Page 1 of 84
ACE NCLEX-RN PHARMACOLOGY PRACTICE (100)
LATEST QUESTIONS WITH RATIONAL-
RATIONALES
Pharmacology / Nursing
Exam coverage:
I. Section 1: Q1-20 – Cardiovascular & Anticoagulant
Medications (beta-blockers, diuretics, digoxin,
anticoagulants, antiplatelets, statins, IV therapy safety)
II. Section 2: Q21-40 – Endocrine & Metabolic Medications
(insulins, oral antidiabetics, thyroid, corticosteroids,
osteoporosis, MAOIs, hormonal therapies)
III. Section 3: Q41-60 – Anti-Infective & Antibiotic Medications
(antibiotics, antifungals, monitoring parameters, high-alert
medications, adverse effects)
IV. Section 4: Q61-80 – Central Nervous System & Psychiatric
Medications (opioids, antidepressants, antipsychotics,
anticonvulsants, anxiolytics, Alzheimer's)
V. Section 5: Q81-100 – Respiratory, GI & Miscellaneous
Medications (COPD, asthma, GI agents, antihistamines,
antihypertensives)
SECTION 1: CARDIOVASCULAR & ANTICOAGULANT
MEDICATIONS (Questions 1–20)
Question 1
, Page 2 of 84
A 68-year-old client with heart failure is prescribed furosemide
(Lasix) 40 mg PO daily. Which laboratory value should the nurse
monitor most closely before administering this medication?
A) Serum sodium of 140 mEq/L
B) Serum potassium of 3.0 mEq/L
C) ✓ Serum potassium of 3.0 mEq/L
D) Serum calcium of 9.5 mg/dL
CORRECT: C
RATIONALE: Furosemide is a loop diuretic that causes
increased excretion of potassium, sodium, and water.
Hypokalemia (potassium less than 3.5 mEq/L) is a common and
dangerous adverse effect that can lead to cardiac
dysrhythmias. A serum potassium of 3.0 mEq/L indicates
hypokalemia and requires immediate intervention such as
potassium supplementation. The nurse should monitor
potassium levels closely and assess for signs of hypokalemia
including muscle weakness, fatigue, and irregular heart rate.
Question 2
, Page 3 of 84
A nurse is preparing to administer digoxin (Lanoxin) to a client
with atrial fibrillation. The client's apical heart rate is 52 beats
per minute. What is the nurse's best action?
A) Administer the dose as prescribed
B) ✓ Hold the dose and notify the provider
C) Administer half the prescribed dose
D) Give the dose with orange juice
CORRECT: B
RATIONALE: Digoxin slows conduction through the AV node
and decreases heart rate. The nurse must assess the apical
heart rate for one full minute before administering digoxin. A
heart rate below 60 beats per minute is a standard indication to
hold the medication and notify the provider due to the risk of
severe bradycardia and digoxin toxicity. Orange juice is not
indicated and may affect absorption.
Question 3
A client on warfarin (Coumadin) therapy has an INR of 4.8. What
is the nurse's priority action?
A) Administer the prescribed warfarin dose and document the
INR result
, Page 4 of 84
B) ✓ Hold the warfarin dose and notify the healthcare
provider immediately
C) Give vitamin B12 supplementation as ordered
D) Instruct the client to increase intake of leafy green vegetables
CORRECT: B
RATIONALE: The therapeutic INR range for most indications is
2.0 to 3.0 (or 2.5 to 3.5 for mechanical heart valves). An INR of
4.8 significantly exceeds the therapeutic goal and indicates
excessive anticoagulation, placing the client at high risk for
bleeding. The nurse should hold the dose and notify the provider
to determine if vitamin K administration or dose adjustment is
needed.
Question 4
A client who receives multiple antihypertensive medications
experiences syncope due to a drop in blood pressure to 70/40
mm Hg. Which is the rationale for the nurse's decision to hold
the client's scheduled antihypertensive medications?
