NCLEX-RN Pharmacology Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Easy

   A nurse discovers that a prescribed morning dose of lisinopril 20 mg was inadvertently administered to the wrong client 30 minutes ago. Which action should the nurse take first?

   1. AA. Complete a facility variance report.
   2. BB. Notify the prescribing health care provider.
   3. CC. Administer intravenous fluids to prevent hypotension.
   4. DD. Measure the client's blood pressure and pulse.
   Show answer to question 1

   Answer: D. Measure the client's blood pressure and pulse.

   The client's safety is always the immediate priority following a medication error, so the nurse must assess vital signs and clinical stability before initiating other steps. Provider notification and incident reporting are necessary, but they occur after the initial nursing assessment. Initiating intravenous fluids without an order and before assessing the client is inappropriate.

2. Question 2 of 25Easy

   A nurse prepares to administer a scheduled dose of oral indomethacin to a client hospitalized with acute gout. Which assessment finding should lead the nurse to withhold the dose and alert the provider?

   1. AA. Chronic localized plaque psoriasis
   2. BB. Well-controlled essential hypertension
   3. CC. Active peptic ulcer disease
   4. DD. Primary chronic open-angle glaucoma
   Show answer to question 2

   Answer: C. Active peptic ulcer disease

   Nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin inhibit cyclooxygenase-1 (COX-1), decreasing protective gastric mucosal prostaglandins and significantly worsening active peptic ulcer disease and gastrointestinal bleeding. Glaucoma and psoriasis are not contraindications to short-term NSAID therapy for acute gout. While NSAIDs can increase fluid retention and elevate blood pressure, controlled hypertension warrants monitoring rather than an outright immediate withholding compared to active peptic ulceration.

3. Question 3 of 25Easy

   A nurse is providing preoperative education to a client who will use a patient-controlled analgesia (PCA) pump with hydromorphone following thoracic surgery. Which statement by the client indicates an understanding of the teaching?

   1. AA. I will wait until the pain is intolerable so that I do not become dependent.
   2. BB. My family can push the button for me if I am sleeping and seem uncomfortable.
   3. CC. I should push the button when I begin to feel pain before it becomes severe.
   4. DD. The machine will deliver a dose every time I push the button without restrictions.
   Show answer to question 3

   Answer: C. I should push the button when I begin to feel pain before it becomes severe.

   PCA is most effective when the client self-administers a dose at the onset of discomfort rather than waiting for pain to peak, which makes relief harder to achieve. Allowing family members to activate the pump increases the risk of fatal overdose, as only the client should operate the button.

4. Question 4 of 25Hard

   A 57-year-old client on the oncology unit has a PICC. Before drawing blood, the nurse flushes the lumen easily with 10 mL of 0.9% sodium chloride but cannot aspirate a blood return. There is no swelling, pain or leakage at the site, and the client is breathing comfortably. Which explanation is most likely?

   1. AA. A clot is completely blocking the catheter lumen.
   2. BB. There is a positional or partial withdrawal occlusion at the catheter tip.
   3. CC. An air embolism developed during the flushing procedure.
   4. DD. The flush solution has infiltrated into the surrounding tissue of the upper arm.
   Show answer to question 4

   Answer: B. There is a positional or partial withdrawal occlusion at the catheter tip.

   When a catheter flushes freely but will not yield blood, the tip is often resting against the vessel wall or covered by a fibrin sheath that acts as a one-way valve. The nurse has the client change position, raise the arm and cough, then follows protocol if blood return is still absent.

   Why the other options are wrong

   • AA complete clot blocks flow in both directions, so the lumen would resist flushing.
   • CAir embolism causes sudden dyspnea, chest pain and hypotension, none of which are present.
   • DInfiltration would cause swelling, pain or leakage at the site, which are absent.

5. Question 5 of 25Easy

   The nurse evaluates the therapeutic response of a client receiving intravenous furosemide for acute pulmonary edema. Which assessment finding indicates the medication is having its intended effect?

   1. AA. Serum potassium concentration increases to 4.8 mEq/L.
   2. BB. Crackles previously heard at bilateral lung bases have resolved.
   3. CC. Systolic blood pressure increases to 142 mm Hg.
   4. DD. Jugular venous distention is noticeable while sitting at 45 degrees.
   Show answer to question 5

   Answer: B. Crackles previously heard at bilateral lung bases have resolved.

