COMPREHENSIVE NURSING PHARMACOLOGY
PRACTICE EXAM 2026
Original Practice Questions with ANSWERs and
Detailed Rationales
Question 1
A nurse is preparing to administer eye drops to a client. Which of the following actions should the nurse
take? (Select all that apply)
A. Have the client lie on their side
B. Ask the client to look up at the ceiling
C. Tell the client to blink when the drops enter the eye
D. Drop the medication into the center of the client's conjunctival sac
E. Instruct the client to close their eye gently after instillation
ANSWER: B, D, E
Rationale:
Option A - Incorrect: The client should be positioned supine or with their head tilted back, not lying on
their side. This position allows for proper administration and distribution of the eye drops.
Option B - Correct: Asking the client to look up at the ceiling helps expose the conjunctival sac and
prevents the client from seeing the drops coming, which can reduce blinking reflex.
Option C - Incorrect: The client should be instructed NOT to blink immediately after administration, as
blinking can cause the medication to be expelled from the eye before absorption occurs.
Option D - Correct: Medication should be dropped into the center of the conjunctival sac (the space
between the lower eyelid and the eye) to ensure proper absorption and distribution.
Option E - Correct: Closing the eye gently (without squeezing) for 1-2 minutes after instillation helps
promote medication absorption and prevents the medication from draining out through the tear duct.
Question 2
A staff educator is reviewing medication dosages and factors that influence medication metabolism with
a group of nurses. Which of the following factors should the educator include as a reason to administer
lower medication dosages? (Select all that apply)
,A. Increased renal secretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medications metabolized by the same pathway
ANSWER: C, E
Rationale:
Option A - Incorrect: Increased renal secretion would actually enhance medication elimination,
potentially requiring higher or more frequent doses, not lower doses.
Option B - Incorrect: Increased medication-metabolizing enzymes would speed up drug metabolism,
potentially requiring higher doses to achieve therapeutic effects, not lower doses.
Option C - Correct: Liver failure impairs the body's ability to metabolize medications, leading to drug
accumulation and increased risk of toxicity. Lower doses are necessary to prevent adverse effects.
Option D - Incorrect: While peripheral vascular disease may affect medication distribution to
extremities, it doesn't typically require dosage reduction for most medications.
Option E - Correct: When multiple medications compete for the same metabolic pathway, metabolism is
slowed, leading to increased drug levels and potential toxicity. Lower doses may be needed to prevent
adverse effects.
Question 3
A nurse is completing discharge teaching for a client who has a new prescription for transdermal
patches. Which of the following statements should the nurse identify as an indication that the client
understands the instructions?
A. "I will clean the site with an alcohol swab before I apply the patch"
B. "I will rotate the application sites weekly"
C. "I will apply the patch to an area of skin with no hair"
D. "I will place the new patch on the site of the old patch"
ANSWER: C
Rationale:
Option A - Incorrect: While cleaning the site is important, alcohol can irritate the skin and affect
medication absorption. The site should be cleaned with soap and water and dried thoroughly, not with
alcohol.
Option B - Incorrect: Transdermal patches are typically rotated with each new application (daily or as
prescribed), not weekly. Weekly rotation could lead to skin irritation and inconsistent absorption.
,Option C - Correct: Applying the patch to hairless skin ensures proper adhesion and optimal medication
absorption. If necessary, hair should be clipped (not shaved) to avoid skin irritation.
Option D - Incorrect: The new patch should NEVER be placed on the same site as the old patch. Sites
should be rotated to prevent skin irritation and allow skin recovery. The same site should not be reused
for at least 1 week.
Question 4
A nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the
client's medication. Which of the following actions should the nurse take?
A. Obtain a blood specimen immediately prior to administering the next dose of medication
B. Verify that the client has been taking the medication for 24 hours before obtaining a blood specimen
C. Ask the client to provide a urine specimen after the next dose of medication
D. Administer the medication and obtain a blood specimen 30 minutes later
ANSWER: A
Rationale:
Option A - Correct: A trough level is the lowest concentration of medication in the bloodstream and
should be drawn immediately BEFORE the next scheduled dose. This helps determine if the medication
level remains therapeutic throughout the dosing interval.
Option B - Incorrect: While steady state is important for accurate trough levels, the timing of 24 hours is
arbitrary and depends on the medication's half-life. The critical factor is drawing the specimen before
the next dose.
