Question

A nurse in an emergency department (ED) is caring for a female client.

Answer 1

Correct Answers

Administer hydralazine IV. [ inappropriate ]
Administer sodium polystyrene rectally. [ appropriate ]
Administer insulin IV. [ appropriate ]
Administer calcium gluconate IV. [ appropriate ]
Administer potassium chloride IV. [ inappropriate ]

Rationale :

Appropriate

Administer sodium polystyrene rectally

🔶Sodium polystyrene sulfonate lowers serum potassium by exchanging sodium for potassium within the gastrointestinal tract.

🔶The bound potassium is then removed from the body through stool, producing an actual reduction in total-body potassium.

🔶Rectal administration can be used when oral administration is not appropriate or when the client cannot safely take the medication by mouth.

🔶Its effect is relatively slow, so it should not be relied upon as the only treatment when hyperkalemia has already produced ECG abnormalities.

🔶It is appropriate as an adjunct to faster therapies while the nurse monitors bowel function, potassium levels, and signs of intestinal complications.

Administer insulin IV

🔶 Intravenous regular insulin rapidly shifts potassium from the extracellular fluid into the body’s cells.

🔶Insulin stimulates the sodium-potassium pump, lowering the serum potassium concentration without immediately removing potassium from the body.

🔶This intervention is appropriate because the client has both an elevated potassium level and dangerous ECG manifestations.

🔶IV dextrose is commonly administered with insulin unless the client is significantly hyperglycemic, because insulin can cause severe hypoglycemia.

🔶The nurse should monitor blood glucose frequently and reassess the potassium level and cardiac rhythm after treatment.

Administer calcium gluconate IV

🔶Intravenous calcium gluconate stabilizes the cardiac cell membrane and reduces the risk of ventricular dysrhythmias caused by hyperkalemia.

🔶It is especially indicated when ECG changes such as peaked T waves, absent P waves, bradycardia, or QRS widening are present.

🔶Calcium gluconate acts rapidly but does not lower the serum potassium concentration or remove potassium from the body.

🔶Potassium-lowering treatments such as insulin with dextrose must therefore be administered in addition to calcium.

🔶The nurse should maintain continuous ECG monitoring and administer the medication slowly through a patent IV line according to the prescribed rate.

Inappropriate

Administer hydralazine IV

🔶 Hydralazine is an antihypertensive vasodilator that lowers blood pressure and does not treat hyperkalemia or its cardiac effects.

🔶The client’s blood pressure is already low-normal at 98/64 mm Hg, so hydralazine could cause dangerous hypotension.

Administer potassium chloride IV

🔶Potassium chloride would further increase the client’s already elevated serum potassium and worsen the risk of lethal cardiac dysrhythmias.

🔶Potassium-containing medications and fluids should be withheld while emergency measures are used to stabilize the heart and reduce potassium.

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Answer 2

Correct Answers:

Morphine
Aspirin
Heparin

Rationale :

Morphine

💊 Morphine may be prescribed for severe, persistent ischemic chest pain that is not relieved by first-line treatment such as nitroglycerin.

💊 It reduces pain and anxiety while producing venodilation, which can decrease venous return and myocardial oxygen demand.

💊 The medication should be administered cautiously because it can cause hypotension, respiratory depression, sedation, and bradycardia.

💊 The nurse should monitor blood pressure, respiratory status, level of consciousness, and pain response closely after administration.

💊 Morphine is not routinely given to every STEMI client, but it is appropriate when significant chest pain continues despite initial anti-ischemic therapy.

Aspirin

🩸 Aspirin should be administered promptly to a client with a suspected acute myocardial infarction unless a contraindication exists.

🩸 It irreversibly inhibits platelet aggregation and helps prevent the coronary thrombus from enlarging.

🩸 The client is usually instructed to chew non-enteric-coated aspirin because chewing promotes faster absorption and a more rapid antiplatelet effect.

🩸 Early aspirin administration reduces recurrent myocardial infarction, vascular complications, and mortality.

🩸 The nurse should assess for active bleeding, severe aspirin allergy, and other contraindications before administering it.

Heparin

🛡️ Heparin is an anticoagulant used during acute coronary syndrome to prevent further formation and extension of the coronary thrombus.

🛡️ It does not dissolve the existing clot but inhibits clotting factors and reduces the risk of additional coronary artery occlusion.

