BSN3A Pharmacology and Medication Administration
Exam Review with Questions, Answers and Rationales
2026/2027 Update
Section 1: Fundamental Principles of Pharmacology & Medication Safety
Question 1
A nurse is preparing to administer medications to a client. Which of the following represents the
correct application of the "rights" of medication administration to ensure client safety?
A. Checking the client's identification band against the medication administration record
using two unique identifiers immediately prior to administration.
B. Relying solely on the client's room and bed number when administering scheduled
morning medications in a shared hospital room.
C. Documenting medication administration in the electronic health record prior to actually
opening and giving the medication to save time.
D. Administering a medication prepared by another nurse on the unit without verifying the
original provider order.
Correct Answer: A. Checking the client's identification band against the medication
administration record using two unique identifiers immediately prior to administration.
Rationale: Standard medication safety protocols dictate using at least two unique client
identifiers (such as name and date of birth) checked against the medication administration record
immediately before administration. Pre-documentation, relying on room numbers, or
administering medications prepared by others violate core safety standards and increase the risk
of medication errors.
Question 2
A nurse receives an order to administer a medication via the sublingual route. Which instruction
should the nurse provide to the client to ensure proper absorption?
A. "Place the tablet under your tongue and allow it to dissolve completely without chewing,
swallowing, or drinking anything immediately."
B. "Swallow the pill whole with a full glass of warm water immediately after placing it in
your mouth."
, C. "Place the medication between your cheek and gum and hold it there until it completely
dissolves."
D. "Crush the tablet into a fine powder and mix it thoroughly with three ounces of
applesauce."
Correct Answer: A. "Place the tablet under your tongue and allow it to dissolve completely
without chewing, swallowing, or drinking anything immediately."
Rationale: Sublingual medications are designed to dissolve rapidly under the tongue, where they
are absorbed directly into the highly vascular mucous membranes, bypassing first-pass hepatic
metabolism. Chewing, swallowing, or drinking fluids prematurely alters absorption efficacy.
Question 3
A nurse is calculating a pediatric liquid medication dosage based on body weight. The safe
dosage range is specified as ten to fifteen milligrams per kilogram per day divided into three
equal doses. The child weighs twenty kilograms. What is the maximum safe single dose for this
child?
A. One hundred milligrams
B. Three hundred milligrams
C. Three hundred pharmacokinetic milligrams
D. Fifty milligrams
Correct Answer: A. One hundred milligrams
Rationale: To calculate the maximum safe single dose, first determine the maximum daily dose:
fifteen milligrams multiplied by twenty kilograms equals three hundred milligrams per day.
Since the dose is divided into three equal doses, divide three hundred milligrams by three,
yielding one hundred milligrams per single dose.
Question 4
A nurse is reviewing a prescription for an adult client that reads "digoxin zero point two five
milligrams PO daily." Which component of the medication order is missing or requires
clarification from the prescribing provider?
A. The frequency is clear, but the route and dose are missing.
B. The order is complete as written, containing drug name, dose, route, and frequency.
C. The medication strength and dosage form are missing.
, D. The clinical indication and diagnosis code are missing.
Correct Answer: B. The order is complete as written, containing drug name, dose, route,
and frequency.
Rationale: A complete medication order must include the client's name, date and time of the
order, drug name, dosage, route of administration, frequency, and signature of the prescriber.
This order specifies the drug (digoxin), dose (zero point two five milligrams), route (PO), and
frequency (daily), making it complete.
Question 5
A nurse is teaching an older adult client about age-related pharmacokinetic changes. Which
physiological alteration commonly affects drug distribution and metabolism in older adults?
A. Decreased total body water, decreased serum albumin levels, and decreased hepatic blood
flow
B. Increased renal glomerular filtration rate and increased plasma protein binding capacity
C. Accelerated gastrointestinal motility and increased first-pass elimination
D. Heightened central nervous system receptor sensitivity paired with rapid drug excretion
Correct Answer: A. Decreased total body water, decreased serum albumin levels, and
decreased hepatic blood flow
Rationale: Aging is associated with physiological changes including decreased total body water,
reduced lean muscle mass, lower serum albumin (affecting protein-bound drug availability), and
diminished hepatic and renal clearance. These changes frequently prolong drug half-lives and
increase the risk of toxicity.
Section 2: Autonomic Nervous System & Cardiovascular Pharmacology
Question 6
A nurse is caring for a client with hypertension who is prescribed metoprolol, a selective beta-
one adrenergic blocker. Which assessment finding should prompt the nurse to hold the
medication and notify the prescribing provider?
