NUR 378 PHARM EXAM 1 (2026/2027) QUESTIONS
AND CORRECT ANSWERS GRADED A+
What are HIGH-ALERT medications? Give 4 examples.
Drugs with heightened risk of significant patient harm when used in error.
Examples: Insulins, Anticoagulants (heparin/warfarin), Opioids, Concentrated
electrolytes (KCl, MgSO4)
What are ISMP safeguards for high-alert medications?
Standardization, restricted access, auxiliary labels, automated alerts, independent
double-checks, pump safety/guardrails
What is the NCLEX Clinical Judgment sequence (6 steps)?
1) Recognize cues 2) Analyze cues 3) Prioritize hypotheses 4) Generate solutions
5) Take action 6) Evaluate outcomes
Before giving METOPROLOL, what is the most important assessment?
Apical pulse and blood pressure — beta blockers can cause bradycardia and
hypotension. Hold if HR <60 or per parameter.
Before giving DIGOXIN, what must you assess?
Apical pulse (hold if <60), potassium level, renal function, digoxin level if ordered.
Hypokalemia INCREASES digoxin toxicity risk.
,Before giving WARFARIN, what must you check?
INR (therapeutic range 2-3 for most indications), bleeding signs, drug/food
interactions, pregnancy status
Before giving an IV OPIOID, what assessment is priority?
Respiratory rate, level of consciousness, O2 saturation, pain score. HOLD if RR
<12 or patient is difficult to arouse.
Before giving IV POTASSIUM, what is the cardinal rule?
NEVER give potassium IV push — causes fatal dysrhythmia. Always dilute and
infuse via pump with rate limits.
When should you HOLD and CLARIFY a medication order? (7 situations)
1) Allergy to drug or same-risk class 2) Incomplete/illegible order 3) Dose outside
safe range 4) KCl ordered IV push 5) Opioid ordered with low RR/hard to arouse
6) Beta blocker with severe bradycardia 7) Anticoagulant with active bleeding
What is the nurse's legal/ethical responsibility when a prescriber writes an unsafe
order?
The nurse is accountable for recognizing safety concerns and must clarify/refuse
even if ordered by prescriber. "The provider ordered it" does NOT remove nursing
responsibility.
, What does AUTONOMY mean in medication administration?
Respecting the client's right to refuse after being informed. Refusal ≠
noncompliance — explore barriers, notify provider, document.
What are the 10 Rights of Medication Administration?
Right client, Right medication, Right dose, Right route, Right time, Right
documentation, Right reason/indication, Right response/evaluation, Right
education, Right to refuse
How do you verify the RIGHT CLIENT?
Two identifiers — name + date of birth or MRN. NEVER use room number or bed
location.
What does RIGHT DOCUMENTATION mean?
Document medication, dose, route, time, site (if applicable), teaching, and patient
response. NEVER document BEFORE giving the medication.
What is the RIGHT to REFUSE?
Assess reason, teach risks/benefits, notify prescriber if refusal creates risk, and
document. NEVER coerce the client.
AND CORRECT ANSWERS GRADED A+
What are HIGH-ALERT medications? Give 4 examples.
Drugs with heightened risk of significant patient harm when used in error.
Examples: Insulins, Anticoagulants (heparin/warfarin), Opioids, Concentrated
electrolytes (KCl, MgSO4)
What are ISMP safeguards for high-alert medications?
Standardization, restricted access, auxiliary labels, automated alerts, independent
double-checks, pump safety/guardrails
What is the NCLEX Clinical Judgment sequence (6 steps)?
1) Recognize cues 2) Analyze cues 3) Prioritize hypotheses 4) Generate solutions
5) Take action 6) Evaluate outcomes
Before giving METOPROLOL, what is the most important assessment?
Apical pulse and blood pressure — beta blockers can cause bradycardia and
hypotension. Hold if HR <60 or per parameter.
Before giving DIGOXIN, what must you assess?
Apical pulse (hold if <60), potassium level, renal function, digoxin level if ordered.
Hypokalemia INCREASES digoxin toxicity risk.
,Before giving WARFARIN, what must you check?
INR (therapeutic range 2-3 for most indications), bleeding signs, drug/food
interactions, pregnancy status
Before giving an IV OPIOID, what assessment is priority?
Respiratory rate, level of consciousness, O2 saturation, pain score. HOLD if RR
<12 or patient is difficult to arouse.
Before giving IV POTASSIUM, what is the cardinal rule?
NEVER give potassium IV push — causes fatal dysrhythmia. Always dilute and
infuse via pump with rate limits.
When should you HOLD and CLARIFY a medication order? (7 situations)
1) Allergy to drug or same-risk class 2) Incomplete/illegible order 3) Dose outside
safe range 4) KCl ordered IV push 5) Opioid ordered with low RR/hard to arouse
6) Beta blocker with severe bradycardia 7) Anticoagulant with active bleeding
What is the nurse's legal/ethical responsibility when a prescriber writes an unsafe
order?
The nurse is accountable for recognizing safety concerns and must clarify/refuse
even if ordered by prescriber. "The provider ordered it" does NOT remove nursing
responsibility.
, What does AUTONOMY mean in medication administration?
Respecting the client's right to refuse after being informed. Refusal ≠
noncompliance — explore barriers, notify provider, document.
What are the 10 Rights of Medication Administration?
Right client, Right medication, Right dose, Right route, Right time, Right
documentation, Right reason/indication, Right response/evaluation, Right
education, Right to refuse
How do you verify the RIGHT CLIENT?
Two identifiers — name + date of birth or MRN. NEVER use room number or bed
location.
What does RIGHT DOCUMENTATION mean?
Document medication, dose, route, time, site (if applicable), teaching, and patient
response. NEVER document BEFORE giving the medication.
What is the RIGHT to REFUSE?
Assess reason, teach risks/benefits, notify prescriber if refusal creates risk, and
document. NEVER coerce the client.
