NCLEX Pharmacology Review 2026:
Most Tested Medications
Exam|||Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Total Questions: 85
Format: Multiple Choice
Instructions: Select the best answer. Correct answers are highlighted in bold.
Rationales are provided.
Section 1: Cardiovascular Medications (Questions 1-15)
1. A client with heart failure is prescribed digoxin. Which assessment finding
requires immediate action?
• A. Apical pulse of 62 bpm
• B. Serum potassium of 3.2 mEq/L
• C. Digoxin level of 1.2 ng/mL
• D. Blood pressure of 118/76 mmHg
Rationale: Hypokalemia (K+ <3.5) increases the risk of digoxin toxicity, leading
to dysrhythmias. Digoxin therapeutic level is 0.8-2.0 ng/mL; pulse >60 is
acceptable.
2. A client taking furosemide (Lasix) reports muscle cramps and weakness.
Which lab value is most likely abnormal?
• A. Potassium 3.1 mEq/L
• B. Sodium 145 mEq/L
, • C. Calcium 9.5 mg/dL
• D. Magnesium 2.1 mEq/L
Rationale: Furosemide is a loop diuretic that causes hypokalemia, leading to
muscle cramps, weakness, and dysrhythmias.
3. Which drug is the first-line treatment for an acute hypertensive emergency?
• A. Metoprolol
• B. Hydralazine
• C. Sodium nitroprusside
• D. Clonidine
Rationale: Sodium nitroprusside is a direct vasodilator with rapid onset, used IV
for hypertensive crises. Monitor for cyanide toxicity with prolonged use.
4. A client on amiodarone develops cough and dyspnea. What is the priority
action?
• A. Administer furosemide
• B. Assess for pulmonary toxicity
• C. Increase oxygen delivery
• D. Give nebulized albuterol
Rationale: Amiodarone causes pulmonary fibrosis in 5-15% of patients. New
cough/dyspnea requires immediate evaluation with chest X-ray or DLCO.
5. After administering sublingual nitroglycerin for chest pain, the client’s pain
is unrelieved after 5 minutes. What should the nurse do next?
• A. Repeat nitroglycerin in 5 minutes
• B. Administer second nitroglycerin and call provider if pain persists
after 3 doses
• C. Apply a nitroglycerin patch
• D. Give aspirin 325 mg and wait 10 minutes
Rationale: Nitroglycerin protocol: one dose q5min up to 3 doses. Unrelieved pain
after 3 doses suggests possible MI.
, 6. Which ACE inhibitor side effect is most important to teach a female client
of childbearing age?
• A. Dry cough
• B. Fetal injury (teratogenicity)
• C. Angioedema
• D. Hyperkalemia
Rationale: ACE inhibitors are contraindicated in pregnancy (Category D/X risk of
fetal renal agenesis, oligohydramnios).
7. A client on warfarin has an INR of 4.5 without bleeding. The next dose is
due in 2 hours. What should the nurse do?
• A. Administer the dose as ordered
• B. Hold the dose and notify provider
• C. Administer vitamin K 10 mg orally
• D. Give protamine sulfate
Rationale: Therapeutic INR for most indications is 2-3; 4.5 increases bleeding
risk. Hold warfarin and notify provider (may require dose reduction or vitamin K if
>5).
8. Which medication is contraindicated in clients with severe asthma?
• A. Carvedilol
• B. Metoprolol succinate
• C. Propranolol
• D. Bisoprolol
Rationale: Propranolol is non-selective beta-blocker (blocks beta-2 receptors in
lungs), causing bronchospasm. Cardioselective agents (metoprolol, bisoprolol) are
safer but still use caution.
9. A client starts atorvastatin. Which instruction is most important?
• A. Take with grapefruit juice to enhance absorption
• B. Report any unexplained muscle pain or dark urine
Most Tested Medications
Exam|||Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Total Questions: 85
Format: Multiple Choice
Instructions: Select the best answer. Correct answers are highlighted in bold.
Rationales are provided.
Section 1: Cardiovascular Medications (Questions 1-15)
1. A client with heart failure is prescribed digoxin. Which assessment finding
requires immediate action?
• A. Apical pulse of 62 bpm
• B. Serum potassium of 3.2 mEq/L
• C. Digoxin level of 1.2 ng/mL
• D. Blood pressure of 118/76 mmHg
Rationale: Hypokalemia (K+ <3.5) increases the risk of digoxin toxicity, leading
to dysrhythmias. Digoxin therapeutic level is 0.8-2.0 ng/mL; pulse >60 is
acceptable.
2. A client taking furosemide (Lasix) reports muscle cramps and weakness.
Which lab value is most likely abnormal?
• A. Potassium 3.1 mEq/L
• B. Sodium 145 mEq/L
, • C. Calcium 9.5 mg/dL
• D. Magnesium 2.1 mEq/L
Rationale: Furosemide is a loop diuretic that causes hypokalemia, leading to
muscle cramps, weakness, and dysrhythmias.
3. Which drug is the first-line treatment for an acute hypertensive emergency?
• A. Metoprolol
• B. Hydralazine
• C. Sodium nitroprusside
• D. Clonidine
Rationale: Sodium nitroprusside is a direct vasodilator with rapid onset, used IV
for hypertensive crises. Monitor for cyanide toxicity with prolonged use.
4. A client on amiodarone develops cough and dyspnea. What is the priority
action?
• A. Administer furosemide
• B. Assess for pulmonary toxicity
• C. Increase oxygen delivery
• D. Give nebulized albuterol
Rationale: Amiodarone causes pulmonary fibrosis in 5-15% of patients. New
cough/dyspnea requires immediate evaluation with chest X-ray or DLCO.
5. After administering sublingual nitroglycerin for chest pain, the client’s pain
is unrelieved after 5 minutes. What should the nurse do next?
• A. Repeat nitroglycerin in 5 minutes
• B. Administer second nitroglycerin and call provider if pain persists
after 3 doses
• C. Apply a nitroglycerin patch
• D. Give aspirin 325 mg and wait 10 minutes
Rationale: Nitroglycerin protocol: one dose q5min up to 3 doses. Unrelieved pain
after 3 doses suggests possible MI.
, 6. Which ACE inhibitor side effect is most important to teach a female client
of childbearing age?
• A. Dry cough
• B. Fetal injury (teratogenicity)
• C. Angioedema
• D. Hyperkalemia
Rationale: ACE inhibitors are contraindicated in pregnancy (Category D/X risk of
fetal renal agenesis, oligohydramnios).
7. A client on warfarin has an INR of 4.5 without bleeding. The next dose is
due in 2 hours. What should the nurse do?
• A. Administer the dose as ordered
• B. Hold the dose and notify provider
• C. Administer vitamin K 10 mg orally
• D. Give protamine sulfate
Rationale: Therapeutic INR for most indications is 2-3; 4.5 increases bleeding
risk. Hold warfarin and notify provider (may require dose reduction or vitamin K if
>5).
8. Which medication is contraindicated in clients with severe asthma?
• A. Carvedilol
• B. Metoprolol succinate
• C. Propranolol
• D. Bisoprolol
Rationale: Propranolol is non-selective beta-blocker (blocks beta-2 receptors in
lungs), causing bronchospasm. Cardioselective agents (metoprolol, bisoprolol) are
safer but still use caution.
9. A client starts atorvastatin. Which instruction is most important?
• A. Take with grapefruit juice to enhance absorption
• B. Report any unexplained muscle pain or dark urine
