NCLEX NURSING PHARMACOLOGY 2026
EXAM WITH SOLUTIONS TO ANSWERS
TESTBANK 1
CASE STUDY 1: Anticoagulation (Items 1–12)
Client: 68-year-old male on warfarin for atrial fibrillation. Presents with gum bleeding and
bruising. INR 6.5.
Item 1 (Highlight): Highlight the findings that require immediate follow-up.
• Gum bleeding
• Bruising on forearms
• INR 6.5
• Heart rate 88
• Blood pressure 138/82
• Temperature 98.6°F
Answer: Gum bleeding, bruising, INR 6.5
Rationale: These indicate over-anticoagulation and bleeding risk.
Item 2 (Matrix): For each medication, indicate whether it is safe to administer.
Medication Safe Hold
Warfarin X
Vitamin K X
Aspirin X
Acetaminophen X
,Rationale: Warfarin is held for INR >3. Vitamin K reverses warfarin. Aspirin increases bleeding
risk.
Item 3 (Drop-down): The nurse should anticipate administering vitamin K to reverse the effects
of warfarin.
Item 4 (Bow-tie): Complete the bow-tie.
• Condition: Warfarin toxicity
• Actions (2): Hold warfarin; administer vitamin K
• Parameters to monitor (2): INR; signs of bleeding
Item 5 (Multiple choice): Which client statement indicates understanding?
A. “I will increase my intake of spinach.”
B. “I will use an electric razor.”
C. “I will take aspirin for headaches.”
D. “I will double my dose if I miss one.”
Answer: B
Rationale: Warfarin increases bleeding risk. Use an electric razor.
Item 6 (SATA): Which foods should the client eat consistently?
A. Spinach
B. Kale
C. Broccoli
D. Bananas
E. Chicken
Answer: A, B, C
Rationale: Vitamin K–rich foods should be consistent, not avoided.
Item 7 (Highlight): Highlight the statement requiring immediate intervention.
• “I take my warfarin at the same time every day.”
• “I have been taking ibuprofen for my back pain.”
• “I check my INR regularly.”
• “I use a soft toothbrush.”
Answer: “I have been taking ibuprofen for my back pain.”
Rationale: NSAIDs increase bleeding risk with warfarin.
,Item 8 (Matrix): Indicate which lab values are expected with warfarin therapy.
Lab Expected Not Expected
INR 2.5 X
INR 6.5 X
aPTT 70 X
Platelets 200,000 X
Rationale: Therapeutic INR is 2–3. aPTT monitors heparin.
Item 9 (Drop-down): The antidote for warfarin is vitamin K. The antidote for heparin is
protamine sulfate.
Item 10 (Multiple choice): The client asks why blood tests are needed. Best response?
A. “It’s routine.”
B. “We need to check your INR to make sure your blood is not too thin or too thick.”
C. “You don’t need to worry.”
D. “Your doctor ordered it.”
Answer: B
Rationale: Explaining INR monitoring in simple terms.
Item 11 (Bow-tie): Complete the bow-tie for heparin overdose.
• Condition: Heparin toxicity
• Actions (2): Stop heparin; administer protamine sulfate
• Parameters to monitor (2): aPTT; signs of bleeding
Item 12 (SATA): Which findings indicate bleeding?
A. Melena
B. Hematuria
C. Bruising
D. Bradycardia
E. Hypertension
, Answer: A, B, C
Rationale: Melena, hematuria, and bruising indicate bleeding.
CASE STUDY 2: Insulin Management (Items 13–24)
Client: 45-year-old female with type 1 diabetes. Glucose 48 mg/dL. Cool, clammy skin.
Confused.
Item 13 (Highlight): Highlight the findings requiring immediate intervention.
• Glucose 48 mg/dL
• Cool, clammy skin
• Confusion
• HR 88
• BP 118/76
• RR 18
Answer: Glucose 48, cool clammy skin, confusion
Rationale: These indicate hypoglycemia.
Item 14 (Matrix): Indicate the appropriate intervention for each glucose level.
Glucose Give 15 g carbs Give insulin Recheck in 15 min
48 mg/dL X X
250 mg/dL X
70 mg/dL X X
Rationale: Hypoglycemia (<70) requires 15 g carbs and recheck. Hyperglycemia requires insulin.
Item 15 (Drop-down): For an unconscious client with hypoglycemia, the nurse should
administer IV dextrose.
Item 16 (Bow-tie): Complete the bow-tie for hypoglycemia.
