NCLEX-RN Pharmacology Exam Prep
2025/2026 – Verified Questions with
Correct Answers and Detailed Rationales
Cardiovascular Medications (Questions 1–20)
1. A nurse is preparing to administer lisinopril to a client with hypertension. Which
assessment finding requires holding the dose?
A. Blood pressure 120/80 mmHg
B. Heart rate 70 bpm
C. Serum potassium 5.8 mEq/L
D. Creatinine clearance 60 mL/min
Correct Answer: C
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia. A serum potassium of 5.8
mEq/L is elevated (>5.0 mEq/L), indicating a risk for toxicity. The nurse should hold the dose
and notify the provider. Other findings are within normal limits for continuing administration.
2. (Select All That Apply) A client is prescribed metoprolol. Which client education points
should the nurse include?
A. Take the medication with food to enhance absorption
B. Monitor pulse before taking the dose
C. Expect orthostatic hypotension as a common side effect
D. Discontinue the medication if dizziness occurs
E. Report a heart rate below 50 bpm to the provider
Correct Answers: B, C, E
Rationale: Metoprolol, a beta-blocker, requires pulse monitoring (B) to detect bradycardia (<50
bpm, E). Orthostatic hypotension (C) is a common side effect. It can be taken with or without
food (A incorrect), and abrupt discontinuation (D) risks rebound hypertension.
3. (Drag-and-Drop) A client is receiving furosemide IV for heart failure. Place the nursing
actions in the correct order.
A. Assess lung sounds
B. Administer the medication
C. Monitor urine output
D. Check potassium levels
Correct Answer: A, D, B, C
Rationale: Assess lung sounds (A) to confirm fluid overload, check potassium (D) to prevent
hypokalemia, administer furosemide (B), then monitor urine output (C) to evaluate effectiveness.
4. (Case Study) A client with atrial fibrillation is prescribed warfarin. Lab results show
INR 4.5. What is the nurse’s priority action?
A. Administer the scheduled dose
B. Hold the dose and notify the provider
C. Administer vitamin K immediately
,D. Increase the dose to achieve therapeutic INR
Correct Answer: B
Rationale: An INR of 4.5 is above the therapeutic range (2–3 for atrial fibrillation), indicating a
bleeding risk. Holding the dose and notifying the provider is the priority to adjust therapy.
Vitamin K (C) requires a provider order, and increasing the dose (D) is unsafe.
5. A nurse is administering amlodipine to a client. Which adverse effect should the nurse
monitor for?
A. Hyperkalemia
B. Peripheral edema
C. Tachycardia
D. Hypoglycemia
Correct Answer: B
Rationale: Amlodipine, a calcium channel blocker, commonly causes peripheral edema due to
vasodilation. Hyperkalemia, tachycardia, and hypoglycemia are not associated with this
medication.
6. A client on digoxin reports nausea and blurred vision. What is the nurse’s first action?
A. Administer an antiemetic
B. Check serum digoxin levels
C. Encourage fluid intake
D. Continue the next dose
Correct Answer: B
Rationale: Nausea and blurred vision suggest digoxin toxicity. Checking serum levels
(therapeutic: 0.5–2 ng/mL) is the priority to confirm toxicity before further dosing or symptom
management.
7. A nurse is teaching a client about atorvastatin. Which instruction is most important?
A. Take the medication in the morning
B. Report muscle pain or weakness
C. Avoid dairy products
D. Expect weight gain
Correct Answer: B
Rationale: Muscle pain or weakness may indicate rhabdomyolysis, a serious statin side effect.
Atorvastatin can be taken any time (A incorrect), dairy is not contraindicated (C), and weight
gain is not typical (D).
8. A client is receiving IV heparin. The aPTT is 90 seconds (control 30–40 seconds). What
should the nurse do?
A. Increase the infusion rate
B. Stop the infusion and notify the provider
C. Continue the current rate
D. Administer protamine sulfate
Correct Answer: B
Rationale: An aPTT >70 seconds indicates excessive anticoagulation, increasing bleeding risk.
Stopping the infusion and notifying the provider is the priority. Protamine sulfate (D) requires an
order.
9. A client with heart failure is prescribed spironolactone. Which lab value should the
nurse monitor closely?
