NSG124 Pharmacology Exam 2 2026/2027 - 100%
Correct Questions & A Grade Verified Answers for
Herzing University
Module 1: Pharmacokinetics & Safety
1. A patient with severe renal impairment (CrCl 20 mL/min) is prescribed
vancomycin. Which nursing action is most critical for safe administration?
A) Monitor for "red man syndrome" during infusion.
B) Check peak and trough levels as ordered.
C) Assess hearing function before starting therapy.
D) Administer with food to reduce GI upset.
Correct Answer: B
Correct Answer Text: Check peak and trough levels as ordered.
Rationale: Vancomycin is renally excreted and can cause nephrotoxicity and
ototoxicity. In renal impairment, therapeutic drug monitoring of peak (efficacy)
and trough (toxicity) levels is essential to adjust dose and interval. While
monitoring for "red man syndrome" (A) and ototoxicity (C) are important,
therapeutic drug monitoring is the most critical safety intervention. Vancomycin
is not administered with food (D).
2. A nurse discovers a patient received double the prescribed dose of digoxin. What
is the priority action?
A) Assess the patient's apical pulse and serum potassium level.
B) Notify the provider and pharmacy of the medication error.
C) Administer digoxin immune fab as an antidote.
D) Document the error in the incident reporting system.
Correct Answer: A
Correct Answer Text: Assess the patient's apical pulse and serum potassium
level.
Rationale: The immediate priority is patient assessment for signs of digoxin
toxicity (bradycardia, arrhythmias, visual disturbances). Hypokalemia increases
toxicity risk. Assessment must precede notification (B) or documentation (D).
Digoxin immune fab (C) requires a specific provider order based on severity.
, 3. A 55-year-old patient with hepatic cirrhosis is prescribed acetaminophen for mild
pain. Which dosage instruction is safest?
A) Do not exceed 4,000 mg in 24 hours.
B) Limit to 2,000 mg/day and use for shortest time.
C) Avoid completely; use ibuprofen instead.
D) Double the dose if pain is severe.
Correct Answer: B
Correct Answer Text: Limit to 2,000 mg/day and use for shortest time.
Rationale: Hepatic impairment reduces metabolism of acetaminophen,
increasing hepatotoxicity risk. 2026 FDA guidance recommends ≤2 g/day in
cirrhosis. Ibuprofen (C) worsens GI/renal issues. Never exceed max dose (A) or
double dose (D).
Module 2: Drug Classes & Clinical Application
4. A patient starting lisinopril for hypertension should be instructed to report which
symptom immediately?
A) Dry, persistent cough
B) Mild headache
C) Occasional dizziness
D) Increased urination
Correct Answer: A
Correct Answer Text: Dry, persistent cough
Rationale: A dry cough is a common side effect of ACE inhibitors like lisinopril,
occurring in up to 20% of patients. While usually not dangerous, it often requires
switching to an ARB. Patients should report this as it affects adherence and
quality of life. Mild headache (B) and occasional dizziness (C) may occur but
aren't ACE-specific. Increased urination (D) is more typical of diuretics.
5. A patient with atrial fibrillation is receiving heparin infusion. The aPTT is 110
seconds (control 30 s). The nurse should:
A) Stop the infusion immediately and call the provider.
B) Continue the current rate and recheck in 4 hours.
C) Reduce the rate per protocol and recheck aPTT.
D) Switch to oral warfarin and stop heparin.
Correct Answer: C
Correct Answer Text: Reduce the rate per protocol and recheck aPTT.
Rationale: A supratherapeutic aPTT (>3 × control or >80 s) increases bleeding
risk. 2026 ACCP guidelines recommend dose reduction and recheck rather than
Correct Questions & A Grade Verified Answers for
Herzing University
Module 1: Pharmacokinetics & Safety
1. A patient with severe renal impairment (CrCl 20 mL/min) is prescribed
vancomycin. Which nursing action is most critical for safe administration?
A) Monitor for "red man syndrome" during infusion.
B) Check peak and trough levels as ordered.
C) Assess hearing function before starting therapy.
D) Administer with food to reduce GI upset.
Correct Answer: B
Correct Answer Text: Check peak and trough levels as ordered.
Rationale: Vancomycin is renally excreted and can cause nephrotoxicity and
ototoxicity. In renal impairment, therapeutic drug monitoring of peak (efficacy)
and trough (toxicity) levels is essential to adjust dose and interval. While
monitoring for "red man syndrome" (A) and ototoxicity (C) are important,
therapeutic drug monitoring is the most critical safety intervention. Vancomycin
is not administered with food (D).
2. A nurse discovers a patient received double the prescribed dose of digoxin. What
is the priority action?
A) Assess the patient's apical pulse and serum potassium level.
B) Notify the provider and pharmacy of the medication error.
C) Administer digoxin immune fab as an antidote.
D) Document the error in the incident reporting system.
Correct Answer: A
Correct Answer Text: Assess the patient's apical pulse and serum potassium
level.
Rationale: The immediate priority is patient assessment for signs of digoxin
toxicity (bradycardia, arrhythmias, visual disturbances). Hypokalemia increases
toxicity risk. Assessment must precede notification (B) or documentation (D).
Digoxin immune fab (C) requires a specific provider order based on severity.
, 3. A 55-year-old patient with hepatic cirrhosis is prescribed acetaminophen for mild
pain. Which dosage instruction is safest?
A) Do not exceed 4,000 mg in 24 hours.
B) Limit to 2,000 mg/day and use for shortest time.
C) Avoid completely; use ibuprofen instead.
D) Double the dose if pain is severe.
Correct Answer: B
Correct Answer Text: Limit to 2,000 mg/day and use for shortest time.
Rationale: Hepatic impairment reduces metabolism of acetaminophen,
increasing hepatotoxicity risk. 2026 FDA guidance recommends ≤2 g/day in
cirrhosis. Ibuprofen (C) worsens GI/renal issues. Never exceed max dose (A) or
double dose (D).
Module 2: Drug Classes & Clinical Application
4. A patient starting lisinopril for hypertension should be instructed to report which
symptom immediately?
A) Dry, persistent cough
B) Mild headache
C) Occasional dizziness
D) Increased urination
Correct Answer: A
Correct Answer Text: Dry, persistent cough
Rationale: A dry cough is a common side effect of ACE inhibitors like lisinopril,
occurring in up to 20% of patients. While usually not dangerous, it often requires
switching to an ARB. Patients should report this as it affects adherence and
quality of life. Mild headache (B) and occasional dizziness (C) may occur but
aren't ACE-specific. Increased urination (D) is more typical of diuretics.
5. A patient with atrial fibrillation is receiving heparin infusion. The aPTT is 110
seconds (control 30 s). The nurse should:
A) Stop the infusion immediately and call the provider.
B) Continue the current rate and recheck in 4 hours.
C) Reduce the rate per protocol and recheck aPTT.
D) Switch to oral warfarin and stop heparin.
Correct Answer: C
Correct Answer Text: Reduce the rate per protocol and recheck aPTT.
Rationale: A supratherapeutic aPTT (>3 × control or >80 s) increases bleeding
risk. 2026 ACCP guidelines recommend dose reduction and recheck rather than
