NCLEX Practice Exam for Pharmacology: Immunologic Medications

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1. An HIV-positive client who has been started on highly active antiretroviral therapy (HAART) came back for a follow-up checkup. Which of the following will be the most helpful in determining the response to the therapy?

  1. Rapid HIV antigen test.
  2. Western Blot analysis.
  3. Viral load test.
  4. White blood cell count.

2. A client with acquired immunodeficiency syndrome is prescribed with Zidovudine (Azidothymidine). Which of the following laboratory results should the nurse monitor while on this medication?

  1. Throat swab gram stain.
  2. Complete blood count.
  3. Random blood sugar.
  4. Blood uric acid.

3. The client who is human immunodeficiency virus seropositive has been taking Saquinavir (Invirase). The nurse provides medication instructions and advises the client to:

  1. Take the medication in the morning before meals.
  2. Include a low-fat diet.
  3. Weight gain is expected.
  4. Avoid being exposed to sunlight.

4. Stavudine (Zerit) is prescribed to a client with human immunodeficiency virus seropositive. The nurse observes which of the following most closely while the client is taking the medication?

  1. Orientation.
  2. Gag reflex.
  3. Appetite.
  4. Gait.

5. A nurse is evaluating a client who is HIV positive who is prescribed with Pentamidine (Pentam) IV for the treatment of Pneumocystis carinii pneumonia. Which of the following assessment after the administration is the most important to relay to the physician?

  1. Blood pressure of 100/62 mm/Hg.
  2. Redness and pain at the site of the infusion.
  3. Sudden sweating and hunger.
  4. Unusual taste or dryness in the mouth.

6. A client is prescribed with Pentamidine (Pentam) IV for the treatment of Pneumocystis carinii pneumonia. Suddenly, the client develops a temperature of 101.5°F. The nurse in charge knows that this sign would mostly indicate on which of the following?

  1. An overdosage of the medication.
  2. The need for an additional dosage.
  3. The client has developed another infection.
  4. The client is experiencing the therapeutic effect of the medication.

7. While on Pentamidine (Pentam) infusion therapy. The nurse must anticipate doing which of the following?

  1. Obtain a 12-lead ECG.
  2. Observe for signs of retinal damage.
  3. Instruct the client on a low potassium diet.
  4. Instruct the client on limit fluid intake.

8. The nurse is monitoring a post-renal transplantation client taking Cyclosporine (Neoral). The nurse observes an elevation in one of the client’s vital sign and the client is complaining of sweating and headache. Which of the following vital sign is most likely increased?

  1. Respiratory rate.
  2. Pulse rate.
  3. Temperature.
  4. Blood pressure.

9. A nurse is doing an assessment data while completing an admission for a patient with a history of liver transplant who is receiving cyclosporine (Sandimmune), Prednisone (Orasone), and Azathioprine (Imuran). Which of the following information will give the nurse the most attention?

  1. The client has a soft non-tender lump in the shoulder.
  2. An increase cholesterol level.
  3. Grade 1+ pitting edema in the feet.
  4. Swollen and pinkish gums noted.

10. A client is admitted to the emergency room complaints of a difficulty of breathing and upon auscultation, the nurse noted that the patient has wheezes. An allergic reaction to penicillin was diagnosed. Which of the following medications should the nurse expect to administer first?

  1. Aminophylline (Theophylline).
  2. Albuterol (Ventolin HFA).
  3. Methylprednisolone (Solu-Medrol).
  4. Pulmicort (Budesonide).

11. The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet (Foscavir). The nurse carefully monitors which of the following laboratory test during the treatment with this medication, except?

  1. Serum creatinine.
  2. Serum calcium.
  3. Serum magnesium.
  4. Serum sodium.

12. A client is recently diagnosed with HIV and a highly antiretroviral therapy is started. After the first week of therapy, the patient complains of headaches, dizziness, and nightmares. Which one of the following anti-retroviral drugs is most likely associated with these symptoms?

  1. Lamivudine.
  2. Efavirenz.
  3. Tenofovir.
  4. Saquinavir.

13. Sirolimus (Rapamune) is prescribed to a post-renal transplantation client. Upon the review of the chart, the nurse expects which of the following laboratory results?

