RASMUSSEN UNIVERSITY
Bachelor of Science in Nursing (BSN)
NUR 2474 Pharmacology
Academic Year: 2026/2027 NCLEX-Style Final Exam Practice
Question 1 Safety
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients
who were just admitted. Which patient should the nurse assess first?
A. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30
Novolin insulin
B. The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin)
C. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache
D. The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin)
CORRECT ANSWER:
A. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30
Novolin insulin
RATIONALE priority
An NPO patient who just received 70/30 insulin is at high risk for hypoglycemia because they cannot
eat to match the insulin peak. Blood glucose of 80 mg/dL is borderline low. The other patients have
stable findings that can be addressed after this urgent risk.
,Question 2 Insulin
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding
scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317
mg/dL. Which formulation of insulin should the nurse prepare to administer?
A. No insulin should be administered.
B. NPH
C. 70/30 mix
D. Lispro (Humalog)
CORRECT ANSWER: D. Lispro (Humalog)
RATIONALE rapid-acting
Lispro is a rapid-acting insulin given just before meals to cover prandial glucose spikes. NPH and
70/30 are intermediate-acting and not appropriate for acute mealtime correction. With a glucose of
317 mg/dL, insulin is clearly needed.
Question 3 Pregnancy
A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose
testing schedule for her. What is the recommended monitoring schedule?
A. Before each meal and before bed
B. In the morning for a fasting level and at 4 PM for the peak level
C. Six or seven times a day
D. Three times a day, along with urine glucose testing
CORRECT ANSWER: C. Six or seven times a day
RATIONALE tight control
During pregnancy, tight glycemic control is critical to prevent fetal complications. The
recommended regimen is 6–7 tests daily (fasting, pre-meal, post-meal, and bedtime) to maintain
strict glucose targets.
,Question 4 Diagnosis
An adolescent patient recently attended a health fair and had a serum glucose test. The
patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have
diabetes?" What is the nurse's most accurate response?
A. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have
diabetes."
B. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this
week."
C. "This level is conclusive evidence that you have diabetes."
D. "This level is conclusive evidence that you do not have diabetes."
CORRECT ANSWER:
A. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have
diabetes."
RATIONALE diagnostic criteria
A random glucose of 125 mg/dL is not diagnostic for diabetes unless the patient has symptoms of
hyperglycemia. Fasting glucose ≥126 mg/dL or 2-hour OGTT ≥200 mg/dL is required. The nurse
should clarify the fasting status and recommend follow-up testing if indicated.
Question 5 Insulin glargine
Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse
administer this drug?
A. Approximately 15 to 30 minutes before each meal
B. In the morning and at 4 PM
C. Once daily at bedtime
D. After meals and at bedtime
CORRECT ANSWER: C. Once daily at bedtime
RATIONALE long-acting
Insulin glargine is a long-acting basal insulin with a duration of about 24 hours. It is administered
once daily at bedtime to provide steady basal coverage without peaks.
, Question 6 Beta blocker
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension.
Why is the nurse concerned?
A. The beta blocker can cause insulin resistance.
B. Using the two agents together increases the risk of ketoacidosis.
C. Propranolol increases insulin requirements because of receptor blocking.
D. The beta blocker can mask the symptoms of hypoglycemia.
CORRECT ANSWER: D. The beta blocker can mask the symptoms of hypoglycemia.
RATIONALE adverse effect
Beta blockers (especially nonselective ones like propranolol) can mask adrenergic symptoms of
hypoglycemia such as tachycardia and tremors. This can delay recognition and treatment of low
blood glucose in insulin-dependent patients.
Question 7 Acarbose vs miglitol
Which statement is correct about the contrast between acarbose and miglitol?
A. Miglitol has not been associated with hepatic dysfunction.
B. With miglitol, sucrose can be used to treat hypoglycemia.
C. Miglitol is less effective in African Americans.
D. Miglitol has no gastrointestinal side effects.
CORRECT ANSWER: A. Miglitol has not been associated with hepatic dysfunction.
RATIONALE key difference
Acarbose has been associated with hepatic enzyme elevations, whereas miglitol has not. Both cause
GI side effects (flatulence, diarrhea), and sucrose is not effective for hypoglycemia because these
drugs inhibit sucrose breakdown.
