NSG 124 PHARMACOLOGY EXAM 2026 300 ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS GRADED A+ LATEST
(NEW!!) WITH RATIONALES ASSURED PASS
This document contains 300 high-standard, multiple-choice questions
designed for NSG 124 Pharmacology exam preparation. Each question
presents a clinical scenario requiring application of pharmacotherapeutic
principles, including medication indications, adverse effects, drug
interactions, nursing interventions, and patient teaching. Every question is
followed by a single correct answer letter and a detailed rationale explaining
the underlying pharmacology, mechanism of action, and clinical reasoning.
The rationales distinguish correct answers from distractors, reinforcing
critical thinking for safe medication administration. Topics cover major drug
categories including cardiovascular, neurological, endocrine, antimicrobial,
psychiatric, and critical care medications, with emphasis on high-alert drugs,
adverse effect monitoring, and evidence-based practice.
1. A 72-year-old patient with a history of heart failure is prescribed metoprolol
succinate for hypertension. Which assessment finding would most warrant a hold
in medication administration and notification of the provider?
A) Blood pressure of 128/74 mmHg
B) Apical heart rate of 54 beats per minute with a first-degree AV block on ECG
C) Respiratory rate of 18 breaths per minute
D) Mild ankle edema noted after walking
Answer: B
Rationale: Metoprolol, a beta-1 selective blocker, decreases heart rate and AV
nodal conduction. A rate of 54 with first-degree AV block indicates excessive beta
blockade, risking further bradycardia or heart block. While metoprolol is used in
heart failure, symptomatic bradycardia or significant conduction delay takes
priority for holding the dose.
2. A nurse administers intravenous furosemide to a patient with pulmonary edema.
Which outcome indicates the medication is having the desired therapeutic effect?
,A) Decreased jugular venous distention and clear lung sounds
B) Increased urine output with dark concentrated urine
C) Blood pressure decrease from 160/90 to 140/85 mmHg
D) Serum potassium level increase from 3.8 to 4.2 mEq/L
Answer: A
Rationale: Furosemide promotes diuresis, reducing preload and relieving
pulmonary congestion. Clear lung sounds and decreased JVD directly reflect
reduced fluid overload. Urine output may increase but should not be
dark/concentrated if hydration is adequate. BP reduction is secondary; electrolyte
changes require monitoring but are not the primary goal in acute pulmonary
edema.
3. A patient receiving a continuous heparin infusion for deep vein thrombosis has
an aPTT of 92 seconds. The therapeutic goal for this patient is 60-80 seconds.
What is the most appropriate nursing action?
A) Increase the heparin infusion rate by 2 units/kg/hour
B) Administer protamine sulfate as ordered
C) Decrease the heparin infusion rate as per protocol
D) Draw a repeat aPTT immediately without changing the rate
Answer: C
Rationale: An aPTT above therapeutic range increases bleeding risk. The nurse
should decrease the infusion rate according to the institution's heparin protocol to
bring the aPTT back into the therapeutic window. Increasing the rate would worsen
the issue. Protamine is for reversal of active bleeding or extreme elevations.
Repeating without intervention delays correction.
4. A patient with type 2 diabetes mellitus is started on metformin. Which
laboratory value requires the most immediate concern and possible discontinuation
of the medication?
A) Hemoglobin A1c of 7.2%
B) Serum creatinine of 1.9 mg/dL in a 68-year-old male
C) Fasting blood glucose of 118 mg/dL
D) ALT of 45 units/L
Answer: B
Rationale: Metformin is renally excreted; a creatinine of 1.9 mg/dL in an older
adult indicates reduced kidney function (eGFR typically below 45). This increases
the risk of lactic acidosis, a rare but life-threatening complication. Metformin
should be held or dose-adjusted. An A1c of 7.2% and glucose of 118 are near
target. ALT of 45 is mild elevation but not as urgent as renal impairment.
,5. A patient is prescribed warfarin after mechanical heart valve replacement. The
patient asks why aspirin is not being used instead. What is the nurse's best
response?
