### Pharmacology Nursing Exam Mastery Guide |
Fall 2026 BSN Pathway | NCLEX-Style Student
Success Edition with Rationales
**100 Questions with Verified Rationales**
---
**1. A patient with heart failure is prescribed digoxin. Which of the following findings indicates digoxin
toxicity?**
A) Visual disturbances (yellow-green halos)
B) Bradycardia with a heart rate of 60 bpm
C) Constipation
D) Weight gain
🎯CORRECT CHOICE: A
💡EXPLANATION: Digoxin toxicity often presents with gastrointestinal symptoms (nausea, vomiting),
cardiac dysrhythmias, and visual disturbances, including seeing yellow-green halos around lights. This
classic sign is highly indicative of toxicity and requires immediate assessment of digoxin levels.
**2. A nurse is administering intravenous furosemide to a patient with pulmonary edema. Which of the
following is the primary mechanism of action of furosemide?**
A) Inhibition of the Na⁺-K⁺-2Cl⁻ cotransporter in the thick ascending loop of Henle
B) Blockade of aldosterone receptors in the distal tubule
C) Inhibition of carbonic anhydrase in the proximal tubule
D) Osmotic pull of water into the renal tubules
🎯CORRECT CHOICE: A
,💡EXPLANATION: Furosemide is a loop diuretic that blocks the sodium-potassium-chloride cotransporter
in the thick ascending limb of the loop of Henle, preventing reabsorption of these ions and leading to
significant diuresis.
**3. A patient with tuberculosis is prescribed a regimen of isoniazid, rifampin, pyrazinamide, and
ethambutol. Which medication is associated with orange-red discoloration of body fluids?**
A) Isoniazid
B) Rifampin
C) Pyrazinamide
D) Ethambutol
🎯CORRECT CHOICE: B
💡EXPLANATION: Rifampin is known to cause harmless but noticeable orange-red discoloration of urine,
sweat, tears, and other body fluids. Patients must be counseled about this side effect to prevent alarm.
**4. A client with a history of peptic ulcer disease is prescribed omeprazole. The nurse explains that this
medication works by:**
A) Inhibiting the gastric proton pump (H⁺/K⁺ ATPase)
B) Blocking histamine H2 receptors
C) Neutralizing gastric acid
D) Forming a protective barrier over the ulcer
🎯CORRECT CHOICE: A
💡EXPLANATION: Omeprazole is a proton pump inhibitor that irreversibly binds to and inhibits the
hydrogen-potassium adenosine triphosphatase enzyme system in the gastric parietal cells, effectively
blocking the final step of acid production.
**5. A nurse is preparing to administer heparin subcutaneously. Which of the following actions is
correct?**
A) Administer in the abdomen, at least 2 inches away from the umbilicus
B) Rub the site vigorously after injection
C) Aspirate before injecting to check for blood return
D) Administer in the deltoid muscle
,🎯CORRECT CHOICE: A
💡EXPLANATION: Heparin is administered subcutaneously in the abdominal fat layer, at least 2 inches
from the umbilicus, to ensure proper absorption and minimize the risk of hematoma formation. The site
should not be rubbed after injection.
**6. A patient on warfarin therapy has an international normalized ratio (INR) of 4.5. The nurse should
anticipate which of the following interventions?**
A) Withholding the next dose and notifying the healthcare provider
B) Increasing the next dose to achieve therapeutic range
C) Administering protamine sulfate
D) Continuing the current dose as prescribed
🎯CORRECT CHOICE: A
💡EXPLANATION: A therapeutic INR for most indications is 2.0 to 3.0. An INR of 4.5 is above the
therapeutic range and indicates an increased risk of bleeding. The nurse should hold the dose and notify
the provider for further instructions, which may include administering vitamin K.
**7. A patient is prescribed metformin for type 2 diabetes mellitus. Which of the following is a serious
adverse effect that the nurse should monitor for?**
A) Lactic acidosis
B) Hyperglycemia
C) Weight gain
D) Hypertension
🎯CORRECT CHOICE: A
💡EXPLANATION: Metformin can cause lactic acidosis, a rare but life-threatening complication,
especially in patients with renal impairment, hepatic disease, or conditions that predispose to hypoxia.
