ESI_Pharmacology Exam Practice
H
2024/2025 (NCLEX PN) 2 VERSIONS
ACTUAL EXAM COMPLETE QUESTIONS
WITH DETAILED VERIFIED ANSWERS
AND RATIONALES (100% CORRECT
ANSWERS)_ALREADY GRADED A+
) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum
1
calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as
prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D - answer....3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia.
Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which
occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be
avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone
resorption and lowering the serum calcium concentration.
.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The
2
nurse instructs the mother to administer the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice - answer....4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother should be instructed to
administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect
absorption of the iron. Water will not assist in absorption. Orange juice contains a greater
amount of vitamin C than apple juice.
, .) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the
3
client, knowing that which of the following would indicate the presence of systemic toxicity from
this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations - answer....1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result.
Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation
and diarrhea are not associated with salicylism.
.) The camp nurse asks the children preparing to swim in the lake if they have applied
4
sunscreen. The nurse reminds the children that chemical sunscreens are most effective when
applied:
1. Immediately before swimming
2. 15 minutes before exposure to the sun
3. Immediately before exposure to the sun
4. At least 30 minutes before exposure to the sun - answer....4. At least 30 minutes before
exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so
that they can penetrate the skin. All sunscreens should be reapplied after swimming or
sweating.
.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying
5
the medication, the client complains of local discomfort and burning. Which of the following is
the most appropriate nursing action?
1. Notifying the registered nurse
2. Discontinuing the medication
3. Informing the client that this is normal
4. Applying a thinner film than prescribed to the burn site - answer....3. Informing the client that
this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used
to treat burns to reduce bacteria present in avascular tissues. The client should be informed that
the medication will cause local discomfort and burning and that this is a normal reaction;
therefore options 1, 2, and 4 are incorrect
.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of
6
injury. The nurse monitors the client, knowing that which of the following indicates that a
systemic effect has occurred?
1.Hyperventilation
, .Elevated blood pressure
2
3.Local pain at the burn site
4.Local rash at the burn site - answer....1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid,
thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an
acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for
1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood
pressure may be expected from the pain that occurs with a burn injury.
.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this
7
medication, the nurse anticipates that which laboratory test will be prescribed?
1. Platelet count
2. Triglyceride level
3. Complete blood count
4. White blood cell count - answer....2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before
treatment and periodically thereafter until the effect on the triglycerides has been evaluated.
Options 1, 3, and 4 do not need to be monitored specifically during this treatment.
.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes
8
isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the
client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin) - answer....1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of
isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should
be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the
use of isotretinoin.
.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would
9
monitor for the potential for increased systemic absorption of the medication if the medication
were being applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands - answer....2. Axilla
Rationale:
, opical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from
T
regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum,
genitalia), and lower from regions in which permeability is poor (back, palms, soles).
0.) The clinic nurse is performing an admission assessment on a client. The nurse notes that
1
the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse
would suspect that the client is being treated for:
1. Acne
2. Eczema
3. Hair loss
4. Herpes simplex - answer....1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to
work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of
keratinocytes. Options 2, 3, and 4 are incorrect.
1.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a
1
partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is
reinforcing information to the client about the medication. Which statement made by the client
indicates a lack of understanding about the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound." - answer....3. "The medication will
permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against
gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to
assist in healing. It does not stain the skin.
2.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an
1
antineoplastic medication. During the infusion, the client complains of pain at the insertion site.
During an inspection of the site, the nurse notes redness and swelling and that the rate of
infusion of the medication has slowed. The nurse should take which appropriate action?
1. Notify the registered nurse.
2. Administer pain medication to reduce the discomfort.
3. Apply ice and maintain the infusion rate, as prescribed.
4. Elevate the extremity of the IV site, and slow the infusion. - answer....1. Notify the registered
nurse.
