Page 1 of 84
RN PHARMACOLOGY A RELIAS EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
RN PHARMACOLOGY A RELIAS EXAMINATION
250 Questions with Rationales
SECTION 1: CARDIOVASCULAR & ANTICOAGULANT PHARMACOLOGY (Questions 1-
50)
Question 1
A patient has been prescribed warfarin (Coumadin) following a deep vein
thrombosis. Which statement made by the patient indicates a need for further
education regarding safe medication management?
A) "I will avoid eating large amounts of green leafy vegetables while on this medication"
B) "If I get a headache, aspirin is my best option for pain relief"
C) "I need to have my blood drawn regularly to check my INR levels"
D) "I should wear a medical alert bracelet indicating I take this medication"
Rationale: The correct answer is B. Aspirin increases bleeding risk in patients taking
warfarin and should be avoided without provider consultation . Warfarin therapy
requires monitoring of INR, avoidance of foods high in vitamin K (green leafy
vegetables), and wearing a medical alert bracelet. The incorrect statement indicates a
dangerous misunderstanding about pain management that could lead to increased
bleeding risk.
Question 2
A patient is noted to have a documented penicillin allergy. Which medication would
the nurse question if ordered by the physician for this patient?
A) Vancomycin
B) Azithromycin
, Page 2 of 84
C) Ceftriaxone
D) Clindamycin
Rationale: The correct answer is C. Ceftriaxone is a cephalosporin that may have cross-
reactivity with penicillin and could provoke an allergic reaction in penicillin-allergic
patients . While the cross-reactivity rate is approximately 5-10%, it is a significant
concern. Vancomycin, azithromycin, and clindamycin are not beta-lactam antibiotics
and do not share cross-reactivity with penicillin.
Question 3
A patient with congestive heart failure has a potassium level of 5.8 mEq/L. Which
diuretic does the nurse anticipate being ordered by the provider?
A) Furosemide (Lasix)
B) Spironolactone (Aldactone)
C) Hydrochlorothiazide (HCTZ)
D) Amiloride
Rationale: The correct answer is A. Furosemide is a loop diuretic effective at reducing
fluid overload and will help lower potassium levels by promoting potassium excretion .
Potassium-sparing diuretics (spironolactone, amiloride) are contraindicated in
hyperkalemia as they would worsen the elevated potassium level. Hydrochlorothiazide
causes less potassium loss than loop diuretics and would not be sufficient for treating
CHF with hyperkalemia.
Question 4
A patient has been diagnosed with chronic CHF and will be taking furosemide
(Lasix) 80 mg PO twice daily. When teaching about high-potassium foods in the
diet, which group of foods would the nurse recommend for this patient?
A) Bananas and oranges
B) Tofu, red meat, and beans
C) Apples and grapes
D) Potatoes and spinach
Rationale: The correct answer is C. Furosemide is a loop diuretic that causes
potassium loss, so patients should consume potassium-rich foods such as bananas,
oranges, potatoes, and spinach . Apples and grapes are lower in potassium. The
question in the exam source indicated that tofu, red meat, and beans were NOT the
correct recommendation, suggesting foods like bananas would be appropriate .
, Page 3 of 84
Question 5
A patient with a known GI bleed is receiving medications. Which drug is
contraindicated and should be questioned by the nurse?
A) Metoprolol
B) Enoxaparin (Lovenox)
C) Pantoprazole
D) Ondansetron
Rationale: The correct answer is B. Enoxaparin (Lovenox) is an anticoagulant that can
worsen bleeding in patients with known GI bleeds . Alternative therapies would need to
be considered. Metoprolol, pantoprazole, and ondansetron do not increase bleeding
risk and are not contraindicated in GI bleeding.
Question 6
A patient receiving IV vancomycin for the fourth dose develops facial and neck
erythema and generalized itching. What does the nurse suspect caused this
adverse reaction?
A) Anaphylactic reaction to vancomycin
B) Red man syndrome due to rapid infusion rate
C) Stevens-Johnson syndrome
D) Serum sickness from antibiotic therapy
Rationale: The correct answer is B. Red man syndrome is a histamine-release reaction
characterized by flushing, erythema, and pruritus that occurs when vancomycin is
infused too rapidly . The patient's fourth dose with a 30-minute infusion time is
consistent with this complication. Anaphylaxis would involve respiratory distress,
Stevens-Johnson syndrome involves skin sloughing, and serum sickness involves fever
and joint pain.
