Pharmacology Pitfalls
Q: Which medication requires monitoring for ototoxicity and nephrotoxicity?
a) Furosemide
b) Vancomycin
c) Metformin
d) Lisinopril
A: b) Vancomycin
Rationale: Vancomycin can damage kidneys and ears, especially at high trough levels.
Q: What is the first action for variable decelerations on a fetal monitor?
a) Administer oxygen
b) Increase IV fluids
c) Reposition the client
d) Call the provider
A: c) Reposition the client
Rationale: May relieve cord compression causing decels.
Q: What is the most therapeutic response to a suicidal statement like "I want it to end"?
a) "That’s not a good thing to say."
b) "Let’s focus on the positives in life."
c) "Can you tell me more about how you’re feeling?"
d) "Why would you feel that way?"
c) "Can you tell me more about how you’re feeling?"
Rationale: Encourages open, nonjudgmental dialogue.
Q: Which lab is most important to monitor with warfarin?
a) aPTT
b) INR
c) Platelets
d) Hemoglobin
b) INR
Rationale: INR monitors warfarin effect; target 2–3.
Q: Which client should the nurse assess first?
a) Fever of 101°F
b) Pain 7/10
c) BP 140/90
d) New confusion
d) New confusion
Rationale: Possible acute neuro change = highest priority.
Q: A patient on lithium reports nausea, tremors, and confusion. What is the nurse’s priority?
a) Reassure the patient
b) Hold dose and check lithium level
c) Administer antiemetic
d) Increase fluids
b) Hold dose and check lithium level
Rationale: These are signs of toxicity; check serum levels before continuing.
Q: What is the safest position during a non-stress test for a hypotensive pregnant client?
a) Supine
b) Right lateral
c) Sitting upright
d) Left lateral
A: d) Left lateral
Rationale: Avoids vena cava compression and increases perfusion
Q: Which side effect of clozapine is life-threatening?
a) Drowsiness
b) Dry mouth
c) Agranulocytosis
d) Constipation
c) Agranulocytosis
Rationale: Requires weekly WBC monitoring
Q: What is the priority action for a potassium of 6.2?
a) Administer insulin
b) Give sodium bicarbonate
c) Administer calcium gluconate
d) Restrict dietary potassium
c) Administer calcium gluconate
Rationale: Protects heart from dangerous arrhythmias.
Q: Which task is appropriate for a UAP?
a) Administer oral meds
b) Assess pain
c) Ambulate a stable patient
d) Teach coughing exercises
c) Ambulate a stable patient
Rationale: Within UAP scope.
Q: Which medication is contraindicated with grapefruit juice?
a) Lisinopril
b) Furosemide
c) Amlodipine
d) Metoprolol
A: c) Amlodipine
Rationale: Grapefruit inhibits CYP3A4, raising drug levels dangerously.
What is the priority for a postpartum patient with a boggy uterus and heavy bleeding?
a) Give IV fluids
b) Notify provider
c) Massage the fundus
d) Check pad count
c) Massage the fundus
Rationale: Uterine atony is the #1 cause of postpartum hemorrhage.
Q: What is the priority action for a patient with command hallucinations?
a) Ask what the voices say
b) Tell the patient the voices aren’t real
c) Give PRN medication
d) Sit quietly with them
a) Ask what the voices say
Rationale: Assess if hallucinations are dangerous.
Q: Which finding post-thyroidectomy is most concerning?
a) Hoarseness
b) Difficulty swallowing
c) Positive Chvostek’s sign
d) Mild neck swelling
c) Positive Chvostek’s sign
Rationale: Indicates hypocalcemia from parathyroid damage.
Q: Who should be seen first during morning rounds?
a) Blood sugar 45
b) Pain 6/10
c) Nausea
d) Low hemoglobin
A)Blood sugar 45
Rationale: Hypoglycemia is urgent and life-threatening.
Q: Which vital sign must be checked before giving digoxin?
a) Blood pressure
b) Respiratory rate
c) Apical heart rate
d) Temperature
A: c) Apical heart rate
Rationale: Hold if <60 bpm; digoxin slows HR.
Q: Which vaccine is not safe during pregnancy?
a) Influenza (injection)
b) Tdap
c) Hepatitis B
d) MMR
A: d) MMR
Rationale: Live virus—contraindicated in pregnancy
Q: What is a priority nursing diagnosis for anorexia nervosa?
a) Disturbed body image
b) Risk for injury
c) Imbalanced nutrition: less than body requirements
d) Anxiety
c) Imbalanced nutrition: less than body requirements
: Which is a late sign of increased ICP?
a) Restlessness
b) Bradycardia
c) Widening pulse pressure
d) Vomiting
c) Widening pulse pressure
Rationale: Classic late ICP sign along with irregular respirations and bradycardia.
Q: What can not be delegated to an LPN?
a) Wound dressing
b) Foley insertion
c) Teaching
d) Medication administration
c) Teaching
Rationale: Only RNs can perform client teaching.
Which insulin has the fastest onset and should be given with meals?
a) Glargine
b) NPH
c) Lispro
d) Regular
c) Lispro
Rationale: Lispro acts in 15 minutes; take with or just before meals
Q: A newborn has HR 90, irregular respirations, flexion, blue extremities, and grimace. What is the APGAR score?
a) 3
b) 5
c) 7
d) 9
A: b) 5
Rationale: Each category = 0, 1, or 2; total here adds up to 5.
Q: What should the nurse do first for a manic client who is pacing and yelling?
a) Call security
b) Restrain the patient
c) Encourage expression
d) Move them to a quiet room
d) Move them to a quiet room
Rationale: Reduce stimulation to prevent escalation.
Q: A post-op patient is restless, has chest pain, and tachypnea. What is suspected?
a) MI
b) Pulmonary embolism
c) Stroke
d) Hypovolemia
b) Pulmonary embolism
Rationale: Classic signs; high-risk post-op complication.
Q: Which clients can safely be roomed together?
a) TB & pneumonia
b) MRSA & wound infection
c) Neutropenic & flu
d) Post-op & C. diff
b) MRSA & wound infection
Rationale: Same precautions; safe to cohort.