Nursing Pharmacology | Comprehensive Study Guide,
Practice Exam, Questions & Answers, Pharmacology
Exam Prep Test Bank, Medication Classifications, Drug
Calculations, Safe Medication Administration,
Pharmacokinetics, Pharmacodynamics, Drug
Interactions, IV Medications, NCLEX-RN & NCLEX-PN
Review, Detailed Rationales, Complete Review
Question 1: A patient with a history of angina is prescribed sublingual nitroglycerin. Which
instruction is MOST critical for the nurse to include in the teaching plan?
A. Take the medication with a full glass of water to enhance absorption.
B. Chew the tablet thoroughly for faster onset of action.
C. Swallow the tablet whole with food to prevent gastric upset.
D. Allow the tablet to dissolve under the tongue and expect a tingling sensation.
CORRECT ANSWER: D. Allow the tablet to dissolve under the tongue and expect a tingling
sensation.
Rationale:Sublingual nitroglycerin must be placed under the tongue and allowed to dissolve
completely for rapid absorption through the sublingual mucosa. A mild tingling or burning sensation is
expected and indicates the tablet is still potent. The tablet should not be chewed or swallowed, as this
would inactivate the drug via first-pass hepatic metabolism. Taking it with water is not appropriate
and would prevent proper sublingual absorption.
Question 2: A nurse is administering digoxin to a patient with heart failure. Which assessment
finding would indicate a potential adverse effect requiring immediate action?
A. Heart rate of 58 beats per minute.
B. Serum potassium level of 3.2 mEq/L.
C. Serum digoxin level of 1.2 ng/mL.
D. Blood pressure of 132/78 mmHg.
CORRECT ANSWER: B. Serum potassium level of 3.2 mEq/L.
Rationale:Hypokalemia (serum K+ < 3.5 mEq/L) increases the risk of digoxin toxicity by enhancing its
binding to the sodium-potassium ATPase pump. A heart rate of 58 bpm is within an acceptable range
for a patient on digoxin, and a serum digoxin level of 1.2 ng/mL is within the therapeutic range (0.8–
2.0 ng/mL). The blood pressure reading is not alarming.
Question 3: A patient is prescribed warfarin for atrial fibrillation. The nurse should instruct
the patient to avoid which over-the-counter product due to a significant drug interaction?
,A. Acetaminophen.
B. Ibuprofen.
C. Diphenhydramine.
D. Loratadine.
CORRECT ANSWER: B. Ibuprofen.
Rationale:Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of
gastrointestinal bleeding and also displace warfarin from protein-binding sites, significantly
increasing the anticoagulant effect and bleeding risk. Acetaminophen is the preferred analgesic for
patients on warfarin. Diphenhydramine and loratadine do not have significant interactions with
warfarin.
Question 4: A patient is receiving an intravenous infusion of heparin. The nurse notes a sudden
drop in the patient's platelet count. Which condition should the nurse suspect?
A. Heparin-induced thrombocytopenia (HIT).
B. Idiopathic thrombocytopenic purpura (ITP).
C. Disseminated intravascular coagulation (DIC).
D. Thrombotic thrombocytopenic purpura (TTP).
CORRECT ANSWER: A. Heparin-induced thrombocytopenia (HIT).
Rationale:Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction to
heparin characterized by a significant drop in platelet count, typically occurring 5-10 days after
initiation of therapy. This condition is paradoxical as it increases the risk of thrombosis despite the
low platelet count. ITP, DIC, and TTP have different etiologies and are not directly caused by heparin
therapy.
Question 5: A nurse is providing education to a patient starting on an ACE inhibitor, lisinopril.
What side effect should the patient be instructed to report immediately?
A. Dry, persistent cough.
B. Dizziness when standing up.
C. Loss of taste.
D. Swelling of the lips and tongue.
CORRECT ANSWER: D. Swelling of the lips and tongue.