• Condition: Hypoglycemia
EXAM WITH SOLUTIONS TO ANSWERS
TESTBANK 1
CASE STUDY 1: Anticoagulation (Items 1–12)
Client: 68-year-old male on warfarin for atrial fibrillation. Presents with gum bleeding and
bruising. INR 6.5.
Item 1 (Highlight): Highlight the findings that require immediate follow-up.
• Gum bleeding
• Bruising on forearms
• INR 6.5
• Heart rate 88
• Blood pressure 138/82
• Temperature 98.6°F
Answer: Gum bleeding, bruising, INR 6.5
Rationale: These indicate over-anticoagulation and bleeding risk.
Item 2 (Matrix): For each medication, indicate whether it is safe to administer.
Medication Safe Hold
Warfarin X
Vitamin K X
Aspirin X
Acetaminophen X
,Rationale: Warfarin is held for INR >3. Vitamin K reverses warfarin. Aspirin increases bleeding
risk.
Item 3 (Drop-down): The nurse should anticipate administering vitamin K to reverse the effects
of warfarin.
Item 4 (Bow-tie): Complete the bow-tie.
• Condition: Warfarin toxicity
• Actions (2): Hold warfarin; administer vitamin K
• Parameters to monitor (2): INR; signs of bleeding
Item 5 (Multiple choice): Which client statement indicates understanding?
A. “I will increase my intake of spinach.”
B. “I will use an electric razor.”
C. “I will take aspirin for headaches.”
D. “I will double my dose if I miss one.”
Answer: B
Rationale: Warfarin increases bleeding risk. Use an electric razor.
Item 6 (SATA): Which foods should the client eat consistently?
A. Spinach
B. Kale
C. Broccoli
D. Bananas
E. Chicken
Answer: A, B, C
Rationale: Vitamin K–rich foods should be consistent, not avoided.
Item 7 (Highlight): Highlight the statement requiring immediate intervention.
• “I take my warfarin at the same time every day.”
• “I have been taking ibuprofen for my back pain.”
• “I check my INR regularly.”
• “I use a soft toothbrush.”
Answer: “I have been taking ibuprofen for my back pain.”
Rationale: NSAIDs increase bleeding risk with warfarin.
,Item 8 (Matrix): Indicate which lab values are expected with warfarin therapy.
Lab Expected Not Expected
INR 2.5 X
INR 6.5 X
aPTT 70 X
Platelets 200,000 X
Rationale: Therapeutic INR is 2–3. aPTT monitors heparin.
Item 9 (Drop-down): The antidote for warfarin is vitamin K. The antidote for heparin is
protamine sulfate.
Item 10 (Multiple choice): The client asks why blood tests are needed. Best response?
A. “It’s routine.”
B. “We need to check your INR to make sure your blood is not too thin or too thick.”
C. “You don’t need to worry.”
D. “Your doctor ordered it.”
Answer: B
Rationale: Explaining INR monitoring in simple terms.
Item 11 (Bow-tie): Complete the bow-tie for heparin overdose.
• Condition: Heparin toxicity
• Actions (2): Stop heparin; administer protamine sulfate
• Parameters to monitor (2): aPTT; signs of bleeding
Item 12 (SATA): Which findings indicate bleeding?
A. Melena
B. Hematuria
C. Bruising
D. Bradycardia
E. Hypertension
, Answer: A, B, C
Rationale: Melena, hematuria, and bruising indicate bleeding.
CASE STUDY 2: Insulin Management (Items 13–24)
Client: 45-year-old female with type 1 diabetes. Glucose 48 mg/dL. Cool, clammy skin.
Confused.
Item 13 (Highlight): Highlight the findings requiring immediate intervention.
• Glucose 48 mg/dL
• Cool, clammy skin
• Confusion
• HR 88
• BP 118/76
• RR 18
Answer: Glucose 48, cool clammy skin, confusion
Rationale: These indicate hypoglycemia.
Item 14 (Matrix): Indicate the appropriate intervention for each glucose level.
Glucose Give 15 g carbs Give insulin Recheck in 15 min
48 mg/dL X X
250 mg/dL X
70 mg/dL X X
Rationale: Hypoglycemia (<70) requires 15 g carbs and recheck. Hyperglycemia requires insulin.
Item 15 (Drop-down): For an unconscious client with hypoglycemia, the nurse should
administer IV dextrose.
Item 16 (Bow-tie): Complete the bow-tie for hypoglycemia.
• Condition: Hypoglycemia
