Nursing Pharmacology | Comprehensive Study Guide, Practice
Exam, Questions & Answers, NCLEX Pharmacology Exam Prep Test
Bank, Medication Classifications, Pharmacokinetics,
Pharmacodynamics, Safe Medication Administration, Drug
Calculations, Drug Interactions, IV Medications, Patient Safety,
Detailed Rationales, Complete Review
Question 1: A patient with atrial fibrillation is prescribed apixaban. Which
laboratory value is most critical to monitor prior to initiating therapy?
A. Serum creatinine and estimated glomerular filtration rate (eGFR)
B. Prothrombin time (PT) and International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
CORRECT ANSWER: A. Serum creatinine and estimated glomerular filtration
rate (eGFR)
Rationale:Apixaban, a direct factor Xa inhibitor, is primarily renally eliminated. Dose
adjustment is required based on serum creatinine and eGFR. Unlike warfarin, PT/INR
and aPTT are not used for routine monitoring of apixaban. While platelet count may be
monitored, it is not the most critical parameter for initial dosing.
Question 2: A nurse is preparing to administer digoxin to a patient with heart
failure. Which finding on the electrocardiogram (ECG) would be most
indicative of digoxin toxicity?
A. Prolonged PR interval
B. ST-segment depression
C. Shortened QT interval
D. Atrial fibrillation with rapid ventricular response
CORRECT ANSWER: A. Prolonged PR interval
Rationale:Digoxin toxicity frequently manifests as a prolonged PR interval, along with
other arrhythmias such as bradycardia and premature ventricular contractions. ST-
segment depression (a "scooping" appearance) is a therapeutic effect, not a sign of
toxicity. Shortened QT and rapid atrial fibrillation are not classic signs of digoxin toxicity.
Question 3: A patient is prescribed losartan for hypertension. Which adverse
effect is specifically associated with this angiotensin II receptor blocker (ARB)?
A. Dry, persistent cough
B. Hyperkalemia
C. Angioedema
D. Peripheral neuropathy
CORRECT ANSWER: B. Hyperkalemia
,Rationale:Losartan, like other ARBs, can cause hyperkalemia by reducing aldosterone
secretion, leading to decreased potassium excretion. A dry cough and angioedema are
more strongly associated with ACE inhibitors, though they can rarely occur with ARBs.
Question 4: A patient receiving an intravenous infusion of vancomycin
complains of pruritus and develops a red rash on the face and upper torso. The
nurse should recognize this as:
A. An anaphylactic reaction requiring immediate epinephrine
B. Red man syndrome, which can be managed by slowing the infusion rate
C. A type IV hypersensitivity reaction requiring discontinuation of the drug
D. A sign of ototoxicity
CORRECT ANSWER: B. Red man syndrome, which can be managed by slowing
the infusion rate
Rationale:Red man syndrome is a histamine-release reaction characterized by pruritus
and erythema, often on the face and upper body, associated with rapid vancomycin
infusion. It is not a true allergic reaction. Slowing the infusion rate and administering
antihistamines can manage the symptoms.
Question 5: A patient on warfarin has an INR of 5.5 without active bleeding.
Which intervention is the most appropriate?
A. Administer vitamin K 10 mg subcutaneously
B. Hold the warfarin dose and monitor the INR
C. Administer fresh frozen plasma (FFP) immediately
D. Increase the warfarin dose to achieve therapeutic range
CORRECT ANSWER: B. Hold the warfarin dose and monitor the INR
Rationale:An INR between 5 and 9 without bleeding is typically managed by holding
warfarin and monitoring. Vitamin K is indicated for higher INRs or active bleeding. FFP
is reserved for life-threatening hemorrhage.
Question 6: A patient with asthma is prescribed a beta-blocker for migraine
prophylaxis. Which beta-blocker is most cardioselective and therefore safest
for this patient?
