NCLEX-PN Pharmacology Exam
2025/2026 – Verified Questions, Correct
Answers, and Expert Rationales
Pharmacological and Parenteral Therapies
1. A client is prescribed lisinopril for hypertension. What is the most important
adverse effect to monitor for?
a. Hyperkalemia
b. Hypoglycemia
c. Bradycardia
d. Rash
Answer: a. Hyperkalemia
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia by inhibiting
aldosterone secretion, which reduces potassium excretion. Monitoring serum potassium
levels is critical, especially in clients with renal impairment, per JNC 8 guidelines.
Hypoglycemia, bradycardia, and rash are not common adverse effects of lisinopril.
2. A client with type 2 diabetes is prescribed metformin. What is the most important
patient teaching point?
a. Take with food to reduce gastrointestinal upset
b. Avoid alcohol to prevent hypoglycemia
c. Monitor for weight gain
d. Expect increased thirst
Answer: a. Take with food to reduce gastrointestinal upset
Rationale: Metformin commonly causes gastrointestinal side effects like nausea and
diarrhea. Taking it with food minimizes these effects, per ADA guidelines. Alcohol
increases the risk of lactic acidosis, not hypoglycemia, and metformin typically does not
cause weight gain or thirst.
3. A client is receiving heparin for a deep vein thrombosis. What laboratory value
should the nurse monitor?
a. INR
b. aPTT
c. Platelet count
d. Serum creatinine
Answer: b. aPTT
Rationale: Heparin’s anticoagulant effect is monitored by the activated partial
thromboplastin time (aPTT), which should be 1.5–2.5 times the control value. INR is
used for warfarin, while platelet count and creatinine are monitored for other
complications but not for heparin’s efficacy.
4. A client is prescribed albuterol for asthma. What is the primary action of this
medication?
a. Reduces inflammation
b. Dilates bronchioles
c. Inhibits histamine release
, d. Decreases mucus production
Answer: b. Dilates bronchioles
Rationale: Albuterol, a short-acting beta-2 agonist, causes bronchodilation by relaxing
bronchial smooth muscle, relieving acute asthma symptoms, per NHLBI guidelines. It
does not reduce inflammation, inhibit histamine, or decrease mucus production.
5. A client is prescribed furosemide for heart failure. What electrolyte imbalance is
most likely to occur?
a. Hyperkalemia
b. Hypokalemia
c. Hypernatremia
d. Hypocalcemia
Answer: b. Hypokalemia
Rationale: Furosemide, a loop diuretic, increases potassium excretion, leading to
hypokalemia, a common adverse effect. Monitoring potassium levels is essential, per
ACC/AHA guidelines.
6. A client with chronic pain is prescribed ibuprofen. What is the most important
adverse effect to monitor for?
a. Hepatotoxicity
b. Gastrointestinal bleeding
c. Hypertension
d. Bradycardia
Answer: b. Gastrointestinal bleeding
Rationale: Ibuprofen, an NSAID, can irritate the gastric mucosa and inhibit platelet
aggregation, increasing the risk of gastrointestinal bleeding, per ACR guidelines.
Hepatotoxicity is less common, and ibuprofen does not typically cause hypertension or
bradycardia.
7. A client is prescribed warfarin for atrial fibrillation. What dietary advice should the
nurse provide?
a. Avoid foods high in vitamin K
b. Increase calcium intake
c. Limit carbohydrate intake
d. Avoid high-protein foods
Answer: a. Avoid foods high in vitamin K
Rationale: Warfarin inhibits vitamin K-dependent clotting factors. Foods high in vitamin
K (e.g., leafy greens) can reduce its effectiveness, requiring consistent dietary intake, per
ACC guidelines.
8. A client with a urinary tract infection is prescribed nitrofurantoin. What should the
nurse teach the client to expect?
a. Orange-colored urine
b. Increased thirst
c. Photosensitivity
d. Weight gain
Answer: a. Orange-colored urine
Rationale: Nitrofurantoin commonly causes harmless urine discoloration (orange or
brown). Patients should be informed to avoid concern, per IDSA guidelines.
Photosensitivity is associated with other antibiotics like doxycycline.
