ICHS PHARMACOLOGY FINAL
EXAM 2025-2026 | Complete
Solutions | Verified Q&A | Nursing
Pharmacology | Pass Guaranteed -
A+ Graded
ART I: MULTIPLE CHOICE (Q1–Q70)
P
Q1 (Anticoagulants): A patient taking warfarin has an INR of 4.5 and is actively bleeding. What
should the nurse administer?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Fresh frozen plasma (FFP) only
D. Andexanet alfa
[CORRECT] B
Rationale: Vitamin K reverses warfarin effect within hours. For active bleeding, FFP (C) provides
immediate clotting factors but vitamin K is definitive. Protamine (A) reverses heparin; andexanet
(D) reverses DOACs. Clinical pearl: For life-threatening bleeding, give FFP + vitamin K.
Q2 (Antibiotics): A patient receiving IV vancomycin develops flushing, pruritus, and erythema on
the face and neck during infusion. What is the nurse's priority action?
A. Stop the infusion permanently and notify the provider
B. Slow the infusion rate and administer an antihistamine
C. Switch to oral vancomycin immediately
D. Give epinephrine 0.3 mg IM
[CORRECT] B
Rationale: These are classic signs of Red Man Syndrome, a histamine-mediated reaction to
rapid vancomycin infusion. Slowing the rate prevents histamine release; antihistamines manage
symptoms. Stopping permanently (A) is unnecessary; oral vancomycin (C) is not indicated for
systemic infection; epinephrine (D) is for anaphylaxis. Clinical pearl: Infuse vancomycin over at
least 1 hour (or per institutional protocol) and monitor trough levels.
Q3 (Cardiovascular): A nurse is teaching a patient newly prescribed lisinopril. Which statement
by the patient indicates understanding of the medication?
A. "I should take this medication on an empty stomach every morning."
B. "I need to avoid potassium-rich foods and salt substitutes."
C. "I can stop taking this medication once my blood pressure is normal."
, . "This medication works by blocking calcium channels in my blood vessels."
D
[CORRECT] B
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia; patients must avoid potassium
supplements and salt substitutes (potassium chloride). ACE inhibitors can be taken with food
(A); they should never be stopped abruptly (C); calcium channel blockers (not ACE inhibitors)
block calcium channels (D). Clinical pearl: Monitor for dry cough and angioedema—common
ACE inhibitor adverse effects.
Q4 (Diabetes): A patient with Type 2 diabetes is prescribed metformin. Which finding would
most concern the nurse before administering the medication?
A. Fasting blood glucose of 140 mg/dL
B. Serum creatinine of 2.1 mg/dL (eGFR 28 mL/min)
C. Hemoglobin A1c of 8.2%
D. Blood pressure of 138/88 mmHg
[CORRECT] B
Rationale: Metformin is contraindicated when eGFR is below 30 mL/min due to risk of lactic
acidosis. A fasting glucose of 140 (A) and A1c of 8.2% (C) indicate the need for treatment;
elevated BP (D) is not a contraindication. Clinical pearl: Hold metformin 48 hours before and
after iodinated contrast studies to prevent renal injury and lactic acidosis.
Q5 (Pain Management): A postoperative patient receiving morphine PCA reports severe
constipation and has not had a bowel movement in 4 days. What is the nurse's best
intervention?
A. Discontinue the PCA and switch to oral acetaminophen
B. Administer a stimulant laxative and increase fluid intake
C. Give naloxone to reverse opioid effects
D. Encourage the patient to bear down during bowel movements
[CORRECT] B
Rationale: Opioid-induced constipation is common; stimulant laxatives (senna, bisacodyl) plus
hydration are first-line. Discontinuing PCA (A) may cause uncontrolled pain; naloxone (C)
reverses analgesia and can precipitate withdrawal; bearing down (D) risks vagal response and
injury. Clinical pearl: Start a bowel regimen (stimulant + stool softener) prophylactically with all
opioid orders.
