Pharmacology Exam Review:
Key Medications, Indications, and Side Effects
2026/2027
Comprehensive Nursing Pharmacology
Key Domains: Major Drug Classifications (Cardiovascular, Respiratory,
Endocrine,
Neurologic, Psychiatric, Anti-infectives, GI, Pain Management), Mechanism of
Action,
Therapeutic Indications, Adverse Effects & Toxicity, Drug Interactions,
Nursing Implications & Patient Education, and Lifespan Considerations
Expert-Aligned Structure | Comprehensive Review Format
Academic Paper Format
March 2026
,Abstract
This comprehensive pharmacology exam review provides 120 exam-style questions with correct
answers and detailed rationales for nursing students preparing for pharmacology examinations in
2026/2027. The document emphasizes critical knowledge required for safe medication administration,
including understanding drug mechanisms, recognizing adverse effects, monitoring therapeutic
responses, and educating patients across all clinical settings. Questions are organized across major drug
classifications: cardiovascular, respiratory, endocrine, neurologic, psychiatric, anti-infectives,
gastrointestinal, and pain management medications. Each question includes rationales explaining the
drug's mechanism of action, primary indication, critical adverse effects to monitor, key nursing
interventions, essential patient teaching points, and why alternative options are incorrect or unsafe.
Keywords: Pharmacology, Drug Classifications, Adverse Effects, Nursing Implications, Medication
Safety, Drug Interactions, Patient Education, Therapeutic Indications
1. Introduction
Pharmacology is a foundational discipline in nursing education, providing the knowledge base
necessary for safe medication administration. Nurses must understand drug mechanisms, therapeutic
indications, adverse effects, drug interactions, and appropriate patient education to ensure optimal
patient outcomes. This review addresses high-yield medications across major drug classifications,
emphasizing critical thinking and clinical application rather than rote memorization.
The questions in this guide reflect current evidence-based pharmacotherapy and are aligned with
NCLEX-RN test plans and nursing curriculum standards. Each question requires application of
pharmacological principles to clinical scenarios, promoting the development of clinical judgment
essential for nursing practice.
2. Review Questions
Domain 1: Cardiovascular Medications
1. A patient is prescribed metoprolol (Lopressor) for hypertension. The nurse should hold the
medication and notify the provider if the heart rate is below:
A. 80 beats per minute
B. 60 beats per minute
C. 50 beats per minute
, D. 40 beats per minute
Rationale: Metoprolol is a beta-blocker that decreases heart rate. The medication should be held if heart
rate is below 60 bpm to prevent symptomatic bradycardia. Beta-blockers also lower blood pressure, so
BP should be assessed. The other thresholds are either too high (80) or dangerously low (50, 40) before
intervention.
2. A patient taking warfarin (Coumadin) has an INR of 4.5. The nurse should:
A. Administer the next dose as scheduled
B. Hold the dose and notify the provider
C. Increase the dose
D. Give vitamin K immediately
Rationale: An INR of 4.5 is above the therapeutic range (2.0-3.0 for most indications). The dose should
be held and the provider notified. Vitamin K is the antidote but is reserved for serious bleeding or very
high INR. Continuing or increasing the dose increases bleeding risk.
3. Which medication is classified as an angiotensin-converting enzyme (ACE) inhibitor?
A. Losartan (Cozaar)
B. Amlodipine (Norvasc)
C. Lisinopril (Prinivil)
D. Carvedilol (Coreg)
Rationale: Lisinopril is an ACE inhibitor, identifiable by the '-pril' suffix. Losartan is an ARB (-sartan),
amlodipine is a calcium channel blocker, and carvedilol is a beta-blocker. ACE inhibitors can cause a
dry cough and angioedema; patients should be taught to report these effects.
4. The nurse teaches a patient taking digoxin (Lanoxin) to report which sign of toxicity?
A. Increased appetite
B. Yellow-green halos around lights
C. Constipation
D. Insomnia
Rationale: Yellow-green halos around lights are a classic sign of digoxin toxicity. Other signs include
nausea, vomiting, anorexia, bradycardia, and confusion. Digoxin has a narrow therapeutic index. Serum
levels should be monitored, and potassium levels maintained as hypokalemia increases toxicity risk.
5. A patient is started on atorvastatin (Lipitor). Which baseline laboratory test should be obtained?
A. Complete blood count
B. Liver function tests
C. Thyroid panel
D. Urinalysis
Rationale: Statins can cause hepatotoxicity and myopathy. Baseline liver function tests (ALT, AST)
should be obtained and monitored periodically. Patients should report unexplained muscle pain,
tenderness, or weakness. CBC, thyroid panel, and urinalysis are not routinely required for statin
monitoring.