Early symptoms include malaise, myalgia, and respiratory distress.
**8. A client is receiving morphine sulfate for severe postoperative pain. Which of the following is the
priority assessment for this patient?**
A) Respiratory rate and depth
B) Blood pressure
C) Pain level
, D) Bowel sounds
🎯CORRECT CHOICE: A
💡EXPLANATION: Morphine is a potent opioid that can cause respiratory depression by depressing the
respiratory center in the brainstem. The priority nursing assessment is monitoring the patient's
respiratory rate, depth, and oxygen saturation to prevent fatal respiratory compromise.
**9. A nurse is administering albuterol via a metered-dose inhaler to a patient with asthma. The nurse
understands that albuterol acts by:**
A) Stimulating beta₂-adrenergic receptors, causing bronchodilation
B) Blocking muscarinic receptors, causing bronchodilation
C) Reducing airway inflammation
D) Thinning mucus secretions
🎯CORRECT CHOICE: A
💡EXPLANATION: Albuterol is a short-acting beta₂-adrenergic agonist that binds to beta₂ receptors in the
bronchial smooth muscle, leading to relaxation and bronchodilation. It is a rescue medication for acute
bronchospasm.
**10. A patient is prescribed amlodipine for hypertension. Which of the following is a common side
effect of this medication?**
A) Peripheral edema
B) Hyperkalemia
C) Dry cough
D) Bradycardia
🎯CORRECT CHOICE: A
💡EXPLANATION: Amlodipine is a calcium channel blocker that causes vasodilation. A common side
effect is peripheral edema, particularly in the ankles and feet, due to increased capillary hydrostatic
pressure and fluid leakage into the interstitial space.
**11. A client is prescribed lithium carbonate for bipolar disorder. Which of the following laboratory
tests should the nurse monitor regularly?**
A) Serum lithium levels
B) Serum potassium levels
Fall 2026 BSN Pathway | NCLEX-Style Student
Success Edition with Rationales
**100 Questions with Verified Rationales**
---
**1. A patient with heart failure is prescribed digoxin. Which of the following findings indicates digoxin
toxicity?**
A) Visual disturbances (yellow-green halos)
B) Bradycardia with a heart rate of 60 bpm
C) Constipation
D) Weight gain
🎯CORRECT CHOICE: A
💡EXPLANATION: Digoxin toxicity often presents with gastrointestinal symptoms (nausea, vomiting),
cardiac dysrhythmias, and visual disturbances, including seeing yellow-green halos around lights. This
classic sign is highly indicative of toxicity and requires immediate assessment of digoxin levels.
**2. A nurse is administering intravenous furosemide to a patient with pulmonary edema. Which of the
following is the primary mechanism of action of furosemide?**
A) Inhibition of the Na⁺-K⁺-2Cl⁻ cotransporter in the thick ascending loop of Henle
B) Blockade of aldosterone receptors in the distal tubule
C) Inhibition of carbonic anhydrase in the proximal tubule
D) Osmotic pull of water into the renal tubules
🎯CORRECT CHOICE: A
,💡EXPLANATION: Furosemide is a loop diuretic that blocks the sodium-potassium-chloride cotransporter
in the thick ascending limb of the loop of Henle, preventing reabsorption of these ions and leading to
significant diuresis.
**3. A patient with tuberculosis is prescribed a regimen of isoniazid, rifampin, pyrazinamide, and
ethambutol. Which medication is associated with orange-red discoloration of body fluids?**
A) Isoniazid
B) Rifampin
C) Pyrazinamide
D) Ethambutol
🎯CORRECT CHOICE: B
💡EXPLANATION: Rifampin is known to cause harmless but noticeable orange-red discoloration of urine,
sweat, tears, and other body fluids. Patients must be counseled about this side effect to prevent alarm.
