NSG 318 EXAM 300 ACTUAL QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE LATEST 2026-2027 ALREADY
GRADED A+
This comprehensive set of 300 unique, multiple-choice questions is specifically
designed for the NSG 318 Pharmacology exam at Grand Canyon University.
Each question targets a distinct drug, clinical scenario, or pharmacological
principle—covering autonomic agents, cardiovascular drugs, antibiotics,
anticoagulants, antipsychotics, anticonvulsants, chemotherapeutics, and
immunosuppressants. No question repeats a drug or scenario. Every item
includes a correct answer and a detailed, evidence-based rationale that
explains the underlying mechanism, side effect, drug interaction, or nursing
intervention. These questions are ideal for self-assessment, exam preparation,
and reinforcing critical thinking for safe medication administration in nursing
practice.
1. A patient prescribed warfarin has an INR of 4.5. Which action is most
appropriate?
A) Increase the warfarin dose
B) Administer vitamin K
C) Administer protamine sulfate
D) Continue the current dose
Correct Answer: B
Rationale: The therapeutic INR range for warfarin is typically 2.0 to 3.0 for most
indications. An INR of 4.5 indicates a high risk of bleeding. Vitamin K is the
specific antidote for warfarin overdose because it reverses the anticoagulant effect
by promoting hepatic synthesis of active clotting factors.
2. Which medication is the antidote for heparin overdose?
A) Vitamin K
B) Naloxone
C) Protamine sulfate
D) Flumazenil
Correct Answer: C
Rationale: Protamine sulfate is a basic protein that binds to heparin molecules,
forming a stable complex that neutralizes the anticoagulant effect. Vitamin K
,reverses warfarin, naloxone reverses opioids, and flumazenil reverses
benzodiazepines.
3. A nurse is teaching a patient about albuterol. Which side effect should be
emphasized?
A) Bradycardia
B) Tachycardia
C) Hypotension
D) Sedation
Correct Answer: B
Rationale: Albuterol is a beta-2 adrenergic agonist, but it also has mild beta-1
effects at therapeutic doses. Beta-1 stimulation in the heart leads to increased heart
rate (tachycardia) and palpitations. It does not typically cause bradycardia,
hypotension, or sedation.
4. A patient with heart failure is prescribed furosemide. What electrolyte imbalance
is most concerning?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Correct Answer: B
Rationale: Furosemide is a loop diuretic that acts on the ascending loop of Henle,
inhibiting sodium and chloride reabsorption and causing significant potassium loss
in the distal tubule. Hypokalemia can precipitate cardiac dysrhythmias, especially
in patients taking digoxin.
5. The mechanism of action of ACE inhibitors like lisinopril is:
A) Blocking beta-1 receptors in the heart
B) Inhibiting conversion of angiotensin I to angiotensin II
C) Blocking calcium channels in vascular smooth muscle
D) Inhibiting the renin enzyme directly
Correct Answer: B
Rationale: ACE inhibitors block the angiotensin-converting enzyme, which is
responsible for converting inactive angiotensin I to active angiotensin II.
Angiotensin II is a potent vasoconstrictor and stimulates aldosterone release.
Blocking this leads to vasodilation and decreased fluid retention.
6. Which symptom is a classic adverse effect of potassium-sparing diuretics such
as spironolactone?
,A) Hypokalemia
B) Hyperkalemia
C) Hypoglycemia
D) Hyponatremia
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that works by blocking
aldosterone receptors in the distal tubule. This reduces sodium reabsorption but
also decreases potassium excretion, leading to a risk of hyperkalemia, especially in
patients with renal impairment.
7. A patient taking metoprolol reports dizziness and a heart rate of 52 bpm. The
nurse should:
A) Encourage the patient to take the next dose immediately
B) Hold the medication and notify the prescriber
C) Administer atropine as a standing order
D) Reassure the patient that this is normal
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that reduces heart rate and contractility. A
heart rate below 60 bpm with symptomatic dizziness warrants holding the dose and
consulting the prescriber, as bradycardia can lead to hypotension and syncope.
8. Which drug is most likely to cause a dry, persistent cough as a side effect?
A) Losartan
B) Enalapril
C) Amlodipine
D) Hydrochlorothiazide
Correct Answer: B
Rationale: Enalapril is an ACE inhibitor. A common and troublesome side effect of
this class is a dry, non-productive cough due to accumulation of bradykinin in the
lungs. Losartan is an ARB and does not typically cause this cough.
