,NURS 1150: Nursing Pharmacology I —
Exam 3
Northwest College (NWC) | Next Generation NCLEX (NGN)
Test Bank & Study Guide (2026/2027)
SECTION 1: NGN-Style Test Bank Questions, Answers &
Rationales
Question 1: Cardiac Glycosides & Digoxin Toxicity
A nurse is preparing to administer the morning dose of Digoxin 0.125 mgPO to a client with
heart failure. Prior to administration, the nurse notes the client's vital signs: BP 118/76 mmHg,
HR 52 bpm, RR 16 breaths/min, Temp 98.4∘ F. Serum digoxin level is 1.8 ng/mL, and serum
potassium is 3.2 mEq/L. Which action should the nurse take first?
• A. Administer the medication as ordered since the digoxin level is within therapeutic
range.
• B. Hold the digoxin dose, notify the healthcare provider, and monitor for signs of digoxin
toxicity.
• C. Administer the digoxin dose and request an order for an oral potassium supplement.
• D. Recheck the apical pulse in 30 minutes and give the medication if the heart rate
increases to 60 bpm.
Correct Answer: B. Hold the digoxin dose, notify the healthcare provider, and monitor for
signs of digoxin toxicity.
Rationale: Digoxin should be held if the apical pulse is < 60 bpmin an adult. Furthermore,
hypokalemia (< 3.5 mEq/L) significantly increases the risk of digoxin toxicity even when serum
digoxin levels are within the therapeutic window (0.5--2.0 ng/mL). Holding the dose and
notifying the provider prevents dangerous ventricular dysrhythmias.
Question 2: ACE Inhibitors & Adverse Effects
A client with hypertension and heart failure is started on Lisinopril 10 mgdaily. During a follow-
up clinic visit 2 weeks later, which clinical finding requires immediate nursing intervention?
• A. A persistent, dry, non-productive cough
• B. Swelling of the lips, tongue, and rapid difficulty breathing
• C. Serum potassium level of 4.8 mEq/L
• D. Mild dizziness when standing up rapidly
, Correct Answer: B. Swelling of the lips, tongue, and rapid difficulty breathing
Rationale: Angioedema (swelling of the lips, tongue, pharynx, and face) is a life-threatening,
emergency adverse effect of ACE inhibitors (such as lisinopril) caused by bradykinin
accumulation. It can cause complete upper airway obstruction. While a persistent dry cough is a
common nuisance side effect of ACE inhibitors, angioedema is an immediate medical
emergency requiring discontinuation of the drug and airway management.
Question 3: Antiarrhythmic Drugs — Amiodarone
A client receiving intravenous Amiodarone for refractory ventricular tachycardia develops
dyspnea, a dry cough, and low-grade fever. Chest radiography reveals diffuse pulmonary
infiltrates. How should the nurse interpret these findings?
• A. An expected adverse effect that resolves spontaneously with continued therapy
• B. Signs of acute cardiac decompensation requiring an increased amiodarone infusion
rate
• C. Amiodarone-induced pulmonary toxicity requiring immediate drug withdrawal and
provider notification
• D. An allergic reaction that should be treated with IV diphenhydramine
Correct Answer: C. Amiodarone-induced pulmonary toxicity requiring immediate drug
withdrawal and provider notification
Rationale: Pulmonary toxicity (interstitial pneumonitis/fibrosis) is one of the most dangerous
long-term adverse reactions associated with amiodarone. Symptoms include progressive
dyspnea, dry cough, fever, and pulmonary infiltrates. The medication must be stopped
immediately to prevent irreversible pulmonary fibrosis and fatal respiratory failure.
Question 4: Nitraglycerin Administration & Patient Education
A nurse is providing discharge teaching to a client prescribed sublingual Nitroglycerin for acute
angina pectoris. Which instruction must the nurse include in the educational plan?
• A. "Swallow the tablet with a full glass of water at the onset of chest pain."
• B. "Take 1 tablet every 5 minutes up to a maximum of 3 doses; call 911 if pain is not
relieved after the first dose."
• C. "Store the nitroglycerin tablets in a clear plastic pill organizer on your nightstand."
• D. "Take a tablet 30 minutes after taking sildenafil for erectile dysfunction to prevent
headache."
Correct Answer: B. "Take 1 tablet every 5 minutes up to a maximum of 3 doses; call 911 if
pain is not relieved after the first dose."
