NUR 2474 Pharmacology for Nursing
Official Pharmacology Competency
Assessment Actual Exam 2026/2027 with
Detailed Rationales | Complete
Exam-Style Questions | Pass Guaranteed
– A+ Graded
═════════════════════════════════════
SECTION 1: PHARMACOKINETICS, PHARMACODYNAMICS & SAFE MEDICATION
ADMINISTRATION Q1 – Q10
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Question 1 of 50
A 78-year-old patient with mild cognitive impairment is admitted for pneumonia. During
medication reconciliation, the nurse notices the patient takes both metformin and metoprolol
at home but confuses the bottles because the labels look similar. The patient's last
creatinine clearance was 42 mL/min. Which action should the nurse prioritize?
A. Crush both medications together and administer via applesauce to improve adherence
B. Place high-alert stickers on both bottles and notify pharmacy to change one to a different
dosage form ✓ CORRECT
C. Ask the patient to memorize the pill colors and stop checking the labels at each dose
D. Hold the metformin until renal function improves and continue metoprolol only
Correct Answer: B
Rationale: Look-alike/sound-alike medication errors are a leading cause of preventable harm,
and the nurse's priority is to implement system-level safeguards rather than relying on patient
memory. Crushing sustained-release metoprolol could cause dangerous bradycardia, making
option A unsafe. Option C places unrealistic responsibility on a patient with documented
cognitive impairment.
Question 2 of 50
,A nurse is preparing to administer IV digoxin to a 67-year-old patient with atrial fibrillation and
heart failure. The patient's apical pulse is 58 beats/min, potassium is 2.9 mEq/L, and the
digoxin level drawn yesterday was 1.8 ng/mL. Which clinical finding should cause the nurse to
hold the dose and contact the provider immediately?
A. The atrial fibrillation has converted to normal sinus rhythm at 72 beats/min
B. The digoxin level is within the therapeutic range of 0.5 to 2.0 ng/mL
C. The serum potassium is below normal and potentiates digoxin toxicity ✓ CORRECT
D. The apical pulse is above 60 beats/min as required by unit protocol
Correct Answer: C
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and dramatically raises
the risk of life-threatening arrhythmias, even when the digoxin level appears therapeutic.
While a pulse below 60 often triggers a hold, the more urgent concern here is the electrolyte
imbalance that predisposes to toxicity. The nurse should always verify potassium status
before giving digoxin.
Question 3 of 50
A 55-year-old patient with newly diagnosed cirrhosis is prescribed oral propranolol for
esophageal varices. The nurse understands that this patient's first-pass metabolism will be
significantly altered. What is the primary pharmacokinetic implication the nurse should
anticipate?
A. Higher bioavailability of oral propranolol, increasing the risk of hypotension ✓ CORRECT
B. Faster elimination of propranolol through the kidneys, requiring more frequent dosing
C. Decreased absorption in the stomach due to portal hypertension and ascites
D. Increased hepatic conversion of propranolol to its active metabolite
Correct Answer: A
Rationale: In cirrhosis, reduced hepatic blood flow and damaged hepatocytes decrease
first-pass metabolism, allowing more of the oral drug to reach systemic circulation and
increasing bioavailability. Propranolol is highly lipophilic and undergoes extensive hepatic
extraction, so this effect is pronounced. The nurse should monitor blood pressure closely
after initiation and expect lower doses to achieve the same effect.
Question 4 of 50
A pediatric patient weighing 22 kg is prescribed a medication with a narrow therapeutic index.
The nurse knows that therapeutic drug monitoring requires drawing a peak level 30 minutes
after an IV infusion ends and a trough level immediately before the next dose. Which
medication requires this specific monitoring protocol?
A. Oral azithromycin for community-acquired pneumonia
, B. IV vancomycin for methicillin-resistant Staphylococcus aureus bacteremia
C. IV gentamicin for suspected gram-negative sepsis ✓ CORRECT
D. Oral phenytoin for seizure prophylaxis
Correct Answer: C
Rationale: Aminoglycosides like gentamicin have a narrow therapeutic index with significant
nephrotoxic and ototoxic risks, making peak and trough monitoring essential for safe dosing.