   Furosemide is a loop diuretic that promotes rapid diuresis, reducing circulating blood volume and pulmonary congestion in clients with pulmonary edema; clear lung sounds demonstrate successful resolution of fluid overload. Persistent jugular venous distention suggests continued volume excess, while furosemide typically lowers potassium and blood pressure rather than increasing them.

6. Question 6 of 25Medium

   A 50-year-old client with short bowel syndrome is receiving parenteral nutrition at 75 mL/hr through a PICC. Which observation requires the nurse to intervene?

   1. AA. The administration tubing was replaced when the current bag was hung.
   2. BB. The client's capillary blood glucose is checked every 6 hours.
   3. CC. Other medications are given through a separate lumen of the catheter.
   4. DD. The LPN/VN plans to speed up the rate because the bag is behind schedule.
   Show answer to question 6

   Answer: D. The LPN/VN plans to speed up the rate because the bag is behind schedule.

   Parenteral nutrition runs at a constant prescribed rate and is never increased to catch up, because a sudden rise in dextrose delivery can cause hyperglycemia and fluid overload. The nurse stops the rate change and contacts the health care provider if the delivered volume is significantly behind.

   Why the other options are wrong

   • AReplacing the administration set with each new parenteral nutrition bag, at least every 24 hours, is correct practice.
   • BRegular glucose monitoring detects hyperglycemia, a common complication of parenteral nutrition.
   • CGiving other medications through a separate lumen avoids incompatibilities and reduces infection risk.

7. Question 7 of 25Medium

   A primary healthcare provider prescribes 2.5 mL of an intramuscular medication for an adult client. Which action should the nurse take to administer this medication safely?

   1. AA. Change the administration route to the subcutaneous tissue.
   2. BB. Divide the dose and administer two injections into the deltoid.
   3. CC. Inject the full volume into the deltoid muscle as a single dose.
   4. DD. Select the ventrogluteal site for administration.
   Show answer to question 7

   Answer: D. Select the ventrogluteal site for administration.

   The ventrogluteal muscle is a large, well-developed deep muscle that safely accommodates volumes up to 2.5 to 3 mL in an adult. The deltoid muscle should receive no more than 1 mL (rarely up to 2 mL in exceptionally muscular adults) because larger volumes cause local tissue trauma and severe discomfort. Dividing 2.5 mL across two deltoid injections is unnecessary and causes avoidable pain when a single injection in the ventrogluteal site is appropriate.

8. Question 8 of 25Easy

   A 65-year-old client with chronic heart failure is prescribed digoxin 0.125 mg daily. Which assessment finding requires the nurse to hold the medication and notify the provider?

   1. AA. A heart rate of 54 beats per minute.
   2. BB. A respiratory rate of 16 breaths per minute.
   3. CC. A serum potassium level of 4.0 mEq/L.
   4. DD. A blood pressure reading of 128/78 mmHg.
   Show answer to question 8

   Answer: A. A heart rate of 54 beats per minute.

   Digoxin slows conduction through the AV node and can cause bradycardia. An apical heart rate below 60 beats per minute in an adult is the usual parameter for holding the dose and notifying the provider, so a rate of 54 requires action.

   Why the other options are wrong

   • BA respiratory rate of 16 breaths per minute is normal and is not a criterion for holding digoxin.
   • CA potassium level of 4.0 mEq/L is normal; it is low potassium that increases the risk of digoxin toxicity.
   • DA blood pressure of 128/78 mmHg is acceptable and does not affect the decision to give digoxin.

9. Question 9 of 25Medium

   A nurse is preparing to administer two prescribed ophthalmic medications to a client: brimonidine eye drops and ciprofloxacin eye drops. What action should the nurse take regarding the timing of administration?

   1. AA. Administer the second eye drop immediately following the first drop.
   2. BB. Wait at least 5 minutes after instilling the first drop before administering the second drop.
   3. CC. Allow a minimum interval of 30 minutes between the instillation of each medication.
   4. DD. Mix both ophthalmic solutions together in a sterile syringe before instillation.
   Show answer to question 9

   Answer: B. Wait at least 5 minutes after instilling the first drop before administering the second drop.

   When administering multiple ophthalmic drops, the nurse should wait at least 5 minutes between medications to prevent dilution and washout of the initial dose. Administering drops back-to-back causes overflow and poor therapeutic absorption of both agents. Mixing ophthalmic solutions is unsafe and alters drug stability, while a 30-minute delay is unnecessarily prolonged.

10. Question 10 of 25Medium

    A home health nurse is visiting a client who is prescribed a transdermal fentanyl patch for palliative pain management. Which action by the caregiver indicates a need for further teaching regarding patch disposal?

