NSG124 Pharmacology - Exam 3 2026/2027
Comprehensive Review | CNS & Special
Topics | 250+ Verified Q&A | Graded A |
Herzing University
Cumulative Pharmacotherapeutics & Clinical Judgment Assessment | 2026/2027
Standards
Herzing University | Department of Nursing | NSG 124 Pharmacology - Final Exam
Review
Part 1 Final Exam Pharmacological Domains (High-Yield Synthesis 2026-2027)
Autonomic & Central Nervous System
● Adrenergic agonists: α1 (vasoconstriction), β1 (heart), β2 (bronchodilation).
Watch HR/BP, tremor, hypokalemia.
● Cholinergics: Direct (bethanechol) & indirect (neostigmine). S/S overdose:
SLUDGE. Antidote: atropine 0.5–2 mg IV.
● Opioids: Morphine 2–10 mg q3-4h; fentanyl 25–100 mcg/h patch. Antagonist:
naloxone 0.4–2 mg IV q2-3 min (max 10 mg). Respiratory depression <12/min =
emergency.
● Anxiolytics/Sedatives: Benzos (lorazepam 0.5–2 mg) – enhanced GABA.
Flumazenil 0.2 mg IV (caution in mixed OD/seizure history).
, ● Antidepressants 2027: SSRIs (sertraline 50–200 mg) – 2–4 wk onset; monitor
QTc, hyponatremia, GI bleed with NSAIDs. SNRIs: venlafaxine (75–225 mg) – ↑BP
at >150 mg. MAOI (phenelzine) – tyramine restriction, 2-wk washout.
● Antipsychotics: 1st-gen (haloperidol 2–5 mg) – EPS, NMS. 2nd-gen (risperidone
2–6 mg) – ↑prolactin, wt gain; aripiprazole partial agonist – ↓prolactin. Clozapine
– agranulocytosis, myocarditis; ANC weekly × 6 mo → monthly.
● Mood stabilizers: Lithium 300–600 mg bid; goal 0.6–1.0 mEq/L, narrow TI; tox:
coarse tremor >1.5, seizures >2.5 mEq/L. Valproate 15–60 mg/kg/day –
hepatotox, ↑NH3, teratogen (spina bifida). Lamotrigine – SJS risk, slow titration
25 mg q2 wk.
Cardiovascular & Renal
● ACE-i (-pril): ↓mortality in HFrEF, DM nephropathy; SE: cough, ↑K, angio-edema;
watch SCr ↑>30 %.
● ARB (-sartan): substitute if cough; do NOT combine with ACE.
● Beta-blockers: metoprolol succinate 25–200 mg daily – ↓sudden death post-MI;
mask hypoglycemia. Carvedilol (α1+β) – also ↓portal HTN.
● Calcium-channel blockers: amlodipine 5–10 mg – peripheral edema; diltiazem
↓HR – caution with digoxin (↑levels).
● Diuretics: Loop (furosemide 20–80 mg) – ototoxicity, ↓K, ↓Mg; give AM. Thiazide
(HCTZ 12.5–25 mg) – hyperGLY, hyperURIC, ↓Na. K-sparing (spironolactone) –
gynecomastia, ↑K (hold if K>5).
● Anticoagulants 2027: Apixaban 5 mg bid – CrCl >25, no lab; SE: bleed – antidote
andexanet alfa 400–800 mg IV. Warfarin – INR 2–3; vit-K 2–10 mg PO/IV
reverses. DOACs preferred in non-valvular AF.
● Antidysrhythmics: Amiodarone – loading 150 mg IV over 10 min; monitor PFTs,
TFTs, LFTs q6 mo; many CYP interactions (↑digoxin, ↑warfarin).
Endocrine & Metabolic
● Insulins 2027: Rapid (aspart) onset 15 min, peak 1 h; give ≤15 min before meal.
Long-acting (glargine U-100) – qHS, no peak. Sliding scale is adjunct ONLY –
basal-bolus preferred.
