PHARMACOLOGY NCLEX – EXAM QUESTIONS AND ANSWERS |
ACCURATE AND WELL DETAILED | COMPLETE GUIDE &
RATIONALES | A+ MATERIAL | NEWEST UPDATE
Core Domains
Pharmacokinetics and Pharmacodynamics
Safe and Effective Care Environment: Medication Administration
Cardiovascular and Renal Pharmacology
Endocrine and Metabolic Pharmacology
Neurological and Psychiatric Medications
Respiratory and Immunological Pharmacology
Gastrointestinal and Nutritional Pharmacology
Introduction
This comprehensive assessment is designed to evaluate foundational
knowledge and clinical judgment in nursing pharmacology. The exam
assesses critical skills in safe medication administration, dosage
calculation interpretation, adverse effect recognition, contraindication
identification, and patient education across diverse clinical populations.
Featuring a rigorous blend of multiple-choice and complex clinical
scenario-based questions, the assessment emphasizes real-world
application, prioritized clinical decision-making, and patient safety under
professional nursing standards. Examinees will be challenged to integrate
pharmacological theory with practical nursing interventions to optimize
patient outcomes across various healthcare settings.
A nurse is preparing to administer digoxin to a client with heart
failure. Which assessment finding requires immediate withholding of
the medication and notification of the primary healthcare provider?
A. Blood pressure of 118/76 mmHg
B. Apical pulse rate of 52 beats/minute
C. Serum potassium level of 4.2 mEq/L
D. Respiratory rate of 16 breaths/minute
🟢 B. Apical pulse rate of 52 beats/minute
🔴 Explanation: Digoxin is a cardiac glycoside that slows the heart rate
and increases myocardial contractility. An apical pulse rate below 60
beats/minute in an adult client indicates potential digitalis toxicity and
warrants withholding the medication and notifying the provider.
, A client prescribed warfarin therapy has an International Normalized
Ratio (INR) of 4.8. Which action should the nurse anticipate taking?
A. Administer the next scheduled dose of warfarin as ordered
B. Prepare to administer intravenous vitamin K
C. Encourage increased intake of dark green leafy vegetables
D. Obtain a repeat blood draw in one week
🟢 B. Prepare to administer intravenous vitamin K
🔴 Explanation: An INR of 4.8 is significantly above the therapeutic range
(typically 2.0 to 3.0 for standard indications) and places the client at high
risk for hemorrhage. The nurse should anticipate holding warfarin and
administering vitamin K as an antidote to reverse the anticoagulant effect.
A client is prescribed regular insulin and NPH insulin
subcutaneously. What is the correct procedure for mixing these
insulins in a single syringe?
A. Draw up NPH insulin first, followed by regular insulin
B. Draw up regular insulin first, followed by NPH insulin
C. Mix the insulins in separate syringes and administer sequentially
D. Inject air into the NPH vial first, then air into the regular vial, and
draw up NPH first
🟢 B. Draw up regular insulin first, followed by NPH insulin
🔴 Explanation: To prevent contaminating the short-acting regular insulin
with the longer-acting NPH insulin, the nurse must draw up the regular
(clear) insulin first, followed by the NPH (cloudy) insulin.
A client receiving intravenous heparin therapy develops petechiae,
ecchymosis, and a drop in platelet count from 250,000/mm3 to
90,000/mm3 over three days. Which condition does the nurse
suspect?
A. Disseminated intravascular coagulation
B. Immune thrombocytopenic purpura
C. Heparin-induced thrombocytopenia
D. Thrombotic thrombocytopenic purpura
🟢 C. Heparin-induced thrombocytopenia
🔴 Explanation: Heparin-induced thrombocytopenia (HIT) is an immune-
mediated adverse reaction characterized by a significant drop in platelet
count and thrombotic complications occurring days after heparin
exposure. The drug must be stopped immediately.
A client with rheumatoid arthritis is prescribed methotrexate. Which
instruction is most critical for the nurse to include in the client's
discharge teaching?
, A. Avoid crowds and individuals with known infections
B. Take the medication on an empty stomach with a full glass of milk
C. Stop the medication immediately if mild hair thinning occurs
D. Increase daily dietary intake of vitamin C
🟢 A. Avoid crowds and individuals with known infections
🔴 Explanation: Methotrexate is an immunosuppressant that increases
the risk of severe infection. Clients must be instructed to monitor for signs
of infection and avoid exposure to crowds and sick individuals.
A client is prescribed furosemide for acute pulmonary edema. Which
laboratory value should the nurse monitor most closely during
therapy?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
🟢 B. Serum potassium
🔴 Explanation: Furosemide is a loop diuretic that inhibits sodium and
chloride reabsorption, leading to significant renal excretion of potassium,
which can precipitate dangerous cardiac dysrhythmias if not monitored.
A client with type 2 diabetes mellitus is scheduled for a computed
tomography (CT) scan with intravenous iodinated contrast media.
Which medication must be temporarily discontinued to prevent acute
kidney injury?
