NCLEX RN Pharmacology Quick Review
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & RESPIRATORY MEDICATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male with a history of atrial fibrillation is receiving a continuous heparin
infusion at 1,200 units per hour. His baseline aPTT was 32 seconds. Six hours after starting
the infusion, his aPTT is 92 seconds. The therapeutic range is 60 to 80 seconds. Which
action should the nurse take first?
A. Continue the infusion at the current rate and recheck the aPTT in 4 hours
B. Stop the infusion immediately and notify the provider ✓ CORRECT
C. Reduce the infusion rate by 10% and recheck the aPTT in 6 hours
D. Administer protamine sulfate 1 mg IV and recheck the aPTT in 1 hour
Correct Answer: B
Rationale: An aPTT of 92 seconds exceeds the therapeutic range and indicates a high
bleeding risk, so the nurse must stop the infusion immediately and notify the provider for
further orders. Reducing the rate by only 10% or continuing the current rate would prolong the
supratherapeutic state and increase the risk of hemorrhage. Protamine sulfate is reserved for
serious or life-threatening bleeding, not for a single elevated aPTT value.
Question 2 of 50
A 54-year-old woman with chronic heart failure is prescribed lisinopril 10 mg daily and
furosemide 40 mg daily. On morning assessment, her blood pressure is 98/62 mmHg, heart
rate is 112 bpm, and she reports dizziness when standing. Her serum creatinine is 1.4 mg/dL,
up from her baseline of 1.0 mg/dL. What is the nurse's priority intervention?
A. Hold the lisinopril and notify the provider ✓ CORRECT
,B. Hold the furosemide and encourage oral fluid intake
C. Administer both medications and reassess blood pressure in 2 hours
D. Give the furosemide but hold the lisinopril until blood pressure improves
Correct Answer: A
Rationale: Hypotension, tachycardia, dizziness, and a rising creatinine in a patient on an ACE
inhibitor and diuretic strongly suggest acute kidney injury from reduced renal perfusion, so
holding the lisinopril and notifying the provider is the priority. While furosemide contributes to
volume depletion, the rising creatinine in the setting of hypotension points more urgently to
ACE inhibitor-induced renal hypoperfusion. Administering either medication or delaying
action could worsen renal function and lead to acute kidney injury.
Question 3 of 50
A 72-year-old male with COPD is started on tiotropium inhalation powder once daily. During
the nurse's medication education, the patient asks why he should not use the inhaler for
sudden breathing problems. What is the nurse's best response?
A. "Tiotropium takes too long to reach the lungs, so it won't work fast enough for sudden
symptoms." ✓ CORRECT
B. "Using it for sudden symptoms will cause dangerous tachycardia and palpitations."
C. "The powder form cannot be inhaled properly during an acute attack."
D. "Your doctor will prescribe a different inhaler if your symptoms worsen suddenly."
Correct Answer: A
Rationale: Tiotropium is a long-acting muscarinic antagonist with an onset of action around
30 minutes, making it unsuitable for rescue from acute bronchospasm. While
anticholinergics can cause tachycardia, this is not the primary reason tiotropium is
contraindicated as a rescue inhaler. A short-acting beta-agonist such as albuterol should be
used for sudden symptoms.
Question 4 of 50
A 45-year-old male with hypertension is prescribed amlodipine 5 mg daily. Three days after
starting the medication, he calls the clinic complaining of severe bilateral ankle edema, mild
headache, and flushing. His blood pressure is 132/84 mmHg. What should the nurse tell the
patient?
A. "Stop the medication immediately and go to the emergency department."
B. "These are expected side effects that usually resolve within 2 weeks; keep taking it." ✓
CORRECT
C. "Take the medication every other day until the swelling goes down."
D. "Elevate your legs and add a diuretic on your own to reduce the edema."
, Correct Answer: B
Rationale: Peripheral edema, headache, and flushing are common and dose-dependent side
effects of dihydropyridine calcium channel blockers like amlodipine, and they typically
diminish with continued use. Stopping the medication abruptly could cause rebound
hypertension, and patients should never adjust antihypertensives or add diuretics without
provider guidance. The nurse should reassure the patient while scheduling follow-up to
monitor tolerance.
