NCLEX Pharmacology: 70 High-Yield
Practice Questions, Answers, and Rationales
1. A patient is prescribed Digoxin. Which electrolyte imbalance most significantly
increases the risk of Digoxin toxicity?
o Answer: Hypokalemia.
o Rationale: Low potassium levels enhance the effects of Digoxin at the
myocardial cell site, which can lead to life-threatening arrhythmias.
2. What is the primary therapeutic goal of administering Filgrastim?
o Answer: To increase the production of neutrophils.
o Rationale: Filgrastim is a colony-stimulating factor used to treat neutropenia,
particularly in patients undergoing chemotherapy, to reduce the risk of infection.
3. A patient is taking Spironolactone. Which medication, if taken concurrently,
requires immediate intervention?
o Answer: Lisinopril (or any ACE inhibitor).
o Rationale: Both Spironolactone and ACE inhibitors can cause potassium
retention. Combining them significantly increases the risk of severe
hyperkalemia.
4. Which instruction is vital for a patient starting Alendronate?
o Answer: Stay upright for at least 30 minutes after taking the medication.
, o Rationale: Alendronate can cause severe esophagitis. Sitting or standing upright
helps ensure the medication reaches the stomach quickly and reduces reflux.
5. A patient is receiving a Heparin infusion. The aPTT is 110 seconds. What is the
priority nursing action?
o Answer: Stop the infusion and notify the provider.
o Rationale: The therapeutic aPTT range is typically 60–80 seconds. A value of
110 is excessively high, placing the patient at a high risk for spontaneous
bleeding.
6. What is the reversal agent for a Magnesium Sulfate overdose?
o Answer: Calcium Gluconate.
o Rationale: Calcium antagonizes the effects of magnesium at the neuromuscular
junction, reversing respiratory depression and cardiac arrest.
7. A patient taking Clozapine must have which lab test performed weekly?
o Answer: White Blood Cell (WBC) count with differential.
o Rationale: Clozapine carries a risk of agranulocytosis, a severe and dangerous
reduction in the number of white blood cells.
8. Which side effect is most common in patients taking Nitroglycerin?
o Answer: Headache.
o Rationale: Vasodilation occurs not only in the coronary arteries but also in the
cerebral vessels, leading to a common, often severe, headache.
9. When administering Ferrous Sulfate (Iron) elixirs, what should the nurse do to
protect the patient's teeth?
o Answer: Administer the medication through a straw.
Practice Questions, Answers, and Rationales
1. A patient is prescribed Digoxin. Which electrolyte imbalance most significantly
increases the risk of Digoxin toxicity?
o Answer: Hypokalemia.
o Rationale: Low potassium levels enhance the effects of Digoxin at the
myocardial cell site, which can lead to life-threatening arrhythmias.
2. What is the primary therapeutic goal of administering Filgrastim?
o Answer: To increase the production of neutrophils.
o Rationale: Filgrastim is a colony-stimulating factor used to treat neutropenia,
particularly in patients undergoing chemotherapy, to reduce the risk of infection.
3. A patient is taking Spironolactone. Which medication, if taken concurrently,
requires immediate intervention?
o Answer: Lisinopril (or any ACE inhibitor).
o Rationale: Both Spironolactone and ACE inhibitors can cause potassium
retention. Combining them significantly increases the risk of severe
hyperkalemia.
4. Which instruction is vital for a patient starting Alendronate?
o Answer: Stay upright for at least 30 minutes after taking the medication.
, o Rationale: Alendronate can cause severe esophagitis. Sitting or standing upright
helps ensure the medication reaches the stomach quickly and reduces reflux.
5. A patient is receiving a Heparin infusion. The aPTT is 110 seconds. What is the
priority nursing action?
o Answer: Stop the infusion and notify the provider.
o Rationale: The therapeutic aPTT range is typically 60–80 seconds. A value of
110 is excessively high, placing the patient at a high risk for spontaneous
bleeding.
6. What is the reversal agent for a Magnesium Sulfate overdose?
o Answer: Calcium Gluconate.
o Rationale: Calcium antagonizes the effects of magnesium at the neuromuscular
junction, reversing respiratory depression and cardiac arrest.
7. A patient taking Clozapine must have which lab test performed weekly?
o Answer: White Blood Cell (WBC) count with differential.
o Rationale: Clozapine carries a risk of agranulocytosis, a severe and dangerous
reduction in the number of white blood cells.
8. Which side effect is most common in patients taking Nitroglycerin?
o Answer: Headache.
o Rationale: Vasodilation occurs not only in the coronary arteries but also in the
cerebral vessels, leading to a common, often severe, headache.
9. When administering Ferrous Sulfate (Iron) elixirs, what should the nurse do to
protect the patient's teeth?
o Answer: Administer the medication through a straw.