A. Metoprolol
B. Propranolol
C. Nadolol
D. Timolol
CORRECT ANSWER: A. Metoprolol
Rationale:Metoprolol is a beta-1 selective (cardioselective) blocker, which has less
effect on bronchial beta-2 receptors compared to non-selective agents like propranolol,
nadolol, and timolol. It is preferred in patients with reactive airway disease.
,Question 7: A nurse is administering furosemide to a patient with pulmonary
edema. Which assessment finding indicates a therapeutic response to the
medication?
A. Decreased urine output
B. Increased blood pressure
C. Decreased dyspnea and crackles
D. Increased peripheral edema
CORRECT ANSWER: C. Decreased dyspnea and crackles
Rationale:Furosemide is a loop diuretic used to reduce fluid volume. A therapeutic
response in pulmonary edema is evidenced by reduced preload, leading to decreased
dyspnea, resolution of crackles, and increased urine output.
Question 8: Which of the following herbal supplements is known to inhibit
platelet aggregation and therefore increases the risk of bleeding when taken
with aspirin?
A. St. John's Wort
B. Echinacea
C. Ginkgo biloba
D. Saw palmetto
CORRECT ANSWER: C. Ginkgo biloba
Rationale:Ginkgo biloba has documented antiplatelet effects. Concurrent use with
aspirin or other anticoagulants significantly increases the risk of bleeding. St. John's
Wort is primarily known for inducing drug metabolism.
Question 9: A patient is started on isotretinoin for severe acne. Which
laboratory test must be monitored monthly due to the risk of a serious adverse
effect?
A. Complete blood count (CBC)
B. Serum glucose
C. Serum triglycerides and liver function tests (LFTs)
D. Serum creatinine
CORRECT ANSWER: C. Serum triglycerides and liver function tests (LFTs)
Rationale:Isotretinoin is associated with significant hypertriglyceridemia and
hepatotoxicity. Regular monitoring of triglycerides and LFTs is mandatory. While CBC
can be monitored, it is not the primary toxicity concern.
Question 10: A patient is prescribed a selective serotonin reuptake inhibitor
(SSRI) for depression. The nurse should instruct the patient that therapeutic
effects may not be fully achieved for:
A. 1 to 2 days
B. 1 to 2 weeks
, C. 4 to 6 weeks
D. 3 to 6 months
CORRECT ANSWER: C. 4 to 6 weeks
Rationale:SSRIs typically have a delayed onset of therapeutic action for depression.
While some improvement may be seen in 1-2 weeks, the full antidepressant effect often
takes 4 to 6 weeks.
Question 11: A patient with a history of renal impairment is receiving
morphine for acute pain. The nurse should monitor for which specific adverse
effect that is more likely in this patient?
A. Hypertension
B. Seizures
C. Respiratory depression
D. Hyperglycemia
CORRECT ANSWER: C. Respiratory depression
Rationale:Morphine's active metabolite (morphine-6-glucuronide) accumulates in renal
impairment, leading to an increased risk of respiratory depression and sedation. The
dose should be reduced.
Question 12: A nurse is teaching a patient about nitroglycerin sublingual
tablets for angina. Which instruction is correct?
A. Swallow the tablet with a full glass of water for rapid absorption.
B. Take one tablet every 5 minutes, up to three tablets, and call 911 if pain persists.
C. Chew the tablet thoroughly to release the medication.
D. Store the medication in the refrigerator to maintain potency.
CORRECT ANSWER: B. Take one tablet every 5 minutes, up to three tablets,
and call 911 if pain persists.
Rationale:Sublingual nitroglycerin is administered under the tongue for rapid
absorption. The standard protocol is to take one tablet every 5 minutes for up to three
doses. If chest pain persists after the first dose, the patient should call 911. The tablets
should be stored in a dark, dry place.
Question 13: A patient is receiving a continuous infusion of heparin. The aPTT
level is 110 seconds (normal is 25-35 seconds). What is the nurse's priority
action?
A. Continue the infusion as prescribed.
B. Stop the infusion and notify the healthcare provider.
C. Increase the infusion rate.
D. Administer vitamin K.
CORRECT ANSWER: B. Stop the infusion and notify the healthcare provider.
