Prophecy RN Pharmacology A Exam Study
Guide | 100 Q&As with Verified Answers &
Rationales (Latest 2026/2027)
Question 1
A nurse is preparing to administer the morning dose of digoxin to a patient with heart
failure. The patient's apical pulse is 54 beats per minute. Which of the following is the
priority nursing action?
A) Administer the dose and document the heart rate.
B) Recheck the pulse in 30 minutes.
C) Hold the medication and notify the healthcare provider.
D) Administer half the prescribed dose.
Correct Answer: C) Hold the medication and notify the healthcare provider.
Rationale: Digoxin is a cardiac glycoside with positive inotropic and negative
chronotropic effects. The nurse must assess the apical pulse for 1 full minute prior to
administration. If the apical pulse is less than 60 beats per minute in an adult, the dose
must be held, and the provider notified to prevent severe bradycardia and digoxin
toxicity.
Incorrect Options: A and D are unsafe because giving any portion of the drug with a
low heart rate can induce life-threatening arrhythmias. B delays necessary clinical
notification.
Question 2
A patient presents to the emergency department reporting severe chest pain. The
patient admits to taking sildenafil (Viagra) approximately 4 hours ago. Which of the
, following prescribed medications must the nurse immediately question?
A) Morphine sulfate
B) Nitroglycerin sublingual
C) Aspirin chewable
D) Metoprolol
Correct Answer: B) Nitroglycerin sublingual
Rationale: Co-administration of sildenafil (a phosphodiesterase-5 inhibitor) and organic
nitrates (like nitroglycerin) is strictly contraindicated. Both medications cause smooth
muscle relaxation and vasodilation. When taken together, they can cause an acute,
profound, and potentially fatal drop in blood pressure (severe hypotension).
Incorrect Options: A, C, and D are standard elements of acute coronary syndrome
management and do not have a fatal interaction with sildenafil.
Question 3
A nurse is providing discharge education to a patient who has been prescribed a 2-
week course of prednisone for an acute asthma exacerbation. Which statement by the
patient indicates a correct understanding of the teaching?
A) "I can stop taking this medication as soon as my breathing feels completely normal."
B) "I will need to gradually lower my dose over several days when it is time to stop."
C) "I should take this medication on an empty stomach right before bedtime."
D) "I can safely take aspirin if I experience joint pain while on this medication."
Correct Answer: B) "I will need to gradually lower my dose over several days
when it is time to stop."
Rationale: Exogenous corticosteroid therapy (like prednisone) suppresses the
hypothalamic-pituitary-adrenal (HPA) axis, causing the adrenal glands to temporarily
stop producing natural cortisol. Abrupt cessation can cause an acute adrenal crisis,
which is a life-threatening medical emergency. Therefore, the medication must be
tapered down gradually.
Incorrect Options: A poses a risk for adrenal crisis. C is incorrect because steroids
cause GI upset and insomnia, so they should be taken with food in the morning. D is
incorrect because both steroids and aspirin increase gastric ulceration risks.
Question 4
A patient with an unresolving urinary tract infection is prescribed intravenous
ceftriaxone. During the admission assessment, the nurse notes a documented history of
severe anaphylaxis to penicillin. Which action should the nurse take first?
A) Administer the ceftriaxone slowly over one hour.
B) Pre-medicate the patient with diphenhydramine.
C) Hold the medication and contact the healthcare provider to clarify the order.
D) Monitor the patient closely for a rash during the infusion.
Correct Answer: C) Hold the medication and contact the healthcare provider to
clarify the order.
Rationale: Ceftriaxone is a cephalosporin. Cephalosporins share a structural beta-
lactam ring with penicillins. Due to this structural similarity, there is a known cross-
sensitivity risk for allergic reactions. When a patient has a documented history of severe
, anaphylaxis to penicillin, cephalosporins should be avoided unless explicitly clarified
and deemed necessary by the provider under controlled conditions.
Incorrect Options: A, B, and D are unsafe because they expose a highly sensitive
patient to a potential anaphylactic trigger without provider clearance.
Question 5
A nurse is caring for a patient who is unresponsive with a blood glucose level of 33
mg/dL. The patient has a patent peripheral intravenous line. Which of the following
medications should the nurse prepare to administer?
A) 4 ounces of orange juice via a nasogastric tube
B) 50% Dextrose (D50) via intravenous push
C) Subcutaneous regular insulin
D) Glucagon intramuscularly
Correct Answer: B) 50% Dextrose (D50) via intravenous push
Rationale: Severe hypoglycemia (<40 mg/dL) in an unresponsive patient requires
immediate, rapid correction to prevent irreversible neurological damage. Because the
patient is unresponsive, oral carbohydrates are contraindicated due to aspiration risk.
Because the patient has established IV access, IV D50 is the fastest and most reliable
method to restore blood sugar levels.
Incorrect Options: A creates an immediate aspiration risk. C would lower the blood
sugar further, causing death. D (Glucagon) is used for severe hypoglycemia only when
IV access is completely unavailable.
