NUR 233 Pharmacology Exam

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Free NUR 233 Pharmacology Exam Questions

1.

A nurse is reviewing the health history of a 38-year-old woman seeing her provider to request a prescription for an oral contraceptive. Which information in this patient's history is most concerning and is a contraindication with most forms of oral contraceptive therapy?

  • Past use of an intrauterine contraceptive device
  • Cigarette smoking of one pack per day
  • A history of uterine fibroids
  • Systolic blood pressure consistently in the low 130's

Explanation

Explanation
Correct Answer: B) Cigarette smoking of one pack per day
Cigarette smoking is a major contraindication to combined oral contraceptive use, particularly in women over 35 years of age. Smoking combined with estrogen-containing oral contraceptives significantly increases the risk of serious cardiovascular events, including deep vein thrombosis, pulmonary embolism, stroke, and myocardial infarction. Past IUD use is not a contraindication. Uterine fibroids are not an absolute contraindication to oral contraceptives. A systolic BP in the low 130s, while slightly elevated, is not an absolute contraindication (severe hypertension would be), and this patient's age and smoking history are the primary concern.
2.

A patient is receiving hydroxychloroquine therapy. The nurse knows that a possible reason for this drug therapy is which of these conditions?

  • Intestinal tapeworms
  • Postpartum Hemorrhage
  • Systemic lupus erythematosus
  • Toxoplasmosis

Explanation

Explanation
Correct Answer: C) Systemic lupus erythematosus
Hydroxychloroquine (Plaquenil) is an antimalarial drug that is also widely used as a disease-modifying agent in autoimmune conditions, most notably systemic lupus erythematosus (SLE) and rheumatoid arthritis. In SLE, it reduces disease flares, decreases organ damage, and improves long-term survival. It is considered a cornerstone of SLE management regardless of disease severity.
Intestinal tapeworms are treated with anthelmintic medications such as praziquantel or albendazole — not hydroxychloroquine. Postpartum hemorrhage is managed with uterotonics such as oxytocin, misoprostol, and carboprost — hydroxychloroquine has no role here. Toxoplasmosis is treated with pyrimethamine combined with sulfadiazine — again, hydroxychloroquine is not indicated for this parasitic infection.
3. When administering propranolol hydrochloride to a patient, the nurse will understand how this medication will affect the patient with this knowledge.
  • increases the force of myocardial contraction and may increase blood pressure

  • is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II

  • blocks beta-adrenergic stimulation, causing a decrease in heart rate, and decreases myocardial contractility

  • increases norepinephrine secretion, causing an increase in blood pressure and heart rate

Explanation

Explanation
Correct Answer: (C) blocks beta-adrenergic stimulation, causing a decrease in heart rate, and decreases myocardial contractility
Propranolol is a non-selective beta-blocker that works by blocking beta-adrenergic receptors, resulting in decreased heart rate, reduced myocardial contractility, and lowered blood pressure. It is used in the management of hypertension, angina, and arrhythmias.
Why the other options are incorrect:
  • A. Propranolol actually decreases myocardial contractility and lowers blood pressure — the opposite of what is described here.
  • B. This describes the mechanism of ACE inhibitors, not beta-blockers like propranolol.
  • D. Propranolol blocks norepinephrine's effects rather than increasing its secretion, resulting in decreased heart rate and blood pressure.
4. What medication does the nurse recognize as the primary vasoconstrictor used in advanced life support that increases coronary, cerebral, and vital organ perfusion?
  • hydralazine

  • nitroglycerin

  • milrinone

  • epinephrine

Explanation

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.
5.

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?

  • Multiple Sclerosis
  • Rheumatoid arthritis
  • Severe anemia
  • Thrombocytopenia

Explanation

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.
6.

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

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.
7.

A patient has been taking selegiline for a few months, and recently the prescriber increased the dose to 20 mg/day. Today, during the office visit, the patient tells the nurse that they forgot and had 3 beers with dinner last evening, and "felt awful." What did the patient most likely experience?