  1. Elevated serum potassium.
  2. Decreased cholesterol level.
  3. Elevated platelet count.
  4. Elevated triglyceride level.

14. A post-kidney transplant client went to the health care facility to ask the nurse regarding vaccinations while on Tacrolimus (Prograf) a medication used to prevent organ rejection. Which of the following is an appropriate response of the nurse?

  1. “Do not skip due doses of vaccination for this can help in your treatment”.
  2. “You can have live vaccinations even without the approval of the physician”.
  3. “Influenza can happen anytime, so a flu vaccine is a must.”
  4. “Do not receive any live vaccinations while on this treatment”.

15. A nurse is giving instructions to a client who is receiving Mycophenolate mofetil (CellCept) and Mycophenolic acid (Myfortic) after undergoing a heart transplant. The nurse tells the client to anticipate the following side effects, except?

  1. Insomnia.
  2. Vomiting.
  3. Hypertension.
  4. Diarrhea.

16. Amikacin (Amikin) is given to a client with E-coli infection. The nurse advises the client to report which of the following symptoms immediately?

  1. Muscle pain.
  2. Constipation.
  3. Fatigue.
  4. Hearing loss.

17. A client went to the emergency room with complaints of abdominal pain, nausea, diarrhea and mucoid stools. Upon the interview of the nurse, the client stated that he is taking Cefixime (Suprax) for the treatment of urinary tract infection. The nurse determines that the client is most likely suffering from?

  1. Crohn’s disease.
  2. Acute Gastroenteritis.
  3. Acute appendicitis.
  4. Pseudomembranous colitis.

18. Amphotericin B (Fungizone) IV is given to a client with aspergillosis, a fungal infection. In order to prevent its side effects, the nurse anticipate administering which of the following prior, except?

  1. Hydrocortisone.
  2. Ketoconazole.
  3. Diphenhydramine.
  4. Meperidine.

19. A nurse is giving instructions to a client taking Ciprofloxacin (Cipro) for the treatment of gonorrhea. The nurse tells the client to?

  1. Report any history of tendon problems.
  2. Resume daily exercise such as biking.
  3. Take an antacid 30 minutes prior.
  4. Take it with a yogurt as part of the treatment.

20. Tetracycline has been prescribed for a client with Chlamydia trachomatis infection. Select the side effect of the medication. Select all that apply?

  1. Glossitis.
  2. Tremors.
  3. Urinary frequency.
  4. Discoloration of the nails.
  5. Photosensitivity.
Answers and Rationale

1. Answer: C. Viral load test. A viral load test helps provide information on the health status and how well antiretroviral therapy (ART – treatment with HIV medicines) is controlling the virus.

  • Options A and B monitors the presence of antibodies to HIV, so these tests will yield a positive result after the patient is infected with HIV even if the drug therapy is effective.
  • Option D will be used to assess the impact of HIV on immune function but will not directly measure the effectiveness of the medicines.

2. Answer: B. Complete blood count. Zidovudine may decrease the number of a certain type of white blood cell in the blood and cause anemia and muscle disorders.

  • Options A, C, and D are not related to the medication.

3. Answer: D. Avoid being exposed to sunlight. Saquinavir (Invirase) is an antiviral medicine that prevents human immunodeficiency virus (HIV) from multiplying in the body. This can cause photosensitivity so the nurse should instruct the client to avoid sun exposure.

  • Option A: The medicine is taken with food or within 2 hours after eating a full meal.
  • Option B: The medicine is best absorbed with a high-fat meal.
  • Option C: Weight loss instead is expected.

4. Answer: D. Gait. One of the most serious side effects of Stavudine (Zerit) is peripheral neuropathy so the nurse should monitor the client’s gait while taking this medication.

  • Options A, B, and C are not related to the use of the medication.

5. Answer: C. Sudden sweating and hunger. Pentamidine can cause fatal hypoglycemia, so symptoms such as sudden sweating and hunger are indicative of a low blood sugar indicates a need for change in the treatment.

  • Option A: A low blood pressure may indicate the need of a slower infusion.
  • Option B: Redness and Pain is a sign for the nurse to establish a new IV line.
  • Option D: Dryness and unusual taste may happen at the start but do not need for an immediate notification of the physician.

6. Answer: C. The client has developed another infection. Pentamidine can cause low white blood cells or low platelets in your blood, so the client is most likely developed another infection brought about these side effects.

