ICHS PHARMACOLOGY DRUGS ACTUAL EXAM QUESTIONS WITH COMPLETE
SOLUTIONS PLUS WELL DETAILED RATIONALES/GRADE A+ ASSURED
Question 1
A patient is prescribed sublingual nitroglycerin for the treatment of angina. Which instruction
should the nurse prioritize during patient teaching?
A) Swallow the tablet with a full glass of water.
B) Take the medication only if the pain lasts longer than 30 minutes.
C) Sit or lie down before taking the medication.
D) Store the medication in a clear plastic container for easy viewing.
E) Discard the tablets if they cause a tingling sensation under the tongue.
Correct Answer: C) Sit or lie down before taking the medication.
Rationale: Nitroglycerin is a potent vasodilator. One of its most common side effects is
orthostatic hypotension, which can lead to dizziness and syncope. Sitting or lying down
prevents falls and injury. Tablets should not be swallowed (A), should be kept in original
dark glass containers (D), and a tingling sensation usually indicates the drug is fresh (E).
Question 2
A nurse is preparing to administer digoxin to a patient with heart failure. Which clinical finding
would require the nurse to withhold the medication and notify the provider?
A) Blood pressure of 110/70 mmHg.
B) Respiratory rate of 18 breaths per minute.
C) Apical pulse of 52 beats per minute.
D) Potassium level of 4.8 mEq/L.
E) Digoxin level of 1.2 ng/mL.
Correct Answer: C) Apical pulse of 52 beats per minute.
Rationale: Digoxin is a negative chronotrope, meaning it slows the heart rate. It is standard
nursing practice to withhold digoxin if the apical pulse is less than 60 beats per minute in
an adult, as it may indicate digitalis toxicity or excessive bradycardia.
Question 3
Which medication is considered the "rescue" inhaler for a patient experiencing an acute asthma
attack?
A) Salmeterol
B) Albuterol
C) Fluticasone
D) Tiotropium
E) Montelukast
Correct Answer: B) Albuterol
Rationale: Albuterol is a short-acting beta-2 agonist (SABA). It works rapidly to cause
bronchodilation during an acute bronchospasm. Salmeterol (A) is long-acting; Fluticasone
, 2
(C) is a corticosteroid for maintenance; Tiotropium (D) is an anticholinergic; and
Montelukast (E) is a leukotriene modifier for long-term control.
Question 4
A patient taking warfarin (Coumadin) for atrial fibrillation should be instructed to maintain a
consistent intake of which of the following?
A) Red meats
B) Citrus fruits
C) Dark green leafy vegetables
D) Dairy products
E) Refined carbohydrates
Correct Answer: C) Dark green leafy vegetables
Rationale: Warfarin works by antagonizing Vitamin K. Dark green leafy vegetables are
high in Vitamin K. A sudden increase in these vegetables can decrease the effectiveness of
warfarin (lowering INR), while a sudden decrease can increase the risk of bleeding.
Consistency is key to maintaining a therapeutic INR.
Question 5
When administering the first dose of an ACE inhibitor such as Lisinopril, what is the most
important assessment for the nurse to perform?
A) Monitor for a dry, non-productive cough.
B) Check the patient's temperature.
C) Monitor the blood pressure for hypotension.
D) Assess for peripheral edema.
E) Evaluate the patient's bowel sounds.
Correct Answer: C) Monitor the blood pressure for hypotension.
Rationale: ACE inhibitors can cause a "first-dose effect," resulting in significant
hypotension. While a dry cough (A) is a common side effect of ACE inhibitors, the priority
assessment following the very first dose is safety related to blood pressure and the risk of
syncope.
Question 6
A patient with Type 1 Diabetes is prescribed Lispro (Humalog) insulin. When should the nurse
administer this medication?
A) 30 to 60 minutes before a meal.
B) Immediately after a meal.
C) 15 minutes before a meal.
D) At bedtime.
E) Only if the blood glucose is above 200 mg/dL.
, 3
Correct Answer: C) 15 minutes before a meal.
Rationale: Lispro is a rapid-acting insulin with an onset of 15 minutes. It must be
administered in close proximity to a meal (within 15 minutes) to prevent hypoglycemia, as
the peak occurs quickly. 30–60 minutes (A) is the timing for Regular (short-acting) insulin.
Question 7
The nurse is reviewing the lab results for a patient taking Furosemide (Lasix). Which value is of
greatest concern?
A) Sodium 138 mEq/L
B) Potassium 3.1 mEq/L
C) Creatinine 1.0 mg/dL
D) Glucose 110 mg/dL
E) BUN 15 mg/dL
Correct Answer: B) Potassium 3.1 mEq/L
Rationale: Furosemide is a loop diuretic that is "potassium-wasting." A potassium level of
3.1 mEq/L is low (hypokalemia), which can lead to cardiac arrhythmias and increases the
risk of digoxin toxicity if the patient is on both medications.
Question 8
Which of the following is the primary mechanism of action for Metformin?
A) Stimulates the pancreas to produce more insulin.
B) Increases glucose production in the liver.