🛡️ Heparin is commonly administered when the client is being prepared for percutaneous coronary intervention or receiving other reperfusion therapy.

🛡️ The nurse should monitor for bleeding, thrombocytopenia, hematuria, gastrointestinal bleeding, and changes in prescribed coagulation studies.

🛡️ Its use supports coronary reperfusion treatment and helps reduce recurrent ischemic events during the acute phase of STEMI care.

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Answer 3

Correct Highlights :

Client is currently taking lisinopril 5 mg PO daily.
Sodium 130 mEq/L (136 to 145 mEq/L)
Potassium 5.6 mEq/L (3.5 to 5 mEq/L)
BUN 30 mg/dL (10 to 20 mg/dL)
Creatine 3 mg/dL (0.5 to 1 mg/dL)

Rationale :

The client is currently taking lisinopril 5 mg PO daily

🩺 Lisinopril is an ACE inhibitor that reduces aldosterone secretion and can increase the serum potassium level.

🩺 Spironolactone is a potassium-sparing diuretic that also blocks aldosterone and promotes potassium retention.

🩺 Administering these medications together significantly increases the client’s risk for severe hyperkalemia.

🩺 This interaction is especially dangerous because the client already has elevated potassium and impaired renal function.

🩺 The nurse should report the concurrent lisinopril therapy before administering the newly prescribed spironolactone.

Sodium 130 mEq/L

🩺 A sodium level of 130 mEq/L indicates hyponatremia, which can be worsened by diuretic therapy.

🩺 Spironolactone promotes sodium and water excretion while retaining potassium.

🩺 Further sodium loss can increase the risk for weakness, confusion, headache, seizures, and other neurological complications.

🩺 The sodium imbalance should be evaluated before spironolactone is initiated, particularly in a client with renal impairment.

🩺 The nurse should report this abnormal laboratory result so the provider can determine whether the medication is safe.

Potassium 5.6 mEq/L

🩺 A potassium level of 5.6 mEq/L indicates hyperkalemia, which is a major contraindication to spironolactone therapy.

🩺 Spironolactone blocks aldosterone and decreases renal potassium excretion, causing additional potassium retention.

🩺 Further elevation can produce muscle weakness, paresthesia, conduction abnormalities, life-threatening dysrhythmias, and cardiac arrest.

🩺 The risk is increased because the client is also taking lisinopril, which can elevate potassium.

🩺 The nurse should withhold the medication and immediately report the elevated potassium level to the provider.

BUN 30 mg/dL

🩺 A BUN level of 30 mg/dL is elevated and suggests decreased renal clearance, dehydration, or another form of renal dysfunction.

🩺 Spironolactone depends on adequate kidney function for safe elimination and electrolyte regulation.

🩺 Impaired renal function increases the risk that potassium will accumulate to dangerous levels.

🩺 The elevated BUN is especially concerning when considered with the client’s markedly elevated creatinine level.

🩺 The nurse should report this result before administering spironolactone so renal function can be further evaluated.

Creatinine 3 mg/dL

🩺 A creatinine level of 3 mg/dL indicates significant renal impairment.

🩺 Clients with severely reduced kidney function cannot excrete potassium effectively, increasing the risk for spironolactone-induced hyperkalemia.

🩺 Spironolactone is generally avoided or used with extreme caution in clients with substantial renal dysfunction.

🩺 The combination of renal impairment, existing hyperkalemia, and concurrent lisinopril therapy creates a high risk for a life-threatening electrolyte disturbance.

🩺 The nurse should report the elevated creatinine and clarify the prescription before administering the medication.

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Answer 4

Correct Answers:

"Rotate Injection sites."
"Inject the medication at a 90-degree angle."
"Pinch up a skin area before Injection."

Rationale :

“Rotate injection sites.”

💉 Rotating injection sites helps prevent repeated trauma to the same area of subcutaneous tissue.

💉 Enoxaparin is commonly administered into the left or right anterolateral or posterolateral abdominal wall, at least 5 cm or 2 inches from the umbilicus.

💉 The client should alternate sides and avoid injecting into bruised, scarred, tender, hardened, or inflamed areas.

💉 Site rotation decreases the risk of bruising, hematoma formation, tissue irritation, and poor medication absorption.