9. A patient on digoxin complains of nausea, vomiting, and seeing yellow halos
around lights. The nurse suspects:
A) Allergic reaction
B) Digoxin toxicity
C) Myocardial infarction
D) Beta-blocker overdose
Correct Answer: B
Rationale: Nausea, vomiting, and visual disturbances (yellow or green halos,
blurred vision) are classic signs of digoxin toxicity. Other signs include confusion
, and cardiac dysrhythmias. These symptoms warrant immediate assessment of
digoxin serum levels.
10. For a patient in severe anaphylactic shock, the first-line medication is:
A) Diphenhydramine
B) Epinephrine
C) Albuterol
D) Corticosteroids
Correct Answer: B
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It acts rapidly to
reverse bronchoconstriction, increase cardiac output, and reduce laryngeal edema
through alpha and beta adrenergic effects. Antihistamines and corticosteroids are
secondary adjuncts.
11. Which medication is considered a high-alert drug requiring special safeguards?
A) Acetaminophen
B) Ibuprofen
C) Heparin
D) Amoxicillin
Correct Answer: C
Rationale: Heparin is a high-alert medication because it has a narrow therapeutic
index and any error in dosing can cause serious bleeding or thrombosis. The
Institute for Safe Medication Practices includes anticoagulants on the high-alert list
requiring independent double checks.
12. A patient is prescribed clopidogrel after a stent placement. The nurse explains
the purpose is:
A) To dissolve existing clots
B) To prevent platelet aggregation
C) To thin the blood by reducing clotting factors
D) To dilate coronary arteries
Correct Answer: B
Rationale: Clopidogrel is a P2Y12 platelet inhibitor that prevents ADP-induced
platelet aggregation. It does not dissolve clots (thrombolytics do), does not directly
affect clotting factors (heparin/warfarin do), and does not cause vasodilation.
13. A patient receiving an IV infusion of dopamine at a low dose will likely
experience:
A) Increased renal blood flow
B) Vasoconstriction
ANSWERS WITH RATIONALE LATEST 2026-2027 ALREADY
GRADED A+
This comprehensive set of 300 unique, multiple-choice questions is specifically
designed for the NSG 318 Pharmacology exam at Grand Canyon University.
Each question targets a distinct drug, clinical scenario, or pharmacological
principle—covering autonomic agents, cardiovascular drugs, antibiotics,
anticoagulants, antipsychotics, anticonvulsants, chemotherapeutics, and
immunosuppressants. No question repeats a drug or scenario. Every item
includes a correct answer and a detailed, evidence-based rationale that
explains the underlying mechanism, side effect, drug interaction, or nursing
intervention. These questions are ideal for self-assessment, exam preparation,
and reinforcing critical thinking for safe medication administration in nursing
practice.
1. A patient prescribed warfarin has an INR of 4.5. Which action is most
appropriate?
A) Increase the warfarin dose
B) Administer vitamin K
C) Administer protamine sulfate
D) Continue the current dose
Correct Answer: B
Rationale: The therapeutic INR range for warfarin is typically 2.0 to 3.0 for most
indications. An INR of 4.5 indicates a high risk of bleeding. Vitamin K is the
specific antidote for warfarin overdose because it reverses the anticoagulant effect
by promoting hepatic synthesis of active clotting factors.
2. Which medication is the antidote for heparin overdose?
A) Vitamin K
B) Naloxone
C) Protamine sulfate
D) Flumazenil
Correct Answer: C
Rationale: Protamine sulfate is a basic protein that binds to heparin molecules,
forming a stable complex that neutralizes the anticoagulant effect. Vitamin K
,reverses warfarin, naloxone reverses opioids, and flumazenil reverses
benzodiazepines.
3. A nurse is teaching a patient about albuterol. Which side effect should be
emphasized?
A) Bradycardia
B) Tachycardia
C) Hypotension
D) Sedation
Correct Answer: B
Rationale: Albuterol is a beta-2 adrenergic agonist, but it also has mild beta-1
effects at therapeutic doses. Beta-1 stimulation in the heart leads to increased heart
rate (tachycardia) and palpitations. It does not typically cause bradycardia,
hypotension, or sedation.
