PROPHECY RN PHARMACOLOGY A LATEST 95%
2026/2027 | Solved Updated Exam | Complete Q&A | Pass
Guaranteed - A+ Graded
Section 1: Medication Administration & Safety (Q1-15)
Q1. A nurse is preparing to administer digoxin 0.25 mg PO to a client with heart
failure. Before administering the medication, the nurse checks the apical pulse and
notes it is 52 bpm. Which nursing action is the PRIORITY?
A. Administer the medication as ordered and reassess the pulse in 30 minutes
B. Hold the medication and notify the provider
C. Administer half the dose and document the pulse
D. Recheck the radial pulse for accuracy
Correct Answer: B
Rationale: Digoxin is contraindicated when apical pulse is <60 bpm (bradycardia
indicates digoxin toxicity risk). The nurse must hold the dose and notify the provider.
Option A risks worsening bradycardia. Option C is outside nursing scope. Option D is
unnecessary—apical pulse is the standard. Prophecy Competency Principle: High-
alert medications require pre-administration assessment; digoxin pulse check is
mandatory. Medication Safety Pearl 2026/2027: Digoxin therapeutic range narrows
with age and renal impairment; hold for pulse <60 or >100; check potassium levels
(hypokalemia increases toxicity risk).
Q2. A nurse is verifying a medication order: "Potassium chloride 20 mEq IV push
STAT." Which nursing action is the PRIORITY?
,A. Prepare the medication and administer immediately as ordered
B. Clarify the order with the provider—potassium chloride is NEVER given IV push
C. Dilute the potassium chloride in 50 mL normal saline and infuse over 1 hour
D. Administer the medication via a central line only
Correct Answer: B
Rationale: Potassium chloride IV push is NEVER appropriate—it causes fatal cardiac
arrest. The nurse must clarify the order with the provider. Option A is dangerous.
Option C describes appropriate administration but doesn't address the unsafe order.
Option D is incorrect—concentration matters more than line type. Prophecy
Competency Principle: Nurses must recognize and challenge unsafe orders;
potassium chloride is a high-alert medication. Medication Safety Pearl 2026/2027:
ISMP lists potassium chloride as a "do not use" abbreviation; always write "potassium
chloride"; max peripheral concentration 10 mEq/100 mL, max rate 10 mEq/hour.
Q3. A nurse is reviewing a client's home medication list during admission. The client
takes warfarin 5 mg daily, atorvastatin 20 mg daily, and omeprazole 20 mg daily. The
provider orders ciprofloxacin 500 mg BID for a UTI. Which nursing action is the
PRIORITY?
A. Administer all medications as ordered
B. Hold the warfarin and notify the provider about the interaction
C. Hold the omeprazole and notify the provider
D. Administer the ciprofloxacin 2 hours after the warfarin
Correct Answer: B
Rationale: Ciprofloxacin inhibits CYP1A2 and displaces warfarin from protein
binding, increasing INR and bleeding risk. The nurse must hold warfarin and notify
the provider for INR monitoring and dose adjustment. Option A ignores the
interaction. Option C addresses a minor interaction. Option D doesn't prevent the
pharmacokinetic interaction. Prophecy Competency Principle: Medication
reconciliation requires identifying drug-drug interactions, especially with high-alert
medications. Medication Safety Pearl 2026/2027: Fluoroquinolones increase
warfarin effect by 30-50%; monitor INR within 3-5 days of starting antibiotic; many
,antibiotics interact with warfarin (TMP-SMX > fluoroquinolones > macrolides >
metronidazole).
Q4. A nurse is preparing insulin for a client with type 1 diabetes. The client is
prescribed NPH 20 units and regular insulin 10 units. Which technique is CORRECT?
A. Draw up the NPH first, then the regular insulin
B. Draw up the regular insulin first, then the NPH
C. Use two separate syringes to avoid contamination
D. Mix the insulins in the vial before drawing up
Correct Answer: B
Rationale: When mixing insulin, draw up clear (regular) before cloudy (NPH) to
prevent contaminating the regular insulin vial with NPH. Option A risks NPH
contamination of regular vial. Option C is unnecessary with proper technique. Option
D is unsafe and unsterile. Prophecy Competency Principle: Insulin mixing technique
prevents dosage errors and contamination. Medication Safety Pearl 2026/2027:
"Clear before cloudy" mnemonic; roll NPH vial gently (don't shake); administer within
15 minutes of mixing; newer premixed insulins reduce mixing errors.