, 9. A client is receiving morphine for severe pain. What is the priority nursing action?
a. Monitor respiratory rate
b. Check blood pressure
c. Assess for nausea
d. Monitor urine output
Answer: a. Monitor respiratory rate
Rationale: Morphine, an opioid, can cause respiratory depression, a life-threatening
adverse effect. Monitoring respiratory rate is the priority to ensure client safety, per APS
guidelines.
10. A client with type 1 diabetes is prescribed insulin lispro. When should this
medication be administered?
a. 30 minutes before meals
b. At bedtime
c. Immediately before or after meals
d. Every 4 hours
Answer: c. Immediately before or after meals
Rationale: Insulin lispro, a rapid-acting insulin, is administered immediately before or
after meals to control postprandial glucose spikes, per ADA guidelines.
11. A client is prescribed digoxin for heart failure. What is a sign of digoxin toxicity?
a. Visual disturbances
b. Hyperglycemia
c. Hypertension
d. Rash
Answer: a. Visual disturbances
Rationale: Digoxin toxicity can cause visual disturbances (e.g., yellow-green halos),
nausea, and arrhythmias due to its narrow therapeutic index, per ACC/AHA guidelines.
Monitoring serum digoxin levels is critical.
12. A client with hypertension is prescribed hydrochlorothiazide. What should the
nurse monitor for?
a. Hypokalemia
b. Hypercalcemia
c. Hypoglycemia
d. Bradycardia
Answer: a. Hypokalemia
Rationale: Hydrochlorothiazide, a thiazide diuretic, increases potassium excretion,
leading to hypokalemia, per JNC 8 guidelines. It may also cause hypercalcemia but not
hypoglycemia or bradycardia.
13. A client is prescribed levothyroxine for hypothyroidism. What is the most important
teaching point?
a. Take on an empty stomach
b. Take at bedtime
c. Take with calcium supplements
d. Expect immediate symptom relief
Answer: a. Take on an empty stomach
Rationale: Levothyroxine should be taken on an empty stomach (30–60 minutes before
breakfast) to ensure optimal absorption, per ATA guidelines. Calcium supplements can
interfere with absorption.
2025/2026 – Verified Questions, Correct
Answers, and Expert Rationales
Pharmacological and Parenteral Therapies
1. A client is prescribed lisinopril for hypertension. What is the most important
adverse effect to monitor for?
a. Hyperkalemia
b. Hypoglycemia
c. Bradycardia
d. Rash
Answer: a. Hyperkalemia
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia by inhibiting
aldosterone secretion, which reduces potassium excretion. Monitoring serum potassium
levels is critical, especially in clients with renal impairment, per JNC 8 guidelines.
Hypoglycemia, bradycardia, and rash are not common adverse effects of lisinopril.
2. A client with type 2 diabetes is prescribed metformin. What is the most important
patient teaching point?
a. Take with food to reduce gastrointestinal upset
b. Avoid alcohol to prevent hypoglycemia
c. Monitor for weight gain
d. Expect increased thirst
Answer: a. Take with food to reduce gastrointestinal upset
Rationale: Metformin commonly causes gastrointestinal side effects like nausea and
diarrhea. Taking it with food minimizes these effects, per ADA guidelines. Alcohol
increases the risk of lactic acidosis, not hypoglycemia, and metformin typically does not
cause weight gain or thirst.
3. A client is receiving heparin for a deep vein thrombosis. What laboratory value
should the nurse monitor?
a. INR
b. aPTT
c. Platelet count
d. Serum creatinine
Answer: b. aPTT
Rationale: Heparin’s anticoagulant effect is monitored by the activated partial
thromboplastin time (aPTT), which should be 1.5–2.5 times the control value. INR is
used for warfarin, while platelet count and creatinine are monitored for other
complications but not for heparin’s efficacy.
4. A client is prescribed albuterol for asthma. What is the primary action of this
medication?
a. Reduces inflammation
b. Dilates bronchioles
c. Inhibits histamine release
, d. Decreases mucus production
Answer: b. Dilates bronchioles
Rationale: Albuterol, a short-acting beta-2 agonist, causes bronchodilation by relaxing
bronchial smooth muscle, relieving acute asthma symptoms, per NHLBI guidelines. It
does not reduce inflammation, inhibit histamine, or decrease mucus production.
