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NCLEX Practice Exam for Pharmacology for Anti-inflammatory and Antineoplastic Medications

NCLEX Practice Exam for

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1. As a well-rounded health care provider, you know of
that corticosteroid therapy is indicated in all of the Nursin
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following conditions except:

A. osteoarthritis
B. rheumatoid arthritis
C. systemic lupus erythematosus
D. acute spinal cord injury

2. Oral steroids are prescribed on a taper in order to:

A. achieve optimal serum levels.

B. ensure drug reliability.
C. ensure compliance.
D. prevent steroid withdrawal syndrome.

 3. Orlando who has been taking steroids for

 rheumatoid arthritis over several years presents with

a compression vertebral fracture. This fracture is due
 to:
 A. an entirely separate condition.
B. the osteoporotic effect of long-term steroid use.
C. deterioration in rheumatoid arthritis.
D. an excessively high dose of steroids.

4. Tom is admitted into the emergency department

with an acute spinal cord injury. Methylprednisolone
is contraindicated for treatment when the injury:

A. is a high cervical lesion.

B. occurred less than 4 hours ago.
C. occurred less than 8 hours ago.
D. occurred more than 8 hours ago.

5. Which of the following statements about

intravenous administration of steroids is true?

A. Steroids administered intravenously must be

diluted.
B. Steroids administered intravenously can be either
in diluted or undiluted form.
C. Steroids should be given IV push only.
D. Intravenous administration of steroids is
contraindicated in acutely ill clients.

6. An appropriate nursing diagnosis for clients who

are taking NSAIDs and anticoagulants would be
which of the following?

A. Risk for injury related to prolonged bleeding time,

inhibition of platelet aggregation, and increased
risk of GI bleeding.
B. Potential for injury related to GI toxicity and
 decrease in bleeding time.
C. Altered protection related to GI bleeding and
 increasing platelet aggregation.
 D. Risk for injury related to thrombocytosis
prolonged prothrombin time.
 7. Teaching has been adequate when a client being
treated with acetylsalicylic acid states:

A. “I can crush the pills before i swallow them.”

B. “I should take the pills with antacids.”
C. “Taking the pills on an empty stomach will help
absorption.”
D. “If the pills smell like vinegar, I should throw them
out.”

8. Which of the following groups of clients are most

at risk for GI bleeding from the use of NSAIDs?

A. Clients with dysmenorrhea

B. Clients with headaches
C. Clients with arthritis
D. Clients with renal failure

9. To minimize the risk of dyspnea and GI bleeding,

OTC ibuprofen is given:

A. IV
B. With orange juice
C. On an empty stomach
D. With meals

10. Which of the following NSAIDs is used to prevent

thrombosis?

A. Motrin
B. Toradol
C. Aspirin
D. naproxen

11. Nurse Corrine may expect to administer

azathioprine (Imuran) to a transplant client in which
 of the following conditions?
 A. Prevention of chronic rejection
B. Prevention of acute rejection
C. Management of chronic rejection
D. Treatment of acute rejection

12. Which of the following laboratory tests should be

monitored when a client is receiving azathioprine?

A. CBC
B. BUN
C. Electrolytes
D. Sedimentation rate

13. In a transplant client, the action of cyclosporine is

to:

A. Defend the body against foreign antigens.

B. Inhibit T cells in response to antigens.
C. Inhibit B cell immunoglobulin.
D. Intensify the production of T lymphocytes

14. Client teaching for mycophenolate mofetil must

include instructions to:

A. Take with food.

B. Avoid use of corticosteroid.
C. Monitor for adverse effects.
D. Practice effective contraception.

15. Which of the following client comments

demonstrates that teaching has been successful
regarding cyclosporine therapy?

 A. “I need to mix the medicine in Styrofoam.”

B. “I should take the medication on an empty

stomach.”
 C. “I need to be consistent about when i take it and
also monitor how much fat is in my food.”
 D. “If I vomit I should take another dose.”

16. Antirheumatics are used to:

A. Directly affect the inflammatory response

B. Encourage excretion of autoantibodies
C. Retard progression of joint deterioration
D. Mediate the action of NSAIDs

17. Gold compounds are contraindicated in clients

with:

A. Liver dysfunction
B. Cardiac disease
C. Preexisting dermatitis
D. Rheumatoid arthritis

18. Which of the following agents can be used in

treatment of rheumatoid arthritis, Sjögren’s syndrome,
and SLE?

A. auranofin (Ridaura)
B. allopurinol (Zyloprim)
C. sulfasalazine (Azulfidine)
D. chloroquine (Aralen)

19. Frequent eye examinations are recommended in

clients receiving:

A. chloroquine
B. colchicine
C. penicillamine
D. gold compounds

20. Nurse Pia is instructing a client receiving

probenecid (Benemid), she should cover all of the
 following information except the need to:
 A. Change dietary habits.
B. Increase fluid intake.
C. Have frequent laboratory work done.
D. Recognize side effects.

21. Enrique who is under chemotherapy has the

following CBC results: WBC 5000/mm3, RBC platelet
10,000/mm3. Which of the following is he at risk for?

A. Infection
B. Bleeding
C. Angina
D. None of the above

22. Lorraine who is on chemotherapy has a history of

cardiac disease. The client is at risk for cardiac
complications because:

A. White blood cells are reduced.

B. Oxygen-carrying capacity may be reduced.
C. Sodium levels may rise meaning fluid overload.
D. Hematocrit is lowered.

23. Which of the following is the priority nursing

diagnosis for a client undergoing chemotherapy?

A. Decreased cardiac output

B. Fear
C. Altered nutrition
D. Anxiety

24. Which of the following contributes most to the

debilitation of an individual during a course of
 chemotherapy?


