Kaplan Pharmacology Integrated
Proctored Exam (Form D) – NGN
Style 200 Practice Questions,,
1. A patient with heart failure is prescribed digoxin. Which finding is most
indicative of toxicity?
A) Heart rate 68 bpm
B) Serum potassium 4.2 mEq/L
C) Visual disturbances (yellow-green halos)
D) Weight gain
Correct answer: C
*Rationale: Yellow-green halos are classic digoxin toxicity signs; bradycardia
(<60) is another.*
2. A patient on warfarin has an INR of 4.8 without bleeding. The nurse
anticipates:
A) Administer vitamin K orally
B) Hold the next dose and notify provider
C) Increase the warfarin dose
D) Give fresh frozen plasma
Correct answer: B
*Rationale: INR 4.8 is above therapeutic (2–3). Hold dose; provider may lower
dose or give low-dose vitamin K if no bleeding.*
3. A nurse is administering IV push furosemide. The patient reports tinnitus.
What is the priority?
A) Slow the injection rate
B) Stop the infusion and notify provider
,C) Continue because this is expected
D) Flush with normal saline
Correct answer: B
Rationale: Tinnitus indicates ototoxicity (dose-related), stop and notify.
4. A patient on metformin reports muscle pain and weakness. Which
laboratory value should be checked immediately?
A) Serum creatinine
B) Lactate
C) Hemoglobin A1c
D) Potassium
Correct answer: B
Rationale: Metformin can cause lactic acidosis; muscle pain/weakness are early
signs.
5. Which medication is most likely to cause a persistent dry cough?
A) Losartan
B) Lisinopril
C) Amlodipine
D) Carvedilol
Correct answer: B
Rationale: ACE inhibitors cause cough via bradykinin accumulation.
6. A patient is prescribed alendronate for osteoporosis. The nurse instructs the
patient to:
A) Lie down for 30 minutes after taking
B) Take with orange juice
C) Take with a full glass of water after waking and stay upright
D) Take at bedtime with a snack
Correct answer: C
Rationale: Alendronate requires upright position for 30–60 minutes to prevent
esophageal injury.
,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 hemolytic reaction; stop transfusion, keep IV
open with saline.
8. A patient on lithium has a level of 1.8 mEq/L and reports nausea, vomiting,
and coarse tremor. The nurse should:
A) Administer the next dose as scheduled
B) Hold the medication and notify provider
C) Increase fluid intake
D) Give a diuretic
Correct answer: B
Rationale: Therapeutic range 0.6–1.2; 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; store in original dark glass bottle; replace every 6
months.
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 assesses for:
A) Tachycardia
B) Bradycardia
C) Hypertension
D) Hyperglycemia
Correct answer: B
Rationale: Timolol is a beta-blocker; systemic absorption can cause bradycardia.
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° angle
Correct answer: C
Rationale: Enoxaparin – no aspiration, no massage; pinch abdomen.
13. A patient taking prednisone for 2 weeks suddenly stops. Which
complication is most concerning?
A) Adrenal crisis
B) Hyperglycemia
C) GI bleeding
D) Osteoporosis
Correct answer: A
Rationale: Sudden withdrawal after >1 week of systemic steroids can cause
adrenal insufficiency.
Proctored Exam (Form D) – NGN
Style 200 Practice Questions,,
1. A patient with heart failure is prescribed digoxin. Which finding is most
indicative of toxicity?
A) Heart rate 68 bpm
B) Serum potassium 4.2 mEq/L
C) Visual disturbances (yellow-green halos)
D) Weight gain
Correct answer: C
*Rationale: Yellow-green halos are classic digoxin toxicity signs; bradycardia
(<60) is another.*
2. A patient on warfarin has an INR of 4.8 without bleeding. The nurse
anticipates:
A) Administer vitamin K orally
B) Hold the next dose and notify provider
C) Increase the warfarin dose
D) Give fresh frozen plasma
Correct answer: B
*Rationale: INR 4.8 is above therapeutic (2–3). Hold dose; provider may lower
dose or give low-dose vitamin K if no bleeding.*
3. A nurse is administering IV push furosemide. The patient reports tinnitus.
What is the priority?
A) Slow the injection rate
B) Stop the infusion and notify provider
,C) Continue because this is expected
D) Flush with normal saline
Correct answer: B
Rationale: Tinnitus indicates ototoxicity (dose-related), stop and notify.
4. A patient on metformin reports muscle pain and weakness. Which
laboratory value should be checked immediately?
A) Serum creatinine
B) Lactate
C) Hemoglobin A1c
D) Potassium
Correct answer: B
Rationale: Metformin can cause lactic acidosis; muscle pain/weakness are early
signs.
5. Which medication is most likely to cause a persistent dry cough?
A) Losartan
B) Lisinopril
C) Amlodipine
D) Carvedilol
Correct answer: B
Rationale: ACE inhibitors cause cough via bradykinin accumulation.
6. A patient is prescribed alendronate for osteoporosis. The nurse instructs the
patient to:
A) Lie down for 30 minutes after taking
B) Take with orange juice
C) Take with a full glass of water after waking and stay upright
D) Take at bedtime with a snack
Correct answer: C
Rationale: Alendronate requires upright position for 30–60 minutes to prevent
esophageal injury.
,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 hemolytic reaction; stop transfusion, keep IV
open with saline.
8. A patient on lithium has a level of 1.8 mEq/L and reports nausea, vomiting,
and coarse tremor. The nurse should:
A) Administer the next dose as scheduled
B) Hold the medication and notify provider
C) Increase fluid intake
D) Give a diuretic
Correct answer: B
Rationale: Therapeutic range 0.6–1.2; 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; store in original dark glass bottle; replace every 6
months.
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 assesses for:
A) Tachycardia
B) Bradycardia
C) Hypertension
D) Hyperglycemia
Correct answer: B
Rationale: Timolol is a beta-blocker; systemic absorption can cause bradycardia.
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° angle
Correct answer: C
Rationale: Enoxaparin – no aspiration, no massage; pinch abdomen.
13. A patient taking prednisone for 2 weeks suddenly stops. Which
complication is most concerning?
A) Adrenal crisis
B) Hyperglycemia
C) GI bleeding
D) Osteoporosis
Correct answer: A
Rationale: Sudden withdrawal after >1 week of systemic steroids can cause
adrenal insufficiency.