Q5. A nurse discovers a medication error: a client received metoprolol 100 mg
instead of the ordered 50 mg. The client's blood pressure is 98/62 mmHg and heart
rate is 56 bpm. Which nursing action is the PRIORITY?
A. Complete the incident report immediately
B. Assess the client for signs of overdose and notify the provider
C. Document the error in the medical record
D. Administer a reversal agent for metoprolol
Correct Answer: B
Rationale: Client safety is the priority—assess for hypotension and bradycardia
(beta-blocker overdose effects) and notify the provider for orders (glucagon, IV
, fluids, atropine if needed). Option A is important but secondary. Option C should be
objective, not accusatory. Option D—glucagon is the reversal but requires provider
order. Prophecy Competency Principle: Medication error management prioritizes
patient assessment and provider notification over documentation. Medication Safety
Pearl 2026/2027: Beta-blocker overdose: glucagon 5-10 mg IV (stimulates cAMP via
non-beta receptors), high-dose insulin therapy, lipid emulsion; monitor glucose
(glucagon causes hyperglycemia).
Q6. A nurse is administering chemotherapy to a client with lymphoma. Which
personal protective equipment (PPE) is REQUIRED when handling the medication?
A. Standard gloves only
B. Double chemotherapy gloves, gown, and face shield
C. Single chemotherapy gloves and a surgical mask
D. N95 respirator and standard gloves
Correct Answer: B
Rationale: OSHA requires double chemotherapy-tested gloves, impermeable gown,
and face/eye protection when handling hazardous drugs. Option A is insufficient.
Option C lacks adequate protection. Option D is for airborne precautions, not
chemotherapy. Prophecy Competency Principle: Hazardous drug handling requires
specific PPE per OSHA guidelines. Medication Safety Pearl 2026/2027: NIOSH 2024
update classifies more drugs as hazardous; closed system transfer devices (CSTDs)
recommended for all antineoplastic administration; pregnant nurses should avoid
handling chemotherapy if possible.
Q7. A nurse is teaching a client about self-administration of subcutaneous
enoxaparin. Which statement by the client indicates correct understanding?
A. "I should inject into the same site each time for consistency."
B. "I should expel the air bubble before injecting."
2026/2027 | Solved Updated Exam | Complete Q&A | Pass
Guaranteed - A+ Graded
Section 1: Medication Administration & Safety (Q1-15)
Q1. A nurse is preparing to administer digoxin 0.25 mg PO to a client with heart
failure. Before administering the medication, the nurse checks the apical pulse and
notes it is 52 bpm. Which nursing action is the PRIORITY?
A. Administer the medication as ordered and reassess the pulse in 30 minutes
B. Hold the medication and notify the provider
C. Administer half the dose and document the pulse
D. Recheck the radial pulse for accuracy
Correct Answer: B
Rationale: Digoxin is contraindicated when apical pulse is <60 bpm (bradycardia
indicates digoxin toxicity risk). The nurse must hold the dose and notify the provider.
Option A risks worsening bradycardia. Option C is outside nursing scope. Option D is
unnecessary—apical pulse is the standard. Prophecy Competency Principle: High-
alert medications require pre-administration assessment; digoxin pulse check is
mandatory. Medication Safety Pearl 2026/2027: Digoxin therapeutic range narrows
with age and renal impairment; hold for pulse <60 or >100; check potassium levels
(hypokalemia increases toxicity risk).
Q2. A nurse is verifying a medication order: "Potassium chloride 20 mEq IV push
STAT." Which nursing action is the PRIORITY?
,A. Prepare the medication and administer immediately as ordered
B. Clarify the order with the provider—potassium chloride is NEVER given IV push
C. Dilute the potassium chloride in 50 mL normal saline and infuse over 1 hour
D. Administer the medication via a central line only
Correct Answer: B
Rationale: Potassium chloride IV push is NEVER appropriate—it causes fatal cardiac
arrest. The nurse must clarify the order with the provider. Option A is dangerous.
Option C describes appropriate administration but doesn't address the unsafe order.
Option D is incorrect—concentration matters more than line type. Prophecy
Competency Principle: Nurses must recognize and challenge unsafe orders;
potassium chloride is a high-alert medication. Medication Safety Pearl 2026/2027:
ISMP lists potassium chloride as a "do not use" abbreviation; always write "potassium
chloride"; max peripheral concentration 10 mEq/100 mL, max rate 10 mEq/hour.