, A. Serum sodium
B. Serum potassium
C. Blood glucose
D. Hemoglobin
Correct Answer: B
Rationale: Spironolactone, a potassium-sparing diuretic, risks hyperkalemia. Monitoring
potassium levels is critical. Other labs are less directly affected.
10. (Select All That Apply) A client is prescribed nitroglycerin sublingual tablets. Which
instructions should the nurse include?
A. Take up to three doses 5 minutes apart if chest pain persists
B. Store tablets in a cool, dry place
C. Swallow the tablet with water
D. Call 911 if pain persists after three doses
E. Expect a burning sensation under the tongue
Correct Answers: A, B, D, E
Rationale: Nitroglycerin is taken every 5 minutes up to three doses (A), stored away from
heat/light (B), and requires emergency action if ineffective (D). A burning sensation is expected
(E). Swallowing (C) is incorrect; it is sublingual.
11. A nurse administers losartan to a client. Which condition contraindicates its use?
A. Asthma
B. Bilateral renal artery stenosis
C. Type 2 diabetes
D. Hyperlipidemia
Correct Answer: B
Rationale: Losartan, an ARB, can worsen renal function in bilateral renal artery stenosis. It is
not contraindicated in asthma, diabetes, or hyperlipidemia.
12. A client on clopidogrel reports bruising. What is the nurse’s best response?
A. Discontinue the medication
B. Monitor for additional bleeding signs
C. Administer vitamin K
D. Ignore as a normal side effect
Correct Answer: B
Rationale: Clopidogrel, an antiplatelet, increases bleeding risk. Monitoring for serious bleeding
is essential. Discontinuing (A) or administering vitamin K (C) requires provider orders, and
ignoring (D) is unsafe.
13. A nurse is preparing to administer diltiazem IV. What is the priority assessment?
A. Blood pressure
B. Respiratory rate
C. Blood glucose
D. Temperature
Correct Answer: A
Rationale: Diltiazem, a calcium channel blocker, can cause hypotension. Monitoring blood
pressure is critical to prevent adverse effects.
14. (Case Study) A client with a history of MI is prescribed aspirin 81 mg daily. The client
reports epigastric pain. What should the nurse do?
2025/2026 – Verified Questions with
Correct Answers and Detailed Rationales
Cardiovascular Medications (Questions 1–20)
1. A nurse is preparing to administer lisinopril to a client with hypertension. Which
assessment finding requires holding the dose?
A. Blood pressure 120/80 mmHg
B. Heart rate 70 bpm
C. Serum potassium 5.8 mEq/L
D. Creatinine clearance 60 mL/min
Correct Answer: C
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia. A serum potassium of 5.8
mEq/L is elevated (>5.0 mEq/L), indicating a risk for toxicity. The nurse should hold the dose
and notify the provider. Other findings are within normal limits for continuing administration.
2. (Select All That Apply) A client is prescribed metoprolol. Which client education points
should the nurse include?
A. Take the medication with food to enhance absorption
B. Monitor pulse before taking the dose
C. Expect orthostatic hypotension as a common side effect
D. Discontinue the medication if dizziness occurs
E. Report a heart rate below 50 bpm to the provider
Correct Answers: B, C, E
Rationale: Metoprolol, a beta-blocker, requires pulse monitoring (B) to detect bradycardia (<50
bpm, E). Orthostatic hypotension (C) is a common side effect. It can be taken with or without
food (A incorrect), and abrupt discontinuation (D) risks rebound hypertension.
3. (Drag-and-Drop) A client is receiving furosemide IV for heart failure. Place the nursing
actions in the correct order.
A. Assess lung sounds
B. Administer the medication
C. Monitor urine output
D. Check potassium levels
Correct Answer: A, D, B, C
Rationale: Assess lung sounds (A) to confirm fluid overload, check potassium (D) to prevent
hypokalemia, administer furosemide (B), then monitor urine output (C) to evaluate effectiveness.
4. (Case Study) A client with atrial fibrillation is prescribed warfarin. Lab results show
INR 4.5. What is the nurse’s priority action?
A. Administer the scheduled dose
B. Hold the dose and notify the provider
C. Administer vitamin K immediately
,D. Increase the dose to achieve therapeutic INR
Correct Answer: B
Rationale: An INR of 4.5 is above the therapeutic range (2–3 for atrial fibrillation), indicating a
bleeding risk. Holding the dose and notifying the provider is the priority to adjust therapy.
