2026 Nursing Pharmacology Practice
Questions: Answer Explanations, Drug
Classes, Medication Safety, Adverse Effects,
Nursing Interventions, Clinical Application
& Exam Prep
1. A nurse is preparing to administer digoxin to a client with heart failure. Which
assessment finding should the nurse report to the provider before administering
the dose?
• A. Heart rate of 88 bpm
• B. Blood pressure of 118/76 mm Hg
• C. Heart rate of 52 bpm
• D. Potassium level of 4.2 mEq/L
Rationale: Digoxin is a positive inotropic agent that also slows the heart rate
(negative chronotropic effect). A heart rate below 60 bpm (bradycardia) in an
adult is a classic sign of digoxin toxicity. The nurse should hold the dose and notify
the provider. A heart rate of 88 is within normal limits. Blood pressure and a
normal potassium level are not immediate contraindications, although
hypokalemia increases the risk of toxicity.
2. A client is prescribed warfarin for atrial fibrillation. Which laboratory value
should the nurse monitor to evaluate the therapeutic effect of this medication?
• A. aPTT
• B. INR
, • C. Platelet count
• D. Hemoglobin
Rationale: Warfarin is an oral anticoagulant that inhibits vitamin K-dependent
clotting factors. Its therapeutic effect is monitored using the International
Normalized Ratio (INR). The target INR for atrial fibrillation is typically between 2.0
and 3.0. aPTT is used to monitor unfractionated heparin. Platelet count and
hemoglobin are not primary monitors for warfarin's therapeutic effect.
3. A nurse is teaching a client about a new prescription for sublingual
nitroglycerin. Which statement by the client indicates a need for further
teaching?
• A. "I will store the tablets in the original dark glass bottle."
• B. "I will sit or lie down when I take this medication."
• C. "I will swallow the tablet with a full glass of water."
• D. "I will call 911 if the pain is not relieved after taking three tablets."
Rationale: Sublingual nitroglycerin is designed to be absorbed rapidly under
the tongue, not swallowed. Swallowing the tablet would result in first-pass
metabolism by the liver, rendering it ineffective. Storing it in the original bottle,
sitting or lying down to prevent hypotension, and calling 911 if chest pain persists
after three doses are all correct instructions.
4. Which class of medications is considered the first-line treatment for
hypertension in most clients, especially those with diabetes or heart failure?
• A. Beta-blockers
• B. Calcium channel blockers
• C. Angiotensin-converting enzyme (ACE) inhibitors
, • D. Loop diuretics
Rationale: ACE inhibitors (e.g., lisinopril) are often first-line for hypertension,
particularly in clients with diabetes (for renal protection) or heart failure (for
improved survival). They work by blocking the conversion of angiotensin I to
angiotensin II, a potent vasoconstrictor, thereby reducing blood pressure and
preload/afterload.
5. A nurse is administering morphine sulfate to a client with severe pain. Which
of the following is the most critical adverse effect to monitor for?
• A. Constipation
• B. Nausea
• C. Respiratory depression
• D. Urinary retention
Rationale: While all listed options are adverse effects of morphine, respiratory
depression is the most critical and life-threatening. The nurse must monitor the
client's respiratory rate and depth, and have naloxone (Narcan) available as an
antidote. Constipation is a common but non-life-threatening effect. Nausea and
urinary retention are also common but less immediately dangerous than
respiratory depression.
6. A client with a history of peptic ulcer disease is prescribed a nonsteroidal anti-
inflammatory drug (NSAID) for arthritis. Which medication should the nurse
anticipate the provider will also prescribe to protect the client's stomach lining?
• A. Acetaminophen
• B. Misoprostol
• C. Ondansetron
, • D. Famotidine
Rationale: Misoprostol is a prostaglandin E1 analog that is specifically
indicated for the prevention of NSAID-induced gastric ulcers. It works by replacing
the protective prostaglandins that NSAIDs deplete. While famotidine (an H2
blocker) can reduce acid, misoprostol is the specific cytoprotective agent for this
purpose.
7. A nurse is reviewing the medication list for a client with asthma. Which
medication is a long-term control medication, not a rescue medication?
• A. Albuterol
• B. Levalbuterol
• C. Fluticasone
• D. Ipratropium
Rationale: Fluticasone is an inhaled corticosteroid used for long-term control
of asthma by reducing airway inflammation. Albuterol and levalbuterol are short-
acting beta-2 agonists (SABAs) used for quick relief of acute bronchospasm.
Ipratropium is an anticholinergic that can be used for maintenance or acute relief,
but it is not the primary long-term anti-inflammatory agent.
8. Which laboratory value is a priority to monitor for a client receiving
furosemide?