Question 5 of 50
A 62-year-old woman with a history of myocardial infarction 6 months ago is taking aspirin 81
mg daily, atorvastatin 40 mg daily, and metoprolol 50 mg twice daily. She reports fatigue, cold
extremities, and a resting heart rate of 52 bpm. Her blood pressure is 108/68 mmHg. Which
medication is most likely causing these findings?
A. Aspirin
B. Atorvastatin
C. Metoprolol ✓ CORRECT
D. Atorvastatin and aspirin together
Correct Answer: C
Rationale: Bradycardia, fatigue, and cold extremities are classic beta-blocker effects resulting
from decreased cardiac output and reduced sympathetic tone. Aspirin commonly causes GI
upset or bleeding, while atorvastatin is associated with myalgias and hepatotoxicity, neither
of which explain bradycardia or cold extremities. The nurse should assess whether the
metoprolol dose needs reduction.
Question 6 of 50
A 78-year-old male with a new diagnosis of heart failure with reduced ejection fraction is
prescribed carvedilol 3.125 mg twice daily. The nurse knows that before administering the
first dose, which assessment is most critical?
A. Checking the patient's potassium level
B. Assessing the apical pulse and blood pressure ✓ CORRECT
C. Reviewing the patient's liver function tests
D. Confirming the patient has not eaten in the past 2 hours
Correct Answer: B
Rationale: Carvedilol is a nonselective beta-blocker with alpha-1 blocking activity that can
cause significant hypotension and bradycardia, especially with the first dose, so assessing
pulse and blood pressure is essential. While electrolyte imbalances and hepatic function are
relevant in heart failure management, they are not the most critical assessments immediately
before initiating beta-blocker therapy. Food does not significantly alter carvedilol absorption.
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & RESPIRATORY MEDICATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male with a history of atrial fibrillation is receiving a continuous heparin
infusion at 1,200 units per hour. His baseline aPTT was 32 seconds. Six hours after starting
the infusion, his aPTT is 92 seconds. The therapeutic range is 60 to 80 seconds. Which
action should the nurse take first?
A. Continue the infusion at the current rate and recheck the aPTT in 4 hours
B. Stop the infusion immediately and notify the provider ✓ CORRECT
C. Reduce the infusion rate by 10% and recheck the aPTT in 6 hours
D. Administer protamine sulfate 1 mg IV and recheck the aPTT in 1 hour
Correct Answer: B
Rationale: An aPTT of 92 seconds exceeds the therapeutic range and indicates a high
bleeding risk, so the nurse must stop the infusion immediately and notify the provider for
further orders. Reducing the rate by only 10% or continuing the current rate would prolong the
supratherapeutic state and increase the risk of hemorrhage. Protamine sulfate is reserved for
serious or life-threatening bleeding, not for a single elevated aPTT value.
Question 2 of 50
A 54-year-old woman with chronic heart failure is prescribed lisinopril 10 mg daily and
furosemide 40 mg daily. On morning assessment, her blood pressure is 98/62 mmHg, heart
rate is 112 bpm, and she reports dizziness when standing. Her serum creatinine is 1.4 mg/dL,
up from her baseline of 1.0 mg/dL. What is the nurse's priority intervention?
A. Hold the lisinopril and notify the provider ✓ CORRECT
,B. Hold the furosemide and encourage oral fluid intake
C. Administer both medications and reassess blood pressure in 2 hours
D. Give the furosemide but hold the lisinopril until blood pressure improves
Correct Answer: A
Rationale: Hypotension, tachycardia, dizziness, and a rising creatinine in a patient on an ACE
inhibitor and diuretic strongly suggest acute kidney injury from reduced renal perfusion, so
holding the lisinopril and notifying the provider is the priority. While furosemide contributes to
volume depletion, the rising creatinine in the setting of hypotension points more urgently to
ACE inhibitor-induced renal hypoperfusion. Administering either medication or delaying
action could worsen renal function and lead to acute kidney injury.