Rationale:Swelling of the lips, tongue, or face is a sign of angioedema, a rare but life-threatening
adverse effect of ACE inhibitors that requires immediate medical attention. While a dry cough,
,dizziness, and loss of taste are known side effects of ACE inhibitors, they are not immediately life-
threatening and can be managed with symptomatic care or medication adjustments.
Question 6: A patient with type 1 diabetes is prescribed insulin lispro. When should the nurse
advise the patient to administer this insulin?
A. 30-45 minutes before a meal.
B. Immediately before a meal.
C. 1 hour after a meal.
D. At bedtime.
CORRECT ANSWER: B. Immediately before a meal.
Rationale:Insulin lispro is a rapid-acting insulin analogue with an onset of action of approximately 15
minutes. It should be administered immediately (within 15 minutes) before a meal to match the
postprandial rise in blood glucose. Administering it 30-45 minutes prior would increase the risk of
hypoglycemia. Administering after a meal or at bedtime is not appropriate for its intended purpose.
Question 7: A patient on a metronidazole infusion reports a severe headache and flushing. The
nurse notes the patient's IV site is patent. Which substance is most likely responsible for this
reaction?
A. The patient ate a banana 30 minutes ago.
B. The patient is using a new brand of mouthwash.
C. The patient consumed a glass of wine with dinner.
D. The patient is taking an over-the-counter multivitamin.
CORRECT ANSWER: C. The patient consumed a glass of wine with dinner.
Rationale:Metronidazole has a disulfiram-like reaction with alcohol, causing symptoms such as
severe headache, flushing, nausea, and vomiting. Patients must be instructed to avoid alcohol for at
least 48 hours after the last dose of metronidazole. Bananas, mouthwash (unless it contains alcohol),
and multivitamins do not typically cause this reaction.
Question 8: The nurse is administering a loop diuretic, furosemide, to a patient with heart
failure. Which laboratory value requires the closest monitoring?
A. Serum sodium.
B. Serum potassium.
, C. Serum calcium.
D. Serum magnesium.
CORRECT ANSWER: B. Serum potassium.
Rationale:Furosemide is a high-ceiling loop diuretic that blocks sodium and chloride reabsorption in
the ascending loop of Henle, leading to significant potassium wasting. Hypokalemia is a major adverse
effect and can precipitate cardiac arrhythmias, especially in patients taking digoxin. While sodium,
calcium, and magnesium levels can be affected, potassium is the most critical to monitor.
Question 9: A patient with tuberculosis is prescribed a combination therapy of isoniazid,
rifampin, and pyrazinamide. The nurse should teach the patient that which side effect is a
harmless but expected outcome?
A. Red-orange discoloration of urine.
B. Yellowing of the skin and eyes.
C. Peripheral neuropathy.
D. Hepatotoxicity.
CORRECT ANSWER: A. Red-orange discoloration of urine.
Rationale:Rifampin is known to cause a benign and harmless red-orange discoloration of urine,
sweat, and tears. Patients must be warned about this to prevent anxiety. Yellowing of the skin,
peripheral neuropathy, and hepatotoxicity are not benign; they are signs of toxicity or adverse effects
that require further evaluation.
Question 10: A pediatric patient is prescribed amoxicillin for otitis media. The parent reports a
rash that appeared three days ago, which was thought to be a viral exanthem. What is the
nurse's priority action?
A. Instruct the parent to stop the medication immediately.
B. Document the rash and continue the medication.
C. Administer diphenhydramine to manage the rash.
D. Advise the parent to give the medication with food.
CORRECT ANSWER: B. Document the rash and continue the medication.
Rationale:A rash occurring 3-5 days after starting amoxicillin in a pediatric patient is often a non-
allergic maculopapular rash, especially when associated with viral infections like Epstein-Barr virus. It
does not require discontinuation unless there are signs of a hypersensitivity reaction (e.g., urticaria,
wheezing). Stopping the antibiotic prematurely could lead to treatment failure.
