NCLEX PHARMACOLOGY REVIEW (2025 > 2026) | LATEST UPDATE
WITH 100 MOST TESTED QUESTIONS AND CORRECT ANSWERS –
HIGH-YIELD REVISION ACTUAL TAKEN EXAM
THIS NCLEX PHARMACOLOGY GUIDE INCLUDES THE MOST FREQUENTLY TESTED
MEDICATIONS AND DRUG CLASSES SEEN ON THE NCLEX-RN AND NCLEX-PN
EXAMS. TOPICS COVER CARDIAC DRUGS, ANTIBIOTICS, PSYCH MEDS, INSULINS,
ELECTROLYTES, AND CRITICAL CARE MEDICATIONS.
EACH SECTION INCLUDES NURSING INTERVENTIONS, SIDE EFFECTS,
CONTRAINDICATIONS, AND SAMPLE QUESTIONS TO BUILD CONFIDENCE AND
CRITICAL THINKING. DESIGNED FOR BOTH FIRST-TIME TEST TAKERS AND
REPEATERS.
1. Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose.
Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following
organs?
a. Lungs
b. Liver
c. Kidney
d. Adrenal Glands - ANSWER****1.Answer B. Acetaminophen is extensively metabolized by
pathways in the liver. Toxic doses of acetaminophen deplete hepatic glutathione, resulting in
accumulation of the intermediate agent, quinine, which leads to hepatic necrosis. Prolonged use of
acetaminophen may result in an increased risk of renal dysfunction, but a single overdose does not
precipitate life-threatening problems in the respiratory system, renal system, or adrenal glands.
2. A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema)
is:
a. Parasite infection.
b. Viral infection.
c. Bacterial infection.
,d. Spirochete infection. - ANSWER****2.Answer B. Topical agents produce a localized, rather than
systemic effect. When treating atopic dermatitis with a steroidal preparation, the site is vulnerable to
invasion by organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of disseminated
infection. Educate the patient using topical corticosteroids to avoid crowds or people known to have
infections and to report even minor signs of an infection. Topical corticosteroid usage results in little
danger of concurrent infection with these agents.
3. In infants and children, the side effects of first generation over-the-counter (OTC) antihistamines,
such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:
a. Reye's syndrome.
b. Cholinergic effects.
c. Paradoxical CNS stimulation.
d. Nausea and diarrhea. - ANSWER****3.Answer C. Typically, first generation OTC antihistamines
have a sedating effect because of passage into the CNS. However, in some individuals, especially infants
and children, paradoxical CNS stimulation occurs and is manifested by excitement, euphoria,
restlessness, and confusion. For this reason, use of first generation OTC antihistamines has declined, and
second generation product usage has increased. Reye's syndrome is a systemic response to a virus. First
generation OTC antihistamines do not exhibit a cholinergic effect. Nausea and diarrhea are uncommon
when first generation OTC antihistamines are taken.
4. Reye's syndrome, a potentially fatal illness associated with liver failure and encephalopathy is
associated with the administration of which over-the-counter (OTC) medication?
a. acetaminophen (Tylenol)
b. ibuprofen (Motrin)
c. aspirin
d. brompheniramine/psudoephedrine (Dimetapp) - ANSWER****4.Answer C. Virus-infected children
who are given aspirin to manage pain, fever, and inflammation are at an increased risk of developing
Reye's syndrome. Use of acetaminophen has not been associated with Reye's syndrome and can be
safely given to patients with fever due to viral illnesses. Ibuprofen adverse effects include GI irritation
and bleeding, and in toxic doses, both renal and hepatic failure are reported. However, ibuprofen has
not been associated with the onset of Reye's disease. Brompheniramine/psudoephedrine contains a first
generation OTC antihistamine and a decongestant. Neither agent has been associated with the
development of Reye's syndrome.
5. The nurse is aware that the patients who are allergic to intravenous contrast media are usually also
allergic to which of the following products?
,a. Eggs
b. Shellfish
c. Soy
d. acidic fruits - ANSWER****5.Answer B. Some types of contrast media contain iodine as an
ingredient. Shellfish also contain significant amounts of iodine. Therefore, a patient who is allergic to
iodine will exhibit an allergic response to both iodine containing contrast media and shellfish. These
products do not contain iodine.
6. A 13-month-old child recently arrived in the United States from a foreign country with his parents and
needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning,
you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not
receive?
a. Hepatitis B
b. inactivated polio
c. diphtheria, acellular pertussis, tetanus (DTaP)
d. mumps, measles, rubella (MMR) - ANSWER****6.Answer D. The measles portion of the MMR
vaccine is grown in chick embryo cells. The current MMR vaccine does not contain a significant amount
of egg proteins, and even children with dramatic egg allergies are extremely unlikely to have an
anaphylactic reaction. However, patients that do respond to egg contact with anaphylaxis should be in a
medically controlled setting where full resuscitation efforts can be administered if anaphylaxis results.
