1
Page | 1
NCLEX-PN Pharmacology Questions with Detailed
Rationales | 2025–2026 Actual Exam Prep | Guaranteed
Pass
, 2
Q1. A patient is prescribed lisinopril. Which lab value should the nurse monitor most
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closely?
A. Sodium
B. Potassium ✅
C. Calcium
D. Hemoglobin
Rationale
Lisinopril is an ACE inhibitor that can cause hyperkalemia due to decreased aldosterone
secretion, which reduces potassium excretion. Monitoring potassium levels is critical because
elevated levels can lead to serious cardiac arrhythmias, including ventricular fibrillation.
While sodium, calcium, and hemoglobin levels are also important, they are not as closely
affected by lisinopril. Early detection of hyperkalemia enables timely intervention, such as
dosage adjustment or switching medications. Nurses should also assess for signs of
hyperkalemia such as muscle weakness, fatigue, or irregular heartbeat. Educating patients to
avoid potassium-rich foods and salt substitutes is also a key nursing responsibility.
Q2. Which side effect is most associated with long-term corticosteroid therapy?
A. Hyperglycemia ✅
B. Hypokalemia
C. Bradycardia
D. Constipation
, 3
Rationale
Corticosteroids like prednisone can elevate blood glucose by promoting gluconeogenesis and
reducing insulin sensitivity. Hyperglycemia is a common and potentially serious side effect,
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especially with long-term use. This effect is particularly significant for patients with diabetes
or glucose intolerance. While corticosteroids may also lead to hypokalemia and other effects,
hyperglycemia remains the most consistently monitored outcome. Nurses must educate
patients about signs of high blood sugar and reinforce blood glucose monitoring. Adjustments
in diabetic medications may be necessary. Long-term use also carries risks like osteoporosis,
infection, and adrenal suppression, making periodic reassessment and patient education
essential in care plans.
Q3. A patient reports tinnitus while taking gentamicin. What should the nurse do?
A. Reassure the patient
B. Administer next dose
C. Report to provider immediately ✅
D. Document and monitor
Rationale
Gentamicin is an aminoglycoside antibiotic with known ototoxic effects. Tinnitus is an early
sign of ototoxicity, which may progress to permanent hearing loss if the drug is continued.
The nurse must immediately report this symptom to the healthcare provider to reassess the
need for continuation or adjust the dose. Continuing the drug without intervention could
cause irreversible damage. Monitoring peak and trough levels is also crucial in gentamicin
therapy to maintain therapeutic range and avoid toxicity. While documentation is important,
, 4
timely reporting and potential discontinuation are the priorities. Patient safety through early
symptom recognition is the nurse’s foremost responsibility.
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Q4. A nurse is educating a patient on nitroglycerin sublingual tablets. Which instruction is
correct?
A. Swallow the tablet whole
B. Take with food
C. Place under the tongue and allow to dissolve ✅
D. Chew the tablet thoroughly
Rationale
Sublingual nitroglycerin must be placed under the tongue and allowed to dissolve for rapid
absorption through the oral mucosa. Swallowing or chewing the tablet bypasses this route,
reducing effectiveness in treating acute angina. The sublingual route allows nitroglycerin to
quickly enter the bloodstream and dilate coronary arteries, alleviating chest pain. The nurse
should instruct patients to sit down when taking it to avoid orthostatic hypotension. If pain
persists after the first dose, they may take up to three doses at 5-minute intervals and call
emergency services if unrelieved. Proper patient education improves adherence and ensures
effective angina management.
Q5. Which medication should be held before surgery due to risk of bleeding?
A. Enalapril
B. Simvastatin
Page | 1
NCLEX-PN Pharmacology Questions with Detailed
Rationales | 2025–2026 Actual Exam Prep | Guaranteed
Pass
, 2
Q1. A patient is prescribed lisinopril. Which lab value should the nurse monitor most
Page | 2
closely?
A. Sodium
B. Potassium ✅
C. Calcium
D. Hemoglobin
Rationale
Lisinopril is an ACE inhibitor that can cause hyperkalemia due to decreased aldosterone
secretion, which reduces potassium excretion. Monitoring potassium levels is critical because
elevated levels can lead to serious cardiac arrhythmias, including ventricular fibrillation.
While sodium, calcium, and hemoglobin levels are also important, they are not as closely
affected by lisinopril. Early detection of hyperkalemia enables timely intervention, such as
dosage adjustment or switching medications. Nurses should also assess for signs of
hyperkalemia such as muscle weakness, fatigue, or irregular heartbeat. Educating patients to
avoid potassium-rich foods and salt substitutes is also a key nursing responsibility.
Q2. Which side effect is most associated with long-term corticosteroid therapy?
A. Hyperglycemia ✅
B. Hypokalemia
C. Bradycardia
D. Constipation
, 3
Rationale
Corticosteroids like prednisone can elevate blood glucose by promoting gluconeogenesis and
reducing insulin sensitivity. Hyperglycemia is a common and potentially serious side effect,
Page | 3
especially with long-term use. This effect is particularly significant for patients with diabetes
or glucose intolerance. While corticosteroids may also lead to hypokalemia and other effects,
hyperglycemia remains the most consistently monitored outcome. Nurses must educate
patients about signs of high blood sugar and reinforce blood glucose monitoring. Adjustments
in diabetic medications may be necessary. Long-term use also carries risks like osteoporosis,
infection, and adrenal suppression, making periodic reassessment and patient education
essential in care plans.
Q3. A patient reports tinnitus while taking gentamicin. What should the nurse do?
A. Reassure the patient
B. Administer next dose
C. Report to provider immediately ✅
D. Document and monitor
Rationale
Gentamicin is an aminoglycoside antibiotic with known ototoxic effects. Tinnitus is an early
sign of ototoxicity, which may progress to permanent hearing loss if the drug is continued.
The nurse must immediately report this symptom to the healthcare provider to reassess the
need for continuation or adjust the dose. Continuing the drug without intervention could
cause irreversible damage. Monitoring peak and trough levels is also crucial in gentamicin
therapy to maintain therapeutic range and avoid toxicity. While documentation is important,
, 4
timely reporting and potential discontinuation are the priorities. Patient safety through early
symptom recognition is the nurse’s foremost responsibility.
Page | 4
Q4. A nurse is educating a patient on nitroglycerin sublingual tablets. Which instruction is
correct?
A. Swallow the tablet whole
B. Take with food
C. Place under the tongue and allow to dissolve ✅
D. Chew the tablet thoroughly
Rationale
Sublingual nitroglycerin must be placed under the tongue and allowed to dissolve for rapid
absorption through the oral mucosa. Swallowing or chewing the tablet bypasses this route,
reducing effectiveness in treating acute angina. The sublingual route allows nitroglycerin to
quickly enter the bloodstream and dilate coronary arteries, alleviating chest pain. The nurse
should instruct patients to sit down when taking it to avoid orthostatic hypotension. If pain
persists after the first dose, they may take up to three doses at 5-minute intervals and call
emergency services if unrelieved. Proper patient education improves adherence and ensures
effective angina management.
Q5. Which medication should be held before surgery due to risk of bleeding?
A. Enalapril
B. Simvastatin
