NRG 200 PHARMACOLOGY FOR HUMAN CARING NURSING – MIDTERM EXAM
NRG 200 Pharmacology for Human Caring Nursing –
Midterm Exam (2025/2026 Edition) – Real Exam
Questions with 100% Verified Correct Answers
Question 1
A client with heart failure is prescribed digoxin (Lanoxin) and furosemide (Lasix). Which
assessment finding is most concerning and requires immediate intervention?
A) Heart rate of 62 beats per minute
B) Serum potassium level of 3.2 mEq/L
C) Blood pressure of 118/76 mmHg
D) Urinary output of 30 mL/hour
Answer: B) Serum potassium level of 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia (normal
range 3.5-5.0 mEq/L) increases the risk of digoxin toxicity because digoxin binds to the same
sodium-potassium ATPase pump. When potassium is low, digoxin binding increases, leading to
toxicity even at therapeutic doses. Digoxin toxicity can cause life-threatening dysrhythmias
including ventricular tachycardia and heart block. A heart rate of 62 is within normal range for
a client on digoxin (hold if <60). Blood pressure is stable. Urinary output of 30 mL/hour is
adequate (minimum 30 mL/hour).
Examiner's Remark: This is a classic high-yield drug interaction question that appears
frequently on pharmacology exams and NCLEX. Students must understand that hypokalemia
potentiates digoxin toxicity. The key is recognizing that the combination of a potassium-
wasting diuretic with digoxin creates a significant safety risk. Many students mistakenly focus
on the heart rate, but the potassium level is the priority because it predicts impending toxicity.
Question 2
A nurse is administering warfarin (Coumadin) to a client with atrial fibrillation. Which
laboratory value indicates that the medication is within therapeutic range?
A) INR of 2.5
B) aPTT of 60 seconds
C) Platelet count of 150,000/mm³
D) PT of 12 seconds
Answer: A) INR of 2.5
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-dependent synthesis of clotting
factors II, VII, IX, and X. Therapeutic effectiveness is monitored using the International
Normalized Ratio (INR). For most indications including atrial fibrillation, the target INR is 2.0-
Page 1 of 50
, NRG 200 PHARMACOLOGY FOR HUMAN CARING NURSING – MIDTERM EXAM
3.0. An INR of 2.5 falls within this therapeutic window. aPTT monitors heparin therapy. Platelet
count assesses thrombocytopenia. PT without INR standardization is insufficient as reagent
variability affects results.
Examiner's Remark: Distinguishing between anticoagulant monitoring parameters is essential
for safe nursing practice. Students frequently confuse aPTT (heparin) with INR (warfarin).
Remember: "WARfarin = WARning with INR." This distinction is critical because administering
additional warfarin based on an aPTT result could cause fatal hemorrhage.
Question 3
A client receiving morphine sulfate via patient-controlled analgesia (PCA) has a respiratory
rate of 8 breaths per minute and is difficult to arouse. Which medication should the nurse
prepare to administer?
A) Naloxone (Narcan)
B) Flumazenil (Romazicon)
C) Acetylcysteine (Mucomyst)
D) Protamine sulfate
Answer: A) Naloxone (Narcan)
Rationale: Naloxone is a pure opioid antagonist that competitively binds to mu, kappa, and
delta opioid receptors, reversing opioid-induced respiratory depression, sedation, and
analgesia. Respiratory rate of 8 with decreased level of consciousness indicates opioid toxicity.
Flumazenil reverses benzodiazepine overdose. Acetylcysteine is the antidote for
acetaminophen toxicity. Protamine sulfate reverses heparin.
Examiner's Remark: This question tests recognition of opioid overdose and knowledge of the
appropriate reversal agent. Students must remember that naloxone has a shorter duration of
action than most opioids, so the client requires ongoing monitoring for recurrence of
respiratory depression after administration. The examiner expects students to also recognize
that rapid reversal may precipitate acute withdrawal and pain crisis.
Question 4
A nurse is teaching a client about newly prescribed metformin (Glucophage) for type 2
diabetes mellitus. Which statement by the client indicates correct understanding?
A) "I should take this medication when my blood sugar is high to bring it down quickly."
B) "I will notify my healthcare provider if I develop muscle pain or feel unusually tired."
C) "This medication works by increasing insulin production from my pancreas."
D) "I need to check my blood sugar every hour because this medication causes low blood
sugar."
Answer: B) "I will notify my healthcare provider if I develop muscle pain or feel unusually
tired."
Rationale: Metformin can cause lactic acidosis, a rare but serious adverse effect. Early signs
include muscle pain, malaise, fatigue, and respiratory distress. Clients should be educated to
Page 2 of 50
, NRG 200 PHARMACOLOGY FOR HUMAN CARING NURSING – MIDTERM EXAM
report these symptoms immediately. Metformin does not cause hypoglycemia when used
alone; it works by decreasing hepatic gluconeogenesis and improving insulin sensitivity, not by
increasing insulin secretion. It is taken regularly, not as a rescue medication for hyperglycemia.