    1. AA. Washing hands thoroughly with plain water immediately after handling the patch
    2. BB. Immediately flushing the folded used patch down the toilet per manufacturer directions
    3. CC. Discarding the folded patch directly into the household open wastebasket
    4. DD. Folding the used patch in half with the adhesive sides pressed together
    Show answer to question 10

    Answer: C. Discarding the folded patch directly into the household open wastebasket

    Used transdermal fentanyl patches retain significant amounts of active opioid medication that can be lethal to children or pets if ingested or handled; therefore, tossing them into an open wastebasket is unsafe. Federal guidelines recommend folding the patch in half with the sticky sides together and immediately flushing it down the toilet or placing it into a designated take-back receptacle. Washing the hands with water rather than alcohol-based sanitizers is appropriate because alcohol can enhance opioid absorption.

11. Question 11 of 25Medium

    A 78-year-old client with heart failure is prescribed digoxin 0.125 mg daily. The client's laboratory results show a serum creatinine level of 2.1 mg/dL and blood urea nitrogen of 38 mg/dL. Which action by the nurse is most appropriate?

    1. AA. Withhold the medication and contact the healthcare provider to adjust the dosage.
    2. BB. Administer the medication with a potassium-sparing diuretic to enhance elimination.
    3. CC. Administer the medication as ordered because the prescribed dose is minimal.
    4. DD. Change the route of administration from oral to intravenous to prevent gastric irritation.
    Show answer to question 11

    Answer: A. Withhold the medication and contact the healthcare provider to adjust the dosage.

    Digoxin is primarily cleared unchanged by the kidneys, so decreased renal function results in prolonged half-life and drug accumulation, significantly raising the risk for life-threatening toxicity. Administering the medication without provider consultation is unsafe because even standard maintenance doses can quickly accumulate to toxic levels when renal clearance is impaired.

12. Question 12 of 25Hard

    An emergency department nurse administers intravenous naloxone to a client who presented with an acute oxycodone overdose. Within 5 minutes, the client becomes alert, oriented, and demands to leave the facility against medical advice. Which physiological rationale must guide the nurse's response to keep the client monitored?

    1. AA. Severe rebound hypertension and intracranial hemorrhage routinely develop as naloxone clears.
    2. BB. Naloxone triggers acute noncardiogenic pulmonary edema in the majority of treated clients.
    3. CC. The duration of action of naloxone is often substantially shorter than that of the opioid.
    4. DD. Rapid clearance of naloxone causes severe metabolic acidosis requiring sodium bicarbonate.
    Show answer to question 12

    Answer: C. The duration of action of naloxone is often substantially shorter than that of the opioid.

    Naloxone has a short half-life, with its antagonistic action typically lasting 30 to 90 minutes, whereas many prescription opioids have durations of action lasting 4 to 12 hours or longer. As naloxone metabolizes, the client is at severe risk of resedation and recurrent life-threatening respiratory depression. While pulmonary edema is a rare adverse effect of rapid opioid reversal, the primary reason for continued monitoring is the mismatch between the half-life of naloxone and the longer duration of the ingested opioid.

13. Question 13 of 25Medium

    A nurse reviews the home medication profile of a client receiving maintenance lithium therapy for bipolar disorder. The primary healthcare provider prescribes hydrochlorothiazide 25 mg daily for newly diagnosed hypertension. Which action should the nurse take first?

    1. AA. Request a prescription for a potassium supplement to prevent hypokalemia.
    2. BB. Administer both medications and monitor the client's daily blood pressure.
    3. CC. Hold the hydrochlorothiazide and notify the healthcare provider of a potential drug interaction.
    4. DD. Instruct the client to restrict dietary sodium intake while taking both medications.
    Show answer to question 13

    Answer: C. Hold the hydrochlorothiazide and notify the healthcare provider of a potential drug interaction.

    Thiazide diuretics promote sodium excretion, which causes the kidneys to reabsorb lithium competitively in the proximal tubules, significantly increasing the risk of lithium toxicity. Holding the medication and contacting the healthcare provider to recommend an alternative antihypertensive agent is the priority action. Instructing the client to restrict dietary sodium would further decrease lithium clearance and worsen the risk of severe toxicity.

14. Question 14 of 25Medium

    A client receiving an intravenous infusion of vancomycin develops facial erythema, warmth, and itching of the neck and chest 15 minutes after the infusion starts. Blood pressure is 116/74 mm Hg, pulse is 82 beats/min, and oxygen saturation is 98% on room air. Which action should the nurse take first?