Q6 (CNS/Psych): A patient taking fluoxetine presents with agitation, hyperthermia, diaphoresis,
tremor, and clonus. What condition is the nurse most concerned about?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. MAOI hypertensive crisis
D. Benzodiazepine withdrawal
[CORRECT] B
Rationale: The triad of mental status changes, autonomic instability, and neuromuscular
abnormalities (clonus, hyperreflexia) defines serotonin syndrome, often caused by SSRIs alone
or in combination with other serotonergic agents. NMS (A) features lead-pipe rigidity and
elevated CK; MAOI crisis (C) features severe hypertension and headache; benzo withdrawal (D)
features seizures and anxiety. Clinical pearl: Never combine SSRIs with MAOIs, tramadol, or St.
John's wort.
, 7 (Respiratory): A patient using a fluticasone/salmeterol inhaler reports white patches in the
Q
mouth and throat. What is the nurse's priority teaching?
A. Stop using the inhaler and contact the provider immediately
B. Rinse the mouth with water after each use and use a spacer
C. Switch to a short-acting beta-2 agonist only
D. Take an oral antifungal prophylactically
[CORRECT] B
Rationale: White patches indicate oral candidiasis (thrush) from inhaled corticosteroids. Rinsing
the mouth and using a spacer reduces deposition in the oropharynx. Stopping the inhaler (A) is
unnecessary and risks asthma/COPD exacerbation; switching to SABA only (C) is inappropriate
for maintenance; prophylactic antifungals (D) are not standard. Clinical pearl: Instruct patients to
rinse, gargle, and spit after every ICS use.
Q8 (GI): A patient on long-term omeprazole presents with watery diarrhea 8 times per day and
abdominal cramping. What is the nurse's priority action?
A. Increase the omeprazole dose to control acid
B. Obtain a stool specimen for C. difficile toxin testing
C. Administer loperamide immediately
D. Switch to an H2 blocker without testing
[CORRECT] B
Rationale: Long-term PPI use is a major risk factor for C. difficile infection due to altered gut
flora. Watery diarrhea with cramping is classic for C. diff. Increasing PPI (A) worsens the
problem; loperamide (C) is contraindicated in infectious diarrhea (toxic megacolon risk);
switching without testing (D) delays diagnosis. Clinical pearl: PPIs should be used at the lowest
effective dose for the shortest duration.
Q9 (Antibiotics): A patient with a penicillin allergy (anaphylaxis history) requires antibiotic
therapy for a severe infection. Which antibiotic is MOST appropriate?
A. Cefazolin
B. Aztreonam
C. Imipenem
D. Piperacillin-tazobactam
[CORRECT] B
Rationale: Aztreonam (a monobactam) has negligible cross-reactivity with penicillin and is safe
for patients with penicillin anaphylaxis. Cephalosporins (A) have ~1-2% cross-reactivity;
carbapenems (C) and penicillin derivatives (D) share beta-lactam rings and are contraindicated.
Clinical pearl: For gram-negative infections in penicillin-allergic patients, aztreonam is the
beta-lactam of choice.
Q10 (Cardiovascular): A patient on digoxin reports nausea, vomiting, and seeing yellow-green
halos around objects. The nurse checks the serum digoxin level. Which value indicates toxicity?
A. 0.5 ng/mL
B. 1.0 ng/mL
C. 1.5 ng/mL
D. 2.5 ng/mL
[CORRECT] D
, ationale: Digoxin therapeutic range is 0.5–2.0 ng/mL; levels above 2.0 ng/mL indicate toxicity.
R
Symptoms include GI upset, visual disturbances (yellow-green halos), and cardiac arrhythmias.
Clinical pearl: Hypokalemia increases digoxin toxicity risk—always check potassium levels and
maintain K+ > 4.0 mEq/L.
Q11 (Diabetes): A patient with Type 1 diabetes is prescribed insulin glargine (Lantus) and insulin
lispro (Humalog). When should the nurse instruct the patient to administer glargine?
A. 30 minutes before each meal
B. At bedtime only, regardless of meals
C. Once daily at the same time each day
D. Only when blood glucose is above 200 mg/dL
[CORRECT] C
Rationale: Glargine is a long-acting basal insulin with no pronounced peak, administered once
daily at a consistent time to provide 24-hour background insulin. It is NOT meal-dependent (A,
D) and can be given morning or evening (B is too restrictive). Clinical pearl: Never mix glargine
or detemir with other insulins in the same syringe.