Examiner's Remark: Metformin is a first-line oral antidiabetic, and its unique adverse effect
profile is frequently tested. Students often incorrectly assume all diabetes medications cause
hypoglycemia. The key teaching point is that metformin is associated with lactic acidosis,
especially in clients with renal impairment, heart failure, or during contrast dye procedures
where it should be temporarily withheld.
Question 5
A client is prescribed amoxicillin for strep throat. Which statement requires immediate
follow-up by the nurse?
A) "I noticed a rash on my chest about an hour after taking the first dose."
B) "I take birth control pills so I will use a backup method during this prescription."
C) "I should finish all the medication even if I feel better."
D) "I will take the medication with food to prevent stomach upset."
Answer: A) "I noticed a rash on my chest about an hour after taking the first dose."
Rationale: A rash occurring shortly after the first dose of a penicillin-class antibiotic suggests a
possible hypersensitivity reaction. This could progress to anaphylaxis with subsequent doses.
The nurse must stop administration and notify the healthcare provider immediately. Option B
is correct education—antibiotics can reduce oral contraceptive effectiveness. Option C is
correct—completing the full course prevents antibiotic resistance. Option D is correct—food
reduces GI upset.
Examiner's Remark: This question distinguishes between correct patient education and a
critical safety alert. Students must recognize that any rash after penicillin administration should
be treated as a potential allergic reaction until proven otherwise. The examiner expects
students to know that penicillin allergies are the most common drug allergy and cross-reactivity
with cephalosporins exists.
Question 6
A nurse is caring for a client receiving IV heparin for deep vein thrombosis. Which finding
indicates a potential adverse effect requiring discontinuation of the infusion?
A) aPTT of 65 seconds (normal 25-35, therapeutic 60-80)
B) Platelet count drop from 250,000 to 100,000/mm³
C) Bruising at IV insertion site
D) Blood pressure of 130/85 mmHg
Answer: B) Platelet count drop from 250,000 to 100,000/mm³
Rationale: Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction
where antibodies form against platelet factor 4-heparin complexes, leading to platelet
destruction and paradoxical thrombosis. A 50% or greater drop in platelet count is a hallmark
Page 3 of 50
, NRG 200 PHARMACOLOGY FOR HUMAN CARING NURSING – MIDTERM EXAM
sign. HIT requires immediate discontinuation of all heparin products and transition to a non-
heparin anticoagulant such as argatroban or fondaparinux. The aPTT of 65 is therapeutic.
Bruising is expected with anticoagulation. Blood pressure is normal.
Examiner's Remark: HIT is a classic "trick" question—students often assume bleeding is the
only complication of heparin, but HIT causes platelet destruction and thrombosis. The key is
recognizing that a dropping platelet count in a heparinized client is a medical emergency. This
concept appears frequently on exams because it represents a paradoxical and potentially
deadly adverse effect.
Question 7
A client with hypertension is started on lisinopril, an ACE inhibitor. Which adverse effect
should the nurse emphasize when teaching the client?
A) Dry, persistent cough
B) Peripheral edema
C) Hyperglycemia
D) Bradycardia
Answer: A) Dry, persistent cough
Rationale: Lisinopril inhibits angiotensin-converting enzyme, which also breaks down
bradykinin. Accumulation of bradykinin causes a characteristic dry, persistent cough that
occurs in approximately 10-20% of clients. This is the most common reason for
discontinuation. If the cough is intolerable, the provider may switch to an angiotensin II
receptor blocker (ARB), which does not affect bradykinin. Peripheral edema is associated with
calcium channel blockers. ACE inhibitors may cause hypoglycemia, not hyperglycemia.
Bradycardia is not a typical adverse effect.
Examiner's Remark: ACE inhibitor-induced cough is a high-yield topic. Students must
differentiate this from cough due to heart failure or other causes. The examiner will expect
students to recognize that this cough is not dangerous but is bothersome, and clients should
not stop the medication abruptly without provider guidance due to rebound hypertension risk.
Question 8
A nurse is administering a dopamine infusion to a client in cardiogenic shock. Which
assessment finding indicates the medication is having the desired effect?
A) Increased blood pressure with adequate urine output
B) Decreased heart rate with regular rhythm
C) Increased respiratory rate with oxygen saturation >92%
D) Decreased central venous pressure
Answer: A) Increased blood pressure with adequate urine output
Rationale: Dopamine is a vasopressor and inotropic agent. At moderate to high doses, it
stimulates beta-1 adrenergic receptors (increasing cardiac contractility and heart rate) and
alpha-1 receptors (causing vasoconstriction). The desired effect in cardiogenic shock is
Page 4 of 50
NRG 200 Pharmacology for Human Caring Nursing –
Midterm Exam (2025/2026 Edition) – Real Exam
Questions with 100% Verified Correct Answers
Question 1
A client with heart failure is prescribed digoxin (Lanoxin) and furosemide (Lasix). Which
assessment finding is most concerning and requires immediate intervention?
