Pharmacological and Parenteral Therapies — NCLEX-RN practice questions

An 8-year-old with type 1 diabetes is playing in a soccer game. Which plan best prevents exercise-induced hypoglycemia?

1. No snack is needed and the insulin dose stays unchanged, since exercise raises blood glucose
2. A carbohydrate snack before exercise, with blood glucose monitoring before, during, and after
3. Increase the insulin dose before exercise to cover the sports drinks consumed during play
4. Restrict fluids during the game to avoid electrolyte shifts and dilution of blood glucose

Answer: B — A carbohydrate snack before exercise, with blood glucose monitoring before, during, and after

B) Correct — exercise increases glucose uptake; a pre-exercise carb snack plus monitoring prevents hypoglycemia. A) Ignores increased glucose utilization with activity. C) Increasing insulin would worsen hypoglycemia risk during exercise. D) Fluid restriction is not indicated and increases dehydration risk.

A pregnant woman asks about folic acid supplementation. The nurse should recommend:

1. Begin folic acid supplementation only after the first prenatal visit has been completed
2. 4 mg per day for all pregnant women, continued throughout the entire pregnancy
3. Supplementation is not necessary if the client eats a balanced diet that includes leafy green vegetables
4. 400 mcg/day starting at least 1 month before conception and continuing through pregnancy

Answer: D — 400 mcg/day starting at least 1 month before conception and continuing through pregnancy

CDC and ACOG recommend 400 mcg/day folic acid for ALL women of reproductive age, ideally starting BEFORE conception to prevent neural tube defects (NTD closes by week 4 — often before pregnancy is recognized). 4 mg/day (B) is the high-dose recommendation for women with a prior NTD pregnancy.

Which patient teaching about anticoagulation with apixaban (Eliquis) is correct?

1. 'Take the medication only together with vitamin K supplements in order to balance its effect.'
2. 'It works in the same way as warfarin and requires frequent INR monitoring at the clinic.'
3. 'Report any unusual bleeding, take with or without food, and avoid missed doses.'
4. 'No bleeding risk exists, so dental work and over-the-counter pain relievers need no precautions.'

Answer: C — 'Report any unusual bleeding, take with or without food, and avoid missed doses.'

Apixaban is a direct factor Xa inhibitor (DOAC). No routine INR monitoring. Patients should report bleeding, take consistently, and discuss any new meds (interactions possible).

A patient with cirrhosis has worsening confusion. Lab shows elevated ammonia. The MOST appropriate medication is:

1. Sliding-scale insulin (corrects the hyperglycemia driving the confusion)
2. Lactulose (lowers blood ammonia by trapping NH4+ in the bowel)
3. Acetaminophen (for comfort while the ammonia clears on its own)
4. Ibuprofen (reduces the inflammation worsening the confusion)

Answer: B — Lactulose (lowers blood ammonia by trapping NH4+ in the bowel)

Hepatic encephalopathy treatment: lactulose (acidifies colon, converts NH3 to NH4+, increases excretion). Rifaximin may also be added. Acetaminophen and NSAIDs are hepatotoxic/nephrotoxic and contraindicated.

A patient on a heparin infusion has an aPTT result that is 3.5× the control. The nurse should:

1. Stop the infusion and notify the provider
2. Continue the current rate and recheck in 6 hours
3. Increase the infusion rate
4. Administer vitamin K

Answer: A — Stop the infusion and notify the provider

Therapeutic aPTT on heparin is 1.5-2.5× control. 3.5× indicates significant over-anticoagulation and bleeding risk. Stop the infusion and notify the provider. Protamine sulfate is the heparin antidote (vitamin K is for warfarin). (C) would worsen the problem.

A child with nephrotic syndrome has significant periorbital and lower extremity edema and is on prednisone. Which assessment is the priority for the nurse to perform daily?

1. Daily weight and abdominal girth
2. Height measured each morning
3. Favorite toys and play preferences
4. School attendance record

Answer: A — Daily weight and abdominal girth

A) Correct — daily weight is the most sensitive indicator of fluid retention/loss in nephrotic syndrome and guides diuretic/steroid therapy. B) Not an acute daily marker. C) Not clinically relevant to fluid status. D) Not a clinical priority.

A heparin infusion is ordered at 18 units/kg/hr for a client weighing 80 kg, using a concentration of 25,000 units in 250 mL. What is the correct infusion rate in mL/hr?

1. 7.2 mL/hr infused continuously
2. 14.4 mL/hr
3. 18 mL/hr infused continuously
4. 72 mL/hr infused continuously

Answer: B — 14.4 mL/hr

B) Correct — 18 units/kg/hr × 80 kg = 1,440 units/hr; concentration is 100 units/mL (25,000/250); 1,440 ÷ 100 = 14.4 mL/hr. A) Reflects a calculation error. C) Confuses the units/kg/hr value with the final rate. D) An order-of-magnitude error.

An order reads: "Give 750 mg of a medication PO. Available: 250 mg tablets." How many tablets should the nurse administer?

1. 1.5 tablets
2. 2 tablets
3. 3 tablets
4. 4 tablets

Answer: C — 3 tablets

C) Correct — 750 mg ÷ 250 mg/tablet = 3 tablets. A) Would deliver only 375 mg, underdosing. B) Would deliver 500 mg, underdosing. D) Would deliver 1,000 mg, overdosing.

Which statement about presbycusis (age-related hearing loss) is accurate?

1. It typically causes loss of high-frequency sounds first, making consonants harder to distinguish
2. It is usually reversible with medication once the underlying middle-ear inflammation is treated
3. It primarily affects low-frequency sounds, making vowel sounds the hardest to distinguish
4. It changes hearing thresholds but has little practical effect on communication or personal safety

Answer: A — It typically causes loss of high-frequency sounds first, making consonants harder to distinguish

A) Correct — presbycusis characteristically affects high-frequency hearing first, making consonants and speech clarity harder to perceive. B) Not typically reversible with medication. C) High-frequency loss predominates. D) It can significantly affect communication and safety.

When preparing to administer regular and NPH insulin in the same syringe, a nurse should:

1. Draw the NPH (cloudy) insulin into the syringe first and then the regular (clear) insulin, so the longer-acting dose is measured most accurately
2. Draw each insulin into its own syringe and give them as two intramuscular injections at separate sites so that no mixing can occur
3. Combine the two insulins in an empty sterile vial first, then withdraw the total dose so that the mixture is uniform before injection
4. Draw regular (clear) insulin into the syringe first, then NPH (cloudy) — \"clear before cloudy\" to avoid contaminating the regular vial

Answer: D — Draw regular (clear) insulin into the syringe first, then NPH (cloudy) — \"clear before cloudy\" to avoid contaminating the regular vial

D) Standard mixing rule. A) Reverses the clear-before-cloudy rule. B) Insulin is given subcutaneously, not IM. C) Mixing in a separate vial is not an accepted technique.

Foods high in vitamin K (warfarin patients)?

Green leafy vegetables (spinach, kale, broccoli). Maintain consistent intake.

Potassium-sparing diuretics (spironolactone)?

Risk of HYPERkalemia (opposite of loop/thiazide). Avoid potassium supplements/salt substitutes. Also has anti-androgen effects (gynecomastia).

Ventricular fibrillation treatment?

Defibrillation (unsynchronized). CPR, epinephrine.

Sublingual nitroglycerin administration?

1 tab every 5 minutes, up to 3 doses, call 911 if no relief. Contraindicated with PDE5 inhibitors (sildenafil) — severe hypotension.