2026 Nursing Pharmacology Study Guide Exam
Prep: Drug Classes, Mechanisms, Adverse
Effects, Nursing Considerations, Medication
Safety & Practice Review
1. A nurse is preparing to administer digoxin. Which assessment finding should
the nurse report before giving the dose?
• A. Heart rate 58 bpm
• B. Blood pressure 128/76 mm Hg
• C. Potassium 3.1 mEq/L
• D. Respiratory rate 18/min
• Correct Answer: C
• Rationale: Hypokalemia increases the risk of digoxin toxicity. Digoxin
and potassium compete for the same binding sites; low potassium
enhances digoxin's effects. The nurse should report potassium 3.1 mEq/L. A
heart rate below 60 also warrants holding digoxin, but potassium 3.1 is the
most critical lab value indicating toxicity risk.
2. Which drug class is considered first-line for hypertension in a patient with
diabetes and proteinuria?
• A. Beta blockers
• B. ACE inhibitors
• C. Thiazide diuretics
• D. Calcium channel blockers
• Correct Answer: B
, • Rationale: ACE inhibitors (e.g., lisinopril) are first-line for hypertensive
patients with diabetes because they are renoprotective and reduce
proteinuria by dilating the efferent arteriole, lowering intraglomerular
pressure.
3. A patient taking warfarin has an INR of 6.5. Which antidote should the nurse
anticipate administering?
• A. Protamine sulfate
• B. Vitamin K (phytonadione)
• C. Fresh frozen plasma only
• D. Aminocaproic acid
• Correct Answer: B
• Rationale: Vitamin K is the antidote for warfarin overdose. Protamine
sulfate reverses heparin. Fresh frozen plasma may be used for active
bleeding, but vitamin K is the specific antidote for warfarin.
4. Which adverse effect is most characteristic of aminoglycoside antibiotics?
• A. Hepatotoxicity
• B. Ototoxicity and nephrotoxicity
• C. Cardiotoxicity
• D. Bone marrow suppression
• Correct Answer: B
• Rationale: Aminoglycosides (gentamicin, tobramycin, amikacin) are
known for dose-related ototoxicity (hearing/balance) and nephrotoxicity.
Peak and trough levels are monitored to prevent toxicity.
5. A nurse is teaching a patient about metformin. Which instruction is most
important?
, • A. Take with food to reduce GI upset
• B. Stop before contrast dye procedures
• C. Report muscle pain or difficulty breathing
• D. All of the above
• Correct Answer: D
• Rationale: Metformin should be taken with food to reduce GI upset,
held before contrast dye procedures due to risk of lactic acidosis, and
patients should report symptoms of lactic acidosis (muscle pain, difficulty
breathing, unusual fatigue).
6. Which medication is a beta-2 adrenergic agonist used for acute asthma relief?
• A. Montelukast
• B. Albuterol
• C. Prednisone
• D. Ipratropium
• Correct Answer: B
• Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that
provides rapid bronchodilation for acute asthma symptoms. Montelukast is
a leukotriene modifier, prednisone is a corticosteroid, and ipratropium is an
anticholinergic.
7. A patient on furosemide should be monitored for which electrolyte
imbalance?
• A. Hyperkalemia
• B. Hypokalemia
• C. Hypernatremia
• D. Hypercalcemia
, • Correct Answer: B
• Rationale: Loop diuretics like furosemide cause potassium loss, leading
to hypokalemia. Patients should be monitored and may need potassium
supplementation or potassium-rich foods.
8. Which drug is used to reverse heparin anticoagulation?
• A. Vitamin K
• B. Protamine sulfate
• C. Fresh frozen plasma
• D. Platelets
• Correct Answer: B
• Rationale: Protamine sulfate binds to heparin and neutralizes its
anticoagulant effect. It is the specific antidote for heparin overdose.
9. A nurse is administering morphine. Which assessment is priority?
• A. Blood glucose
• B. Respiratory rate
• C. Urine output
• D. Skin color
• Correct Answer: B
• Rationale: Morphine is an opioid that causes respiratory depression.
The nurse must assess respiratory rate before and after administration. A
rate below 12/min warrants holding the dose and notifying the provider.
