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NCLEX PREP PHARM
1. A client is prescribed lisinopril (Prinivil, Zestril). Which adverse effect requires the nurse to notify the healthcare provider immediately? A) Dry cough B) Swelling of the lips and tongue C) Dizziness when standing D) Hyperkalemia Answer: B Rationale: Angioedema (swelling of lips, tongue, larynx) is a rare but life-threatening adverse effect of ACE inhibitors. The nurse should stop the medication and seek emergency care. Dry cough is common but not emergent. 2. A client taking metoprolol (Lopressor) has a heart rate of 52 bpm and blood pressure of 90/60 mmHg. The nurse should: A) Administer the medication as ordered B) Hold the medication and notify the healthcare provider C) Give the medication with a full glass of water D) Double the next dose Answer: B Rationale: Beta-blockers (metoprolol) should be held for HR <60 bpm or
SBP <90 mmHg (depending on the order). Notify the provider; bradycardia and hypotension may indicate excessive beta-blockade.
3. A client is prescribed warfarin (Coumadin) for atrial fibrillation. Which laboratory value indicates a therapeutic effect? A) aPTT 60 seconds B) INR 2. C) Platelets 150,000/mm³ D) PT 12 seconds Answer: B Rationale: For most indications (AF, DVT, PE), target INR is 2–3. aPTT monitors heparin. PT without INR is not standardized. 4. A client receiving heparin IV reports tingling in the fingers and nose. The nurse notes a BP of 160/90 mmHg (baseline 120/80). Which condition does the nurse suspect? A) Heparin-induced thrombocytopenia (HIT) B) Anaphylaxis C) Heparin overdose D) Cerebrovascular accident Answer: A Rationale: Heparin-induced thrombocytopenia (HIT) presents with thrombocytopenia and paradoxical thrombosis (often arterial). Symptoms include pain, paresthesias, and hypertension from thrombosis. HIT requires immediate discontinuation of heparin.
C) Hyperglycemia D) Bronchospasm Answer: B Rationale: Diltiazem (nondihydropyridine CCB) causes peripheral edema, bradycardia, constipation, and heart block. Dihydropyridines (nifedipine) cause reflex tachycardia.
8. A client is prescribed clopidogrel (Plavix) after a coronary stent placement. Which statement indicates understanding? A) “I will stop this medication if I develop bruising.” B) “I can take ibuprofen for headaches.” C) “I will notify my dentist that I take this medication.” D) “This medication dissolves clots.” Answer: C Rationale: Clopidogrel (antiplatelet) increases bleeding risk. All healthcare providers must be notified. NSAIDs (ibuprofen, naproxen) increase bleeding and are avoided. Clopidogrel prevents platelet aggregation; it does not dissolve clots. 9. A client with heart failure is prescribed carvedilol (Coreg). The nurse understands that the therapeutic effect of this medication is: A) Increased heart rate B) Decreased myocardial oxygen demand C) Increased blood pressure D) Bronchodilation
Answer: B Rationale: Carvedilol is a nonselective beta-blocker with alpha-blocking effects. It reduces heart rate, contractility, and BP → decreased myocardial oxygen demand. It is used in HF to reduce mortality.
10. A client is prescribed nitroglycerin sublingual tablets for angina. Which instruction is correct? A) “Take one tablet every 15 minutes for up to 4 doses.” B) “Swallow the tablet with a full glass of water.” C) “Store the tablets in a light-resistant, tightly closed container.” D) “If you have no pain, take a tablet before exercise.” Answer: C Rationale: Nitroglycerin is light- and heat-sensitive. It should be stored in the original dark glass container. Dose is 1 tablet every 5 minutes up to 3 doses. Tablets are placed under the tongue (sublingual), not swallowed. 11. A client is prescribed atorvastatin (Lipitor). Which instruction is most important? A) “Take this medication with grapefruit juice.” B) “Report unexplained muscle pain or weakness.” C) “Take the medication only when your cholesterol is high.” D) “Avoid all fatty foods entirely.” Answer: B Rationale: Statins can cause myopathy and rhabdomyolysis (muscle
14. A client is prescribed enoxaparin (Lovenox) subcutaneously. Which technique is correct? A) Aspirate before injecting B) Massage the site after injection C) Inject into the abdomen while pinching a skin fold D) Administer intramuscularly in the deltoid Answer: C Rationale: Enoxaparin is given subcutaneously in the abdomen, pinching a skin fold to ensure deep subcutaneous administration. Do not aspirate or massage (risk of hematoma). Rotate sites. 15. A client with heart failure is prescribed metolazone (Zaroxolyn) and furosemide (Lasix). The nurse recognizes this combination is used to: A) Decrease the risk of hypokalemia B) Provide synergistic diuretic effect C) Reduce the risk of ototoxicity D) Allow once-daily dosing Answer: B Rationale: Metolazone (thiazide) plus furosemide (loop) causes sequential nephron blockade → synergistic diuresis. Use in refractory edema. Monitor electrolytes and volume closely. 16. A client is prescribed hydralazine (Apresoline). The nurse should monitor for which adverse effect? A) Reflex tachycardia
B) Bradycardia C) Dry cough D) Hyperkalemia Answer: A Rationale: Hydralazine is a direct vasodilator that causes reflex tachycardia (compensatory sympathetic response). Clients may require concurrent beta-blocker to control heart rate.
