NUR 210 PRINCIPLES OF
PHARMACOLOGY 150 NCLEX STYLE
EXAM QUESTIONS WITH BOLD
ANSWERS AND INTEGRATED
RATIONALES
1. A nurse is administering digoxin to a patient with heart
failure and notes that the patient’s apical pulse is 58 beats per
minute. The nurse understands that the pharmacological action
of digoxin involves inhibiting the sodium-potassium ATPase
pump to increase intracellular calcium, thereby increasing
myocardial contractility; however, because bradycardia is a sign
of potential toxicity, the correct answer is to hold the
medication and notify the healthcare provider,
Rationale: Digoxin has a narrow therapeutic index and
can cause severe bradyarrhythmias; administering the drug
when the apical pulse is below 60 bpm in an adult increases
the risk of fatal dysrhythmias and indicates possible
accumulation of the drug.
2. When teaching a patient newly prescribed lisinopril for
hypertension, the nurse explains that this medication belongs
to the angiotensin-converting enzyme (ACE) inhibitor class
which prevents the conversion of angiotensin I to angiotensin
II, leading to vasodilation and decreased aldosterone secretion;
therefore, the correct answer is to instruct the patient to
report any persistent dry cough or swelling of the
lips/tongue immediately, Rationale: ACE inhibitors
prevent the breakdown of bradykinin, which accumulates in
the respiratory tract causing a dry cough in up to 20% of
patients, and while rare, angioedema is a life-threatening
emergency associated with this drug class that requires
immediate discontinuation.
,3. A patient receiving intravenous vancomycin begins to
experience flushing, pruritus, and erythema of the upper body
during the infusion, a reaction known as Red Man Syndrome;
the nurse recognizes that this is not a true IgE-mediated allergy
but rather a rate-related histamine release, so the correct
answer is to stop the infusion temporarily, administer
an antihistamine if ordered, and restart at a slower
rate once symptoms resolve, Rationale: Red Man
Syndrome is caused by rapid infusion of vancomycin leading
to direct mast cell degranulation; slowing the infusion rate to
at least 10 mg/min or over a minimum of 60 minutes prevents
this adverse effect without requiring permanent
discontinuation of the antibiotic.
4. A nurse is caring for a patient taking warfarin who has an
INR of 7.2 and reports bleeding gums and hematuria;
understanding that warfarin acts as a vitamin K antagonist
affecting clotting factors II, VII, IX, and X, the correct
answer is to anticipate the administration of
phytonadione (vitamin K) and hold further warfarin
doses, Rationale: An INR above 4.5 with active bleeding
indicates supratherapeutic anticoagulation; vitamin K is the
specific antidote that restores hepatic synthesis of functional
clotting factors, whereas fresh frozen plasma or prothrombin
complex concentrate would be reserved for life-threatening
hemorrhage.
5. During pharmacology education regarding nitroglycerin
sublingual tablets for angina pectoris, the nurse emphasizes
that this medication causes systemic venous and arterial
dilation to reduce preload and afterload; consequently, the
correct answer is to teach the patient to sit or lie down
before taking the medication and to store tablets in
their original dark glass container away from heat and
moisture, Rationale: Nitroglycerin can cause profound
,orthostatic hypotension and syncope due to rapid
vasodilation; additionally, the drug is volatile and loses
potency when exposed to light, air, or plastic containers,
rendering it ineffective during an acute anginal attack.
6. A patient with type 2 diabetes mellitus is prescribed
metformin and asks the nurse why they must hold the
medication before and after a scheduled CT scan with iodinated
contrast; the nurse knows that metformin is renally excreted
and does not cause hypoglycemia alone, so the correct
answer is to explain that contrast media can cause
acute kidney injury which may lead to metformin
accumulation and lactic acidosis, Rationale:
Metformin-associated lactic acidosis is a rare but fatal
complication that occurs when renal function declines and the
drug accumulates; holding metformin for 48 hours post-
procedure and restarting only after confirming normal renal
function prevents this metabolic emergency.
7. When administering furosemide IV push to a patient with
pulmonary edema, the nurse recalls that this loop diuretic
inhibits the Na+/K+/2Cl- cotransporter in the thick ascending
limb of the loop of Henle; therefore, the correct answer is to
administer the medication slowly over 1 to 2 minutes
and monitor serum potassium levels closely,
Rationale: Rapid IV administration of furosemide can
cause ototoxicity resulting in temporary or permanent
hearing loss due to high peak concentrations in the perilymph;
furthermore, aggressive diuresis leads to significant
potassium wasting which predisposes patients to cardiac
dysrhythmias.