C) Decreases insulin sensitivity in the muscle.
D) Decreases hepatic glucose production and increases insulin sensitivity.
E) Delays the absorption of carbohydrates in the GI tract.
Correct Answer: D) Decreases hepatic glucose production and increases insulin sensitivity.
Rationale: Metformin is a biguanide. Unlike sulfonylureas, it does not stimulate insulin
secretion from the pancreas (so it has a lower risk of hypoglycemia). Instead, it reduces the
amount of glucose the liver makes and helps cells use insulin more effectively.
Question 9
A nurse is preparing to administer Vancomycin IV. To prevent "Red Man Syndrome," the nurse
should perform which action?
A) Premedicate the patient with aspirin.
B) Administer the infusion over at least 60 minutes.
C) Dilute the medication in 10 mL of Normal Saline.
D) Use a rapid IV push technique.
E) Administer the medication via the intramuscular route.
, 4
Correct Answer: B) Administer the infusion over at least 60 minutes.
Rationale: Red Man Syndrome is a rate-dependent infusion reaction caused by the release
of histamine. It is characterized by flushing, rash, and hypotension. It is prevented by
infusing Vancomycin slowly, typically over 60 to 90 minutes.
Question 10
A patient is prescribed Spironolactone (Aldactone). The nurse should instruct the patient to avoid
which of the following?
A) Bananas and salt substitutes.
B) White bread and pasta.
C) Apple juice and grapes.
D) Hard cheeses and yogurt.
E) Chicken and fish.
Correct Answer: A) Bananas and salt substitutes.
Rationale: Spironolactone is a potassium-sparing diuretic. Patients are at risk for
hyperkalemia. Salt substitutes often contain potassium chloride instead of sodium chloride,
and bananas are high in potassium. Combining these with Spironolactone can lead to
dangerously high potassium levels.
Question 11
Which of the following is the antidote for an overdose of Heparin?
A) Vitamin K
B) Protamine sulfate
C) Glucagon
D) Naloxone
E) Acetylcysteine
Correct Answer: B) Protamine sulfate
Rationale: Protamine sulfate is the specific antagonist for Heparin. Vitamin K (A) is for
Warfarin; Naloxone (D) is for Opioids; and Acetylcysteine (E) is for Acetaminophen
(Tylenol).
Question 12
A patient is receiving Gentamicin (an aminoglycoside). The nurse should monitor which
laboratory values due to the risk of organ toxicity?
A) AST and ALT
B) Hemoglobin and Hematocrit
C) BUN and Creatinine
D) Amylase and Lipase
E) Sodium and Calcium
SOLUTIONS PLUS WELL DETAILED RATIONALES/GRADE A+ ASSURED
Question 1
A patient is prescribed sublingual nitroglycerin for the treatment of angina. Which instruction
should the nurse prioritize during patient teaching?
A) Swallow the tablet with a full glass of water.
B) Take the medication only if the pain lasts longer than 30 minutes.
C) Sit or lie down before taking the medication.
D) Store the medication in a clear plastic container for easy viewing.
E) Discard the tablets if they cause a tingling sensation under the tongue.
Correct Answer: C) Sit or lie down before taking the medication.
Rationale: Nitroglycerin is a potent vasodilator. One of its most common side effects is
orthostatic hypotension, which can lead to dizziness and syncope. Sitting or lying down
prevents falls and injury. Tablets should not be swallowed (A), should be kept in original
dark glass containers (D), and a tingling sensation usually indicates the drug is fresh (E).
Question 2
A nurse is preparing to administer digoxin to a patient with heart failure. Which clinical finding
would require the nurse to withhold the medication and notify the provider?
A) Blood pressure of 110/70 mmHg.
B) Respiratory rate of 18 breaths per minute.
C) Apical pulse of 52 beats per minute.
D) Potassium level of 4.8 mEq/L.
E) Digoxin level of 1.2 ng/mL.
Correct Answer: C) Apical pulse of 52 beats per minute.
Rationale: Digoxin is a negative chronotrope, meaning it slows the heart rate. It is standard
nursing practice to withhold digoxin if the apical pulse is less than 60 beats per minute in
an adult, as it may indicate digitalis toxicity or excessive bradycardia.
Question 3
Which medication is considered the "rescue" inhaler for a patient experiencing an acute asthma
attack?
A) Salmeterol
B) Albuterol
C) Fluticasone
D) Tiotropium
E) Montelukast
Correct Answer: B) Albuterol
Rationale: Albuterol is a short-acting beta-2 agonist (SABA). It works rapidly to cause
bronchodilation during an acute bronchospasm. Salmeterol (A) is long-acting; Fluticasone
, 2
(C) is a corticosteroid for maintenance; Tiotropium (D) is an anticholinergic; and
Montelukast (E) is a leukotriene modifier for long-term control.
Question 4
A patient taking warfarin (Coumadin) for atrial fibrillation should be instructed to maintain a
consistent intake of which of the following?