Question 7
Which medication would the nurse question if prescribed for a patient taking
sildenafil (Viagra) for erectile dysfunction?
A) Metoprolol
B) Nitroglycerin
C) Lisinopril
D) Furosemide
Rationale: The correct answer is B. Nitroglycerin and sildenafil are both vasodilators
that can cause severe hypotension when used together due to synergistic effects . This
, Page 4 of 84
combination is contraindicated. Metoprolol, lisinopril, and furosemide do not have this
dangerous interaction with sildenafil.
Question 8
A patient is receiving a heparin drip at 18 units/kg/hr and weighs 75 kg. The heparin
is supplied in a 500 mL bag with 25,000 units. What is the correct starting rate of the
infusion?
A) 54 mL/hr
B) 27 mL/hr
C) 13.5 mL/hr
D) 40.5 mL/hr
Rationale: The correct answer is B. Calculation: 18 units/kg/hr × 75 kg = 1,350 units/hr.
The concentration is 25,000 units/500 mL = 50 units/mL. 1,350 units/hr ÷ 50 units/mL =
27 mL/hr .
Question 9
The physician orders 1000 mL of normal saline over 6 hours. What is the correct
infusion rate?
A) 125 mL/hr
B) 150 mL/hr
C) 166.7 mL/hr
D) 200 mL/hr
Rationale: The correct answer is C. 1000 mL ÷ 6 hours = 166.67 mL/hr . This is a
standard intravenous fluid rate calculation. The rate should be rounded to the nearest
whole number for infusion pump programming.
Question 10
A patient has a new order for digoxin. What is the most important assessment the
nurse should perform immediately before administering this medication?
A) Respiratory rate
B) Apical heart rate
C) Blood pressure
D) Serum potassium level
Rationale: The correct answer is B. The apical heart rate should be assessed before
administering digoxin, and the medication should be held if the pulse is below 60
RN PHARMACOLOGY A RELIAS EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
RN PHARMACOLOGY A RELIAS EXAMINATION
250 Questions with Rationales
SECTION 1: CARDIOVASCULAR & ANTICOAGULANT PHARMACOLOGY (Questions 1-
50)
Question 1
A patient has been prescribed warfarin (Coumadin) following a deep vein
thrombosis. Which statement made by the patient indicates a need for further
education regarding safe medication management?
A) "I will avoid eating large amounts of green leafy vegetables while on this medication"
B) "If I get a headache, aspirin is my best option for pain relief"
C) "I need to have my blood drawn regularly to check my INR levels"
D) "I should wear a medical alert bracelet indicating I take this medication"
Rationale: The correct answer is B. Aspirin increases bleeding risk in patients taking
warfarin and should be avoided without provider consultation . Warfarin therapy
requires monitoring of INR, avoidance of foods high in vitamin K (green leafy
vegetables), and wearing a medical alert bracelet. The incorrect statement indicates a
dangerous misunderstanding about pain management that could lead to increased
bleeding risk.
Question 2
A patient is noted to have a documented penicillin allergy. Which medication would
the nurse question if ordered by the physician for this patient?
A) Vancomycin
B) Azithromycin
, Page 2 of 84
C) Ceftriaxone
D) Clindamycin
Rationale: The correct answer is C. Ceftriaxone is a cephalosporin that may have cross-
reactivity with penicillin and could provoke an allergic reaction in penicillin-allergic
patients . While the cross-reactivity rate is approximately 5-10%, it is a significant
concern. Vancomycin, azithromycin, and clindamycin are not beta-lactam antibiotics
and do not share cross-reactivity with penicillin.
Question 3
A patient with congestive heart failure has a potassium level of 5.8 mEq/L. Which
diuretic does the nurse anticipate being ordered by the provider?
A) Furosemide (Lasix)
B) Spironolactone (Aldactone)
C) Hydrochlorothiazide (HCTZ)
D) Amiloride
Rationale: The correct answer is A. Furosemide is a loop diuretic effective at reducing
fluid overload and will help lower potassium levels by promoting potassium excretion .
