NUR 210 • PHARMACOLOGY PRACTICE SERIES
NUR 210 Pharmacology Clinical Case Studies
2026–2027 • 110 Clinical Practice Questions with Rationales
Case-focused practice emphasizing presenting symptoms, medication interactions, urgent findings, side-effect recognition
and priority nursing responses.
USE & SCOPE
Independent practice questions, not an official test, answer key, or course syllabus. NUR 210 varies by school. Dose
calculations are educational examples, not prescribing directions. Verify medication orders, current labeling, facility policies,
monitoring thresholds and patient-specific factors in actual care.
PRACTICE EXAM: QUESTIONS, ANSWERS & RATIONALES
1. A 69-year-old with hypertension has started lisinopril. At morning rounds, the patient has lip swelling, hoarseness, and
new stridor. What is the most important immediate nursing response?
A. Offer water and recheck in two hours
B. Prepare for emergency airway evaluation and stop ACE inhibitor exposure
C. Administer a PRN cough lozenge
D. Give lisinopril with food
Correct answer: B. Prepare for emergency airway evaluation and stop ACE inhibitor exposure
Detailed rationale: New stridor and orofacial edema suggest airway-threatening angioedema.
Why other options are incorrect: Water, lozenges, delay, and giving the drug again fail to protect the airway.
2. A 72-year-old on furosemide for edema has lost 2.5 kg in 24 hours and now has dizziness, BP 88/52 mmHg, and
weakness. What should be assessed first?
A. Hair distribution
B. Volume status, orthostatic symptoms, and electrolytes
C. Last annual eye exam
D. Whether the dose tasted bitter
Correct answer: B. Volume status, orthostatic symptoms, and electrolytes
Detailed rationale: Rapid volume loss with hypotension suggests excessive diuresis.
Why other options are incorrect: The other choices do not address perfusion or electrolyte concerns.
3. A patient with heart failure takes digoxin and furosemide. Labs show K 2.9 mEq/L and the patient reports halos,
nausea, and palpitations. What is the priority?
A. Continue both drugs without assessment
B. Notify the treating team urgently and evaluate digoxin toxicity and electrolytes
C. Increase exercise
D. Give a large OTC potassium dose without authorization
Correct answer: B. Notify the treating team urgently and evaluate digoxin toxicity and electrolytes
Detailed rationale: Hypokalemia increases the risk of digoxin toxicity and dysrhythmia.
Why other options are incorrect: Routine continuation or self-treatment ignores potential life-threatening arrhythmia.
4. A patient taking apixaban arrives pale and dizzy and reports maroon stools. BP is 92/58 mmHg. What is the priority?
A. Routine discharge instructions
B. Urgent assessment for major bleeding and hemodynamic instability
C. Give ibuprofen for discomfort
D. Schedule follow-up in six weeks
Correct answer: B. Urgent assessment for major bleeding and hemodynamic instability
Detailed rationale: Possible major GI bleeding on an anticoagulant requires urgent evaluation.
Why other options are incorrect: Ibuprofen and delayed care increase risk.
NUR 210 | Original educational practice resource • 2026–2027 | Page 1
, NUR 210 • PHARMACOLOGY PRACTICE SERIES
5. A patient with COPD normally uses tiotropium each morning. The patient suddenly has severe wheezing and increased
work of breathing. What should the nurse do?
A. Rely only on the next tiotropium maintenance dose
B. Assess airway and initiate ordered rapid-acting rescue treatment and escalation
C. Give oral iron
D. Reassure that severe dyspnea is always expected
Correct answer: B. Assess airway and initiate ordered rapid-acting rescue treatment and escalation
Detailed rationale: Severe acute bronchospasm requires prompt assessment and a fast-acting bronchodilator pathway.
Why other options are incorrect: Tiotropium is maintenance rather than rescue therapy.
6. A patient treated for asthma has used albuterol every hour and remains unable to speak full sentences. What finding
most changes the urgency?
A. A normal appetite
B. Difficulty speaking due to breathlessness
C. A regular bowel movement
D. A request for water
Correct answer: B. Difficulty speaking due to breathlessness
Detailed rationale: Persistent severe respiratory distress indicates potentially life-threatening exacerbation.
Why other options are incorrect: The other observations do not lessen respiratory urgency.
7. After IV penicillin starts, a patient develops diffuse hives, wheezing, stridor, and BP 74/40. Which medication is first-
line?
