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MEDICAL-SURGICAL NURSING 11TH
EDITION — PHARMACOLOGY AND
MEDICATION SAFETY PRACTICE
[QUESTION 1-100] AND ANSWERS
UPDATED 2026/2027 | 100% VERIFIED |
DETAILED RATIONALES – PASS
GUARANTEED A+ GRADED | INSTANT
DOWNLOAD
INTRODUCTION
Medical-Surgical Nursing 11th Edition — Pharmacology and Medication Safety Practice is an
advanced preparation resource designed to strengthen clinical reasoning related to medication
administration, pharmacokinetics, adverse effects, drug interactions, high-alert medications,
dosage safety, and evaluation of therapeutic responses. It is appropriate for nursing students
preparing for medical-surgical examinations, comprehensive nursing assessments, and NCLEX-
style clinical-judgment questions. The questions emphasize application rather than
memorization, requiring the learner to recognize deteriorating patients, interpret medication-
related assessment findings, prioritize nursing interventions, and determine whether therapy is
effective or potentially harmful. The question bank incorporates cardiovascular, respiratory,
neurologic, renal, endocrine, gastrointestinal, infectious-disease, hematologic, oncology, pain-
management, and multisystem pharmacology. Each item contains four answer choices with one
best answer followed by a detailed rationale explaining both the correct choice and the
distractors. Working through these scenarios can help students identify medication-safety
patterns, distinguish expected effects from dangerous adverse reactions, improve prioritization,
and develop the clinical judgment needed to approach difficult examination questions with
greater confidence.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
Cardiovascular Antihypertensives, antianginals, anticoagulants,
1–12 12%
Pharmacology dysrhythmics, heart failure drugs
Bronchodilators, corticosteroids, oxygen-related
Respiratory
13–22 medication management, respiratory adverse 10%
Pharmacology
effects
,2|Page
Content Area Questions Key Topics Weight
Antiepileptics, thrombolytics, Parkinson therapy,
Neurologic Pharmacology 23–32 10%
CNS safety
Renal & Electrolyte Diuretics, electrolyte replacement, nephrotoxic
33–42 10%
Pharmacology medications, dialysis-related drugs
Insulin, thyroid drugs, corticosteroids,
Endocrine Pharmacology 43–52 10%
antidiabetic medications
GI & Hepatic Acid suppression, antiemetics, lactulose,
53–62 10%
Pharmacology inflammatory bowel therapy, hepatotoxicity
Infection & Antimicrobial Antibiotics, cultures, resistance, adverse effects,
63–72 10%
Therapy sepsis pharmacology
Chemotherapy, anticoagulation, transfusion-
Hematology & Oncology 73–80 8%
related medications, hematopoietic agents
Pain, Sedation & Opioids, reversal agents, NSAIDs, muscle
81–88 8%
Musculoskeletal Drugs relaxants, bone medications
Medication Safety & High-alert drugs, interactions, reconciliation,
89–100 12%
Clinical Prioritization delegation, error prevention
QUESTIONS 1-100
CARDIOVASCULAR PHARMACOLOGY
Q1:
A patient with acute decompensated heart failure receives IV furosemide. Two hours later, the
patient has a blood pressure of 88/54 mm Hg, potassium of 3.0 mEq/L, and ventricular ectopy on
the cardiac monitor. Which action should the nurse take first?
A) Administer the next scheduled dose of furosemide
B) Hold further diuretic therapy and notify the provider about hypotension and dysrhythmia
C) Encourage the patient to increase oral potassium intake
D) Administer an additional dose of a prescribed vasodilator
Rationale: The correct answer is B because significant hypotension, hypokalemia, and
ventricular ectopy indicate potentially dangerous consequences of aggressive diuresis. Further
furosemide could worsen both volume depletion and potassium loss. A is unsafe because
additional diuresis may further compromise perfusion. C is inadequate for an acutely unstable
patient with dysrhythmia because oral replacement is too slow to address immediate risk. D
would further lower blood pressure and worsen perfusion.
Q2:
,3|Page
A patient taking lisinopril for hypertension reports dizziness after standing. The blood pressure is
86/50 mm Hg, potassium is 5.8 mEq/L, and creatinine has increased substantially from baseline.