Q3. A nurse is reviewing a client's home medication list during admission. The client
takes warfarin 5 mg daily, atorvastatin 20 mg daily, and omeprazole 20 mg daily. The
provider orders ciprofloxacin 500 mg BID for a UTI. Which nursing action is the
PRIORITY?
A. Administer all medications as ordered
B. Hold the warfarin and notify the provider about the interaction
C. Hold the omeprazole and notify the provider
D. Administer the ciprofloxacin 2 hours after the warfarin
Correct Answer: B
Rationale: Ciprofloxacin inhibits CYP1A2 and displaces warfarin from protein
binding, increasing INR and bleeding risk. The nurse must hold warfarin and notify
the provider for INR monitoring and dose adjustment. Option A ignores the
interaction. Option C addresses a minor interaction. Option D doesn't prevent the
pharmacokinetic interaction. Prophecy Competency Principle: Medication
reconciliation requires identifying drug-drug interactions, especially with high-alert
medications. Medication Safety Pearl 2026/2027: Fluoroquinolones increase
warfarin effect by 30-50%; monitor INR within 3-5 days of starting antibiotic; many
,antibiotics interact with warfarin (TMP-SMX > fluoroquinolones > macrolides >
metronidazole).
Q4. A nurse is preparing insulin for a client with type 1 diabetes. The client is
prescribed NPH 20 units and regular insulin 10 units. Which technique is CORRECT?
A. Draw up the NPH first, then the regular insulin
B. Draw up the regular insulin first, then the NPH
C. Use two separate syringes to avoid contamination
D. Mix the insulins in the vial before drawing up
Correct Answer: B
Rationale: When mixing insulin, draw up clear (regular) before cloudy (NPH) to
prevent contaminating the regular insulin vial with NPH. Option A risks NPH
contamination of regular vial. Option C is unnecessary with proper technique. Option
D is unsafe and unsterile. Prophecy Competency Principle: Insulin mixing technique
prevents dosage errors and contamination. Medication Safety Pearl 2026/2027:
"Clear before cloudy" mnemonic; roll NPH vial gently (don't shake); administer within
15 minutes of mixing; newer premixed insulins reduce mixing errors.
Q5. A nurse discovers a medication error: a client received metoprolol 100 mg
instead of the ordered 50 mg. The client's blood pressure is 98/62 mmHg and heart
rate is 56 bpm. Which nursing action is the PRIORITY?
A. Complete the incident report immediately
B. Assess the client for signs of overdose and notify the provider
C. Document the error in the medical record
D. Administer a reversal agent for metoprolol
Correct Answer: B
Rationale: Client safety is the priority—assess for hypotension and bradycardia
(beta-blocker overdose effects) and notify the provider for orders (glucagon, IV
, fluids, atropine if needed). Option A is important but secondary. Option C should be
objective, not accusatory. Option D—glucagon is the reversal but requires provider
order. Prophecy Competency Principle: Medication error management prioritizes
patient assessment and provider notification over documentation. Medication Safety
Pearl 2026/2027: Beta-blocker overdose: glucagon 5-10 mg IV (stimulates cAMP via
non-beta receptors), high-dose insulin therapy, lipid emulsion; monitor glucose
(glucagon causes hyperglycemia).
Q6. A nurse is administering chemotherapy to a client with lymphoma. Which
personal protective equipment (PPE) is REQUIRED when handling the medication?
A. Standard gloves only
B. Double chemotherapy gloves, gown, and face shield
C. Single chemotherapy gloves and a surgical mask
D. N95 respirator and standard gloves
Correct Answer: B
Rationale: OSHA requires double chemotherapy-tested gloves, impermeable gown,
and face/eye protection when handling hazardous drugs. Option A is insufficient.
Option C lacks adequate protection. Option D is for airborne precautions, not
chemotherapy. Prophecy Competency Principle: Hazardous drug handling requires
specific PPE per OSHA guidelines. Medication Safety Pearl 2026/2027: NIOSH 2024
update classifies more drugs as hazardous; closed system transfer devices (CSTDs)
recommended for all antineoplastic administration; pregnant nurses should avoid
handling chemotherapy if possible.
Q7. A nurse is teaching a client about self-administration of subcutaneous
enoxaparin. Which statement by the client indicates correct understanding?
A. "I should inject into the same site each time for consistency."
B. "I should expel the air bubble before injecting."
