Pharmacology: Pharmacology: Adverse Effects Practice Questions
Test yourself on Pharmacology: Adverse Effects with 12 original NCLEX-RN practice questions. Pick an answer to see instant feedback and a full explanation.
Free original practice questions for study purposes. Open Exam Prep is an independent study resource and is not affiliated with, endorsed by, or sponsored by the makers of NCLEX-RN.
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1. A client receiving IV vancomycin develops flushing, erythema of the face and upper body, and pruritus shortly after the infusion begins. Which nursing action is most appropriate?
Explanation. Flushing of the face/upper body (vancomycin flushing syndrome, formerly 'red man syndrome') results from histamine release with too-rapid infusion. Slowing the rate typically resolves it; it is not a true allergy. Anaphylaxis would include hypotension and bronchospasm, which are absent here.
2. A client taking warfarin reports new black, tarry stools. The nurse recognizes this finding most likely indicates which adverse effect?
Explanation. Black, tarry stools (melena) indicate GI bleeding, a serious adverse effect of warfarin's anticoagulant action. The nurse should check INR and notify the provider. It is not a normal byproduct, hepatotoxicity, or allergy.
3. A client on long-term prednisone therapy should be monitored for which adverse effect?
Explanation. Corticosteroids like prednisone raise blood glucose, promote fluid retention, cause hypokalemia (not hyperkalemia), weight gain, and increased infection risk. Hyperglycemia is a classic adverse effect requiring monitoring.
4. A client receiving aminoglycoside therapy (gentamicin) should be monitored most closely for which two adverse effects?
Explanation. Aminoglycosides are well known for nephrotoxicity (monitor BUN/creatinine) and ototoxicity (hearing/balance changes). Peak and trough levels are drawn to minimize these. The other pairings belong to different drug classes.
5. A client starting an ACE inhibitor (lisinopril) develops a persistent dry, hacking cough. The nurse explains that this adverse effect is caused by:
Explanation. ACE inhibitors block breakdown of bradykinin, leading to its accumulation and a characteristic persistent dry cough. The drug is often switched to an ARB, which does not cause cough. It is not direct irritation or pulmonary edema.
6. A client taking the antipsychotic haloperidol develops a high fever, muscle rigidity, altered mental status, and autonomic instability. The nurse suspects:
Explanation. Neuroleptic malignant syndrome (NMS) is a life-threatening reaction marked by hyperthermia, lead-pipe rigidity, altered consciousness, and autonomic instability. It is a medical emergency. Tardive dyskinesia (involuntary movements) and akathisia (restlessness) are not febrile emergencies.
7. A client receiving long-term phenytoin should be assessed for which oral adverse effect?
Explanation. Phenytoin classically causes gingival hyperplasia (overgrowth of gum tissue); meticulous oral hygiene and dental follow-up are taught. The other options are associated with different drugs/conditions.
8. A client on amiodarone reports a new dry cough and dyspnea on exertion. The nurse is most concerned about which serious adverse effect?
Explanation. Amiodarone can cause pulmonary toxicity (pneumonitis/fibrosis), presenting with dry cough and dyspnea. Baseline and periodic chest X-rays and pulmonary function tests are recommended. While amiodarone affects the thyroid and eyes, the respiratory symptoms point to pulmonary toxicity.
9. A client taking a statin (atorvastatin) reports unexplained muscle pain and weakness along with dark-colored urine. The nurse should:
Explanation. Muscle pain/weakness with dark urine suggests rhabdomyolysis, a serious statin adverse effect that can cause myoglobinuria and renal damage. The nurse should hold the drug and notify the provider; a CK level would be checked. This is not an expected ache or an allergic reaction.
10. A client receiving heparin therapy has a sudden drop in platelet count to 90,000/mm³ (from a baseline of 250,000/mm³) on day 6. The nurse recognizes this may indicate:
Explanation. A significant platelet drop occurring around days 5–10 of heparin therapy suggests heparin-induced thrombocytopenia (HIT), an immune-mediated reaction that paradoxically increases clotting risk. Heparin must be stopped. Thrombocytopenia is not a normal/therapeutic effect.
11. A client started on isoniazid (INH) for tuberculosis should be monitored for which adverse effect?
Explanation. Isoniazid can cause peripheral neuropathy (pyridoxine/B6 is given to prevent it) and hepatotoxicity (monitor LFTs, teach signs of liver injury). The other pairings are linked to corticosteroids, fluoroquinolones, and ACE inhibitors.
12. A client on opioid analgesics reports no bowel movement in three days. The nurse understands that constipation from opioids:
Explanation. Unlike sedation and nausea, tolerance to opioid-induced constipation does NOT develop. It persists with ongoing use, so a prophylactic bowel regimen (stimulant laxative ± stool softener, fluids, activity) is standard. It is not an allergy and occurs by all routes.
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FAQ
How do I tell the difference between an expected side effect and a serious adverse effect on the NCLEX?
Side effects are common, often dose-related, and manageable (e.g., mild drowsiness, dry mouth). Serious adverse effects threaten organ function or life (e.g., rhabdomyolysis, NMS, HIT, GI bleeding) and usually require holding the drug and notifying the provider. On exam questions, look for vital-sign instability, organ-specific damage, or hallmark syndrome clusters to flag a reportable adverse effect.
What is the best strategy for memorizing drug adverse effects?
Group drugs by class and learn the signature toxicities: aminoglycosides = nephro/ototoxicity, statins = rhabdomyolysis, ACE inhibitors = cough/angioedema/hyperkalemia, corticosteroids = hyperglycemia/infection/osteoporosis. Then attach the priority nursing action (assess, hold, monitor lab, teach). Linking a key assessment finding to one action helps you answer application-level items quickly.
Do NCLEX questions test specific lab values for monitoring drug toxicity?
Yes. Know which labs pair with which drugs: warfarin/INR, heparin/aPTT and platelets, aminoglycosides/peak-trough and creatinine, statins/CK and LFTs, isoniazid and amiodarone/LFTs. Recognizing an abnormal value plus a symptom is often the key to identifying the correct adverse-effect answer.