Kaplan Pharmacology Integrated Exam
(Forms A, B, C, D) | NGN Questions with
Correct Answers,
1. A patient with heart failure is prescribed digoxin. Which finding is most
indicative of digoxin toxicity?
A) Heart rate of 68 bpm
B) Serum potassium of 4.0 mEq/L
C) Visual changes (yellow-green halos)
D) Weight gain of 2 kg in 24 hours
Correct answer: C
*Rationale: Yellow-green halos are classic signs of digoxin toxicity. Bradycardia
(<60) and hypokalemia increase risk.*
2. A patient on warfarin has an INR of 4.8 and no bleeding. What should the
nurse anticipate?
A) Administer vitamin K intramuscularly
B) Hold the next dose and notify the provider
C) Increase the warfarin dose
D) Give fresh frozen plasma immediately
Correct answer: B
*Rationale: INR >4.5 without bleeding: hold warfarin; provider may order low-
dose oral vitamin K.*
3. A nurse is administering IV furosemide. The patient reports ringing in the
ears. What is the priority action?
A) Slow the injection rate
B) Stop the infusion and notify the provider
,C) Continue because this is a common side effect
D) Flush the IV line with normal saline
Correct answer: B
Rationale: Tinnitus indicates ototoxicity, a serious adverse effect of loop diuretics.
4. A patient taking metformin reports muscle pain and weakness. Which
laboratory value should be checked immediately?
A) Serum creatinine
B) Lactate level
C) Hemoglobin A1c
D) Potassium
Correct answer: B
Rationale: Metformin can cause lactic acidosis; muscle pain and weakness are
early signs.
5. Which medication is most likely to cause a persistent dry cough?
A) Losartan
B) Lisinopril
C) Amlodipine
D) Metoprolol
Correct answer: B
Rationale: ACE inhibitors (lisinopril) cause cough due to bradykinin
accumulation.
6. A patient is prescribed alendronate for osteoporosis. Which instruction is
most important?
A) Lie down for 30 minutes after taking
B) Take with orange juice
C) Take with a full glass of water after waking and remain upright for 30–60
minutes
D) Take at bedtime with a snack
Correct answer: C
,Rationale: Alendronate can cause esophagitis; upright position and plain water
are essential.
7. A patient receiving a blood transfusion develops chills, fever, and back
pain. What is the first action?
A) Slow the infusion rate
B) Stop the transfusion
C) Administer acetaminophen
D) Check vital signs
Correct answer: B
Rationale: These symptoms suggest a hemolytic transfusion reaction; stop the
transfusion immediately.
8. A patient on lithium has a serum level of 1.8 mEq/L and reports nausea,
vomiting, and coarse tremor. What should the nurse do?
A) Administer the next dose as scheduled
B) Hold the medication and notify the provider
C) Increase fluid intake
D) Give a diuretic
Correct answer: B
*Rationale: Therapeutic range 0.6–1.2 mEq/L; 1.8 is toxic. Hold and notify.*
9. A patient is prescribed nitroglycerin sublingual for angina. Which
instruction is correct?
A) Swallow the tablet with water
B) Store in a clear plastic bottle
C) Replace every 3 months
D) Take one tablet every 5 minutes for up to 3 doses; if no relief, call 911
Correct answer: D
Rationale: Standard dosing: 1 tablet q5 min ×3; call 911 if no relief after first dose
in some protocols.
, 10. A patient on isoniazid (INH) for tuberculosis should be monitored for
which deficiency?
A) Vitamin B12
B) Vitamin B6 (pyridoxine)
C) Vitamin D
D) Folic acid
Correct answer: B
Rationale: INH causes peripheral neuropathy; pyridoxine prevents it.
11. A patient with glaucoma uses timolol eye drops. The nurse should assess
for which systemic side effect?
A) Tachycardia
B) Bradycardia
C) Hypertension
D) Hyperglycemia
Correct answer: B
Rationale: Timolol is a beta-blocker; systemic absorption can cause bradycardia
and hypotension.
12. A patient is prescribed enoxaparin subcutaneously. Which technique is
correct?
A) Aspirate before injection
B) Massage the site after injection
C) Inject into the abdomen while pinching a skin fold
D) Use a 1-inch needle at a 45-degree angle
Correct answer: C
Rationale: Enoxaparin: no aspiration, no massage; pinch abdomen, insert at 90°
with short needle.
13. A patient taking prednisone for 2 weeks suddenly stops. Which
complication is most concerning?
