Nursing Pharmacology | Comprehensive Study
Guide, Practice Exam, Questions & Answers,
Pharmacology Exam Prep Test Bank, Medication
Classifications, Drug Calculations, Safe
Medication Administration, Adverse Drug
Reactions, IV Medications, Patient Safety, NCLEX-
RN & NCLEX-PN Review, Detailed Rationales,
Complete Review
Question 1: A patient with a history of gout is prescribed hydrochlorothiazide
for hypertension. Which adverse effect is of greatest concern when
administering this medication?
A. Hyperkalemia
B. Hypoglycemia
C. Hyperuricemia
D. Hypomagnesemia
CORRECT ANSWER: C. Hyperuricemia
Rationale:Thiazide diuretics, such as hydrochlorothiazide, decrease the excretion of
uric acid, leading to hyperuricemia. This can precipitate an acute gout attack in
susceptible patients. Hyperkalemia is more commonly associated with potassium-
sparing diuretics, not thiazides.
Question 2: A nurse is providing teaching to a patient prescribed nitroglycerin
sublingual tablets for angina. Which instruction is most important regarding
the storage of this medication?
A. Store in the refrigerator to maintain potency.
B. Keep the tablets in the original amber glass bottle with the cap tightly closed.
C. Discard the medication 6 months after the bottle is opened, regardless of the
expiration date.
D. Store the medication near a heat source to ensure rapid dissolution.
CORRECT ANSWER: B. Keep the tablets in the original amber glass bottle with
the cap tightly closed.
Rationale:Nitroglycerin is volatile and degraded by light, heat, and moisture. The amber
glass bottle protects it from light, and the tight cap prevents moisture absorption. It
should be replaced every 6 months after opening, not 6 months regardless of the date,
and should never be stored near heat.
Question 3: A patient is receiving an intravenous infusion of vancomycin. The
nurse notes the patient is experiencing flushing, tachycardia, and a diffuse
erythematous rash on the face and upper torso. What is the most appropriate
initial nursing action?
,A. Stop the infusion immediately and notify the provider.
B. Slow the rate of the infusion and administer diphenhydramine as prescribed.
C. Flush the IV line with normal saline and continue the infusion.
D. Apply a cold compress to the rash and reassure the patient.
CORRECT ANSWER: B. Slow the rate of the infusion and administer
diphenhydramine as prescribed.
Rationale:These symptoms are characteristic of Red Man Syndrome, a histamine-
release reaction associated with rapid vancomycin infusion. The recommended action is
to slow the infusion rate (typically over at least 60 minutes) and administer
antihistamines like diphenhydramine. Stopping the infusion completely is not indicated
unless severe hypotension occurs.
Question 4: Which laboratory value is the most critical to monitor in a patient
prescribed lithium carbonate for bipolar disorder?
A. Serum sodium levels
B. Serum potassium levels
C. Serum calcium levels
D. Serum creatinine levels
CORRECT ANSWER: D. Serum creatinine levels
Rationale:Lithium has a narrow therapeutic index and is excreted renally. Monitoring
renal function via serum creatinine and BUN is essential to prevent toxicity, especially
since renal impairment can lead to dangerous accumulation. While sodium is important
(as hyponatremia can increase lithium levels), creatinine is the standard and most direct
monitor of renal clearance.
Question 5: A patient is prescribed warfarin for atrial fibrillation. The nurse
should recognize that which herbal supplement can significantly increase the
risk of bleeding when taken concurrently?
A. St. John's Wort
B. Ginseng
C. Garlic
D. Ginkgo Biloba
CORRECT ANSWER: D. Ginkgo Biloba
Rationale:Ginkgo biloba has antiplatelet properties and can increase the risk of
bleeding when taken with warfarin. St. John's Wort and Ginseng can decrease warfarin's
effectiveness by inducing CYP450 enzymes, while garlic also has antiplatelet effects but
Ginkgo is the most notable for this specific interaction.