A) Heart rate of 62 beats per minute
B) Serum potassium level of 3.2 mEq/L
C) Blood pressure of 118/76 mmHg
D) Urinary output of 30 mL/hour
Answer: B) Serum potassium level of 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia (normal
range 3.5-5.0 mEq/L) increases the risk of digoxin toxicity because digoxin binds to the same
sodium-potassium ATPase pump. When potassium is low, digoxin binding increases, leading to
toxicity even at therapeutic doses. Digoxin toxicity can cause life-threatening dysrhythmias
including ventricular tachycardia and heart block. A heart rate of 62 is within normal range for
a client on digoxin (hold if <60). Blood pressure is stable. Urinary output of 30 mL/hour is
adequate (minimum 30 mL/hour).
Examiner's Remark: This is a classic high-yield drug interaction question that appears
frequently on pharmacology exams and NCLEX. Students must understand that hypokalemia
potentiates digoxin toxicity. The key is recognizing that the combination of a potassium-
wasting diuretic with digoxin creates a significant safety risk. Many students mistakenly focus
on the heart rate, but the potassium level is the priority because it predicts impending toxicity.
Question 2
A nurse is administering warfarin (Coumadin) to a client with atrial fibrillation. Which
laboratory value indicates that the medication is within therapeutic range?
A) INR of 2.5
B) aPTT of 60 seconds
C) Platelet count of 150,000/mm³
D) PT of 12 seconds
Answer: A) INR of 2.5
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-dependent synthesis of clotting
factors II, VII, IX, and X. Therapeutic effectiveness is monitored using the International
Normalized Ratio (INR). For most indications including atrial fibrillation, the target INR is 2.0-
Page 1 of 50
, NRG 200 PHARMACOLOGY FOR HUMAN CARING NURSING – MIDTERM EXAM
3.0. An INR of 2.5 falls within this therapeutic window. aPTT monitors heparin therapy. Platelet
count assesses thrombocytopenia. PT without INR standardization is insufficient as reagent
variability affects results.
Examiner's Remark: Distinguishing between anticoagulant monitoring parameters is essential
for safe nursing practice. Students frequently confuse aPTT (heparin) with INR (warfarin).
Remember: "WARfarin = WARning with INR." This distinction is critical because administering
additional warfarin based on an aPTT result could cause fatal hemorrhage.
Question 3
A client receiving morphine sulfate via patient-controlled analgesia (PCA) has a respiratory
rate of 8 breaths per minute and is difficult to arouse. Which medication should the nurse
prepare to administer?
A) Naloxone (Narcan)
B) Flumazenil (Romazicon)
C) Acetylcysteine (Mucomyst)
D) Protamine sulfate
Answer: A) Naloxone (Narcan)
Rationale: Naloxone is a pure opioid antagonist that competitively binds to mu, kappa, and
delta opioid receptors, reversing opioid-induced respiratory depression, sedation, and
analgesia. Respiratory rate of 8 with decreased level of consciousness indicates opioid toxicity.
Flumazenil reverses benzodiazepine overdose. Acetylcysteine is the antidote for
acetaminophen toxicity. Protamine sulfate reverses heparin.
Examiner's Remark: This question tests recognition of opioid overdose and knowledge of the
appropriate reversal agent. Students must remember that naloxone has a shorter duration of
action than most opioids, so the client requires ongoing monitoring for recurrence of
respiratory depression after administration. The examiner expects students to also recognize
that rapid reversal may precipitate acute withdrawal and pain crisis.
Question 4
A nurse is teaching a client about newly prescribed metformin (Glucophage) for type 2
diabetes mellitus. Which statement by the client indicates correct understanding?
A) "I should take this medication when my blood sugar is high to bring it down quickly."
B) "I will notify my healthcare provider if I develop muscle pain or feel unusually tired."
C) "This medication works by increasing insulin production from my pancreas."
D) "I need to check my blood sugar every hour because this medication causes low blood
sugar."
Answer: B) "I will notify my healthcare provider if I develop muscle pain or feel unusually
tired."
Rationale: Metformin can cause lactic acidosis, a rare but serious adverse effect. Early signs
include muscle pain, malaise, fatigue, and respiratory distress. Clients should be educated to
Page 2 of 50
, NRG 200 PHARMACOLOGY FOR HUMAN CARING NURSING – MIDTERM EXAM
report these symptoms immediately. Metformin does not cause hypoglycemia when used
alone; it works by decreasing hepatic gluconeogenesis and improving insulin sensitivity, not by
increasing insulin secretion. It is taken regularly, not as a rescue medication for hyperglycemia.