8. A nurse is reviewing the medication list for a patient
prescribed clopidogrel and omeprazole for gastroesophageal
reflux disease and recent stent placement; recognizing that
clopidogrel is a prodrug requiring CYP2C19 activation, the
, correct answer is to consult the prescriber about
switching omeprazole to pantoprazole or famotidine,
Rationale: Omeprazole is a strong CYP2C19 inhibitor that
significantly reduces the bioactivation of clopidogrel,
decreasing its antiplatelet efficacy and increasing the risk of
stent thrombosis; pantoprazole has minimal CYP2C19
inhibition and is considered safer for concomitant use.
9. A patient taking levothyroxine for hypothyroidism asks the
nurse why they must take the medication on an empty stomach
in the morning; the nurse understands that thyroid hormone
replacement mimics endogenous T4, so the correct answer is
to advise taking the medication 30 to 60 minutes
before breakfast and separating it from calcium or
iron supplements by at least 4 hours, Rationale:
Levothyroxine absorption is highly variable and significantly
reduced by food, coffee, calcium, iron, and antacids; consistent
fasting administration ensures stable serum levels and
prevents iatrogenic hypothyroidism despite adequate dosing.
10. While monitoring a patient receiving a continuous heparin
infusion for deep vein thrombosis, the nurse notes that the
aPTT is 120 seconds (control 30 seconds); knowing that
unfractionated heparin potentiates antithrombin III to inhibit
thrombin and factor Xa, the correct answer is to stop the
heparin infusion immediately and prepare to
administer protamine sulfate if bleeding occurs,
Rationale: An aPTT greater than 2.5 times the control
indicates excessive anticoagulation; stopping the infusion
allows the short half-life of heparin to reduce levels, while
protamine sulfate serves as the specific cationic antidote that
binds and neutralizes heparin’s negative charge.
11. A nurse is educating a patient starting allopurinol for
chronic gout management and explains that this drug inhibits
xanthine oxidase to decrease uric acid production; thus, the
PHARMACOLOGY 150 NCLEX STYLE
EXAM QUESTIONS WITH BOLD
ANSWERS AND INTEGRATED
RATIONALES
1. A nurse is administering digoxin to a patient with heart
failure and notes that the patient’s apical pulse is 58 beats per
minute. The nurse understands that the pharmacological action
of digoxin involves inhibiting the sodium-potassium ATPase
pump to increase intracellular calcium, thereby increasing
myocardial contractility; however, because bradycardia is a sign
of potential toxicity, the correct answer is to hold the
medication and notify the healthcare provider,
Rationale: Digoxin has a narrow therapeutic index and
can cause severe bradyarrhythmias; administering the drug
when the apical pulse is below 60 bpm in an adult increases
the risk of fatal dysrhythmias and indicates possible
accumulation of the drug.
2. When teaching a patient newly prescribed lisinopril for
hypertension, the nurse explains that this medication belongs
to the angiotensin-converting enzyme (ACE) inhibitor class
which prevents the conversion of angiotensin I to angiotensin
II, leading to vasodilation and decreased aldosterone secretion;
therefore, the correct answer is to instruct the patient to
report any persistent dry cough or swelling of the
lips/tongue immediately, Rationale: ACE inhibitors
prevent the breakdown of bradykinin, which accumulates in
the respiratory tract causing a dry cough in up to 20% of
patients, and while rare, angioedema is a life-threatening
emergency associated with this drug class that requires
immediate discontinuation.
,3. A patient receiving intravenous vancomycin begins to
experience flushing, pruritus, and erythema of the upper body
during the infusion, a reaction known as Red Man Syndrome;
the nurse recognizes that this is not a true IgE-mediated allergy
but rather a rate-related histamine release, so the correct
answer is to stop the infusion temporarily, administer
an antihistamine if ordered, and restart at a slower
rate once symptoms resolve, Rationale: Red Man
Syndrome is caused by rapid infusion of vancomycin leading
to direct mast cell degranulation; slowing the infusion rate to
at least 10 mg/min or over a minimum of 60 minutes prevents
this adverse effect without requiring permanent
discontinuation of the antibiotic.