Practice Exam, Questions & Answers, Pharmacology
Exam Prep Test Bank, Medication Classifications, Drug
Calculations, Safe Medication Administration,
Pharmacokinetics, Pharmacodynamics, Drug
Interactions, IV Medications, NCLEX-RN & NCLEX-PN
Review, Detailed Rationales, Complete Review
Question 1: A patient with a history of angina is prescribed sublingual nitroglycerin. Which
instruction is MOST critical for the nurse to include in the teaching plan?
A. Take the medication with a full glass of water to enhance absorption.
B. Chew the tablet thoroughly for faster onset of action.
C. Swallow the tablet whole with food to prevent gastric upset.
D. Allow the tablet to dissolve under the tongue and expect a tingling sensation.
CORRECT ANSWER: D. Allow the tablet to dissolve under the tongue and expect a tingling
sensation.
Rationale:Sublingual nitroglycerin must be placed under the tongue and allowed to dissolve
completely for rapid absorption through the sublingual mucosa. A mild tingling or burning sensation is
expected and indicates the tablet is still potent. The tablet should not be chewed or swallowed, as this
would inactivate the drug via first-pass hepatic metabolism. Taking it with water is not appropriate
and would prevent proper sublingual absorption.
Question 2: A nurse is administering digoxin to a patient with heart failure. Which assessment
finding would indicate a potential adverse effect requiring immediate action?
A. Heart rate of 58 beats per minute.
B. Serum potassium level of 3.2 mEq/L.
C. Serum digoxin level of 1.2 ng/mL.
D. Blood pressure of 132/78 mmHg.
CORRECT ANSWER: B. Serum potassium level of 3.2 mEq/L.
Rationale:Hypokalemia (serum K+ < 3.5 mEq/L) increases the risk of digoxin toxicity by enhancing its
binding to the sodium-potassium ATPase pump. A heart rate of 58 bpm is within an acceptable range
for a patient on digoxin, and a serum digoxin level of 1.2 ng/mL is within the therapeutic range (0.8–
2.0 ng/mL). The blood pressure reading is not alarming.
Question 3: A patient is prescribed warfarin for atrial fibrillation. The nurse should instruct
the patient to avoid which over-the-counter product due to a significant drug interaction?
,A. Acetaminophen.
B. Ibuprofen.
C. Diphenhydramine.
D. Loratadine.
CORRECT ANSWER: B. Ibuprofen.
Rationale:Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of
gastrointestinal bleeding and also displace warfarin from protein-binding sites, significantly
increasing the anticoagulant effect and bleeding risk. Acetaminophen is the preferred analgesic for
patients on warfarin. Diphenhydramine and loratadine do not have significant interactions with
warfarin.
Question 4: A patient is receiving an intravenous infusion of heparin. The nurse notes a sudden
drop in the patient's platelet count. Which condition should the nurse suspect?
A. Heparin-induced thrombocytopenia (HIT).
B. Idiopathic thrombocytopenic purpura (ITP).
C. Disseminated intravascular coagulation (DIC).
D. Thrombotic thrombocytopenic purpura (TTP).
CORRECT ANSWER: A. Heparin-induced thrombocytopenia (HIT).
Rationale:Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction to
heparin characterized by a significant drop in platelet count, typically occurring 5-10 days after
initiation of therapy. This condition is paradoxical as it increases the risk of thrombosis despite the
low platelet count. ITP, DIC, and TTP have different etiologies and are not directly caused by heparin
therapy.
Question 5: A nurse is providing education to a patient starting on an ACE inhibitor, lisinopril.
What side effect should the patient be instructed to report immediately?
A. Dry, persistent cough.
B. Dizziness when standing up.
C. Loss of taste.
D. Swelling of the lips and tongue.
CORRECT ANSWER: D. Swelling of the lips and tongue.