💉 The nurse should instruct the client to keep a simple record of injection locations to ensure consistent rotation.

“Inject the medication at a 90-degree angle.”

💉 Enoxaparin is administered into the subcutaneous tissue, and a 90-degree angle is appropriate when a skinfold is pinched.

💉 The needle should be inserted completely into the skinfold to ensure that the medication reaches fatty tissue rather than muscle.

💉 Injecting the medication into muscle can increase the risk of bleeding and hematoma formation because enoxaparin is an anticoagulant.

💉 The medication should be injected slowly and steadily while the client continues holding the skinfold.

💉 After the medication is delivered, the needle should be withdrawn at the same angle and disposed of immediately in a sharps container.

“Pinch up a skin area before injection.”

💉 Pinching a fold of skin separates the subcutaneous fatty tissue from the underlying muscle.

💉 This technique helps ensure that enoxaparin is deposited in the correct tissue layer and reduces the chance of intramuscular administration.

💉 The client should gently grasp the abdominal skin between the thumb and fingers without squeezing excessively.

💉 The skinfold should remain pinched throughout the injection and should be released only after the needle has been removed.

💉 Correct skinfold technique promotes reliable medication absorption and reduces the risk of bleeding, pain, and tissue injury.

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Answer 5

Correct Answers:

Epigastric pain

Rationale :

💊 Gemfibrozil lowers triglycerides but can increase cholesterol secretion into bile, raising the risk of gallstone formation.

💊 Persistent or severe epigastric or right upper-quadrant pain can indicate cholelithiasis or inflammation of the gallbladder.

💊 The pain may occur with nausea, vomiting, fever, jaundice, or tenderness after eating fatty foods.

💊 The client should promptly report this symptom because gallbladder complications may require laboratory testing, imaging, and discontinuation of the medication.

💊 The nurse should also teach the client to report unexplained muscle pain because gemfibrozil can rarely cause myopathy or rhabdomyolysis.

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Answer 6

Correct Answers:

Tinnitus

Rationale :

👂 Tinnitus, or ringing in the ears, is a classic early manifestation of salicylism from excessive aspirin exposure.

👂 Other early findings can include headache, dizziness, sweating, nausea, vomiting, and decreased hearing.

👂 More severe toxicity can cause tachypnea, fever, confusion, metabolic abnormalities, seizures, and coma.

👂 The nurse should hold further aspirin doses and notify the provider when salicylate toxicity is suspected.

👂 Serum salicylate levels, acid-base balance, electrolytes, respiratory status, and neurological status should be evaluated promptly.

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Answer 7

Correct Answers:

Seizure

Rationale :

⚠️ A seizure is a severe neurological manifestation of lithium toxicity and requires immediate intervention.

⚠️ Severe toxicity can progress to confusion, coarse tremors, ataxia, coma, cardiovascular instability, and permanent neurological injury.

⚠️ The nurse should withhold lithium, protect the client from injury, maintain the airway, and notify the provider immediately.

⚠️ An urgent serum lithium level, electrolyte panel, renal function tests, and continuous neurological monitoring are indicated.

⚠️ Severe toxicity may require aggressive IV hydration or hemodialysis, particularly when renal clearance is impaired.

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Answer 8

Correct Answers:

Phenelzine

Rationale :

🚨 Phenelzine is a nonselective monoamine oxidase inhibitor that can interact dangerously with levodopa.

🚨 Combining these medications can produce excessive catecholamine activity and trigger a life-threatening hypertensive crisis.

🚨 Manifestations may include severe headache, markedly elevated blood pressure, chest pain, palpitations, diaphoresis, and neurological changes.

🚨 Phenelzine generally must be discontinued for at least 14 days before levodopa therapy is initiated.

🚨 The nurse should complete a thorough medication reconciliation and immediately clarify concurrent prescriptions for these medications.

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Answer 9

Correct Answers:

Fluid retention

Rationale :

💧 Pioglitazone can cause sodium and water retention, resulting in peripheral edema and weight gain.

💧 Fluid retention can precipitate or worsen heart failure, especially in clients with existing cardiac dysfunction.

💧 The nurse should monitor daily weight, peripheral edema, lung sounds, shortness of breath, and activity tolerance.

💧 Rapid weight gain, orthopnea, crackles, or increasing dyspnea should be reported promptly to the provider.