A) "Aspirin only works for preventing clots in arteries, not in mechanical heart
valves."
B) "Warfarin is cheaper and easier to monitor than aspirin for valve patients."
C) "Mechanical valves require stronger anticoagulation than aspirin can provide to
prevent clot formation."
D) "Aspirin would interact with your other heart medications, so warfarin is safer."
Answer: C
Rationale: Mechanical heart valves are highly thrombogenic and require intense
anticoagulation with a vitamin K antagonist like warfarin to achieve an INR of 2.5-
3.5. Aspirin alone provides insufficient platelet inhibition for this purpose. Option
A is partially true but oversimplified; the core answer is warfarin's superior
efficacy in this context.
6. A patient receiving morphine sulfate via patient-controlled analgesia reports
pruritus without rash or respiratory depression. Which intervention should the
nurse implement first?
A) Administer naloxone immediately
B) Reduce the basal rate of the PCA pump
C) Assess the patient's pain level and consider a low-dose antihistamine
D) Discontinue the morphine and notify the provider for a change to
hydromorphone
Answer: C
Rationale: Pruritus is a common opioid side effect mediated by histamine release.
In the absence of respiratory depression or severe allergy, the nurse should assess
pain (to ensure adequate analgesia) and then administer an antihistamine like
diphenhydramine. Naloxone is for life-threatening respiratory depression, not
isolated pruritus. Reducing the rate may compromise pain control.
7. A patient with asthma is prescribed albuterol via metered-dose inhaler two puffs
every 4-6 hours as needed. Which statement by the patient indicates a need for
further teaching?
A) "I will rinse my mouth after each use to prevent thrush."
B) "I should feel my heart race a little when I take this medication."
C) "If I need this more than twice a week for wheezing, I will call my doctor."
D) "This medication opens my airways by relaxing the muscles around them."
Answer: A
, Rationale: Albuterol is a beta-2 agonist that does not cause oral thrush. Rinsing the
mouth is important for inhaled corticosteroids to prevent candidiasis. Tachycardia
is a common side effect of albuterol. Using rescue inhaler more than twice weekly
indicates poor asthma control. The mechanism described (bronchodilation) is
correct.
8. A patient is started on lisinopril for hypertension. One week later, the patient
reports a persistent dry cough that is worse at night. What is the nurse's priority
action?
A) Instruct the patient to take the medication with food
B) Advise the patient to use an over-the-counter dextromethorphan suppressant
C) Document the finding and notify the provider for possible medication change
D) Tell the patient the cough will resolve within 2-4 weeks as tolerance develops
Answer: C
Rationale: Lisinopril (an ACE inhibitor) commonly causes a dry, non-productive
cough due to accumulation of bradykinin. This side effect does not typically
resolve with continued use and often requires switching to an angiotensin II
receptor blocker (ARB). Antitussives are not effective. Taking with food affects GI
absorption but not cough.
9. A patient with pneumonia is receiving intravenous ceftriaxone. Twenty minutes
into the infusion, the patient reports itching and shortness of breath. Vital signs
show BP 88/52, HR 120, and O2 saturation 89%. What is the nurse's immediate
priority?
A) Slow the infusion rate to 10 mL/hour
B) Administer diphenhydramine 50 mg IV push
C) Stop the infusion, call a rapid response, and prepare epinephrine
D) Flush the IV line with normal saline to clear any residual medication
Answer: C
Rationale: The presentation (itching, dyspnea, hypotension, tachycardia,
hypoxemia) indicates anaphylaxis to ceftriaxone. The immediate priority is to stop
the offending agent, activate emergency response, and prepare epinephrine (first-
line for anaphylaxis). Antihistamines are secondary. Slowing or flushing does not
address life-threatening bronchospasm and hypotension.
10. A patient on digoxin for heart failure presents with nausea, vomiting, and
yellow-tinged vision. Which laboratory value is most critical to obtain
immediately?
