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RELIAS RN PHARMACOLOGY
COMPREHENSIVE EXAM TEST BANK 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ALREADY A
GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
1. A patient with heart failure is prescribed digoxin. The nurse notes a
heart rate of 52 bpm and the patient reports nausea and yellow-tinged
vision. Which action should the nurse take first?
A. Administer the digoxin as ordered.
B. Hold the digoxin and check the serum digoxin level.
C. Give potassium chloride as ordered.
D. Reassess the heart rate in 30 minutes.
Rationale: Nausea and yellow vision are classic signs of digoxin
toxicity, especially with bradycardia. The nurse should withhold the
next dose and notify the provider for a digoxin level. Administering the
dose (A) would worsen toxicity. Potassium (C) may be indicated if
hypokalemic, but only after evaluation. Waiting (D) delays necessary
intervention.
2. A patient is receiving IV vancomycin. Which assessment finding
requires immediate nursing action?
A. Mild flushing of the face and neck
B. Sudden onset of wheezing and hypotension
C. An increase in serum creatinine from 0.8 to 0.9 mg/dL
D. Complaints of a bad taste in the mouth
Rationale: Wheezing and hypotension suggest anaphylaxis, a
life-threatening allergic reaction requiring immediate discontinuation
,2|Page
and emergency treatment. Vancomycin infusion reaction (Red Man
syndrome, A) causes flushing and is usually benign with slower
infusion. A slight rise in creatinine (C) is not urgent. Bad taste (D) is
common.
3. A patient with type 2 diabetes takes metformin. Which instruction
should the nurse include regarding the timing of administration?
A. Take on an empty stomach 30 minutes before meals.
B. Take with meals to reduce gastrointestinal upset.
C. Take only at bedtime with a full glass of water.
D. Take with grapefruit juice to increase absorption.
Rationale: Metformin commonly causes GI side effects (nausea,
diarrhea); taking with meals substantially reduces these symptoms. It
does not require an empty stomach (A). Bedtime dosing is not
standard. Grapefruit juice (D) does not enhance metformin absorption
and is unnecessary.
4. A nurse is preparing to administer furosemide 40 mg IV push. The
medication vial contains 10 mg/mL. How many mL should the nurse
administer?
A. 2 mL
B. 4 mL
C. 6 mL
D. 8 mL
*Rationale: Desired dose (40 mg) divided by concentration (10 mg/mL)
= 4 mL. Option B is correct.*
5. A patient is prescribed warfarin. Which laboratory value indicates a
therapeutic international normalized ratio (INR) for a patient with atrial
fibrillation?
A. 0.8 – 1.2
B. 1.5 – 2.0
C. 2.0 – 3.0
D. 3.5 – 4.5
,3|Page
Rationale: For most indications (atrial fibrillation, VTE treatment),
the target INR is 2.0–3.0. Mechanical heart valves require 2.5–3.5.
Option C is correct.
6. A patient is receiving an albuterol nebulizer treatment for an asthma
exacerbation. The nurse should monitor for which adverse effect?
A. Bradycardia
B. Tachycardia and palpitations
C. Constipation
D. Sedation
Rationale: Albuterol is a beta-2 agonist that can cause beta-1-mediated
cardiac effects, including tachycardia, palpitations, and anxiety.
Bradycardia (A) is not expected. Constipation and sedation are not
typical.
7. A patient with a history of anaphylaxis to penicillin is prescribed
clindamycin for a dental infection. The nurse should administer the
medication and observe for which potential adverse effect?
A. Hypertension
B. Clostridioides difficile-associated diarrhea (CDAD)
C. Hypoglycemia
D. Ototoxicity
Rationale: Clindamycin is strongly associated with CDAD, which can
be severe and occur even after the course is completed. The nurse
should educate the patient to report diarrhea. Hypertension,
hypoglycemia, and ototoxicity are not common with clindamycin.
8. A nurse is teaching a patient about insulin glargine (Lantus). Which
statement by the patient indicates understanding?
