NUR 233 Pharmacology Exam
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Free NUR 233 Pharmacology Exam Questions
The nurse is monitoring a patient who is receiving mycophenolate after an organ transplant. Which adverse effect is possible with mycophenolate therapy?
- Dysuria
- Constipation
- Confusion
- Hypertension
Explanation
Correct Answer: D) Hypertension
Mycophenolate (CellCept) is an immunosuppressant used post-transplant to prevent organ rejection. Hypertension is a well-recognized adverse effect associated with mycophenolate therapy. Additionally, mycophenolate commonly causes GI side effects (nausea, diarrhea) and bone marrow suppression (leukopenia), but among the choices given, hypertension is the correct answer. Dysuria, constipation, and confusion are not characteristic adverse effects of mycophenolate.
A patient has been given a prescription for levodopa-carbidopa (Sinemet) for a new diagnosis of Parkinson's disease. The patient asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact?
- Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system.
- Carbidopa allows for larger doses of levodopa to be given.
- Carbidopa prevents the breakdown of levodopa in the periphery.
- There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.
Explanation
Correct Answer: C) Carbidopa prevents the breakdown of levodopa in the periphery.
Levodopa crosses the blood-brain barrier and is converted to dopamine in the brain — this is the desired therapeutic effect. However, without carbidopa, a large proportion of levodopa is broken down (decarboxylated) in the peripheral tissues before it reaches the brain, causing significant systemic side effects (nausea, vomiting, hypotension). Carbidopa is a peripheral dopa decarboxylase inhibitor — it inhibits this peripheral breakdown, allowing more levodopa to reach the brain at lower doses. It is levodopa (not carbidopa) that is the dopamine precursor, so Option A is incorrect. Option B is a partial consequence but not the primary reason. Option D is inaccurate — food interactions (particularly high-protein meals) still exist with combination therapy.
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
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.
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the drug is slightly yellow in appearance
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the drug is cloudy white in appearance
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the drug appears light brown in color
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the drug is clear in appearance without discoloration
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.
A patient is asking a nurse about taking conjugated equine estrogens for hot flashes. The nurse informs the patient that she should not take this medication because it is contraindicated due to the patient's documented medical history of:
- Osteoporosis
- Atrophic vaginitis
- Irritable bowel syndrome
- Thrombophlebitis
Explanation
Correct Answer: D) Thrombophlebitis
Conjugated equine estrogens (hormone replacement therapy) are contraindicated in patients with a history of thrombophlebitis (blood clots/deep vein thrombosis) because estrogen therapy increases clotting factor production and significantly raises the risk of thromboembolic events, including DVT, pulmonary embolism, and stroke. Osteoporosis and atrophic vaginitis are actually conditions estrogen therapy is used to treat. Irritable bowel syndrome is not a contraindication to estrogen therapy.
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"I should inform my provider about other medications I am taking."
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"This medication will reduce the duration of my symptoms."
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"I should wait 5 days to start taking this medication."
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"It is recommended that I still get my flu shot."
Explanation
Correct Answer: (C) "I should wait 5 days to start taking this medication."
Oseltamivir (Tamiflu) is most effective when started within 48 hours of symptom onset. Waiting 5 days would significantly reduce its effectiveness, indicating the client needs further education.
Why Other Options are Incorrect:
- A. Informing the provider about other medications is correct practice due to potential drug interactions.
- B. Oseltamivir does reduce the duration and severity of influenza symptoms, making this a correct statement.
- D. Getting a flu shot is still recommended even when taking oseltamivir, as the medication treats active infection but does not provide future immunity.
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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.
When monitoring a patient who is on immunosuppressant therapy with azathioprine, the nurse will monitor which laboratory results?
- Serum albumin levels
- White blood cell (leukocyte) count
- Serum calcium levels
- Serum potassium levels
Explanation
Correct Answer: B) White blood cell (leukocyte) count
Azathioprine is an immunosuppressant that works by inhibiting purine synthesis, thereby suppressing the proliferation of immune cells. The most critical lab to monitor is the white blood cell (leukocyte) count, as azathioprine causes bone marrow suppression leading to leukopenia, which significantly increases the patient's risk for serious infection. Serum albumin reflects nutritional status and is not a primary concern with azathioprine. Calcium and potassium are not directly affected by azathioprine therapy.
A nurse is reviewing a chart of a patient who has been given a new prescription of phenytoin. The nurse is aware that because phenytoin is highly protein-bound, the medication would be contraindicated if the patient has this condition:
- Hirsutism
- Psoriasis
- Failure to thrive
- Benign prostatic hyperplasia
Explanation
Correct Answer: C) Failure to thrive
Phenytoin is highly protein-bound (approximately 90%), meaning it binds to albumin in the blood. Patients who are malnourished or have failure to thrive typically have low serum albumin levels (hypoalbuminemia). When albumin is low, more phenytoin remains unbound and pharmacologically active in the blood, dramatically increasing the risk of toxicity at standard doses. This makes it a condition requiring extreme caution or making phenytoin contraindicated without careful dose adjustment and monitoring. Hirsutism, psoriasis, and benign prostatic hyperplasia are not related to protein binding concerns with phenytoin.
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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.
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