5. A client is prescribed furosemide for heart failure. What electrolyte imbalance is
most likely to occur?
a. Hyperkalemia
b. Hypokalemia
c. Hypernatremia
d. Hypocalcemia
Answer: b. Hypokalemia
Rationale: Furosemide, a loop diuretic, increases potassium excretion, leading to
hypokalemia, a common adverse effect. Monitoring potassium levels is essential, per
ACC/AHA guidelines.
6. A client with chronic pain is prescribed ibuprofen. What is the most important
adverse effect to monitor for?
a. Hepatotoxicity
b. Gastrointestinal bleeding
c. Hypertension
d. Bradycardia
Answer: b. Gastrointestinal bleeding
Rationale: Ibuprofen, an NSAID, can irritate the gastric mucosa and inhibit platelet
aggregation, increasing the risk of gastrointestinal bleeding, per ACR guidelines.
Hepatotoxicity is less common, and ibuprofen does not typically cause hypertension or
bradycardia.
7. A client is prescribed warfarin for atrial fibrillation. What dietary advice should the
nurse provide?
a. Avoid foods high in vitamin K
b. Increase calcium intake
c. Limit carbohydrate intake
d. Avoid high-protein foods
Answer: a. Avoid foods high in vitamin K
Rationale: Warfarin inhibits vitamin K-dependent clotting factors. Foods high in vitamin
K (e.g., leafy greens) can reduce its effectiveness, requiring consistent dietary intake, per
ACC guidelines.
8. A client with a urinary tract infection is prescribed nitrofurantoin. What should the
nurse teach the client to expect?
a. Orange-colored urine
b. Increased thirst
c. Photosensitivity
d. Weight gain
Answer: a. Orange-colored urine
Rationale: Nitrofurantoin commonly causes harmless urine discoloration (orange or
brown). Patients should be informed to avoid concern, per IDSA guidelines.
Photosensitivity is associated with other antibiotics like doxycycline.
, 9. A client is receiving morphine for severe pain. What is the priority nursing action?
a. Monitor respiratory rate
b. Check blood pressure
c. Assess for nausea
d. Monitor urine output
Answer: a. Monitor respiratory rate
Rationale: Morphine, an opioid, can cause respiratory depression, a life-threatening
adverse effect. Monitoring respiratory rate is the priority to ensure client safety, per APS
guidelines.
10. A client with type 1 diabetes is prescribed insulin lispro. When should this
medication be administered?
a. 30 minutes before meals
b. At bedtime
c. Immediately before or after meals
d. Every 4 hours
Answer: c. Immediately before or after meals
Rationale: Insulin lispro, a rapid-acting insulin, is administered immediately before or
after meals to control postprandial glucose spikes, per ADA guidelines.
11. A client is prescribed digoxin for heart failure. What is a sign of digoxin toxicity?
a. Visual disturbances
b. Hyperglycemia
c. Hypertension
d. Rash
Answer: a. Visual disturbances
Rationale: Digoxin toxicity can cause visual disturbances (e.g., yellow-green halos),
nausea, and arrhythmias due to its narrow therapeutic index, per ACC/AHA guidelines.
Monitoring serum digoxin levels is critical.
12. A client with hypertension is prescribed hydrochlorothiazide. What should the
nurse monitor for?
a. Hypokalemia
b. Hypercalcemia
c. Hypoglycemia
d. Bradycardia
Answer: a. Hypokalemia
Rationale: Hydrochlorothiazide, a thiazide diuretic, increases potassium excretion,
leading to hypokalemia, per JNC 8 guidelines. It may also cause hypercalcemia but not
hypoglycemia or bradycardia.
13. A client is prescribed levothyroxine for hypothyroidism. What is the most important
teaching point?
a. Take on an empty stomach
b. Take at bedtime
c. Take with calcium supplements
d. Expect immediate symptom relief
Answer: a. Take on an empty stomach
Rationale: Levothyroxine should be taken on an empty stomach (30–60 minutes before
breakfast) to ensure optimal absorption, per ATA guidelines. Calcium supplements can
interfere with absorption.