● Oral hypoglycemics: Metformin 1–2 g daily – lactic acidosis if SCr >1.4 (♀) or
eGFR <30; hold before IV contrast. SGLT2-i (empagliflozin) – ↓HF
hospitalizations, ↑mycotic infections, euglycemic DKA. GLP-1 RA (semaglutide) –
weekly SC, delayed gastric emptying, wt loss, black-box thyroid C-cell tumors in
rodents.
, ● Corticosteroids: Prednisone 40 mg/day × 5 days – taper if >3 wk to prevent
adrenal insufficiency. SE: ↑GLC, osteoporosis, psychosis, ↑BP. Give AM to mimic
circadian rhythm.
Anti-infectives & Immune Modulators
● Penicillin allergy: avoid cephalosporins if anaphylaxis; use aztreonam (gram-neg
only) or vancomycin (gram-pos).
● Aminoglycosides: gentamicin – peak 6–10 mcg/mL, trough <2; nephro/oto-toxic;
once-daily (5–7 mg/kg) preferred.
● Vancomycin: trough 10–15 mcg/mL (15–20 in severe MRSA); ↑nephrotox with
piperacillin-tazobactam. New 2026 AUC-guided dosing (400–600 mg·h/L).
● Antivirals: Oseltamivir 75 mg bid × 5 d – start ≤48 h of flu onset; SE: N/V,
hallucinations in kids.
● Vaccines 2027: Live (MMR, varicella, nasal flu) – contraindicated in pregnancy &
immunosuppression. Give inactivated flu shot to all ≥6 mo.
High-Alert / Emergency
● Chemo safety: wear double gloves, gown; dispose in cytotoxic container.
Vesicant extravasation: stop infusion, aspirate, elevate, apply cold (except
vincristine – heat).
● Epinephrine anaphylaxis: 0.3–0.5 mg (0.3–0.5 mL of 1:1000) IM mid-outer thigh;
repeat q5-15 min.
● High-alert list 2027: insulin, heparin, warfarin, chemo, PCA opioids, amiodarone,
magnesium sulfate, oxytocin – independent double check.
Part 2 Cumulative Final Practice Examination – Complex Scenario Questions &
Verified Solutions
Instructions: This practice exam assesses comprehensive pharmacology knowledge for
the final. Analyze each complex case, considering all medications and conditions. Apply
the nursing process and 2026/2027 medication safety standards. Select the SINGLE
BEST answer.
Question 1.
, A 68-year-old female (62 kg) with HFrEF (EF 30 %), type-2 DM, and AF on metformin 1 g
bid, digoxin 0.25 mg daily, warfarin 5 mg daily, and furosemide 40 mg bid arrives for
same-day surgery. Yesterday her INR was 3.8 (target 2.5); today SCr 1.4 mg/dL
(baseline 1.0), K 3.1 mEq/L, glucose 210 mg/dL. VS: BP 98/58, HR 92 irregular, RR 22,
O2 sat 94 % RA. Which pre-operative medication action is priority?
A. Hold today’s warfarin and give 2 mg PO vitamin K now
B. Hold furosemide and give 40 mEq oral KCl now*
C. Reduce digoxin to 0.125 mg and monitor
D. Increase metformin to 850 mg tid
Rationale: Correct answer B. Loop diuretic caused hypokalemia (K 3.1) which increases
risk of digoxin toxicity and peri-operative dysrhythmia; holding furosemide and repleting
K is priority. INR 3.8 is only modestly above target—vitamin K would over-correct and
increase thrombotic risk. Digoxin dose is appropriate for HF/AF; no indication to reduce.
Metformin should be held (not increased) 48 h pre-op due to SCr ↑>30 % and risk of
lactic acidosis with contrast dye.
Question 2.
A 14-year-old (45 kg) with ADHD combined type, asthma, and recent sinusitis is
prescribed methylphenidate ER 36 mg qAM, albuterol MDI 2 puffs q4h PRN, and is
finishing a 10-day course of amoxicillin-clavulanate 875/125 mg bid. His mother reports
new resting HR 120, hand tremor, and 2-lb weight loss in 1 week. Which nursing
intervention is most appropriate?