  • Urinary retention
  • Hypertension
  • Bradycardia
  • Fever

Explanation

Explanation
Correct Answer: B) Hypertension
Selegiline is an MAO-B inhibitor used in Parkinson's disease. At higher doses (≥10 mg/day), selegiline loses its MAO-B selectivity and also inhibits MAO-A, which metabolizes tyramine. Tyramine is present in alcohol (especially wine and beer). When MAO-A is inhibited and the patient consumes tyramine-containing substances, tyramine accumulates and triggers massive norepinephrine release, causing a hypertensive crisis — characterized by severe headache, sweating, palpitations, and generally "feeling awful." This is the classic tyramine interaction with MAO inhibitors. Urinary retention, bradycardia, and fever are not the hallmark of this interaction.
8. A nurse is administering intravenous (IV) acyclovir to a patient with a viral infection. Which administration technique is correct?
  • Infuse acyclovir over 15 minutes, and rotate IV sites

  • Acyclovir may be given IV push, over 5 minutes, and rotate IV sites

  • Infuse acyclovir over at least one hour, and rotate IV sites

  • Infuse intravenous acyclovir by rapid bolus, and rotate IV sites

Explanation

Explanation
Correct Answer: (C) Infuse acyclovir over at least one hour, and rotate IV sites
IV acyclovir must be infused slowly over at least one hour to prevent nephrotoxicity and renal tubular crystallization. Rapid infusion can cause severe kidney damage. IV sites should be rotated to minimize the risk of phlebitis and local tissue irritation.
Why Other Options are Incorrect:
  • A. Infusing over 15 minutes is too rapid and increases the risk of nephrotoxicity and adverse renal effects.
  • B. Acyclovir must never be given as an IV push; this method of delivery would cause serious renal and vascular complications.
  • D. Rapid bolus administration is contraindicated with acyclovir due to the high risk of acute kidney injury and crystalluria.
9. A nurse is administering rifampin to a client for the first time. What should be included in client teaching? (Select all that apply)
  • Limit alcohol consumption while on this medication

  • Urine, tears, and other body fluids will be discolored red-orange

  • Photophobia and visual changes are common

  • This medication decreases effectiveness of oral contraceptives

  • Supplementation with pyridoxine (B6) is advised

Explanation

Explanation
Correct Answer: (A, B, D) Limit alcohol consumption; Urine, tears, and other body fluids will be discolored red-orange; This medication decreases effectiveness of oral contraceptives
Rifampin is a potent liver enzyme inducer that increases alcohol-related hepatotoxicity risk, causes characteristic red-orange discoloration of body fluids (a harmless but alarming side effect patients must be warned about), and significantly reduces the effectiveness of oral contraceptives by accelerating their metabolism.

Why Other Options are Incorrect:
  • C. Photophobia and visual changes are not commonly associated with rifampin; these side effects are more characteristic of ethambutol, another TB medication.
  • E. Pyridoxine (B6) supplementation is recommended with isoniazid, not rifampin, to prevent peripheral neuropathy.
10. The nurse is caring for a client who just had a normal spontaneous vaginal delivery 1 hour ago and has a provider order for methylergonovine 0.2 mg IM. What assessment finding does the nurse understand is a contraindication for administration of methylergonovine?
  • Quantitative blood loss of 800 ml

  • Heart rate 112

  • Pain 8/10

  • BP 160/98

Explanation

Explanation
Correct Answer: (D) BP 160/98
Methylergonovine is an ergot alkaloid that causes vasoconstriction and uterine contraction. Hypertension is an absolute contraindication because the vasoconstrictive effects of the drug can dangerously elevate blood pressure further, increasing the risk of stroke or other cardiovascular complications.
Why Other Options are Incorrect:
  • A. Quantitative blood loss of 800 ml is an indication for methylergonovine, not a contraindication, as the drug is used to manage postpartum hemorrhage.
  • B. A heart rate of 112 may indicate tachycardia but is not a contraindication to methylergonovine administration.
  • C. Pain 8/10 is an expected finding in the immediate postpartum period and is not a contraindication to methylergonovine.

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