BIOL3080 NCLEX STYLE PRACTICE QUESTIONS ANSWERS 2023/2024 NCLEX STYLE PRACTICE QUESTIONS F, Exams of Nursing

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ANSWERS 2023/2024 NCLEX STYLE PRACTICE

QUESTIONS FOR PHARM EXAM WEEKS 3-8-

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 A patient is taking sildenafil (Viagra) asks a nurse what action to take if priapism occurs. Which response should the nurse take? a. “Take an additional half-strengthen dose of sildenafil” b. “The condition usually resolves in 12 hrs or less” c. “Wait until the following day and notify the doctor” d. “Seek emergency help, because permanent damage can occur.”

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QUESTIONS FOR PHARM EXAM WEEKS 3-8-

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RATIONALE: Patients are advised to seek medical attention for an erection that lasts longer 4hrs, because left untreated, priapism can damage penile tissue which can cause permanent loss of potency  A patient in the emergency department reports taking sildenafil (Viagra) and Nitroglycerin 1 hr before sexual activity. Which finding should the nurse immediately report to the physician? a. WBC of 3200units/L b. RR of 26 breaths/min c. Temp of 38C d. BP of 70/ RATIONALE: When taken with nitro, Viagra can cause severe hypotension that is unresponsive to treatment. 24hrs should elapse between last dose of sildenafil and nitro.  A post-op patient has an epidural infusion of morphine sulfate. The patient’s respiratory rate declines to 8 breaths/minute. Which medication would the nurse anticipate administering? a. Naloxone (Narcan) b. Acetylcysteine (Mucomyst) c. Methyprednisolone (Solu-Medrol d. Protamine Sulfate RATIONALE: Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.  The nurse is teaching a patient with cancer about a new prescription for a fentanyl patch, 25mcg/hr. for chronic back pain. Which statement is the most appropriate to include in the teaching plan. a. “You will need to change this patch every day, regardless of your pain level.”

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b. “This type of pain medication is not as likely to cause breathing problems.” c. “With the first patch, it will take about 24hrs before you feel the full effects.”

d. “Use your heating pad for the back pain. It will also improve the patch’s effectiveness.” RATIONALE: Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Has the same adverse effects as other opioids, including respiratory depression. Should avoid exposing the patch to external heat sources, because this may increase toxicity  A patient is prescribed Lisinopril as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? a. +2 edema of the lower extremeties b. Potassium level of 3.5mEq/L c. Crackles in the lungs are no longer heard d. Jugular vein distention RATIONALE: Because ACE inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 is a normal value.  The nurse is caring for a patient with bipolar disorder treated with lithium. The patient as a new prescription for captopril for hypertension. The combination of these two drugs makes which assessment particularly important? a. Potassium level b. Lithium level c. Creatinine level d. Blood pressure RATIONALE: ACE inhibitors, such as captopril, can cause lithium accumulation. Lithium levels should be monitored on a regular basis. ACE

inhibitors can cause hyperkalemia, renal insufficiency in some patients and hypotension. However, the combination of lithium and captopril would not increase the risk of these effects  A patient is discharge from the hospital on warfarin for DVT prevention. Which instructions should the nurse include in the patient’s discharge teaching plan? Select all that apply. a. Wear a medical alert bracelet b. Check all urine and stool for discoloration c. Do not start any new medication without first talking to your HCP d. Enteric-coated aspirin and any aspirin products can be used unless they cause a GI ulcer e. No laboratory or home monitoring of INR is required after 6 months. RATIONALE: Advise the patient to wear some form of ID to alert emergency personnel to warfarin use. Bleeding is a major complication of warfarin therapy. Inform pts about the signs of bleeding. Inform patients that warfarin is subject to a large number of potentially dangerous drug interactions. Instruct them to avoid all prescription and non-prescription drugs that have nor been specifically approved by the prescriber. Aspirin and aspirin products should be avoided (Increase effects). ING should be determined frequently  The nurse is preparing to administer a daily dose of digoxin. What is the priority nursing intervention? a. Analyze HR and rhythm b. Assess for Homan’s sign c. Check BP d. Palpate the pedal pulses