4. A patient with heart failure is prescribed furosemide. What electrolyte imbalance
is most concerning?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Correct Answer: B
Rationale: Furosemide is a loop diuretic that acts on the ascending loop of Henle,
inhibiting sodium and chloride reabsorption and causing significant potassium loss
in the distal tubule. Hypokalemia can precipitate cardiac dysrhythmias, especially
in patients taking digoxin.
5. The mechanism of action of ACE inhibitors like lisinopril is:
A) Blocking beta-1 receptors in the heart
B) Inhibiting conversion of angiotensin I to angiotensin II
C) Blocking calcium channels in vascular smooth muscle
D) Inhibiting the renin enzyme directly
Correct Answer: B
Rationale: ACE inhibitors block the angiotensin-converting enzyme, which is
responsible for converting inactive angiotensin I to active angiotensin II.
Angiotensin II is a potent vasoconstrictor and stimulates aldosterone release.
Blocking this leads to vasodilation and decreased fluid retention.
6. Which symptom is a classic adverse effect of potassium-sparing diuretics such
as spironolactone?
,A) Hypokalemia
B) Hyperkalemia
C) Hypoglycemia
D) Hyponatremia
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that works by blocking
aldosterone receptors in the distal tubule. This reduces sodium reabsorption but
also decreases potassium excretion, leading to a risk of hyperkalemia, especially in
patients with renal impairment.
7. A patient taking metoprolol reports dizziness and a heart rate of 52 bpm. The
nurse should:
A) Encourage the patient to take the next dose immediately
B) Hold the medication and notify the prescriber
C) Administer atropine as a standing order
D) Reassure the patient that this is normal
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that reduces heart rate and contractility. A
heart rate below 60 bpm with symptomatic dizziness warrants holding the dose and
consulting the prescriber, as bradycardia can lead to hypotension and syncope.
8. Which drug is most likely to cause a dry, persistent cough as a side effect?
A) Losartan
B) Enalapril
C) Amlodipine
D) Hydrochlorothiazide
Correct Answer: B
Rationale: Enalapril is an ACE inhibitor. A common and troublesome side effect of
this class is a dry, non-productive cough due to accumulation of bradykinin in the
lungs. Losartan is an ARB and does not typically cause this cough.
9. A patient on digoxin complains of nausea, vomiting, and seeing yellow halos
around lights. The nurse suspects:
A) Allergic reaction
B) Digoxin toxicity
C) Myocardial infarction
D) Beta-blocker overdose
Correct Answer: B
Rationale: Nausea, vomiting, and visual disturbances (yellow or green halos,
blurred vision) are classic signs of digoxin toxicity. Other signs include confusion
, and cardiac dysrhythmias. These symptoms warrant immediate assessment of
digoxin serum levels.
10. For a patient in severe anaphylactic shock, the first-line medication is:
A) Diphenhydramine
B) Epinephrine
C) Albuterol
D) Corticosteroids
Correct Answer: B
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It acts rapidly to
reverse bronchoconstriction, increase cardiac output, and reduce laryngeal edema
through alpha and beta adrenergic effects. Antihistamines and corticosteroids are
secondary adjuncts.
11. Which medication is considered a high-alert drug requiring special safeguards?
A) Acetaminophen
B) Ibuprofen
C) Heparin
D) Amoxicillin
Correct Answer: C
Rationale: Heparin is a high-alert medication because it has a narrow therapeutic
index and any error in dosing can cause serious bleeding or thrombosis. The
Institute for Safe Medication Practices includes anticoagulants on the high-alert list
requiring independent double checks.
12. A patient is prescribed clopidogrel after a stent placement. The nurse explains
the purpose is:
A) To dissolve existing clots
B) To prevent platelet aggregation
C) To thin the blood by reducing clotting factors
D) To dilate coronary arteries
Correct Answer: B
Rationale: Clopidogrel is a P2Y12 platelet inhibitor that prevents ADP-induced
platelet aggregation. It does not dissolve clots (thrombolytics do), does not directly
affect clotting factors (heparin/warfarin do), and does not cause vasodilation.
13. A patient receiving an IV infusion of dopamine at a low dose will likely
experience:
A) Increased renal blood flow
B) Vasoconstriction