💧 Pioglitazone is generally avoided in clients with severe or uncontrolled heart failure because of this adverse effect.

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Answer 10

Correct Answers:

WBC count 2.5 / mm³ (5,000 to 10,000 / mm³)

Rationale :

🩸 A WBC count of 2.5/mm³ is critically low and suggests severe leukopenia associated with clozapine-induced neutropenia or agranulocytosis.

🩸 Clozapine can suppress bone marrow production of neutrophils, leaving the client vulnerable to rapidly developing and potentially fatal infections.

🩸 The medication should be withheld, and the provider should be notified immediately according to the clozapine monitoring protocol.

🩸 The nurse should assess for fever, sore throat, chills, mouth ulcers, malaise, and other signs of infection.

🩸 An absolute neutrophil count should be obtained because it is the primary laboratory value used to determine whether clozapine can be safely continued.

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Provider Prescription	appropriate	inappropriate
Administer hydralazine IV.
Administer sodium polystyrene rectally.
Administer insulin IV.
Administer calcium gluconate IV.
Administer potassium chloride IV.

RN Pharmacology Exam Summer 2026

No.

1 :
A nurse in an emergency department (ED) is caring for a female client.

Correct Answers

2 :
A nurse is caring for a client in an emergency department (ED).

Answer Options

3 :
A nurse is assessing a female client.

Correct Highlights :

4 :
A nurse is caring for a client.

Answer Options

5 :
A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following findings should the nurse instruct the client to report as an adverse effect of the medication?

6 :
A nurse is assessing a client who takes prescribed daily aspirin. Which of the following findings indicates salicylism?

7 :
A nurse is reviewing the medical record of a client who has been taking lithium. Which of the following findings should the nurse notify the provider of immediately?

8 :
A nurse is caring for a client who has Parkinson's disease and a new prescription for levodopa. The nurse should identify which of the following medications can interact with levodopa to cause a life-threatening complication?

9 :
A nurse is caring for a client who has diabetes mellitus and is taking pioglitazone. The nurse should monitor the client for which of the following adverse effects?

10 :
A nurse is reviewing the medical record of a client who is taking clozapine. Which of the following findings should the nurse report to the provider immediately?

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RN Pharmacology Exam Summer 2026

No.

1 : A nurse in an emergency department (ED) is caring for a female client.

Correct Answers

2 : A nurse is caring for a client in an emergency department (ED).

Answer Options

3 : A nurse is assessing a female client.

Correct Highlights :

4 : A nurse is caring for a client.

Answer Options

5 : A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following findings should the nurse instruct the client to report as an adverse effect of the medication?

6 : A nurse is assessing a client who takes prescribed daily aspirin. Which of the following findings indicates salicylism?

7 : A nurse is reviewing the medical record of a client who has been taking lithium. Which of the following findings should the nurse notify the provider of immediately?

8 : A nurse is caring for a client who has Parkinson's disease and a new prescription for levodopa. The nurse should identify which of the following medications can interact with levodopa to cause a life-threatening complication?

9 : A nurse is caring for a client who has diabetes mellitus and is taking pioglitazone. The nurse should monitor the client for which of the following adverse effects?

10 : A nurse is reviewing the medical record of a client who is taking clozapine. Which of the following findings should the nurse report to the provider immediately?

1 :
A nurse in an emergency department (ED) is caring for a female client.

2 :
A nurse is caring for a client in an emergency department (ED).

3 :
A nurse is assessing a female client.

4 :
A nurse is caring for a client.

5 :
A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following findings should the nurse instruct the client to report as an adverse effect of the medication?

6 :
A nurse is assessing a client who takes prescribed daily aspirin. Which of the following findings indicates salicylism?

7 :
A nurse is reviewing the medical record of a client who has been taking lithium. Which of the following findings should the nurse notify the provider of immediately?

8 :
A nurse is caring for a client who has Parkinson's disease and a new prescription for levodopa. The nurse should identify which of the following medications can interact with levodopa to cause a life-threatening complication?

9 :
A nurse is caring for a client who has diabetes mellitus and is taking pioglitazone. The nurse should monitor the client for which of the following adverse effects?

10 :
A nurse is reviewing the medical record of a client who is taking clozapine. Which of the following findings should the nurse report to the provider immediately?