Pharmacology Exam Questions and Answers
A Comprehensive Review 2026/2027
Comprehensive Nursing Pharmacology Review
Key Domains: Cardiovascular Drugs | Respiratory Drugs | Endocrine Drugs | Neurologic Drugs |
Psychiatric Drugs | Anti-infectives | Gastrointestinal Drugs | Pain Management | Drug Calculations |
Mechanism of Action | Adverse Effects & Toxicity | Drug Interactions | Nursing Implications
Total Questions: 150 | Expert-Aligned Structure | Comprehensive Review Format
Instructions: This examination consists of 150 multiple-choice questions designed to assess comprehensive pharmacology
knowledge for safe medication administration. Select the best answer for each question. Correct answers are indicated in bold
cyan blue. Each question includes a detailed rationale explaining the drug's mechanism of action, therapeutic indication,
critical adverse effects, key nursing interventions, essential patient teaching points, and why alternative options are incorrect
or unsafe.
,SECTION 1: CARDIOVASCULAR DRUGS
1. A nurse is administering digoxin (Lanoxin) to a client with heart failure. Which assessment finding requires
holding the medication?
A. Blood pressure of 110/70 mmHg
B. Heart rate of 52 beats per minute
C. Respiratory rate of 18 breaths per minute
D. Serum potassium of 4.0 mEq/L
Rationale: The correct answer is Heart rate of 52 beats per minute. Digoxin is a cardiac glycoside that increases myocardial
contractility and slows conduction through the AV node. A heart rate below 60 bpm indicates bradycardia, a sign of digoxin
toxicity. The nurse must hold the medication and notify the healthcare provider. Mechanism: digoxin inhibits
Na+/K+-ATPase, increasing intracellular calcium. Critical adverse effects include bradycardia, arrhythmias, and visual
disturbances. Patient teaching: take apical pulse for 1 full minute before administration and hold if HR less than 60.
2. A client is receiving a continuous infusion of nitroglycerin for acute coronary syndrome. Which finding
indicates the infusion is achieving the desired therapeutic effect?
A. Blood pressure has decreased by 10%
B. Heart rate has increased by 20%
C. Chest pain has been relieved
D. Cardiac output has decreased
Rationale: The correct answer is Chest pain has been relieved. Nitroglycerin is a nitrate that causes venous and arterial
vasodilation, reducing myocardial oxygen demand and increasing oxygen supply. The primary therapeutic goal in acute
coronary syndrome is relief of chest pain. Mechanism: nitroglycerin converts to nitric oxide, causing smooth muscle
relaxation. Critical adverse effects: severe hypotension, reflex tachycardia, and headache. Patient teaching: report headache
(common side effect), rise slowly to prevent orthostatic hypotension.
3. A nurse is teaching a client about warfarin (Coumadin) therapy. Which statement indicates a need for further
teaching?
A. I will use a soft toothbrush to prevent bleeding.
B. I will maintain consistent intake of green leafy vegetables.
C. I can take ibuprofen for occasional headaches.
D. I will wear a medical alert bracelet indicating I take warfarin.
Rationale: The correct answer is I can take ibuprofen for occasional headaches. This statement indicates need for further
teaching. Ibuprofen is an NSAID that increases bleeding risk when combined with warfarin by inhibiting platelet function
and potentially causing GI ulceration. Mechanism: warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X).
Critical adverse effects: bleeding, INR elevation. Patient teaching: avoid NSAIDs, maintain consistent vitamin K intake,
report signs of bleeding, obtain regular INR monitoring.
4. A client with hypertension is prescribed lisinopril (Prinivil). Which adverse effect is most important for the
nurse to monitor?
A. Persistent dry cough
B. Reflex tachycardia
C. Hyperkalemia
D. Hypokalemia
Rationale: The correct answer is Hyperkalemia. Lisinopril is an ACE inhibitor that blocks conversion of angiotensin I to
angiotensin II, reducing aldosterone secretion. Decreased aldosterone leads to potassium retention and potential
hyperkalemia, which can cause life-threatening cardiac arrhythmias. Mechanism: ACE inhibition reduces angiotensin II and
aldosterone. Critical adverse effects: hyperkalemia, angioedema, persistent dry cough (due to bradykinin accumulation).
Patient teaching: avoid potassium supplements and salt substitutes containing potassium.
5. A nurse is caring for a client receiving amiodarone (Cordarone) for ventricular arrhythmias. Which baseline
test is essential before initiating therapy?