The vaccines in options a,b and c do not contain egg protein.
7. The cell and Coombs classification system categorizes allergic reactions and is useful in describing and
classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are
mediated by:
a. immunoglobulin E (IgE).
b. immunoglobulin G (IgG).
c. immunoglobulin A (IgA).
d. immunoglobulin M (IgM). - ANSWER****7.Answer A. IgE, the least common serum
immunoglobulin (Ig) binds very tightly to receptors on basophils and mast cells and is involved in allergic
reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological
mediators that result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most
versatile Ig because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class
of Ig that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the second
most common serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is important in
, local (mucosal) immunity. IgM, the third most common serum Ig, is the first Ig to be made by the fetus
and the first Ig to be made by a virgin B cell when it is stimulated by antigen. IgM antibodies are very
efficient in leading to the lysis of microorganisms.
8. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types
of drug-induced toxicity. The most serious form of bone marrow toxicity is:
a. aplastic anemia.
b. thrombocytosis.
c. leukocytosis.
d. granulocytosis. - ANSWER****8.Answer A. Aplastic anemia is the result of a hypersensitivity
reaction and is often irreversible. It leads to pancytopenia, a severe decrease in all cell types: red blood
cells, white blood cells, and platelets. A reduced number of red blood cells causes hemoglobin to drop. A
reduced number of white blood cells make the patient susceptible to infection. And, a reduced number
of platelets cause the blood not to clot as easily. Treatment for mild cases is supportive. Transfusions
may be necessary. Severe cases require a bone marrow transplant. Option 2 is an elevated platelet
count. Option 3 is an elevated white count. Option 4 is an elevated granulocyte count. A granulocyte is a
type of white blood cell.
9. Serious adverse effects of oral contraceptives include:
a. Increase in skin oil followed by acne.
b. Headache and dizziness.
c. Early or mid-cycle bleeding.
d. Thromboembolic complications. - ANSWER****9.Answer D. Oral contraceptives have been
associated with an increased risk of stroke, myocardial infarction, and deep vein thrombosis. These risks
are increased in women who smoke. Increased skin oil and acne are effects of progestin excess.
Headache and dizziness are effects of estrogen excess. Early or mid-cycle bleeding are effects of
estrogen deficiency.
10. The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in
neonates is:
a. Apnea.
b. Bleeding tendencies.
c. Hypotension.
WITH 100 MOST TESTED QUESTIONS AND CORRECT ANSWERS –
HIGH-YIELD REVISION ACTUAL TAKEN EXAM
THIS NCLEX PHARMACOLOGY GUIDE INCLUDES THE MOST FREQUENTLY TESTED
MEDICATIONS AND DRUG CLASSES SEEN ON THE NCLEX-RN AND NCLEX-PN
EXAMS. TOPICS COVER CARDIAC DRUGS, ANTIBIOTICS, PSYCH MEDS, INSULINS,
ELECTROLYTES, AND CRITICAL CARE MEDICATIONS.
EACH SECTION INCLUDES NURSING INTERVENTIONS, SIDE EFFECTS,
CONTRAINDICATIONS, AND SAMPLE QUESTIONS TO BUILD CONFIDENCE AND
CRITICAL THINKING. DESIGNED FOR BOTH FIRST-TIME TEST TAKERS AND
REPEATERS.
1. Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose.
Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following
organs?
a. Lungs
b. Liver
c. Kidney
d. Adrenal Glands - ANSWER****1.Answer B. Acetaminophen is extensively metabolized by
pathways in the liver. Toxic doses of acetaminophen deplete hepatic glutathione, resulting in
accumulation of the intermediate agent, quinine, which leads to hepatic necrosis. Prolonged use of
acetaminophen may result in an increased risk of renal dysfunction, but a single overdose does not
precipitate life-threatening problems in the respiratory system, renal system, or adrenal glands.
2. A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema)
is:
a. Parasite infection.
b. Viral infection.
c. Bacterial infection.
,d. Spirochete infection. - ANSWER****2.Answer B. Topical agents produce a localized, rather than
systemic effect. When treating atopic dermatitis with a steroidal preparation, the site is vulnerable to
invasion by organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of disseminated
infection. Educate the patient using topical corticosteroids to avoid crowds or people known to have
infections and to report even minor signs of an infection. Topical corticosteroid usage results in little
danger of concurrent infection with these agents.
