15 free questions from the CinnaRN pharmacology bank (932 in the app). Tap an answer to check it. The rationale opens right away.
A client with cocaine-induced chest pain and severe hypertension is in the emergency department. Which class of medication should the nurse question if prescribed alone for this client?
Answer: B. A beta-blocker used alone
In cocaine toxicity, giving a beta-blocker alone is generally avoided because blocking beta receptors can leave alpha-mediated vasoconstriction unopposed, worsening hypertension and coronary vasoconstriction. Benzodiazepines are first-line to reduce sympathetic drive; nitroglycerin and aspirin are appropriate for chest pain. The nurse should question an order for a non-selective beta-blocker used alone.
A nurse is reviewing the use of a short-acting beta-2 agonist for exercise-induced bronchospasm. When should the nurse instruct the client to use the albuterol inhaler?
Answer: B. About 15 to 30 minutes before starting exercise
For exercise-induced bronchospasm, a short-acting beta-2 agonist such as albuterol is most effective when used 15 to 30 minutes before exercise to prevent bronchospasm. Using it only after symptoms begin is less effective for prevention. The drug's onset and duration make pretreatment the recommended strategy.
A client is prescribed an SGLT2 inhibitor (for example empagliflozin). The nurse teaches the client about which common side effect linked to its mechanism?
Answer: A. Increased risk of genital and urinary tract infections from urinary glucose
SGLT2 inhibitors lower glucose by blocking renal reabsorption of glucose, causing glucose to be excreted in the urine (glycosuria). This sugar-rich urine increases the risk of genital and urinary tract infections, so the client should maintain good hygiene and report symptoms. They also cause increased urination.
A client receiving a continuous IV insulin infusion for diabetic ketoacidosis has a blood glucose that has fallen to 250 mg/dL. The nurse anticipates which order?
Answer: B. Add dextrose to the IV fluids while continuing the insulin infusion
In DKA management, when blood glucose reaches approximately 200 to 250 mg/dL, dextrose-containing IV fluids are added so the insulin infusion can continue to clear ketones and correct acidosis without causing hypoglycemia. The insulin is not abruptly stopped, as that would allow ketoacidosis to recur. A bolus of regular insulin or oral hypoglycemics would not be appropriate here.
A nurse is teaching a client about salmeterol, a long-acting beta-2 agonist (LABA). Which statement by the client indicates correct understanding?
Answer: B. This medication is for long-term control, not for sudden symptoms
Salmeterol is a long-acting beta-2 agonist used for maintenance (controller) therapy and has a slow onset, so it cannot relieve an acute attack. The client must use a short-acting bronchodilator such as albuterol for rescue. LABAs in asthma should never be used as monotherapy and are combined with an inhaled corticosteroid.
A client receiving chemotherapy develops nausea and vomiting. The provider prescribes ondansetron. The nurse explains that this medication works by which mechanism?
Answer: B. It blocks serotonin (5-HT3) receptors
Ondansetron is a serotonin (5-HT3) receptor antagonist that blocks serotonin at the chemoreceptor trigger zone and in the GI tract, preventing chemotherapy-induced nausea and vomiting. It does not coat the stomach, increase gastric pH, or stimulate motility.
A nurse is reviewing new prescriptions for a pregnant client who requires anticoagulation. Which medication is contraindicated because it crosses the placenta and is teratogenic?
Answer: C. Warfarin
Warfarin crosses the placenta and is teratogenic, causing fetal warfarin syndrome, so it is contraindicated in pregnancy. Heparin and the low-molecular-weight heparins enoxaparin and dalteparin do not cross the placenta and are the preferred anticoagulants during pregnancy.
A nurse is monitoring a client receiving terbutaline as a tocolytic for preterm labor. Which maternal finding is an expected side effect of this beta-adrenergic agonist?
Answer: A. Maternal tachycardia and tremor
Terbutaline is a beta-adrenergic agonist; common maternal side effects include tachycardia, tremor, nervousness, and palpitations. The nurse monitors maternal heart rate and holds the dose if it exceeds about 120 beats per minute. Bradycardia and hypertension are not expected.
A client is prescribed warfarin 5 mg daily. The nurse notes the client is also taking an antibiotic that displaces warfarin from protein-binding sites. What effect should the nurse anticipate?
Answer: A. Increased free warfarin, elevated INR, and higher bleeding risk
Drugs that displace warfarin from protein-binding sites increase the amount of free, active warfarin, raising the INR and the risk of bleeding. The nurse should monitor for an elevated INR and bleeding. This interaction does not decrease warfarin effect or render it ineffective.
A client with a hypertensive emergency is receiving an IV sodium nitroprusside infusion. Which nursing action is the priority during titration?
Answer: A. Monitor blood pressure continuously during titration
Sodium nitroprusside is a potent vasodilator that can cause precipitous hypotension, so continuous (often arterial line) BP monitoring is essential to avoid dropping the pressure too fast. Hourly oral intake checks, daily weights, and routine q4h vitals are inadequate for a rapidly acting IV titration.
A nurse is reviewing acetaminophen use with a client who takes it for osteoarthritis pain. What is the maximum recommended daily dose the nurse should reinforce for a healthy adult?
Answer: B. 4,000 mg in 24 hours
The recommended maximum acetaminophen dose for a healthy adult is generally 4,000 mg (4 grams) in 24 hours; exceeding it risks hepatotoxicity. Clients must also count acetaminophen hidden in combination products. The other values are either too low to mention as the ceiling or unsafely high.
The nurse administers IV norepinephrine to a client in septic shock. Which assessment finding indicates the medication is having the desired effect?
Answer: A. Mean arterial pressure rising to 70 mmHg with warm extremities
Norepinephrine is a potent vasopressor that increases systemic vascular resistance and raises blood pressure to improve perfusion. The desired effect is an increase in blood pressure toward the target (for example, a mean arterial pressure of 65 mmHg or greater) with improved organ perfusion. A falling blood pressure, decreasing urine output, and worsening hypotension indicate the drug is not achieving its goal.
A client with tuberculosis is prescribed isoniazid and rifampin. Which instruction is most important for the nurse to provide about monitoring for hepatotoxicity?
Answer: A. Report any yellowing of the skin, dark urine, or persistent nausea
Both isoniazid and rifampin are hepatotoxic, so the client must report signs of liver injury such as jaundice, dark urine, nausea, anorexia, and right upper quadrant pain, and should avoid alcohol, which increases hepatotoxicity. Taking the drugs with grapefruit juice, doubling missed doses, and ignoring yellowing skin are unsafe instructions.
A client on an antipsychotic develops high fever, severe muscle rigidity, altered mental status, and unstable vital signs. Which complication does the nurse suspect?
Answer: A. Neuroleptic malignant syndrome
Hyperthermia, lead-pipe rigidity, autonomic instability, and altered consciousness are hallmark signs of neuroleptic malignant syndrome, a life-threatening emergency requiring immediate discontinuation of the antipsychotic and supportive care.
A client in myasthenic crisis is intubated and the provider holds anticholinesterase medications temporarily. The nurse understands the rationale for holding these drugs is primarily to:
Answer: A. Rest the receptors and avoid cholinergic toxicity while ventilated
During myasthenic crisis with respiratory support, anticholinesterase drugs are sometimes held temporarily to allow the receptors to rest and to differentiate myasthenic from cholinergic crisis, avoiding the risk of excessive secretions and cholinergic toxicity while the client is ventilated. It is not held to raise blood pressure, treat infection, or promote sleep.
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