A. “I will take this insulin 15 minutes before each meal.”
B. “I should not mix glargine with other insulins in the same
syringe.”
C. “This insulin has a peak effect 2 to 4 hours after injection.”
D. “I will keep the vial in the freezer to maintain potency.”
, 4|Page
Rationale: Glargine is a long-acting basal insulin that should not be
mixed with other insulins due to pH changes that alter absorption. It
has no pronounced peak (C false). It is given once daily at the same
time, not before meals (A). It should be refrigerated until opened, then
room temperature; never frozen (D).
9. A patient is started on lisinopril for hypertension. Which potential side
effect should the nurse emphasize when teaching the patient?
A. Hyperkalemia and constipation
B. Persistent dry cough and angioedema
C. Tachycardia and insomnia
D. Weight gain and hyperglycemia
Rationale: Lisinopril (ACE inhibitor) commonly causes a dry,
non-productive cough due to bradykinin accumulation; angioedema is
rare but serious. Hyperkalemia can occur, but constipation (A) is not
typical. Tachycardia (C) is not common. Weight gain and
hyperglycemia (D) are associated with some beta-blockers and
thiazides, not ACE inhibitors.
10. A nurse is administering subcutaneous heparin to a patient for DVT
prophylaxis. Which injection technique is correct?
A. Use a 1-inch needle at a 90-degree angle.
B. Insert the needle at a 90-degree angle into a pinched skin fold,
and do not aspirate.
C. Massage the site after injection to promote absorption.
D. Administer into the deltoid muscle.
*Rationale: Heparin is given subcutaneously into the abdomen (avoiding
the umbilicus), pinching the skin, inserting at 90°, and not aspirating.
Massaging (C) can cause bruising. Deltoid (D) is not used. A 1-inch
needle is too long; a short needle (5/8 inch) is typical.*
11. A patient with bipolar disorder is prescribed lithium. Which
laboratory test must be monitored at regular intervals to prevent
toxicity?
RELIAS RN PHARMACOLOGY
COMPREHENSIVE EXAM TEST BANK 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ALREADY A
GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
1. A patient with heart failure is prescribed digoxin. The nurse notes a
heart rate of 52 bpm and the patient reports nausea and yellow-tinged
vision. Which action should the nurse take first?
A. Administer the digoxin as ordered.
B. Hold the digoxin and check the serum digoxin level.
C. Give potassium chloride as ordered.
D. Reassess the heart rate in 30 minutes.
Rationale: Nausea and yellow vision are classic signs of digoxin
toxicity, especially with bradycardia. The nurse should withhold the
next dose and notify the provider for a digoxin level. Administering the
dose (A) would worsen toxicity. Potassium (C) may be indicated if
hypokalemic, but only after evaluation. Waiting (D) delays necessary
intervention.
2. A patient is receiving IV vancomycin. Which assessment finding
requires immediate nursing action?
A. Mild flushing of the face and neck
B. Sudden onset of wheezing and hypotension
C. An increase in serum creatinine from 0.8 to 0.9 mg/dL
D. Complaints of a bad taste in the mouth
Rationale: Wheezing and hypotension suggest anaphylaxis, a
life-threatening allergic reaction requiring immediate discontinuation
,2|Page
and emergency treatment. Vancomycin infusion reaction (Red Man
syndrome, A) causes flushing and is usually benign with slower
infusion. A slight rise in creatinine (C) is not urgent. Bad taste (D) is
common.
3. A patient with type 2 diabetes takes metformin. Which instruction
should the nurse include regarding the timing of administration?
A. Take on an empty stomach 30 minutes before meals.
B. Take with meals to reduce gastrointestinal upset.
C. Take only at bedtime with a full glass of water.
D. Take with grapefruit juice to increase absorption.
Rationale: Metformin commonly causes GI side effects (nausea,
diarrhea); taking with meals substantially reduces these symptoms. It
does not require an empty stomach (A). Bedtime dosing is not
standard. Grapefruit juice (D) does not enhance metformin absorption
and is unnecessary.