A. Heart rate of fifty-two beats per minute and blood pressure of ninety-eight over sixty
millimeters of mercury
B. Respiratory rate of sixteen breaths per minute and clear bilateral breath sounds
C. Serum potassium level of four point two milliequivalents per liter
, D. Blood glucose level of ninety-five milligrams per deciliter
Correct Answer: A. Heart rate of fifty-two beats per minute and blood pressure of ninety-
eight over sixty millimeters of mercury
Rationale: Beta-1 blockers decrease heart rate and myocardial contractility. If the client's heart
rate drops below sixty beats per minute or systolic blood pressure drops below one hundred
millimeters of mercury, the nurse must hold the dose and notify the provider to prevent severe
bradycardia and hypotension.
Question 7
A client is prescribed lisinopril, an angiotensin-converting enzyme inhibitor, for management of
heart failure. Which adverse effect should the nurse monitor for that is uniquely characteristic of
angiotensin-converting enzyme inhibitors?
A. Persistent, dry, hacking cough caused by accumulation of bradykinin in the lungs
B. Severe hypokalemia and muscle weakness
C. Peripheral pitting edema of the lower extremities
D. Permanent discoloration and hyperpigmentation of the skin
Correct Answer: A. Persistent, dry, hacking cough caused by accumulation of bradykinin
in the lungs
Rationale: Angiotensin-converting enzyme inhibitors frequently cause a dry, persistent cough
due to the inhibition of kininase II, which leads to a buildup of bradykinin in the respiratory tract.
This adverse effect is harmless but often requires switching to an angiotensin receptor blocker.
Question 8
A nurse is administering intravenous nitroglycerin to a client experiencing an acute myocardial
infarction. Which mechanism of action explains how nitroglycerin relieves ischemic chest pain?
A. It relaxes vascular smooth muscle, causing venous dilation that decreases preload and
myocardial oxygen demand.
B. It directly increases systemic arterial blood pressure to enhance coronary perfusion.
C. It blocks calcium channels in cardiac pacemaker cells to slow the heart rate.
D. It dissolves existing coronary thrombi by activating plasminogen.
Exam Review with Questions, Answers and Rationales
2026/2027 Update
Section 1: Fundamental Principles of Pharmacology & Medication Safety
Question 1
A nurse is preparing to administer medications to a client. Which of the following represents the
correct application of the "rights" of medication administration to ensure client safety?
A. Checking the client's identification band against the medication administration record
using two unique identifiers immediately prior to administration.
B. Relying solely on the client's room and bed number when administering scheduled
morning medications in a shared hospital room.
C. Documenting medication administration in the electronic health record prior to actually
opening and giving the medication to save time.
D. Administering a medication prepared by another nurse on the unit without verifying the
original provider order.
Correct Answer: A. Checking the client's identification band against the medication
administration record using two unique identifiers immediately prior to administration.
Rationale: Standard medication safety protocols dictate using at least two unique client
identifiers (such as name and date of birth) checked against the medication administration record
immediately before administration. Pre-documentation, relying on room numbers, or
administering medications prepared by others violate core safety standards and increase the risk
of medication errors.
Question 2
A nurse receives an order to administer a medication via the sublingual route. Which instruction
should the nurse provide to the client to ensure proper absorption?
A. "Place the tablet under your tongue and allow it to dissolve completely without chewing,
swallowing, or drinking anything immediately."
B. "Swallow the pill whole with a full glass of warm water immediately after placing it in
your mouth."
, C. "Place the medication between your cheek and gum and hold it there until it completely
dissolves."
D. "Crush the tablet into a fine powder and mix it thoroughly with three ounces of
applesauce."
Correct Answer: A. "Place the tablet under your tongue and allow it to dissolve completely
without chewing, swallowing, or drinking anything immediately."
Rationale: Sublingual medications are designed to dissolve rapidly under the tongue, where they
are absorbed directly into the highly vascular mucous membranes, bypassing first-pass hepatic
metabolism. Chewing, swallowing, or drinking fluids prematurely alters absorption efficacy.
Question 3
A nurse is calculating a pediatric liquid medication dosage based on body weight. The safe
dosage range is specified as ten to fifteen milligrams per kilogram per day divided into three
equal doses. The child weighs twenty kilograms. What is the maximum safe single dose for this
child?