10. Which class of drugs is used to treat anaphylaxis?
• A. Corticosteroids
• B. Antihistamines
Prep: Drug Classes, Mechanisms, Adverse
Effects, Nursing Considerations, Medication
Safety & Practice Review
1. A nurse is preparing to administer digoxin. Which assessment finding should
the nurse report before giving the dose?
• A. Heart rate 58 bpm
• B. Blood pressure 128/76 mm Hg
• C. Potassium 3.1 mEq/L
• D. Respiratory rate 18/min
• Correct Answer: C
• Rationale: Hypokalemia increases the risk of digoxin toxicity. Digoxin
and potassium compete for the same binding sites; low potassium
enhances digoxin's effects. The nurse should report potassium 3.1 mEq/L. A
heart rate below 60 also warrants holding digoxin, but potassium 3.1 is the
most critical lab value indicating toxicity risk.
2. Which drug class is considered first-line for hypertension in a patient with
diabetes and proteinuria?
• A. Beta blockers
• B. ACE inhibitors
• C. Thiazide diuretics
• D. Calcium channel blockers
• Correct Answer: B
, • Rationale: ACE inhibitors (e.g., lisinopril) are first-line for hypertensive
patients with diabetes because they are renoprotective and reduce
proteinuria by dilating the efferent arteriole, lowering intraglomerular
pressure.
3. A patient taking warfarin has an INR of 6.5. Which antidote should the nurse
anticipate administering?
• A. Protamine sulfate
• B. Vitamin K (phytonadione)
• C. Fresh frozen plasma only
• D. Aminocaproic acid
• Correct Answer: B
• Rationale: Vitamin K is the antidote for warfarin overdose. Protamine
sulfate reverses heparin. Fresh frozen plasma may be used for active
bleeding, but vitamin K is the specific antidote for warfarin.
4. Which adverse effect is most characteristic of aminoglycoside antibiotics?
• A. Hepatotoxicity
• B. Ototoxicity and nephrotoxicity
• C. Cardiotoxicity
• D. Bone marrow suppression
• Correct Answer: B
• Rationale: Aminoglycosides (gentamicin, tobramycin, amikacin) are
known for dose-related ototoxicity (hearing/balance) and nephrotoxicity.
Peak and trough levels are monitored to prevent toxicity.
5. A nurse is teaching a patient about metformin. Which instruction is most
important?
, • A. Take with food to reduce GI upset
• B. Stop before contrast dye procedures
• C. Report muscle pain or difficulty breathing
• D. All of the above
• Correct Answer: D
• Rationale: Metformin should be taken with food to reduce GI upset,
held before contrast dye procedures due to risk of lactic acidosis, and
patients should report symptoms of lactic acidosis (muscle pain, difficulty
breathing, unusual fatigue).
6. Which medication is a beta-2 adrenergic agonist used for acute asthma relief?
• A. Montelukast
• B. Albuterol
• C. Prednisone
• D. Ipratropium
• Correct Answer: B
• Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that
provides rapid bronchodilation for acute asthma symptoms. Montelukast is
a leukotriene modifier, prednisone is a corticosteroid, and ipratropium is an
anticholinergic.
7. A patient on furosemide should be monitored for which electrolyte
imbalance?
• A. Hyperkalemia
• B. Hypokalemia
• C. Hypernatremia
• D. Hypercalcemia
, • Correct Answer: B
• Rationale: Loop diuretics like furosemide cause potassium loss, leading
to hypokalemia. Patients should be monitored and may need potassium
supplementation or potassium-rich foods.
8. Which drug is used to reverse heparin anticoagulation?
• A. Vitamin K
• B. Protamine sulfate
• C. Fresh frozen plasma
• D. Platelets
• Correct Answer: B
• Rationale: Protamine sulfate binds to heparin and neutralizes its
anticoagulant effect. It is the specific antidote for heparin overdose.
9. A nurse is administering morphine. Which assessment is priority?
• A. Blood glucose
• B. Respiratory rate
• C. Urine output
• D. Skin color
• Correct Answer: B
• Rationale: Morphine is an opioid that causes respiratory depression.
The nurse must assess respiratory rate before and after administration. A
rate below 12/min warrants holding the dose and notifying the provider.
10. Which class of drugs is used to treat anaphylaxis?
• A. Corticosteroids
• B. Antihistamines