A. Diarrhea
 B. Alopecia
C. Constipation
 D. Pain

25. Combination chemotherapy is used in the

treatment of cancer because:

A. Single-agent therapy produces cell lines that are

resistant.
B. Two drugs are more likely to work.
C. Single-agent therapy requires larger doses for
long remissions.
D. Two cancers may be present.

Answers and Rationale

1. Answer: A. osteoarthritis. Osteoarthritis is not an

indication for corticosteroid therapy. It has an
inflammatory component, but the disease is not
severe enough to suppress the immune system.
Lupus, spinal injury, and rheumatoid arthritis are
conditions that require suppression of the
immune system in order for the client to survive.
2. Answer: D. prevent steroid withdrawal
syndrome. Steroids are tapered off in order to
prevent a withdrawal syndrome. Optimal serum
levels do not require tapering in order to be
maintained. Tapering has nothing to do with drug
reliability. Compliance is not dependent on
tapering.
3. Answer: B. the osteoporotic effect of long-term
steroid use. In a client on long-term steroids, a
compression vertebral fracture can be assumed
to be due to the steroids’ bone-softening effect.
4. Answer: D. occurred more than 8 hours
 ago. Research has shown that steroids are
ineffective when given more than 8 hours after
 acute spinal injury.
 5. Answer: B. Steroids administered intravenously
can be either in diluted or undiluted form. IV
 steroids can either be diluted or given without
dilution.
6. Answer: A. Risk for injury related to prolonged
bleeding time, inhibition of platelet aggregation,
and increased risk of GI bleeding. The nursing
diagnosis addresses all the interactions that
pose a threat to the client taking both these
drugs. Choice B is incorrect because bleeding
time is prolonged not decreased when both drugs
are used. Choice C is incorrect because platelet
aggregation is inhibited not increased when both
drugs are used. Choice D is incorrect because
thrombocytosis does not occur with use of either
drugs.
7. Answer: D. “If the pills smell like vinegar, I should
throw them out.” Any aspirin should be discarded
if a vinegar odor is noticed. Crushing is not
recommended for sustained-release
preparations. Antacids impair absorption. Taking
the medication on an empty stomach will
increase GI irritation.
8. Answer: C. Clients with arthritis. Clients with
arthritis are taking the drugs for prolonged
periods of time and may take higher doses.
Choices A and B are incorrect because the use of
NSAIDs with these clients is intermittent. Renal
failure is a contraindication for NSAIDs because
most of the drug is excreted through the kidneys.
9. Answer: D. With meals. Taking ibuprofen with
meals will decrease GI irritation. Ibuprofen is
never given IV. Orange juice may promote acidity
and increase gastric irritation. Ibuprofen will
cause GI upset if given on an empty stomach.
 10. Answer: C. Aspirin. Aspirin prevents platelet
aggregation and thereby has an anticoagulant
 effect.
11. Answer: B. Prevention of acute

rejection. Azathioprine inhibits humoral and
 cellular immunity during the early stages of
lymphoid differentiation and is useful in
preventing the onset of acute rejection.
12. Answer: A. CBC. CBC will identify leukopenia, a
common side effect.
13. Answer: B. Inhibit T cells in response to
antigens. The primary action of cyclosporine is to
inhibit T-cell generation in response to transplant
antigens.
14. Answer: D. Practice effective
contraception. Effective contraception is
essential because of the potential for teratogenic
effects. It is recommended that the drug be taken
on empty stomach. The drug is often given with
corticosteroid. All medication should be
monitored for side effects.
15. Answer: C. “I need to be consistent about when i
take it and also monitor how much fat is in my
food.” Cyclosporines need to be taken
consistently in relation to meals, and fat content
should not vary to maintain serum levels.
16. Answer: C. Retard progression of joint
deterioration. These drugs cannot stop the
disease itself but are believed to retard or prevent
the process of joint deterioration. For choice A,
the inflammatory process is affected indirectly.
Autoantibodies are not excreted. Disease
modifying antirheumatic drugs are used in
combination with NSAIDs but do not mediate
their effect.
17. Answer: A. Liver dysfunction. An adverse
reaction to gold compounds is liver toxicity;
therefore, use care in clients with preexisting liver
 dysfunction.
18. Answer: D. chloroquine (Aralen). Chloroquine has
 had documented success in the treatment of
rheumatoid arthritis, Sjögren’s syndrome, and

SLE. Auranofin and sulfasalazine are used in the
 treatment of rheumatoid arthritis, but none are
used in the treatment of all three syndromes.
19. Answer: A. chloroquine. Corneal deposits are an
adverse reaction associated with chloroquine
administration, necessitating frequent eye
examination.
20. Answer: C. Have frequent laboratory work
done. Side effects of probenecid treatment are
relatively benign, and there is no indication that
there is a need for frequent laboratory evaluation.
21. Answer: B. Bleeding. A platelet count of
10,000/mm3 means that the client does not have
enough platelets to clot the blood; therefore, the
possibility of bleeding is high. Choice A is a
normal value of WBC. Angina would only be a risk
if the client had a lower RBC count.
22. Answer: B. Oxygen-carrying capacity may be
reduced. If hemoglobin and red cell counts drop
from myelosuppression, the oxygen-carrying
capacity will fall, leaving the person at risk for
angina.
23. Answer: A. Decreased cardiac output. Decreased
cardiac output is more important than the other
choices because it can jeopardize the client’s life.
24. Answer: A. Diarrhea. Diarrhea will cause
debilitation as fluid and nutrients are lost at a
time when the body most needs to be nourished.
25. Answer: A. Single-agent therapy produces cell
lines that are resistant. Single-agent therapy
tends to produce resistant tumor cells, making
remission or cure impossible.

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