PHARMACOLOGY & MEDICATION SAFETY
NURSING PHARMACOLOGY COMPREHENSIVE
STUDY GUIDE
2026–2027
Drug Classes, Adverse Effects &
Rationales
Nursing Pharmacology Comprehensive Study Guide 2026–2027 | Practice Resource
, Nursing Pharmacology Comprehensive Study Guide 2026–2027
Drug Classes, Adverse Effects & Rationales
Question 1.
A nurse is preparing to administer furosemide, a loop diuretic, to a patient with heart failure. Which laboratory
value is most important for the nurse to monitor?
A. Serum potassium
B. Serum calcium
C. Serum amylase
D. Hemoglobin
Correct Answer:
A. Serum potassium
Rationale:
Furosemide promotes significant urinary excretion of sodium
and water and can also cause potassium loss. Hypokalemia can produce
muscle weakness, cardiac dysrhythmias, and ECG changes. The nurse should
monitor potassium levels and assess for manifestations of electrolyte
depletion.
Loop diuretics can also contribute to volume depletion and
hypotension, so blood pressure, renal function, intake/output, and daily weight
should be monitored.
Why the Other Options Are Incorrect:
- B. Serum calcium: Calcium may be affected by loop diuretics, but potassium monitoring is a more
immediate and clinically important nursing concern.
- C. Serum amylase: Amylase is primarily associated with pancreatic disorders and is not a routine
monitoring parameter for furosemide.
- D. Hemoglobin: Hemoglobin does not directly reflect the major electrolyte-related adverse effect of
furosemide.
---
Question 2.
A patient taking lisinopril reports swelling of the lips and difficulty breathing. What is the nurse's priority action?
A. Administer the next dose with food
B. Hold the medication and obtain emergency assistance
C. Encourage increased oral fluids
D. Document the finding as an expected adverse effect
Correct Answer:
B. Hold the medication and obtain emergency assistance
Rationale:
Lisinopril is an angiotensin-converting enzyme (ACE)
Nursing Pharmacology Comprehensive Study Guide 2026–2027 | Practice Resource
, inhibitor. Facial, lip, tongue, or airway swelling may indicate angioedema,
which can rapidly become life-threatening.
The medication should be withheld and the patient should
receive immediate evaluation and emergency treatment according to the clinical
situation and facility protocol.
Why the Other Options Are Incorrect:
- A. Administer the next dose with food: Food does not correct ACE-inhibitor-associated angioedema.
- C. Encourage increased oral fluids: Fluids do not treat airway edema and may delay emergency treatment.
- D. Document as expected: Mild cough is a common ACE-inhibitor effect; significant facial or airway swelling
is a serious adverse reaction requiring immediate intervention.
---
Question 3.
Which adverse effect should the nurse associate most closely with metoprolol?
A. Tachycardia
B. Bradycardia
C. Severe hyperglycemia
D. Increased gastrointestinal motility
Correct Answer:
B. Bradycardia
Rationale:
Metoprolol is a beta-1 adrenergic blocker. It
decreases heart rate, myocardial contractility, and blood pressure. Bradycardia
and hypotension are important effects to monitor.
Beta blockers may also mask some manifestations of
hypoglycemia, particularly tachycardia.
Why the Other Options Are Incorrect:
- A. Tachycardia: Beta blockade generally decreases heart rate.
- C. Severe hyperglycemia: This is not the characteristic primary effect of metoprolol.
- D. Increased gastrointestinal motility: Increased GI motility is not the expected pharmacologic effect.
---
Question 4.
A patient receiving digoxin has a serum potassium level of 2.8 mEq/L. What should the nurse do?
A. Administer digoxin as prescribed
B. Hold digoxin and notify the healthcare provider
C. Give digoxin with an antacid
D. Restrict dietary potassium
Correct Answer:
B. Hold digoxin and notify the healthcare provider
Nursing Pharmacology Comprehensive Study Guide 2026–2027 | Practice Resource
, Rationale:
Hypokalemia increases the risk of digoxin toxicity
because low potassium enhances digoxin binding to the sodium-potassium ATPase
pump.