Bachelor of Science in Nursing (BSN)
NUR 2474 Pharmacology
Academic Year: 2026/2027 NCLEX-Style Final Exam Practice
Question 1 Safety
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients
who were just admitted. Which patient should the nurse assess first?
A. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30
Novolin insulin
B. The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin)
C. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache
D. The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin)
CORRECT ANSWER:
A. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30
Novolin insulin
RATIONALE priority
An NPO patient who just received 70/30 insulin is at high risk for hypoglycemia because they cannot
eat to match the insulin peak. Blood glucose of 80 mg/dL is borderline low. The other patients have
stable findings that can be addressed after this urgent risk.
,Question 2 Insulin
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding
scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317
mg/dL. Which formulation of insulin should the nurse prepare to administer?
A. No insulin should be administered.
B. NPH
C. 70/30 mix
D. Lispro (Humalog)
CORRECT ANSWER: D. Lispro (Humalog)
RATIONALE rapid-acting
Lispro is a rapid-acting insulin given just before meals to cover prandial glucose spikes. NPH and
70/30 are intermediate-acting and not appropriate for acute mealtime correction. With a glucose of
317 mg/dL, insulin is clearly needed.
Question 3 Pregnancy
A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose
testing schedule for her. What is the recommended monitoring schedule?
A. Before each meal and before bed
B. In the morning for a fasting level and at 4 PM for the peak level
C. Six or seven times a day
D. Three times a day, along with urine glucose testing
CORRECT ANSWER: C. Six or seven times a day
RATIONALE tight control
During pregnancy, tight glycemic control is critical to prevent fetal complications. The
recommended regimen is 6–7 tests daily (fasting, pre-meal, post-meal, and bedtime) to maintain
strict glucose targets.
,Question 4 Diagnosis
An adolescent patient recently attended a health fair and had a serum glucose test. The
patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have
diabetes?" What is the nurse's most accurate response?
A. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have
diabetes."
B. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this
week."
C. "This level is conclusive evidence that you have diabetes."
D. "This level is conclusive evidence that you do not have diabetes."
CORRECT ANSWER:
A. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have
diabetes."
RATIONALE diagnostic criteria
A random glucose of 125 mg/dL is not diagnostic for diabetes unless the patient has symptoms of
hyperglycemia. Fasting glucose ≥126 mg/dL or 2-hour OGTT ≥200 mg/dL is required. The nurse
should clarify the fasting status and recommend follow-up testing if indicated.
Question 5 Insulin glargine
Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse
administer this drug?
A. Approximately 15 to 30 minutes before each meal
B. In the morning and at 4 PM
C. Once daily at bedtime
D. After meals and at bedtime
CORRECT ANSWER: C. Once daily at bedtime
RATIONALE long-acting
Insulin glargine is a long-acting basal insulin with a duration of about 24 hours. It is administered
once daily at bedtime to provide steady basal coverage without peaks.
, Question 6 Beta blocker
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension.
Why is the nurse concerned?
A. The beta blocker can cause insulin resistance.
B. Using the two agents together increases the risk of ketoacidosis.
C. Propranolol increases insulin requirements because of receptor blocking.
D. The beta blocker can mask the symptoms of hypoglycemia.
CORRECT ANSWER: D. The beta blocker can mask the symptoms of hypoglycemia.
RATIONALE adverse effect
Beta blockers (especially nonselective ones like propranolol) can mask adrenergic symptoms of
hypoglycemia such as tachycardia and tremors. This can delay recognition and treatment of low
blood glucose in insulin-dependent patients.
Question 7 Acarbose vs miglitol
Which statement is correct about the contrast between acarbose and miglitol?
A. Miglitol has not been associated with hepatic dysfunction.
B. With miglitol, sucrose can be used to treat hypoglycemia.
C. Miglitol is less effective in African Americans.
D. Miglitol has no gastrointestinal side effects.
CORRECT ANSWER: A. Miglitol has not been associated with hepatic dysfunction.
RATIONALE key difference
Acarbose has been associated with hepatic enzyme elevations, whereas miglitol has not. Both cause
GI side effects (flatulence, diarrhea), and sucrose is not effective for hypoglycemia because these
drugs inhibit sucrose breakdown.
