NR 293 Pharmacology Exam 1 | 75 Questions And Answers
With Detailed Rationale | 2026/2027 Updates
Question 1.
A nurse is reviewing a patient's medication list and notes that the patient is taking both warfarin and
aspirin. The nurse recognizes that this combination increases the risk of which adverse effect?
A. Hyperglycemia
B. Gastrointestinal bleeding
C. Hypertension
D. Bradycardia
Correct Answer: B
Rationale:
Both warfarin (an anticoagulant) and aspirin (an antiplatelet agent) interfere with normal clotting mechanisms. Aspirin also
causes direct mucosal injury to the GI tract. The combined effect significantly increases the risk of gastrointestinal bleeding.
A is incorrect because neither drug affects glucose metabolism. C is incorrect because neither drug causes hypertension
as a primary interaction effect. D is incorrect because bradycardia is not associated with this drug combination.
Question 2.
A patient is prescribed oral penicillin V potassium for a streptococcal throat infection. The nurse should
instruct the patient to take this medication:
A. With a full glass of water on an empty stomach
B. With food to enhance absorption
C. At bedtime only
D. With an antacid to prevent stomach upset
Correct Answer: A
Rationale:
Penicillin V potassium is best absorbed on an empty stomach with a full glass of water. Food can decrease the rate and
extent of absorption. B is incorrect because food reduces absorption, not enhances it. C is incorrect because penicillin
must be taken around the clock to maintain therapeutic blood levels, not just at bedtime. D is incorrect because antacids
can interfere with absorption and are not routinely needed.
Question 3.
The nurse is caring for a patient receiving morphine sulfate via patient-controlled analgesia (PCA).
Which assessment finding requires immediate intervention?
A. Respiratory rate of 10 breaths per minute
B. Pain rating of 4 out of 10
C. Mild sedation
D. Nausea without vomiting
Correct Answer: A
Rationale:
Page 1
,A respiratory rate of 10 breaths per minute indicates respiratory depression, the most serious adverse effect of opioid
analgesics. This requires immediate intervention, including possible naloxone administration and notification of the
provider. B is incorrect because a pain rating of 4/10 may be acceptable depending on patient goals. C is incorrect because
mild sedation is an expected side effect. D is incorrect because nausea is common and not immediately life-threatening.
Question 4.
A patient with heart failure is prescribed furosemide (Lasix). The nurse should monitor for which
electrolyte imbalance most commonly associated with this medication?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
D. Hypercalcemia
Correct Answer: C
Rationale:
Furosemide is a loop diuretic that acts on the ascending loop of Henle, causing increased excretion of potassium along
with sodium and water. Hypokalemia is the most common and dangerous electrolyte imbalance. A is incorrect because
loop diuretics cause potassium loss, not retention. B is incorrect because furosemide causes sodium excretion
(hyponatremia risk), not hypernatremia. D is incorrect because furosemide can cause calcium excretion, not retention.
Question 5.
A nurse is preparing to administer digoxin to a patient. Before giving the medication, the nurse checks
the apical pulse for 1 full minute. The nurse should withhold the dose and notify the provider if the
pulse rate is:
A. 72 beats per minute
B. 88 beats per minute
C. 68 beats per minute
D. 52 beats per minute
Correct Answer: D
Rationale:
Digoxin has a narrow therapeutic index and can cause bradycardia. The dose should be withheld and the provider notified
if the apical pulse is below 60 beats per minute in adults. A, B, and C are all within normal range and do not contraindicate
digoxin administration.
Question 6.
A patient receiving levodopa/carbidopa for Parkinson's disease reports experiencing a dark
discoloration of urine and sweat. The nurse should respond by:
A. Notifying the provider immediately
B. Explaining that this is a harmless side effect
C. Discontinuing the medication
D. Increasing fluid intake to flush the medication
Page 2
,Correct Answer: B
Rationale:
Darkening of urine, sweat, and saliva is a harmless, expected side effect of levodopa and does not indicate toxicity or
require intervention. A is incorrect because this is not an emergency. C is incorrect because the medication should not be
discontinued for this benign effect. D is incorrect because while adequate hydration is always encouraged, it will not
change this harmless discoloration.