A. One hundred milligrams
B. Three hundred milligrams
C. Three hundred pharmacokinetic milligrams
D. Fifty milligrams
Correct Answer: A. One hundred milligrams
Rationale: To calculate the maximum safe single dose, first determine the maximum daily dose:
fifteen milligrams multiplied by twenty kilograms equals three hundred milligrams per day.
Since the dose is divided into three equal doses, divide three hundred milligrams by three,
yielding one hundred milligrams per single dose.
Question 4
A nurse is reviewing a prescription for an adult client that reads "digoxin zero point two five
milligrams PO daily." Which component of the medication order is missing or requires
clarification from the prescribing provider?
A. The frequency is clear, but the route and dose are missing.
B. The order is complete as written, containing drug name, dose, route, and frequency.
C. The medication strength and dosage form are missing.
, D. The clinical indication and diagnosis code are missing.
Correct Answer: B. The order is complete as written, containing drug name, dose, route,
and frequency.
Rationale: A complete medication order must include the client's name, date and time of the
order, drug name, dosage, route of administration, frequency, and signature of the prescriber.
This order specifies the drug (digoxin), dose (zero point two five milligrams), route (PO), and
frequency (daily), making it complete.
Question 5
A nurse is teaching an older adult client about age-related pharmacokinetic changes. Which
physiological alteration commonly affects drug distribution and metabolism in older adults?
A. Decreased total body water, decreased serum albumin levels, and decreased hepatic blood
flow
B. Increased renal glomerular filtration rate and increased plasma protein binding capacity
C. Accelerated gastrointestinal motility and increased first-pass elimination
D. Heightened central nervous system receptor sensitivity paired with rapid drug excretion
Correct Answer: A. Decreased total body water, decreased serum albumin levels, and
decreased hepatic blood flow
Rationale: Aging is associated with physiological changes including decreased total body water,
reduced lean muscle mass, lower serum albumin (affecting protein-bound drug availability), and
diminished hepatic and renal clearance. These changes frequently prolong drug half-lives and
increase the risk of toxicity.
Section 2: Autonomic Nervous System & Cardiovascular Pharmacology
Question 6
A nurse is caring for a client with hypertension who is prescribed metoprolol, a selective beta-
one adrenergic blocker. Which assessment finding should prompt the nurse to hold the
medication and notify the prescribing provider?
A. Heart rate of fifty-two beats per minute and blood pressure of ninety-eight over sixty
millimeters of mercury
B. Respiratory rate of sixteen breaths per minute and clear bilateral breath sounds
C. Serum potassium level of four point two milliequivalents per liter
, D. Blood glucose level of ninety-five milligrams per deciliter
Correct Answer: A. Heart rate of fifty-two beats per minute and blood pressure of ninety-
eight over sixty millimeters of mercury
Rationale: Beta-1 blockers decrease heart rate and myocardial contractility. If the client's heart
rate drops below sixty beats per minute or systolic blood pressure drops below one hundred
millimeters of mercury, the nurse must hold the dose and notify the provider to prevent severe
bradycardia and hypotension.
Question 7
A client is prescribed lisinopril, an angiotensin-converting enzyme inhibitor, for management of
heart failure. Which adverse effect should the nurse monitor for that is uniquely characteristic of
angiotensin-converting enzyme inhibitors?
A. Persistent, dry, hacking cough caused by accumulation of bradykinin in the lungs
B. Severe hypokalemia and muscle weakness
C. Peripheral pitting edema of the lower extremities
D. Permanent discoloration and hyperpigmentation of the skin
Correct Answer: A. Persistent, dry, hacking cough caused by accumulation of bradykinin
in the lungs
Rationale: Angiotensin-converting enzyme inhibitors frequently cause a dry, persistent cough
due to the inhibition of kininase II, which leads to a buildup of bradykinin in the respiratory tract.
This adverse effect is harmless but often requires switching to an angiotensin receptor blocker.
Question 8
A nurse is administering intravenous nitroglycerin to a client experiencing an acute myocardial
infarction. Which mechanism of action explains how nitroglycerin relieves ischemic chest pain?
A. It relaxes vascular smooth muscle, causing venous dilation that decreases preload and
myocardial oxygen demand.
B. It directly increases systemic arterial blood pressure to enhance coronary perfusion.
C. It blocks calcium channels in cardiac pacemaker cells to slow the heart rate.
D. It dissolves existing coronary thrombi by activating plasminogen.