Rationale:Swelling of the lips, tongue, or face is a sign of angioedema, a rare but life-threatening
adverse effect of ACE inhibitors that requires immediate medical attention. While a dry cough,
,dizziness, and loss of taste are known side effects of ACE inhibitors, they are not immediately life-
threatening and can be managed with symptomatic care or medication adjustments.
Question 6: A patient with type 1 diabetes is prescribed insulin lispro. When should the nurse
advise the patient to administer this insulin?
A. 30-45 minutes before a meal.
B. Immediately before a meal.
C. 1 hour after a meal.
D. At bedtime.
CORRECT ANSWER: B. Immediately before a meal.
Rationale:Insulin lispro is a rapid-acting insulin analogue with an onset of action of approximately 15
minutes. It should be administered immediately (within 15 minutes) before a meal to match the
postprandial rise in blood glucose. Administering it 30-45 minutes prior would increase the risk of
hypoglycemia. Administering after a meal or at bedtime is not appropriate for its intended purpose.
Question 7: A patient on a metronidazole infusion reports a severe headache and flushing. The
nurse notes the patient's IV site is patent. Which substance is most likely responsible for this
reaction?
A. The patient ate a banana 30 minutes ago.
B. The patient is using a new brand of mouthwash.
C. The patient consumed a glass of wine with dinner.
D. The patient is taking an over-the-counter multivitamin.
CORRECT ANSWER: C. The patient consumed a glass of wine with dinner.
Rationale:Metronidazole has a disulfiram-like reaction with alcohol, causing symptoms such as
severe headache, flushing, nausea, and vomiting. Patients must be instructed to avoid alcohol for at
least 48 hours after the last dose of metronidazole. Bananas, mouthwash (unless it contains alcohol),
and multivitamins do not typically cause this reaction.
Question 8: The nurse is administering a loop diuretic, furosemide, to a patient with heart
failure. Which laboratory value requires the closest monitoring?
A. Serum sodium.
B. Serum potassium.
, C. Serum calcium.
D. Serum magnesium.
CORRECT ANSWER: B. Serum potassium.
Rationale:Furosemide is a high-ceiling loop diuretic that blocks sodium and chloride reabsorption in
the ascending loop of Henle, leading to significant potassium wasting. Hypokalemia is a major adverse
effect and can precipitate cardiac arrhythmias, especially in patients taking digoxin. While sodium,
calcium, and magnesium levels can be affected, potassium is the most critical to monitor.
Question 9: A patient with tuberculosis is prescribed a combination therapy of isoniazid,
rifampin, and pyrazinamide. The nurse should teach the patient that which side effect is a
harmless but expected outcome?
A. Red-orange discoloration of urine.
B. Yellowing of the skin and eyes.
C. Peripheral neuropathy.
D. Hepatotoxicity.
CORRECT ANSWER: A. Red-orange discoloration of urine.
Rationale:Rifampin is known to cause a benign and harmless red-orange discoloration of urine,
sweat, and tears. Patients must be warned about this to prevent anxiety. Yellowing of the skin,
peripheral neuropathy, and hepatotoxicity are not benign; they are signs of toxicity or adverse effects
that require further evaluation.
Question 10: A pediatric patient is prescribed amoxicillin for otitis media. The parent reports a
rash that appeared three days ago, which was thought to be a viral exanthem. What is the
nurse's priority action?
A. Instruct the parent to stop the medication immediately.
B. Document the rash and continue the medication.
C. Administer diphenhydramine to manage the rash.
D. Advise the parent to give the medication with food.
CORRECT ANSWER: B. Document the rash and continue the medication.
Rationale:A rash occurring 3-5 days after starting amoxicillin in a pediatric patient is often a non-
allergic maculopapular rash, especially when associated with viral infections like Epstein-Barr virus. It
does not require discontinuation unless there are signs of a hypersensitivity reaction (e.g., urticaria,
wheezing). Stopping the antibiotic prematurely could lead to treatment failure.
