NUR 233 Pharmacology Exam

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Free NUR 233 Pharmacology Exam Questions

1.

Which statement should the nurse include when discussing estradiol cream with a patient experiencing post-menopausal vaginitis?

  • Very little hormone is absorbed systemically with cream-based preparations resulting in fewer adverse effects compared to oral estrogen replacement therapy.
  • This form of hormone replacement therapy is the least effective for vaginitis
  • Recent menopausal women should not use hormone replacement as symptoms of vaginitis may be transient
  • There is a higher incidence of thrombophlebitis with estradiol cream than with oral estrogen preparations

Explanation

Explanation
Correct Answer: A) Very little hormone is absorbed systemically with cream-based preparations resulting in fewer adverse effects compared to oral estrogen replacement therapy.
Topical (vaginal) estradiol cream delivers estrogen locally to vaginal tissues with minimal systemic absorption, making it a safer option for patients concerned about systemic risks (such as thromboembolism). This localized delivery effectively treats post-menopausal vaginitis symptoms (dryness, irritation, dyspareunia) while significantly reducing systemic adverse effects compared to oral estrogen. Option B is incorrect — topical estradiol is actually very effective for vaginitis. Option C is not evidence-based guidance for treatment. Option D is the reverse of the truth; oral estrogen carries higher thrombophlebitis risk than topical preparations.
2. 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.
3. A nurse is monitoring a client receiving atropine. Which finding requires immediate nursing action?
  • Nasal congestion

  • Heart rate of 60 beats/min

  • Blood pressure 90/40 mmHg

  • Constricted pupils

Explanation

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.
4.

The nurse is administering nifedipine to a pregnant client at 25 2/7 weeks gestation for preterm labor. What assessment(s) is/are required prior to administration? (Select all that apply)

  • Maternal blood pressure
  • Uterine contraction pattern
  • Fetal non-stress test
  • Deep tendon reflexes
  • Maternal pulse

Explanation

Explanation
Correct Answer: A) Maternal blood pressure, B) Uterine contraction pattern, E) Maternal pulse
Nifedipine is a calcium channel blocker used as a tocolytic to stop preterm labor. Prior to administration, the nurse must assess maternal blood pressure (nifedipine causes vasodilation and can significantly drop BP), maternal pulse (nifedipine causes reflex tachycardia and cardiovascular changes), and the uterine contraction pattern (to establish a baseline and evaluate tocolytic effectiveness). A fetal non-stress test (C) is not a required pre-administration assessment for nifedipine. Deep tendon reflexes (D) are specifically monitored with magnesium sulfate therapy, not nifedipine — DTR assessment is not required before giving nifedipine.
5. A nurse is caring for a patient in the emergency department with symptoms of an acute ischemic stroke. The stroke team orders tenecteplase (TNK) at a dose of 0.25 mg/kg, IV bolus. The patient weighs 82 kg. The hospital supplies tenecteplase in a vial of 50 mg powder, which is reconstituted with 10 mL of sterile water to yield a concentration of 5 mg/mL. How many milliliters (mL) should the nurse draw up and administer by IV push for this patient? Do not label your answer and round to the nearest 10th if needed.

Explanation

Explanation
Correct Answer: 4.1
Step 1: Calculate the required dose in mg: 0.25 mg/kg × 82 kg = 20.5 mg
Step 2: Identify the concentration of the reconstituted solution: 50 mg powder reconstituted with 10 mL sterile water = 5 mg/mL
Step 3: Calculate the volume to draw up: 20.5 mg ÷ 5 mg/mL = 4.1 mL
The nurse should draw up and administer 4.1 mL by IV push.
Why Other Calculations Would Be Incorrect:
Failing to correctly convert the dose using the patient's weight would yield a wrong mg amount. Using the unreconstituted powder concentration instead of the final 5 mg/mL concentration after reconstitution would also produce an incorrect volume. Every step must be carried out sequentially and accurately — weight-based dosing first, then concentration-based volume calculation — to arrive at the correct answer of 4.1 mL.
6.