4. A nurse is preparing to administer furosemide 40 mg IV push. The
medication vial contains 10 mg/mL. How many mL should the nurse
administer?
A. 2 mL
B. 4 mL
C. 6 mL
D. 8 mL
*Rationale: Desired dose (40 mg) divided by concentration (10 mg/mL)
= 4 mL. Option B is correct.*
5. A patient is prescribed warfarin. Which laboratory value indicates a
therapeutic international normalized ratio (INR) for a patient with atrial
fibrillation?
A. 0.8 – 1.2
B. 1.5 – 2.0
C. 2.0 – 3.0
D. 3.5 – 4.5
,3|Page
Rationale: For most indications (atrial fibrillation, VTE treatment),
the target INR is 2.0–3.0. Mechanical heart valves require 2.5–3.5.
Option C is correct.
6. A patient is receiving an albuterol nebulizer treatment for an asthma
exacerbation. The nurse should monitor for which adverse effect?
A. Bradycardia
B. Tachycardia and palpitations
C. Constipation
D. Sedation
Rationale: Albuterol is a beta-2 agonist that can cause beta-1-mediated
cardiac effects, including tachycardia, palpitations, and anxiety.
Bradycardia (A) is not expected. Constipation and sedation are not
typical.
7. A patient with a history of anaphylaxis to penicillin is prescribed
clindamycin for a dental infection. The nurse should administer the
medication and observe for which potential adverse effect?
A. Hypertension
B. Clostridioides difficile-associated diarrhea (CDAD)
C. Hypoglycemia
D. Ototoxicity
Rationale: Clindamycin is strongly associated with CDAD, which can
be severe and occur even after the course is completed. The nurse
should educate the patient to report diarrhea. Hypertension,
hypoglycemia, and ototoxicity are not common with clindamycin.
8. A nurse is teaching a patient about insulin glargine (Lantus). Which
statement by the patient indicates understanding?
A. “I will take this insulin 15 minutes before each meal.”
B. “I should not mix glargine with other insulins in the same
syringe.”
C. “This insulin has a peak effect 2 to 4 hours after injection.”
D. “I will keep the vial in the freezer to maintain potency.”
, 4|Page
Rationale: Glargine is a long-acting basal insulin that should not be
mixed with other insulins due to pH changes that alter absorption. It
has no pronounced peak (C false). It is given once daily at the same
time, not before meals (A). It should be refrigerated until opened, then
room temperature; never frozen (D).
9. A patient is started on lisinopril for hypertension. Which potential side
effect should the nurse emphasize when teaching the patient?
A. Hyperkalemia and constipation
B. Persistent dry cough and angioedema
C. Tachycardia and insomnia
D. Weight gain and hyperglycemia
Rationale: Lisinopril (ACE inhibitor) commonly causes a dry,
non-productive cough due to bradykinin accumulation; angioedema is
rare but serious. Hyperkalemia can occur, but constipation (A) is not
typical. Tachycardia (C) is not common. Weight gain and
hyperglycemia (D) are associated with some beta-blockers and
thiazides, not ACE inhibitors.
10. A nurse is administering subcutaneous heparin to a patient for DVT
prophylaxis. Which injection technique is correct?
A. Use a 1-inch needle at a 90-degree angle.
B. Insert the needle at a 90-degree angle into a pinched skin fold,
and do not aspirate.
C. Massage the site after injection to promote absorption.
D. Administer into the deltoid muscle.
*Rationale: Heparin is given subcutaneously into the abdomen (avoiding
the umbilicus), pinching the skin, inserting at 90°, and not aspirating.
Massaging (C) can cause bruising. Deltoid (D) is not used. A 1-inch
needle is too long; a short needle (5/8 inch) is typical.*
11. A patient with bipolar disorder is prescribed lithium. Which
laboratory test must be monitored at regular intervals to prevent
toxicity?