6. Which instruction is essential for a patient taking sublingual nitroglycerin?
A. Swallow the tablet whole with water
, B. Take the tablet with food
C. Sit or lie down before taking the medication
D. Chew the tablet for faster absorption
Rationale: Nitroglycerin causes vasodilation and can cause severe hypotension and dizziness. Patients
should sit or lie down before administration to prevent falls. Sublingual tablets should dissolve under
the tongue, not be swallowed or chewed. Food does not affect sublingual absorption.
7. A patient is receiving heparin infusion. Which laboratory value monitors therapeutic effect?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Rationale: aPTT monitors heparin therapy, with a target of 1.5-2.5 times the control value. PT/INR
monitors warfarin therapy. Platelet count should be monitored to detect heparin-induced
thrombocytopenia (HIT), but it does not measure therapeutic effect.
8. The nurse is administering amiodarone (Cordarone). Which baseline assessment is essential?
A. Liver function tests only
B. Pulmonary function tests and thyroid function tests
C. Renal function tests only
D. Complete blood count only
Rationale: Amiodarone can cause pulmonary toxicity and thyroid dysfunction (hypo- or
hyperthyroidism). Baseline chest X-ray, pulmonary function tests, and thyroid function tests are
essential. Liver function tests are also monitored. Ophthalmologic exams may be needed for long-term
therapy.
9. A patient taking hydrochlorothiazide should be monitored for which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Rationale: Thiazide diuretics increase potassium excretion, causing hypokalemia. Patients should be
taught to consume potassium-rich foods or may require potassium supplementation. Thiazides can also
cause hyponatremia, hyperglycemia, and hyperuricemia. Potassium-sparing diuretics cause
hyperkalemia.
10. Which medication requires monitoring for QT prolongation on ECG?
A. Metoprolol
B. Amiodarone
C. Lisinopril
D. Amlodipine
Rationale: Amiodarone can prolong the QT interval, increasing risk of torsades de pointes (a
life-threatening arrhythmia). Other drugs causing QT prolongation include certain antipsychotics,
fluoroquinolones, and macrolides. Metoprolol, lisinopril, and amlodipine do not typically cause QT
prolongation.
Key Medications, Indications, and Side Effects
2026/2027
Comprehensive Nursing Pharmacology
Key Domains: Major Drug Classifications (Cardiovascular, Respiratory,
Endocrine,
Neurologic, Psychiatric, Anti-infectives, GI, Pain Management), Mechanism of
Action,
Therapeutic Indications, Adverse Effects & Toxicity, Drug Interactions,
Nursing Implications & Patient Education, and Lifespan Considerations
Expert-Aligned Structure | Comprehensive Review Format
Academic Paper Format
March 2026
,Abstract
This comprehensive pharmacology exam review provides 120 exam-style questions with correct
answers and detailed rationales for nursing students preparing for pharmacology examinations in
2026/2027. The document emphasizes critical knowledge required for safe medication administration,
including understanding drug mechanisms, recognizing adverse effects, monitoring therapeutic
responses, and educating patients across all clinical settings. Questions are organized across major drug
classifications: cardiovascular, respiratory, endocrine, neurologic, psychiatric, anti-infectives,
gastrointestinal, and pain management medications. Each question includes rationales explaining the
drug's mechanism of action, primary indication, critical adverse effects to monitor, key nursing
interventions, essential patient teaching points, and why alternative options are incorrect or unsafe.
Keywords: Pharmacology, Drug Classifications, Adverse Effects, Nursing Implications, Medication
Safety, Drug Interactions, Patient Education, Therapeutic Indications
1. Introduction
Pharmacology is a foundational discipline in nursing education, providing the knowledge base
necessary for safe medication administration. Nurses must understand drug mechanisms, therapeutic
indications, adverse effects, drug interactions, and appropriate patient education to ensure optimal
patient outcomes. This review addresses high-yield medications across major drug classifications,
emphasizing critical thinking and clinical application rather than rote memorization.
The questions in this guide reflect current evidence-based pharmacotherapy and are aligned with
NCLEX-RN test plans and nursing curriculum standards. Each question requires application of
pharmacological principles to clinical scenarios, promoting the development of clinical judgment
essential for nursing practice.