, A. Liver function tests only
B. Thyroid function tests and chest X-ray
C. Renal function tests only
D. Complete blood count only
Rationale: The correct answer is Thyroid function tests and chest X-ray. Amiodarone contains iodine and can cause both
hypothyroidism and hyperthyroidism. It also causes pulmonary toxicity, including interstitial pneumonitis. Baseline thyroid
function tests and chest X-ray are essential for monitoring these adverse effects. Mechanism: amiodarone blocks potassium
channels, prolonging the action potential duration. Critical adverse effects: pulmonary toxicity, thyroid dysfunction,
hepatotoxicity, corneal deposits, QT prolongation.
6. A client is prescribed metoprolol (Lopressor) for hypertension. The nurse should teach the client to avoid
abrupt discontinuation of the medication because of the risk of:
A. Severe hypotension
B. Rebound hypertension and tachycardia
C. Acute kidney injury
D. Severe bradycardia
Rationale: The correct answer is Rebound hypertension and tachycardia. Beta-blockers like metoprolol cause upregulation of
beta receptors during chronic therapy. Abrupt discontinuation leads to excessive catecholamine stimulation of upregulated
receptors, causing rebound hypertension, tachycardia, and potential myocardial ischemia. Mechanism: metoprolol selectively
blocks beta-1 receptors, reducing heart rate and cardiac output. Patient teaching: taper medication gradually under healthcare
provider supervision.
7. A nurse is administering IV verapamil (Calan) for supraventricular tachycardia. Which assessment finding
requires immediate intervention?
A. Blood pressure of 100/60 mmHg
B. Heart rate of 80 beats per minute
C. Blood pressure of 80/50 mmHg
D. Respiratory rate of 16 breaths per minute
Rationale: The correct answer is Blood pressure of 80/50 mmHg. Verapamil is a calcium channel blocker that causes
negative inotropy and vasodilation, which can lead to significant hypotension. A blood pressure of 80/50 mmHg indicates
hypotension requiring immediate intervention. Mechanism: verapamil blocks calcium channels in cardiac and vascular
smooth muscle. Critical adverse effects: hypotension, bradycardia, heart block, heart failure exacerbation. Patient teaching:
rise slowly, avoid grapefruit juice (increases drug levels).
8. A client with heart failure is prescribed carvedilol (Coreg). The nurse understands that this medication is
initiated at a low dose and titrated slowly to:
A. Prevent reflex tachycardia
B. Allow the heart to adapt to the negative inotropic effects
C. Reduce the risk of hepatotoxicity
D. Prevent the development of tolerance
Rationale: The correct answer is Allow the heart to adapt to the negative inotropic effects. Carvedilol is a non-selective
beta-blocker with alpha-1 blocking activity. Initial negative inotropic effects can worsen heart failure symptoms. Starting low
and titrating slowly allows the heart to adapt and ultimately benefit from neurohormonal blockade. Mechanism: carvedilol
blocks beta-1, beta-2, and alpha-1 receptors, reducing afterload and blocking sympathetic stimulation. Patient teaching: report
worsening symptoms initially.
9. A client receiving heparin therapy has an aPTT of 98 seconds (control: 36 seconds). What is the nurse's
priority action?
A. Continue the infusion as prescribed
B. Increase the infusion rate
C. Stop the infusion and notify the healthcare provider
D. Administer protamine sulfate immediately
, Rationale: The correct answer is Stop the infusion and notify the healthcare provider. An aPTT of 98 seconds indicates
excessive anticoagulation (therapeutic range is 1.5-2.5 times control, or 54-90 seconds). The client is at high risk for
bleeding. The nurse should stop the infusion immediately and notify the provider. Mechanism: heparin enhances
antithrombin III activity, inhibiting thrombin and factor Xa. Critical adverse effects: bleeding, heparin-induced
thrombocytopenia (HIT). Protamine sulfate is the antidote but requires a provider order.
10. A nurse is teaching a client about sublingual nitroglycerin tablets. Which instruction is correct?
A. Swallow the tablet whole with water
B. Take one tablet every 5 minutes for chest pain, up to 3 tablets total
C. Store the tablets in a warm, humid location
D. Crush the tablet before administration
Rationale: The correct answer is Take one tablet every 5 minutes for chest pain, up to 3 tablets total. Sublingual nitroglycerin
should be taken at the onset of chest pain, with emergency services called if pain persists after 3 tablets. Mechanism:
sublingual administration bypasses first-pass hepatic metabolism for rapid effect. Critical teaching: store tablets in original
dark container (light degrades them), replace every 6 months, sit or lie down before taking (causes hypotension), call 911 if
pain persists after first dose.
11. A client is prescribed hydralazine (Apresoline) for hypertension. Which adverse effect should the nurse
monitor for with long-term use?
