Pharmacology NCLEX Questions with Rationale 13-20

Working through our free  Pharmacology NCLEX Questions with Rationale is a great way to practice and review these important topics since it comprises almost 15% of the questions on the NCLEX-RN. 

13. A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/ hour. The nurse determines that the client is receiving the therapeutic effect based on which results?

a) Prothrombin time of 12.5 seconds
b) Activated partial thromboplastin time of 60 seconds
c) Activated partial thromboplastin time of 28 seconds
d0 Activated partial thromboplastin time longer than 120 seconds

14. The nurse provides discharge instructions to a client who is taking warfarin sodium (Coumadin). Which statement, by the client, reflects the need for further teaching?

a) “I will avoid alcohol consumption.”
b) “I will take my pills every day at the same time.”
c) “I have already called my family to pick up a Medic-Alert bracelet.”
d) “I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated.”

15. A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3 mEq/ L and is complaining of anorexia. The health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. The nurse checks the results, knowing that which value is the therapeutic serum level (range) for digoxin?

a) 0.5 to 2 ng/ mL
b) 1.2 to 2.8 ng/ mL
c) 3.0 to 5.0 ng/ mL
d) 3.5 to 5.5 ng/ mL

16. Pharmacology NCLEX Questions with Rationale about a client that is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first?

a) Measure the heart rate on the rhythm strip.
b) Administer prescribed nitroglycerin tablets.
c) Obtain a 12-lead electrocardiogram immediately.
d0 Auscultate the client’s apical pulse and obtain a blood pressure.

17. The nurse is monitoring a client who is taking propranolol (Inderal LA). Which assessment data indicates a potential serious complication associated with this medication?

a) The development of complaints of insomnia
b) The development of audible expiratory wheezes
c) A baseline blood pressure of 150/ 80 mm Hg followed by a blood pressure of 138/ 72 mm Hg after two doses of the medication
d) A baseline resting heart rate of 88 beats/ minute followed by a resting heart rate of 72 beats/ minute after two doses of the medication

18. A client with atrial fibrillation secondary to mitral stenosis is receiving a heparin sodium infusion at 1000 units/ hour and warfarin sodium (Coumadin) 7.5 mg at 5: 00 PM daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT) = 32 seconds; internationalized normalized ratio (INR) = 1.3. The nurse should plan to take which action based on the client’s laboratory results?

a) Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed.
b) Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed.
c) Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range.
d) Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate (Pradaxa) in place of warfarin sodium.

19. Pharmacology NCLEX Questions with Rationale about a client who is diagnosed with an ST-segment elevation myocardial infarction (STEMI) and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention?

a) Monitor for kidney failure.
b) Monitor psychosocial status.
c) Monitor for signs of bleeding.
d) Have heparin sodium available.

20. The nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication?

a) Hypouricemia, hyperkalemia
b) Increased risk of osteoporosis
c) Hypokalemia, hyperglycemia, sulfa allergy
d) Hyperkalemia, hypoglycemia, penicillin allergy





Pharmacology NCLEX Questions with Rationale

13) B
- Rationale: Common laboratory ranges for activated partial thromboplastin time are 20 to 36 seconds. Because the activated partial thromboplastin time should be 1.5 to 2.5 times the normal value, the client’s activated partial thromboplastin time would be considered therapeutic if it was 60 seconds.

- Test-Taking Strategy: Focus on the subject, the therapeutic effect of heparin. Prothrombin time is eliminated because it assesses response to warfarin (Coumadin) therapy. The activated partial thromboplastin time of 28 seconds is eliminated because this result indicates that the client is receiving no therapeutic effect from the continuous heparin infusion. Finally the activated partial thromboplastin time greater than 120 seconds can be eliminated because this value is beyond the therapeutic range and the client is at risk for bleeding.

14) D
- Pharmacology NCLEX Questions with Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

- Test-Taking Strategy: Note the strategic words need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Recalling that warfarin (Coumadin) is an anticoagulant and that Ecotrin is an aspirin-containing product will direct you to the correct option.

15) A
- Rationale: Therapeutic levels for digoxin range from 0.5 to 2 ng/ mL. The ranges in the remaining options are incorrect.

- Test-Taking Strategy: Focus on the subject, therapeutic serum digoxin level. It is necessary to remember that the therapeutic range is 0.5 to 2 ng/ mL to answer correctly.

16) D
- Pharmacology NCLEX Questions with Rationale: Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the rhythm strip and obtaining a 12-lead EKG may be interventions, these would be done after the vital signs are taken. Nitroglycerin is a vasodilator and will lower the blood pressure.

- Test-Taking Strategy: Note the strategic word first. Also use the steps of the nursing process to answer correctly. Remember to always assess the client first, not the monitoring devices. Therefore auscultating the apical rate and taking the blood pressure are the first actions.

17) B
- Pharmacology NCLEX Questions Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

- Test-Taking Strategy: Focus on the subject, a potential serious complication. Eliminate options indicating a decrease in blood pressure and a decrease in heart rate first because these are expected effects from the medication. Next, focusing on the subject will direct you to the correct option.

18) B
- Rationale: When a client is receiving warfarin (Coumadin) for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the health care provider to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

- Test-Taking Strategy: Focus on the subject, laboratory result analysis related to these medications. First eliminate the option that indicates to discuss use of Pradaxa, recalling that it is contraindicated for use in atrial fibrillation associated with valvular heart disease. Next, recall that if the warfarin sodium has achieved the therapeutic range for the INR for clot prevention in atrial fibrillation, the heparin infusion is no longer necessary. This will help you to eliminate the option that indicates to withhold the warfarin sodium because the INR is not therapeutic. Last, keep in mind that if both the aPTT and INR are not within therapeutic range the client is left unprotected from clot formation.

19) C
- Pharmacology NCLEX Questions with Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client’s psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.

- Test-Taking Strategy: Note the strategic word priority. Remember, bleeding is a priority for thrombolytic medications.

20) C
- Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

- Test-Taking Strategy: Focus on the subject, a concern related to administration of hydrochlorothiazide. Recalling that thiazide diuretics carry a sulfa ring will direct you to the correct option.


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Pharmacology NCLEX Questions with Rationale 1-5


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Pharmacology NCLEX Questions with Rationale 21-25