Basic Pharmacology for Nurses 19th
Edition: NCLEX Practice Questions &
Study Guide
Question 1
A home health nurse is conducting an initial assessment on an 82-year-old client
who takes 11 different daily prescription and over-the-counter medications. The
nurse identifies that the client has been prescribed two different brand-name
drugs that contain the same generic active ingredient (acetaminophen). What is
the priority nursing diagnosis for this client?
• A. Risk for Deficient Fluid Volume related to polypharmacy
• B. Risk for Prone-for-Enhanced Knowledge related to drug regimen
• C. Risk for Poisoning / Accidental Toxicity related to drug duplication and
polypharmacy
• D. Impaired Memory related to medication complexity
Correct Answer: C
Rationale: Drug duplication in polypharmacy creates a major safety hazard for acute
hepatotoxicity (acetaminophen toxicity). The priority nursing diagnosis is identifying and
preventing drug duplication to protect the client from inadvertent overdose.
Question 2
Which pharmacokinetic process is most directly affected when a client with end-
stage liver disease (cirrhosis) receives a drug that is highly bound to plasma
proteins (such as warfarin or phenytoin)?
• A. Active tubular excretion in the nephron
• B. Drug distribution and serum active free-drug concentrations
• C. Gastric mucosal absorption rates
• D. Pulmonary clearance via exhalation
Correct Answer: B
Rationale: The liver synthesizes plasma proteins (primarily albumin). Severe liver
dysfunction causes hypoalbuminemia, reducing the available protein binding sites. As a
result, a higher percentage of the drug remains unbound ("free"), significantly increasing
pharmacologic activity and toxicity risk.
,Question 3
A nurse prepares to administer a sublingual nitroglycerin tablet to a client
experiencing acute angina. What rationale explains why this medication is
administered sublingually rather than swallowed orally?
• A. Sublingual absorption prevents destruction by gastric acid and bypasses
hepatic first-pass metabolism.
• B. Sublingual routes guarantee a slower, sustained release over 24 hours.
• C. Swallowing nitroglycerin causes immediate esophageal ulceration.
• D. Sublingual administration stimulates renal excretion within minutes.
Correct Answer: A
Rationale: Sublingual administration allows rapid absorption directly into the systemic
venous circulation via the oral mucosa, completely bypassing the GI tract and hepatic
first-pass metabolism, ensuring rapid onset of action.
Question 4
A pediatric nurse calculates a weight-based medication dosage for a 6-year-old
child. The medication order reads: "Administer 15 mg/kg PO every 8 hours." The
child weighs 44 lbs. What total daily dose (in milligrams) will the child receive?
• A. 300 mg/day
• B. 600 mg/day
• C. 900 mg/day
• D. 1,200 mg/day
Correct Answer: C
Rationale:
1. Convert weight from pounds to kilograms:
44 lbs
Weight = = 20 kg
2.2
2. Calculate single dose:
Single Dose = 20 kg × 15 mg/kg = 300 mg
3. Calculate total daily dose (every 8 hours = 3 doses/day):
Total Daily Dose = 300 mg × 3 = 900 mg/day
,Question 5
Which clinical finding represents a true Type 1 IgE-mediated hypersensitivity
reaction to a newly prescribed antibiotic?
• A. Mild nausea and epigastric discomfort after taking the first dose
• B. Urticaria (hives), bronchospasm, and laryngeal edema
• C. Constipation and dry mouth after 3 days of therapy
• D. Black hairy tongue after 10 days of oral therapy
Correct Answer: B
Rationale: IgE-mediated anaphylactic reactions present with sudden histamine release
causing urticaria, angioedema, bronchospasm, and hypotension. Mild GI upset is a
common side effect, not an allergic reaction.
Questions 6–10 Quick-Reference Matrix (Foundations of Pharmacology)
Pharmacokinetic / Core Definition / Key NCLEX Safety
Q#
Nursing Concept Clinical Focus Priority
Inactivation of oral Explains why oral doses of
drugs by hepatic morphine/propranolol are
6 First-Pass Effect
portal circulation prior much higher than IV
to systemic reach. doses.
Time required for Determines dosing
serum drug intervals and time required
7 Half-Life (𝑡1/2 )
concentration to to reach steady state (~4–
decline by 50%. 5 half-lives).
Narrow TI drugs (digoxin,
Ratio between toxic
Therapeutic Index lithium, warfarin) require
8 dose (TD50 ) and
(TI) strict serum level
effective dose (ED50 ).
monitoring.