A. Glipizide
B. Metformin
C. Insulin glargine
D. Pioglitazone
🟢 B. Metformin
🔴 Explanation: Metformin must be held before and for 48 hours after
receiving iodinated contrast media because the combination increases
the risk of lactic acidosis if contrast-induced acute kidney injury occurs.
A client is receiving an intravenous infusion of vancomycin. The
nurse notes flushing of the neck and face, erythematous rash, and
hypotension. What is the priority nursing action?
A. Administer an intramuscular dose of diphenhydramine
immediately
B. Slow the rate of the vancomycin infusion
C. Discontinue the intravenous line and start a new site
D. Administer a rapid intravenous fluid bolus
, 🟢 B. Slow the rate of the vancomycin infusion
🔴 Explanation: These clinical manifestations describe Red Man
Syndrome, which is an infusion-related reaction caused by rapid
administration of vancomycin. Slowing the infusion rate typically resolves
the symptoms.
A client is prescribed levothyroxine for hypothyroidism. Which
statement by the client indicates an understanding of the medication
therapy?
A. "I will take this medication in the evening right before I go to bed."
B. "I can stop taking this medication once my weight returns to
normal."
C. "I should take this medication on an empty stomach with a full
glass of water."
D. "I will skip my dose if my heart rate feels slightly elevated."
🟢 C. "I should take this medication on an empty stomach with a full
glass of water."
🔴 Explanation: Levothyroxine absorption is optimized when taken on an
empty stomach, typically 30 to 60 minutes before breakfast, with a full
glass of water.
A client with a history of asthma is prescribed propranolol for
hypertension. Which action should the nurse take?
A. Administer the medication as prescribed and monitor lung sounds
B. Hold the medication and contact the prescribing healthcare
provider
C. Administer a bronchodilator prior to giving the propranolol dose
D. Check the client's blood pressure and pulse before administration
🟢 B. Hold the medication and contact the prescribing healthcare
provider
🔴 Explanation: Propranolol is a non-selective beta-blocker that blocks
both beta-1 and beta-2 receptors. Beta-2 blockade in bronchial smooth
muscle can trigger severe bronchospasm, making it contraindicated in
clients with asthma.
A nurse is teaching a client prescribed alendronate for osteoporosis.
Which instruction is essential for preventing esophageal irritation
and ulceration?
A. Remain upright for at least 30 minutes after taking the medication
B. Take the medication with a full glass of milk or orange juice
C. Crush the tablet if it is too difficult to swallow whole
D. Take the medication immediately before lying down for sleep
ACCURATE AND WELL DETAILED | COMPLETE GUIDE &
RATIONALES | A+ MATERIAL | NEWEST UPDATE
Core Domains
Pharmacokinetics and Pharmacodynamics
Safe and Effective Care Environment: Medication Administration
Cardiovascular and Renal Pharmacology
Endocrine and Metabolic Pharmacology
Neurological and Psychiatric Medications
Respiratory and Immunological Pharmacology
Gastrointestinal and Nutritional Pharmacology
Introduction
This comprehensive assessment is designed to evaluate foundational
knowledge and clinical judgment in nursing pharmacology. The exam
assesses critical skills in safe medication administration, dosage
calculation interpretation, adverse effect recognition, contraindication
identification, and patient education across diverse clinical populations.
Featuring a rigorous blend of multiple-choice and complex clinical
scenario-based questions, the assessment emphasizes real-world
application, prioritized clinical decision-making, and patient safety under
professional nursing standards. Examinees will be challenged to integrate
pharmacological theory with practical nursing interventions to optimize
patient outcomes across various healthcare settings.
A nurse is preparing to administer digoxin to a client with heart
failure. Which assessment finding requires immediate withholding of
the medication and notification of the primary healthcare provider?
A. Blood pressure of 118/76 mmHg
B. Apical pulse rate of 52 beats/minute
C. Serum potassium level of 4.2 mEq/L
D. Respiratory rate of 16 breaths/minute
🟢 B. Apical pulse rate of 52 beats/minute
🔴 Explanation: Digoxin is a cardiac glycoside that slows the heart rate
and increases myocardial contractility. An apical pulse rate below 60
beats/minute in an adult client indicates potential digitalis toxicity and
warrants withholding the medication and notifying the provider.
, A client prescribed warfarin therapy has an International Normalized
Ratio (INR) of 4.8. Which action should the nurse anticipate taking?
A. Administer the next scheduled dose of warfarin as ordered
B. Prepare to administer intravenous vitamin K
C. Encourage increased intake of dark green leafy vegetables
D. Obtain a repeat blood draw in one week
🟢 B. Prepare to administer intravenous vitamin K
🔴 Explanation: An INR of 4.8 is significantly above the therapeutic range
(typically 2.0 to 3.0 for standard indications) and places the client at high
risk for hemorrhage. The nurse should anticipate holding warfarin and
administering vitamin K as an antidote to reverse the anticoagulant effect.