Vitamin K (C) requires a provider order, and increasing the dose (D) is unsafe.
5. A nurse is administering amlodipine to a client. Which adverse effect should the nurse
monitor for?
A. Hyperkalemia
B. Peripheral edema
C. Tachycardia
D. Hypoglycemia
Correct Answer: B
Rationale: Amlodipine, a calcium channel blocker, commonly causes peripheral edema due to
vasodilation. Hyperkalemia, tachycardia, and hypoglycemia are not associated with this
medication.
6. A client on digoxin reports nausea and blurred vision. What is the nurse’s first action?
A. Administer an antiemetic
B. Check serum digoxin levels
C. Encourage fluid intake
D. Continue the next dose
Correct Answer: B
Rationale: Nausea and blurred vision suggest digoxin toxicity. Checking serum levels
(therapeutic: 0.5–2 ng/mL) is the priority to confirm toxicity before further dosing or symptom
management.
7. A nurse is teaching a client about atorvastatin. Which instruction is most important?
A. Take the medication in the morning
B. Report muscle pain or weakness
C. Avoid dairy products
D. Expect weight gain
Correct Answer: B
Rationale: Muscle pain or weakness may indicate rhabdomyolysis, a serious statin side effect.
Atorvastatin can be taken any time (A incorrect), dairy is not contraindicated (C), and weight
gain is not typical (D).
8. A client is receiving IV heparin. The aPTT is 90 seconds (control 30–40 seconds). What
should the nurse do?
A. Increase the infusion rate
B. Stop the infusion and notify the provider
C. Continue the current rate
D. Administer protamine sulfate
Correct Answer: B
Rationale: An aPTT >70 seconds indicates excessive anticoagulation, increasing bleeding risk.
Stopping the infusion and notifying the provider is the priority. Protamine sulfate (D) requires an
order.
9. A client with heart failure is prescribed spironolactone. Which lab value should the
nurse monitor closely?
, A. Serum sodium
B. Serum potassium
C. Blood glucose
D. Hemoglobin
Correct Answer: B
Rationale: Spironolactone, a potassium-sparing diuretic, risks hyperkalemia. Monitoring
potassium levels is critical. Other labs are less directly affected.
10. (Select All That Apply) A client is prescribed nitroglycerin sublingual tablets. Which
instructions should the nurse include?
A. Take up to three doses 5 minutes apart if chest pain persists
B. Store tablets in a cool, dry place
C. Swallow the tablet with water
D. Call 911 if pain persists after three doses
E. Expect a burning sensation under the tongue
Correct Answers: A, B, D, E
Rationale: Nitroglycerin is taken every 5 minutes up to three doses (A), stored away from
heat/light (B), and requires emergency action if ineffective (D). A burning sensation is expected
(E). Swallowing (C) is incorrect; it is sublingual.
11. A nurse administers losartan to a client. Which condition contraindicates its use?
A. Asthma
B. Bilateral renal artery stenosis
C. Type 2 diabetes
D. Hyperlipidemia
Correct Answer: B
Rationale: Losartan, an ARB, can worsen renal function in bilateral renal artery stenosis. It is
not contraindicated in asthma, diabetes, or hyperlipidemia.
12. A client on clopidogrel reports bruising. What is the nurse’s best response?
A. Discontinue the medication
B. Monitor for additional bleeding signs
C. Administer vitamin K
D. Ignore as a normal side effect
Correct Answer: B
Rationale: Clopidogrel, an antiplatelet, increases bleeding risk. Monitoring for serious bleeding
is essential. Discontinuing (A) or administering vitamin K (C) requires provider orders, and
ignoring (D) is unsafe.
13. A nurse is preparing to administer diltiazem IV. What is the priority assessment?
A. Blood pressure
B. Respiratory rate
C. Blood glucose
D. Temperature
Correct Answer: A
Rationale: Diltiazem, a calcium channel blocker, can cause hypotension. Monitoring blood
pressure is critical to prevent adverse effects.
14. (Case Study) A client with a history of MI is prescribed aspirin 81 mg daily. The client
reports epigastric pain. What should the nurse do?
