RN Pharmacology Competency Exam —
Code: RN-PHARMA-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A patient with heart failure is receiving digoxin. The nurse notes an apical
pulse of 52/min, nausea, and yellow-green visual disturbances. Which
action is the priority?
A. Administer the scheduled dose with food
B. Hold digoxin and notify the provider
C. Administer potassium supplementation immediately
D. Reassess the apical pulse in 4 hours
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic manifestations of digoxin toxicity. The medication should be withheld
,and the provider notified. Serum digoxin and electrolyte levels, particularly
potassium, should be evaluated.
2. A patient taking warfarin has an INR of 5.8 without active bleeding. Which
prescription should the nurse anticipate?
A. Administer protamine sulfate
B. Administer vitamin K as indicated
C. Give aspirin
D. Increase the warfarin dose
Answer: Administer vitamin K as indicated
Rationale: An excessively elevated INR increases bleeding risk. Vitamin K may be
prescribed depending on the degree of elevation and clinical circumstances.
Protamine sulfate reverses heparin, not warfarin.
3. A patient receiving unfractionated heparin develops a platelet count that
falls from 220,000/mm³ to 95,000/mm³. What is the nurse's priority action?
A. Continue heparin and monitor platelets
B. Stop heparin and notify the provider
C. Administer vitamin K
D. Apply pressure to the patient's extremities
Answer: Stop heparin and notify the provider
Rationale: A significant platelet decline after heparin exposure suggests
heparin-induced thrombocytopenia (HIT), a potentially life-threatening
prothrombotic disorder. Heparin should be discontinued and an alternative
anticoagulant may be prescribed.
, 4. A patient taking lisinopril develops facial swelling and difficulty swallowing.
What should the nurse do first?
A. Administer the next dose with food
B. Place the patient supine
C. Hold lisinopril and initiate emergency management
D. Document the finding as an expected adverse effect
Answer: Hold lisinopril and initiate emergency management
Rationale: Angioedema is a potentially life-threatening adverse reaction to ACE
inhibitors and can rapidly compromise the airway. The medication must be
discontinued and immediate airway-focused treatment initiated.
5. A patient receiving IV vancomycin develops flushing, erythema, and
pruritus over the face and upper torso during infusion. Which intervention
is most appropriate?
A. Increase the infusion rate
B. Stop or slow the infusion and notify the provider
C. Administer another dose immediately
D. Permanently discontinue all antibiotics
Answer: Stop or slow the infusion and notify the provider
Rationale: Rapid vancomycin infusion can cause vancomycin infusion reaction,
characterized by flushing and pruritus. Slowing or temporarily stopping the
infusion and providing appropriate treatment can reduce symptoms.
6. A patient receiving gentamicin has a rising serum creatinine and reports
new difficulty hearing. Which adverse effects should the nurse suspect?
A. Hepatotoxicity and pancreatitis
B. Nephrotoxicity and ototoxicity
, C. Cardiotoxicity and hyperglycemia
D. Bone marrow suppression and constipation
Answer: Nephrotoxicity and ototoxicity
Rationale: Aminoglycosides such as gentamicin can cause significant renal injury
and vestibular or cochlear toxicity. Renal function and auditory symptoms
require close monitoring.
7. A patient taking lithium develops severe diarrhea, coarse tremors, ataxia,
and confusion. What is the priority nursing action?
A. Administer the next lithium dose
B. Encourage a high-calcium diet
C. Hold lithium and notify the provider
D. Restrict sodium intake
Answer: Hold lithium and notify the provider
Rationale: Severe gastrointestinal symptoms, coarse tremor, ataxia, and
confusion indicate possible lithium toxicity. Lithium has a narrow therapeutic
index, and toxicity requires prompt evaluation and treatment.
8. Which laboratory result is most important for a patient receiving
unfractionated heparin?
