NUR 233 Pharmacology Exam
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Free NUR 233 Pharmacology Exam Questions
A nurse is caring for a new patient admitted after having 3 seizures at home. The provider has ordered: phenytoin (Dilantin), 100 mg, IV infusion, over 30 minutes, every eight hours. Why will the nurse question this order and contact the provider?
- Phenytoin should be given as an IV push and not as a slow infusion over 30 minutes
- Phenytoin should be given as needed (prn) and there is no indication listed in the order
- Phenytoin given greater than two times a day can cause gingival hyperplasia and excessive hair growth
- Phenytoin should be given very slowly over at least one hour
Explanation
Correct Answer: D) Phenytoin should be given very slowly over at least one hour
Phenytoin (Dilantin) IV must be infused no faster than 50 mg/min in adults, which means 100 mg should take at least 2 minutes, but when given as a full loading or maintenance infusion, it must be given slowly to prevent cardiovascular toxicity (hypotension, bradycardia, cardiac arrhythmias). An infusion over 30 minutes at 100 mg is too fast and poses cardiovascular risk. The standard safe practice is to infuse no faster than 50 mg/min, and many institutional protocols require at least one hour for therapeutic doses. The nurse should question this order and contact the provider to clarify a safer rate.
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Cardiac disease
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Pulmonary disease
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Hepatic disease
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Endocrine disease
Explanation
Correct Answer: (C) Hepatic disease
Fluconazole is an azole antifungal that is extensively metabolized by the liver. Pre-existing hepatic disease significantly increases the risk of drug-induced hepatotoxicity and elevated liver enzymes, making it the most concerning condition in a patient's history prior to initiating fluconazole therapy.
Why Other Options are Incorrect:
- A. Cardiac disease is not a primary concern with fluconazole, though QT prolongation can occur; hepatic disease remains the priority concern.
- B. Pulmonary disease is not a contraindication or major concern with fluconazole use.
- D. Endocrine disease is not a primary concern with fluconazole therapy.
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Methylergonovine
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Carboprost
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Nalbuphine
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Tranexamic acid
Explanation
Correct Answer: (D) Tranexamic acid
Methylergonovine is contraindicated in hypertension, and Carboprost is contraindicated in asthma. Tranexamic acid is an antifibrinolytic agent safe to use in this client and is the appropriate next step when initial uterotonic therapy has failed.
Why Other Options are Incorrect:
- A. Methylergonovine is contraindicated in clients with hypertension as it causes vasoconstriction and can dangerously elevate blood pressure.
- B. Carboprost is contraindicated in clients with asthma as it can cause severe bronchospasm.
- C. Nalbuphine is an opioid analgesic used for pain management, not for treating postpartum hemorrhage.
A patient has been post-menopausal for two years and has been taking hormone replacement therapy. Which assessment finding should the nurse report to the provider immediately?
- Uterine bleeding
- Weight gain
- Fluid retention
- Breast tenderness
Explanation
Correct Answer: A) Uterine bleeding
Uterine (vaginal) bleeding in a post-menopausal woman on hormone replacement therapy is a serious finding that must be reported to the provider immediately, as it can indicate endometrial hyperplasia or endometrial cancer — a known risk of unopposed or prolonged estrogen use. This is a red flag symptom that requires prompt investigation. Weight gain, fluid retention, and breast tenderness are common, expected, and manageable side effects of hormone replacement therapy that do not require immediate reporting to the provider.
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Lidocaine
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Amlodipine
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Hydralazine
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Epinephrine
Explanation
Correct Answer: (C) Hydralazine
Hydralazine is a first-line antihypertensive used in obstetric hypertensive emergencies. When labetalol has failed to adequately control severe hypertension in preeclampsia, hydralazine is the next anticipated agent due to its direct arterial vasodilation and established safety profile in pregnancy.
Why Other Options are Incorrect:
- A. Lidocaine is an antiarrhythmic agent used for ventricular arrhythmias and has no role in managing hypertensive crisis in preeclampsia.
- B. Amlodipine is an oral calcium channel blocker not used for acute hypertensive emergencies in obstetric settings.
- D. Epinephrine is a vasoconstrictor used in cardiac arrest and anaphylaxis; administering it would dangerously worsen hypertension.