A) Serum digoxin level
B) Complete blood count
QUESTIONS AND CORRECT ANSWERS GRADED A+ LATEST
(NEW!!) WITH RATIONALES ASSURED PASS
This document contains 300 high-standard, multiple-choice questions
designed for NSG 124 Pharmacology exam preparation. Each question
presents a clinical scenario requiring application of pharmacotherapeutic
principles, including medication indications, adverse effects, drug
interactions, nursing interventions, and patient teaching. Every question is
followed by a single correct answer letter and a detailed rationale explaining
the underlying pharmacology, mechanism of action, and clinical reasoning.
The rationales distinguish correct answers from distractors, reinforcing
critical thinking for safe medication administration. Topics cover major drug
categories including cardiovascular, neurological, endocrine, antimicrobial,
psychiatric, and critical care medications, with emphasis on high-alert drugs,
adverse effect monitoring, and evidence-based practice.
1. A 72-year-old patient with a history of heart failure is prescribed metoprolol
succinate for hypertension. Which assessment finding would most warrant a hold
in medication administration and notification of the provider?
A) Blood pressure of 128/74 mmHg
B) Apical heart rate of 54 beats per minute with a first-degree AV block on ECG
C) Respiratory rate of 18 breaths per minute
D) Mild ankle edema noted after walking
Answer: B
Rationale: Metoprolol, a beta-1 selective blocker, decreases heart rate and AV
nodal conduction. A rate of 54 with first-degree AV block indicates excessive beta
blockade, risking further bradycardia or heart block. While metoprolol is used in
heart failure, symptomatic bradycardia or significant conduction delay takes
priority for holding the dose.
2. A nurse administers intravenous furosemide to a patient with pulmonary edema.
Which outcome indicates the medication is having the desired therapeutic effect?
,A) Decreased jugular venous distention and clear lung sounds
B) Increased urine output with dark concentrated urine
C) Blood pressure decrease from 160/90 to 140/85 mmHg
D) Serum potassium level increase from 3.8 to 4.2 mEq/L
Answer: A
Rationale: Furosemide promotes diuresis, reducing preload and relieving
pulmonary congestion. Clear lung sounds and decreased JVD directly reflect
reduced fluid overload. Urine output may increase but should not be
dark/concentrated if hydration is adequate. BP reduction is secondary; electrolyte
changes require monitoring but are not the primary goal in acute pulmonary
edema.
3. A patient receiving a continuous heparin infusion for deep vein thrombosis has
an aPTT of 92 seconds. The therapeutic goal for this patient is 60-80 seconds.
What is the most appropriate nursing action?
A) Increase the heparin infusion rate by 2 units/kg/hour
B) Administer protamine sulfate as ordered
C) Decrease the heparin infusion rate as per protocol
D) Draw a repeat aPTT immediately without changing the rate
Answer: C
Rationale: An aPTT above therapeutic range increases bleeding risk. The nurse
should decrease the infusion rate according to the institution's heparin protocol to
bring the aPTT back into the therapeutic window. Increasing the rate would worsen
the issue. Protamine is for reversal of active bleeding or extreme elevations.
Repeating without intervention delays correction.
4. A patient with type 2 diabetes mellitus is started on metformin. Which
laboratory value requires the most immediate concern and possible discontinuation
of the medication?
A) Hemoglobin A1c of 7.2%
B) Serum creatinine of 1.9 mg/dL in a 68-year-old male
C) Fasting blood glucose of 118 mg/dL
D) ALT of 45 units/L
Answer: B
Rationale: Metformin is renally excreted; a creatinine of 1.9 mg/dL in an older
adult indicates reduced kidney function (eGFR typically below 45). This increases
the risk of lactic acidosis, a rare but life-threatening complication. Metformin
should be held or dose-adjusted. An A1c of 7.2% and glucose of 118 are near
target. ALT of 45 is mild elevation but not as urgent as renal impairment.
,5. A patient is prescribed warfarin after mechanical heart valve replacement. The
patient asks why aspirin is not being used instead. What is the nurse's best
response?
