NGN NCLEX-RN
PHARMACOLOGY
Exam Elaborations Questions & Answers
2026
A patient with atrial fibrillation is prescribed apixaban. Which assessment finding requires
immediate intervention?
A. Heart rate of 90 bpm
B. Hematuria
C. Blood pressure 130/80 mmHg
D. INR of 2.0
Answer: B. Hematuria
Rationale: Apixaban is a direct oral anticoagulant; bleeding (e.g., hematuria) is a serious
adverse effect requiring prompt action.
A patient on gentamicin reports tinnitus and dizziness. What is the priority nursing action?
A. Administer antiemetics
B. Hold the medication
C. Increase hydration
D. Reassure patient
Answer: B. Hold the medication
Rationale: Ototoxicity is a known adverse effect of aminoglycosides; the drug must be
stopped to prevent permanent damage.
True/False: ACE inhibitors commonly cause hyperkalemia.
Answer: True
Rationale: ACE inhibitors decrease aldosterone, leading to potassium retention.
Fill in the blank: The therapeutic range for digoxin is ________ ng/mL.
,Answer: 0.5–2.0
Rationale: Levels above this increase risk of toxicity, including arrhythmias.
A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. What is the priority
concern?
A. Reduced anticoagulation
B. Increased bleeding risk
C. Hypertension
D. Hypoglycemia
Answer: B. Increased bleeding risk
Rationale: Antibiotics can potentiate warfarin, increasing INR and bleeding risk.
True/False: Beta-lactam antibiotics inhibit bacterial protein synthesis.
Answer: False
Rationale: They inhibit cell wall synthesis.
A patient with asthma is prescribed propranolol. What should the nurse do?
A. Administer medication
B. Question the order
C. Monitor blood pressure
D. Give with food
Answer: B. Question the order
Rationale: Non-selective beta-blockers can cause bronchoconstriction.
Fill in the blank: The antidote for acetaminophen toxicity is ________.
Answer: N-acetylcysteine
Rationale: Restores glutathione and prevents liver damage.
A patient on insulin therapy develops confusion and diaphoresis. What is the priority
intervention?
A. Administer insulin
B. Give IV glucose
C. Check blood pressure
D. Give potassium
Answer: B. Give IV glucose
Rationale: Symptoms indicate hypoglycemia, requiring immediate glucose administration.
True/False: Loop diuretics can cause hypokalemia.
Answer: True
Rationale: Increased urinary potassium excretion leads to low potassium.
A patient taking lithium has a level of 2.0 mEq/L. What is the priority action?
A. Continue medication
B. Administer next dose
, C. Hold medication
D. Encourage fluids only
Answer: C. Hold medication
Rationale: Level indicates toxicity; medication must be withheld.
Fill in the blank: The mechanism of action of statins is inhibition of ________.
Answer: HMG-CoA reductase
Rationale: This enzyme is key in cholesterol synthesis.
A patient is prescribed morphine. Which assessment finding requires intervention?
A. Respiratory rate 10/min
B. Pain score 8/10
C. BP 140/90 mmHg
D. HR 88 bpm
Answer: A. Respiratory rate 10/min
Rationale: Opioids depress respiration; RR <12 is concerning.
True/False: Naloxone reverses benzodiazepine overdose.
Answer: False
Rationale: Flumazenil reverses benzodiazepines; naloxone reverses opioids.
A patient taking metformin is scheduled for contrast CT. What is the priority action?
A. Administer medication
B. Hold metformin
C. Increase dose
D. Give insulin
Answer: B. Hold metformin
Rationale: Prevents lactic acidosis in renal impairment from contrast.
Fill in the blank: The primary neurotransmitter affected by SSRIs is ________.
Answer: Serotonin
Rationale: SSRIs inhibit serotonin reuptake.
A patient on heparin develops thrombocytopenia. What is suspected?
A. DIC
B. HIT
C. Anemia
D. Sepsis
Answer: B. HIT
Rationale: Heparin-induced thrombocytopenia is immune-mediated and dangerous.
True/False: Calcium channel blockers decrease heart rate and contractility.
Answer: True
Rationale: They reduce myocardial oxygen demand.