Option C - Incorrect: Trough levels are measured through blood specimens, not urine. Urine specimens
may be used for other types of drug monitoring but not for trough levels.
Option D - Incorrect: This describes a peak level, not a trough level. Peak levels are drawn after
medication administration to measure the highest concentration, while trough levels are drawn before
the next dose.
Question 5
A nurse is preparing a client's medications. Which of the following actions should the nurse take in
following legal practice guidelines? (Select all that apply)
A. Maintain skill competency
B. Determine the dosage
C. Monitor for adverse effects
D. Safeguard medications
E. Identify the client's diagnosis
, ANSWER: A, C, D
Rationale:
Option A - Correct: Maintaining skill competency is a legal and ethical responsibility. Nurses must stay
current with medication knowledge, administration techniques, and safety protocols.
Option B - Incorrect: Nurses do NOT determine medication dosages. Dosages are prescribed by licensed
independent practitioners (physicians, nurse practitioners, etc.). Nurses verify that dosages are within
safe ranges but do not prescribe them.
Option C - Correct: Monitoring for adverse effects is a critical nursing responsibility. Early detection and
reporting of adverse reactions can prevent serious complications and is part of the nurse's legal duty.
Option D - Correct: Safeguarding medications includes proper storage, securing controlled substances,
preventing unauthorized access, and ensuring medications are not tampered with. This is a legal
requirement.
Option E - Incorrect: While understanding the client's diagnosis helps with medication administration,
identifying or diagnosing conditions is outside the nurse's scope of practice. Diagnosis is the role of the
prescribing provider.
Question 6
A nurse is administering medications to a client and is using the "rights" of medication administration.
Which of the following are included in the rights of medication administration? (Select all that apply)
A. Right medication
B. Right dose
C. Right diagnosis
D. Right route
E. Right time
F. Right patient
ANSWER: A, B, D, E, F
Rationale:
Option A - Correct: Right medication is one of the fundamental rights. The nurse must verify that the
medication being administered matches the medication order.
Option B - Correct: Right dose ensures the client receives the correct amount of medication. The nurse
must verify the dosage is appropriate and matches the prescription.
Option C - Incorrect: Right diagnosis is NOT one of the traditional rights of medication administration.
While understanding the diagnosis is important, it is not one of the core rights used during medication
administration.
PRACTICE EXAM 2026
Original Practice Questions with ANSWERs and
Detailed Rationales
Question 1
A nurse is preparing to administer eye drops to a client. Which of the following actions should the nurse
take? (Select all that apply)
A. Have the client lie on their side
B. Ask the client to look up at the ceiling
C. Tell the client to blink when the drops enter the eye
D. Drop the medication into the center of the client's conjunctival sac
E. Instruct the client to close their eye gently after instillation
ANSWER: B, D, E
Rationale:
Option A - Incorrect: The client should be positioned supine or with their head tilted back, not lying on
their side. This position allows for proper administration and distribution of the eye drops.
Option B - Correct: Asking the client to look up at the ceiling helps expose the conjunctival sac and
prevents the client from seeing the drops coming, which can reduce blinking reflex.
Option C - Incorrect: The client should be instructed NOT to blink immediately after administration, as
blinking can cause the medication to be expelled from the eye before absorption occurs.
Option D - Correct: Medication should be dropped into the center of the conjunctival sac (the space
between the lower eyelid and the eye) to ensure proper absorption and distribution.
Option E - Correct: Closing the eye gently (without squeezing) for 1-2 minutes after instillation helps
promote medication absorption and prevents the medication from draining out through the tear duct.
Question 2
A staff educator is reviewing medication dosages and factors that influence medication metabolism with
a group of nurses. Which of the following factors should the educator include as a reason to administer
lower medication dosages? (Select all that apply)
,A. Increased renal secretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medications metabolized by the same pathway
ANSWER: C, E
Rationale:
Option A - Incorrect: Increased renal secretion would actually enhance medication elimination,
potentially requiring higher or more frequent doses, not lower doses.
Option B - Incorrect: Increased medication-metabolizing enzymes would speed up drug metabolism,
potentially requiring higher doses to achieve therapeutic effects, not lower doses.
Option C - Correct: Liver failure impairs the body's ability to metabolize medications, leading to drug
accumulation and increased risk of toxicity. Lower doses are necessary to prevent adverse effects.
Option D - Incorrect: While peripheral vascular disease may affect medication distribution to
extremities, it doesn't typically require dosage reduction for most medications.
