PHARM Exam 3 Latest Practice Questions 2026-2027 | Verified
Answers Plus Rationales | Graded Q&A Study Guide | Latest
2027
1. A patient with a history of chronic heart failure is prescribed digoxin. Which clinical
laboratory value requires the most immediate assessment by the healthcare provider
before administering the next dose?
A. Serum sodium level of 138 mEq/L
B. Serum potassium level of 3.1 mEq/L
C. Total calcium level of 9.2 mg/dL
D. Serum creatinine level of 1.0 mg/dL
Answer: B
Rationale: Hypokalemia significantly increases the risk of digoxin toxicity because potassium
and digoxin compete for binding sites on the Na+/K+ ATPase pump. When serum potassium is
low, digoxin binding increases, leading to severe dysrhythmias and toxic manifestations.
2. A patient receiving an intravenous infusion of heparin for deep vein thrombosis exhibits
an activated partial thromboplastin time (aPTT) of 115 seconds. The control value is 30
seconds. What is the priority nursing action?
A. Continue the infusion at the current rate and recheck aPTT in 6 hours.
B. Stop the heparin infusion and notify the prescribing healthcare provider.
C. Increase the infusion rate by 10% to achieve therapeutic range.
D. Administer oral vitamin K immediately.
Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5 times
the control value (45 to 75 seconds). An aPTT of 115 seconds indicates excessive
anticoagulation and a high risk of hemorrhage, requiring immediate cessation of the infusion.
3. A client diagnosed with hypertension is initiated on lisinopril. Which side effect, if
reported by the patient, warrants discontinuing the drug and switching to a different
therapeutic class?
,A. Mild fatigue in the evening
B. Persistent, dry, nonproductive cough
C. Transient dizziness upon standing
D. Slight increase in urinary output
Answer: B
Rationale: A persistent dry cough is a well-known side effect of ACE inhibitors caused by the
accumulation of bradykinin in the lungs. It does not resolve over time and requires switching
to an Angiotensin II Receptor Blocker (ARB).
4. A nurse is preparing to administer sublingual nitroglycerin to a client experiencing acute
chest pain. What is the maximum number of doses that can be administered within a 15-
minute timeframe?
A. 1 dose
B. 2 doses
C. 3 doses
D. 4 doses
Answer: C
Rationale: The protocol for sublingual nitroglycerin in acute angina is to administer one tablet
every 5 minutes for a maximum of 3 doses over 15 minutes. If pain persists after the first
dose, emergency services should be contacted.
5. A patient prescribed warfarin for atrial fibrillation asks about dietary restrictions.
Which food choice should the nurse instruct the patient to keep consistent in their diet?
A. Red meat and poultry
B. Bananas and oranges
C. Spinach and kale
D. Whole grains and oats
Answer: C
,Rationale: Green leafy vegetables are high in Vitamin K, which antagonizes the anticoagulant
effect of warfarin. Patients do not need to eliminate Vitamin K entirely, but must maintain a
consistent daily intake to ensure stable INR levels.
6. A client taking furosemide for peripheral edema develops muscle cramps and weakness.
Which drug-induced electrolyte imbalance is the primary cause of these symptoms?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Answer: B
Rationale: Furosemide is a loop diuretic that causes significant renal excretion of potassium
along with sodium and water. Hypokalemia manifests clinically as muscle weakness,
cramping, fatigue, and potential cardiac dysrhythmias.
7. A patient with asthma is prescribed albuterol and beclomethasone via metered-dose
inhalers. How should the nurse instruct the patient to administer these medications?
A. Administer beclomethasone first, wait 5 minutes, then administer albuterol.
B. Administer albuterol first, wait 5 minutes, then administer beclomethasone.
C. Mix both medications together in a single nebulizer chamber.
D. Administer beclomethasone immediately before sleep and albuterol upon awakening.
Answer: B
Rationale: Albuterol is a short-acting beta2-agonist that dilates the bronchioles.
Administering it first opens the airways, allowing deeper penetration and enhanced
absorption of the inhaled corticosteroid (beclomethasone) administered 5 minutes later.
8. A healthcare provider prescribes atorvastatin for a patient with hyperlipidemia. The
patient should be counseled to immediately report which potential adverse effect?
A. Constipation
B. Unexplained muscle pain or weakness
, C. Nasal congestion
D. Mild headache
Answer: B
Rationale: Unexplained muscle soreness, pain, or weakness during statin therapy can indicate
myopathy or rhabdomyolysis, a severe condition characterized by muscle breakdown that can
lead to acute renal failure.
9. A client receiving intravenous vancomycin develops facial flushing, erythema, and a rash
across the neck and upper torso. What is the initial action by the nurse?
A. Immediately stop the infusion and administer epinephrine.
B. Slow the infusion rate of vancomycin and monitor vital signs.
C. Discontinue vancomycin permanently and document a severe drug allergy.
D. Administer a bolus of normal saline and increase the infusion rate.
Answer: B
Rationale: The described symptoms represent "Red Man Syndrome," a histamine-mediated
reaction caused by rapid infusion of vancomycin, not a true allergic reaction. Slowing the
infusion rate over 60 to 90 minutes typically resolves the symptoms.
10. Which medication is considered the drug of choice for the immediate reversal of
respiratory depression induced by opioid overdose?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Atropine
Answer: B
Rationale: Naloxone is a pure opioid antagonist that rapidly displaces opioids from mu-opioid
receptors, completely reversing opioid-induced central nervous system and respiratory
depression.