17. A client receiving a heparin infusion has an aPTT of 110 seconds (control 30 seconds). The nurse should anticipate: A) Increasing the heparin rate B) Decreasing or holding the heparin and notifying the provider C) No change in therapy D) Administering protamine sulfate immediately Answer: B Rationale: Therapeutic aPTT for heparin is typically 1.5–2.5 times control (45–75 seconds). aPTT >100 seconds indicates excessive anticoagulation with bleeding risk. The infusion should be decreased or held. 18. A client is prescribed losartan (Cozaar). Which statement indicates understanding of this medication? A) “I will avoid salt substitutes.” B) “I will take this medication at bedtime.” C) “I can stop taking it if I feel dizzy.” D) “I will take it with grapefruit juice.”
of the small intestine. It is often used with statins (which inhibit HMG- CoA reductase) for additive effect. Questions 21–40: Antibiotics & Anti-infectives
21. A client is prescribed amoxicillin (Amoxil). Which statement indicates a need for further teaching? A) “I will take the medication with food if it upsets my stomach.” B) “I can stop taking the medication when I feel better.” C) “I will report any rash or difficulty breathing.” D) “I will finish the entire course of antibiotics.” Answer: B Rationale: Antibiotics must be taken for the full prescribed course to prevent resistance and relapse, even if symptoms improve. Stopping early may lead to incomplete eradication. 22. A client is prescribed ciprofloxacin (Cipro). Which instruction is most important? A) “Take with dairy products to reduce stomach upset.” B) “Report any tendon pain or swelling.” C) “Avoid sunlight but continue the medication.” D) “Take on an empty stomach with a full glass of water.” Answer: B Rationale: Fluoroquinolones (ciprofloxacin, levofloxacin) increase the risk of tendonitis and tendon rupture (especially Achilles). Clients should report pain immediately and avoid exercise. Cipro should not be taken with dairy (calcium reduces absorption).
23. A client is prescribed metronidazole (Flagyl). Which instruction is essential? A) “Avoid alcohol during and for 48 hours after treatment.” B) “Take with grapefruit juice to increase absorption.” C) “This medication may turn your urine blue.” D) “Take with an antacid to prevent nausea.” Answer: A Rationale: Metronidazole + alcohol causes a disulfiram-like reaction (nausea, vomiting, flushing, hypotension). Alcohol (including mouthwash, cough syrup) must be avoided for at least 48 hours after the last dose. 24. A client is prescribed vancomycin IV. The nurse notes the infusion site is red and swollen and the client reports pain. The nurse should: A) Slow the infusion rate B) Apply a warm compress C) Stop the infusion and notify the provider and pharmacy D) Continue the infusion and document Answer: C Rationale: Vancomycin is a vesicant. Extravasation or phlebitis requires immediate discontinuation and provider notification. Peripheral administration may cause thrombophlebitis; central line is preferred. 25. A client is prescribed doxycycline (Vibramycin). The nurse should instruct the client to:
C) Hemoglobin D) Potassium Answer: B Rationale: Isoniazid can cause hepatotoxicity (elevated liver enzymes, hepatitis). Baseline and periodic LFTs are essential. Pyridoxine (B6) is given to prevent peripheral neuropathy.
28. A client is prescribed rifampin (Rifadin). Which expected side effect should the nurse include in teaching? A) Blue-gray discoloration of the skin B) Red-orange discoloration of urine, sweat, and tears C) Ringing in the ears D) Black hairy tongue Answer: B Rationale: Rifampin causes harmless orange-red discoloration of body fluids (urine, sweat, tears, saliva). Contact lenses may be stained. Clients should be forewarned. 29. A client is prescribed azithromycin (Zithromax) as a 5-day course. Which instruction is correct? A) “Take all 5 doses at once to improve compliance.” B) “Take with antacids to reduce GI upset.” C) “Finish the entire prescription even if you feel better.” D) “Avoid dairy products for 2 hours after taking.” Answer: C Rationale: Azithromycin should be taken as prescribed (usually once
daily). Dairy products do not significantly reduce absorption. Antacids should be separated by 2 hours. Full course is required.
