Free practice questions · Pharmacology
Pharmacology practice questions.
Ten pharmacology questions from the NCLEX-RN bank: drug classes, adverse effects, interactions, what to check before giving a dose and what to teach after it. Doses and rates in the bank are checked against a formulary before an item is published.
1Multiple choice, single answerPharmacology
A 16-year-old with type 1 diabetes tells the school nurse they have soccer practice this afternoon. The blood glucose before practice is 118 mg/dL. Which action should the school nurse plan?
Give the usual insulin dose and have the client take a snack after practice
Withhold the afternoon insulin entirely until after practice
Arrange for the insulin dose to be reduced and have rapid carbohydrate available
Have the client check the glucose at the end of practice and report anything low
Answer it, then check it.
Answer and rationale
Answer
- C: Arrange for the insulin dose to be reduced and have rapid carbohydrate available
The key, and why
Type 1 diabetes is an autoimmune disease in which the body's immune system destroys the cells in the pancreas that make insulin.
Exercise potentiates insulin, and the plainest way to say it is that exercise is like another shot of insulin. It makes the body more sensitive to whatever insulin is on board and it burns glucose at the same time, so a client who exercises with a full dose working can drop a long way.
The plan has two parts. The dose is reduced, on the prescriber's instruction, because the exercise is doing part of the work the insulin would have done. And rapidly metabolized carbohydrate, a snack or juice, is kept where the client can reach it, because even a reduced dose plus an hour of soccer can go low.
Each distractor
Option A leaves the full dose working through an hour of soccer and puts the carbohydrate at the end, by which time the client may already have dropped.
Option B swings too far the other way. Withholding insulin in type 1 risks ketoacidosis, and the answer is a smaller dose, not none.
Option D checks after the event. It would catch a low that has already happened, and the point of the plan is to stop it happening.
The teaching point
EXERCISE POTENTIATES INSULIN. It is like another shot of insulin. Planned exercise means a REDUCED dose, on the prescriber's instruction. Keep a RAPIDLY METABOLISED CARBOHYDRATE within reach, a snack or juice. Never withhold insulin altogether in type 1.
2Multiple choice, single answerPharmacology
Two hours after a first dose of haloperidol IM, a 25-year-old client with acute psychosis is resting in bed. Which of the following findings would require immediate follow-up?
Reports that the tongue feels thick and swallowing has become difficult
Reports feeling drowsy and asks to skip the evening group session
Reports a dry mouth and asks the nurse for a cup of water to sip
Has a blood pressure of 108/70 mm Hg, down from 122/78 mm Hg before the dose
Answer it, then check it.
Answer and rationale
Answer
- A: Reports that the tongue feels thick and swallowing has become difficult
The key, and why
Acute dystonia can affect any muscle group, and when it involves the tongue, throat or larynx it becomes an emergency. A thick-feeling tongue and new difficulty swallowing 2 hours after a first injection of haloperidol are early signs that the spasm is affecting the muscles that protect the airway. Laryngeal dystonia can progress to stridor and airway obstruction.
The nurse stays with the client, assesses the airway and breathing, gives the prescribed anticholinergic (benztropine or diphenhydramine) by injection, and notifies the provider. Swallowing pills or food is held until the spasm resolves.
Each distractor
Option B, drowsiness, is a common and expected effect of haloperidol. The client can rest, and the nurse reassesses later.
Option C, a dry mouth, is an anticholinergic effect that is uncomfortable but not dangerous. Sips of water help.
Option D, a small drop in blood pressure, is expected after an antipsychotic and is still within a safe range. The nurse reminds the client to rise slowly.
The teaching point
Dystonia of the TONGUE or THROAT = AIRWAY emergency. Thick tongue, trouble swallowing, hoarse voice, stridor → stay, give the anticholinergic, notify. Drowsy, dry mouth, mild BP drop = EXPECTED.
3Select all that applyPharmacology
A client taking lithium reports the findings below. Which are expected effects rather than signs of toxicity? Select all that apply.
Vomiting since yesterday with unsteady walking
Passing urine more often than before
Mild thirst through the day
A fine tremor of the hands
A metallic taste with severe diarrhea
Answer it, then check it.
Answer and rationale
Answer
- B: Passing urine more often than before
- C: Mild thirst through the day
- D: A fine tremor of the hands
The key, and why
Lithium is a mood-stabilizing medicine used to treat bipolar disorder.
Lithium behaves in the body much like an electrolyte, and the effects a client notices early reflect that. Passing more urine, feeling thirsty and a fine tremor of the hands are ordinary on a therapeutic level. They are monitored and taught about rather than treated as an emergency.
Toxicity looks different, and the difference is worth being exact about. The tremor changes from fine to coarse. Vomiting and severe diarrhea appear. The client becomes unsteady, then confused. A metallic taste is part of that toxic picture.