Q12 (Anticoagulants): A patient on heparin therapy has an aPTT of 90 seconds (therapeutic
range: 60–80 seconds). What is the nurse's priority action?
A. Continue the current infusion rate and recheck in 4 hours
B. Hold the heparin infusion for 1 hour, then resume at a reduced rate
C. Administer protamine sulfate immediately
D. Increase the infusion rate to achieve better anticoagulation
[CORRECT] B
Rationale: An aPTT of 90 seconds is supratherapeutic; the nurse should hold the infusion briefly
and reduce the rate per protocol. Continuing (A) or increasing (D) risks bleeding; protamine (C)
is for active bleeding or severe overdose, not mild elevation. Clinical pearl: aPTT is checked 6
hours after any rate change; therapeutic range is typically 1.5–2.5 times control.
Q13 (Pain Management): A patient accidentally receives too much fentanyl and develops
respiratory depression with a respiratory rate of 6 breaths/min. What is the nurse's immediate
intervention?
A. Administer naloxone 0.4–2 mg IV every 2–3 minutes as needed
B. Give flumazenil 0.2 mg IV
C. Place the patient in the prone position
D. Administer oxygen via nasal cannula at 2 L/min only
[CORRECT] A
Rationale: Naloxone is the specific antidote for opioid-induced respiratory depression.
Flumazenil (B) reverses benzodiazepines; prone positioning (C) is unsafe; oxygen alone (D)
does not reverse the opioid effect. Clinical pearl: Titrate naloxone carefully to reverse respiratory
depression without causing acute withdrawal or cardiovascular instability.
Q14 (CNS/Psych): A patient on phenytoin for seizure control presents with swollen, bleeding
gums and overgrowth of gum tissue. What is this adverse effect called?
A. Stevens-Johnson syndrome
B. Gingival hyperplasia
C. Agranulocytosis
D. Osteomalacia
EXAM 2025-2026 | Complete
Solutions | Verified Q&A | Nursing
Pharmacology | Pass Guaranteed -
A+ Graded
ART I: MULTIPLE CHOICE (Q1–Q70)
P
Q1 (Anticoagulants): A patient taking warfarin has an INR of 4.5 and is actively bleeding. What
should the nurse administer?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Fresh frozen plasma (FFP) only
D. Andexanet alfa
[CORRECT] B
Rationale: Vitamin K reverses warfarin effect within hours. For active bleeding, FFP (C) provides
immediate clotting factors but vitamin K is definitive. Protamine (A) reverses heparin; andexanet
(D) reverses DOACs. Clinical pearl: For life-threatening bleeding, give FFP + vitamin K.
Q2 (Antibiotics): A patient receiving IV vancomycin develops flushing, pruritus, and erythema on
the face and neck during infusion. What is the nurse's priority action?
A. Stop the infusion permanently and notify the provider
B. Slow the infusion rate and administer an antihistamine
C. Switch to oral vancomycin immediately
D. Give epinephrine 0.3 mg IM
[CORRECT] B
Rationale: These are classic signs of Red Man Syndrome, a histamine-mediated reaction to
rapid vancomycin infusion. Slowing the rate prevents histamine release; antihistamines manage
symptoms. Stopping permanently (A) is unnecessary; oral vancomycin (C) is not indicated for
systemic infection; epinephrine (D) is for anaphylaxis. Clinical pearl: Infuse vancomycin over at
least 1 hour (or per institutional protocol) and monitor trough levels.
Q3 (Cardiovascular): A nurse is teaching a patient newly prescribed lisinopril. Which statement
by the patient indicates understanding of the medication?
A. "I should take this medication on an empty stomach every morning."
B. "I need to avoid potassium-rich foods and salt substitutes."
C. "I can stop taking this medication once my blood pressure is normal."
, . "This medication works by blocking calcium channels in my blood vessels."