Question 6: A patient is prescribed digoxin for heart failure. The nurse
assesses the patient's apical pulse for one minute before administration. What
heart rate would indicate that the medication should be withheld?
,A. 72 beats per minute
B. 68 beats per minute
C. 55 beats per minute
D. 80 beats per minute
CORRECT ANSWER: C. 55 beats per minute
Rationale:The standard parameter for withholding digoxin is an apical pulse of less than
60 beats per minute in an adult. A rate of 55 bpm is below this threshold and warrants
holding the dose and notifying the provider due to the risk of bradycardia and digoxin
toxicity.
Question 7: Which adverse effect is a common and distinctive side effect of
theophylline therapy, often indicating the need for serum level monitoring?
A. Hyperkalemia
B. Tachycardia and gastrointestinal upset
C. Peripheral neuropathy
D. Alopecia
CORRECT ANSWER: B. Tachycardia and gastrointestinal upset
Rationale:Theophylline, a methylxanthine bronchodilator, has a narrow therapeutic
range. Common adverse effects of toxicity include tachycardia, nausea, vomiting, and
anorexia. These symptoms are often the first signs of elevated serum levels and require
monitoring.
Question 8: A client who is HIV-positive is started on zidovudine (AZT). The
nurse's teaching plan should include monitoring for which primary life-
threatening adverse effect?
A. Nephrotoxicity
B. Cardiotoxicity
C. Hepatotoxicity
D. Bone marrow suppression
CORRECT ANSWER: D. Bone marrow suppression
Rationale:A major dose-limiting toxicity of zidovudine is bone marrow suppression,
leading to severe anemia and neutropenia. Regular monitoring of complete blood counts
is essential to prevent life-threatening infections and severe fatigue.
Question 9: In the context of opioid analgesics, which medication is preferred
for reversing respiratory depression caused by a morphine overdose?
A. Naloxone
B. Naltrexone
C. Flumazenil
D. Acetylcysteine
CORRECT ANSWER: A. Naloxone
, Rationale:Naloxone is a pure opioid antagonist that competitively binds to opioid
receptors, rapidly reversing the effects of morphine, including respiratory depression.
Naltrexone is used for longer-term management, Flumazenil reverses benzodiazepines,
and Acetylcysteine is an antidote for acetaminophen toxicity.
Question 10: A patient is to receive a new prescription for an ACE inhibitor.
The nurse is reviewing the patient's chart. Which condition is a
contraindication to the use of ACE inhibitors?
A. Type 2 diabetes mellitus
B. Pregnancy
C. Hypertension
D. Glaucoma
CORRECT ANSWER: B. Pregnancy
Rationale:ACE inhibitors are contraindicated in pregnancy (Category D in the second
and third trimesters) due to the risk of fetal renal abnormalities, oligohydramnios, and
neonatal death. They are actually used in hypertension and diabetic nephropathy, and
have no specific contraindication for glaucoma.
Question 11: A nurse is preparing to administer an IM injection of vitamin
B12. Which route of administration is specific to this medication?
A. Z-track method
B. Deltoid site
C. Dorsogluteal site
D. Subcutaneous injection
CORRECT ANSWER: A. Z-track method
Rationale:The Z-track method is used for deep IM injections of medications that can
stain or irritate tissue, such as iron dextran and vitamin B12. This technique prevents
leakage of the medication into subcutaneous tissues, minimizing pain and discoloration.
Question 12: A patient is prescribed lovastatin. Which instruction is crucial
regarding the timing of administration?
A. Administer in the morning with breakfast.
B. Administer with the evening meal.
C. Administer on an empty stomach.
D. Administer at bedtime without food.
CORRECT ANSWER: B. Administer with the evening meal.
Rationale:Lovastatin is a statin that should be taken with food to enhance absorption.
More specifically, it's recommended to be taken with the evening meal because
cholesterol synthesis is highest during the night, maximizing the drug's effectiveness.
While some statins are taken at bedtime, Lovastatin specifically should be taken with the
evening meal.