    1. AA. Stop or slow the infusion and notify the healthcare provider
    2. BB. Administer intramuscular epinephrine and summon emergency assistance
    3. CC. Discontinue the peripheral catheter and apply a warm moist compress
    4. DD. Increase the primary maintenance fluid rate to flush the IV tubing
    Show answer to question 14

    Answer: A. Stop or slow the infusion and notify the healthcare provider

    The client is exhibiting vancomycin infusion reaction, formerly known as red man syndrome, which is a rate-related histamine reaction characterized by flushing, erythema, and pruritus without true IgE-mediated anaphylaxis. Stopping or slowing the infusion relieves histamine release, and the provider should be notified to obtain orders for an antihistamine and a slower infusion rate. Administering intramuscular epinephrine is inappropriate because the client has stable hemodynamics and no signs of systemic anaphylaxis such as airway compromise or hypotension.

15. Question 15 of 25Hard

    A 70-year-old client in the emergency department with septic shock is receiving norepinephrine through a peripheral IV catheter in the left forearm while central venous access is being arranged. The nurse notes that the skin around the insertion site is cool, pale and swollen. Which action should the nurse take first?

    1. AA. Flush the catheter with 10 mL of 0.9% sodium chloride to clear the vein.
    2. BB. Stop the infusion and aspirate residual drug through the catheter.
    3. CC. Remove the catheter and apply firm pressure to the site for 5 minutes.
    4. DD. Slow the infusion rate and elevate the arm on a pillow.
    Show answer to question 15

    Answer: B. Stop the infusion and aspirate residual drug through the catheter.

    Norepinephrine is a vesicant, and these findings indicate extravasation. The infusion is stopped and residual drug is aspirated before the catheter is removed; the vasopressor is restarted at another site, and the health care provider is notified so the antidote phentolamine can be given per protocol.

    Why the other options are wrong

    • AFlushing pushes more vesicant into the tissue and worsens the injury.
    • CRemoving the catheter first prevents aspiration of residual drug and loses access that may be used per protocol.
    • DContinuing the infusion at any rate allows more vesicant to leak into the tissue.

16. Question 16 of 25Medium

    A 49-year-old client with type 2 diabetes started semaglutide 0.25 mg subcutaneously once weekly 3 weeks ago. During a follow-up call, which client report should the nurse address first?

    1. AA. "I feel full sooner than before, and I'm eating smaller meals."
    2. BB. "I had some mild nausea the day after my last injection."
    3. CC. "Severe upper belly pain going through to my back started last night."
    4. DD. "I give my injection on the same day every week, usually in my thigh."
    Show answer to question 16

    Answer: C. "Severe upper belly pain going through to my back started last night."

    GLP-1 receptor agonists such as semaglutide have been associated with acute pancreatitis. Persistent severe abdominal pain radiating to the back requires stopping the drug and prompt medical evaluation.

    Why the other options are wrong

    • AEarly satiety and smaller meals are expected effects that contribute to glucose and weight control.
    • BMild nausea is common, especially early in therapy, and often improves over time.
    • DInjecting on the same day each week into the thigh, abdomen or upper arm is correct use.

17. Question 17 of 25Medium

    A client with heart failure receives a new prescription for spironolactone 25 mg orally daily. Which dietary instruction should the nurse include when teaching this client?

    1. AA. Increase the intake of citrus fruits and green leafy vegetables.
    2. BB. Avoid using potassium-containing salt substitutes.
    3. CC. Restrict dietary protein to prevent kidney overload.
    4. DD. Drink at least four liters of fluid each day.
    Show answer to question 17

    Answer: B. Avoid using potassium-containing salt substitutes.

    Spironolactone is an aldosterone antagonist that promotes sodium excretion while retaining potassium in the distal renal tubules, placing the client at high risk for dangerous hyperkalemia if potassium-containing salt substitutes are consumed. Increasing potassium-rich foods such as citrus fruits or dark greens could trigger cardiac arrhythmias. Forcing high fluid intake of four liters daily is contraindicated because it exacerbates volume overload in heart failure.

18. Question 18 of 25Medium

    A 34-year-old female client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis. The nurse initiates an intravenous insulin infusion at 0.1 units/kg/hr per protocol. The client's blood glucose is 520 mg/dL. One hour later, the blood glucose is 490 mg/dL. Which action should the nurse take?