The nurse should recognize a potassium level of 2.8 mEq/L as
significantly low and should hold the medication and notify the appropriate
provider according to institutional protocol.
Signs of digoxin toxicity may include nausea, vomiting,
anorexia, visual disturbances, confusion, and dysrhythmias.
Why the Other Options Are Incorrect:
- A. Administer digoxin: Giving digoxin in significant hypokalemia can increase toxicity risk.
- C. Give digoxin with an antacid: An antacid does not correct hypokalemia or eliminate the toxicity risk.
- D. Restrict dietary potassium: Potassium restriction would worsen the electrolyte abnormality.
---
Question 5.
A patient receiving warfarin asks which laboratory test is used to monitor the therapeutic effect of the
medication. Which response is correct?
A. aPTT
B. INR
C. Troponin
D. Serum creatinine only
Correct Answer:
B. INR
Rationale:
Warfarin is an oral vitamin K antagonist anticoagulant.
Its therapeutic effect is routinely monitored using the international
normalized ratio (INR).
The nurse should also assess for bleeding, including
bruising, hematuria, melena, bleeding gums, and prolonged bleeding.
Why the Other Options Are Incorrect:
- A. aPTT: aPTT is commonly used to monitor unfractionated heparin therapy.
- C. Troponin: Troponin is used primarily to evaluate myocardial injury.
- D. Serum creatinine only: Renal function can be clinically relevant, but creatinine does not measure
warfarin's anticoagulant effect.
---
Question 6.
A nurse is administering unfractionated heparin. Which laboratory test is commonly used to evaluate its
anticoagulant effect?
A. INR
B. aPTT
C. Hemoglobin A1c
D. Serum sodium
Nursing Pharmacology Comprehensive Study Guide 2026–2027 | Practice Resource
NURSING PHARMACOLOGY COMPREHENSIVE
STUDY GUIDE
2026–2027
Drug Classes, Adverse Effects &
Rationales
Nursing Pharmacology Comprehensive Study Guide 2026–2027 | Practice Resource
, Nursing Pharmacology Comprehensive Study Guide 2026–2027
Drug Classes, Adverse Effects & Rationales
Question 1.
A nurse is preparing to administer furosemide, a loop diuretic, to a patient with heart failure. Which laboratory
value is most important for the nurse to monitor?
A. Serum potassium
B. Serum calcium
C. Serum amylase
D. Hemoglobin
Correct Answer:
A. Serum potassium
Rationale:
Furosemide promotes significant urinary excretion of sodium
and water and can also cause potassium loss. Hypokalemia can produce
muscle weakness, cardiac dysrhythmias, and ECG changes. The nurse should
monitor potassium levels and assess for manifestations of electrolyte
depletion.
Loop diuretics can also contribute to volume depletion and
hypotension, so blood pressure, renal function, intake/output, and daily weight
should be monitored.
Why the Other Options Are Incorrect:
- B. Serum calcium: Calcium may be affected by loop diuretics, but potassium monitoring is a more
immediate and clinically important nursing concern.
- C. Serum amylase: Amylase is primarily associated with pancreatic disorders and is not a routine
monitoring parameter for furosemide.
- D. Hemoglobin: Hemoglobin does not directly reflect the major electrolyte-related adverse effect of
furosemide.
---
Question 2.
A patient taking lisinopril reports swelling of the lips and difficulty breathing. What is the nurse's priority action?
A. Administer the next dose with food
B. Hold the medication and obtain emergency assistance
C. Encourage increased oral fluids
D. Document the finding as an expected adverse effect
Correct Answer:
B. Hold the medication and obtain emergency assistance
Rationale:
Lisinopril is an angiotensin-converting enzyme (ACE)
Nursing Pharmacology Comprehensive Study Guide 2026–2027 | Practice Resource
, inhibitor. Facial, lip, tongue, or airway swelling may indicate angioedema,
which can rapidly become life-threatening.