The overlap catches students out because thirst and urination sit on both sides in a loose sense, so the discriminator is the tremor and the gut. A fine tremor with mild thirst is expected. A coarse tremor with vomiting and ataxia is a level above 1.5 until proven otherwise.
Each distractor
Option A is vomiting with unsteady walking, which is toxicity. It is also self-worsening, because the fluid loss concentrates the lithium further.
Option E is a metallic taste with severe diarrhea, both recognized markers of a toxic level. Severe diarrhea does the same thing as vomiting and drives the level higher still.
The teaching point
EXPECTED = more urine, mild thirst, FINE hand tremor. TOXIC = COARSE tremor, vomiting, severe diarrhea, metallic taste, ataxia, confusion. The tremor is the discriminator. FINE is expected, COARSE is not. Vomiting and diarrhea RAISE the level further, so toxicity accelerates once they start. Therapeutic 0.6 to 1.2. Toxic above 1.5.
4Multiple choice, single answerPharmacology
A client with hepatic encephalopathy is prescribed an oral aminoglycoside. Which explanation best describes why this treatment lowers the ammonia level?
The medication binds ammonia in the bloodstream and carries it to the kidneys
The medication improves the liver's ability to convert ammonia to urea
The medication increases the number of bowel movements, removing ammonia in the stool
The medication kills the bowel bacteria that produce ammonia, so less ammonia is made
Answer it, then check it.
Answer and rationale
Answer
- D: The medication kills the bowel bacteria that produce ammonia, so less ammonia is made
The key, and why
Follow the chain backwards. The confusion comes from ammonia reaching the brain. The ammonia is there because the diseased liver cannot clear it. And the ammonia was made in the first place by bacteria living in the gut, with Escherichia coli the biggest producer of all.
An oral aminoglycoside attacks the last step in that chain. Kill the bacteria and less ammonia gets made, so less arrives at the brain and the client clears. The drug does not touch the liver, it does not bind anything in the blood, and it works entirely inside the bowel because that is the only place it ever goes.
Each distractor
Option A describes a binding agent working in the blood. An oral aminoglycoside never enters the blood, so it cannot bind anything there.
Option B credits the drug with improving liver function. Nothing in this class does that, and the liver damage in cirrhosis is not reversed by an antibiotic.
Option C describes how lactulose works, which is the other treatment for hepatic encephalopathy. Lactulose draws ammonia into the bowel and pulls it out in soft stools, with two to three soft stools a day as the goal. That is a different mechanism from killing the bacteria, and the two treatments are often used together.
The teaching point
The chain is BACTERIA → AMMONIA → BRAIN. E. COLI in the gut is the number 1 ammonia producer. Oral mycin kills the bacteria, so LESS ammonia is MADE. Lactulose does something different. It pulls the ammonia OUT in the stool. Goal is 2 to 3 soft stools a day. Both lower the ammonia, by different routes.
5Select all that applyPharmacology
The health care provider prescribes pancrelipase capsules for a 52-year-old client with chronic pancreatitis related to alcohol use. The client has bulky, foul-smelling, oily stools and has lost 6 kg (13.2 lb) in 4 months. Which of the following instructions should the nurse include?
Take the capsules about 1 hour after each meal, once digestion is under way
Crush the beads and stir them into a glass of milk if the capsules are hard to swallow
Stop drinking alcohol completely, including beer and wine
Swallow the capsules whole, or sprinkle the beads on a spoonful of applesauce
Take the capsules with the first bite of each meal and each snack
Answer it, then check it.
Answer and rationale
Answer
- C: Stop drinking alcohol completely, including beer and wine
- D: Swallow the capsules whole, or sprinkle the beads on a spoonful of applesauce
- E: Take the capsules with the first bite of each meal and each snack
The key, and why
Chronic pancreatitis is ongoing inflammation that scars the pancreas until it can no longer release enough digestive enzymes. Fat is the first nutrient to go undigested, so the stools become bulky, greasy, pale, and foul-smelling, a pattern called steatorrhea, and the client loses weight and fat-soluble vitamins.
Pancrelipase replaces lipase, protease, and amylase. The enzymes work only while food is in the intestine, so they are taken with the first bite of every meal and snack. The beads have an enteric coating that protects them from stomach acid. They are swallowed whole, or sprinkled on a soft, acidic food such as applesauce and swallowed without chewing. Alcohol is the main cause of the ongoing damage and of painful flares, so stopping completely is part of the treatment.
Each distractor
Option A takes the enzymes after much of the meal has already moved through the intestine without them, so most of the fat is still not digested.
Option B destroys the enteric coating. Crushed beads release their enzymes in the stomach, where acid inactivates them, and the enzymes can irritate the mouth. Milk is not acidic enough (its pH is well above 4.5), so it starts to dissolve the coating before the beads reach the intestine.
