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RN PHARMACOLOGY A – RELIAS ACTUAL
EXAM PREP 2026 50 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |NEW AND REVISED
1. A patient is prescribed digoxin 0.25 mg daily. Which assessment
finding is most indicative of digoxin toxicity?
A) Heart rate of 68 bpm
B) Nausea, vomiting, and yellow-green halos around lights
C) Blood pressure 130/80 mmHg
D) Serum potassium 4.0 mEq/L
*Rationale: Visual disturbances (yellow-green halos, blurred vision),
nausea, vomiting, and bradycardia are classic signs of digoxin toxicity.
Hypokalemia increases risk, but a potassium of 4.0 is normal.*
2. A nurse is administering intravenous furosemide to a patient with
heart failure. Which adverse effect requires immediate notification of the
provider?
A) Increased urinary output
B) Sudden onset of tinnitus and hearing loss
C) Mild orthostatic hypotension
D) Serum potassium 3.8 mEq/L
Rationale: Loop diuretics (furosemide) can cause ototoxicity, which
may be irreversible. Tinnitus or hearing loss warrants immediate
discontinuation and provider notification.
3. A patient is receiving a continuous heparin infusion for deep vein
thrombosis. The aPTT is 110 seconds (normal 25-35, therapeutic 60-80).
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What is the priority nursing action?
A) Continue the infusion and recheck aPTT in 6 hours
B) Stop the infusion and notify the provider
C) Increase the infusion rate to achieve therapeutic range
D) Administer protamine sulfate immediately
*Rationale: An aPTT >100 seconds indicates excessive
anticoagulation and increased bleeding risk. The infusion should be
paused and the provider notified. Protamine is reserved for life-
threatening bleeding.*
4. Which medication is safest to administer via a peripheral intravenous
line if extravasation occurs?
A) Dopamine
B) Normal saline
C) Phenytoin
D) Vasopressin
Rationale: Normal saline is isotonic and non-vesicant; extravasation
causes no tissue damage. Dopamine, phenytoin, and vasopressin are
vesicants and can cause severe tissue necrosis if infiltrated.
5. A patient with type 2 diabetes is prescribed metformin. Which
instruction is most important to include in discharge teaching?
A) Take metformin only on days you eat carbohydrates
B) Report any unusual muscle pain or weakness, especially with
malaise
C) Take metformin with a full glass of grapefruit juice
D) Monitor blood glucose only once weekly
Rationale: Metformin can cause lactic acidosis (rare but serious).
Symptoms include muscle pain, weakness, malaise, respiratory
distress. Grapefruit juice is not contraindicated but not required.
6. A nurse is preparing to administer enoxaparin subcutaneously. Which
technique is correct?
A) Aspirate before injection to avoid intravascular administration
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B) Inject into the anterolateral abdominal wall without aspirating
C) Rub the injection site vigorously after administration
D) Expel the air bubble from the prefilled syringe before injecting
Rationale: Enoxaparin (LMWH) is given subcutaneously in the
abdomen without aspiration (to prevent hematoma). The air bubble
should not be expelled; it ensures full dose delivery.
7. A patient on warfarin has an INR of 1.2. The nurse understands that
this indicates:
A) Therapeutic anticoagulation
B) Subtherapeutic anticoagulation
C) Supratherapeutic anticoagulation
D) Normal INR for a patient not on warfarin
*Rationale: Target INR for most indications (e.g., atrial fibrillation,
DVT) is 2.0-3.0. An INR of 1.2 suggests warfarin dose is too low;
increased thrombotic risk.*
8. Which medication is associated with the highest risk of anaphylaxis
and requires a test dose before full administration?
A) Penicillin
B) Acetaminophen
C) Ibuprofen
D) Omeprazole
Rationale: Penicillin and related beta-lactams are common causes of
anaphylaxis. However, test doses are not routine; the question likely
refers to drugs like IV iron or certain antibodies. But among options,
penicillin has highest anaphylaxis risk. More precise: IV iron or
penicillin skin testing. But standard teaching: penicillin allergy is most
common drug allergy. I'll keep penicillin.
9. A nurse is administering morphine 4 mg IV push for postoperative
pain. Which vital sign change requires immediate intervention?