D
[CORRECT] B
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia; patients must avoid potassium
supplements and salt substitutes (potassium chloride). ACE inhibitors can be taken with food
(A); they should never be stopped abruptly (C); calcium channel blockers (not ACE inhibitors)
block calcium channels (D). Clinical pearl: Monitor for dry cough and angioedema—common
ACE inhibitor adverse effects.
Q4 (Diabetes): A patient with Type 2 diabetes is prescribed metformin. Which finding would
most concern the nurse before administering the medication?
A. Fasting blood glucose of 140 mg/dL
B. Serum creatinine of 2.1 mg/dL (eGFR 28 mL/min)
C. Hemoglobin A1c of 8.2%
D. Blood pressure of 138/88 mmHg
[CORRECT] B
Rationale: Metformin is contraindicated when eGFR is below 30 mL/min due to risk of lactic
acidosis. A fasting glucose of 140 (A) and A1c of 8.2% (C) indicate the need for treatment;
elevated BP (D) is not a contraindication. Clinical pearl: Hold metformin 48 hours before and
after iodinated contrast studies to prevent renal injury and lactic acidosis.
Q5 (Pain Management): A postoperative patient receiving morphine PCA reports severe
constipation and has not had a bowel movement in 4 days. What is the nurse's best
intervention?
A. Discontinue the PCA and switch to oral acetaminophen
B. Administer a stimulant laxative and increase fluid intake
C. Give naloxone to reverse opioid effects
D. Encourage the patient to bear down during bowel movements
[CORRECT] B
Rationale: Opioid-induced constipation is common; stimulant laxatives (senna, bisacodyl) plus
hydration are first-line. Discontinuing PCA (A) may cause uncontrolled pain; naloxone (C)
reverses analgesia and can precipitate withdrawal; bearing down (D) risks vagal response and
injury. Clinical pearl: Start a bowel regimen (stimulant + stool softener) prophylactically with all
opioid orders.
Q6 (CNS/Psych): A patient taking fluoxetine presents with agitation, hyperthermia, diaphoresis,
tremor, and clonus. What condition is the nurse most concerned about?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. MAOI hypertensive crisis
D. Benzodiazepine withdrawal
[CORRECT] B
Rationale: The triad of mental status changes, autonomic instability, and neuromuscular
abnormalities (clonus, hyperreflexia) defines serotonin syndrome, often caused by SSRIs alone
or in combination with other serotonergic agents. NMS (A) features lead-pipe rigidity and
elevated CK; MAOI crisis (C) features severe hypertension and headache; benzo withdrawal (D)
features seizures and anxiety. Clinical pearl: Never combine SSRIs with MAOIs, tramadol, or St.
John's wort.
, 7 (Respiratory): A patient using a fluticasone/salmeterol inhaler reports white patches in the
Q
mouth and throat. What is the nurse's priority teaching?
A. Stop using the inhaler and contact the provider immediately
B. Rinse the mouth with water after each use and use a spacer
C. Switch to a short-acting beta-2 agonist only
D. Take an oral antifungal prophylactically
[CORRECT] B
Rationale: White patches indicate oral candidiasis (thrush) from inhaled corticosteroids. Rinsing
the mouth and using a spacer reduces deposition in the oropharynx. Stopping the inhaler (A) is
unnecessary and risks asthma/COPD exacerbation; switching to SABA only (C) is inappropriate
for maintenance; prophylactic antifungals (D) are not standard. Clinical pearl: Instruct patients to
rinse, gargle, and spit after every ICS use.
Q8 (GI): A patient on long-term omeprazole presents with watery diarrhea 8 times per day and
abdominal cramping. What is the nurse's priority action?
A. Increase the omeprazole dose to control acid
B. Obtain a stool specimen for C. difficile toxin testing
C. Administer loperamide immediately
D. Switch to an H2 blocker without testing
[CORRECT] B
Rationale: Long-term PPI use is a major risk factor for C. difficile infection due to altered gut
flora. Watery diarrhea with cramping is classic for C. diff. Increasing PPI (A) worsens the
problem; loperamide (C) is contraindicated in infectious diarrhea (toxic megacolon risk);
switching without testing (D) delays diagnosis. Clinical pearl: PPIs should be used at the lowest
effective dose for the shortest duration.