2. Review Questions
Domain 1: Cardiovascular Medications
1. A patient is prescribed metoprolol (Lopressor) for hypertension. The nurse should hold the
medication and notify the provider if the heart rate is below:
A. 80 beats per minute
B. 60 beats per minute
C. 50 beats per minute
, D. 40 beats per minute
Rationale: Metoprolol is a beta-blocker that decreases heart rate. The medication should be held if heart
rate is below 60 bpm to prevent symptomatic bradycardia. Beta-blockers also lower blood pressure, so
BP should be assessed. The other thresholds are either too high (80) or dangerously low (50, 40) before
intervention.
2. A patient taking warfarin (Coumadin) has an INR of 4.5. The nurse should:
A. Administer the next dose as scheduled
B. Hold the dose and notify the provider
C. Increase the dose
D. Give vitamin K immediately
Rationale: An INR of 4.5 is above the therapeutic range (2.0-3.0 for most indications). The dose should
be held and the provider notified. Vitamin K is the antidote but is reserved for serious bleeding or very
high INR. Continuing or increasing the dose increases bleeding risk.
3. Which medication is classified as an angiotensin-converting enzyme (ACE) inhibitor?
A. Losartan (Cozaar)
B. Amlodipine (Norvasc)
C. Lisinopril (Prinivil)
D. Carvedilol (Coreg)
Rationale: Lisinopril is an ACE inhibitor, identifiable by the '-pril' suffix. Losartan is an ARB (-sartan),
amlodipine is a calcium channel blocker, and carvedilol is a beta-blocker. ACE inhibitors can cause a
dry cough and angioedema; patients should be taught to report these effects.
4. The nurse teaches a patient taking digoxin (Lanoxin) to report which sign of toxicity?
A. Increased appetite
B. Yellow-green halos around lights
C. Constipation
D. Insomnia
Rationale: Yellow-green halos around lights are a classic sign of digoxin toxicity. Other signs include
nausea, vomiting, anorexia, bradycardia, and confusion. Digoxin has a narrow therapeutic index. Serum
levels should be monitored, and potassium levels maintained as hypokalemia increases toxicity risk.
5. A patient is started on atorvastatin (Lipitor). Which baseline laboratory test should be obtained?
A. Complete blood count
B. Liver function tests
C. Thyroid panel
D. Urinalysis
Rationale: Statins can cause hepatotoxicity and myopathy. Baseline liver function tests (ALT, AST)
should be obtained and monitored periodically. Patients should report unexplained muscle pain,
tenderness, or weakness. CBC, thyroid panel, and urinalysis are not routinely required for statin
monitoring.
6. Which instruction is essential for a patient taking sublingual nitroglycerin?
A. Swallow the tablet whole with water
, B. Take the tablet with food
C. Sit or lie down before taking the medication
D. Chew the tablet for faster absorption
Rationale: Nitroglycerin causes vasodilation and can cause severe hypotension and dizziness. Patients
should sit or lie down before administration to prevent falls. Sublingual tablets should dissolve under
the tongue, not be swallowed or chewed. Food does not affect sublingual absorption.
7. A patient is receiving heparin infusion. Which laboratory value monitors therapeutic effect?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Rationale: aPTT monitors heparin therapy, with a target of 1.5-2.5 times the control value. PT/INR
monitors warfarin therapy. Platelet count should be monitored to detect heparin-induced
thrombocytopenia (HIT), but it does not measure therapeutic effect.
8. The nurse is administering amiodarone (Cordarone). Which baseline assessment is essential?
A. Liver function tests only
B. Pulmonary function tests and thyroid function tests
C. Renal function tests only
D. Complete blood count only
Rationale: Amiodarone can cause pulmonary toxicity and thyroid dysfunction (hypo- or
hyperthyroidism). Baseline chest X-ray, pulmonary function tests, and thyroid function tests are
essential. Liver function tests are also monitored. Ophthalmologic exams may be needed for long-term
therapy.
9. A patient taking hydrochlorothiazide should be monitored for which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Rationale: Thiazide diuretics increase potassium excretion, causing hypokalemia. Patients should be
taught to consume potassium-rich foods or may require potassium supplementation. Thiazides can also
cause hyponatremia, hyperglycemia, and hyperuricemia. Potassium-sparing diuretics cause
hyperkalemia.
10. Which medication requires monitoring for QT prolongation on ECG?
A. Metoprolol
B. Amiodarone
C. Lisinopril
D. Amlodipine
Rationale: Amiodarone can prolong the QT interval, increasing risk of torsades de pointes (a
life-threatening arrhythmia). Other drugs causing QT prolongation include certain antipsychotics,
fluoroquinolones, and macrolides. Metoprolol, lisinopril, and amlodipine do not typically cause QT
prolongation.