Question 7.
A nurse is teaching a patient about the proper use of a metered-dose inhaler (MDI) with a spacer.
Which statement by the patient indicates understanding of the teaching?
A. I should inhale quickly and deeply when I press down on the canister.
B. I need to wait at least 1 minute between puffs if taking two doses.
C. I should exhale into the spacer before pressing the canister.
D. I can use the inhaler even if I have a respiratory infection.
Correct Answer: B
Rationale:
When using an MDI with a spacer, patients should wait 30-60 seconds between puffs to allow the medication to settle and
the airways to open. A is incorrect because the patient should inhale slowly and deeply, not quickly. C is incorrect because
the patient should exhale away from the spacer, not into it. D is incorrect because while inhalers can be used during
infections, this statement does not demonstrate understanding of proper technique.
Question 8.
A patient is prescribed metformin for type 2 diabetes mellitus. The nurse should include which
instruction in the teaching plan?
A. Take the medication 30 minutes before meals.
B. Hold the medication if you are unable to eat.
C. This medication will cure your diabetes.
D. You may stop taking this once your blood sugar is normal.
Correct Answer: B
Rationale:
Metformin should be held if the patient is NPO, has poor oral intake, or is at risk for dehydration to prevent lactic acidosis.
A is incorrect because metformin is typically taken with meals to reduce GI upset. C is incorrect because metformin
manages but does not cure diabetes. D is incorrect because patients should never discontinue antidiabetic medications
without provider guidance.
Question 9.
A nurse is reviewing a new prescription for levothyroxine. Which statement by the patient requires
further teaching?
A. I will take this medication first thing in the morning on an empty stomach.
B. I will take this medication with my calcium supplement.
Page 3
, C. I will have my TSH levels checked regularly.
D. I will not stop taking this medication without talking to my provider.
Correct Answer: B
Rationale:
Calcium supplements interfere with the absorption of levothyroxine. They should be taken at least 4 hours apart. A is
correct because levothyroxine is best absorbed on an empty stomach. C is correct because TSH monitoring is essential
for dose adjustment. D is correct because levothyroxine is a lifelong replacement therapy that should not be discontinued
abruptly.
Question 10.
A patient is receiving gentamicin for a severe gram-negative infection. The nurse should monitor for
which adverse effect?
A. Ototoxicity and nephrotoxicity
B. Hepatotoxicity and pancreatitis
C. Pulmonary fibrosis and hypertension
D. Cardiotoxicity and arrhythmias
Correct Answer: A
Rationale:
Gentamicin is an aminoglycoside antibiotic known for dose-related ototoxicity (vestibular and cochlear damage) and
nephrotoxicity (acute tubular necrosis). Peak and trough levels should be monitored. B is incorrect because
aminoglycosides do not primarily affect the liver or pancreas. C is incorrect because pulmonary fibrosis is associated with
drugs like bleomycin, not gentamicin. D is incorrect because cardiotoxicity is not a characteristic adverse effect of
aminoglycosides.
Question 11.
A nurse is preparing to administer a scheduled dose of prednisone to a patient with an exacerbation of
asthma. The nurse notes that the patient's blood glucose is 280 mg/dL. The nurse should:
A. Administer the prednisone as scheduled
B. Hold the dose and notify the provider
C. Administer insulin without notifying the provider
D. Discontinue the prednisone permanently
Correct Answer: B
Rationale:
Prednisone is a corticosteroid that can cause hyperglycemia, especially in patients with diabetes or prediabetes. A blood
glucose of 280 mg/dL is significantly elevated and requires provider notification to determine if the dose should be adjusted
or if additional antidiabetic therapy is needed. A is incorrect because administering without addressing hyperglycemia
could worsen the patient's condition. C is incorrect because nurses cannot independently prescribe insulin. D is incorrect
because the nurse cannot discontinue a prescribed medication permanently.