A) The synergistic effect of the multiple medications has
resulted in drug toxicity
ACE NCLEX-RN PHARMACOLOGY PRACTICE (100)
LATEST QUESTIONS WITH RATIONAL-
RATIONALES
Pharmacology / Nursing
Exam coverage:
I. Section 1: Q1-20 – Cardiovascular & Anticoagulant
Medications (beta-blockers, diuretics, digoxin,
anticoagulants, antiplatelets, statins, IV therapy safety)
II. Section 2: Q21-40 – Endocrine & Metabolic Medications
(insulins, oral antidiabetics, thyroid, corticosteroids,
osteoporosis, MAOIs, hormonal therapies)
III. Section 3: Q41-60 – Anti-Infective & Antibiotic Medications
(antibiotics, antifungals, monitoring parameters, high-alert
medications, adverse effects)
IV. Section 4: Q61-80 – Central Nervous System & Psychiatric
Medications (opioids, antidepressants, antipsychotics,
anticonvulsants, anxiolytics, Alzheimer's)
V. Section 5: Q81-100 – Respiratory, GI & Miscellaneous
Medications (COPD, asthma, GI agents, antihistamines,
antihypertensives)
SECTION 1: CARDIOVASCULAR & ANTICOAGULANT
MEDICATIONS (Questions 1–20)
Question 1
, Page 2 of 84
A 68-year-old client with heart failure is prescribed furosemide
(Lasix) 40 mg PO daily. Which laboratory value should the nurse
monitor most closely before administering this medication?
A) Serum sodium of 140 mEq/L
B) Serum potassium of 3.0 mEq/L
C) ✓ Serum potassium of 3.0 mEq/L
D) Serum calcium of 9.5 mg/dL
CORRECT: C
RATIONALE: Furosemide is a loop diuretic that causes
increased excretion of potassium, sodium, and water.
Hypokalemia (potassium less than 3.5 mEq/L) is a common and
dangerous adverse effect that can lead to cardiac
dysrhythmias. A serum potassium of 3.0 mEq/L indicates
hypokalemia and requires immediate intervention such as
potassium supplementation. The nurse should monitor
potassium levels closely and assess for signs of hypokalemia
including muscle weakness, fatigue, and irregular heart rate.
Question 2
, Page 3 of 84
A nurse is preparing to administer digoxin (Lanoxin) to a client
with atrial fibrillation. The client's apical heart rate is 52 beats
per minute. What is the nurse's best action?
A) Administer the dose as prescribed
B) ✓ Hold the dose and notify the provider
C) Administer half the prescribed dose
D) Give the dose with orange juice
CORRECT: B
RATIONALE: Digoxin slows conduction through the AV node
and decreases heart rate. The nurse must assess the apical
heart rate for one full minute before administering digoxin. A
heart rate below 60 beats per minute is a standard indication to
hold the medication and notify the provider due to the risk of
severe bradycardia and digoxin toxicity. Orange juice is not
indicated and may affect absorption.
Question 3
A client on warfarin (Coumadin) therapy has an INR of 4.8. What
is the nurse's priority action?
A) Administer the prescribed warfarin dose and document the
INR result
, Page 4 of 84
B) ✓ Hold the warfarin dose and notify the healthcare
provider immediately
C) Give vitamin B12 supplementation as ordered
D) Instruct the client to increase intake of leafy green vegetables
CORRECT: B
RATIONALE: The therapeutic INR range for most indications is
2.0 to 3.0 (or 2.5 to 3.5 for mechanical heart valves). An INR of
4.8 significantly exceeds the therapeutic goal and indicates
excessive anticoagulation, placing the client at high risk for
bleeding. The nurse should hold the dose and notify the provider
to determine if vitamin K administration or dose adjustment is
needed.
Question 4
A client who receives multiple antihypertensive medications
experiences syncope due to a drop in blood pressure to 70/40
mm Hg. Which is the rationale for the nurse's decision to hold
the client's scheduled antihypertensive medications?
A) The synergistic effect of the multiple medications has
resulted in drug toxicity