Option E - Correct: When multiple medications compete for the same metabolic pathway, metabolism is
slowed, leading to increased drug levels and potential toxicity. Lower doses may be needed to prevent
adverse effects.
Question 3
A nurse is completing discharge teaching for a client who has a new prescription for transdermal
patches. Which of the following statements should the nurse identify as an indication that the client
understands the instructions?
A. "I will clean the site with an alcohol swab before I apply the patch"
B. "I will rotate the application sites weekly"
C. "I will apply the patch to an area of skin with no hair"
D. "I will place the new patch on the site of the old patch"
ANSWER: C
Rationale:
Option A - Incorrect: While cleaning the site is important, alcohol can irritate the skin and affect
medication absorption. The site should be cleaned with soap and water and dried thoroughly, not with
alcohol.
Option B - Incorrect: Transdermal patches are typically rotated with each new application (daily or as
prescribed), not weekly. Weekly rotation could lead to skin irritation and inconsistent absorption.
,Option C - Correct: Applying the patch to hairless skin ensures proper adhesion and optimal medication
absorption. If necessary, hair should be clipped (not shaved) to avoid skin irritation.
Option D - Incorrect: The new patch should NEVER be placed on the same site as the old patch. Sites
should be rotated to prevent skin irritation and allow skin recovery. The same site should not be reused
for at least 1 week.
Question 4
A nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the
client's medication. Which of the following actions should the nurse take?
A. Obtain a blood specimen immediately prior to administering the next dose of medication
B. Verify that the client has been taking the medication for 24 hours before obtaining a blood specimen
C. Ask the client to provide a urine specimen after the next dose of medication
D. Administer the medication and obtain a blood specimen 30 minutes later
ANSWER: A
Rationale:
Option A - Correct: A trough level is the lowest concentration of medication in the bloodstream and
should be drawn immediately BEFORE the next scheduled dose. This helps determine if the medication
level remains therapeutic throughout the dosing interval.
Option B - Incorrect: While steady state is important for accurate trough levels, the timing of 24 hours is
arbitrary and depends on the medication's half-life. The critical factor is drawing the specimen before
the next dose.
Option C - Incorrect: Trough levels are measured through blood specimens, not urine. Urine specimens
may be used for other types of drug monitoring but not for trough levels.
Option D - Incorrect: This describes a peak level, not a trough level. Peak levels are drawn after
medication administration to measure the highest concentration, while trough levels are drawn before
the next dose.
Question 5
A nurse is preparing a client's medications. Which of the following actions should the nurse take in
following legal practice guidelines? (Select all that apply)
A. Maintain skill competency
B. Determine the dosage
C. Monitor for adverse effects
D. Safeguard medications
E. Identify the client's diagnosis
, ANSWER: A, C, D
Rationale:
Option A - Correct: Maintaining skill competency is a legal and ethical responsibility. Nurses must stay
current with medication knowledge, administration techniques, and safety protocols.
Option B - Incorrect: Nurses do NOT determine medication dosages. Dosages are prescribed by licensed
independent practitioners (physicians, nurse practitioners, etc.). Nurses verify that dosages are within
safe ranges but do not prescribe them.
Option C - Correct: Monitoring for adverse effects is a critical nursing responsibility. Early detection and
reporting of adverse reactions can prevent serious complications and is part of the nurse's legal duty.
Option D - Correct: Safeguarding medications includes proper storage, securing controlled substances,
preventing unauthorized access, and ensuring medications are not tampered with. This is a legal
requirement.
Option E - Incorrect: While understanding the client's diagnosis helps with medication administration,
identifying or diagnosing conditions is outside the nurse's scope of practice. Diagnosis is the role of the
prescribing provider.
Question 6
A nurse is administering medications to a client and is using the "rights" of medication administration.
Which of the following are included in the rights of medication administration? (Select all that apply)
A. Right medication
B. Right dose
C. Right diagnosis
D. Right route
E. Right time
F. Right patient
ANSWER: A, B, D, E, F
Rationale:
Option A - Correct: Right medication is one of the fundamental rights. The nurse must verify that the
medication being administered matches the medication order.
Option B - Correct: Right dose ensures the client receives the correct amount of medication. The nurse
must verify the dosage is appropriate and matches the prescription.
Option C - Incorrect: Right diagnosis is NOT one of the traditional rights of medication administration.
While understanding the diagnosis is important, it is not one of the core rights used during medication
administration.