Question 12.
Page 4
With Detailed Rationale | 2026/2027 Updates
Question 1.
A nurse is reviewing a patient's medication list and notes that the patient is taking both warfarin and
aspirin. The nurse recognizes that this combination increases the risk of which adverse effect?
A. Hyperglycemia
B. Gastrointestinal bleeding
C. Hypertension
D. Bradycardia
Correct Answer: B
Rationale:
Both warfarin (an anticoagulant) and aspirin (an antiplatelet agent) interfere with normal clotting mechanisms. Aspirin also
causes direct mucosal injury to the GI tract. The combined effect significantly increases the risk of gastrointestinal bleeding.
A is incorrect because neither drug affects glucose metabolism. C is incorrect because neither drug causes hypertension
as a primary interaction effect. D is incorrect because bradycardia is not associated with this drug combination.
Question 2.
A patient is prescribed oral penicillin V potassium for a streptococcal throat infection. The nurse should
instruct the patient to take this medication:
A. With a full glass of water on an empty stomach
B. With food to enhance absorption
C. At bedtime only
D. With an antacid to prevent stomach upset
Correct Answer: A
Rationale:
Penicillin V potassium is best absorbed on an empty stomach with a full glass of water. Food can decrease the rate and
extent of absorption. B is incorrect because food reduces absorption, not enhances it. C is incorrect because penicillin
must be taken around the clock to maintain therapeutic blood levels, not just at bedtime. D is incorrect because antacids
can interfere with absorption and are not routinely needed.
Question 3.
The nurse is caring for a patient receiving morphine sulfate via patient-controlled analgesia (PCA).
Which assessment finding requires immediate intervention?
A. Respiratory rate of 10 breaths per minute
B. Pain rating of 4 out of 10
C. Mild sedation
D. Nausea without vomiting
Correct Answer: A
Rationale:
Page 1
,A respiratory rate of 10 breaths per minute indicates respiratory depression, the most serious adverse effect of opioid
analgesics. This requires immediate intervention, including possible naloxone administration and notification of the
provider. B is incorrect because a pain rating of 4/10 may be acceptable depending on patient goals. C is incorrect because
mild sedation is an expected side effect. D is incorrect because nausea is common and not immediately life-threatening.
Question 4.
A patient with heart failure is prescribed furosemide (Lasix). The nurse should monitor for which
electrolyte imbalance most commonly associated with this medication?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
D. Hypercalcemia
Correct Answer: C
Rationale:
Furosemide is a loop diuretic that acts on the ascending loop of Henle, causing increased excretion of potassium along
with sodium and water. Hypokalemia is the most common and dangerous electrolyte imbalance. A is incorrect because
loop diuretics cause potassium loss, not retention. B is incorrect because furosemide causes sodium excretion
(hyponatremia risk), not hypernatremia. D is incorrect because furosemide can cause calcium excretion, not retention.
Question 5.
A nurse is preparing to administer digoxin to a patient. Before giving the medication, the nurse checks
the apical pulse for 1 full minute. The nurse should withhold the dose and notify the provider if the
pulse rate is:
A. 72 beats per minute
B. 88 beats per minute
C. 68 beats per minute
D. 52 beats per minute
Correct Answer: D
Rationale:
Digoxin has a narrow therapeutic index and can cause bradycardia. The dose should be withheld and the provider notified
if the apical pulse is below 60 beats per minute in adults. A, B, and C are all within normal range and do not contraindicate
digoxin administration.
Question 6.
A patient receiving levodopa/carbidopa for Parkinson's disease reports experiencing a dark
discoloration of urine and sweat. The nurse should respond by:
A. Notifying the provider immediately
B. Explaining that this is a harmless side effect
C. Discontinuing the medication
D. Increasing fluid intake to flush the medication
Page 2
,Correct Answer: B
Rationale:
Darkening of urine, sweat, and saliva is a harmless, expected side effect of levodopa and does not indicate toxicity or
require intervention. A is incorrect because this is not an emergency. C is incorrect because the medication should not be
discontinued for this benign effect. D is incorrect because while adequate hydration is always encouraged, it will not
change this harmless discoloration.