A. Montelukast orally
B. IM epinephrine per emergency protocol
C. Inhaled fluticasone alone
D. Oral loratadine as sole therapy
Correct answer: B. IM epinephrine per emergency protocol
Detailed rationale: Epinephrine is first-line for anaphylaxis, together with emergency response and airway care.
Why other options are incorrect: Controller medicines and antihistamines must not delay epinephrine.
8. A person with type 1 diabetes receives rapid-acting insulin, but the meal has been delayed 50 minutes. They become
sweaty and confused. Which bedside test takes priority?
A. Blood glucose
B. Serum calcium only
C. Troponin in every case
D. Thyroid antibody test
Correct answer: A. Blood glucose
Detailed rationale: Symptoms and insulin/meal mismatch suggest hypoglycemia requiring immediate point-of-care
assessment.
Why other options are incorrect: The other tests do not identify the most likely immediate threat.
9. A patient taking empagliflozin has nausea, abdominal pain, and deep breathing while glucose is only mildly elevated.
What should be considered?
A. Euglycemic ketoacidosis
B. Normal harmless exercise recovery
C. Opioid overdose as the only cause
D. Expected isolated dry mouth
Correct answer: A. Euglycemic ketoacidosis
Detailed rationale: SGLT2-associated ketoacidosis can occur despite glucose below traditional DKA thresholds.
Why other options are incorrect: The alternatives do not explain the concerning metabolic symptoms.
10. A patient on methimazole calls with a temperature of 39°C and severe sore throat. Which instruction is most
appropriate?
A. Prompt urgent medical assessment and CBC as indicated
B. Take double methimazole
C. Wait one week without contact
NUR 210 | Original educational practice resource • 2026–2027 | Page 2
, NUR 210 • PHARMACOLOGY PRACTICE SERIES
D. Start iron supplements
Correct answer: A. Prompt urgent medical assessment and CBC as indicated
Detailed rationale: Fever and sore throat can signal potentially severe agranulocytosis.
Why other options are incorrect: Extra methimazole and delayed assessment can increase harm.
11. During a vancomycin infusion, a patient becomes diffusely flushed and itchy without airway swelling. What is the
initial nursing action?
A. Pause/stop infusion and assess per protocol
B. Increase infusion rate
C. Start another vancomycin bag
D. Ignore the reaction
Correct answer: A. Pause/stop infusion and assess per protocol
Detailed rationale: A rate-related infusion reaction should prompt an assessment and protocol-guided rate correction.
Why other options are incorrect: A faster infusion can worsen a reaction.
12. An older patient is receiving gentamicin and now reports ringing in both ears and has rising creatinine. Which action
is warranted?
A. Prompt medication safety assessment and prescriber notification
B. Give the next dose earlier
C. Treat tinnitus as proof the antibiotic works
D. Stop checking renal function
Correct answer: A. Prompt medication safety assessment and prescriber notification
Detailed rationale: Gentamicin can cause ototoxicity and nephrotoxicity.
Why other options are incorrect: Ignoring toxicity signs risks permanent injury.
13. A patient finishes antibiotics and develops 8 watery stools per day with cramping and fever. What is important?
A. Assess for C. difficile and implement indicated precautions
B. Give loperamide without assessment for all cases
C. Assume viral gastroenteritis is the only explanation
D. Start another random antibiotic
Correct answer: A. Assess for C. difficile and implement indicated precautions
Detailed rationale: New severe diarrhea following antibiotics raises concern for C. difficile infection.
Why other options are incorrect: Empiric symptomatic treatment without evaluation can be unsafe.
14. A patient taking tramadol and sertraline presents with fever, tremor, hyperreflexia and clonus. Which drug
complication is likely?
A. Serotonin syndrome
B. Stable therapeutic effect
C. Simple constipation
D. Expected anticholinergic dry mouth
Correct answer: A. Serotonin syndrome
Detailed rationale: Serotonergic drug interactions may trigger clonus, hyperreflexia, autonomic symptoms, and fever.
Why other options are incorrect: The other choices do not explain this acute toxidrome.
15. A patient on chronic lithium has gastroenteritis with dehydration and becomes ataxic and confused. Which action is
the priority?
A. Hold and promptly assess for lithium toxicity and renal status
B. Increase lithium dose
C. Add ibuprofen without a medication check
D. Ignore the change in mental status
Correct answer: A. Hold and promptly assess for lithium toxicity and renal status
Detailed rationale: Dehydration may elevate lithium concentration and precipitate toxicity.
Why other options are incorrect: More lithium or NSAIDs can worsen risk.