Potassium-sparing diuretics (spironolactone, amiloride) are contraindicated in
hyperkalemia as they would worsen the elevated potassium level. Hydrochlorothiazide
causes less potassium loss than loop diuretics and would not be sufficient for treating
CHF with hyperkalemia.
Question 4
A patient has been diagnosed with chronic CHF and will be taking furosemide
(Lasix) 80 mg PO twice daily. When teaching about high-potassium foods in the
diet, which group of foods would the nurse recommend for this patient?
A) Bananas and oranges
B) Tofu, red meat, and beans
C) Apples and grapes
D) Potatoes and spinach
Rationale: The correct answer is C. Furosemide is a loop diuretic that causes
potassium loss, so patients should consume potassium-rich foods such as bananas,
oranges, potatoes, and spinach . Apples and grapes are lower in potassium. The
question in the exam source indicated that tofu, red meat, and beans were NOT the
correct recommendation, suggesting foods like bananas would be appropriate .
, Page 3 of 84
Question 5
A patient with a known GI bleed is receiving medications. Which drug is
contraindicated and should be questioned by the nurse?
A) Metoprolol
B) Enoxaparin (Lovenox)
C) Pantoprazole
D) Ondansetron
Rationale: The correct answer is B. Enoxaparin (Lovenox) is an anticoagulant that can
worsen bleeding in patients with known GI bleeds . Alternative therapies would need to
be considered. Metoprolol, pantoprazole, and ondansetron do not increase bleeding
risk and are not contraindicated in GI bleeding.
Question 6
A patient receiving IV vancomycin for the fourth dose develops facial and neck
erythema and generalized itching. What does the nurse suspect caused this
adverse reaction?
A) Anaphylactic reaction to vancomycin
B) Red man syndrome due to rapid infusion rate
C) Stevens-Johnson syndrome
D) Serum sickness from antibiotic therapy
Rationale: The correct answer is B. Red man syndrome is a histamine-release reaction
characterized by flushing, erythema, and pruritus that occurs when vancomycin is
infused too rapidly . The patient's fourth dose with a 30-minute infusion time is
consistent with this complication. Anaphylaxis would involve respiratory distress,
Stevens-Johnson syndrome involves skin sloughing, and serum sickness involves fever
and joint pain.
Question 7
Which medication would the nurse question if prescribed for a patient taking
sildenafil (Viagra) for erectile dysfunction?
A) Metoprolol
B) Nitroglycerin
C) Lisinopril
D) Furosemide
Rationale: The correct answer is B. Nitroglycerin and sildenafil are both vasodilators
that can cause severe hypotension when used together due to synergistic effects . This
, Page 4 of 84
combination is contraindicated. Metoprolol, lisinopril, and furosemide do not have this
dangerous interaction with sildenafil.
Question 8
A patient is receiving a heparin drip at 18 units/kg/hr and weighs 75 kg. The heparin
is supplied in a 500 mL bag with 25,000 units. What is the correct starting rate of the
infusion?
A) 54 mL/hr
B) 27 mL/hr
C) 13.5 mL/hr
D) 40.5 mL/hr
Rationale: The correct answer is B. Calculation: 18 units/kg/hr × 75 kg = 1,350 units/hr.
The concentration is 25,000 units/500 mL = 50 units/mL. 1,350 units/hr ÷ 50 units/mL =
27 mL/hr .
Question 9
The physician orders 1000 mL of normal saline over 6 hours. What is the correct
infusion rate?
A) 125 mL/hr
B) 150 mL/hr
C) 166.7 mL/hr
D) 200 mL/hr
Rationale: The correct answer is C. 1000 mL ÷ 6 hours = 166.67 mL/hr . This is a
standard intravenous fluid rate calculation. The rate should be rounded to the nearest
whole number for infusion pump programming.
Question 10
A patient has a new order for digoxin. What is the most important assessment the
nurse should perform immediately before administering this medication?
A) Respiratory rate
B) Apical heart rate
C) Blood pressure
D) Serum potassium level
Rationale: The correct answer is B. The apical heart rate should be assessed before
administering digoxin, and the medication should be held if the pulse is below 60