• A. Serum calcium
• B. Serum sodium
• C. Serum potassium
• D. Serum magnesium
Questions: Answer Explanations, Drug
Classes, Medication Safety, Adverse Effects,
Nursing Interventions, Clinical Application
& Exam Prep
1. A nurse is preparing to administer digoxin to a client with heart failure. Which
assessment finding should the nurse report to the provider before administering
the dose?
• A. Heart rate of 88 bpm
• B. Blood pressure of 118/76 mm Hg
• C. Heart rate of 52 bpm
• D. Potassium level of 4.2 mEq/L
Rationale: Digoxin is a positive inotropic agent that also slows the heart rate
(negative chronotropic effect). A heart rate below 60 bpm (bradycardia) in an
adult is a classic sign of digoxin toxicity. The nurse should hold the dose and notify
the provider. A heart rate of 88 is within normal limits. Blood pressure and a
normal potassium level are not immediate contraindications, although
hypokalemia increases the risk of toxicity.
2. A client is prescribed warfarin for atrial fibrillation. Which laboratory value
should the nurse monitor to evaluate the therapeutic effect of this medication?
• A. aPTT
• B. INR
, • C. Platelet count
• D. Hemoglobin
Rationale: Warfarin is an oral anticoagulant that inhibits vitamin K-dependent
clotting factors. Its therapeutic effect is monitored using the International
Normalized Ratio (INR). The target INR for atrial fibrillation is typically between 2.0
and 3.0. aPTT is used to monitor unfractionated heparin. Platelet count and
hemoglobin are not primary monitors for warfarin's therapeutic effect.
3. A nurse is teaching a client about a new prescription for sublingual
nitroglycerin. Which statement by the client indicates a need for further
teaching?
• A. "I will store the tablets in the original dark glass bottle."
• B. "I will sit or lie down when I take this medication."
• C. "I will swallow the tablet with a full glass of water."
• D. "I will call 911 if the pain is not relieved after taking three tablets."
Rationale: Sublingual nitroglycerin is designed to be absorbed rapidly under
the tongue, not swallowed. Swallowing the tablet would result in first-pass
metabolism by the liver, rendering it ineffective. Storing it in the original bottle,
sitting or lying down to prevent hypotension, and calling 911 if chest pain persists
after three doses are all correct instructions.
4. Which class of medications is considered the first-line treatment for
hypertension in most clients, especially those with diabetes or heart failure?
• A. Beta-blockers
• B. Calcium channel blockers
• C. Angiotensin-converting enzyme (ACE) inhibitors
, • D. Loop diuretics
Rationale: ACE inhibitors (e.g., lisinopril) are often first-line for hypertension,
particularly in clients with diabetes (for renal protection) or heart failure (for
improved survival). They work by blocking the conversion of angiotensin I to
angiotensin II, a potent vasoconstrictor, thereby reducing blood pressure and
preload/afterload.
5. A nurse is administering morphine sulfate to a client with severe pain. Which
of the following is the most critical adverse effect to monitor for?
• A. Constipation
• B. Nausea
• C. Respiratory depression
• D. Urinary retention
Rationale: While all listed options are adverse effects of morphine, respiratory
depression is the most critical and life-threatening. The nurse must monitor the
client's respiratory rate and depth, and have naloxone (Narcan) available as an
antidote. Constipation is a common but non-life-threatening effect. Nausea and
urinary retention are also common but less immediately dangerous than
respiratory depression.
6. A client with a history of peptic ulcer disease is prescribed a nonsteroidal anti-
inflammatory drug (NSAID) for arthritis. Which medication should the nurse
anticipate the provider will also prescribe to protect the client's stomach lining?
• A. Acetaminophen
• B. Misoprostol
• C. Ondansetron
, • D. Famotidine
Rationale: Misoprostol is a prostaglandin E1 analog that is specifically
indicated for the prevention of NSAID-induced gastric ulcers. It works by replacing
the protective prostaglandins that NSAIDs deplete. While famotidine (an H2
blocker) can reduce acid, misoprostol is the specific cytoprotective agent for this
purpose.
7. A nurse is reviewing the medication list for a client with asthma. Which
medication is a long-term control medication, not a rescue medication?
• A. Albuterol
• B. Levalbuterol
• C. Fluticasone
• D. Ipratropium
Rationale: Fluticasone is an inhaled corticosteroid used for long-term control
of asthma by reducing airway inflammation. Albuterol and levalbuterol are short-
acting beta-2 agonists (SABAs) used for quick relief of acute bronchospasm.
Ipratropium is an anticholinergic that can be used for maintenance or acute relief,
but it is not the primary long-term anti-inflammatory agent.
8. Which laboratory value is a priority to monitor for a client receiving
furosemide?
• A. Serum calcium
• B. Serum sodium
• C. Serum potassium
• D. Serum magnesium