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QUESTIONS FOR PHARM EXAM WEEKS 3-8-

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RATIONALE: Before giving digoxin, the nurse will assess the HR and rhythm. The dosage will be held and the prescriber notified if the HR is below 60bpm or if the cardiac rhythm has changes. Digoxin can cause bradycardia and electrical changes in the heart.  Which patient symptoms should cause the nurse to be concerned about digoxin toxicity? Select all that apply a. Fatigue b. Vomiting c. Dizziness d. Blurred vision e. Muscle Weakness RATIONALE: Fatigue, vomiting, and blurred vision are common non-cardiac symptoms that can provide advance warning of digoxin toxicity. Muscle weakness is an early sign of hypokalemia. Dizziness is not a symptom of digoxin toxicity. Week 6: Opioids  A nurse administers naloxone (Narcan) to a post-op patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? a. Drowsiness b. Tics and tremors c. Increased Pain d. Nausea and vomiting RATIONALE: Naloxone reverses the effects of narcotics. Although patient’s respiratory status will improve after administration of naloxone, the pain will

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be more acute.  The nurse is teaching a patient prescribed captopril for the treatment of hypertension. Which instructions should the nurse include? Select all that apply. a. Take the medication with food b. Expect a sore throat and fever

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c. Avoid potassium salt subtitutes d. A persistent dry cough may occur e. Report difficulty in breathing immediately RATIONALE: Salt substitutes contain potassium and may increase risk of hyperkalemia with ACE inhibitors. A persistent, dry, non-productive cough may develop. Angioedema of the tongue, glottis, and pharynx may cause difficulty breathing which requires immediate medical attention. Captopril must be taken at least one hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body’s ability to fight an infection. Early signs of infection include fever and sore throat  The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure a. Angiotensin I b. Angiotensin II c. Angiotensin III d. Renin RATIONALE: Angiotensin II is a potent vasoconstrictor. It participates in all pathways regulated by the renin-angiotensin-aldosterone system. Angiotensin I is a precursor to angiotensin II; angiotensin III is formed by degradation of angiotensin II and is less potent. Renin catalyzes the conversion of angiotensinogen to angiotensin I.  The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine be least appropriate? a. Angina Pectoris

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b. Essential HTN c. Atrial Fibrillation d. Vasospastic Angina RATIONALE: Nifedipine produces very little blockade of the calcium channels of the heart; therefore, it is ineffective for treating dysrhythmias, such as A.Fib. Therapeutic uses for nifedipine include treatment of angina, essential HTN, and vasospastic angina.  The nurse provides discharge instructions to a patient prescribed verapamil SR 120mg PO daily for HTN. Which statement by the patient indicates understanding of the medication? a. “I will take the medication with grapefruit juice each morning.” b. “I should expect occasional loose stools from this medication” c. “I’ll need to reduce the amount of fiber in my diet” d. “I must swallow the pill whole.” RATIONALE: “SR” indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools, is a common side effect. Increasing fluids and dietary fiber can help prevent this adverse effect.

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QUESTIONS FOR PHARM EXAM WEEKS 3-8-

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 What is the most appropriate nursing consideration a patient who is prescribed verapamil and digoxin? a. Restrict intake of oral fluids and high-fiber food b. Take an apical pulse for 30 seconds before administration c. Notify the healthcare provider of nausea, vomiting, and visual changes d. Hold the medications if the heart rate is greater than 110bpm RATIONALE: Verapamil can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting and visual changes. Increase intake of oral fluids and high fiber food can decrease the adverse effect of constipation. An apical pulse should be taken for a full minute prior to administering digoxin. Verapamil and Digoxin can cause bradycardia not tachycardia  A patient is prescribed Lisinopril 40mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor? a. Slowing of the heart rate b. Decrease in blood pressure c. Symptoms such as dizziness and fainting d. Pulse oximetry oxygen saturation of 100% RATIONALE: The therapeutic effect of ACE inhibitors is to reduce BP in patients with HTN. ACE inhibitors do not affect patient’s heart rate. Dizziness and fainting are all symptoms of hypotension. ACE inhibitors do not affect oxygen saturation.