Rationale:
When antineoplastic medications (Chemotherapeutic Agents) are administered via IV, great
care must be taken to prevent the medication from escaping into the tissues surrounding the
injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for
signs of extravasation, such as redness or swelling at the insertion site and a decreased
H
2024/2025 (NCLEX PN) 2 VERSIONS
ACTUAL EXAM COMPLETE QUESTIONS
WITH DETAILED VERIFIED ANSWERS
AND RATIONALES (100% CORRECT
ANSWERS)_ALREADY GRADED A+
) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum
1
calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as
prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D - answer....3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia.
Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which
occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be
avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone
resorption and lowering the serum calcium concentration.
.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The
2
nurse instructs the mother to administer the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice - answer....4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother should be instructed to
administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect
absorption of the iron. Water will not assist in absorption. Orange juice contains a greater
amount of vitamin C than apple juice.
, .) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the
3
client, knowing that which of the following would indicate the presence of systemic toxicity from
this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations - answer....1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result.
Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation
and diarrhea are not associated with salicylism.
.) The camp nurse asks the children preparing to swim in the lake if they have applied
4
sunscreen. The nurse reminds the children that chemical sunscreens are most effective when
applied:
1. Immediately before swimming
2. 15 minutes before exposure to the sun
3. Immediately before exposure to the sun
4. At least 30 minutes before exposure to the sun - answer....4. At least 30 minutes before
exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so
that they can penetrate the skin. All sunscreens should be reapplied after swimming or
sweating.
.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying
5
the medication, the client complains of local discomfort and burning. Which of the following is
the most appropriate nursing action?
1. Notifying the registered nurse
2. Discontinuing the medication
3. Informing the client that this is normal
4. Applying a thinner film than prescribed to the burn site - answer....3. Informing the client that
this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used
to treat burns to reduce bacteria present in avascular tissues. The client should be informed that
the medication will cause local discomfort and burning and that this is a normal reaction;
therefore options 1, 2, and 4 are incorrect
.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of
6
injury. The nurse monitors the client, knowing that which of the following indicates that a
systemic effect has occurred?
1.Hyperventilation
, .Elevated blood pressure
2
3.Local pain at the burn site
4.Local rash at the burn site - answer....1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid,
thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an
acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for
1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood
pressure may be expected from the pain that occurs with a burn injury.
.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this
7
medication, the nurse anticipates that which laboratory test will be prescribed?
1. Platelet count
2. Triglyceride level
3. Complete blood count
4. White blood cell count - answer....2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before
treatment and periodically thereafter until the effect on the triglycerides has been evaluated.
Options 1, 3, and 4 do not need to be monitored specifically during this treatment.
.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes
8
isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the
client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin) - answer....1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of
isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should
be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the
use of isotretinoin.
.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would
9
monitor for the potential for increased systemic absorption of the medication if the medication
were being applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands - answer....2. Axilla
Rationale:
, opical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from
T
regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum,
genitalia), and lower from regions in which permeability is poor (back, palms, soles).
0.) The clinic nurse is performing an admission assessment on a client. The nurse notes that
1
the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse
would suspect that the client is being treated for:
1. Acne
2. Eczema
3. Hair loss
4. Herpes simplex - answer....1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to
work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of
keratinocytes. Options 2, 3, and 4 are incorrect.
1.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a
1
partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is
reinforcing information to the client about the medication. Which statement made by the client
indicates a lack of understanding about the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound." - answer....3. "The medication will
permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against
gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to
assist in healing. It does not stain the skin.
2.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an
1
antineoplastic medication. During the infusion, the client complains of pain at the insertion site.
During an inspection of the site, the nurse notes redness and swelling and that the rate of
infusion of the medication has slowed. The nurse should take which appropriate action?
1. Notify the registered nurse.
2. Administer pain medication to reduce the discomfort.
3. Apply ice and maintain the infusion rate, as prescribed.
4. Elevate the extremity of the IV site, and slow the infusion. - answer....1. Notify the registered
nurse.
Rationale:
When antineoplastic medications (Chemotherapeutic Agents) are administered via IV, great
care must be taken to prevent the medication from escaping into the tissues surrounding the
injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for
signs of extravasation, such as redness or swelling at the insertion site and a decreased