A) Respiratory rate drop from 18 to 12 breaths/min
B) Respiratory rate drop from 16 to 8 breaths/min
RN PHARMACOLOGY A – RELIAS ACTUAL
EXAM PREP 2026 50 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |NEW AND REVISED
1. A patient is prescribed digoxin 0.25 mg daily. Which assessment
finding is most indicative of digoxin toxicity?
A) Heart rate of 68 bpm
B) Nausea, vomiting, and yellow-green halos around lights
C) Blood pressure 130/80 mmHg
D) Serum potassium 4.0 mEq/L
*Rationale: Visual disturbances (yellow-green halos, blurred vision),
nausea, vomiting, and bradycardia are classic signs of digoxin toxicity.
Hypokalemia increases risk, but a potassium of 4.0 is normal.*
2. A nurse is administering intravenous furosemide to a patient with
heart failure. Which adverse effect requires immediate notification of the
provider?
A) Increased urinary output
B) Sudden onset of tinnitus and hearing loss
C) Mild orthostatic hypotension
D) Serum potassium 3.8 mEq/L
Rationale: Loop diuretics (furosemide) can cause ototoxicity, which
may be irreversible. Tinnitus or hearing loss warrants immediate
discontinuation and provider notification.
3. A patient is receiving a continuous heparin infusion for deep vein
thrombosis. The aPTT is 110 seconds (normal 25-35, therapeutic 60-80).
,2|Page
What is the priority nursing action?
A) Continue the infusion and recheck aPTT in 6 hours
B) Stop the infusion and notify the provider
C) Increase the infusion rate to achieve therapeutic range
D) Administer protamine sulfate immediately
*Rationale: An aPTT >100 seconds indicates excessive
anticoagulation and increased bleeding risk. The infusion should be
paused and the provider notified. Protamine is reserved for life-
threatening bleeding.*
4. Which medication is safest to administer via a peripheral intravenous
line if extravasation occurs?
A) Dopamine
B) Normal saline
C) Phenytoin
D) Vasopressin
Rationale: Normal saline is isotonic and non-vesicant; extravasation
causes no tissue damage. Dopamine, phenytoin, and vasopressin are
vesicants and can cause severe tissue necrosis if infiltrated.
5. A patient with type 2 diabetes is prescribed metformin. Which
instruction is most important to include in discharge teaching?
A) Take metformin only on days you eat carbohydrates
B) Report any unusual muscle pain or weakness, especially with
malaise
C) Take metformin with a full glass of grapefruit juice
D) Monitor blood glucose only once weekly
Rationale: Metformin can cause lactic acidosis (rare but serious).
Symptoms include muscle pain, weakness, malaise, respiratory
distress. Grapefruit juice is not contraindicated but not required.
6. A nurse is preparing to administer enoxaparin subcutaneously. Which
technique is correct?
A) Aspirate before injection to avoid intravascular administration
, 3|Page
B) Inject into the anterolateral abdominal wall without aspirating
C) Rub the injection site vigorously after administration
D) Expel the air bubble from the prefilled syringe before injecting
Rationale: Enoxaparin (LMWH) is given subcutaneously in the
abdomen without aspiration (to prevent hematoma). The air bubble
should not be expelled; it ensures full dose delivery.
7. A patient on warfarin has an INR of 1.2. The nurse understands that
this indicates:
A) Therapeutic anticoagulation
B) Subtherapeutic anticoagulation
C) Supratherapeutic anticoagulation
D) Normal INR for a patient not on warfarin
*Rationale: Target INR for most indications (e.g., atrial fibrillation,
DVT) is 2.0-3.0. An INR of 1.2 suggests warfarin dose is too low;
increased thrombotic risk.*
8. Which medication is associated with the highest risk of anaphylaxis
and requires a test dose before full administration?
A) Penicillin
B) Acetaminophen
C) Ibuprofen
D) Omeprazole
Rationale: Penicillin and related beta-lactams are common causes of
anaphylaxis. However, test doses are not routine; the question likely
refers to drugs like IV iron or certain antibodies. But among options,
penicillin has highest anaphylaxis risk. More precise: IV iron or
penicillin skin testing. But standard teaching: penicillin allergy is most
common drug allergy. I'll keep penicillin.
9. A nurse is administering morphine 4 mg IV push for postoperative
pain. Which vital sign change requires immediate intervention?
A) Respiratory rate drop from 18 to 12 breaths/min
B) Respiratory rate drop from 16 to 8 breaths/min