Question 6
A nurse is preparing to initiate an intravenous infusion of 1,000 mL of 0.9% Normal
Saline to run over exactly 8 hours. At what hourly rate should the nurse program the
infusion pump?
A) 83 mL/hr
B) 100 mL/hr
C) 125 mL/hr
D) 150 mL/hr
Correct Answer: C) 125 mL/hr
Rationale: To find the hourly infusion rate, divide the total volume in milliliters by the
total time required in hours.
\(\frac{1,000\text{\ mL}}{8\text{\ hours}}=125\text{\ mL/hr}\)
Incorrect Options: A, B, and D represent mathematical miscalculations that would lead
to fluid volume deficits or fluid overloads.
Question 7
A patient is receiving an intravenous heparin infusion for a deep vein thrombosis (DVT).
The nurse notes that the patient's latest activated partial thromboplastin time (aPTT) is
115 seconds. Which of the following is the priority nursing action?
A) Increase the infusion rate by 10%.
B) Continue the infusion at the current rate and document the value.
C) Stop the infusion immediately and prepare to administer protamine sulfate if ordered.
D) Obtain a second blood sample to verify the result before taking action.
, Correct Answer: C) Stop the infusion immediately and prepare to administer
protamine sulfate if ordered.
Rationale: The therapeutic target range for aPTT during heparin therapy is typically 1.5
to 2.5 times the normal baseline value (roughly 60 to 80 seconds). An aPTT of 115
seconds indicates a critical over-anticoagulation status, putting the patient at a severe
risk for spontaneous and internal hemorrhage. The infusion must be stopped
immediately, and the provider notified. Protamine sulfate is the specific antidote for
heparin.
Incorrect Options: A would aggravate the hemorrhage risk. B ignores a critically
dangerous laboratory value. D delays essential emergency response actions.
Question 8
A patient diagnosed with chronic atrial fibrillation has been prescribed oral warfarin
(Coumadin) therapy. Which laboratory test must be monitored regularly to evaluate the
therapeutic efficacy and safety of this drug?
A) Activated partial thromboplastin time (aPTT)
B) Platelet count
C) International Normalized Ratio (INR)
D) Bleeding time
Correct Answer: C) International Normalized Ratio (INR)
Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors. The
standard lab test used to monitor its efficacy and safety is the Prothrombin Time (PT)
reported alongside the International Normalized Ratio (INR). For standard atrial
fibrillation, the typical therapeutic INR goal is 2.0 to 3.0.
Incorrect Options: A is used primarily to monitor unfractionated heparin infusions. B
assesses thrombocytes, which are not directly targeted by warfarin's mechanism of
action. D is an obsolete assessment for platelet function.
Question 9
A patient is prescribed lithium carbonate for the management of bipolar disorder. Which
of the following dietary instructions is most critical for the nurse to include in the
discharge teaching?
A) Maintain a strict low-sodium diet to prevent fluid retention.
B) Maintain a consistent intake of sodium and fluids.
C) Restrict overall daily fluid intake to under 1,000 mL.
D) Eliminate caffeine and chocolate entirely from the diet.
Correct Answer: B) Maintain a consistent intake of sodium and fluids.
Rationale: Lithium is a monovalent cation that is handled by the kidneys in a manner
virtually identical to sodium. If sodium intake drops or if the patient becomes dehydrated
(low fluid intake/sweating), the kidneys will actively reabsorb lithium in place of sodium.
This leads to a rapid rise in serum lithium levels, precipitating severe lithium toxicity.
Incorrect Options: A is dangerous because a low-sodium diet directly induces lithium
toxicity. C would cause severe dehydration, also triggering toxicity. D is an unneeded
restriction, though moderate consistency with stimulants is advised.
Question 10
Guide | 100 Q&As with Verified Answers &
Rationales (Latest 2026/2027)
Question 1
A nurse is preparing to administer the morning dose of digoxin to a patient with heart
failure. The patient's apical pulse is 54 beats per minute. Which of the following is the
priority nursing action?
A) Administer the dose and document the heart rate.
B) Recheck the pulse in 30 minutes.
C) Hold the medication and notify the healthcare provider.
D) Administer half the prescribed dose.
Correct Answer: C) Hold the medication and notify the healthcare provider.
Rationale: Digoxin is a cardiac glycoside with positive inotropic and negative
chronotropic effects. The nurse must assess the apical pulse for 1 full minute prior to
administration. If the apical pulse is less than 60 beats per minute in an adult, the dose
must be held, and the provider notified to prevent severe bradycardia and digoxin
toxicity.
Incorrect Options: A and D are unsafe because giving any portion of the drug with a
low heart rate can induce life-threatening arrhythmias. B delays necessary clinical
notification.
Question 2
A patient presents to the emergency department reporting severe chest pain. The
patient admits to taking sildenafil (Viagra) approximately 4 hours ago. Which of the
, following prescribed medications must the nurse immediately question?
A) Morphine sulfate
B) Nitroglycerin sublingual
C) Aspirin chewable
D) Metoprolol
Correct Answer: B) Nitroglycerin sublingual
Rationale: Co-administration of sildenafil (a phosphodiesterase-5 inhibitor) and organic
nitrates (like nitroglycerin) is strictly contraindicated. Both medications cause smooth
muscle relaxation and vasodilation. When taken together, they can cause an acute,
profound, and potentially fatal drop in blood pressure (severe hypotension).