The medication should be withheld and the patient should
receive immediate evaluation and emergency treatment according to the clinical
situation and facility protocol.
Why the Other Options Are Incorrect:
- A. Administer the next dose with food: Food does not correct ACE-inhibitor-associated angioedema.
- C. Encourage increased oral fluids: Fluids do not treat airway edema and may delay emergency treatment.
- D. Document as expected: Mild cough is a common ACE-inhibitor effect; significant facial or airway swelling
is a serious adverse reaction requiring immediate intervention.
---
Question 3.
Which adverse effect should the nurse associate most closely with metoprolol?
A. Tachycardia
B. Bradycardia
C. Severe hyperglycemia
D. Increased gastrointestinal motility
Correct Answer:
B. Bradycardia
Rationale:
Metoprolol is a beta-1 adrenergic blocker. It
decreases heart rate, myocardial contractility, and blood pressure. Bradycardia
and hypotension are important effects to monitor.
Beta blockers may also mask some manifestations of
hypoglycemia, particularly tachycardia.
Why the Other Options Are Incorrect:
- A. Tachycardia: Beta blockade generally decreases heart rate.
- C. Severe hyperglycemia: This is not the characteristic primary effect of metoprolol.
- D. Increased gastrointestinal motility: Increased GI motility is not the expected pharmacologic effect.
---
Question 4.
A patient receiving digoxin has a serum potassium level of 2.8 mEq/L. What should the nurse do?
A. Administer digoxin as prescribed
B. Hold digoxin and notify the healthcare provider
C. Give digoxin with an antacid
D. Restrict dietary potassium
Correct Answer:
B. Hold digoxin and notify the healthcare provider
Nursing Pharmacology Comprehensive Study Guide 2026–2027 | Practice Resource
, Rationale:
Hypokalemia increases the risk of digoxin toxicity
because low potassium enhances digoxin binding to the sodium-potassium ATPase
pump.
The nurse should recognize a potassium level of 2.8 mEq/L as
significantly low and should hold the medication and notify the appropriate
provider according to institutional protocol.
Signs of digoxin toxicity may include nausea, vomiting,
anorexia, visual disturbances, confusion, and dysrhythmias.
Why the Other Options Are Incorrect:
- A. Administer digoxin: Giving digoxin in significant hypokalemia can increase toxicity risk.
- C. Give digoxin with an antacid: An antacid does not correct hypokalemia or eliminate the toxicity risk.
- D. Restrict dietary potassium: Potassium restriction would worsen the electrolyte abnormality.
---
Question 5.
A patient receiving warfarin asks which laboratory test is used to monitor the therapeutic effect of the
medication. Which response is correct?
A. aPTT
B. INR
C. Troponin
D. Serum creatinine only
Correct Answer:
B. INR
Rationale:
Warfarin is an oral vitamin K antagonist anticoagulant.
Its therapeutic effect is routinely monitored using the international
normalized ratio (INR).
The nurse should also assess for bleeding, including
bruising, hematuria, melena, bleeding gums, and prolonged bleeding.
Why the Other Options Are Incorrect:
- A. aPTT: aPTT is commonly used to monitor unfractionated heparin therapy.
- C. Troponin: Troponin is used primarily to evaluate myocardial injury.
- D. Serum creatinine only: Renal function can be clinically relevant, but creatinine does not measure
warfarin's anticoagulant effect.
---
Question 6.
A nurse is administering unfractionated heparin. Which laboratory test is commonly used to evaluate its
anticoagulant effect?
A. INR
B. aPTT
C. Hemoglobin A1c
D. Serum sodium
Nursing Pharmacology Comprehensive Study Guide 2026–2027 | Practice Resource