**4. A client with a history of peptic ulcer disease is prescribed omeprazole. The nurse explains that this
medication works by:**
A) Inhibiting the gastric proton pump (H⁺/K⁺ ATPase)
B) Blocking histamine H2 receptors
C) Neutralizing gastric acid
D) Forming a protective barrier over the ulcer
🎯CORRECT CHOICE: A
💡EXPLANATION: Omeprazole is a proton pump inhibitor that irreversibly binds to and inhibits the
hydrogen-potassium adenosine triphosphatase enzyme system in the gastric parietal cells, effectively
blocking the final step of acid production.
**5. A nurse is preparing to administer heparin subcutaneously. Which of the following actions is
correct?**
A) Administer in the abdomen, at least 2 inches away from the umbilicus
B) Rub the site vigorously after injection
C) Aspirate before injecting to check for blood return
D) Administer in the deltoid muscle
,🎯CORRECT CHOICE: A
💡EXPLANATION: Heparin is administered subcutaneously in the abdominal fat layer, at least 2 inches
from the umbilicus, to ensure proper absorption and minimize the risk of hematoma formation. The site
should not be rubbed after injection.
**6. A patient on warfarin therapy has an international normalized ratio (INR) of 4.5. The nurse should
anticipate which of the following interventions?**
A) Withholding the next dose and notifying the healthcare provider
B) Increasing the next dose to achieve therapeutic range
C) Administering protamine sulfate
D) Continuing the current dose as prescribed
🎯CORRECT CHOICE: A
💡EXPLANATION: A therapeutic INR for most indications is 2.0 to 3.0. An INR of 4.5 is above the
therapeutic range and indicates an increased risk of bleeding. The nurse should hold the dose and notify
the provider for further instructions, which may include administering vitamin K.
**7. A patient is prescribed metformin for type 2 diabetes mellitus. Which of the following is a serious
adverse effect that the nurse should monitor for?**
A) Lactic acidosis
B) Hyperglycemia
C) Weight gain
D) Hypertension
🎯CORRECT CHOICE: A
💡EXPLANATION: Metformin can cause lactic acidosis, a rare but life-threatening complication,
especially in patients with renal impairment, hepatic disease, or conditions that predispose to hypoxia.
Early symptoms include malaise, myalgia, and respiratory distress.
**8. A client is receiving morphine sulfate for severe postoperative pain. Which of the following is the
priority assessment for this patient?**
A) Respiratory rate and depth
B) Blood pressure
C) Pain level
, D) Bowel sounds
🎯CORRECT CHOICE: A
💡EXPLANATION: Morphine is a potent opioid that can cause respiratory depression by depressing the
respiratory center in the brainstem. The priority nursing assessment is monitoring the patient's
respiratory rate, depth, and oxygen saturation to prevent fatal respiratory compromise.
**9. A nurse is administering albuterol via a metered-dose inhaler to a patient with asthma. The nurse
understands that albuterol acts by:**
A) Stimulating beta₂-adrenergic receptors, causing bronchodilation
B) Blocking muscarinic receptors, causing bronchodilation
C) Reducing airway inflammation
D) Thinning mucus secretions
🎯CORRECT CHOICE: A
💡EXPLANATION: Albuterol is a short-acting beta₂-adrenergic agonist that binds to beta₂ receptors in the
bronchial smooth muscle, leading to relaxation and bronchodilation. It is a rescue medication for acute
bronchospasm.
**10. A patient is prescribed amlodipine for hypertension. Which of the following is a common side
effect of this medication?**
A) Peripheral edema
B) Hyperkalemia
C) Dry cough
D) Bradycardia
🎯CORRECT CHOICE: A
💡EXPLANATION: Amlodipine is a calcium channel blocker that causes vasodilation. A common side
effect is peripheral edema, particularly in the ankles and feet, due to increased capillary hydrostatic
pressure and fluid leakage into the interstitial space.
**11. A client is prescribed lithium carbonate for bipolar disorder. Which of the following laboratory
tests should the nurse monitor regularly?**
A) Serum lithium levels
B) Serum potassium levels