  • Options A, B, and D are inappropriate interpretation.

7. Answer: A. Do a 12-lead ECG. Pentamidine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need an urgent medical attention.

  • Options B and D are not related to the use of the medication.
  • Option C: Low levels of potassium in the blood can increase the risk of QT prolongation.

8. Answer: D. Blood pressure. Hypertension is one of the side effects of taking cyclosporine (Neoral) and since the client is also complaining of sweating and headache, the blood pressure is the important sign to be monitored closely.

9. Answer: A. The client has a soft non-tender lump in the shoulder. A client taking immunosuppressive medications are at risk for development of cancer. A soft non-tender lump will indicate that the patient has lymphoma.

  • Options B, C, and D are common side effects of the immunosuppressive medications.

10. Answer: B. Albuterol (Ventolin HFA). Albuterol (Ventolin HFA) is the most rapidly acting of the medications among the choices.

  • Option A is not the first line treatment for a bronchospasm.
  • Options C and D are corticosteroids that are used during allergic reaction but are not rapidly acting.

11. Answer: D. Serum sodium. Renal impairment is the major toxicity involve in Foscarnet (Foscavir); This medicine also may cause decreased levels of calcium, magnesium, phosphorous, and potassium.

12. Answer: B. Efavirenz. Efavirenz is a non-nucleoside reverse transcriptase inhibitor. Side effects include rash, dizziness, confusion, headache, and nightmares.

  • Options A and C: Lamivudine and Tenofovir side effects includes headache, dizziness, nausea, diarrhea, or trouble sleeping.
  • Option D: Saquinavir can cause headache, nausea, diarrhea, and photosensitivity.

13. Answer: D. Elevated triglyceride level. Sirolimus (Rapamune) raises cholesterol and triglyceride levels. This medication also causes a decrease in potassium and platelet count.

14. Answer: D. “Do not receive any live vaccinations while on this treatment”. Tacrolimus may lower your body’s resistance and the vaccine may not work as well or the client may get the infection the vaccine is meant to prevent.

15. Answer: A. Insomnia. These medications can cause diarrhea, vomiting, sepsis, back pain, neutropenia and hypertension.

16. Answer: D. Hearing loss. Amikacin is an aminoglycoside. Side effects of this medication includes ototoxicity (Hearing loss), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes and nephrotoxicity.

  • Options A, B, and C are not related with the medication.

17. Answer: D. Pseudomembranous colitis. Pseudomembranous colitis also called antibiotic-associated colitis or C. difficile colitis, is the inflammation of the colon associated with an overgrowth of the bacterium Clostridium difficile. This overgrowth of C. difficile is most often related to recent antibiotic use such as ampicillin, clindamycin, fluoroquinolones, and cephalosporins.

  • Options A, B, and C may have the symptoms of the client but are not likely due to this case.

18. Answer: B. Ketoconazole. Azole antifungals (eg, ketoconazole) decreases the effectiveness of amphotericin b.

  • Options A and C: Fever, shaking, chills, flushing, loss of appetite, dizziness, nausea, vomiting, headache, shortness of breath, or fast breathing may occur 1 to 3 hours after the infusion is started. Medications such as acetaminophen, diphenhydramine, corticosteroids such as hydrocortisone) may be necessary to prevent these side effects.
  • Option D: Meperidine (25 to 50 mg IV) has been shown in some patients to decrease the duration of shaking chills and fever that may accompany the infusion of amphotericin B.

19. Answer: A. Report any history of tendon problems. Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles’ tendon of the heel. This can happen during treatment or up to several months after the client stop taking ciprofloxacin

  • Option B: This medication can cause dizziness so avoid any activity that requires alertness until the client is sure to perform such activities safely.
  • Option C: Take ciprofloxacin at least 2 hours before or 6 hours after taking an antacid.
  • Option D: Eating dairy products such as yogurt will impair the effectiveness of ciprofloxacin.

20. Answer: A. Glossitis., D. Discoloration of the nails., E. Photosensitivity. Side effects of tetracycline include glossitis, discoloration of the nails, photosensitivity,  anorexia, nausea, vomiting, diarrhea, bulky loose stools, stomatitis, sore throat, black hairy tongue,dysphagia,and hoarseness.