Q9 (Antibiotics): A patient with a penicillin allergy (anaphylaxis history) requires antibiotic
therapy for a severe infection. Which antibiotic is MOST appropriate?
A. Cefazolin
B. Aztreonam
C. Imipenem
D. Piperacillin-tazobactam
[CORRECT] B
Rationale: Aztreonam (a monobactam) has negligible cross-reactivity with penicillin and is safe
for patients with penicillin anaphylaxis. Cephalosporins (A) have ~1-2% cross-reactivity;
carbapenems (C) and penicillin derivatives (D) share beta-lactam rings and are contraindicated.
Clinical pearl: For gram-negative infections in penicillin-allergic patients, aztreonam is the
beta-lactam of choice.
Q10 (Cardiovascular): A patient on digoxin reports nausea, vomiting, and seeing yellow-green
halos around objects. The nurse checks the serum digoxin level. Which value indicates toxicity?
A. 0.5 ng/mL
B. 1.0 ng/mL
C. 1.5 ng/mL
D. 2.5 ng/mL
[CORRECT] D
, ationale: Digoxin therapeutic range is 0.5–2.0 ng/mL; levels above 2.0 ng/mL indicate toxicity.
R
Symptoms include GI upset, visual disturbances (yellow-green halos), and cardiac arrhythmias.
Clinical pearl: Hypokalemia increases digoxin toxicity risk—always check potassium levels and
maintain K+ > 4.0 mEq/L.
Q11 (Diabetes): A patient with Type 1 diabetes is prescribed insulin glargine (Lantus) and insulin
lispro (Humalog). When should the nurse instruct the patient to administer glargine?
A. 30 minutes before each meal
B. At bedtime only, regardless of meals
C. Once daily at the same time each day
D. Only when blood glucose is above 200 mg/dL
[CORRECT] C
Rationale: Glargine is a long-acting basal insulin with no pronounced peak, administered once
daily at a consistent time to provide 24-hour background insulin. It is NOT meal-dependent (A,
D) and can be given morning or evening (B is too restrictive). Clinical pearl: Never mix glargine
or detemir with other insulins in the same syringe.
Q12 (Anticoagulants): A patient on heparin therapy has an aPTT of 90 seconds (therapeutic
range: 60–80 seconds). What is the nurse's priority action?
A. Continue the current infusion rate and recheck in 4 hours
B. Hold the heparin infusion for 1 hour, then resume at a reduced rate
C. Administer protamine sulfate immediately
D. Increase the infusion rate to achieve better anticoagulation
[CORRECT] B
Rationale: An aPTT of 90 seconds is supratherapeutic; the nurse should hold the infusion briefly
and reduce the rate per protocol. Continuing (A) or increasing (D) risks bleeding; protamine (C)
is for active bleeding or severe overdose, not mild elevation. Clinical pearl: aPTT is checked 6
hours after any rate change; therapeutic range is typically 1.5–2.5 times control.
Q13 (Pain Management): A patient accidentally receives too much fentanyl and develops
respiratory depression with a respiratory rate of 6 breaths/min. What is the nurse's immediate
intervention?
A. Administer naloxone 0.4–2 mg IV every 2–3 minutes as needed
B. Give flumazenil 0.2 mg IV
C. Place the patient in the prone position
D. Administer oxygen via nasal cannula at 2 L/min only
[CORRECT] A
Rationale: Naloxone is the specific antidote for opioid-induced respiratory depression.
Flumazenil (B) reverses benzodiazepines; prone positioning (C) is unsafe; oxygen alone (D)
does not reverse the opioid effect. Clinical pearl: Titrate naloxone carefully to reverse respiratory
depression without causing acute withdrawal or cardiovascular instability.
Q14 (CNS/Psych): A patient on phenytoin for seizure control presents with swollen, bleeding
gums and overgrowth of gum tissue. What is this adverse effect called?
A. Stevens-Johnson syndrome
B. Gingival hyperplasia
C. Agranulocytosis
D. Osteomalacia