A. Drug-induced lupus erythematosus
B. Rebound hypertension
C. Thyroid dysfunction
D. Hepatotoxicity
Rationale: The correct answer is Drug-induced lupus erythematosus. Long-term use of hydralazine can cause drug-induced
lupus, particularly in slow acetylators. Symptoms include arthralgia, myalgia, fever, and rash. ANA titers should be
monitored. Mechanism: hydralazine is a direct-acting arterial vasodilator. Critical adverse effects: reflex tachycardia,
drug-induced lupus, sodium and water retention. Often combined with beta-blocker to prevent reflex tachycardia.
12. A nurse is administering clopidogrel (Plavix). The nurse understands that this medication works by:
A. Inhibiting vitamin K-dependent clotting factors
B. Blocking ADP receptors on platelets
C. Inhibiting the enzyme cyclooxygenase
D. Directly inhibiting thrombin
Rationale: The correct answer is Blocking ADP receptors on platelets. Clopidogrel is an antiplatelet medication that
irreversibly inhibits ADP receptors on platelets, preventing platelet aggregation. It is a prodrug requiring CYP2C19
activation. Mechanism: irreversible inhibition of P2Y12 ADP receptors on platelets. Critical adverse effects: bleeding,
thrombotic thrombocytopenic purpura (rare). Patient teaching: stop 5-7 days before surgery, report unusual bleeding, avoid
NSAIDs which increase bleeding risk.
13. A client with hyperlipidemia is prescribed atorvastatin (Lipitor). Which instruction should the nurse include
in patient teaching?
A. Take the medication with breakfast
B. Report any unexplained muscle pain or weakness
C. Increase intake of grapefruit juice
D. Take the medication only when cholesterol is elevated
Rationale: The correct answer is Report any unexplained muscle pain or weakness. Statins can cause myopathy and, rarely,
rhabdomyolysis. Patients should report muscle pain, tenderness, or weakness. Mechanism: atorvastatin inhibits HMG-CoA
reductase, reducing hepatic cholesterol synthesis. Critical adverse effects: myopathy, rhabdomyolysis, hepatotoxicity. Patient
teaching: take at any time of day (long half-life), avoid grapefruit juice (increases drug levels), obtain baseline and periodic
liver function tests.
14. A client is receiving dobutamine (Dobutrex) for acute decompensated heart failure. Which therapeutic
response indicates the medication is effective?
A Comprehensive Review 2026/2027
Comprehensive Nursing Pharmacology Review
Key Domains: Cardiovascular Drugs | Respiratory Drugs | Endocrine Drugs | Neurologic Drugs |
Psychiatric Drugs | Anti-infectives | Gastrointestinal Drugs | Pain Management | Drug Calculations |
Mechanism of Action | Adverse Effects & Toxicity | Drug Interactions | Nursing Implications
Total Questions: 150 | Expert-Aligned Structure | Comprehensive Review Format
Instructions: This examination consists of 150 multiple-choice questions designed to assess comprehensive pharmacology
knowledge for safe medication administration. Select the best answer for each question. Correct answers are indicated in bold
cyan blue. Each question includes a detailed rationale explaining the drug's mechanism of action, therapeutic indication,
critical adverse effects, key nursing interventions, essential patient teaching points, and why alternative options are incorrect
or unsafe.
,SECTION 1: CARDIOVASCULAR DRUGS
1. A nurse is administering digoxin (Lanoxin) to a client with heart failure. Which assessment finding requires
holding the medication?
A. Blood pressure of 110/70 mmHg
B. Heart rate of 52 beats per minute
C. Respiratory rate of 18 breaths per minute
D. Serum potassium of 4.0 mEq/L
Rationale: The correct answer is Heart rate of 52 beats per minute. Digoxin is a cardiac glycoside that increases myocardial
contractility and slows conduction through the AV node. A heart rate below 60 bpm indicates bradycardia, a sign of digoxin
toxicity. The nurse must hold the medication and notify the healthcare provider. Mechanism: digoxin inhibits
Na+/K+-ATPase, increasing intracellular calcium. Critical adverse effects include bradycardia, arrhythmias, and visual
disturbances. Patient teaching: take apical pulse for 1 full minute before administration and hold if HR less than 60.
2. A client is receiving a continuous infusion of nitroglycerin for acute coronary syndrome. Which finding
indicates the infusion is achieving the desired therapeutic effect?
