RN Pharmacology – Registered Nurse Pharmacology Study Guide & Exam Preparation
RN Pharmacology 2026: NCLEX-Style Practice Exam
Focus Area: Newer Diabetes Medications (GLP-1 Agonists, SGLT2 Inhibitors) & Nursing
Management
Total Questions: 5 (3 Traditional MCQs, 2 NGN-Format)
Question 1 of 5 (Traditional MCQ)
Scenario: Maria Santos, a 45-year-old Hispanic woman with Type 2 diabetes (BMI 38),
presents to the emergency department via ambulance. She has been taking
semaglutide (Ozempic) 1 mg subcutaneously weekly for 8 months. Her husband reports
48 hours of severe epigastric pain radiating to her back, intractable vomiting, and
confusion. Vital signs: BP 88/58 mmHg, HR 128 bpm (sinus tachycardia), RR 24, SpO2
94% on room air, Temp 101.2°F (38.4°C). Laboratory studies reveal serum lipase 1,240
U/L (normal: 13-60), glucose 412 mg/dL, WBC 16,000/mm³.
Question: Which assessment finding requires the most immediate intervention by the
nurse?
A) Serum glucose of 412 mg/dL
B) Blood pressure of 88/58 mmHg and heart rate of 128 bpm
C) History of GLP-1 agonist use for 8 months
D) Fever of 101.2°F (38.4°C)
Correct Answer: B) Blood pressure of 88/58 mmHg and heart rate of 128 bpm
Rationale:
● Why correct: The patient presents with acute pancreatitis (elevated lipase,
characteristic pain, nausea), a known serious adverse effect of GLP-1 receptor
agonists (FDA Black Box Warning). The vital signs indicate hemodynamic
, instability/hypovolemic shock (hypotension with compensatory tachycardia)
suggesting possible hemorrhagic or severe necrotizing pancreatitis. This
requires immediate fluid resuscitation, hemodynamic monitoring, and provider
notification for ICU consideration per 2026 sepsis/pancreatitis protocols.
● Why incorrect:
○ A: While hyperglycemia requires correction, an elevated glucose in this
context is expected due to acute illness and counter-regulatory hormone
surge; it is not immediately life-threatening compared to shock.
○ C: The medication history is crucial causative data but is not an
assessment finding requiring intervention—it is background information for
the medical team.
○ D: Fever suggests inflammatory response or possible infection, but
without hemodynamic compromise, it is less immediately threatening
than shock.
NCLEX Blueprint Category: Pharmacological and Parenteral Therapies (Reduction of
Risk Potential)
Clinical Judgment (CJMM): Recognize Cues (Layer 2) – Identifying life-threatening
complications from medication adverse effects.
2026 Relevance: The FDA issued updated safety communications in late 2024-early
2025 regarding GLP-1 RAs and risks of ileus and pancreatitis. Additionally, 2026 ADA
Standards emphasize cardiovascular risk stratification, making recognition of acute
complications critical for patients on these high-risk medications.
Question 2 of 5 (Traditional MCQ – Dosage Calculation)
Scenario: James Thompson, a 68-year-old African American man with Type 2 diabetes,
CKD Stage 3b (eGFR 42 mL/min/1.73m²), and established ASCVD, is admitted for heart
failure optimization. His current regimen includes insulin glargine (Lantus) 52 units
subcutaneously at bedtime and metformin (held due to contrast study). The provider
prescribes dulaglutide (Trulicity) 1.5 mg weekly subcutaneous injection to improve
glycemic control and provide cardiovascular protection. Per 2025 ADA Standards of
Care, the provider orders a 20% reduction in basal insulin upon initiation of the GLP-1 RA
to prevent hypoglycemia.
RN Pharmacology 2026: NCLEX-Style Practice Exam
Focus Area: Newer Diabetes Medications (GLP-1 Agonists, SGLT2 Inhibitors) & Nursing
Management
Total Questions: 5 (3 Traditional MCQs, 2 NGN-Format)
Question 1 of 5 (Traditional MCQ)
Scenario: Maria Santos, a 45-year-old Hispanic woman with Type 2 diabetes (BMI 38),
presents to the emergency department via ambulance. She has been taking
semaglutide (Ozempic) 1 mg subcutaneously weekly for 8 months. Her husband reports
48 hours of severe epigastric pain radiating to her back, intractable vomiting, and
confusion. Vital signs: BP 88/58 mmHg, HR 128 bpm (sinus tachycardia), RR 24, SpO2
94% on room air, Temp 101.2°F (38.4°C). Laboratory studies reveal serum lipase 1,240
U/L (normal: 13-60), glucose 412 mg/dL, WBC 16,000/mm³.
Question: Which assessment finding requires the most immediate intervention by the
nurse?
A) Serum glucose of 412 mg/dL
B) Blood pressure of 88/58 mmHg and heart rate of 128 bpm
C) History of GLP-1 agonist use for 8 months
D) Fever of 101.2°F (38.4°C)
Correct Answer: B) Blood pressure of 88/58 mmHg and heart rate of 128 bpm
Rationale:
● Why correct: The patient presents with acute pancreatitis (elevated lipase,
characteristic pain, nausea), a known serious adverse effect of GLP-1 receptor
agonists (FDA Black Box Warning). The vital signs indicate hemodynamic
, instability/hypovolemic shock (hypotension with compensatory tachycardia)
suggesting possible hemorrhagic or severe necrotizing pancreatitis. This
requires immediate fluid resuscitation, hemodynamic monitoring, and provider
notification for ICU consideration per 2026 sepsis/pancreatitis protocols.
● Why incorrect:
○ A: While hyperglycemia requires correction, an elevated glucose in this
context is expected due to acute illness and counter-regulatory hormone
surge; it is not immediately life-threatening compared to shock.
○ C: The medication history is crucial causative data but is not an
assessment finding requiring intervention—it is background information for
the medical team.
○ D: Fever suggests inflammatory response or possible infection, but
without hemodynamic compromise, it is less immediately threatening
than shock.
NCLEX Blueprint Category: Pharmacological and Parenteral Therapies (Reduction of
Risk Potential)
Clinical Judgment (CJMM): Recognize Cues (Layer 2) – Identifying life-threatening
complications from medication adverse effects.
2026 Relevance: The FDA issued updated safety communications in late 2024-early
2025 regarding GLP-1 RAs and risks of ileus and pancreatitis. Additionally, 2026 ADA
Standards emphasize cardiovascular risk stratification, making recognition of acute
complications critical for patients on these high-risk medications.
Question 2 of 5 (Traditional MCQ – Dosage Calculation)
Scenario: James Thompson, a 68-year-old African American man with Type 2 diabetes,
CKD Stage 3b (eGFR 42 mL/min/1.73m²), and established ASCVD, is admitted for heart
failure optimization. His current regimen includes insulin glargine (Lantus) 52 units
subcutaneously at bedtime and metformin (held due to contrast study). The provider
prescribes dulaglutide (Trulicity) 1.5 mg weekly subcutaneous injection to improve
glycemic control and provide cardiovascular protection. Per 2025 ADA Standards of
Care, the provider orders a 20% reduction in basal insulin upon initiation of the GLP-1 RA
to prevent hypoglycemia.