Right Client, Right
Verify using two client
Drug, Right Dose,
The 6 Rights of identifiers and check the
9 Right Route, Right
Medication Safety MAR three times prior to
Time, Right
administration.
Documentation.
Evidence-based list Focuses on reducing
10 Beers Criteria
of high-risk drugs to anticholinergic toxicity,
, Pharmacokinetic / Core Definition / Key NCLEX Safety
Q#
Nursing Concept Clinical Focus Priority
avoid or dose-adjust falls, delirium, and GI
in older adults. bleeding in seniors.
Module 2: Cardiovascular & Renal Pharmacology
Question 11
A client receiving digoxin 0.125 mg PO daily presents with nausea, vomiting,
blurred vision with yellow-green halos, and a resting heart rate of 48 beats/min.
The nurse notes a serum digoxin level of 2.6 ng/mL. What is the immediate
priority nursing action?
• A. Administer the next scheduled dose with a glass of milk.
• B. Withhold the digoxin dose, notify the healthcare provider immediately, and
prepare digoxin immune Fab (Digibind) if ordered.
• C. Instruct the client to perform isometric exercises to raise heart rate.
• D. Encourage the client to eat high-potassium foods only.
Correct Answer: B
Rationale: Serum digoxin > 2.0 ng/mL accompanied by bradycardia, gastrointestinal
upset, and visual disturbances confirms digoxin toxicity. The nurse must hold the
drug, notify the provider, monitor ECG/potassium, and administer Digibind for severe
toxicity.
Question 12
A client with primary hypertension is prescribed lisinopril, an ACE inhibitor.
Which client statement during a follow-up visit requires immediate evaluation by
the nurse?
• A. "I have a mild, dry tickling cough at night."
• B. "My lips and tongue felt swollen when I woke up this morning."
• C. "My urine output has been light yellow."
• D. "I noticed my blood pressure dropped from 148/90 to 126/82."
Correct Answer: B
Rationale: Facial and lip/tongue swelling indicates angioedema, a life-threatening
adverse reaction to ACE inhibitors caused by bradykinin accumulation. It requires
immediate drug discontinuation and airway protection.
Edition: NCLEX Practice Questions &
Study Guide
Question 1
A home health nurse is conducting an initial assessment on an 82-year-old client
who takes 11 different daily prescription and over-the-counter medications. The
nurse identifies that the client has been prescribed two different brand-name
drugs that contain the same generic active ingredient (acetaminophen). What is
the priority nursing diagnosis for this client?
• A. Risk for Deficient Fluid Volume related to polypharmacy
• B. Risk for Prone-for-Enhanced Knowledge related to drug regimen
• C. Risk for Poisoning / Accidental Toxicity related to drug duplication and
polypharmacy
• D. Impaired Memory related to medication complexity
Correct Answer: C
Rationale: Drug duplication in polypharmacy creates a major safety hazard for acute
hepatotoxicity (acetaminophen toxicity). The priority nursing diagnosis is identifying and
preventing drug duplication to protect the client from inadvertent overdose.
Question 2
Which pharmacokinetic process is most directly affected when a client with end-
stage liver disease (cirrhosis) receives a drug that is highly bound to plasma
proteins (such as warfarin or phenytoin)?
• A. Active tubular excretion in the nephron
• B. Drug distribution and serum active free-drug concentrations
• C. Gastric mucosal absorption rates
• D. Pulmonary clearance via exhalation
Correct Answer: B
Rationale: The liver synthesizes plasma proteins (primarily albumin). Severe liver
dysfunction causes hypoalbuminemia, reducing the available protein binding sites. As a
result, a higher percentage of the drug remains unbound ("free"), significantly increasing
pharmacologic activity and toxicity risk.
,Question 3
A nurse prepares to administer a sublingual nitroglycerin tablet to a client
experiencing acute angina. What rationale explains why this medication is
administered sublingually rather than swallowed orally?
• A. Sublingual absorption prevents destruction by gastric acid and bypasses
hepatic first-pass metabolism.
• B. Sublingual routes guarantee a slower, sustained release over 24 hours.
• C. Swallowing nitroglycerin causes immediate esophageal ulceration.
• D. Sublingual administration stimulates renal excretion within minutes.