A. Blood pressure has decreased by 10%
B. Heart rate has increased by 20%
C. Chest pain has been relieved
D. Cardiac output has decreased
Rationale: The correct answer is Chest pain has been relieved. Nitroglycerin is a nitrate that causes venous and arterial
vasodilation, reducing myocardial oxygen demand and increasing oxygen supply. The primary therapeutic goal in acute
coronary syndrome is relief of chest pain. Mechanism: nitroglycerin converts to nitric oxide, causing smooth muscle
relaxation. Critical adverse effects: severe hypotension, reflex tachycardia, and headache. Patient teaching: report headache
(common side effect), rise slowly to prevent orthostatic hypotension.
3. A nurse is teaching a client about warfarin (Coumadin) therapy. Which statement indicates a need for further
teaching?
A. I will use a soft toothbrush to prevent bleeding.
B. I will maintain consistent intake of green leafy vegetables.
C. I can take ibuprofen for occasional headaches.
D. I will wear a medical alert bracelet indicating I take warfarin.
Rationale: The correct answer is I can take ibuprofen for occasional headaches. This statement indicates need for further
teaching. Ibuprofen is an NSAID that increases bleeding risk when combined with warfarin by inhibiting platelet function
and potentially causing GI ulceration. Mechanism: warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X).
Critical adverse effects: bleeding, INR elevation. Patient teaching: avoid NSAIDs, maintain consistent vitamin K intake,
report signs of bleeding, obtain regular INR monitoring.
4. A client with hypertension is prescribed lisinopril (Prinivil). Which adverse effect is most important for the
nurse to monitor?
A. Persistent dry cough
B. Reflex tachycardia
C. Hyperkalemia
D. Hypokalemia
Rationale: The correct answer is Hyperkalemia. Lisinopril is an ACE inhibitor that blocks conversion of angiotensin I to
angiotensin II, reducing aldosterone secretion. Decreased aldosterone leads to potassium retention and potential
hyperkalemia, which can cause life-threatening cardiac arrhythmias. Mechanism: ACE inhibition reduces angiotensin II and
aldosterone. Critical adverse effects: hyperkalemia, angioedema, persistent dry cough (due to bradykinin accumulation).
Patient teaching: avoid potassium supplements and salt substitutes containing potassium.
5. A nurse is caring for a client receiving amiodarone (Cordarone) for ventricular arrhythmias. Which baseline
test is essential before initiating therapy?
, A. Liver function tests only
B. Thyroid function tests and chest X-ray
C. Renal function tests only
D. Complete blood count only
Rationale: The correct answer is Thyroid function tests and chest X-ray. Amiodarone contains iodine and can cause both
hypothyroidism and hyperthyroidism. It also causes pulmonary toxicity, including interstitial pneumonitis. Baseline thyroid
function tests and chest X-ray are essential for monitoring these adverse effects. Mechanism: amiodarone blocks potassium
channels, prolonging the action potential duration. Critical adverse effects: pulmonary toxicity, thyroid dysfunction,
hepatotoxicity, corneal deposits, QT prolongation.
6. A client is prescribed metoprolol (Lopressor) for hypertension. The nurse should teach the client to avoid
abrupt discontinuation of the medication because of the risk of:
A. Severe hypotension
B. Rebound hypertension and tachycardia
C. Acute kidney injury
D. Severe bradycardia
Rationale: The correct answer is Rebound hypertension and tachycardia. Beta-blockers like metoprolol cause upregulation of
beta receptors during chronic therapy. Abrupt discontinuation leads to excessive catecholamine stimulation of upregulated
receptors, causing rebound hypertension, tachycardia, and potential myocardial ischemia. Mechanism: metoprolol selectively
blocks beta-1 receptors, reducing heart rate and cardiac output. Patient teaching: taper medication gradually under healthcare
provider supervision.
7. A nurse is administering IV verapamil (Calan) for supraventricular tachycardia. Which assessment finding
requires immediate intervention?
A. Blood pressure of 100/60 mmHg
B. Heart rate of 80 beats per minute
C. Blood pressure of 80/50 mmHg
D. Respiratory rate of 16 breaths per minute
Rationale: The correct answer is Blood pressure of 80/50 mmHg. Verapamil is a calcium channel blocker that causes
negative inotropy and vasodilation, which can lead to significant hypotension. A blood pressure of 80/50 mmHg indicates
hypotension requiring immediate intervention. Mechanism: verapamil blocks calcium channels in cardiac and vascular
smooth muscle. Critical adverse effects: hypotension, bradycardia, heart block, heart failure exacerbation. Patient teaching:
rise slowly, avoid grapefruit juice (increases drug levels).