Guide, Practice Exam, Questions & Answers,
Pharmacology Exam Prep Test Bank, Medication
Classifications, Drug Calculations, Safe
Medication Administration, Adverse Drug
Reactions, IV Medications, Patient Safety, NCLEX-
RN & NCLEX-PN Review, Detailed Rationales,
Complete Review
Question 1: A patient with a history of gout is prescribed hydrochlorothiazide
for hypertension. Which adverse effect is of greatest concern when
administering this medication?
A. Hyperkalemia
B. Hypoglycemia
C. Hyperuricemia
D. Hypomagnesemia
CORRECT ANSWER: C. Hyperuricemia
Rationale:Thiazide diuretics, such as hydrochlorothiazide, decrease the excretion of
uric acid, leading to hyperuricemia. This can precipitate an acute gout attack in
susceptible patients. Hyperkalemia is more commonly associated with potassium-
sparing diuretics, not thiazides.
Question 2: A nurse is providing teaching to a patient prescribed nitroglycerin
sublingual tablets for angina. Which instruction is most important regarding
the storage of this medication?
A. Store in the refrigerator to maintain potency.
B. Keep the tablets in the original amber glass bottle with the cap tightly closed.
C. Discard the medication 6 months after the bottle is opened, regardless of the
expiration date.
D. Store the medication near a heat source to ensure rapid dissolution.
CORRECT ANSWER: B. Keep the tablets in the original amber glass bottle with
the cap tightly closed.
Rationale:Nitroglycerin is volatile and degraded by light, heat, and moisture. The amber
glass bottle protects it from light, and the tight cap prevents moisture absorption. It
should be replaced every 6 months after opening, not 6 months regardless of the date,
and should never be stored near heat.
Question 3: A patient is receiving an intravenous infusion of vancomycin. The
nurse notes the patient is experiencing flushing, tachycardia, and a diffuse
erythematous rash on the face and upper torso. What is the most appropriate
initial nursing action?
,A. Stop the infusion immediately and notify the provider.
B. Slow the rate of the infusion and administer diphenhydramine as prescribed.
C. Flush the IV line with normal saline and continue the infusion.
D. Apply a cold compress to the rash and reassure the patient.
CORRECT ANSWER: B. Slow the rate of the infusion and administer
diphenhydramine as prescribed.
Rationale:These symptoms are characteristic of Red Man Syndrome, a histamine-
release reaction associated with rapid vancomycin infusion. The recommended action is
to slow the infusion rate (typically over at least 60 minutes) and administer
antihistamines like diphenhydramine. Stopping the infusion completely is not indicated
unless severe hypotension occurs.
Question 4: Which laboratory value is the most critical to monitor in a patient
prescribed lithium carbonate for bipolar disorder?
A. Serum sodium levels
B. Serum potassium levels
C. Serum calcium levels
D. Serum creatinine levels
CORRECT ANSWER: D. Serum creatinine levels
Rationale:Lithium has a narrow therapeutic index and is excreted renally. Monitoring
renal function via serum creatinine and BUN is essential to prevent toxicity, especially
since renal impairment can lead to dangerous accumulation. While sodium is important
(as hyponatremia can increase lithium levels), creatinine is the standard and most direct
monitor of renal clearance.
Question 5: A patient is prescribed warfarin for atrial fibrillation. The nurse
should recognize that which herbal supplement can significantly increase the
risk of bleeding when taken concurrently?
A. St. John's Wort
B. Ginseng
C. Garlic
D. Ginkgo Biloba
CORRECT ANSWER: D. Ginkgo Biloba
Rationale:Ginkgo biloba has antiplatelet properties and can increase the risk of
bleeding when taken with warfarin. St. John's Wort and Ginseng can decrease warfarin's
effectiveness by inducing CYP450 enzymes, while garlic also has antiplatelet effects but
Ginkgo is the most notable for this specific interaction.