A. Discontinue methylphenidate immediately
B. Switch to atomoxetine 40 mg daily
Comprehensive Review | CNS & Special
Topics | 250+ Verified Q&A | Graded A |
Herzing University
Cumulative Pharmacotherapeutics & Clinical Judgment Assessment | 2026/2027
Standards
Herzing University | Department of Nursing | NSG 124 Pharmacology - Final Exam
Review
Part 1 Final Exam Pharmacological Domains (High-Yield Synthesis 2026-2027)
Autonomic & Central Nervous System
● Adrenergic agonists: α1 (vasoconstriction), β1 (heart), β2 (bronchodilation).
Watch HR/BP, tremor, hypokalemia.
● Cholinergics: Direct (bethanechol) & indirect (neostigmine). S/S overdose:
SLUDGE. Antidote: atropine 0.5–2 mg IV.
● Opioids: Morphine 2–10 mg q3-4h; fentanyl 25–100 mcg/h patch. Antagonist:
naloxone 0.4–2 mg IV q2-3 min (max 10 mg). Respiratory depression <12/min =
emergency.
● Anxiolytics/Sedatives: Benzos (lorazepam 0.5–2 mg) – enhanced GABA.
Flumazenil 0.2 mg IV (caution in mixed OD/seizure history).
, ● Antidepressants 2027: SSRIs (sertraline 50–200 mg) – 2–4 wk onset; monitor
QTc, hyponatremia, GI bleed with NSAIDs. SNRIs: venlafaxine (75–225 mg) – ↑BP
at >150 mg. MAOI (phenelzine) – tyramine restriction, 2-wk washout.
● Antipsychotics: 1st-gen (haloperidol 2–5 mg) – EPS, NMS. 2nd-gen (risperidone
2–6 mg) – ↑prolactin, wt gain; aripiprazole partial agonist – ↓prolactin. Clozapine
– agranulocytosis, myocarditis; ANC weekly × 6 mo → monthly.
● Mood stabilizers: Lithium 300–600 mg bid; goal 0.6–1.0 mEq/L, narrow TI; tox:
coarse tremor >1.5, seizures >2.5 mEq/L. Valproate 15–60 mg/kg/day –
hepatotox, ↑NH3, teratogen (spina bifida). Lamotrigine – SJS risk, slow titration
25 mg q2 wk.
Cardiovascular & Renal
● ACE-i (-pril): ↓mortality in HFrEF, DM nephropathy; SE: cough, ↑K, angio-edema;
watch SCr ↑>30 %.
● ARB (-sartan): substitute if cough; do NOT combine with ACE.
● Beta-blockers: metoprolol succinate 25–200 mg daily – ↓sudden death post-MI;
mask hypoglycemia. Carvedilol (α1+β) – also ↓portal HTN.
● Calcium-channel blockers: amlodipine 5–10 mg – peripheral edema; diltiazem
↓HR – caution with digoxin (↑levels).
● Diuretics: Loop (furosemide 20–80 mg) – ototoxicity, ↓K, ↓Mg; give AM. Thiazide
(HCTZ 12.5–25 mg) – hyperGLY, hyperURIC, ↓Na. K-sparing (spironolactone) –
gynecomastia, ↑K (hold if K>5).
● Anticoagulants 2027: Apixaban 5 mg bid – CrCl >25, no lab; SE: bleed – antidote
andexanet alfa 400–800 mg IV. Warfarin – INR 2–3; vit-K 2–10 mg PO/IV
reverses. DOACs preferred in non-valvular AF.
● Antidysrhythmics: Amiodarone – loading 150 mg IV over 10 min; monitor PFTs,
TFTs, LFTs q6 mo; many CYP interactions (↑digoxin, ↑warfarin).
Endocrine & Metabolic
● Insulins 2027: Rapid (aspart) onset 15 min, peak 1 h; give ≤15 min before meal.
Long-acting (glargine U-100) – qHS, no peak. Sliding scale is adjunct ONLY –
basal-bolus preferred.