8. A client with heart failure is prescribed carvedilol (Coreg). The nurse understands that this medication is
initiated at a low dose and titrated slowly to:
A. Prevent reflex tachycardia
B. Allow the heart to adapt to the negative inotropic effects
C. Reduce the risk of hepatotoxicity
D. Prevent the development of tolerance
Rationale: The correct answer is Allow the heart to adapt to the negative inotropic effects. Carvedilol is a non-selective
beta-blocker with alpha-1 blocking activity. Initial negative inotropic effects can worsen heart failure symptoms. Starting low
and titrating slowly allows the heart to adapt and ultimately benefit from neurohormonal blockade. Mechanism: carvedilol
blocks beta-1, beta-2, and alpha-1 receptors, reducing afterload and blocking sympathetic stimulation. Patient teaching: report
worsening symptoms initially.
9. A client receiving heparin therapy has an aPTT of 98 seconds (control: 36 seconds). What is the nurse's
priority action?
A. Continue the infusion as prescribed
B. Increase the infusion rate
C. Stop the infusion and notify the healthcare provider
D. Administer protamine sulfate immediately
, Rationale: The correct answer is Stop the infusion and notify the healthcare provider. An aPTT of 98 seconds indicates
excessive anticoagulation (therapeutic range is 1.5-2.5 times control, or 54-90 seconds). The client is at high risk for
bleeding. The nurse should stop the infusion immediately and notify the provider. Mechanism: heparin enhances
antithrombin III activity, inhibiting thrombin and factor Xa. Critical adverse effects: bleeding, heparin-induced
thrombocytopenia (HIT). Protamine sulfate is the antidote but requires a provider order.
10. A nurse is teaching a client about sublingual nitroglycerin tablets. Which instruction is correct?
A. Swallow the tablet whole with water
B. Take one tablet every 5 minutes for chest pain, up to 3 tablets total
C. Store the tablets in a warm, humid location
D. Crush the tablet before administration
Rationale: The correct answer is Take one tablet every 5 minutes for chest pain, up to 3 tablets total. Sublingual nitroglycerin
should be taken at the onset of chest pain, with emergency services called if pain persists after 3 tablets. Mechanism:
sublingual administration bypasses first-pass hepatic metabolism for rapid effect. Critical teaching: store tablets in original
dark container (light degrades them), replace every 6 months, sit or lie down before taking (causes hypotension), call 911 if
pain persists after first dose.
11. A client is prescribed hydralazine (Apresoline) for hypertension. Which adverse effect should the nurse
monitor for with long-term use?
A. Drug-induced lupus erythematosus
B. Rebound hypertension
C. Thyroid dysfunction
D. Hepatotoxicity
Rationale: The correct answer is Drug-induced lupus erythematosus. Long-term use of hydralazine can cause drug-induced
lupus, particularly in slow acetylators. Symptoms include arthralgia, myalgia, fever, and rash. ANA titers should be
monitored. Mechanism: hydralazine is a direct-acting arterial vasodilator. Critical adverse effects: reflex tachycardia,
drug-induced lupus, sodium and water retention. Often combined with beta-blocker to prevent reflex tachycardia.
12. A nurse is administering clopidogrel (Plavix). The nurse understands that this medication works by:
A. Inhibiting vitamin K-dependent clotting factors
B. Blocking ADP receptors on platelets
C. Inhibiting the enzyme cyclooxygenase
D. Directly inhibiting thrombin
Rationale: The correct answer is Blocking ADP receptors on platelets. Clopidogrel is an antiplatelet medication that
irreversibly inhibits ADP receptors on platelets, preventing platelet aggregation. It is a prodrug requiring CYP2C19
activation. Mechanism: irreversible inhibition of P2Y12 ADP receptors on platelets. Critical adverse effects: bleeding,
thrombotic thrombocytopenic purpura (rare). Patient teaching: stop 5-7 days before surgery, report unusual bleeding, avoid
NSAIDs which increase bleeding risk.
13. A client with hyperlipidemia is prescribed atorvastatin (Lipitor). Which instruction should the nurse include
in patient teaching?
A. Take the medication with breakfast
B. Report any unexplained muscle pain or weakness
C. Increase intake of grapefruit juice
D. Take the medication only when cholesterol is elevated
Rationale: The correct answer is Report any unexplained muscle pain or weakness. Statins can cause myopathy and, rarely,
rhabdomyolysis. Patients should report muscle pain, tenderness, or weakness. Mechanism: atorvastatin inhibits HMG-CoA
reductase, reducing hepatic cholesterol synthesis. Critical adverse effects: myopathy, rhabdomyolysis, hepatotoxicity. Patient
teaching: take at any time of day (long half-life), avoid grapefruit juice (increases drug levels), obtain baseline and periodic
liver function tests.
14. A client is receiving dobutamine (Dobutrex) for acute decompensated heart failure. Which therapeutic
response indicates the medication is effective?