    1. AA. Increase the insulin infusion to 0.14 units/kg/hr and recheck the blood glucose in 1 hour.
    2. BB. Continue the current infusion rate and monitor the blood glucose level every 2 hours.
    3. CC. Administer a 10-unit intravenous bolus of regular insulin and continue the current infusion.
    4. DD. Decrease the insulin infusion to 0.05 units/kg/hr to prevent hypoglycemia and recheck in 2 hours.
    Show answer to question 18

    Answer: A. Increase the insulin infusion to 0.14 units/kg/hr and recheck the blood glucose in 1 hour.

    In DKA, glucose should fall about 50 to 75 mg/dL per hour. A drop of only 30 mg/dL in the first hour is inadequate, so the infusion is titrated upward per protocol and glucose is rechecked hourly.

    Why the other options are wrong

    • BKeeping the same rate ignores an inadequate response, and checks every 2 hours are too infrequent during an insulin infusion.
    • CA fixed 10-unit bolus is not weight-based and is not the protocol's titration step; it would need a separate prescription.
    • DDecreasing the rate would slow glucose and ketone correction further when the response is already too slow.

19. Question 19 of 25Medium

    A nurse prepares to administer an immediate-release medication to an alert client through a small-bore nasogastric feeding tube. After confirming correct tube position and elevating the head of the bed, which action should the nurse take next?

    1. AA. Lower the head of the bed flat to facilitate gravity flow of the medication.
    2. BB. Mix the crushed medication with 60 mL of enteral feeding formula.
    3. CC. Instill 30 mL of air through the tube to test lumen patency.
    4. DD. Flush the tube with 15 to 30 mL of water before instilling the dissolved medication.
    Show answer to question 19

    Answer: D. Flush the tube with 15 to 30 mL of water before instilling the dissolved medication.

    Before administering any medication via an enteral tube, the nurse must flush the tube with 15 to 30 mL of water to establish patency and clear residual formula. The dissolved medication is then instilled, followed by another water flush to ensure the entire dose reaches the stomach. Injecting air is not an accepted method to clear the tube prior to medication administration, and the head of the bed should remain elevated at least 30 to 45 degrees to prevent aspiration.

20. Question 20 of 25Easy

    A 2-year-old child with otitis externa is prescribed antibiotic ear drops. Which technique should the nurse use to instill the drops?

    1. AA. Pull the earlobe down and back, and instill drops warmed to room temperature.
    2. BB. Pull the pinna up and back, and instill drops taken directly from the refrigerator.
    3. CC. Pull the earlobe down and back, and insert the dropper tip into the ear canal.
    4. DD. Pull the pinna up and back, and instill drops warmed to room temperature.
    Show answer to question 20

    Answer: A. Pull the earlobe down and back, and instill drops warmed to room temperature.

    In children younger than about 3 years, the ear canal is short and directed upward, so the earlobe is pulled down and back to straighten it. Drops at room or body temperature prevent the dizziness and discomfort caused by cold solution.

    Why the other options are wrong

    • BUp and back is the technique for adults and older children, and cold drops can cause vertigo and nausea.
    • CInserting the dropper into the canal can injure the canal and contaminate the dropper.
    • DPulling the pinna up and back straightens the ear canal of an adult, not a toddler.

21. Question 21 of 25Easy

    A nurse is caring for a client receiving continuous parenteral nutrition without lipids via a central venous access device. According to standard clinical guidelines, what is the maximum duration this parenteral nutrition solution container may hang before it must be replaced?

    1. AA. 48 hours
    2. BB. 72 hours
    3. CC. 12 hours
    4. DD. 24 hours
    Show answer to question 21

    Answer: D. 24 hours

    A container of parenteral nutrition amino acid and dextrose solution must be discarded and replaced every 24 hours to minimize the risk of microbial growth and catheter-related bloodstream infections. A 12-hour limit applies specifically to standalone intravenous lipid emulsions, whereas allowing a standard solution to hang for 48 or 72 hours significantly increases the risk of contamination.

22. Question 22 of 25Hard

    A client who received two units of fresh frozen plasma develops acute dyspnea, tachypnea, and severe hypoxemia 3 hours after completion of the infusion. Physical assessment reveals bilateral crackles, a temperature of 38.7 C (101.6 F), and a blood pressure of 84/50 mm Hg. A chest radiograph demonstrates diffuse bilateral infiltrates, and the B-type natriuretic peptide (BNP) is normal. Which complication should the nurse suspect?