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QUESTIONS FOR PHARM EXAM WEEKS 3-8-

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 A patient with angina pectoris has been prescribed nifedipine. Which possible adverse effects should the nurse expect with this medication? Select all that apply. a. Headache b. Constipation c. Nausea and vomiting d. Edema of ankle and feet e. Overgrowth of gum tissue RATIONALE: Some adverse effects of nifedipine are headache, edema of ankles and feet, and gingival hyperplasia. Nifedipine causes very little constipation. Nausea and vomiting are common side effects of clevidipine.  The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil. Which statements by the patient indicate that the teaching was effective? Select all that apply. a. “I will increase my intake of fluid and foods high in fiber.” b. “I should stay out of direct sunlight to prevent exposing my skin to the sun.” c. “I will call my healthcare provider if I notice swelling in my ankles” d. “I need to avoid salt substitutes and potassium supplements.” e. “I may notice easy bruising and bleeding with this drug.” RATIONALE: Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. Patients taking verapamil should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.  The nurse plans to closely monitor for which clinical manifestation

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after administering furosemide (Lasix)? a. Decrease pulse b. Decrease temperature c. Decrease BP

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d. Decrease respiratory rate. RATIONALE: High-ceiling diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased BP. When BP drops, the pulse will probably increase rather than decrease. Lasix should not affect respirations or temperature. The nurse should also closely monitor patient’s potassium level.  The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure. a. Furosemide (Lasix) b. Hydrochlorothiazide (HydroDIURIL) c. Spironolactone (Aldactone) d. Mannitol (Osmitrol) RATIONALE: Spironolactone is a potassium-sparing diuretic used to treat both HTN and edema. It is preferred drug in heart failure, because it has been shown to have a cardio-protective effect, reducing mortality in patients with heart failure.  The nurse is teaching a patient who has a new prescription for spironolactone (Aldactone). Which statement by the patient indicated that the teaching was effective? a. “I will use salt substitutes to lower my sodium intake” b. “I will increase my intake of foods that are high in potassium” c. “I will call my doctor if I begin having menstrual irregularities” d. “I will take this medication at bedtime each evening” RATIONALE: Spironolactone is a potassium-sparing, aldosterone-blocking

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diuretic. As such, it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. Patients taking spironolactone should avoid salt substitutes because they contain potassium, high-potassium foods should be avoided with this drug. Ideally, all diuretics should be taken in the morning to prevent nocturia.  The nurse is reviewing the home medication list with the patient. The nurse recognizes that hydrochlorothiazide is used primarily for which condition? a. Hypertension b. Edema c. Diabetes insipidus d. Protection against postmenopausal osteoporosis RATIONALE: The primary indication for hydrochlorothiazide is HTN, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides are used for the other conditions, but primarily HTN.  The nurse is caring for a patient who takes warfarin for prevention of deep vein thrombosis. The patient as an INR of 1.2. Which action by the nurse is most appropriate?

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a. Administer IV push protamine sulfate b. Continue with current prescription. c. Prepare to administer Vitamin K d. Call HCP to increase the dose RATIONALE: An INR in the range of 2-3 is considered the level for warfarin therapy. For a level of 1.2, the nurse should contact the HCP to discuss an order for an increased dose.  The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely related to an adverse effect of heparin? a. HR of 60bpm b. BP of 160/ c. Discoloured urine d. Inspiratory wheezing RATIONALE: The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any site and may be manifested in various ways, including reduced BP, increased HR, bruises, petechiae, hematomas, red/black stools, cloudy or discoloured urine, pelvic pain, headache and lumbar pain.  What is the goal of pharmacologic therapy in the treatment of Parkinson’s disease? a. To increase the amount of acetylcholine at the pre-synaptic neurons b. To reduce the amount of dopamine available in the substantia nigra c. To balance cholinergic and dopaminergic activity in the brain d. To block dopamine receptors in pre-synaptic and post-synaptic neurons RATIONALE: Parkinson’s disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much