Which finding is most concerning?
A) Mild orthostatic dizziness
B) Hyperkalemia accompanied by worsening renal function
C) Decreased blood pressure after taking the medication
D) Mild fatigue during the first week of therapy
Rationale: The correct answer is B because ACE inhibitors decrease aldosterone activity and
can cause hyperkalemia, particularly when renal function deteriorates. Significant hyperkalemia
can produce life-threatening dysrhythmias. A and C may occur with excessive antihypertensive
effect but are less immediately dangerous than severe potassium elevation. D can occur during
therapy but is nonspecific and does not indicate an immediate threat.
Q3:
A patient receiving digoxin for heart failure develops nausea, anorexia, confusion, and yellow-
green visual disturbances. The apical pulse is 48/min. Which action has the highest priority?
A) Administer the medication with food
B) Hold digoxin and notify the provider
C) Administer the medication and recheck the pulse in 1 hour
D) Encourage increased dietary sodium intake
Rationale: The correct answer is B because gastrointestinal symptoms, neurologic changes,
visual disturbances, and bradycardia strongly suggest digoxin toxicity. Continuing the
medication could precipitate severe bradyarrhythmias. A does not correct toxicity. C is unsafe
because the medication should not be administered when toxicity is suspected. D is
inappropriate for a patient with heart failure because excess sodium promotes fluid retention.
Q4:
A patient taking warfarin for atrial fibrillation reports black, tarry stools and increasing fatigue.
The INR is 5.8. Which nursing action is most appropriate?
A) Administer the scheduled warfarin dose
B) Hold warfarin and immediately notify the provider
C) Encourage foods high in vitamin K and discharge the patient
D) Recheck the INR at the next routine appointment
Rationale: The correct answer is B because melena suggests gastrointestinal bleeding and the
INR is markedly elevated. Continued anticoagulation could worsen hemorrhage. A is
contraindicated in the presence of active bleeding and excessive anticoagulation. C is not
sufficient treatment for active bleeding and should not replace urgent evaluation. D delays
treatment and is unsafe.
, 4|Page
Q5:
A patient receiving IV heparin develops sudden severe headache, vomiting, and a decreasing
level of consciousness. Which action should the nurse take first?
A) Increase the heparin infusion
B) Stop the heparin infusion and activate emergency evaluation for possible intracranial
hemorrhage
C) Administer aspirin
D) Place the patient flat and reassess in 30 minutes
Rationale: The correct answer is B because sudden neurologic deterioration during
anticoagulation is highly concerning for intracranial bleeding. Heparin should be stopped while
urgent evaluation occurs. A would worsen hemorrhage. C would increase bleeding risk. D
delays evaluation and may worsen intracranial pressure if the patient is neurologically unstable.
Q6:
A patient prescribed metoprolol after myocardial infarction has a heart rate of 44/min, blood
pressure of 92/56 mm Hg, and reports dizziness. Which action is most appropriate?
A) Administer the medication because beta-blockers prevent reinfarction
B) Hold the dose and notify the provider
C) Give the medication with an additional dose of atropine automatically
D) Encourage ambulation to increase the heart rate
Rationale: The correct answer is B because symptomatic bradycardia and hypotension indicate
excessive beta-adrenergic blockade. Administering another dose could worsen cardiovascular
compromise. A ignores the patient's current instability. C is inappropriate because atropine
requires clinical assessment and a specific indication rather than automatic administration. D
increases physiologic demand and could worsen symptoms.
Q7:
A patient with angina has a prescription for sublingual nitroglycerin. Before administration, the
nurse notes a blood pressure of 82/48 mm Hg. Which action is appropriate?
A) Administer nitroglycerin because chest pain indicates myocardial ischemia
B) Withhold nitroglycerin and notify the provider because severe hypotension is present
C) Administer two tablets simultaneously
D) Have the patient stand before receiving the medication
Rationale: The correct answer is B because nitroglycerin causes vasodilation and can
significantly worsen already severe hypotension. A fails to account for the medication's
hemodynamic effects. C could cause profound hypotension. D increases the risk of syncope and
falls.