The teaching point
PANCRELIPASE = with the FIRST BITE of EVERY meal and snack. SWALLOW WHOLE or beads on APPLESAUCE. Never CRUSH or CHEW. Never mix with MILK. Enzymes WORKING = stools become FORMED and less GREASY, and WEIGHT stabilizes.
6Multiple choice, single answerPharmacology
A client who has taken lithium for 5 years is seen in the primary care clinic for newly diagnosed hypertension and knee pain. Which prescription should the nurse question?
Acetaminophen 650 mg by mouth every 6 hours as needed for knee pain
Levothyroxine 50 mcg by mouth daily for a low thyroid hormone level
Hydrochlorothiazide 25 mg by mouth daily for hypertension
Docusate sodium 100 mg by mouth twice daily for occasional constipation
Answer it, then check it.
Answer and rationale
Answer
- C: Hydrochlorothiazide 25 mg by mouth daily for hypertension
The key, and why
Thiazide diuretics such as hydrochlorothiazide cause the kidneys to lose sodium. In response, the kidneys reabsorb more sodium, and lithium along with it, so the lithium level rises, often by a quarter or more. A client who has been stable on lithium for years can become toxic within days of starting a thiazide.
The nurse holds the new prescription and contacts the prescriber, who may choose a different antihypertensive or, if a diuretic is essential, lower the lithium dose with close level monitoring.
Each distractor
Option A is appropriate. Acetaminophen is the preferred pain reliever with lithium because, unlike NSAIDs, it does not raise the lithium level.
Option B is appropriate. Lithium commonly causes hypothyroidism, so a client on long-term lithium may well need levothyroxine.
Option D is appropriate. Docusate is a stool softener with no interaction with lithium.
The teaching point
LITHIUM + THIAZIDE diuretic = lithium level RISES → question it. LITHIUM + NSAID = level rises. LITHIUM + ACETAMINOPHEN = safe. Long-term lithium → watch the THYROID and the KIDNEYS.
7Select all that applyPharmacology
A client is prescribed a long-acting intramuscular antipsychotic. Which statements about this form are correct? Select all that apply.
It can be stopped immediately if an adverse effect appears
It is given at intervals of weeks rather than daily
It helps a client who finds daily tablets hard to keep up with
It removes the need for any further monitoring
Adverse effects can last for weeks after a dose
Answer it, then check it.
Answer and rationale
Answer
- B: It is given at intervals of weeks rather than daily
- C: It helps a client who finds daily tablets hard to keep up with
- E: Adverse effects can last for weeks after a dose
The key, and why
A long-acting injectable antipsychotic is given into muscle and released slowly over weeks, so one injection covers what would otherwise be dozens of tablets. For a client who struggles to take a daily medicine, that turns a daily decision into an appointment every few weeks.
The same property is the drawback. A drug designed to last for weeks cannot be taken back out, so an adverse effect that appears after the injection has to be managed while the drug is still working its way out of the muscle. That is why a client is usually established on the oral form first, to see how they tolerate it.
Monitoring continues throughout. The movement effects, the metabolic effects and the blood monitoring that go with the class do not change because the route changed.
Each distractor
Option A says it can be stopped immediately. It cannot. The depot continues to release from the muscle for weeks, which is precisely why tolerance is established on tablets first.
Option D says monitoring stops. Nothing about the injectable route removes the need to watch for movement effects, metabolic change or blood problems.
The teaching point
DEPOT injection = released over WEEKS from muscle. Helps when taking a DAILY tablet is the barrier. It CANNOT be withdrawn once given, so an adverse effect has to be managed in place. Establish tolerance on the ORAL form first. All the usual monitoring continues.
8Trend questionPharmacology
Measure | Day 1 | Day 3 | Day 5
Serum creatinine (mg/dL) | 0.9 | 1.4 | 2.1
White blood cell count (per mm3) | 19,000 | 14,000 | 11,500
Temperature (C) | 38.9 | 37.8 | 37.2
Heart rate (beats per minute) | 104 | 92 | 84
A client is receiving intravenous gentamicin every 8 hours for septic peritonitis. The nurse reviews the following results collected across the course of therapy. Which change requires immediate follow-up by the nurse?
The white blood cell count falling from 19,000 to 11,500 per mm3
The temperature falling from 38.9 C to 37.2 C
The serum creatinine rising from 0.9 to 2.1 mg/dL
The heart rate falling from 104 to 84 beats per minute
Answer it, then check it.
Answer and rationale
Answer
- C: The serum creatinine rising from 0.9 to 2.1 mg/dL
The key, and why
Gentamicin is a strong antibiotic given intravenously for serious bacterial infections.