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cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.  Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa (Sinemet) for newly diagnosed Parkinson’s disease? a. Take medication on a full stomach b. Change positions slowly c. The drug may cause the urine to be very dilute d. Carbidopa has many adverse effects RATIONALE: Postural hypotension is common early in tx, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may be considered. The levodopa component may darken urine. Carbidopa has no adverse effects of its own.  The nurse is working in an immunization clinic. Which patient will the nurse identify as not eligible to receive routine immunizations? a. An 8-year old experiencing diarrhea b. A 2-year old with a history of pre-mature birth c. A 4-year old with a fever and upper respiratory tract infection d. A 6-year old who has been recently exposed to a classmate with chickenpox RATIONALE: The only true contraindications to receiving vaccines are an anaphylactic reaction to a specific vaccine or vaccine component and moderate to severe illness with or without fever

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 A child receives a vaccine for MMR. Six hours after the injection, the child’s parent reports local soreness, erythema, lethargy, and a fever of 101degress F to a nurse. Which action should the nurse take? a. Give instructions on relieving symptoms with acetaminophen b. Seek emergency help, because these symptoms are signs of anaphylactic reaction c. Tell the parent that a live vaccine will cause a mild case of measles

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d. Obtain and fill out a Vaccine Adverse Event Report form RATIONALE: Low-grade fever, malaise, and muscle-aches are common reactions. Acetaminophen usually alleviates these problems. MMR is a live vaccine but it is attenuated or completely avirulent and does not cause measles in healthy children only immunocompromised children  Which statement by an 18-year-old women vaccinated with Gardasil indicates that more teaching is necessary? a. “This vaccination will cure the HPV infection I got when I was 16” b. “I will still need to have a routine PAP screen performed.” c. “Gardasil can prevent genital warts in males and females.” d. “This drug does not protect against all types of HPV.” RATIONALE: Gardasil does not prevent against HPV infection that was present before vaccination. All other statements are true.  A nurse administers Gardasil, the HPV vaccine, to an 11-year-old girl. The nurse informs the parent that routine screening with which diagnostic test is needed? a. Beta hCG b. Chlamydia test c. PAP test d. mammogram RATIONALE: Routine screening with a PAP test is still necessary, because Gardasil protects against four types of HPV which may leave those vaccinated at risk for cervical cancer from other types. Does not eliminate pre-existing HPV infection.

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 A nurse is educating a patient about sildenafil (Viagra). The nurse should instruct the patient that which adverse effect would be a priority for the patient to report to his prescriber? a. Flushing b. Diarrhea c. Hearing loss d. Dyspepsia RATIONALE: In rare cases, Viagra has caused sudden hearing loss, usually in one ear, which may be partial or complete. Medication should be discontinued if it is being used for erectile dysfunction. All other options are less serious adverse effects  Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? a. Morphine b. Pentazocine c. Hydrocodone d. Nalmefene RATIONALE: Morphine is a strong opioid agonist and as such has the highest likelihood of causing respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression, but they do not do so as often or as seriously as morphine. Nalmefene, an opioid antagonist, would be used to reverse respiratory depression with opioids.  The nurse is planning care for a patient receiving morphine sulfate by means of a patient controlled analgesia pump. Which intervention may be required because of a potential adverse effect of this drug?

