Pharmacology NCLEX Exam Pack:
High-Yield Drug Q&A (2026
Update)|| questions and answers
with rationales/graded A+/2026
update/100% correct /instant
download
Section 1: Cardiovascular Medications (Questions 1-15)
1. A nurse is administering digoxin 0.25 mg PO daily. Which finding requires
immediate intervention?
• A. Apical pulse of 62 bpm
• B. Serum potassium level of 3.2 mEq/L
• C. Serum digoxin level of 1.2 ng/mL
• D. Patient reports blurred yellow vision
Correct Answer: B – *Rationale: Hypokalemia (K+ <3.5) increases risk of
digoxin toxicity. Yellow/green halos (Option D) also indicate toxicity, but
hypokalemia is the cause needing urgent correction. Option A: hold if <60 bpm.
Option C: therapeutic range 0.8-2.0 ng/mL.*
2. A patient on furosemide is started on lisinopril. What is the priority nursing
assessment?
• A. Hyperkalemia
• B. First-dose hypotensive effect
• C. Dry cough
• D. Ototoxicity
,Correct Answer: B – Rationale: Furosemide causes volume depletion; adding an
ACE inhibitor can cause severe hypotension (first-dose phenomenon). Give low
initial dose, administer at bedtime.
3. Which statement by a patient prescribed clopidogrel indicates effective
teaching?
• A. “I will take this with grapefruit juice daily.”
• B. “I will stop taking it 5 days before my dental extraction.”
• C. “I will notify my dentist that I am on this medication.”
• D. “I can take aspirin if I get a headache.”
Correct Answer: C – Rationale: Clopidogrel (P2Y12 inhibitor) increases bleeding
risk; all healthcare providers must be notified. Do not stop without provider order
(stent thrombosis risk). Avoid grapefruit; avoid extra antiplatelet agents like
aspirin unless prescribed.
4. A patient receives IV metoprolol. Which finding is most concerning?
• A. HR 58 bpm
• B. BP 110/70 mm Hg
• C. Wheezing in all lung fields
• D. Patient reports dizziness when standing
Correct Answer: C – *Rationale: Metoprolol is beta-1 selective but can still cause
bronchospasm at high doses. Wheezing indicates possible bronchospasm; hold and
notify provider. Option A/B are expected. Option D is common but not emergent.*
5. A client with atrial fibrillation is prescribed warfarin. Which lab value
requires dose adjustment?
• A. INR 2.5
• B. aPTT 35 seconds
• C. INR 1.2
• D. Platelets 180,000/mm³
Correct Answer: C – *Rationale: Therapeutic INR for AF is 2.0-3.0. INR 1.2 is
subtherapeutic, requiring dose increase. aPTT is for heparin.*
, 6-7. Bowtie Question: A patient is admitted with acute decompensated heart
failure. The nurse prepares to administer dobutamine.
• Left option (Therapeutic use): Increase cardiac output
• Right option (Adverse effect): Tachycardia
6. What is the primary therapeutic action? → Increase contractility and CO
7. What is the most serious adverse effect? → Ventricular
arrhythmias/tachycardia
8. A patient takes amiodarone. Which finding is most specific to this drug’s
toxicity?
• A. Thyroid dysfunction
• B. Pulmonary fibrosis
• C. Corneal microdeposits
• D. Blue-gray skin discoloration
Correct Answer: B – Rationale: Pulmonary toxicity (cough, dyspnea, infiltrates)
is the most serious and potentially fatal adverse effect of amiodarone. All options
are adverse effects, but pulmonary fibrosis is the priority.
9. Which patient is most at risk for hyperkalemia when starting
spironolactone?
• A. Patient taking furosemide
• B. Patient taking hydrochlorothiazide
• C. Patient taking lisinopril
• D. Patient with liver cirrhosis
Correct Answer: C – Rationale: Spironolactone (potassium-sparing diuretic) +
ACE inhibitor (lisinopril) = synergistic hyperkalemia risk. Avoid combination
unless close monitoring.
10. A patient with heparin-induced thrombocytopenia (HIT) is ordered which
medication?