Correct Answer: A
Rationale: Sublingual administration allows rapid absorption directly into the systemic
venous circulation via the oral mucosa, completely bypassing the GI tract and hepatic
first-pass metabolism, ensuring rapid onset of action.
Question 4
A pediatric nurse calculates a weight-based medication dosage for a 6-year-old
child. The medication order reads: "Administer 15 mg/kg PO every 8 hours." The
child weighs 44 lbs. What total daily dose (in milligrams) will the child receive?
• A. 300 mg/day
• B. 600 mg/day
• C. 900 mg/day
• D. 1,200 mg/day
Correct Answer: C
Rationale:
1. Convert weight from pounds to kilograms:
44 lbs
Weight = = 20 kg
2.2
2. Calculate single dose:
Single Dose = 20 kg × 15 mg/kg = 300 mg
3. Calculate total daily dose (every 8 hours = 3 doses/day):
Total Daily Dose = 300 mg × 3 = 900 mg/day
,Question 5
Which clinical finding represents a true Type 1 IgE-mediated hypersensitivity
reaction to a newly prescribed antibiotic?
• A. Mild nausea and epigastric discomfort after taking the first dose
• B. Urticaria (hives), bronchospasm, and laryngeal edema
• C. Constipation and dry mouth after 3 days of therapy
• D. Black hairy tongue after 10 days of oral therapy
Correct Answer: B
Rationale: IgE-mediated anaphylactic reactions present with sudden histamine release
causing urticaria, angioedema, bronchospasm, and hypotension. Mild GI upset is a
common side effect, not an allergic reaction.
Questions 6–10 Quick-Reference Matrix (Foundations of Pharmacology)
Pharmacokinetic / Core Definition / Key NCLEX Safety
Q#
Nursing Concept Clinical Focus Priority
Inactivation of oral Explains why oral doses of
drugs by hepatic morphine/propranolol are
6 First-Pass Effect
portal circulation prior much higher than IV
to systemic reach. doses.
Time required for Determines dosing
serum drug intervals and time required
7 Half-Life (𝑡1/2 )
concentration to to reach steady state (~4–
decline by 50%. 5 half-lives).
Narrow TI drugs (digoxin,
Ratio between toxic
Therapeutic Index lithium, warfarin) require
8 dose (TD50 ) and
(TI) strict serum level
effective dose (ED50 ).
monitoring.
Right Client, Right
Verify using two client
Drug, Right Dose,
The 6 Rights of identifiers and check the
9 Right Route, Right
Medication Safety MAR three times prior to
Time, Right
administration.
Documentation.
Evidence-based list Focuses on reducing
10 Beers Criteria
of high-risk drugs to anticholinergic toxicity,
, Pharmacokinetic / Core Definition / Key NCLEX Safety
Q#
Nursing Concept Clinical Focus Priority
avoid or dose-adjust falls, delirium, and GI
in older adults. bleeding in seniors.
Module 2: Cardiovascular & Renal Pharmacology
Question 11
A client receiving digoxin 0.125 mg PO daily presents with nausea, vomiting,
blurred vision with yellow-green halos, and a resting heart rate of 48 beats/min.
The nurse notes a serum digoxin level of 2.6 ng/mL. What is the immediate
priority nursing action?
• A. Administer the next scheduled dose with a glass of milk.
• B. Withhold the digoxin dose, notify the healthcare provider immediately, and
prepare digoxin immune Fab (Digibind) if ordered.
• C. Instruct the client to perform isometric exercises to raise heart rate.
• D. Encourage the client to eat high-potassium foods only.
Correct Answer: B
Rationale: Serum digoxin > 2.0 ng/mL accompanied by bradycardia, gastrointestinal
upset, and visual disturbances confirms digoxin toxicity. The nurse must hold the
drug, notify the provider, monitor ECG/potassium, and administer Digibind for severe
toxicity.
Question 12
A client with primary hypertension is prescribed lisinopril, an ACE inhibitor.
Which client statement during a follow-up visit requires immediate evaluation by
the nurse?
• A. "I have a mild, dry tickling cough at night."
• B. "My lips and tongue felt swollen when I woke up this morning."
• C. "My urine output has been light yellow."
• D. "I noticed my blood pressure dropped from 148/90 to 126/82."
Correct Answer: B
Rationale: Facial and lip/tongue swelling indicates angioedema, a life-threatening
adverse reaction to ACE inhibitors caused by bradykinin accumulation. It requires
immediate drug discontinuation and airway protection.