A) Adrenal crisis
(Forms A, B, C, D) | NGN Questions with
Correct Answers,
1. A patient with heart failure is prescribed digoxin. Which finding is most
indicative of digoxin toxicity?
A) Heart rate of 68 bpm
B) Serum potassium of 4.0 mEq/L
C) Visual changes (yellow-green halos)
D) Weight gain of 2 kg in 24 hours
Correct answer: C
*Rationale: Yellow-green halos are classic signs of digoxin toxicity. Bradycardia
(<60) and hypokalemia increase risk.*
2. A patient on warfarin has an INR of 4.8 and no bleeding. What should the
nurse anticipate?
A) Administer vitamin K intramuscularly
B) Hold the next dose and notify the provider
C) Increase the warfarin dose
D) Give fresh frozen plasma immediately
Correct answer: B
*Rationale: INR >4.5 without bleeding: hold warfarin; provider may order low-
dose oral vitamin K.*
3. A nurse is administering IV furosemide. The patient reports ringing in the
ears. What is the priority action?
A) Slow the injection rate
B) Stop the infusion and notify the provider
,C) Continue because this is a common side effect
D) Flush the IV line with normal saline
Correct answer: B
Rationale: Tinnitus indicates ototoxicity, a serious adverse effect of loop diuretics.
4. A patient taking metformin reports muscle pain and weakness. Which
laboratory value should be checked immediately?
A) Serum creatinine
B) Lactate level
C) Hemoglobin A1c
D) Potassium
Correct answer: B
Rationale: Metformin can cause lactic acidosis; muscle pain and weakness are
early signs.
5. Which medication is most likely to cause a persistent dry cough?
A) Losartan
B) Lisinopril
C) Amlodipine
D) Metoprolol
Correct answer: B
Rationale: ACE inhibitors (lisinopril) cause cough due to bradykinin
accumulation.
6. A patient is prescribed alendronate for osteoporosis. Which instruction is
most important?
A) Lie down for 30 minutes after taking
B) Take with orange juice
C) Take with a full glass of water after waking and remain upright for 30–60
minutes
D) Take at bedtime with a snack
Correct answer: C
,Rationale: Alendronate can cause esophagitis; upright position and plain water
are essential.
7. A patient receiving a blood transfusion develops chills, fever, and back
pain. What is the first action?
A) Slow the infusion rate
B) Stop the transfusion
C) Administer acetaminophen
D) Check vital signs
Correct answer: B
Rationale: These symptoms suggest a hemolytic transfusion reaction; stop the
transfusion immediately.
8. A patient on lithium has a serum level of 1.8 mEq/L and reports nausea,
vomiting, and coarse tremor. What should the nurse do?
A) Administer the next dose as scheduled
B) Hold the medication and notify the provider
C) Increase fluid intake
D) Give a diuretic
Correct answer: B
*Rationale: Therapeutic range 0.6–1.2 mEq/L; 1.8 is toxic. Hold and notify.*
9. A patient is prescribed nitroglycerin sublingual for angina. Which
instruction is correct?
A) Swallow the tablet with water
B) Store in a clear plastic bottle
C) Replace every 3 months
D) Take one tablet every 5 minutes for up to 3 doses; if no relief, call 911
Correct answer: D
Rationale: Standard dosing: 1 tablet q5 min ×3; call 911 if no relief after first dose
in some protocols.
, 10. A patient on isoniazid (INH) for tuberculosis should be monitored for
which deficiency?
A) Vitamin B12
B) Vitamin B6 (pyridoxine)
C) Vitamin D
D) Folic acid
Correct answer: B
Rationale: INH causes peripheral neuropathy; pyridoxine prevents it.
11. A patient with glaucoma uses timolol eye drops. The nurse should assess
for which systemic side effect?
A) Tachycardia
B) Bradycardia
C) Hypertension
D) Hyperglycemia
Correct answer: B
Rationale: Timolol is a beta-blocker; systemic absorption can cause bradycardia
and hypotension.
12. A patient is prescribed enoxaparin subcutaneously. Which technique is
correct?
A) Aspirate before injection
B) Massage the site after injection
C) Inject into the abdomen while pinching a skin fold
D) Use a 1-inch needle at a 45-degree angle
Correct answer: C
Rationale: Enoxaparin: no aspiration, no massage; pinch abdomen, insert at 90°
with short needle.
13. A patient taking prednisone for 2 weeks suddenly stops. Which
complication is most concerning?
A) Adrenal crisis