● Oral hypoglycemics: Metformin 1–2 g daily – lactic acidosis if SCr >1.4 (♀) or
eGFR <30; hold before IV contrast. SGLT2-i (empagliflozin) – ↓HF
hospitalizations, ↑mycotic infections, euglycemic DKA. GLP-1 RA (semaglutide) –
weekly SC, delayed gastric emptying, wt loss, black-box thyroid C-cell tumors in
rodents.
, ● Corticosteroids: Prednisone 40 mg/day × 5 days – taper if >3 wk to prevent
adrenal insufficiency. SE: ↑GLC, osteoporosis, psychosis, ↑BP. Give AM to mimic
circadian rhythm.
Anti-infectives & Immune Modulators
● Penicillin allergy: avoid cephalosporins if anaphylaxis; use aztreonam (gram-neg
only) or vancomycin (gram-pos).
● Aminoglycosides: gentamicin – peak 6–10 mcg/mL, trough <2; nephro/oto-toxic;
once-daily (5–7 mg/kg) preferred.
● Vancomycin: trough 10–15 mcg/mL (15–20 in severe MRSA); ↑nephrotox with
piperacillin-tazobactam. New 2026 AUC-guided dosing (400–600 mg·h/L).
● Antivirals: Oseltamivir 75 mg bid × 5 d – start ≤48 h of flu onset; SE: N/V,
hallucinations in kids.
● Vaccines 2027: Live (MMR, varicella, nasal flu) – contraindicated in pregnancy &
immunosuppression. Give inactivated flu shot to all ≥6 mo.
High-Alert / Emergency
● Chemo safety: wear double gloves, gown; dispose in cytotoxic container.
Vesicant extravasation: stop infusion, aspirate, elevate, apply cold (except
vincristine – heat).
● Epinephrine anaphylaxis: 0.3–0.5 mg (0.3–0.5 mL of 1:1000) IM mid-outer thigh;
repeat q5-15 min.
● High-alert list 2027: insulin, heparin, warfarin, chemo, PCA opioids, amiodarone,
magnesium sulfate, oxytocin – independent double check.
Part 2 Cumulative Final Practice Examination – Complex Scenario Questions &
Verified Solutions
Instructions: This practice exam assesses comprehensive pharmacology knowledge for
the final. Analyze each complex case, considering all medications and conditions. Apply
the nursing process and 2026/2027 medication safety standards. Select the SINGLE
BEST answer.
Question 1.
, A 68-year-old female (62 kg) with HFrEF (EF 30 %), type-2 DM, and AF on metformin 1 g
bid, digoxin 0.25 mg daily, warfarin 5 mg daily, and furosemide 40 mg bid arrives for
same-day surgery. Yesterday her INR was 3.8 (target 2.5); today SCr 1.4 mg/dL
(baseline 1.0), K 3.1 mEq/L, glucose 210 mg/dL. VS: BP 98/58, HR 92 irregular, RR 22,
O2 sat 94 % RA. Which pre-operative medication action is priority?
A. Hold today’s warfarin and give 2 mg PO vitamin K now
B. Hold furosemide and give 40 mEq oral KCl now*
C. Reduce digoxin to 0.125 mg and monitor
D. Increase metformin to 850 mg tid
Rationale: Correct answer B. Loop diuretic caused hypokalemia (K 3.1) which increases
risk of digoxin toxicity and peri-operative dysrhythmia; holding furosemide and repleting
K is priority. INR 3.8 is only modestly above target—vitamin K would over-correct and
increase thrombotic risk. Digoxin dose is appropriate for HF/AF; no indication to reduce.
Metformin should be held (not increased) 48 h pre-op due to SCr ↑>30 % and risk of
lactic acidosis with contrast dye.
Question 2.
A 14-year-old (45 kg) with ADHD combined type, asthma, and recent sinusitis is
prescribed methylphenidate ER 36 mg qAM, albuterol MDI 2 puffs q4h PRN, and is
finishing a 10-day course of amoxicillin-clavulanate 875/125 mg bid. His mother reports
new resting HR 120, hand tremor, and 2-lb weight loss in 1 week. Which nursing
intervention is most appropriate?
A. Discontinue methylphenidate immediately
B. Switch to atomoxetine 40 mg daily
