College Exams & Notes

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QUESTION #1
Pharmacology Exam 1 Pharmacology
A male patient has been taking duloxetine daily for 2 weeks and reports an increase in blood pressure. The nurse understands that this is due to which of the following?
A Increased dopamine levels
B Increased norepinephrine levels
C Increased serotonin levels
D Increased acetylcholine levels

Explanations

A
Duloxetine does not significantly elevate dopamine levels; dopamine changes are not the primary cause of blood pressure elevation with this medication.
B
Duloxetine is a serotonin–norepinephrine reuptake inhibitor (SNRI). By increasing norepinephrine levels, it can produce vasoconstriction and increase blood pressure in some patients.
C
While duloxetine does increase serotonin, serotonin alone does not typically cause elevated blood pressure in this context.
D
Duloxetine does not affect acetylcholine levels; therefore, this is unrelated to the increase in blood pressure.
SNRIs raise both serotonin and norepinephrine, but it is the norepinephrine component that can lead to hypertension. Always monitor vital signs—especially during the first weeks of therapy.
QUESTION #2
Pharmacology Exam 1 Pharmacology
A female patient who takes phenytoin for epilepsy becomes pregnant. The nurse will notify the patient’s provider and will anticipate that the provider will take which action?
A Add valproic acid (Depakote) for improved seizure control.
B Closely monitor this patient’s serum phenytoin levels twice a day.
C Consider discontinuing the phenytoin and discuss alternative options to manage her epilepsy.
D Discontinue all anticonvulsant medications and prescribe a benzodiazepine for use as needed instead.

Explanations

A
Valproic acid is also highly teratogenic and should not be added during pregnancy; combining two teratogenic anticonvulsants is unsafe.
B
While monitoring drug levels is important during pregnancy, it is not the safest long-term option because phenytoin is teratogenic and associated with fetal hydantoin syndrome. The priority is exploring safer alternatives.
C
Phenytoin poses significant risks to the fetus, including craniofacial abnormalities, cardiac defects, growth restriction, and developmental issues. The provider will typically consider switching to a safer anticonvulsant and review seizure-control options that minimize fetal harm.
D
Stopping all anticonvulsants is unsafe for both mother and fetus because uncontrolled seizures can lead to hypoxia, trauma, and fetal injury. Benzodiazepines are not an appropriate primary therapy for long-term seizure control.
Pregnancy drastically changes anticonvulsant management—some drugs are teratogenic, but untreated seizures are also dangerous. Always think risk–benefit and anticipate that the provider will consider switching to a safer alternative.
QUESTION #3
Pharmacology Exam 1 Pharmacology
The nurse is developing a teaching plan with a client with seizures who is going home with a prescription for gabapentin. What information should the nurse give the client about taking gabapentin?
A Take all the medication until it is gone.
B Notify the health care provider (HCP) if skin changes occur.
C Always keep gabapentin on hand for use if seizures occur.
D Take gabapentin with an antacid to protect against ulcers.

Explanations

A
Gabapentin is not a short-term antibiotic or “take-until-gone” medication; it is a long-term anticonvulsant requiring routine dosing to prevent seizures.
B
Gabapentin can rarely cause serious dermatologic reactions, including Stevens-Johnson syndrome. Skin changes such as rash, blistering, or peeling must be reported immediately.
C
Gabapentin is not a rescue medication for acute seizures; it must be taken consistently, not only when seizures occur.
D
Gabapentin should not be taken with antacids because antacids decrease its absorption, lowering therapeutic levels.
Gabapentin must be taken on a regular schedule, not PRN, to maintain seizure control. Teach clients to report any rash or skin changes immediately, as early detection prevents severe complications.
QUESTION #4
Pharmacology Exam 1 Pharmacology
The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen, and acetaminophen overdose is suspected. Which antidote should the nurse prepare for administration if prescribed?
A Naloxone
B Acetylcysteine
C Methylphenidate
D Diazepam

Explanations

A
Naloxone is the antidote for opioid overdose, not acetaminophen toxicity. It does not address liver injury.
B
Acetylcysteine is the specific antidote for acetaminophen overdose. It works by restoring glutathione in the liver, preventing severe hepatotoxicity when given promptly.
C
Methylphenidate is a stimulant used for ADHD and has no role in treating medication overdoses.
D
Diazepam is a benzodiazepine used for seizures or anxiety, not for reversing acetaminophen toxicity.
Memorize: Acetaminophen = Acetylcysteine antidote. Early administration is critical to prevent irreversible liver damage, so always act quickly when an overdose is suspected.
QUESTION #5
Pharmacology Exam 1 Pharmacology
The client diagnosed with osteoarthritis tells the clinic nurse about taking the herb ginkgo. Which intervention should the nurse implement?
A Determine what medications the client is currently taking.
B Praise the client because this herb helps decrease inflammation.
C Notify the HCP that the client is taking ginkgo.
D Examine why the client thought they needed to take herbs.

Explanations

A
Ginkgo has antiplatelet effects and can interact with anticoagulants, NSAIDs, and other medications that increase bleeding risk. The nurse’s first action should be to assess for possible interactions by determining what medications the client is currently taking.
B
The nurse should not praise or encourage ginkgo use; it can cause serious interactions and has limited evidence for osteoarthritis relief.
C
Notifying the HCP may be appropriate after the nurse assesses the client’s current medications. Assessment always comes first.
D
Exploring the client's reasoning is not the priority. Safety and interaction risks must be addressed before discussing beliefs about herbs.
Always ask clients about all supplements and herbs, as many have powerful effects and can interact with prescription medications. Ginkgo increases bleeding risk, especially when taken with NSAIDs or anticoagulants.
QUESTION #6
Pharmacology Exam 1 Pharmacology
Allopurinol is prescribed for a client and the nurse provides medication instructions to the client. Which instruction would the nurse provide?
A Drink 3000 mL of fluid a day.
B Take the medication on an empty stomach.
C The effect of the medication will occur immediately.
D Take the medication as soon as you notice a gout flare.