The nurse is teaching a group of nursing students about administration of erythromycin ointment to a newborn. Which statement by the students indicates the need for further instruction?
- "I will flush the newborn's eye after administering the ointment."
- "I will need to administer the eye ointment within 1 hour of the newborn's birth."
- "I will cleanse the newborn's eyes prior to administering the ointment."
- "I will administer the eye ointment in each of the newborn's conjunctival sac."
Explanation
Correct Answer: A) "I will flush the newborn's eye after administering the ointment."
This statement requires further teaching. Erythromycin ophthalmic ointment is applied to the newborn's eyes to prevent ophthalmia neonatorum (gonococcal/chlamydial eye infection acquired during birth). After application, the eyes should NOT be flushed — flushing would remove the medication and reduce its effectiveness. The ointment must remain in contact with the conjunctiva to work. Options B, C, and D are all correct practices: administration within 1 hour of birth, cleansing the eyes before application, and administering in each conjunctival sac are all proper technique.
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We will schedule you to see the provider so you can get a prescription as soon as possible
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Masking and good hand hygiene may help to prevent you from getting the virus
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Remdesivir will not prevent COVID-19
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Remdesivir is used for those diagnosed with COVID-19 and are at high risk for progression to severe COVID-19
Explanation
Correct Answer: (A) We will schedule you to see the provider so you can get a prescription as soon as possible
Remdesivir is an antiviral medication approved for treatment of COVID-19 in high-risk patients, not for prevention. Scheduling the patient for a prescription to prevent COVID-19 would be incorrect nursing education.
Why Other Options are Incorrect:
- B. Masking and good hand hygiene may help to prevent you from getting the virus — this is correct education and therefore not an incorrect response.
- C. Remdesivir will not prevent COVID-19 — this is a true and accurate statement, making it a correct response.
- D. Remdesivir is used for those diagnosed with COVID-19 and are at high risk for progression to severe COVID-19 — this accurately describes the approved use of remdesivir.
A newly arrived immigrant attends the prenatal clinic at 30 weeks' gestation for the first time. Which immunizations would the nurse recommend? (Select all that apply.)
- Mumps
- Tetanus, Diphtheria, Pertussis (TDAP)
- Measles
- Hepatitis B
- Varicella
Explanation
Correct Answer: B) Tetanus, Diphtheria, Pertussis (TDAP) and D) Hepatitis B
During pregnancy, live vaccines are contraindicated because they pose a risk to the fetus. TDAP is a safe inactivated vaccine recommended between 27–36 weeks of every pregnancy to protect the newborn from pertussis (whooping cough) via maternal antibody transfer. Hepatitis B vaccine is also a safe, inactivated vaccine recommended for pregnant women who are unvaccinated, especially high-risk individuals such as new immigrants. Mumps (A), Measles (C), and Varicella (E) are all live attenuated vaccines and are absolutely contraindicated during pregnancy due to teratogenicity risk. They should be administered postpartum.
The nurse is caring for a neonate born at 38 weeks gestation and weighs 3625 grams. The provider orders a septic workup and the administration of Ampicillin 75 mg/kg/day every 8 hours. What dose in milligrams will the nurse administer per dose? Round to the nearest whole number.
Explanation
Correct Answer: 91 mg per dose
Step 1: Convert weight to kg → 3625 g ÷ 1000 = 3.625 kg
Step 2: Calculate total daily dose → 75 mg/kg/day × 3.625 kg = 271.875 mg/day
Step 3: Divide by frequency (every 8 hours = 3 doses/day) → 271.875 ÷ 3 = 90.625 mg ≈ 91 mg per dose
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Apixaban
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Tranexamic acid
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Aminocaproic acid
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Protamine sulfate
Explanation
Correct Answer: (D) Protamine sulfate
Protamine sulfate is the specific antidote for heparin toxicity. It binds directly to heparin and neutralizes its anticoagulant effect, making it the first-line reversal agent when signs of heparin-induced bleeding are present.
Why Other Options are Incorrect:
- A. Apixaban is a factor Xa inhibitor anticoagulant and would worsen bleeding, not reverse heparin toxicity.
- B. Tranexamic acid is an antifibrinolytic used to control general bleeding but is not the specific antidote for heparin.
- C. Aminocaproic acid is also an antifibrinolytic agent and is not the appropriate reversal agent for heparin toxicity.
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