A. INR
B. aPTT or institution-specific anti-Xa level
C. Serum amylase
D. Hemoglobin A1c
Answer: aPTT or institution-specific anti-Xa level
Code: RN-PHARMA-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A patient with heart failure is receiving digoxin. The nurse notes an apical
pulse of 52/min, nausea, and yellow-green visual disturbances. Which
action is the priority?
A. Administer the scheduled dose with food
B. Hold digoxin and notify the provider
C. Administer potassium supplementation immediately
D. Reassess the apical pulse in 4 hours
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic manifestations of digoxin toxicity. The medication should be withheld
,and the provider notified. Serum digoxin and electrolyte levels, particularly
potassium, should be evaluated.
2. A patient taking warfarin has an INR of 5.8 without active bleeding. Which
prescription should the nurse anticipate?
A. Administer protamine sulfate
B. Administer vitamin K as indicated
C. Give aspirin
D. Increase the warfarin dose
Answer: Administer vitamin K as indicated
Rationale: An excessively elevated INR increases bleeding risk. Vitamin K may be
prescribed depending on the degree of elevation and clinical circumstances.
Protamine sulfate reverses heparin, not warfarin.
3. A patient receiving unfractionated heparin develops a platelet count that
falls from 220,000/mm³ to 95,000/mm³. What is the nurse's priority action?
A. Continue heparin and monitor platelets
B. Stop heparin and notify the provider
C. Administer vitamin K
D. Apply pressure to the patient's extremities
Answer: Stop heparin and notify the provider
Rationale: A significant platelet decline after heparin exposure suggests
heparin-induced thrombocytopenia (HIT), a potentially life-threatening
prothrombotic disorder. Heparin should be discontinued and an alternative
anticoagulant may be prescribed.
, 4. A patient taking lisinopril develops facial swelling and difficulty swallowing.
What should the nurse do first?
A. Administer the next dose with food
B. Place the patient supine
C. Hold lisinopril and initiate emergency management
D. Document the finding as an expected adverse effect
Answer: Hold lisinopril and initiate emergency management
Rationale: Angioedema is a potentially life-threatening adverse reaction to ACE
inhibitors and can rapidly compromise the airway. The medication must be
discontinued and immediate airway-focused treatment initiated.
5. A patient receiving IV vancomycin develops flushing, erythema, and
pruritus over the face and upper torso during infusion. Which intervention
is most appropriate?
A. Increase the infusion rate
B. Stop or slow the infusion and notify the provider
C. Administer another dose immediately
D. Permanently discontinue all antibiotics
Answer: Stop or slow the infusion and notify the provider
Rationale: Rapid vancomycin infusion can cause vancomycin infusion reaction,
characterized by flushing and pruritus. Slowing or temporarily stopping the
infusion and providing appropriate treatment can reduce symptoms.
6. A patient receiving gentamicin has a rising serum creatinine and reports
new difficulty hearing. Which adverse effects should the nurse suspect?
A. Hepatotoxicity and pancreatitis
B. Nephrotoxicity and ototoxicity
, C. Cardiotoxicity and hyperglycemia
D. Bone marrow suppression and constipation
Answer: Nephrotoxicity and ototoxicity
Rationale: Aminoglycosides such as gentamicin can cause significant renal injury
and vestibular or cochlear toxicity. Renal function and auditory symptoms
require close monitoring.
7. A patient taking lithium develops severe diarrhea, coarse tremors, ataxia,
and confusion. What is the priority nursing action?
A. Administer the next lithium dose
B. Encourage a high-calcium diet
C. Hold lithium and notify the provider
D. Restrict sodium intake
Answer: Hold lithium and notify the provider
Rationale: Severe gastrointestinal symptoms, coarse tremor, ataxia, and
confusion indicate possible lithium toxicity. Lithium has a narrow therapeutic
index, and toxicity requires prompt evaluation and treatment.
8. Which laboratory result is most important for a patient receiving
unfractionated heparin?
A. INR
B. aPTT or institution-specific anti-Xa level
C. Serum amylase
D. Hemoglobin A1c
Answer: aPTT or institution-specific anti-Xa level