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a. Administering a cough suppressant b. Inserting a Foley catheter c. Administering an anti-diarrheal d. Monitoring LFTs RATIONALE: Morphine can cause urinary hesitancy and urinary retention. If bladder distention or inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an anti-diarrheal, so neither of those types of drugs would be needed to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine. Week 7: Glucocorticoids and Antihistamines  A patient takes glucocorticoids and digoxin. It is most important for the nurse to monitor which electrolyte? a. Calcium b. Magnesium c. Sodium d. Potassium RATIONALE: because of the mineralocorticoid activity of sodium and water retention and potassium loss, glucocorticoids can increase the risk of toxicity from digoxin. Can also exacerbate hypokalemia cause by thiazide and loop diuretics  The nurse is screening a patient before administering a live virus vaccine. The patient is currently taking a glucocorticoid medication. Which action should the nurse take? a. Continue screening and give the vaccine if appropriate b. Note the contraindication but give the vaccine anyway

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c. Note the contraindication and clarify the order with the HCP d. Hold the vaccine and notify the department of health RATIONALE: The nurse should note the contraindication and clarify the order with the provider. Because of their immunosuppressant actions, glucocorticoids can decrease antibody responses to vaccines. Accordingly, immunizations should not be attempted while glucocorticoids are in use. Furthermore, if a live virus vaccine is employed, there is an increased risk of developing viral disease.  What does the nurse identify as a possible adverse effect of long- term glucocorticoid therapy? Select all that apply. a. Adrenal insufficiency b. Osteoporosis c. Hypoglycemia

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d. Hyperkalemia e. Cataracts RATIONALE: Adverse effects of long-term glucocorticoid therapy include adrenal insufficiency, osteoporosis, hyperglycemia, hypokalemia and cataracts  The nurse should question an order for glucocorticoids in the treatment of a patient with what? a. Systemic fungal infection b. Diabetes Mellitus c. Myasthenia Gravis d. Glaucoma RATIONALE: Glucocorticoids are contraindicated in the treatment of a patient with systemic fungal infection or in patients receiving live vaccines. Should be used with caution in patients with DM, myasthenia gravis and glaucoma.  A patient is receiving glucocorticoids for the treatment of rheumatoid arthritis. The patient complains of having a headache. Which ordered medication should the nurse administer? a. Aspirin b. Acetaminophen c. Ibuprofen d. Naproxen Sodium (Aleve) RATIONALE: The risk of GI irritation and ulceration for a patient taking glucocorticoids is increased by concurrent use of other medications, such as aspirin and NSAIDs  A patient is taking a first-generation H1 blocker for the treatment of

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allergic rhinitis. It is most important for the nurse to assess for which adverse effect? a. Skin flushing b. Wheezing c. Insomnia d. Dry mouth RATIONALE: Adverse Effect of Histamine – First Generation H  A patient develops hypotension, laryngeal edema, and bronchospasm after eating peanuts. Which medication should the nurse prepare to administer? a. Promethazine b. Epinephrine c. Diphenhydramine d. Hydroxyzine RATIONALE: The patient is showing signs of anaphylaxis caused by a peanut allergy Week 8: OTC, Antacids, PPI, L-Dopa, Immunizations, MMR, HPV  A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient’s history should the nurse recognize as a contributing factor? a. Amoxicillin (Amoxil) b. Cimetidine (Tagamet) c. Metronidazole (Flagyl) d. Omeprazole (Prilosec) RATIONALE: Cimetidine binds to androgen receptors, producing receptor

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blockade, which can cause enlarged breast tissue, reduced libido, and impotence. All these effects reverse when dosing stops. Amoxicillin, metronidazole, and omeprazole are not associated with gynecomastia.

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 An 80-year old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication a. +3 Pitting edema b. Pain with urination c. New onset disorientation to time and place d. HR changes from a baseline of 70-80bpms to 110-120bpm RATIONALE: Effects on the CNS system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures. The remaining options are not adverse effects of cimetidine.  A patient who has PUD and is receiving magnesium hydroxide (MOM) is experiencing an increased number of BM. Which is the nurse’s priority action? a. Ask the HCP for a reduction in dose b. Encourage the patient to increase dietary fiber c. Administer the drug with an aluminum hydroxide antacid d. Instruct patient to keep an accurate stool count RATIONALE: MOM is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combo with aluminum hydroxide which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not a priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.