KAPLAN PHARMACOLOGY INTEGRATED PROCTORED EXAM (FORM D) – NGN STYLE 70
PRACTICE QUESTIONS WITH 4 ANSWER OPTIONS & DETAILED RATIONALES
Core Domains
Cardiovascular and Hematologic Pharmacology
Antimicrobial and Anti-Infective Pharmacology
Endocrine Pharmacology
Central Nervous System Pharmacology
Gastrointestinal and Respiratory Pharmacology
Pharmacokinetics and Pharmacodynamics
Medication Safety and Administration
Introduction
This comprehensive assessment is designed to evaluate the nursing student's mastery of
pharmacologic principles essential for safe, effective medication administration. It assesses the
candidate's ability to apply clinical judgment, prioritize patient safety, and integrate
pharmacokinetic and pharmacodynamic concepts with evidence-based nursing interventions. The
exam utilizes multiple-choice and scenario-based questions mirroring the NGN (Next Generation
NCLEX) format. Emphasis is placed on recognizing adverse effects, monitoring parameters, patient
,teaching, and clinical decision-making across diverse medication classes. Success demonstrates
readiness for safe medication administration in professional nursing practice.
Section One: Cardiovascular and Hematologic Pharmacology (Questions 1–15)
1. A client with heart failure is prescribed digoxin (Lanoxin). Which assessment finding should the
nurse report to the provider immediately?
A) Apical pulse of 62 bpm
B) Serum potassium level of 4.2 mEq/L
🟢 C) Nausea and yellowish-green halos around lights
D) Blood pressure of 130/80 mm Hg
🔴 RATIONALE: Nausea and visual disturbances (yellow-green halos) are classic signs of digoxin
toxicity. The therapeutic digoxin level is 0.8–2.0 ng/mL. Hypokalemia (not seen here) also
increases toxicity risk. A pulse of 62 bpm is acceptable (hold if <60). Nausea with visual changes
requires immediate provider notification.
2. A nurse is teaching a client with atrial fibrillation about warfarin (Coumadin). Which statement
indicates a need for further teaching?
A) "I will eat the same amount of green leafy vegetables every week."
B) "I will use a soft toothbrush and electric razor."
🟢 C) "I can take ibuprofen for headaches because it is over-the-counter."
D) "I will have my INR checked regularly."
,🔴 RATIONALE: Ibuprofen (NSAID) increases bleeding risk and should be avoided while taking
warfarin. Consistent vitamin K intake (green leafy vegetables) helps maintain stable INR. Soft
toothbrush/electric razor reduce bleeding risk. INR monitoring is essential.
3. A client is receiving a continuous heparin infusion. The nurse notes a sudden drop in platelet
count from 250,000/mm³ to 90,000/mm³. Which action should the nurse take first?
A) Administer protamine sulfate as ordered.
🟢 B) Stop the heparin infusion.
C) Increase the heparin rate to prevent clotting.
D) Obtain aPTT and INR levels.
🔴 RATIONALE: This platelet drop suggests heparin-induced thrombocytopenia (HIT), a life-
threatening prothrombotic condition. Heparin must be stopped immediately. Protamine sulfate
is for bleeding reversal, not HIT. aPTT monitoring is secondary.
4. A nurse is preparing to administer furosemide (Lasix) 40 mg IV push. Which laboratory value
should the nurse review before administration?
A) Serum creatinine
🟢 B) Serum potassium
C) Serum sodium
D) Hemoglobin
🔴 RATIONALE: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
increases the risk of cardiac arrhythmias, especially in clients taking digoxin. The nurse should
, review potassium and hold the dose if it is low (<3.5 mEq/L).
5. A client with hypertension is prescribed lisinopril (Prinivil). Which adverse effect should the
nurse instruct the client to report immediately?
A) Dry, nonproductive cough
🟢 B) Swelling of the lips and tongue
C) Headache
D) Fatigue
🔴 RATIONALE: Angioedema (swelling of lips, tongue, throat) is a rare but life-threatening
adverse effect of ACE inhibitors. Dry cough is common but not emergent. Headache and fatigue
are common side effects that do not require immediate reporting.
6. A nurse is administering alteplase (tPA) to a client with acute ischemic stroke. Which
assessment finding requires immediate discontinuation of the infusion?
A) Blood pressure of 150/90 mm Hg
🟢 B) Sudden onset of severe headache and vomiting
C) Heart rate of 88 bpm
D) Temperature of 37.8°C (100°F)
🔴 RATIONALE: Sudden severe headache and vomiting may indicate intracranial hemorrhage, a
life-threatening complication of thrombolytic therapy. The infusion must be stopped
immediately and the provider notified. The other findings do not require immediate
discontinuation.