A client is prescribed regular insulin and NPH insulin
subcutaneously. What is the correct procedure for mixing these
insulins in a single syringe?
A. Draw up NPH insulin first, followed by regular insulin
B. Draw up regular insulin first, followed by NPH insulin
C. Mix the insulins in separate syringes and administer sequentially
D. Inject air into the NPH vial first, then air into the regular vial, and
draw up NPH first
🟢 B. Draw up regular insulin first, followed by NPH insulin
🔴 Explanation: To prevent contaminating the short-acting regular insulin
with the longer-acting NPH insulin, the nurse must draw up the regular
(clear) insulin first, followed by the NPH (cloudy) insulin.
A client receiving intravenous heparin therapy develops petechiae,
ecchymosis, and a drop in platelet count from 250,000/mm3 to
90,000/mm3 over three days. Which condition does the nurse
suspect?
A. Disseminated intravascular coagulation
B. Immune thrombocytopenic purpura
C. Heparin-induced thrombocytopenia
D. Thrombotic thrombocytopenic purpura
🟢 C. Heparin-induced thrombocytopenia
🔴 Explanation: Heparin-induced thrombocytopenia (HIT) is an immune-
mediated adverse reaction characterized by a significant drop in platelet
count and thrombotic complications occurring days after heparin
exposure. The drug must be stopped immediately.
A client with rheumatoid arthritis is prescribed methotrexate. Which
instruction is most critical for the nurse to include in the client's
discharge teaching?
, A. Avoid crowds and individuals with known infections
B. Take the medication on an empty stomach with a full glass of milk
C. Stop the medication immediately if mild hair thinning occurs
D. Increase daily dietary intake of vitamin C
🟢 A. Avoid crowds and individuals with known infections
🔴 Explanation: Methotrexate is an immunosuppressant that increases
the risk of severe infection. Clients must be instructed to monitor for signs
of infection and avoid exposure to crowds and sick individuals.
A client is prescribed furosemide for acute pulmonary edema. Which
laboratory value should the nurse monitor most closely during
therapy?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
🟢 B. Serum potassium
🔴 Explanation: Furosemide is a loop diuretic that inhibits sodium and
chloride reabsorption, leading to significant renal excretion of potassium,
which can precipitate dangerous cardiac dysrhythmias if not monitored.
A client with type 2 diabetes mellitus is scheduled for a computed
tomography (CT) scan with intravenous iodinated contrast media.
Which medication must be temporarily discontinued to prevent acute
kidney injury?
A. Glipizide
B. Metformin
C. Insulin glargine
D. Pioglitazone
🟢 B. Metformin
🔴 Explanation: Metformin must be held before and for 48 hours after
receiving iodinated contrast media because the combination increases
the risk of lactic acidosis if contrast-induced acute kidney injury occurs.
A client is receiving an intravenous infusion of vancomycin. The
nurse notes flushing of the neck and face, erythematous rash, and
hypotension. What is the priority nursing action?
A. Administer an intramuscular dose of diphenhydramine
immediately
B. Slow the rate of the vancomycin infusion
C. Discontinue the intravenous line and start a new site
D. Administer a rapid intravenous fluid bolus
, 🟢 B. Slow the rate of the vancomycin infusion
🔴 Explanation: These clinical manifestations describe Red Man
Syndrome, which is an infusion-related reaction caused by rapid
administration of vancomycin. Slowing the infusion rate typically resolves
the symptoms.
A client is prescribed levothyroxine for hypothyroidism. Which
statement by the client indicates an understanding of the medication
therapy?
A. "I will take this medication in the evening right before I go to bed."
B. "I can stop taking this medication once my weight returns to
normal."
C. "I should take this medication on an empty stomach with a full
glass of water."
D. "I will skip my dose if my heart rate feels slightly elevated."
🟢 C. "I should take this medication on an empty stomach with a full
glass of water."
🔴 Explanation: Levothyroxine absorption is optimized when taken on an
empty stomach, typically 30 to 60 minutes before breakfast, with a full
glass of water.
A client with a history of asthma is prescribed propranolol for
hypertension. Which action should the nurse take?
A. Administer the medication as prescribed and monitor lung sounds
B. Hold the medication and contact the prescribing healthcare
provider
C. Administer a bronchodilator prior to giving the propranolol dose
D. Check the client's blood pressure and pulse before administration
🟢 B. Hold the medication and contact the prescribing healthcare
provider
🔴 Explanation: Propranolol is a non-selective beta-blocker that blocks
both beta-1 and beta-2 receptors. Beta-2 blockade in bronchial smooth
muscle can trigger severe bronchospasm, making it contraindicated in
clients with asthma.
A nurse is teaching a client prescribed alendronate for osteoporosis.
Which instruction is essential for preventing esophageal irritation
and ulceration?
A. Remain upright for at least 30 minutes after taking the medication
B. Take the medication with a full glass of milk or orange juice
C. Crush the tablet if it is too difficult to swallow whole
D. Take the medication immediately before lying down for sleep