Exam, Questions & Answers, NCLEX Pharmacology Exam Prep Test
Bank, Medication Classifications, Pharmacokinetics,
Pharmacodynamics, Safe Medication Administration, Drug
Calculations, Drug Interactions, IV Medications, Patient Safety,
Detailed Rationales, Complete Review
Question 1: A patient with atrial fibrillation is prescribed apixaban. Which
laboratory value is most critical to monitor prior to initiating therapy?
A. Serum creatinine and estimated glomerular filtration rate (eGFR)
B. Prothrombin time (PT) and International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
CORRECT ANSWER: A. Serum creatinine and estimated glomerular filtration
rate (eGFR)
Rationale:Apixaban, a direct factor Xa inhibitor, is primarily renally eliminated. Dose
adjustment is required based on serum creatinine and eGFR. Unlike warfarin, PT/INR
and aPTT are not used for routine monitoring of apixaban. While platelet count may be
monitored, it is not the most critical parameter for initial dosing.
Question 2: A nurse is preparing to administer digoxin to a patient with heart
failure. Which finding on the electrocardiogram (ECG) would be most
indicative of digoxin toxicity?
A. Prolonged PR interval
B. ST-segment depression
C. Shortened QT interval
D. Atrial fibrillation with rapid ventricular response
CORRECT ANSWER: A. Prolonged PR interval
Rationale:Digoxin toxicity frequently manifests as a prolonged PR interval, along with
other arrhythmias such as bradycardia and premature ventricular contractions. ST-
segment depression (a "scooping" appearance) is a therapeutic effect, not a sign of
toxicity. Shortened QT and rapid atrial fibrillation are not classic signs of digoxin toxicity.
Question 3: A patient is prescribed losartan for hypertension. Which adverse
effect is specifically associated with this angiotensin II receptor blocker (ARB)?
A. Dry, persistent cough
B. Hyperkalemia
C. Angioedema
D. Peripheral neuropathy
CORRECT ANSWER: B. Hyperkalemia
,Rationale:Losartan, like other ARBs, can cause hyperkalemia by reducing aldosterone
secretion, leading to decreased potassium excretion. A dry cough and angioedema are
more strongly associated with ACE inhibitors, though they can rarely occur with ARBs.
Question 4: A patient receiving an intravenous infusion of vancomycin
complains of pruritus and develops a red rash on the face and upper torso. The
nurse should recognize this as:
A. An anaphylactic reaction requiring immediate epinephrine
B. Red man syndrome, which can be managed by slowing the infusion rate
C. A type IV hypersensitivity reaction requiring discontinuation of the drug
D. A sign of ototoxicity
CORRECT ANSWER: B. Red man syndrome, which can be managed by slowing
the infusion rate
Rationale:Red man syndrome is a histamine-release reaction characterized by pruritus
and erythema, often on the face and upper body, associated with rapid vancomycin
infusion. It is not a true allergic reaction. Slowing the infusion rate and administering
antihistamines can manage the symptoms.
Question 5: A patient on warfarin has an INR of 5.5 without active bleeding.
Which intervention is the most appropriate?
A. Administer vitamin K 10 mg subcutaneously
B. Hold the warfarin dose and monitor the INR
C. Administer fresh frozen plasma (FFP) immediately
D. Increase the warfarin dose to achieve therapeutic range
CORRECT ANSWER: B. Hold the warfarin dose and monitor the INR
Rationale:An INR between 5 and 9 without bleeding is typically managed by holding
warfarin and monitoring. Vitamin K is indicated for higher INRs or active bleeding. FFP
is reserved for life-threatening hemorrhage.
Question 6: A patient with asthma is prescribed a beta-blocker for migraine
prophylaxis. Which beta-blocker is most cardioselective and therefore safest
for this patient?
A. Metoprolol
B. Propranolol
C. Nadolol
D. Timolol
CORRECT ANSWER: A. Metoprolol
Rationale:Metoprolol is a beta-1 selective (cardioselective) blocker, which has less
effect on bronchial beta-2 receptors compared to non-selective agents like propranolol,
nadolol, and timolol. It is preferred in patients with reactive airway disease.