Examiner's Remark: Metformin is a first-line oral antidiabetic, and its unique adverse effect
profile is frequently tested. Students often incorrectly assume all diabetes medications cause
hypoglycemia. The key teaching point is that metformin is associated with lactic acidosis,
especially in clients with renal impairment, heart failure, or during contrast dye procedures
where it should be temporarily withheld.
Question 5
A client is prescribed amoxicillin for strep throat. Which statement requires immediate
follow-up by the nurse?
A) "I noticed a rash on my chest about an hour after taking the first dose."
B) "I take birth control pills so I will use a backup method during this prescription."
C) "I should finish all the medication even if I feel better."
D) "I will take the medication with food to prevent stomach upset."
Answer: A) "I noticed a rash on my chest about an hour after taking the first dose."
Rationale: A rash occurring shortly after the first dose of a penicillin-class antibiotic suggests a
possible hypersensitivity reaction. This could progress to anaphylaxis with subsequent doses.
The nurse must stop administration and notify the healthcare provider immediately. Option B
is correct education—antibiotics can reduce oral contraceptive effectiveness. Option C is
correct—completing the full course prevents antibiotic resistance. Option D is correct—food
reduces GI upset.
Examiner's Remark: This question distinguishes between correct patient education and a
critical safety alert. Students must recognize that any rash after penicillin administration should
be treated as a potential allergic reaction until proven otherwise. The examiner expects
students to know that penicillin allergies are the most common drug allergy and cross-reactivity
with cephalosporins exists.
Question 6
A nurse is caring for a client receiving IV heparin for deep vein thrombosis. Which finding
indicates a potential adverse effect requiring discontinuation of the infusion?
A) aPTT of 65 seconds (normal 25-35, therapeutic 60-80)
B) Platelet count drop from 250,000 to 100,000/mm³
C) Bruising at IV insertion site
D) Blood pressure of 130/85 mmHg
Answer: B) Platelet count drop from 250,000 to 100,000/mm³
Rationale: Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction
where antibodies form against platelet factor 4-heparin complexes, leading to platelet
destruction and paradoxical thrombosis. A 50% or greater drop in platelet count is a hallmark
Page 3 of 50
, NRG 200 PHARMACOLOGY FOR HUMAN CARING NURSING – MIDTERM EXAM
sign. HIT requires immediate discontinuation of all heparin products and transition to a non-
heparin anticoagulant such as argatroban or fondaparinux. The aPTT of 65 is therapeutic.
Bruising is expected with anticoagulation. Blood pressure is normal.
Examiner's Remark: HIT is a classic "trick" question—students often assume bleeding is the
only complication of heparin, but HIT causes platelet destruction and thrombosis. The key is
recognizing that a dropping platelet count in a heparinized client is a medical emergency. This
concept appears frequently on exams because it represents a paradoxical and potentially
deadly adverse effect.
Question 7
A client with hypertension is started on lisinopril, an ACE inhibitor. Which adverse effect
should the nurse emphasize when teaching the client?
A) Dry, persistent cough
B) Peripheral edema
C) Hyperglycemia
D) Bradycardia
Answer: A) Dry, persistent cough
Rationale: Lisinopril inhibits angiotensin-converting enzyme, which also breaks down
bradykinin. Accumulation of bradykinin causes a characteristic dry, persistent cough that
occurs in approximately 10-20% of clients. This is the most common reason for
discontinuation. If the cough is intolerable, the provider may switch to an angiotensin II
receptor blocker (ARB), which does not affect bradykinin. Peripheral edema is associated with
calcium channel blockers. ACE inhibitors may cause hypoglycemia, not hyperglycemia.
Bradycardia is not a typical adverse effect.
Examiner's Remark: ACE inhibitor-induced cough is a high-yield topic. Students must
differentiate this from cough due to heart failure or other causes. The examiner will expect
students to recognize that this cough is not dangerous but is bothersome, and clients should
not stop the medication abruptly without provider guidance due to rebound hypertension risk.
Question 8
A nurse is administering a dopamine infusion to a client in cardiogenic shock. Which
assessment finding indicates the medication is having the desired effect?
A) Increased blood pressure with adequate urine output
B) Decreased heart rate with regular rhythm
C) Increased respiratory rate with oxygen saturation >92%
D) Decreased central venous pressure
Answer: A) Increased blood pressure with adequate urine output
Rationale: Dopamine is a vasopressor and inotropic agent. At moderate to high doses, it
stimulates beta-1 adrenergic receptors (increasing cardiac contractility and heart rate) and
alpha-1 receptors (causing vasoconstriction). The desired effect in cardiogenic shock is
Page 4 of 50