Explanations

A
Allopurinol reduces uric acid production, and increasing fluid intake to about 3000 mL/day helps prevent kidney stone formation and promotes excretion of uric acid. Adequate hydration is a key teaching point for all clients on allopurinol.
B
Allopurinol should be taken with food to reduce gastric upset; taking it on an empty stomach may increase GI irritation.
C
Allopurinol does not work immediately; it is a maintenance medication that can take several weeks to reduce uric acid levels. It is not effective for acute attacks.
D
Allopurinol should not be started or increased during an acute gout flare, as this can worsen symptoms. It is taken daily for long-term uric acid control.
Remember that allopurinol is preventive, not for acute gout pain. Combine the medication with plenty of hydration to protect kidney function and help reduce uric acid buildup.
QUESTION #7
Pharmacology Exam 1 Pharmacology
A geriatric client received a dose of morphine before leaving the post anesthesia care unit to return to the regular unit. What is the priority nursing intervention for the nurse receiving the client on the regular unit?
A Maintain the head of the client’s bed at 90°.
B Encourage use of incentive spirometer.
C Create a restful, dark, quiet environment.
D Put side rails up and place bed in low position.

Explanations

A
Keeping the bed at 90° is not the immediate priority and may even increase fall risk in a sedated older adult who has just received morphine.
B
Encouraging use of the incentive spirometer is appropriate later but not the priority when the client remains sedated from opioid administration.
C
Providing a quiet environment is helpful for comfort but does not address the immediate safety concerns associated with opioid-induced sedation in a geriatric client.
D
Older adults are at extremely high risk for falls and injury after receiving morphine due to sedation, dizziness, and delayed reaction time. Ensuring side rails are up and the bed is in the lowest position is the priority safety intervention to prevent harm.
Opioids + geriatric clients = fall risk first. Before anything else, ensure the environment is physically safe because sedated clients can attempt to move unpredictably and fall.
QUESTION #8
Pharmacology Exam 1 Pharmacology
A client presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the client has been taking medication throughout the evening and gives the nurse an almost empty bottle of benzodiazepines. The nurse addresses potential factors that could exacerbate the effects of the benzodiazepines with which assessment question?
A “Is the client currently taking any blood pressure medications?”
B “Does the client have any history of kidney disease?”
C “Are there any allergies that you know about?”
D “Has the client had any alcohol to drink?”

Explanations

A
Blood pressure medications may cause hypotension but do not significantly potentiate the CNS-depressant effects of benzodiazepines in a way that would explain severe respiratory depression.
B
Kidney disease may affect drug clearance, but benzodiazepines are primarily metabolized by the liver, and renal impairment alone would not cause sudden, profound sedation.
C
Allergies do not exacerbate benzodiazepine effects; allergic reactions present differently and are unrelated to the respiratory depression the client is experiencing.
D
Alcohol is a central nervous system depressant that dramatically increases the sedative and respiratory-depressant effects of benzodiazepines. Concurrent use is one of the most dangerous interactions and can quickly lead to overdose or respiratory failure.
Always ask about alcohol use when assessing a client on sedatives—benzodiazepines and alcohol can be fatal when combined. In any situation involving altered breathing and sedation, think CNS depressants first.
QUESTION #9
Pharmacology Exam 1 Pharmacology
The nurse is providing health education to a client prescribed sumatriptan for the treatment of migraines. The nurse should caution the client about what potential adverse reaction?
A Urinary hesitation and diarrhea
B Dry mouth and urinary frequency
C Numbness and chest tightness
D Nausea and vomiting

Explanations

A
Urinary hesitation and diarrhea are not common adverse reactions associated with sumatriptan and do not reflect the drug’s vasoconstrictive effects.
B
Dry mouth and urinary frequency are not typical reactions of triptan medications; they are more commonly associated with anticholinergic drugs.
C
Sumatriptan can cause paresthesia (numbness) and chest tightness due to coronary artery vasospasm, a recognized adverse effect. These symptoms may indicate serious cardiovascular reactions requiring immediate evaluation.
D
Nausea and vomiting can occur with migraines themselves but are not the specific adverse reactions the nurse must caution the client about when using sumatriptan.
Because sumatriptan causes vasoconstriction, it can produce chest heaviness or pressure that must always be reported. Remind clients to seek urgent care if they experience symptoms that resemble cardiac pain.
QUESTION #10
Pharmacology Exam 1 Pharmacology
The nurse is assessing a 10-year-old child who has been experiencing chronic headaches. The child’s parent reports the administration of acetaminophen three to four times a day for the past several weeks. What assessment should the nurse prioritize?
A Blood urea nitrogen, and creatinine
B Liver Enzymes
C Breath sounds and oxygen saturation
D Cardiac rhythm

Explanations

A
BUN and creatinine assess kidney function, but acetaminophen toxicity primarily affects the liver, not the kidneys, making this a lower priority.
B
Chronic or excessive acetaminophen use is a major cause of hepatotoxicity in children, so monitoring liver enzymes (AST, ALT) is the priority assessment. Early detection of liver injury is essential to prevent progression to acute liver failure.
C
Breath sounds and oxygen saturation are not directly affected by acetaminophen overuse unless advanced liver injury leads to secondary complications, which is not indicated here.
D
Cardiac rhythm is not typically impacted by acetaminophen toxicity and therefore is not a priority in this context.
Acetaminophen is safe when used appropriately, but frequent dosing over weeks can quietly damage the liver, especially in children. Always ask about dosing frequency and teach families to avoid exceeding daily limits.