Every line on this table moved, which is what makes it a trend, and only one moved in a direction that is bad for the client. The creatinine started at 0.9, which is normal, and has more than doubled to 2.1, which is above the normal range of roughly 0.6 to 1.3. That is the aminoglycoside damaging the kidneys, and it needs reporting now so the drug can be held or the dose adjusted.
Look at what the other three lines are telling you. The white cell count is falling toward normal, the fever is settling, and the heart rate is coming down. Those are all signs that the infection is responding to treatment, which is good news. The problem is that the drug curing the infection is injuring the kidney at the same time, and that is the entire risk of this drug class.
Each distractor
Option A, a falling white cell count, is improvement. It started at 19,000, well above the normal 5,000 to 10,000, and is heading back toward normal.
Option B, a falling temperature, is also improvement. The fever is resolving.
Option D, a falling heart rate, is improvement too. The tachycardia that came with sepsis is settling as the client gets better.
The teaching point
In a trend, find the line that left its NORMAL RANGE in the WRONG direction. Creatinine 0.9 → 2.1 = NEPHROTOXICITY. Report it. WBC down, temperature down, heart rate down = the infection is RESPONDING. Good. The aminoglycoside is curing the infection and hurting the kidney at the same time. Both are true. Also check the urine output and ask about ringing in the ears, because the other toxicity does not show on this table. Lab values that matter: Serum creatinine roughly 0.6 to 1.3 mg/dL, white blood cell count 5,000 to 10,000 per mm3. Only the creatinine is outside its range at day 5, and it is the only value moving away from normal.
9Multiple choice, single answerPharmacology
A 70-year-old client with end-stage kidney disease is scheduled for hemodialysis at 0800. At 0700 the nurse prepares the morning medications, which are carvedilol 12.5 mg, amlodipine 10 mg, sevelamer 800 mg with breakfast, and a renal multivitamin. The BP is 118/70 mm Hg. Which action should the nurse take?
Hold sevelamer until after dialysis because the treatment will remove it from the blood
Give the renal multivitamin now so that it is absorbed before the dialysis treatment begins
Give all four medications as scheduled because the client's BP is within the normal range
Hold carvedilol and amlodipine and verify with the provider whether to give them after dialysis
Answer it, then check it.
Answer and rationale
Answer
- D: Hold carvedilol and amlodipine and verify with the provider whether to give them after dialysis
The key, and why
Hemodialysis pulls 1 to 4 L of fluid from the blood over a few hours, and hypotension during treatment is the commonest complication. Antihypertensives taken just before dialysis add to that drop, so carvedilol and amlodipine are usually held until after the treatment, and the nurse verifies the plan with the provider because some clients do take them.
Two other timing rules matter. Sevelamer is a phosphate binder. It is not absorbed, works only in the gut, and must be taken with meals to bind the phosphate in food, so it is given with breakfast. Water-soluble vitamins in a renal multivitamin are removed by dialysis, so the vitamin is given after the treatment.
Each distractor
Option A misunderstands sevelamer. It stays in the gut and is not removed by dialysis, and holding it means breakfast phosphate is absorbed.
Option B has the timing backward. A multivitamin given before dialysis is largely removed during the treatment.
Option C gives two blood pressure medications right before a treatment that lowers the BP. A normal BP now does not predict the pressure halfway through dialysis.
The teaching point
BEFORE HEMODIALYSIS → HOLD ANTIHYPERTENSIVES (verify) → risk of HYPOTENSION. PHOSPHATE BINDERS (sevelamer, calcium acetate) → WITH MEALS. WATER-SOLUBLE vitamins and dialyzable medications → AFTER dialysis.
10Multiple choice, single answerPharmacology
A client in thyroid storm has a temperature of 40.6°C (105.1°F). Which medication should the nurse question if it is prescribed to lower the temperature?
Propranolol
Acetaminophen
Aspirin
Propylthiouracil
Answer it, then check it.
Answer and rationale
Answer
- C: Aspirin
The key, and why
Aspirin is the one to question, and the reason is specific to this condition. Salicylates displace thyroid hormone from the proteins that carry it in the blood, which raises the amount of free, active hormone and makes the storm worse.
Acetaminophen is the antipyretic used instead. The rest of the temperature management is physical: a cooling blanket, ice packs to the groin and axillae, and a cool environment.
Each distractor
Option A is part of the treatment, because it blocks the effects of the hormone on the heart.
Option B is the correct antipyretic in this situation and is the drug that replaces aspirin.
Option D is part of the treatment, because it blocks the gland from making more hormone.
The teaching point
NEVER give ASPIRIN in thyroid storm. SALICYLATES displace thyroid hormone from its carrier proteins. ACETAMINOPHEN is the antipyretic used instead. COOLING BLANKET and ICE PACKS do the rest.
Safety note
Aspirin is avoided in thyroid storm. It frees bound thyroid hormone and makes the crisis worse.
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