A) Red meats
B) Citrus fruits
C) Dark green leafy vegetables
D) Dairy products
E) Refined carbohydrates
Correct Answer: C) Dark green leafy vegetables
Rationale: Warfarin works by antagonizing Vitamin K. Dark green leafy vegetables are
high in Vitamin K. A sudden increase in these vegetables can decrease the effectiveness of
warfarin (lowering INR), while a sudden decrease can increase the risk of bleeding.
Consistency is key to maintaining a therapeutic INR.
Question 5
When administering the first dose of an ACE inhibitor such as Lisinopril, what is the most
important assessment for the nurse to perform?
A) Monitor for a dry, non-productive cough.
B) Check the patient's temperature.
C) Monitor the blood pressure for hypotension.
D) Assess for peripheral edema.
E) Evaluate the patient's bowel sounds.
Correct Answer: C) Monitor the blood pressure for hypotension.
Rationale: ACE inhibitors can cause a "first-dose effect," resulting in significant
hypotension. While a dry cough (A) is a common side effect of ACE inhibitors, the priority
assessment following the very first dose is safety related to blood pressure and the risk of
syncope.
Question 6
A patient with Type 1 Diabetes is prescribed Lispro (Humalog) insulin. When should the nurse
administer this medication?
A) 30 to 60 minutes before a meal.
B) Immediately after a meal.
C) 15 minutes before a meal.
D) At bedtime.
E) Only if the blood glucose is above 200 mg/dL.
, 3
Correct Answer: C) 15 minutes before a meal.
Rationale: Lispro is a rapid-acting insulin with an onset of 15 minutes. It must be
administered in close proximity to a meal (within 15 minutes) to prevent hypoglycemia, as
the peak occurs quickly. 30–60 minutes (A) is the timing for Regular (short-acting) insulin.
Question 7
The nurse is reviewing the lab results for a patient taking Furosemide (Lasix). Which value is of
greatest concern?
A) Sodium 138 mEq/L
B) Potassium 3.1 mEq/L
C) Creatinine 1.0 mg/dL
D) Glucose 110 mg/dL
E) BUN 15 mg/dL
Correct Answer: B) Potassium 3.1 mEq/L
Rationale: Furosemide is a loop diuretic that is "potassium-wasting." A potassium level of
3.1 mEq/L is low (hypokalemia), which can lead to cardiac arrhythmias and increases the
risk of digoxin toxicity if the patient is on both medications.
Question 8
Which of the following is the primary mechanism of action for Metformin?
A) Stimulates the pancreas to produce more insulin.
B) Increases glucose production in the liver.
C) Decreases insulin sensitivity in the muscle.
D) Decreases hepatic glucose production and increases insulin sensitivity.
E) Delays the absorption of carbohydrates in the GI tract.
Correct Answer: D) Decreases hepatic glucose production and increases insulin sensitivity.
Rationale: Metformin is a biguanide. Unlike sulfonylureas, it does not stimulate insulin
secretion from the pancreas (so it has a lower risk of hypoglycemia). Instead, it reduces the
amount of glucose the liver makes and helps cells use insulin more effectively.
Question 9
A nurse is preparing to administer Vancomycin IV. To prevent "Red Man Syndrome," the nurse
should perform which action?
A) Premedicate the patient with aspirin.
B) Administer the infusion over at least 60 minutes.
C) Dilute the medication in 10 mL of Normal Saline.
D) Use a rapid IV push technique.
E) Administer the medication via the intramuscular route.
, 4
Correct Answer: B) Administer the infusion over at least 60 minutes.
Rationale: Red Man Syndrome is a rate-dependent infusion reaction caused by the release
of histamine. It is characterized by flushing, rash, and hypotension. It is prevented by
infusing Vancomycin slowly, typically over 60 to 90 minutes.
Question 10
A patient is prescribed Spironolactone (Aldactone). The nurse should instruct the patient to avoid
which of the following?
A) Bananas and salt substitutes.
B) White bread and pasta.
C) Apple juice and grapes.
D) Hard cheeses and yogurt.
E) Chicken and fish.
Correct Answer: A) Bananas and salt substitutes.
Rationale: Spironolactone is a potassium-sparing diuretic. Patients are at risk for
hyperkalemia. Salt substitutes often contain potassium chloride instead of sodium chloride,
and bananas are high in potassium. Combining these with Spironolactone can lead to
dangerously high potassium levels.
Question 11
Which of the following is the antidote for an overdose of Heparin?
A) Vitamin K
B) Protamine sulfate
C) Glucagon
D) Naloxone
E) Acetylcysteine
Correct Answer: B) Protamine sulfate
Rationale: Protamine sulfate is the specific antagonist for Heparin. Vitamin K (A) is for
Warfarin; Naloxone (D) is for Opioids; and Acetylcysteine (E) is for Acetaminophen
(Tylenol).
Question 12
A patient is receiving Gentamicin (an aminoglycoside). The nurse should monitor which
laboratory values due to the risk of organ toxicity?
A) AST and ALT
B) Hemoglobin and Hematocrit
C) BUN and Creatinine
D) Amylase and Lipase
E) Sodium and Calcium