PRACTICE QUESTIONS WITH 4 ANSWER OPTIONS & DETAILED RATIONALES
Core Domains
Cardiovascular and Hematologic Pharmacology
Antimicrobial and Anti-Infective Pharmacology
Endocrine Pharmacology
Central Nervous System Pharmacology
Gastrointestinal and Respiratory Pharmacology
Pharmacokinetics and Pharmacodynamics
Medication Safety and Administration
Introduction
This comprehensive assessment is designed to evaluate the nursing student's mastery of
pharmacologic principles essential for safe, effective medication administration. It assesses the
candidate's ability to apply clinical judgment, prioritize patient safety, and integrate
pharmacokinetic and pharmacodynamic concepts with evidence-based nursing interventions. The
exam utilizes multiple-choice and scenario-based questions mirroring the NGN (Next Generation
NCLEX) format. Emphasis is placed on recognizing adverse effects, monitoring parameters, patient
,teaching, and clinical decision-making across diverse medication classes. Success demonstrates
readiness for safe medication administration in professional nursing practice.
Section One: Cardiovascular and Hematologic Pharmacology (Questions 1–15)
1. A client with heart failure is prescribed digoxin (Lanoxin). Which assessment finding should the
nurse report to the provider immediately?
A) Apical pulse of 62 bpm
B) Serum potassium level of 4.2 mEq/L
🟢 C) Nausea and yellowish-green halos around lights
D) Blood pressure of 130/80 mm Hg
🔴 RATIONALE: Nausea and visual disturbances (yellow-green halos) are classic signs of digoxin
toxicity. The therapeutic digoxin level is 0.8–2.0 ng/mL. Hypokalemia (not seen here) also
increases toxicity risk. A pulse of 62 bpm is acceptable (hold if <60). Nausea with visual changes
requires immediate provider notification.
2. A nurse is teaching a client with atrial fibrillation about warfarin (Coumadin). Which statement
indicates a need for further teaching?
A) "I will eat the same amount of green leafy vegetables every week."
B) "I will use a soft toothbrush and electric razor."
🟢 C) "I can take ibuprofen for headaches because it is over-the-counter."
D) "I will have my INR checked regularly."
,🔴 RATIONALE: Ibuprofen (NSAID) increases bleeding risk and should be avoided while taking
warfarin. Consistent vitamin K intake (green leafy vegetables) helps maintain stable INR. Soft
toothbrush/electric razor reduce bleeding risk. INR monitoring is essential.
3. A client is receiving a continuous heparin infusion. The nurse notes a sudden drop in platelet
count from 250,000/mm³ to 90,000/mm³. Which action should the nurse take first?
A) Administer protamine sulfate as ordered.
🟢 B) Stop the heparin infusion.
C) Increase the heparin rate to prevent clotting.
D) Obtain aPTT and INR levels.
🔴 RATIONALE: This platelet drop suggests heparin-induced thrombocytopenia (HIT), a life-
threatening prothrombotic condition. Heparin must be stopped immediately. Protamine sulfate
is for bleeding reversal, not HIT. aPTT monitoring is secondary.
4. A nurse is preparing to administer furosemide (Lasix) 40 mg IV push. Which laboratory value
should the nurse review before administration?
A) Serum creatinine
🟢 B) Serum potassium
C) Serum sodium
D) Hemoglobin
🔴 RATIONALE: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
increases the risk of cardiac arrhythmias, especially in clients taking digoxin. The nurse should
, review potassium and hold the dose if it is low (<3.5 mEq/L).
5. A client with hypertension is prescribed lisinopril (Prinivil). Which adverse effect should the
nurse instruct the client to report immediately?
A) Dry, nonproductive cough
🟢 B) Swelling of the lips and tongue
C) Headache
D) Fatigue
🔴 RATIONALE: Angioedema (swelling of lips, tongue, throat) is a rare but life-threatening
adverse effect of ACE inhibitors. Dry cough is common but not emergent. Headache and fatigue
are common side effects that do not require immediate reporting.
6. A nurse is administering alteplase (tPA) to a client with acute ischemic stroke. Which
assessment finding requires immediate discontinuation of the infusion?
A) Blood pressure of 150/90 mm Hg
🟢 B) Sudden onset of severe headache and vomiting
C) Heart rate of 88 bpm
D) Temperature of 37.8°C (100°F)
🔴 RATIONALE: Sudden severe headache and vomiting may indicate intracranial hemorrhage, a
life-threatening complication of thrombolytic therapy. The infusion must be stopped
immediately and the provider notified. The other findings do not require immediate
discontinuation.