PHARMACOLOGY
Exam Elaborations Questions & Answers
2026
A patient with atrial fibrillation is prescribed apixaban. Which assessment finding requires
immediate intervention?
A. Heart rate of 90 bpm
B. Hematuria
C. Blood pressure 130/80 mmHg
D. INR of 2.0
Answer: B. Hematuria
Rationale: Apixaban is a direct oral anticoagulant; bleeding (e.g., hematuria) is a serious
adverse effect requiring prompt action.
A patient on gentamicin reports tinnitus and dizziness. What is the priority nursing action?
A. Administer antiemetics
B. Hold the medication
C. Increase hydration
D. Reassure patient
Answer: B. Hold the medication
Rationale: Ototoxicity is a known adverse effect of aminoglycosides; the drug must be
stopped to prevent permanent damage.
True/False: ACE inhibitors commonly cause hyperkalemia.
Answer: True
Rationale: ACE inhibitors decrease aldosterone, leading to potassium retention.
Fill in the blank: The therapeutic range for digoxin is ________ ng/mL.
,Answer: 0.5–2.0
Rationale: Levels above this increase risk of toxicity, including arrhythmias.
A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. What is the priority
concern?
A. Reduced anticoagulation
B. Increased bleeding risk
C. Hypertension
D. Hypoglycemia
Answer: B. Increased bleeding risk
Rationale: Antibiotics can potentiate warfarin, increasing INR and bleeding risk.
True/False: Beta-lactam antibiotics inhibit bacterial protein synthesis.
Answer: False
Rationale: They inhibit cell wall synthesis.
A patient with asthma is prescribed propranolol. What should the nurse do?
A. Administer medication
B. Question the order
C. Monitor blood pressure
D. Give with food
Answer: B. Question the order
Rationale: Non-selective beta-blockers can cause bronchoconstriction.
Fill in the blank: The antidote for acetaminophen toxicity is ________.
Answer: N-acetylcysteine
Rationale: Restores glutathione and prevents liver damage.
A patient on insulin therapy develops confusion and diaphoresis. What is the priority
intervention?
A. Administer insulin
B. Give IV glucose
C. Check blood pressure
D. Give potassium
Answer: B. Give IV glucose
Rationale: Symptoms indicate hypoglycemia, requiring immediate glucose administration.
True/False: Loop diuretics can cause hypokalemia.
Answer: True
Rationale: Increased urinary potassium excretion leads to low potassium.
A patient taking lithium has a level of 2.0 mEq/L. What is the priority action?
A. Continue medication
B. Administer next dose
, C. Hold medication
D. Encourage fluids only
Answer: C. Hold medication
Rationale: Level indicates toxicity; medication must be withheld.
Fill in the blank: The mechanism of action of statins is inhibition of ________.
Answer: HMG-CoA reductase
Rationale: This enzyme is key in cholesterol synthesis.
A patient is prescribed morphine. Which assessment finding requires intervention?
A. Respiratory rate 10/min
B. Pain score 8/10
C. BP 140/90 mmHg
D. HR 88 bpm
Answer: A. Respiratory rate 10/min
Rationale: Opioids depress respiration; RR <12 is concerning.
True/False: Naloxone reverses benzodiazepine overdose.
Answer: False
Rationale: Flumazenil reverses benzodiazepines; naloxone reverses opioids.
A patient taking metformin is scheduled for contrast CT. What is the priority action?
A. Administer medication
B. Hold metformin
C. Increase dose
D. Give insulin
Answer: B. Hold metformin
Rationale: Prevents lactic acidosis in renal impairment from contrast.
Fill in the blank: The primary neurotransmitter affected by SSRIs is ________.
Answer: Serotonin
Rationale: SSRIs inhibit serotonin reuptake.
A patient on heparin develops thrombocytopenia. What is suspected?
A. DIC
B. HIT
C. Anemia
D. Sepsis
Answer: B. HIT
Rationale: Heparin-induced thrombocytopenia is immune-mediated and dangerous.
True/False: Calcium channel blockers decrease heart rate and contractility.
Answer: True
Rationale: They reduce myocardial oxygen demand.