NUR 210 | Original educational practice resource • 2026–2027 | Page 3
NUR 210 Pharmacology Clinical Case Studies
2026–2027 • 110 Clinical Practice Questions with Rationales
Case-focused practice emphasizing presenting symptoms, medication interactions, urgent findings, side-effect recognition
and priority nursing responses.
USE & SCOPE
Independent practice questions, not an official test, answer key, or course syllabus. NUR 210 varies by school. Dose
calculations are educational examples, not prescribing directions. Verify medication orders, current labeling, facility policies,
monitoring thresholds and patient-specific factors in actual care.
PRACTICE EXAM: QUESTIONS, ANSWERS & RATIONALES
1. A 69-year-old with hypertension has started lisinopril. At morning rounds, the patient has lip swelling, hoarseness, and
new stridor. What is the most important immediate nursing response?
A. Offer water and recheck in two hours
B. Prepare for emergency airway evaluation and stop ACE inhibitor exposure
C. Administer a PRN cough lozenge
D. Give lisinopril with food
Correct answer: B. Prepare for emergency airway evaluation and stop ACE inhibitor exposure
Detailed rationale: New stridor and orofacial edema suggest airway-threatening angioedema.
Why other options are incorrect: Water, lozenges, delay, and giving the drug again fail to protect the airway.
2. A 72-year-old on furosemide for edema has lost 2.5 kg in 24 hours and now has dizziness, BP 88/52 mmHg, and
weakness. What should be assessed first?
A. Hair distribution
B. Volume status, orthostatic symptoms, and electrolytes
C. Last annual eye exam
D. Whether the dose tasted bitter
Correct answer: B. Volume status, orthostatic symptoms, and electrolytes
Detailed rationale: Rapid volume loss with hypotension suggests excessive diuresis.
Why other options are incorrect: The other choices do not address perfusion or electrolyte concerns.
3. A patient with heart failure takes digoxin and furosemide. Labs show K 2.9 mEq/L and the patient reports halos,
nausea, and palpitations. What is the priority?
A. Continue both drugs without assessment
B. Notify the treating team urgently and evaluate digoxin toxicity and electrolytes
C. Increase exercise
D. Give a large OTC potassium dose without authorization
Correct answer: B. Notify the treating team urgently and evaluate digoxin toxicity and electrolytes
Detailed rationale: Hypokalemia increases the risk of digoxin toxicity and dysrhythmia.
Why other options are incorrect: Routine continuation or self-treatment ignores potential life-threatening arrhythmia.
4. A patient taking apixaban arrives pale and dizzy and reports maroon stools. BP is 92/58 mmHg. What is the priority?
A. Routine discharge instructions
B. Urgent assessment for major bleeding and hemodynamic instability
C. Give ibuprofen for discomfort
D. Schedule follow-up in six weeks
Correct answer: B. Urgent assessment for major bleeding and hemodynamic instability
Detailed rationale: Possible major GI bleeding on an anticoagulant requires urgent evaluation.
Why other options are incorrect: Ibuprofen and delayed care increase risk.
NUR 210 | Original educational practice resource • 2026–2027 | Page 1
, NUR 210 • PHARMACOLOGY PRACTICE SERIES
5. A patient with COPD normally uses tiotropium each morning. The patient suddenly has severe wheezing and increased
work of breathing. What should the nurse do?
A. Rely only on the next tiotropium maintenance dose
B. Assess airway and initiate ordered rapid-acting rescue treatment and escalation
C. Give oral iron
D. Reassure that severe dyspnea is always expected
Correct answer: B. Assess airway and initiate ordered rapid-acting rescue treatment and escalation
Detailed rationale: Severe acute bronchospasm requires prompt assessment and a fast-acting bronchodilator pathway.
Why other options are incorrect: Tiotropium is maintenance rather than rescue therapy.
6. A patient treated for asthma has used albuterol every hour and remains unable to speak full sentences. What finding
most changes the urgency?
A. A normal appetite
B. Difficulty speaking due to breathlessness
C. A regular bowel movement
D. A request for water
Correct answer: B. Difficulty speaking due to breathlessness
Detailed rationale: Persistent severe respiratory distress indicates potentially life-threatening exacerbation.
Why other options are incorrect: The other observations do not lessen respiratory urgency.
7. After IV penicillin starts, a patient develops diffuse hives, wheezing, stridor, and BP 74/40. Which medication is first-
line?