    1. AA. Febrile non-hemolytic transfusion reaction
    2. BB. Delayed hemolytic transfusion reaction
    3. CC. Transfusion-associated circulatory overload
    4. DD. Transfusion-related acute lung injury
    Show answer to question 22

    Answer: D. Transfusion-related acute lung injury

    Transfusion-related acute lung injury (TRALI) is characterized by acute hypoxemia, non-cardiogenic pulmonary edema (diffuse infiltrates with normal BNP levels), fever, and hypotension developing within 6 hours of a transfusion containing plasma. Transfusion-associated circulatory overload produces cardiogenic pulmonary edema, which typically presents with hypertension, elevated BNP levels, and no fever. Febrile non-hemolytic reactions cause temperature elevation and rigors but do not produce acute lung injury or alveolar infiltrates.

23. Question 23 of 25Hard

    A client taking clonidine 0.2 mg orally twice daily for hypertension ran out of medication 2 days ago and decided to delay refilling it until an upcoming clinic visit. The home health nurse observes restlessness, diaphoresis, and tremors; blood pressure is 214/116 mm Hg and pulse is 120 beats/min. Which physiologic process explains the client's condition?

    1. AA. Rebound sympathetic overactivity resulting from the sudden discontinuation of an alpha-2 agonist
    2. BB. Acute adrenal crisis caused by secondary suppression of mineralocorticoid synthesis
    3. CC. Delayed hypersensitivity response to accumulated inactive clonidine metabolites
    4. DD. Reflex parasympathetic stimulation secondary to sudden vascular smooth muscle relaxation
    Show answer to question 23

    Answer: A. Rebound sympathetic overactivity resulting from the sudden discontinuation of an alpha-2 agonist

    Clonidine is a centrally acting alpha-2 adrenergic agonist that inhibits sympathetic outflow from the central nervous system; abrupt cessation causes a surge of catecholamines resulting in severe rebound hypertension, tachycardia, headache, and tremors. This condition is a medical emergency that requires prompt intervention to prevent stroke or myocardial infarction. It is not an allergic reaction, adrenal insufficiency, or a parasympathetic response.

24. Question 24 of 25Hard

    A client admitted with diabetic ketoacidosis is receiving an intravenous infusion of regular insulin at 0.1 units/kg/hr alongside normal saline. The client's blood glucose level decreases from 420 mg/dL to 230 mg/dL. Which prescription should the nurse anticipate next?

    1. AA. Administer subcutaneous insulin glargine and stop all intravenous fluids.
    2. BB. Add 5% dextrose to the intravenous fluids while continuing insulin therapy.
    3. CC. Discontinue the regular insulin infusion immediately to avoid hypoglycemia.
    4. DD. Double the regular insulin infusion rate to clear serum ketones more rapidly.
    Show answer to question 24

    Answer: B. Add 5% dextrose to the intravenous fluids while continuing insulin therapy.

    When blood glucose drops to approximately 200 to 250 mg/dL in diabetic ketoacidosis, 5% dextrose is added to intravenous fluids (such as 5% dextrose in 0.45% normal saline) to prevent hypoglycemia and cerebral edema from rapid osmolar shifts, while the insulin infusion is continued to resolve ongoing ketoacidosis. Discontinuing the insulin infusion prematurely will halt the suppression of lipolysis and ketogenesis, prolonging the acidotic state. Doubling the insulin rate is inappropriate and would cause precipitous hypoglycemia.

25. Question 25 of 25Hard

    A client who takes oral atenolol daily presents to the emergency department in anaphylactic shock following an insect sting. After receiving two doses of intramuscular epinephrine and normal saline boluses, the client remains hypotensive at 72/40 mm Hg and bradycardic at 46/min. Which medication should the nurse anticipate administering next?

    1. AA. Continuous infusion nitroprusside
    2. BB. Intravenous atropine
    3. CC. Intravenous glucagon
    4. DD. Continuous infusion dopamine
    Show answer to question 25

    Answer: C. Intravenous glucagon

    Clients receiving chronic beta-adrenergic antagonist therapy may develop refractory anaphylaxis that is unresponsive to epinephrine due to competitive beta-receptor blockade. Intravenous glucagon activates adenylate cyclase through non-beta-adrenergic pathways, providing positive inotropic and chronotropic effects that bypass blocked beta receptors. Atropine may not sufficiently overcome beta-blocker-mediated bradycardia in anaphylactic shock, and nitroprusside is a vasodilator that would worsen hypotension.

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