Which medication does the nurse anticipate to be ordered to reduce cerebral edema in a patient who is experiencing severe increased intracranial pressure?

  • Pregabalin
  • Dexamethasone
  • Mannitol
  • Phenytoin

Explanation

Explanation
Correct Answer: C) Mannitol
Mannitol is an osmotic diuretic that is the drug of choice for the acute reduction of increased intracranial pressure (ICP) and cerebral edema in emergency situations. It works by creating an osmotic gradient that draws fluid out of brain tissue and into the bloodstream for excretion. Dexamethasone (a corticosteroid) can reduce cerebral edema related to tumor or inflammation but is not the first-line agent for acute severe ICP elevation. Pregabalin is an anticonvulsant/neuropathic pain agent with no role in ICP management. Phenytoin is an anticonvulsant, not an agent for ICP reduction.
7.

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.
8.

What best response does the nurse provide for a patient who is asking how her new prescription for norethindrone and ethinyl estradiol works in preventing pregnancy?

  • This medication causes the destruction of a fertilized egg
  • This medication increases the development of hormones released by the pituitary which prevents egg fertilization and implantation
  • This medication causes the thickening of uterine mucus which decreases sperm movement and it also inhibits egg implantation
  • This medication induces the maturation of the ovarian follicle

Explanation

Explanation
Correct Answer: C) This medication causes the thickening of uterine mucus which decreases sperm movement and it also inhibits egg implantation
Norethindrone (progestin) and ethinyl estradiol (estrogen) are combined oral contraceptives. They work through multiple mechanisms: suppressing ovulation via feedback inhibition on the pituitary, thickening cervical mucus to impede sperm motility, and altering the endometrial lining to inhibit implantation. Option C most accurately describes the progestin-dominant mechanism. Option B is incorrect because combined OCs actually suppress pituitary hormone release, they do not increase it. Option A implies an abortifacient mechanism, which is inaccurate. Option D is the opposite of what occurs — these medications suppress follicular maturation.
9. Prior to starting a patient's ordered continuous infusion of nitroprusside, the nurse inspects the drug for which characteristic?
  • the drug is slightly yellow in appearance

  • the drug is cloudy white in appearance

  • the drug appears light brown in color

  • the drug is clear in appearance without discoloration

Explanation

Explanation
Correct Answer: (A) the drug is slightly yellow in appearance

Sodium nitroprusside is normally a slightly brownish-yellow or faint yellow color in solution. Any significant color change, such as turning blue, green, or dark brown, indicates degradation and the solution should be discarded. The drug is also highly light-sensitive and must be wrapped in opaque material to prevent breakdown.


Why the other options are incorrect:
  • B. A cloudy white appearance would indicate contamination or precipitation, meaning the drug should not be administered.
  • C. A light brown color may suggest early degradation; significant darkening is a sign the drug has broken down and is unsafe to use.
  • D. Nitroprusside is not a clear solution — it has a characteristic faint yellow tint, so expecting a completely clear appearance would be incorrect.
10. For which indication will the nurse give a patient intravenous lidocaine?
  • ventricular tachycardia

  • first-degree heart block

  • atrial fibrillation

  • symptomatic bradycardia

Explanation

Explanation
Correct Answer: (A) ventricular tachycardia
Intravenous lidocaine is a Class IB antiarrhythmic used primarily to treat ventricular arrhythmias, particularly ventricular tachycardia and ventricular fibrillation. It works by blocking sodium channels to stabilize cardiac membranes and suppress abnormal ventricular activity.
Why Other Options are Incorrect:
  • B. First-degree heart block is typically asymptomatic and does not require antiarrhythmic treatment with lidocaine.
  • C. Atrial fibrillation is managed with other agents such as amiodarone, digoxin, or beta-blockers — not lidocaine.
  • D. Symptomatic bradycardia is treated with atropine or pacing, not lidocaine, which could further slow conduction.

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