Rationale: Sublingual nitroglycerin must dissolve under the tongue for rapid systemic
absorption. Current emergency protocols advise taking 1 sublingual tablet at the onset of chest
Exam 3
Northwest College (NWC) | Next Generation NCLEX (NGN)
Test Bank & Study Guide (2026/2027)
SECTION 1: NGN-Style Test Bank Questions, Answers &
Rationales
Question 1: Cardiac Glycosides & Digoxin Toxicity
A nurse is preparing to administer the morning dose of Digoxin 0.125 mgPO to a client with
heart failure. Prior to administration, the nurse notes the client's vital signs: BP 118/76 mmHg,
HR 52 bpm, RR 16 breaths/min, Temp 98.4∘ F. Serum digoxin level is 1.8 ng/mL, and serum
potassium is 3.2 mEq/L. Which action should the nurse take first?
• A. Administer the medication as ordered since the digoxin level is within therapeutic
range.
• B. Hold the digoxin dose, notify the healthcare provider, and monitor for signs of digoxin
toxicity.
• C. Administer the digoxin dose and request an order for an oral potassium supplement.
• D. Recheck the apical pulse in 30 minutes and give the medication if the heart rate
increases to 60 bpm.
Correct Answer: B. Hold the digoxin dose, notify the healthcare provider, and monitor for
signs of digoxin toxicity.
Rationale: Digoxin should be held if the apical pulse is < 60 bpmin an adult. Furthermore,
hypokalemia (< 3.5 mEq/L) significantly increases the risk of digoxin toxicity even when serum
digoxin levels are within the therapeutic window (0.5--2.0 ng/mL). Holding the dose and
notifying the provider prevents dangerous ventricular dysrhythmias.
Question 2: ACE Inhibitors & Adverse Effects
A client with hypertension and heart failure is started on Lisinopril 10 mgdaily. During a follow-
up clinic visit 2 weeks later, which clinical finding requires immediate nursing intervention?
• A. A persistent, dry, non-productive cough
• B. Swelling of the lips, tongue, and rapid difficulty breathing
• C. Serum potassium level of 4.8 mEq/L
• D. Mild dizziness when standing up rapidly
, Correct Answer: B. Swelling of the lips, tongue, and rapid difficulty breathing
Rationale: Angioedema (swelling of the lips, tongue, pharynx, and face) is a life-threatening,
emergency adverse effect of ACE inhibitors (such as lisinopril) caused by bradykinin
accumulation. It can cause complete upper airway obstruction. While a persistent dry cough is a
common nuisance side effect of ACE inhibitors, angioedema is an immediate medical
emergency requiring discontinuation of the drug and airway management.
Question 3: Antiarrhythmic Drugs — Amiodarone
A client receiving intravenous Amiodarone for refractory ventricular tachycardia develops
dyspnea, a dry cough, and low-grade fever. Chest radiography reveals diffuse pulmonary
infiltrates. How should the nurse interpret these findings?
• A. An expected adverse effect that resolves spontaneously with continued therapy
• B. Signs of acute cardiac decompensation requiring an increased amiodarone infusion
rate
• C. Amiodarone-induced pulmonary toxicity requiring immediate drug withdrawal and
provider notification
• D. An allergic reaction that should be treated with IV diphenhydramine
Correct Answer: C. Amiodarone-induced pulmonary toxicity requiring immediate drug
withdrawal and provider notification
Rationale: Pulmonary toxicity (interstitial pneumonitis/fibrosis) is one of the most dangerous
long-term adverse reactions associated with amiodarone. Symptoms include progressive
dyspnea, dry cough, fever, and pulmonary infiltrates. The medication must be stopped
immediately to prevent irreversible pulmonary fibrosis and fatal respiratory failure.
Question 4: Nitraglycerin Administration & Patient Education
A nurse is providing discharge teaching to a client prescribed sublingual Nitroglycerin for acute
angina pectoris. Which instruction must the nurse include in the educational plan?
• A. "Swallow the tablet with a full glass of water at the onset of chest pain."
• B. "Take 1 tablet every 5 minutes up to a maximum of 3 doses; call 911 if pain is not
relieved after the first dose."
• C. "Store the nitroglycerin tablets in a clear plastic pill organizer on your nightstand."
• D. "Take a tablet 30 minutes after taking sildenafil for erectile dysfunction to prevent
headache."
Correct Answer: B. "Take 1 tablet every 5 minutes up to a maximum of 3 doses; call 911 if
pain is not relieved after the first dose."
Rationale: Sublingual nitroglycerin must dissolve under the tongue for rapid systemic
absorption. Current emergency protocols advise taking 1 sublingual tablet at the onset of chest