A. Montelukast orally
B. IM epinephrine per emergency protocol
C. Inhaled fluticasone alone
D. Oral loratadine as sole therapy
Correct answer: B. IM epinephrine per emergency protocol
Detailed rationale: Epinephrine is first-line for anaphylaxis, together with emergency response and airway care.
Why other options are incorrect: Controller medicines and antihistamines must not delay epinephrine.
8. A person with type 1 diabetes receives rapid-acting insulin, but the meal has been delayed 50 minutes. They become
sweaty and confused. Which bedside test takes priority?
A. Blood glucose
B. Serum calcium only
C. Troponin in every case
D. Thyroid antibody test
Correct answer: A. Blood glucose
Detailed rationale: Symptoms and insulin/meal mismatch suggest hypoglycemia requiring immediate point-of-care
assessment.
Why other options are incorrect: The other tests do not identify the most likely immediate threat.
9. A patient taking empagliflozin has nausea, abdominal pain, and deep breathing while glucose is only mildly elevated.
What should be considered?
A. Euglycemic ketoacidosis
B. Normal harmless exercise recovery
C. Opioid overdose as the only cause
D. Expected isolated dry mouth
Correct answer: A. Euglycemic ketoacidosis
Detailed rationale: SGLT2-associated ketoacidosis can occur despite glucose below traditional DKA thresholds.
Why other options are incorrect: The alternatives do not explain the concerning metabolic symptoms.
10. A patient on methimazole calls with a temperature of 39°C and severe sore throat. Which instruction is most
appropriate?
A. Prompt urgent medical assessment and CBC as indicated
B. Take double methimazole
C. Wait one week without contact
NUR 210 | Original educational practice resource • 2026–2027 | Page 2
, NUR 210 • PHARMACOLOGY PRACTICE SERIES
D. Start iron supplements
Correct answer: A. Prompt urgent medical assessment and CBC as indicated
Detailed rationale: Fever and sore throat can signal potentially severe agranulocytosis.
Why other options are incorrect: Extra methimazole and delayed assessment can increase harm.
11. During a vancomycin infusion, a patient becomes diffusely flushed and itchy without airway swelling. What is the
initial nursing action?
A. Pause/stop infusion and assess per protocol
B. Increase infusion rate
C. Start another vancomycin bag
D. Ignore the reaction
Correct answer: A. Pause/stop infusion and assess per protocol
Detailed rationale: A rate-related infusion reaction should prompt an assessment and protocol-guided rate correction.
Why other options are incorrect: A faster infusion can worsen a reaction.
12. An older patient is receiving gentamicin and now reports ringing in both ears and has rising creatinine. Which action
is warranted?
A. Prompt medication safety assessment and prescriber notification
B. Give the next dose earlier
C. Treat tinnitus as proof the antibiotic works
D. Stop checking renal function
Correct answer: A. Prompt medication safety assessment and prescriber notification
Detailed rationale: Gentamicin can cause ototoxicity and nephrotoxicity.
Why other options are incorrect: Ignoring toxicity signs risks permanent injury.
13. A patient finishes antibiotics and develops 8 watery stools per day with cramping and fever. What is important?
A. Assess for C. difficile and implement indicated precautions
B. Give loperamide without assessment for all cases
C. Assume viral gastroenteritis is the only explanation
D. Start another random antibiotic
Correct answer: A. Assess for C. difficile and implement indicated precautions
Detailed rationale: New severe diarrhea following antibiotics raises concern for C. difficile infection.
Why other options are incorrect: Empiric symptomatic treatment without evaluation can be unsafe.
14. A patient taking tramadol and sertraline presents with fever, tremor, hyperreflexia and clonus. Which drug
complication is likely?
A. Serotonin syndrome
B. Stable therapeutic effect
C. Simple constipation
D. Expected anticholinergic dry mouth
Correct answer: A. Serotonin syndrome
Detailed rationale: Serotonergic drug interactions may trigger clonus, hyperreflexia, autonomic symptoms, and fever.
Why other options are incorrect: The other choices do not explain this acute toxidrome.
15. A patient on chronic lithium has gastroenteritis with dehydration and becomes ataxic and confused. Which action is
the priority?
A. Hold and promptly assess for lithium toxicity and renal status
B. Increase lithium dose
C. Add ibuprofen without a medication check
D. Ignore the change in mental status
Correct answer: A. Hold and promptly assess for lithium toxicity and renal status
Detailed rationale: Dehydration may elevate lithium concentration and precipitate toxicity.
Why other options are incorrect: More lithium or NSAIDs can worsen risk.
NUR 210 | Original educational practice resource • 2026–2027 | Page 3