Question 6: A patient is prescribed digoxin for heart failure. The nurse
assesses the patient's apical pulse for one minute before administration. What
heart rate would indicate that the medication should be withheld?
,A. 72 beats per minute
B. 68 beats per minute
C. 55 beats per minute
D. 80 beats per minute
CORRECT ANSWER: C. 55 beats per minute
Rationale:The standard parameter for withholding digoxin is an apical pulse of less than
60 beats per minute in an adult. A rate of 55 bpm is below this threshold and warrants
holding the dose and notifying the provider due to the risk of bradycardia and digoxin
toxicity.
Question 7: Which adverse effect is a common and distinctive side effect of
theophylline therapy, often indicating the need for serum level monitoring?
A. Hyperkalemia
B. Tachycardia and gastrointestinal upset
C. Peripheral neuropathy
D. Alopecia
CORRECT ANSWER: B. Tachycardia and gastrointestinal upset
Rationale:Theophylline, a methylxanthine bronchodilator, has a narrow therapeutic
range. Common adverse effects of toxicity include tachycardia, nausea, vomiting, and
anorexia. These symptoms are often the first signs of elevated serum levels and require
monitoring.
Question 8: A client who is HIV-positive is started on zidovudine (AZT). The
nurse's teaching plan should include monitoring for which primary life-
threatening adverse effect?
A. Nephrotoxicity
B. Cardiotoxicity
C. Hepatotoxicity
D. Bone marrow suppression
CORRECT ANSWER: D. Bone marrow suppression
Rationale:A major dose-limiting toxicity of zidovudine is bone marrow suppression,
leading to severe anemia and neutropenia. Regular monitoring of complete blood counts
is essential to prevent life-threatening infections and severe fatigue.
Question 9: In the context of opioid analgesics, which medication is preferred
for reversing respiratory depression caused by a morphine overdose?
A. Naloxone
B. Naltrexone
C. Flumazenil
D. Acetylcysteine
CORRECT ANSWER: A. Naloxone
, Rationale:Naloxone is a pure opioid antagonist that competitively binds to opioid
receptors, rapidly reversing the effects of morphine, including respiratory depression.
Naltrexone is used for longer-term management, Flumazenil reverses benzodiazepines,
and Acetylcysteine is an antidote for acetaminophen toxicity.
Question 10: A patient is to receive a new prescription for an ACE inhibitor.
The nurse is reviewing the patient's chart. Which condition is a
contraindication to the use of ACE inhibitors?
A. Type 2 diabetes mellitus
B. Pregnancy
C. Hypertension
D. Glaucoma
CORRECT ANSWER: B. Pregnancy
Rationale:ACE inhibitors are contraindicated in pregnancy (Category D in the second
and third trimesters) due to the risk of fetal renal abnormalities, oligohydramnios, and
neonatal death. They are actually used in hypertension and diabetic nephropathy, and
have no specific contraindication for glaucoma.
Question 11: A nurse is preparing to administer an IM injection of vitamin
B12. Which route of administration is specific to this medication?
A. Z-track method
B. Deltoid site
C. Dorsogluteal site
D. Subcutaneous injection
CORRECT ANSWER: A. Z-track method
Rationale:The Z-track method is used for deep IM injections of medications that can
stain or irritate tissue, such as iron dextran and vitamin B12. This technique prevents
leakage of the medication into subcutaneous tissues, minimizing pain and discoloration.
Question 12: A patient is prescribed lovastatin. Which instruction is crucial
regarding the timing of administration?
A. Administer in the morning with breakfast.
B. Administer with the evening meal.
C. Administer on an empty stomach.
D. Administer at bedtime without food.
CORRECT ANSWER: B. Administer with the evening meal.
Rationale:Lovastatin is a statin that should be taken with food to enhance absorption.
More specifically, it's recommended to be taken with the evening meal because
cholesterol synthesis is highest during the night, maximizing the drug's effectiveness.
While some statins are taken at bedtime, Lovastatin specifically should be taken with the
evening meal.