30. A client receiving IV gentamicin (aminoglycoside) reports ringing in the ears (tinnitus). The nurse should: A) Document the finding and continue the infusion B) Stop the infusion and notify the provider C) Slow the infusion rate D) Administer an antihistamine Answer: B Rationale: Tinnitus is an early sign of ototoxicity (irreversible hearing loss) from aminoglycosides. Stop the medication and notify the provider immediately. Monitor peak/trough levels. **Questions 31–50: Respiratory Medications
- A client uses an albuterol (Proventil, Ventolin) metered-dose inhaler (MDI) for asthma. The nurse knows this medication is classified as a:** A) Long-acting beta agonist (LABA) B) Short-acting beta agonist (SABA) C) Inhaled corticosteroid D) Anticholinergic Answer: B Rationale: Albuterol is a SABA (rescue inhaler) for acute bronchospasm. LABAs (salmeterol) are for maintenance, not rescue. Beta-agonists relax bronchial smooth muscle.
A) Dry mouth B) Wheezing C) Hyperglycemia D) Bradycardia Answer: A Rationale: Ipratropium (anticholinergic) causes dry mouth, hoarseness, and throat irritation. It does not typically cause wheezing; paradoxical bronchospasm is rare.
35. A client is prescribed montelukast (Singulair). The nurse knows this medication works by: A) Blocking leukotriene receptors B) Dilating bronchioles C) Reducing mucus production D) Suppressing the cough reflex Answer: A Rationale: Montelukast is a leukotriene receptor antagonist used for maintenance of asthma/allergic rhinitis. It does not relieve acute symptoms. 36. A client with asthma is started on prednisone. Which instruction is most important? A) “Stop the medication immediately if you feel better.” B) “Take the medication with food to prevent stomach upset.” C) “You may take over-the-counter NSAIDs for fever.” D) “Avoid all carbohydrates while taking this medication.”
Answer: B Rationale: Prednisone (systemic corticosteroid) causes GI irritation; take with food. Do not stop abruptly (taper is required). NSAIDs increase ulcer risk. Monitor blood glucose.
37. A client is prescribed theophylline (Theo-Dur). Which finding indicates toxicity? A) Drowsiness B) Nausea and vomiting C) Tachycardia D) All of the above Answer: D Rationale: Theophylline toxicity (theophylline level >20 mcg/mL) presents with nausea, vomiting, tachycardia, dysrhythmias, seizures, and agitation. Monitor levels. 38. A client is prescribed cromolyn sodium (Intal) as an inhaler. The nurse explains that this medication: A) Dilates bronchioles during an asthma attack B) Prevents mast cell degranulation (prophylactic) C) Is a systemic corticosteroid D) Suppresses the immune system Answer: B Rationale: Cromolyn is a mast cell stabilizer used for prophylaxis of asthma. It does not relieve acute symptoms and is not a corticosteroid.
A) 30 minutes before meals B) 15 minutes before meals C) With meals D) Only at bedtime Answer: B Rationale: Regular insulin (short-acting) onset 30–60 minutes, peak 2– 4 hours. For mealtime coverage, give 15–30 minutes before meals. Rapid- acting (lispro, aspart) is given just before (0–15 min) or with meals.
42. A client with type 1 diabetes is prescribed NPH insulin (intermediate-acting) and regular insulin together. The nurse should draw up: A) NPH first, then regular (cloudy to clear) B) Regular first, then NPH (clear to cloudy) C) Into separate syringes D) Either order is acceptable Answer: B Rationale: Draw clear regular insulin before cloudy NPH to prevent contamination of the regular vial with NPH. Roll NPH gently to resuspend; do not shake. 43. A client is prescribed metformin (Glucophage). Which instruction is important? A) “Take this medication with meals to prevent GI upset.” B) “If you miss a dose, double the next dose.”
C) “This medication may cause weight gain.” D) “Check your blood glucose 4 times daily.” Answer: A Rationale: Metformin causes GI upset (nausea, diarrhea). Taking with meals reduces symptoms. Metformin is weight neutral or causes weight loss. It does not cause hypoglycemia alone.
44. A client taking metformin is scheduled for a CT scan with IV contrast. The nurse should: A) Administer metformin as scheduled B) Hold metformin before and after the procedure (per protocol) C) Double the metformin dose after contrast D) Give metformin with an antacid Answer: B Rationale: IV contrast can cause acute kidney injury. Metformin in the setting of AKI increases the risk of lactic acidosis. Metformin is typically held 48 hours before and after contrast (per institutional protocol). 45. A client is prescribed glipizide (Glucotrol). Which statement by the client indicates understanding? A) “I will take this medication 30 minutes before breakfast.” B) “I do not need to monitor my blood glucose.” C) “This medication will not cause hypoglycemia.” D) “I can drink alcohol as much as I want.” Answer: A Rationale: Glipizide (sulfonylurea) should be taken 30 minutes before a