A) "Aspirin only works for preventing clots in arteries, not in mechanical heart
valves."
B) "Warfarin is cheaper and easier to monitor than aspirin for valve patients."
C) "Mechanical valves require stronger anticoagulation than aspirin can provide to
prevent clot formation."
D) "Aspirin would interact with your other heart medications, so warfarin is safer."
Answer: C
Rationale: Mechanical heart valves are highly thrombogenic and require intense
anticoagulation with a vitamin K antagonist like warfarin to achieve an INR of 2.5-
3.5. Aspirin alone provides insufficient platelet inhibition for this purpose. Option
A is partially true but oversimplified; the core answer is warfarin's superior
efficacy in this context.
6. A patient receiving morphine sulfate via patient-controlled analgesia reports
pruritus without rash or respiratory depression. Which intervention should the
nurse implement first?
A) Administer naloxone immediately
B) Reduce the basal rate of the PCA pump
C) Assess the patient's pain level and consider a low-dose antihistamine
D) Discontinue the morphine and notify the provider for a change to
hydromorphone
Answer: C
Rationale: Pruritus is a common opioid side effect mediated by histamine release.
In the absence of respiratory depression or severe allergy, the nurse should assess
pain (to ensure adequate analgesia) and then administer an antihistamine like
diphenhydramine. Naloxone is for life-threatening respiratory depression, not
isolated pruritus. Reducing the rate may compromise pain control.
7. A patient with asthma is prescribed albuterol via metered-dose inhaler two puffs
every 4-6 hours as needed. Which statement by the patient indicates a need for
further teaching?
A) "I will rinse my mouth after each use to prevent thrush."
B) "I should feel my heart race a little when I take this medication."
C) "If I need this more than twice a week for wheezing, I will call my doctor."
D) "This medication opens my airways by relaxing the muscles around them."
Answer: A
, Rationale: Albuterol is a beta-2 agonist that does not cause oral thrush. Rinsing the
mouth is important for inhaled corticosteroids to prevent candidiasis. Tachycardia
is a common side effect of albuterol. Using rescue inhaler more than twice weekly
indicates poor asthma control. The mechanism described (bronchodilation) is
correct.
8. A patient is started on lisinopril for hypertension. One week later, the patient
reports a persistent dry cough that is worse at night. What is the nurse's priority
action?
A) Instruct the patient to take the medication with food
B) Advise the patient to use an over-the-counter dextromethorphan suppressant
C) Document the finding and notify the provider for possible medication change
D) Tell the patient the cough will resolve within 2-4 weeks as tolerance develops
Answer: C
Rationale: Lisinopril (an ACE inhibitor) commonly causes a dry, non-productive
cough due to accumulation of bradykinin. This side effect does not typically
resolve with continued use and often requires switching to an angiotensin II
receptor blocker (ARB). Antitussives are not effective. Taking with food affects GI
absorption but not cough.
9. A patient with pneumonia is receiving intravenous ceftriaxone. Twenty minutes
into the infusion, the patient reports itching and shortness of breath. Vital signs
show BP 88/52, HR 120, and O2 saturation 89%. What is the nurse's immediate
priority?
A) Slow the infusion rate to 10 mL/hour
B) Administer diphenhydramine 50 mg IV push
C) Stop the infusion, call a rapid response, and prepare epinephrine
D) Flush the IV line with normal saline to clear any residual medication
Answer: C
Rationale: The presentation (itching, dyspnea, hypotension, tachycardia,
hypoxemia) indicates anaphylaxis to ceftriaxone. The immediate priority is to stop
the offending agent, activate emergency response, and prepare epinephrine (first-
line for anaphylaxis). Antihistamines are secondary. Slowing or flushing does not
address life-threatening bronchospasm and hypotension.
10. A patient on digoxin for heart failure presents with nausea, vomiting, and
yellow-tinged vision. Which laboratory value is most critical to obtain
immediately?
A) Serum digoxin level
B) Complete blood count