Vancomycin also requires trough monitoring but does not typically require routine peak
levels in the same way. Azithromycin and phenytoin do not follow this specific
peak-and-trough IV monitoring protocol.
Question 5 of 50
During a busy evening shift, a nurse is preparing medications for four patients. The unit has
implemented barcode medication administration. The nurse scans the patient's wristband,
but the barcode on the medication does not match the electronic medication record. The
nurse is confident the medication is correct based on memory from the prior shift. What is
the safest action?
A. Administer the medication and document the barcode malfunction in the incident report
B. Return the medication to the automated dispensing cabinet and investigate the
discrepancy before administering ✓ CORRECT
C. Ask the charge nurse to override the system and manually document the dose
D. Give the medication and scan the barcode after the patient has swallowed the pills
Correct Answer: B
Rationale: Barcode mismatches are designed to prevent wrong-patient, wrong-drug, or
wrong-dose errors, and overriding the system based on memory introduces significant risk.
The nurse must treat the mismatch as a potential safety signal rather than a technical
nuisance. Investigating the discrepancy protects the patient and maintains the integrity of the
safety system.
Question 6 of 50
A nurse is caring for a patient receiving a continuous IV heparin infusion. The hospital uses a
weight-based protocol with aPTT monitoring every 6 hours. The patient's aPTT comes back
at 98 seconds, and the baseline aPTT was 32 seconds. The therapeutic range is 1.5 to 2.5
times the baseline. Based on this result, what should the nurse anticipate?
A. The infusion rate will be decreased and the aPTT rechecked per protocol ✓ CORRECT
B. The infusion rate will be increased because the patient is under-anticoagulated
C. The next aPTT will be drawn in 24 hours since the patient is now therapeutic
D. Protamine sulfate will be administered immediately to reverse the heparin
Official Pharmacology Competency
Assessment Actual Exam 2026/2027 with
Detailed Rationales | Complete
Exam-Style Questions | Pass Guaranteed
– A+ Graded
═════════════════════════════════════
SECTION 1: PHARMACOKINETICS, PHARMACODYNAMICS & SAFE MEDICATION
ADMINISTRATION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 78-year-old patient with mild cognitive impairment is admitted for pneumonia. During
medication reconciliation, the nurse notices the patient takes both metformin and metoprolol
at home but confuses the bottles because the labels look similar. The patient's last
creatinine clearance was 42 mL/min. Which action should the nurse prioritize?
A. Crush both medications together and administer via applesauce to improve adherence
B. Place high-alert stickers on both bottles and notify pharmacy to change one to a different
dosage form ✓ CORRECT
C. Ask the patient to memorize the pill colors and stop checking the labels at each dose
D. Hold the metformin until renal function improves and continue metoprolol only
Correct Answer: B
Rationale: Look-alike/sound-alike medication errors are a leading cause of preventable harm,
and the nurse's priority is to implement system-level safeguards rather than relying on patient
memory. Crushing sustained-release metoprolol could cause dangerous bradycardia, making
option A unsafe. Option C places unrealistic responsibility on a patient with documented
cognitive impairment.
Question 2 of 50
,A nurse is preparing to administer IV digoxin to a 67-year-old patient with atrial fibrillation and
heart failure. The patient's apical pulse is 58 beats/min, potassium is 2.9 mEq/L, and the
digoxin level drawn yesterday was 1.8 ng/mL. Which clinical finding should cause the nurse to
hold the dose and contact the provider immediately?
A. The atrial fibrillation has converted to normal sinus rhythm at 72 beats/min
B. The digoxin level is within the therapeutic range of 0.5 to 2.0 ng/mL
C. The serum potassium is below normal and potentiates digoxin toxicity ✓ CORRECT
D. The apical pulse is above 60 beats/min as required by unit protocol
Correct Answer: C
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and dramatically raises
the risk of life-threatening arrhythmias, even when the digoxin level appears therapeutic.