3. In infants and children, the side effects of first generation over-the-counter (OTC) antihistamines,
such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:
a. Reye's syndrome.
b. Cholinergic effects.
c. Paradoxical CNS stimulation.
d. Nausea and diarrhea. - ANSWER****3.Answer C. Typically, first generation OTC antihistamines
have a sedating effect because of passage into the CNS. However, in some individuals, especially infants
and children, paradoxical CNS stimulation occurs and is manifested by excitement, euphoria,
restlessness, and confusion. For this reason, use of first generation OTC antihistamines has declined, and
second generation product usage has increased. Reye's syndrome is a systemic response to a virus. First
generation OTC antihistamines do not exhibit a cholinergic effect. Nausea and diarrhea are uncommon
when first generation OTC antihistamines are taken.
4. Reye's syndrome, a potentially fatal illness associated with liver failure and encephalopathy is
associated with the administration of which over-the-counter (OTC) medication?
a. acetaminophen (Tylenol)
b. ibuprofen (Motrin)
c. aspirin
d. brompheniramine/psudoephedrine (Dimetapp) - ANSWER****4.Answer C. Virus-infected children
who are given aspirin to manage pain, fever, and inflammation are at an increased risk of developing
Reye's syndrome. Use of acetaminophen has not been associated with Reye's syndrome and can be
safely given to patients with fever due to viral illnesses. Ibuprofen adverse effects include GI irritation
and bleeding, and in toxic doses, both renal and hepatic failure are reported. However, ibuprofen has
not been associated with the onset of Reye's disease. Brompheniramine/psudoephedrine contains a first
generation OTC antihistamine and a decongestant. Neither agent has been associated with the
development of Reye's syndrome.
5. The nurse is aware that the patients who are allergic to intravenous contrast media are usually also
allergic to which of the following products?
,a. Eggs
b. Shellfish
c. Soy
d. acidic fruits - ANSWER****5.Answer B. Some types of contrast media contain iodine as an
ingredient. Shellfish also contain significant amounts of iodine. Therefore, a patient who is allergic to
iodine will exhibit an allergic response to both iodine containing contrast media and shellfish. These
products do not contain iodine.
6. A 13-month-old child recently arrived in the United States from a foreign country with his parents and
needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning,
you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not
receive?
a. Hepatitis B
b. inactivated polio
c. diphtheria, acellular pertussis, tetanus (DTaP)
d. mumps, measles, rubella (MMR) - ANSWER****6.Answer D. The measles portion of the MMR
vaccine is grown in chick embryo cells. The current MMR vaccine does not contain a significant amount
of egg proteins, and even children with dramatic egg allergies are extremely unlikely to have an
anaphylactic reaction. However, patients that do respond to egg contact with anaphylaxis should be in a
medically controlled setting where full resuscitation efforts can be administered if anaphylaxis results.
The vaccines in options a,b and c do not contain egg protein.
7. The cell and Coombs classification system categorizes allergic reactions and is useful in describing and
classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are
mediated by:
a. immunoglobulin E (IgE).
b. immunoglobulin G (IgG).
c. immunoglobulin A (IgA).
d. immunoglobulin M (IgM). - ANSWER****7.Answer A. IgE, the least common serum
immunoglobulin (Ig) binds very tightly to receptors on basophils and mast cells and is involved in allergic
reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological
mediators that result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most
versatile Ig because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class
of Ig that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the second
most common serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is important in
, local (mucosal) immunity. IgM, the third most common serum Ig, is the first Ig to be made by the fetus
and the first Ig to be made by a virgin B cell when it is stimulated by antigen. IgM antibodies are very
efficient in leading to the lysis of microorganisms.
8. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types
of drug-induced toxicity. The most serious form of bone marrow toxicity is:
a. aplastic anemia.
b. thrombocytosis.
c. leukocytosis.
d. granulocytosis. - ANSWER****8.Answer A. Aplastic anemia is the result of a hypersensitivity
reaction and is often irreversible. It leads to pancytopenia, a severe decrease in all cell types: red blood
cells, white blood cells, and platelets. A reduced number of red blood cells causes hemoglobin to drop. A
reduced number of white blood cells make the patient susceptible to infection. And, a reduced number
of platelets cause the blood not to clot as easily. Treatment for mild cases is supportive. Transfusions
may be necessary. Severe cases require a bone marrow transplant. Option 2 is an elevated platelet
count. Option 3 is an elevated white count. Option 4 is an elevated granulocyte count. A granulocyte is a
type of white blood cell.
9. Serious adverse effects of oral contraceptives include:
a. Increase in skin oil followed by acne.
b. Headache and dizziness.
c. Early or mid-cycle bleeding.
d. Thromboembolic complications. - ANSWER****9.Answer D. Oral contraceptives have been
associated with an increased risk of stroke, myocardial infarction, and deep vein thrombosis. These risks
are increased in women who smoke. Increased skin oil and acne are effects of progestin excess.
Headache and dizziness are effects of estrogen excess. Early or mid-cycle bleeding are effects of
estrogen deficiency.
10. The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in
neonates is:
a. Apnea.
b. Bleeding tendencies.
c. Hypotension.