4. A nurse is caring for a patient taking warfarin who has an
INR of 7.2 and reports bleeding gums and hematuria;
understanding that warfarin acts as a vitamin K antagonist
affecting clotting factors II, VII, IX, and X, the correct
answer is to anticipate the administration of
phytonadione (vitamin K) and hold further warfarin
doses, Rationale: An INR above 4.5 with active bleeding
indicates supratherapeutic anticoagulation; vitamin K is the
specific antidote that restores hepatic synthesis of functional
clotting factors, whereas fresh frozen plasma or prothrombin
complex concentrate would be reserved for life-threatening
hemorrhage.
5. During pharmacology education regarding nitroglycerin
sublingual tablets for angina pectoris, the nurse emphasizes
that this medication causes systemic venous and arterial
dilation to reduce preload and afterload; consequently, the
correct answer is to teach the patient to sit or lie down
before taking the medication and to store tablets in
their original dark glass container away from heat and
moisture, Rationale: Nitroglycerin can cause profound
,orthostatic hypotension and syncope due to rapid
vasodilation; additionally, the drug is volatile and loses
potency when exposed to light, air, or plastic containers,
rendering it ineffective during an acute anginal attack.
6. A patient with type 2 diabetes mellitus is prescribed
metformin and asks the nurse why they must hold the
medication before and after a scheduled CT scan with iodinated
contrast; the nurse knows that metformin is renally excreted
and does not cause hypoglycemia alone, so the correct
answer is to explain that contrast media can cause
acute kidney injury which may lead to metformin
accumulation and lactic acidosis, Rationale:
Metformin-associated lactic acidosis is a rare but fatal
complication that occurs when renal function declines and the
drug accumulates; holding metformin for 48 hours post-
procedure and restarting only after confirming normal renal
function prevents this metabolic emergency.
7. When administering furosemide IV push to a patient with
pulmonary edema, the nurse recalls that this loop diuretic
inhibits the Na+/K+/2Cl- cotransporter in the thick ascending
limb of the loop of Henle; therefore, the correct answer is to
administer the medication slowly over 1 to 2 minutes
and monitor serum potassium levels closely,
Rationale: Rapid IV administration of furosemide can
cause ototoxicity resulting in temporary or permanent
hearing loss due to high peak concentrations in the perilymph;
furthermore, aggressive diuresis leads to significant
potassium wasting which predisposes patients to cardiac
dysrhythmias.
8. A nurse is reviewing the medication list for a patient
prescribed clopidogrel and omeprazole for gastroesophageal
reflux disease and recent stent placement; recognizing that
clopidogrel is a prodrug requiring CYP2C19 activation, the
, correct answer is to consult the prescriber about
switching omeprazole to pantoprazole or famotidine,
Rationale: Omeprazole is a strong CYP2C19 inhibitor that
significantly reduces the bioactivation of clopidogrel,
decreasing its antiplatelet efficacy and increasing the risk of
stent thrombosis; pantoprazole has minimal CYP2C19
inhibition and is considered safer for concomitant use.
9. A patient taking levothyroxine for hypothyroidism asks the
nurse why they must take the medication on an empty stomach
in the morning; the nurse understands that thyroid hormone
replacement mimics endogenous T4, so the correct answer is
to advise taking the medication 30 to 60 minutes
before breakfast and separating it from calcium or
iron supplements by at least 4 hours, Rationale:
Levothyroxine absorption is highly variable and significantly
reduced by food, coffee, calcium, iron, and antacids; consistent
fasting administration ensures stable serum levels and
prevents iatrogenic hypothyroidism despite adequate dosing.
10. While monitoring a patient receiving a continuous heparin
infusion for deep vein thrombosis, the nurse notes that the
aPTT is 120 seconds (control 30 seconds); knowing that
unfractionated heparin potentiates antithrombin III to inhibit
thrombin and factor Xa, the correct answer is to stop the
heparin infusion immediately and prepare to
administer protamine sulfate if bleeding occurs,
Rationale: An aPTT greater than 2.5 times the control
indicates excessive anticoagulation; stopping the infusion
allows the short half-life of heparin to reduce levels, while
protamine sulfate serves as the specific cationic antidote that
binds and neutralizes heparin’s negative charge.
11. A nurse is educating a patient starting allopurinol for
chronic gout management and explains that this drug inhibits
xanthine oxidase to decrease uric acid production; thus, the