While a pulse below 60 often triggers a hold, the more urgent concern here is the electrolyte
imbalance that predisposes to toxicity. The nurse should always verify potassium status
before giving digoxin.
Question 3 of 50
A 55-year-old patient with newly diagnosed cirrhosis is prescribed oral propranolol for
esophageal varices. The nurse understands that this patient's first-pass metabolism will be
significantly altered. What is the primary pharmacokinetic implication the nurse should
anticipate?
A. Higher bioavailability of oral propranolol, increasing the risk of hypotension ✓ CORRECT
B. Faster elimination of propranolol through the kidneys, requiring more frequent dosing
C. Decreased absorption in the stomach due to portal hypertension and ascites
D. Increased hepatic conversion of propranolol to its active metabolite
Correct Answer: A
Rationale: In cirrhosis, reduced hepatic blood flow and damaged hepatocytes decrease
first-pass metabolism, allowing more of the oral drug to reach systemic circulation and
increasing bioavailability. Propranolol is highly lipophilic and undergoes extensive hepatic
extraction, so this effect is pronounced. The nurse should monitor blood pressure closely
after initiation and expect lower doses to achieve the same effect.
Question 4 of 50
A pediatric patient weighing 22 kg is prescribed a medication with a narrow therapeutic index.
The nurse knows that therapeutic drug monitoring requires drawing a peak level 30 minutes
after an IV infusion ends and a trough level immediately before the next dose. Which
medication requires this specific monitoring protocol?
A. Oral azithromycin for community-acquired pneumonia
, B. IV vancomycin for methicillin-resistant Staphylococcus aureus bacteremia
C. IV gentamicin for suspected gram-negative sepsis ✓ CORRECT
D. Oral phenytoin for seizure prophylaxis
Correct Answer: C
Rationale: Aminoglycosides like gentamicin have a narrow therapeutic index with significant
nephrotoxic and ototoxic risks, making peak and trough monitoring essential for safe dosing.
Vancomycin also requires trough monitoring but does not typically require routine peak
levels in the same way. Azithromycin and phenytoin do not follow this specific
peak-and-trough IV monitoring protocol.
Question 5 of 50
During a busy evening shift, a nurse is preparing medications for four patients. The unit has
implemented barcode medication administration. The nurse scans the patient's wristband,
but the barcode on the medication does not match the electronic medication record. The
nurse is confident the medication is correct based on memory from the prior shift. What is
the safest action?
A. Administer the medication and document the barcode malfunction in the incident report
B. Return the medication to the automated dispensing cabinet and investigate the
discrepancy before administering ✓ CORRECT
C. Ask the charge nurse to override the system and manually document the dose
D. Give the medication and scan the barcode after the patient has swallowed the pills
Correct Answer: B
Rationale: Barcode mismatches are designed to prevent wrong-patient, wrong-drug, or
wrong-dose errors, and overriding the system based on memory introduces significant risk.
The nurse must treat the mismatch as a potential safety signal rather than a technical
nuisance. Investigating the discrepancy protects the patient and maintains the integrity of the
safety system.
Question 6 of 50
A nurse is caring for a patient receiving a continuous IV heparin infusion. The hospital uses a
weight-based protocol with aPTT monitoring every 6 hours. The patient's aPTT comes back
at 98 seconds, and the baseline aPTT was 32 seconds. The therapeutic range is 1.5 to 2.5
times the baseline. Based on this result, what should the nurse anticipate?
A. The infusion rate will be decreased and the aPTT rechecked per protocol ✓ CORRECT
B. The infusion rate will be increased because the patient is under-anticoagulated
C. The next aPTT will be drawn in 24 hours since the patient is now therapeutic
D. Protamine sulfate will be administered immediately to reverse the heparin