• A. Enoxaparin
• B. Warfarin
High-Yield Drug Q&A (2026
Update)|| questions and answers
with rationales/graded A+/2026
update/100% correct /instant
download
Section 1: Cardiovascular Medications (Questions 1-15)
1. A nurse is administering digoxin 0.25 mg PO daily. Which finding requires
immediate intervention?
• A. Apical pulse of 62 bpm
• B. Serum potassium level of 3.2 mEq/L
• C. Serum digoxin level of 1.2 ng/mL
• D. Patient reports blurred yellow vision
Correct Answer: B – *Rationale: Hypokalemia (K+ <3.5) increases risk of
digoxin toxicity. Yellow/green halos (Option D) also indicate toxicity, but
hypokalemia is the cause needing urgent correction. Option A: hold if <60 bpm.
Option C: therapeutic range 0.8-2.0 ng/mL.*
2. A patient on furosemide is started on lisinopril. What is the priority nursing
assessment?
• A. Hyperkalemia
• B. First-dose hypotensive effect
• C. Dry cough
• D. Ototoxicity
,Correct Answer: B – Rationale: Furosemide causes volume depletion; adding an
ACE inhibitor can cause severe hypotension (first-dose phenomenon). Give low
initial dose, administer at bedtime.
3. Which statement by a patient prescribed clopidogrel indicates effective
teaching?
• A. “I will take this with grapefruit juice daily.”
• B. “I will stop taking it 5 days before my dental extraction.”
• C. “I will notify my dentist that I am on this medication.”
• D. “I can take aspirin if I get a headache.”
Correct Answer: C – Rationale: Clopidogrel (P2Y12 inhibitor) increases bleeding
risk; all healthcare providers must be notified. Do not stop without provider order
(stent thrombosis risk). Avoid grapefruit; avoid extra antiplatelet agents like
aspirin unless prescribed.
4. A patient receives IV metoprolol. Which finding is most concerning?
• A. HR 58 bpm
• B. BP 110/70 mm Hg
• C. Wheezing in all lung fields
• D. Patient reports dizziness when standing
Correct Answer: C – *Rationale: Metoprolol is beta-1 selective but can still cause
bronchospasm at high doses. Wheezing indicates possible bronchospasm; hold and
notify provider. Option A/B are expected. Option D is common but not emergent.*
5. A client with atrial fibrillation is prescribed warfarin. Which lab value
requires dose adjustment?
• A. INR 2.5
• B. aPTT 35 seconds
• C. INR 1.2
• D. Platelets 180,000/mm³
Correct Answer: C – *Rationale: Therapeutic INR for AF is 2.0-3.0. INR 1.2 is
subtherapeutic, requiring dose increase. aPTT is for heparin.*
, 6-7. Bowtie Question: A patient is admitted with acute decompensated heart
failure. The nurse prepares to administer dobutamine.
• Left option (Therapeutic use): Increase cardiac output
• Right option (Adverse effect): Tachycardia
6. What is the primary therapeutic action? → Increase contractility and CO
7. What is the most serious adverse effect? → Ventricular
arrhythmias/tachycardia
8. A patient takes amiodarone. Which finding is most specific to this drug’s
toxicity?
• A. Thyroid dysfunction
• B. Pulmonary fibrosis
• C. Corneal microdeposits
• D. Blue-gray skin discoloration
Correct Answer: B – Rationale: Pulmonary toxicity (cough, dyspnea, infiltrates)
is the most serious and potentially fatal adverse effect of amiodarone. All options
are adverse effects, but pulmonary fibrosis is the priority.
9. Which patient is most at risk for hyperkalemia when starting
spironolactone?
• A. Patient taking furosemide
• B. Patient taking hydrochlorothiazide
• C. Patient taking lisinopril
• D. Patient with liver cirrhosis
Correct Answer: C – Rationale: Spironolactone (potassium-sparing diuretic) +
ACE inhibitor (lisinopril) = synergistic hyperkalemia risk. Avoid combination
unless close monitoring.
10. A patient with heparin-induced thrombocytopenia (HIT) is ordered which
medication?
• A. Enoxaparin
• B. Warfarin