,Question 7: A nurse is administering furosemide to a patient with pulmonary
edema. Which assessment finding indicates a therapeutic response to the
medication?
A. Decreased urine output
B. Increased blood pressure
C. Decreased dyspnea and crackles
D. Increased peripheral edema
CORRECT ANSWER: C. Decreased dyspnea and crackles
Rationale:Furosemide is a loop diuretic used to reduce fluid volume. A therapeutic
response in pulmonary edema is evidenced by reduced preload, leading to decreased
dyspnea, resolution of crackles, and increased urine output.
Question 8: Which of the following herbal supplements is known to inhibit
platelet aggregation and therefore increases the risk of bleeding when taken
with aspirin?
A. St. John's Wort
B. Echinacea
C. Ginkgo biloba
D. Saw palmetto
CORRECT ANSWER: C. Ginkgo biloba
Rationale:Ginkgo biloba has documented antiplatelet effects. Concurrent use with
aspirin or other anticoagulants significantly increases the risk of bleeding. St. John's
Wort is primarily known for inducing drug metabolism.
Question 9: A patient is started on isotretinoin for severe acne. Which
laboratory test must be monitored monthly due to the risk of a serious adverse
effect?
A. Complete blood count (CBC)
B. Serum glucose
C. Serum triglycerides and liver function tests (LFTs)
D. Serum creatinine
CORRECT ANSWER: C. Serum triglycerides and liver function tests (LFTs)
Rationale:Isotretinoin is associated with significant hypertriglyceridemia and
hepatotoxicity. Regular monitoring of triglycerides and LFTs is mandatory. While CBC
can be monitored, it is not the primary toxicity concern.
Question 10: A patient is prescribed a selective serotonin reuptake inhibitor
(SSRI) for depression. The nurse should instruct the patient that therapeutic
effects may not be fully achieved for:
A. 1 to 2 days
B. 1 to 2 weeks
, C. 4 to 6 weeks
D. 3 to 6 months
CORRECT ANSWER: C. 4 to 6 weeks
Rationale:SSRIs typically have a delayed onset of therapeutic action for depression.
While some improvement may be seen in 1-2 weeks, the full antidepressant effect often
takes 4 to 6 weeks.
Question 11: A patient with a history of renal impairment is receiving
morphine for acute pain. The nurse should monitor for which specific adverse
effect that is more likely in this patient?
A. Hypertension
B. Seizures
C. Respiratory depression
D. Hyperglycemia
CORRECT ANSWER: C. Respiratory depression
Rationale:Morphine's active metabolite (morphine-6-glucuronide) accumulates in renal
impairment, leading to an increased risk of respiratory depression and sedation. The
dose should be reduced.
Question 12: A nurse is teaching a patient about nitroglycerin sublingual
tablets for angina. Which instruction is correct?
A. Swallow the tablet with a full glass of water for rapid absorption.
B. Take one tablet every 5 minutes, up to three tablets, and call 911 if pain persists.
C. Chew the tablet thoroughly to release the medication.
D. Store the medication in the refrigerator to maintain potency.
CORRECT ANSWER: B. Take one tablet every 5 minutes, up to three tablets,
and call 911 if pain persists.
Rationale:Sublingual nitroglycerin is administered under the tongue for rapid
absorption. The standard protocol is to take one tablet every 5 minutes for up to three
doses. If chest pain persists after the first dose, the patient should call 911. The tablets
should be stored in a dark, dry place.
Question 13: A patient is receiving a continuous infusion of heparin. The aPTT
level is 110 seconds (normal is 25-35 seconds). What is the nurse's priority
action?
A. Continue the infusion as prescribed.
B. Stop the infusion and notify the healthcare provider.
C. Increase the infusion rate.
D. Administer vitamin K.
CORRECT ANSWER: B. Stop the infusion and notify the healthcare provider.
