts of iodine. Therefore, a patient who is allergic to iodine will
exhibit an allergic response to both iodine containing contrast media and shellfish. These
products do not contain iodine.
6. A 13-month-old child recently arrived in the United States from a foreign country with his
parents and needs childhood immunizations. His mother reports that he is allergic to eggs.
Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the
following vaccines should he not receive?
a. Hepatitis B
b. inactivated polio
c. diphtheria, acellular pertussis, tetanus (DTaP)
d. mumps, measles, rubella (MMR)
---Correct---Answer D. The measles portion of the MMR vaccine is grown in chick embryo cells.
The current MMR vaccine does not contain a significant amount of egg proteins, and even
children with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction.
However, patients that do respond to egg contact with anaphylaxis should be in a medically
controlled setting where full resuscitation efforts can be administered if anaphylaxis results. The
vaccines in options a,b and c do not contain egg protein.
7. The cell and Coombs classification system categorizes allergic reactions and is useful in
describing and classifying patient reactions to drugs. Type I reactions are immediate
hypersensitivity reactions and are mediated by:
a. immunoglobulin E (IgE).
b. immunoglobulin G (IgG).
c. immunoglobulin A (IgA).
d. immunoglobulin M (IgM).
, ---Correct---Answer A. IgE, the least common serum immunoglobulin (Ig) binds very tightly to
receptors on basophils and mast cells and is involved in allergic reactions. Binding of the
allergen to the IgE on the cells results in the release of various pharmacological mediators that
result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most versatile Ig
because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class of
Ig that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the
second most common serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is
important in local (mucosal) immunity. IgM, the third most common serum Ig, is the first Ig to
be made by the fetus and the first Ig to be made by a virgin B cell when it is stimulated by
antigen. IgM antibodies are very efficient in leading to the lysis of microorganisms.
8. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most
frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is:
a. aplastic anemia.
b. thrombocytosis.
c. leukocytosis.
d. granulocytosis.
---Correct---Answer A. Aplastic anemia is the result of a hypersensitivity reaction and is often
irreversible. It leads to pancytopenia, a severe decrease in all cell types: red blood cells, white
blood cells, and platelets. A reduced number of red blood cells causes hemoglobin to drop. A
reduced number of white blood cells make the patient susceptible to infection. And, a reduced
number of platelets cause the blood not to clot as easily. Treatment for mild cases is supportive.
Transfusions may be necessary. Severe cases require a bone marrow transplant. Option 2 is an
elevated platelet count. Option 3 is an elevated white count. Option 4 is an elevated granulocyte
count. A granulocyte is a type of white blood cell.
9. Serious adverse effects of oral contraceptives include:
a. Increase in skin oil followed by acne.
b. Headache and dizziness.
c. Early or mid-cycle bleeding.
d. Thromboembolic complications.