Answers Plus Rationales | Graded Q&A Study Guide | Latest
2027
1. A patient with a history of chronic heart failure is prescribed digoxin. Which clinical
laboratory value requires the most immediate assessment by the healthcare provider
before administering the next dose?
A. Serum sodium level of 138 mEq/L
B. Serum potassium level of 3.1 mEq/L
C. Total calcium level of 9.2 mg/dL
D. Serum creatinine level of 1.0 mg/dL
Answer: B
Rationale: Hypokalemia significantly increases the risk of digoxin toxicity because potassium
and digoxin compete for binding sites on the Na+/K+ ATPase pump. When serum potassium is
low, digoxin binding increases, leading to severe dysrhythmias and toxic manifestations.
2. A patient receiving an intravenous infusion of heparin for deep vein thrombosis exhibits
an activated partial thromboplastin time (aPTT) of 115 seconds. The control value is 30
seconds. What is the priority nursing action?
A. Continue the infusion at the current rate and recheck aPTT in 6 hours.
B. Stop the heparin infusion and notify the prescribing healthcare provider.
C. Increase the infusion rate by 10% to achieve therapeutic range.
D. Administer oral vitamin K immediately.
Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5 times
the control value (45 to 75 seconds). An aPTT of 115 seconds indicates excessive
anticoagulation and a high risk of hemorrhage, requiring immediate cessation of the infusion.
3. A client diagnosed with hypertension is initiated on lisinopril. Which side effect, if
reported by the patient, warrants discontinuing the drug and switching to a different
therapeutic class?
,A. Mild fatigue in the evening
B. Persistent, dry, nonproductive cough
C. Transient dizziness upon standing
D. Slight increase in urinary output
Answer: B
Rationale: A persistent dry cough is a well-known side effect of ACE inhibitors caused by the
accumulation of bradykinin in the lungs. It does not resolve over time and requires switching
to an Angiotensin II Receptor Blocker (ARB).
4. A nurse is preparing to administer sublingual nitroglycerin to a client experiencing acute
chest pain. What is the maximum number of doses that can be administered within a 15-
minute timeframe?
A. 1 dose
B. 2 doses
C. 3 doses
D. 4 doses
Answer: C
Rationale: The protocol for sublingual nitroglycerin in acute angina is to administer one tablet
every 5 minutes for a maximum of 3 doses over 15 minutes. If pain persists after the first
dose, emergency services should be contacted.
5. A patient prescribed warfarin for atrial fibrillation asks about dietary restrictions.
Which food choice should the nurse instruct the patient to keep consistent in their diet?
A. Red meat and poultry
B. Bananas and oranges
C. Spinach and kale
D. Whole grains and oats
Answer: C
,Rationale: Green leafy vegetables are high in Vitamin K, which antagonizes the anticoagulant
effect of warfarin. Patients do not need to eliminate Vitamin K entirely, but must maintain a
consistent daily intake to ensure stable INR levels.
6. A client taking furosemide for peripheral edema develops muscle cramps and weakness.
Which drug-induced electrolyte imbalance is the primary cause of these symptoms?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Answer: B
Rationale: Furosemide is a loop diuretic that causes significant renal excretion of potassium
along with sodium and water. Hypokalemia manifests clinically as muscle weakness,
cramping, fatigue, and potential cardiac dysrhythmias.
7. A patient with asthma is prescribed albuterol and beclomethasone via metered-dose
inhalers. How should the nurse instruct the patient to administer these medications?
A. Administer beclomethasone first, wait 5 minutes, then administer albuterol.
B. Administer albuterol first, wait 5 minutes, then administer beclomethasone.
C. Mix both medications together in a single nebulizer chamber.
D. Administer beclomethasone immediately before sleep and albuterol upon awakening.
Answer: B
Rationale: Albuterol is a short-acting beta2-agonist that dilates the bronchioles.
Administering it first opens the airways, allowing deeper penetration and enhanced
absorption of the inhaled corticosteroid (beclomethasone) administered 5 minutes later.
8. A healthcare provider prescribes atorvastatin for a patient with hyperlipidemia. The
patient should be counseled to immediately report which potential adverse effect?
A. Constipation
B. Unexplained muscle pain or weakness
, C. Nasal congestion
D. Mild headache
Answer: B
Rationale: Unexplained muscle soreness, pain, or weakness during statin therapy can indicate
myopathy or rhabdomyolysis, a severe condition characterized by muscle breakdown that can
lead to acute renal failure.
9. A client receiving intravenous vancomycin develops facial flushing, erythema, and a rash
across the neck and upper torso. What is the initial action by the nurse?
A. Immediately stop the infusion and administer epinephrine.
B. Slow the infusion rate of vancomycin and monitor vital signs.
C. Discontinue vancomycin permanently and document a severe drug allergy.
D. Administer a bolus of normal saline and increase the infusion rate.
Answer: B
Rationale: The described symptoms represent "Red Man Syndrome," a histamine-mediated
reaction caused by rapid infusion of vancomycin, not a true allergic reaction. Slowing the
infusion rate over 60 to 90 minutes typically resolves the symptoms.
10. Which medication is considered the drug of choice for the immediate reversal of
respiratory depression induced by opioid overdose?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Atropine
Answer: B
Rationale: Naloxone is a pure opioid antagonist that rapidly displaces opioids from mu-opioid
receptors, completely reversing opioid-induced central nervous system and respiratory
depression.
