2026 Nursing Pharmacology Case Studies
Clinical Scenarios Medication Decisions
Drug Interactions Adverse Reactions
Nursing Interventions Patient Safety
Answer Rationales
1. A patient is prescribed digoxin for heart failure. Which assessment finding
should the nurse report immediately?
• A. Heart rate of 58 beats per minute
• B. Serum potassium of 3.2 mEq/L
• C. Blood pressure of 110/70 mm Hg
• D. Serum digoxin level of 0.8 ng/mL
• Correct Answer: B
• Rationale: Hypokalemia (potassium < 3.5 mEq/L) greatly increases the
risk of digoxin toxicity. A heart rate of 58 is bradycardic but may be
acceptable; the potassium level is a more critical safety concern. A level of
0.8 ng/mL is therapeutic (0.5-2.0 ng/mL).
2. A nurse is administering morning medications. Which drug should be held if
the patient's apical pulse is 52 beats per minute?
• A. Metoprolol
• B. Furosemide
• C. Lisinopril
• D. Atorvastatin
• Correct Answer: A
, • Rationale: Beta-blockers like metoprolol slow the heart rate. They are
typically held if the apical pulse is below 60 beats per minute in adults, as
this could lead to symptomatic bradycardia.
3. A patient on warfarin has an INR of 6.5. Which action should the nurse
anticipate taking first?
• A. Administer the next scheduled dose of warfarin.
• B. Prepare to administer Vitamin K (phytonadione).
• C. Encourage the patient to increase intake of green leafy vegetables.
• D. Document the finding and continue to monitor.
• Correct Answer: B
• Rationale: An INR of 6.5 is critically high, indicating a severe risk of
bleeding. The antidote for warfarin is Vitamin K. The nurse should hold the
warfarin and prepare to administer the antidote as prescribed.
4. Which instruction is most important for a patient taking oral iron
supplements?
• A. Take the medication with an antacid to reduce stomach upset.
• B. Take the medication with a glass of milk.
• C. Take the medication with orange juice.
• D. Take the medication at bedtime.
• Correct Answer: C
• Rationale: Vitamin C (ascorbic acid), found in orange juice, enhances
the absorption of iron. Antacids and milk decrease absorption.
5. A patient is receiving IV vancomycin. The nurse should monitor for which sign
of "red man syndrome"?
• A. Hypertension and tachycardia
, • B. Flushing of the face, neck, and upper torso
• C. Severe constipation and abdominal pain
• D. Jaundice and clay-colored stools
• Correct Answer: B
• Rationale: "Red man syndrome" is a histamine reaction characterized
by flushing, erythema, and pruritus on the face, neck, and upper torso. It is
often related to infusing the drug too quickly.
6. A patient with asthma is prescribed albuterol. The nurse should teach the
patient that the primary purpose of this drug is to:
• A. Reduce inflammation in the airways.
• B. Thin respiratory secretions.
• C. Provide immediate relief of bronchospasm.
• D. Prevent respiratory infections.
• Correct Answer: C
• Rationale: Albuterol is a short-acting beta-2 agonist (SABA) used as a
rescue inhaler for immediate relief of acute bronchospasms. Inhaled
corticosteroids are used for long-term inflammation control.
7. Which patient is at the highest risk for developing nephrotoxicity while taking
gentamicin?
• A. A 25-year-old with a fractured femur.
• B. A 45-year-old with hypertension.
• C. A 78-year-old with dehydration.
• D. A 30-year-old with a urinary tract infection.
• Correct Answer: C
, • Rationale: Aminoglycosides like gentamicin are nephrotoxic. The risk is
increased in older adults and patients who are dehydrated or have pre-
existing renal impairment.
8. A patient taking levothyroxine reports palpitations, weight loss, and insomnia.
The nurse should suspect:
• A. An allergic reaction to the medication.
• B. Excessive dosing of the medication.
• C. Inadequate dosing of the medication.
• D. A common, temporary side effect.
• Correct Answer: B
• Rationale: These are signs of hyperthyroidism, which can be caused by
an excessive dose of levothyroxine. The nurse should hold the dose and
notify the provider.
9. A patient is prescribed potassium-sparing diuretic spironolactone. Which food
should the nurse instruct the patient to avoid?
• A. Bananas
• B. Apples
• C. White bread
• D. Chicken
• Correct Answer: A
• Rationale: Spironolactone is a potassium-sparing diuretic. Patients
should avoid high-potassium foods like bananas, oranges, and potatoes to
prevent hyperkalemia.
10. A nurse is preparing to administer enoxaparin. Which technique is correct?
• A. Administer IM in the deltoid.