Question 3 of 50
A 72-year-old male with COPD is started on tiotropium inhalation powder once daily. During
the nurse's medication education, the patient asks why he should not use the inhaler for
sudden breathing problems. What is the nurse's best response?
A. "Tiotropium takes too long to reach the lungs, so it won't work fast enough for sudden
symptoms." ✓ CORRECT
B. "Using it for sudden symptoms will cause dangerous tachycardia and palpitations."
C. "The powder form cannot be inhaled properly during an acute attack."
D. "Your doctor will prescribe a different inhaler if your symptoms worsen suddenly."
Correct Answer: A
Rationale: Tiotropium is a long-acting muscarinic antagonist with an onset of action around
30 minutes, making it unsuitable for rescue from acute bronchospasm. While
anticholinergics can cause tachycardia, this is not the primary reason tiotropium is
contraindicated as a rescue inhaler. A short-acting beta-agonist such as albuterol should be
used for sudden symptoms.
Question 4 of 50
A 45-year-old male with hypertension is prescribed amlodipine 5 mg daily. Three days after
starting the medication, he calls the clinic complaining of severe bilateral ankle edema, mild
headache, and flushing. His blood pressure is 132/84 mmHg. What should the nurse tell the
patient?
A. "Stop the medication immediately and go to the emergency department."
B. "These are expected side effects that usually resolve within 2 weeks; keep taking it." ✓
CORRECT
C. "Take the medication every other day until the swelling goes down."
D. "Elevate your legs and add a diuretic on your own to reduce the edema."
, Correct Answer: B
Rationale: Peripheral edema, headache, and flushing are common and dose-dependent side
effects of dihydropyridine calcium channel blockers like amlodipine, and they typically
diminish with continued use. Stopping the medication abruptly could cause rebound
hypertension, and patients should never adjust antihypertensives or add diuretics without
provider guidance. The nurse should reassure the patient while scheduling follow-up to
monitor tolerance.
Question 5 of 50
A 62-year-old woman with a history of myocardial infarction 6 months ago is taking aspirin 81
mg daily, atorvastatin 40 mg daily, and metoprolol 50 mg twice daily. She reports fatigue, cold
extremities, and a resting heart rate of 52 bpm. Her blood pressure is 108/68 mmHg. Which
medication is most likely causing these findings?
A. Aspirin
B. Atorvastatin
C. Metoprolol ✓ CORRECT
D. Atorvastatin and aspirin together
Correct Answer: C
Rationale: Bradycardia, fatigue, and cold extremities are classic beta-blocker effects resulting
from decreased cardiac output and reduced sympathetic tone. Aspirin commonly causes GI
upset or bleeding, while atorvastatin is associated with myalgias and hepatotoxicity, neither
of which explain bradycardia or cold extremities. The nurse should assess whether the
metoprolol dose needs reduction.
Question 6 of 50
A 78-year-old male with a new diagnosis of heart failure with reduced ejection fraction is
prescribed carvedilol 3.125 mg twice daily. The nurse knows that before administering the
first dose, which assessment is most critical?
A. Checking the patient's potassium level
B. Assessing the apical pulse and blood pressure ✓ CORRECT
C. Reviewing the patient's liver function tests
D. Confirming the patient has not eaten in the past 2 hours
Correct Answer: B
Rationale: Carvedilol is a nonselective beta-blocker with alpha-1 blocking activity that can
cause significant hypotension and bradycardia, especially with the first dose, so assessing
pulse and blood pressure is essential. While electrolyte imbalances and hepatic function are
relevant in heart failure management, they are not the most critical assessments immediately
before initiating beta-blocker therapy. Food does not significantly alter carvedilol absorption.
