NUR 233 Pharmacology Exam
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Free NUR 233 Pharmacology Exam Questions
A nurse is reviewing the history of a patient prescribed fluconazole for a fungal infection. Which problem in the patient's history would be of most concern?
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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.
The nurse is caring for a client who is being induced for preeclampsia with severe features and is experiencing a hypertensive crisis with repeated BPs > 180/110. The client is receiving a Magnesium sulfate infusion and has received 4 doses of labetalol IVP without improvement. Which medication would the nurse anticipate administering next?
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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 caring for a postpartum client who has a blood type of A- (Rh negative) and is reviewing the cord blood sample results for the newborn. Which newborn blood type does the nurse understand would necessitate the client receiving a dose of RhoGAM within 72 hours of delivery?
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B + (Rh positive)
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AB - (Rh negative)
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A - (Rh negative)
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O - (Rh negative)
Explanation
Correct Answer: (A) B + (Rh positive)
RhoGAM is administered to Rh-negative mothers when the newborn is Rh positive. This prevents the mother from developing Rh antibodies that could affect future pregnancies. Since the mother is Rh negative, only an Rh positive newborn would trigger the need for RhoGAM.
Why Other Options are Incorrect:
- B. AB- (Rh negative) — the newborn is Rh negative, so there is no risk of Rh incompatibility and RhoGAM is not needed.
- C. A- (Rh negative) — the newborn is Rh negative, so RhoGAM is not indicated.
- D. O- (Rh negative) — the newborn is Rh negative, so there is no Rh incompatibility and RhoGAM is not required.
The nurse is administering medications to a patient with Crohn's disease. The nurse recognizes that which medication has a black box warning for fatal tuberculosis infection?
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Bromocriptine
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Belimumab
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Infliximab
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Ropinrole
Explanation
Correct Answer: C) Infliximab
Infliximab is a TNF-alpha inhibitor (biologic) used in Crohn's disease and other inflammatory conditions. It carries a black box warning for serious infections, including the reactivation of latent tuberculosis, which can be fatal. Patients must be screened for latent TB before starting infliximab. Bromocriptine and ropinirole are dopaminergic agents used in Parkinson's disease, not Crohn's. Belimumab is a B-lymphocyte stimulator inhibitor used in lupus, not Crohn's disease.
A nurse is monitoring a client receiving atropine. Which finding requires immediate nursing action?
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Nasal congestion
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Heart rate of 60 beats/min
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Blood pressure 90/40 mmHg
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Constricted pupils
Explanation
Correct Answer: (C) Blood pressure 90/40 mmHg
A blood pressure of 90/40 mmHg indicates hypotension, which is a serious and potentially life-threatening finding requiring immediate nursing action. While atropine is used to increase heart rate, significant hypotension can indicate cardiovascular compromise that needs urgent intervention.
Why the other options are incorrect:
- A. Nasal congestion is not a concerning side effect of atropine and does not require immediate action.
- B. A heart rate of 60 beats/min is within normal range and is not an immediate concern in a client receiving atropine.
- D. Atropine typically causes dilated pupils (mydriasis), not constricted pupils. While constricted pupils are inconsistent with atropine's expected effects, hypotension remains the more immediately life-threatening finding.
The nurse is teaching a nursing student about tocolytics. Which statement by the student indicates teaching was effective?
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Tocolytics stimulate uterine contractions
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Tocolytics will inhibit labor and maintain a pregnancy
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Tocolytics will induce an abortion during pregnancy
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Tocolytics will cause harm to the fetus
Explanation
Correct Answer: B) Tocolytics will inhibit labor and maintain a pregnancy
Tocolytics are a class of medications specifically used to suppress uterine contractions and delay preterm labor, thereby helping to maintain the pregnancy and allow more time for fetal lung development or transfer to a higher-level facility. Option A is the opposite — tocolytics inhibit, not stimulate, contractions. Options C and D are false; tocolytics are used to protect the pregnancy and are generally considered safe for the fetus.
A patient has an order for the monoclonal antibody adalimumab (Humira). The nurse notes that the patient does not have a history of cancer. What is another possible reason for administering this drug?
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Multiple Sclerosis
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Rheumatoid arthritis
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Severe anemia
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Thrombocytopenia
Explanation
Correct Answer: B) Rheumatoid arthritis
Adalimumab (Humira) is a TNF-alpha inhibitor monoclonal antibody approved for multiple inflammatory and autoimmune conditions including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, plaque psoriasis, and ulcerative colitis. It is not indicated for Multiple Sclerosis (MS is treated with interferons, glatiramer acetate, natalizumab, etc.), severe anemia, or thrombocytopenia, which are conditions unrelated to TNF-alpha-mediated inflammation.
When a patient is receiving vasopressin, the nurse will monitor for which expected response?
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Decreased urinary output
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Increased serum albumin levels
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Increased serum potassium levels
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Improved appetite
Explanation
Correct Answer: A) Decreased urinary output
Vasopressin (ADH — antidiuretic hormone) works by promoting water reabsorption in the renal collecting ducts, which concentrates the urine and decreases urinary output — this is its therapeutic effect when used for diabetes insipidus or as a vasopressor. Vasopressin has no direct effect on serum albumin, potassium, or appetite. Decreased urinary output is the expected and desired therapeutic response when vasopressin is administered.
What medication does the nurse recognize as the primary vasoconstrictor used in advanced life support that increases coronary, cerebral, and vital organ perfusion?
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hydralazine
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nitroglycerin
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milrinone
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epinephrine
Explanation
Correct Answer: (D) epinephrine
Epinephrine is the primary vasoconstrictor used in advanced cardiac life support (ACLS). It stimulates alpha-adrenergic receptors to cause vasoconstriction, which increases coronary and cerebral perfusion pressure during cardiac arrest, improving the chances of return of spontaneous circulation.
Why Other Options are Incorrect:
- A. Hydralazine is an antihypertensive vasodilator, which actually decreases vascular resistance — the opposite effect needed in ACLS.
- B. Nitroglycerin is a vasodilator used for angina and hypertensive emergencies, not a vasoconstrictor used in cardiac arrest.
- C. Milrinone is a phosphodiesterase inhibitor used for acute heart failure that causes vasodilation and increased contractility, not vasoconstriction for ACLS.
The nurse is administering Isoniazid therapy to a patient. Which contraindication will the nurse assess the patient for prior to administration?
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Heart failure
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Hepatic impairment
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Glaucoma
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Anemia
Explanation
Correct Answer: (B) Hepatic impairment
Isoniazid is primarily metabolized by the liver and is known to be hepatotoxic. Patients with pre-existing hepatic impairment are at significantly increased risk of severe liver damage, making hepatic impairment a major contraindication to its use. Liver function tests should be monitored throughout therapy.
Why Other Options are Incorrect:
- A. Heart failure is not a contraindication to isoniazid therapy; the medication does not significantly affect cardiac function.
- C. Glaucoma is not a contraindication to isoniazid; this is more relevant to anticholinergic medications.
- D. Anemia is not a contraindication to isoniazid, though the drug can occasionally affect vitamin B6 levels which may have hematologic effects if untreated.
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