MEDICAL-SURGICAL NURSING 11TH
EDITION — PHARMACOLOGY AND
MEDICATION SAFETY PRACTICE
[QUESTION 1-100] AND ANSWERS
UPDATED 2026/2027 | 100% VERIFIED |
DETAILED RATIONALES – PASS
GUARANTEED A+ GRADED | INSTANT
DOWNLOAD
INTRODUCTION
Medical-Surgical Nursing 11th Edition — Pharmacology and Medication Safety Practice is an
advanced preparation resource designed to strengthen clinical reasoning related to medication
administration, pharmacokinetics, adverse effects, drug interactions, high-alert medications,
dosage safety, and evaluation of therapeutic responses. It is appropriate for nursing students
preparing for medical-surgical examinations, comprehensive nursing assessments, and NCLEX-
style clinical-judgment questions. The questions emphasize application rather than
memorization, requiring the learner to recognize deteriorating patients, interpret medication-
related assessment findings, prioritize nursing interventions, and determine whether therapy is
effective or potentially harmful. The question bank incorporates cardiovascular, respiratory,
neurologic, renal, endocrine, gastrointestinal, infectious-disease, hematologic, oncology, pain-
management, and multisystem pharmacology. Each item contains four answer choices with one
best answer followed by a detailed rationale explaining both the correct choice and the
distractors. Working through these scenarios can help students identify medication-safety
patterns, distinguish expected effects from dangerous adverse reactions, improve prioritization,
and develop the clinical judgment needed to approach difficult examination questions with
greater confidence.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
Cardiovascular Antihypertensives, antianginals, anticoagulants,
1–12 12%
Pharmacology dysrhythmics, heart failure drugs
Bronchodilators, corticosteroids, oxygen-related
Respiratory
13–22 medication management, respiratory adverse 10%
Pharmacology
effects
,2|Page
Content Area Questions Key Topics Weight
Antiepileptics, thrombolytics, Parkinson therapy,
Neurologic Pharmacology 23–32 10%
CNS safety
Renal & Electrolyte Diuretics, electrolyte replacement, nephrotoxic
33–42 10%
Pharmacology medications, dialysis-related drugs
Insulin, thyroid drugs, corticosteroids,
Endocrine Pharmacology 43–52 10%
antidiabetic medications
GI & Hepatic Acid suppression, antiemetics, lactulose,
53–62 10%
Pharmacology inflammatory bowel therapy, hepatotoxicity
Infection & Antimicrobial Antibiotics, cultures, resistance, adverse effects,
63–72 10%
Therapy sepsis pharmacology
Chemotherapy, anticoagulation, transfusion-
Hematology & Oncology 73–80 8%
related medications, hematopoietic agents
Pain, Sedation & Opioids, reversal agents, NSAIDs, muscle
81–88 8%
Musculoskeletal Drugs relaxants, bone medications
Medication Safety & High-alert drugs, interactions, reconciliation,
89–100 12%
Clinical Prioritization delegation, error prevention
QUESTIONS 1-100
CARDIOVASCULAR PHARMACOLOGY
Q1:
A patient with acute decompensated heart failure receives IV furosemide. Two hours later, the
patient has a blood pressure of 88/54 mm Hg, potassium of 3.0 mEq/L, and ventricular ectopy on
the cardiac monitor. Which action should the nurse take first?
A) Administer the next scheduled dose of furosemide
B) Hold further diuretic therapy and notify the provider about hypotension and dysrhythmia
C) Encourage the patient to increase oral potassium intake
D) Administer an additional dose of a prescribed vasodilator
Rationale: The correct answer is B because significant hypotension, hypokalemia, and
ventricular ectopy indicate potentially dangerous consequences of aggressive diuresis. Further
furosemide could worsen both volume depletion and potassium loss. A is unsafe because
additional diuresis may further compromise perfusion. C is inadequate for an acutely unstable
patient with dysrhythmia because oral replacement is too slow to address immediate risk. D
would further lower blood pressure and worsen perfusion.
Q2:
,3|Page
A patient taking lisinopril for hypertension reports dizziness after standing. The blood pressure is
86/50 mm Hg, potassium is 5.8 mEq/L, and creatinine has increased substantially from baseline.