Question 7.
A nurse is teaching a patient about the proper use of a metered-dose inhaler (MDI) with a spacer.
Which statement by the patient indicates understanding of the teaching?
A. I should inhale quickly and deeply when I press down on the canister.
B. I need to wait at least 1 minute between puffs if taking two doses.
C. I should exhale into the spacer before pressing the canister.
D. I can use the inhaler even if I have a respiratory infection.
Correct Answer: B
Rationale:
When using an MDI with a spacer, patients should wait 30-60 seconds between puffs to allow the medication to settle and
the airways to open. A is incorrect because the patient should inhale slowly and deeply, not quickly. C is incorrect because
the patient should exhale away from the spacer, not into it. D is incorrect because while inhalers can be used during
infections, this statement does not demonstrate understanding of proper technique.
Question 8.
A patient is prescribed metformin for type 2 diabetes mellitus. The nurse should include which
instruction in the teaching plan?
A. Take the medication 30 minutes before meals.
B. Hold the medication if you are unable to eat.
C. This medication will cure your diabetes.
D. You may stop taking this once your blood sugar is normal.
Correct Answer: B
Rationale:
Metformin should be held if the patient is NPO, has poor oral intake, or is at risk for dehydration to prevent lactic acidosis.
A is incorrect because metformin is typically taken with meals to reduce GI upset. C is incorrect because metformin
manages but does not cure diabetes. D is incorrect because patients should never discontinue antidiabetic medications
without provider guidance.
Question 9.
A nurse is reviewing a new prescription for levothyroxine. Which statement by the patient requires
further teaching?
A. I will take this medication first thing in the morning on an empty stomach.
B. I will take this medication with my calcium supplement.
Page 3
, C. I will have my TSH levels checked regularly.
D. I will not stop taking this medication without talking to my provider.
Correct Answer: B
Rationale:
Calcium supplements interfere with the absorption of levothyroxine. They should be taken at least 4 hours apart. A is
correct because levothyroxine is best absorbed on an empty stomach. C is correct because TSH monitoring is essential
for dose adjustment. D is correct because levothyroxine is a lifelong replacement therapy that should not be discontinued
abruptly.
Question 10.
A patient is receiving gentamicin for a severe gram-negative infection. The nurse should monitor for
which adverse effect?
A. Ototoxicity and nephrotoxicity
B. Hepatotoxicity and pancreatitis
C. Pulmonary fibrosis and hypertension
D. Cardiotoxicity and arrhythmias
Correct Answer: A
Rationale:
Gentamicin is an aminoglycoside antibiotic known for dose-related ototoxicity (vestibular and cochlear damage) and
nephrotoxicity (acute tubular necrosis). Peak and trough levels should be monitored. B is incorrect because
aminoglycosides do not primarily affect the liver or pancreas. C is incorrect because pulmonary fibrosis is associated with
drugs like bleomycin, not gentamicin. D is incorrect because cardiotoxicity is not a characteristic adverse effect of
aminoglycosides.
Question 11.
A nurse is preparing to administer a scheduled dose of prednisone to a patient with an exacerbation of
asthma. The nurse notes that the patient's blood glucose is 280 mg/dL. The nurse should:
A. Administer the prednisone as scheduled
B. Hold the dose and notify the provider
C. Administer insulin without notifying the provider
D. Discontinue the prednisone permanently
Correct Answer: B
Rationale:
Prednisone is a corticosteroid that can cause hyperglycemia, especially in patients with diabetes or prediabetes. A blood
glucose of 280 mg/dL is significantly elevated and requires provider notification to determine if the dose should be adjusted
or if additional antidiabetic therapy is needed. A is incorrect because administering without addressing hyperglycemia
could worsen the patient's condition. C is incorrect because nurses cannot independently prescribe insulin. D is incorrect
because the nurse cannot discontinue a prescribed medication permanently.
Question 12.
Page 4
