Prophecy RN Pharmacology Exam Prep
2024/2025: Core Concepts & Practice
Section 1: High-Alert Medications (6 Questions)
1. High-Alert Medication: Insulin
A patient with type 1 diabetes receives Lispro insulin at 0730. At 0800, the patient reports
dizziness and sweating. What is the priority nursing action? A) Administer a snack with
complex carbohydrates B) Check the patient’s blood glucose level C) Administer glucagon IM D)
Notify the provider for a dose adjustment
Answer: B) Check the patient’s blood glucose level Rationale: Lispro insulin peaks in 30–90
minutes, so the patient’s symptoms (dizziness, sweating) suggest hypoglycemia. The priority
is to confirm the blood glucose level before intervening. If hypoglycemia is confirmed, a
fast-acting carbohydrate (e.g., glucose gel) should be administered.
● A) Incorrect: Complex carbohydrates take too long to absorb in acute hypoglycemia.
● C) Incorrect: Glucagon is used for severe hypoglycemia (e.g., unconsciousness), not
mild symptoms.
● D) Incorrect: The provider does not need to be notified before assessing and treating
hypoglycemia.
2. High-Alert Medication: Heparin
A patient on a heparin drip has a PTT of 90 seconds (target: 60–80 seconds). What is the
most appropriate nursing action? A) Increase the heparin infusion rate B) Hold the heparin
and notify the provider C) Administer protamine sulfate D) Check for signs of bleeding
Answer: B) Hold the heparin and notify the provider Rationale: A PTT of 90 seconds is above
the therapeutic range , increasing the risk of bleeding. The nurse should hold the infusion
and notify the provider for further orders.
● A) Incorrect: Increasing the rate would further elevate PTT and bleeding risk.
, ● C) Incorrect: Protamine sulfate is used for heparin overdose with active bleeding, not
for mild PTT elevation.
● D) Incorrect: While assessing for bleeding is important, the priority is to hold the heparin
and notify the provider.
3. High-Alert Medication: Opioids
A postoperative patient receiving IV morphine develops respiratory depression (RR 8, SpO₂
88%). What is the first nursing action? A) Administer naloxone 0.4 mg IV B) Stimulate the
patient and encourage deep breaths C) Decrease the morphine infusion rate D) Administer
oxygen via nasal cannula
Answer: B) Stimulate the patient and encourage deep breaths Rationale: The first action is to
stimulate the patient and encourage breathing. If respiratory depression persists, naloxone
may be required.
● A) Incorrect: Naloxone is used if stimulation fails or for severe respiratory depression.
● C) Incorrect: The infusion should be stopped, not just decreased.
● D) Incorrect: Oxygen is adjunctive but does not address the cause (opioid-induced
respiratory depression).
4. High-Alert Medication: Ketamine
A patient receiving ketamine for procedural sedation develops hypertension and
tachycardia. What is the most likely cause ? A) Allergic reaction B) Sympathomimetic effects of
ketamine C) Overdose D) Hypoxemia
Answer: B) Sympathomimetic effects of ketamine Rationale: Ketamine stimulates the
sympathetic nervous system, causing hypertension and tachycardia. This is an expected
side effect, not an allergy or overdose.
● A) Incorrect: Allergic reactions typically cause hypotension and bronchospasm.
● C) Incorrect: Overdose would cause CNS depression, not stimulation.
● D) Incorrect: Hypoxemia would cause bradycardia and hypotension.
5. Anticoagulation Monitoring: Warfarin
A patient on warfarin has an INR of 5.2 (target: 2–3). The provider orders vitamin K 2.5 mg PO .
What should the nurse teach the patient? A) “You will need to stop warfarin permanently.” B)
2024/2025: Core Concepts & Practice
Section 1: High-Alert Medications (6 Questions)
1. High-Alert Medication: Insulin
A patient with type 1 diabetes receives Lispro insulin at 0730. At 0800, the patient reports
dizziness and sweating. What is the priority nursing action? A) Administer a snack with
complex carbohydrates B) Check the patient’s blood glucose level C) Administer glucagon IM D)
Notify the provider for a dose adjustment
Answer: B) Check the patient’s blood glucose level Rationale: Lispro insulin peaks in 30–90
minutes, so the patient’s symptoms (dizziness, sweating) suggest hypoglycemia. The priority
is to confirm the blood glucose level before intervening. If hypoglycemia is confirmed, a
fast-acting carbohydrate (e.g., glucose gel) should be administered.
● A) Incorrect: Complex carbohydrates take too long to absorb in acute hypoglycemia.
● C) Incorrect: Glucagon is used for severe hypoglycemia (e.g., unconsciousness), not
mild symptoms.
● D) Incorrect: The provider does not need to be notified before assessing and treating
hypoglycemia.
2. High-Alert Medication: Heparin
A patient on a heparin drip has a PTT of 90 seconds (target: 60–80 seconds). What is the
most appropriate nursing action? A) Increase the heparin infusion rate B) Hold the heparin
and notify the provider C) Administer protamine sulfate D) Check for signs of bleeding
Answer: B) Hold the heparin and notify the provider Rationale: A PTT of 90 seconds is above
the therapeutic range , increasing the risk of bleeding. The nurse should hold the infusion
and notify the provider for further orders.
● A) Incorrect: Increasing the rate would further elevate PTT and bleeding risk.
, ● C) Incorrect: Protamine sulfate is used for heparin overdose with active bleeding, not
for mild PTT elevation.
● D) Incorrect: While assessing for bleeding is important, the priority is to hold the heparin
and notify the provider.
3. High-Alert Medication: Opioids
A postoperative patient receiving IV morphine develops respiratory depression (RR 8, SpO₂
88%). What is the first nursing action? A) Administer naloxone 0.4 mg IV B) Stimulate the
patient and encourage deep breaths C) Decrease the morphine infusion rate D) Administer
oxygen via nasal cannula
Answer: B) Stimulate the patient and encourage deep breaths Rationale: The first action is to
stimulate the patient and encourage breathing. If respiratory depression persists, naloxone
may be required.
● A) Incorrect: Naloxone is used if stimulation fails or for severe respiratory depression.
● C) Incorrect: The infusion should be stopped, not just decreased.
● D) Incorrect: Oxygen is adjunctive but does not address the cause (opioid-induced
respiratory depression).
4. High-Alert Medication: Ketamine
A patient receiving ketamine for procedural sedation develops hypertension and
tachycardia. What is the most likely cause ? A) Allergic reaction B) Sympathomimetic effects of
ketamine C) Overdose D) Hypoxemia
Answer: B) Sympathomimetic effects of ketamine Rationale: Ketamine stimulates the
sympathetic nervous system, causing hypertension and tachycardia. This is an expected
side effect, not an allergy or overdose.
● A) Incorrect: Allergic reactions typically cause hypotension and bronchospasm.
● C) Incorrect: Overdose would cause CNS depression, not stimulation.
● D) Incorrect: Hypoxemia would cause bradycardia and hypotension.
5. Anticoagulation Monitoring: Warfarin
A patient on warfarin has an INR of 5.2 (target: 2–3). The provider orders vitamin K 2.5 mg PO .
What should the nurse teach the patient? A) “You will need to stop warfarin permanently.” B)