Clinical Scenarios Medication Decisions
Drug Interactions Adverse Reactions
Nursing Interventions Patient Safety
Answer Rationales
1. A patient is prescribed digoxin for heart failure. Which assessment finding
should the nurse report immediately?
• A. Heart rate of 58 beats per minute
• B. Serum potassium of 3.2 mEq/L
• C. Blood pressure of 110/70 mm Hg
• D. Serum digoxin level of 0.8 ng/mL
• Correct Answer: B
• Rationale: Hypokalemia (potassium < 3.5 mEq/L) greatly increases the
risk of digoxin toxicity. A heart rate of 58 is bradycardic but may be
acceptable; the potassium level is a more critical safety concern. A level of
0.8 ng/mL is therapeutic (0.5-2.0 ng/mL).
2. A nurse is administering morning medications. Which drug should be held if
the patient's apical pulse is 52 beats per minute?
• A. Metoprolol
• B. Furosemide
• C. Lisinopril
• D. Atorvastatin
• Correct Answer: A
, • Rationale: Beta-blockers like metoprolol slow the heart rate. They are
typically held if the apical pulse is below 60 beats per minute in adults, as
this could lead to symptomatic bradycardia.
3. A patient on warfarin has an INR of 6.5. Which action should the nurse
anticipate taking first?
• A. Administer the next scheduled dose of warfarin.
• B. Prepare to administer Vitamin K (phytonadione).
• C. Encourage the patient to increase intake of green leafy vegetables.
• D. Document the finding and continue to monitor.
• Correct Answer: B
• Rationale: An INR of 6.5 is critically high, indicating a severe risk of
bleeding. The antidote for warfarin is Vitamin K. The nurse should hold the
warfarin and prepare to administer the antidote as prescribed.
4. Which instruction is most important for a patient taking oral iron
supplements?
• A. Take the medication with an antacid to reduce stomach upset.
• B. Take the medication with a glass of milk.
• C. Take the medication with orange juice.
• D. Take the medication at bedtime.
• Correct Answer: C
• Rationale: Vitamin C (ascorbic acid), found in orange juice, enhances
the absorption of iron. Antacids and milk decrease absorption.
5. A patient is receiving IV vancomycin. The nurse should monitor for which sign
of "red man syndrome"?
• A. Hypertension and tachycardia
, • B. Flushing of the face, neck, and upper torso
• C. Severe constipation and abdominal pain
• D. Jaundice and clay-colored stools
• Correct Answer: B
• Rationale: "Red man syndrome" is a histamine reaction characterized
by flushing, erythema, and pruritus on the face, neck, and upper torso. It is
often related to infusing the drug too quickly.
6. A patient with asthma is prescribed albuterol. The nurse should teach the
patient that the primary purpose of this drug is to:
• A. Reduce inflammation in the airways.
• B. Thin respiratory secretions.
• C. Provide immediate relief of bronchospasm.
• D. Prevent respiratory infections.
• Correct Answer: C
• Rationale: Albuterol is a short-acting beta-2 agonist (SABA) used as a
rescue inhaler for immediate relief of acute bronchospasms. Inhaled
corticosteroids are used for long-term inflammation control.
7. Which patient is at the highest risk for developing nephrotoxicity while taking
gentamicin?
• A. A 25-year-old with a fractured femur.
• B. A 45-year-old with hypertension.
• C. A 78-year-old with dehydration.
• D. A 30-year-old with a urinary tract infection.
• Correct Answer: C
, • Rationale: Aminoglycosides like gentamicin are nephrotoxic. The risk is
increased in older adults and patients who are dehydrated or have pre-
existing renal impairment.
8. A patient taking levothyroxine reports palpitations, weight loss, and insomnia.
The nurse should suspect:
• A. An allergic reaction to the medication.
• B. Excessive dosing of the medication.
• C. Inadequate dosing of the medication.
• D. A common, temporary side effect.
• Correct Answer: B
• Rationale: These are signs of hyperthyroidism, which can be caused by
an excessive dose of levothyroxine. The nurse should hold the dose and
notify the provider.
9. A patient is prescribed potassium-sparing diuretic spironolactone. Which food
should the nurse instruct the patient to avoid?
• A. Bananas
• B. Apples
• C. White bread
• D. Chicken
• Correct Answer: A
• Rationale: Spironolactone is a potassium-sparing diuretic. Patients
should avoid high-potassium foods like bananas, oranges, and potatoes to
prevent hyperkalemia.
10. A nurse is preparing to administer enoxaparin. Which technique is correct?
• A. Administer IM in the deltoid.