Which finding is most concerning?
A) Mild orthostatic dizziness
B) Hyperkalemia accompanied by worsening renal function
C) Decreased blood pressure after taking the medication
D) Mild fatigue during the first week of therapy
Rationale: The correct answer is B because ACE inhibitors decrease aldosterone activity and
can cause hyperkalemia, particularly when renal function deteriorates. Significant hyperkalemia
can produce life-threatening dysrhythmias. A and C may occur with excessive antihypertensive
effect but are less immediately dangerous than severe potassium elevation. D can occur during
therapy but is nonspecific and does not indicate an immediate threat.
Q3:
A patient receiving digoxin for heart failure develops nausea, anorexia, confusion, and yellow-
green visual disturbances. The apical pulse is 48/min. Which action has the highest priority?
A) Administer the medication with food
B) Hold digoxin and notify the provider
C) Administer the medication and recheck the pulse in 1 hour
D) Encourage increased dietary sodium intake
Rationale: The correct answer is B because gastrointestinal symptoms, neurologic changes,
visual disturbances, and bradycardia strongly suggest digoxin toxicity. Continuing the
medication could precipitate severe bradyarrhythmias. A does not correct toxicity. C is unsafe
because the medication should not be administered when toxicity is suspected. D is
inappropriate for a patient with heart failure because excess sodium promotes fluid retention.
Q4:
A patient taking warfarin for atrial fibrillation reports black, tarry stools and increasing fatigue.
The INR is 5.8. Which nursing action is most appropriate?
A) Administer the scheduled warfarin dose
B) Hold warfarin and immediately notify the provider
C) Encourage foods high in vitamin K and discharge the patient
D) Recheck the INR at the next routine appointment
Rationale: The correct answer is B because melena suggests gastrointestinal bleeding and the
INR is markedly elevated. Continued anticoagulation could worsen hemorrhage. A is
contraindicated in the presence of active bleeding and excessive anticoagulation. C is not
sufficient treatment for active bleeding and should not replace urgent evaluation. D delays
treatment and is unsafe.
, 4|Page
Q5:
A patient receiving IV heparin develops sudden severe headache, vomiting, and a decreasing
level of consciousness. Which action should the nurse take first?
A) Increase the heparin infusion
B) Stop the heparin infusion and activate emergency evaluation for possible intracranial
hemorrhage
C) Administer aspirin
D) Place the patient flat and reassess in 30 minutes
Rationale: The correct answer is B because sudden neurologic deterioration during
anticoagulation is highly concerning for intracranial bleeding. Heparin should be stopped while
urgent evaluation occurs. A would worsen hemorrhage. C would increase bleeding risk. D
delays evaluation and may worsen intracranial pressure if the patient is neurologically unstable.
Q6:
A patient prescribed metoprolol after myocardial infarction has a heart rate of 44/min, blood
pressure of 92/56 mm Hg, and reports dizziness. Which action is most appropriate?
A) Administer the medication because beta-blockers prevent reinfarction
B) Hold the dose and notify the provider
C) Give the medication with an additional dose of atropine automatically
D) Encourage ambulation to increase the heart rate
Rationale: The correct answer is B because symptomatic bradycardia and hypotension indicate
excessive beta-adrenergic blockade. Administering another dose could worsen cardiovascular
compromise. A ignores the patient's current instability. C is inappropriate because atropine
requires clinical assessment and a specific indication rather than automatic administration. D
increases physiologic demand and could worsen symptoms.
Q7:
A patient with angina has a prescription for sublingual nitroglycerin. Before administration, the
nurse notes a blood pressure of 82/48 mm Hg. Which action is appropriate?
A) Administer nitroglycerin because chest pain indicates myocardial ischemia
B) Withhold nitroglycerin and notify the provider because severe hypotension is present
C) Administer two tablets simultaneously
D) Have the patient stand before receiving the medication
Rationale: The correct answer is B because nitroglycerin causes vasodilation and can
significantly worsen already severe hypotension. A fails to account for the medication's
hemodynamic effects. C could cause profound hypotension. D increases the risk of syncope and
falls.