Incorrect Options: A, C, and D are standard elements of acute coronary syndrome
management and do not have a fatal interaction with sildenafil.
Question 3
A nurse is providing discharge education to a patient who has been prescribed a 2-
week course of prednisone for an acute asthma exacerbation. Which statement by the
patient indicates a correct understanding of the teaching?
A) "I can stop taking this medication as soon as my breathing feels completely normal."
B) "I will need to gradually lower my dose over several days when it is time to stop."
C) "I should take this medication on an empty stomach right before bedtime."
D) "I can safely take aspirin if I experience joint pain while on this medication."
Correct Answer: B) "I will need to gradually lower my dose over several days
when it is time to stop."
Rationale: Exogenous corticosteroid therapy (like prednisone) suppresses the
hypothalamic-pituitary-adrenal (HPA) axis, causing the adrenal glands to temporarily
stop producing natural cortisol. Abrupt cessation can cause an acute adrenal crisis,
which is a life-threatening medical emergency. Therefore, the medication must be
tapered down gradually.
Incorrect Options: A poses a risk for adrenal crisis. C is incorrect because steroids
cause GI upset and insomnia, so they should be taken with food in the morning. D is
incorrect because both steroids and aspirin increase gastric ulceration risks.
Question 4
A patient with an unresolving urinary tract infection is prescribed intravenous
ceftriaxone. During the admission assessment, the nurse notes a documented history of
severe anaphylaxis to penicillin. Which action should the nurse take first?
A) Administer the ceftriaxone slowly over one hour.
B) Pre-medicate the patient with diphenhydramine.
C) Hold the medication and contact the healthcare provider to clarify the order.
D) Monitor the patient closely for a rash during the infusion.
Correct Answer: C) Hold the medication and contact the healthcare provider to
clarify the order.
Rationale: Ceftriaxone is a cephalosporin. Cephalosporins share a structural beta-
lactam ring with penicillins. Due to this structural similarity, there is a known cross-
sensitivity risk for allergic reactions. When a patient has a documented history of severe
, anaphylaxis to penicillin, cephalosporins should be avoided unless explicitly clarified
and deemed necessary by the provider under controlled conditions.
Incorrect Options: A, B, and D are unsafe because they expose a highly sensitive
patient to a potential anaphylactic trigger without provider clearance.
Question 5
A nurse is caring for a patient who is unresponsive with a blood glucose level of 33
mg/dL. The patient has a patent peripheral intravenous line. Which of the following
medications should the nurse prepare to administer?
A) 4 ounces of orange juice via a nasogastric tube
B) 50% Dextrose (D50) via intravenous push
C) Subcutaneous regular insulin
D) Glucagon intramuscularly
Correct Answer: B) 50% Dextrose (D50) via intravenous push
Rationale: Severe hypoglycemia (<40 mg/dL) in an unresponsive patient requires
immediate, rapid correction to prevent irreversible neurological damage. Because the
patient is unresponsive, oral carbohydrates are contraindicated due to aspiration risk.
Because the patient has established IV access, IV D50 is the fastest and most reliable
method to restore blood sugar levels.
Incorrect Options: A creates an immediate aspiration risk. C would lower the blood
sugar further, causing death. D (Glucagon) is used for severe hypoglycemia only when
IV access is completely unavailable.
Question 6
A nurse is preparing to initiate an intravenous infusion of 1,000 mL of 0.9% Normal
Saline to run over exactly 8 hours. At what hourly rate should the nurse program the
infusion pump?
A) 83 mL/hr
B) 100 mL/hr
C) 125 mL/hr
D) 150 mL/hr
Correct Answer: C) 125 mL/hr
Rationale: To find the hourly infusion rate, divide the total volume in milliliters by the
total time required in hours.
\(\frac{1,000\text{\ mL}}{8\text{\ hours}}=125\text{\ mL/hr}\)
Incorrect Options: A, B, and D represent mathematical miscalculations that would lead
to fluid volume deficits or fluid overloads.
Question 7
A patient is receiving an intravenous heparin infusion for a deep vein thrombosis (DVT).
The nurse notes that the patient's latest activated partial thromboplastin time (aPTT) is
115 seconds. Which of the following is the priority nursing action?
A) Increase the infusion rate by 10%.
B) Continue the infusion at the current rate and document the value.
C) Stop the infusion immediately and prepare to administer protamine sulfate if ordered.
D) Obtain a second blood sample to verify the result before taking action.
, Correct Answer: C) Stop the infusion immediately and prepare to administer
protamine sulfate if ordered.
Rationale: The therapeutic target range for aPTT during heparin therapy is typically 1.5
to 2.5 times the normal baseline value (roughly 60 to 80 seconds). An aPTT of 115
seconds indicates a critical over-anticoagulation status, putting the patient at a severe
risk for spontaneous and internal hemorrhage. The infusion must be stopped
immediately, and the provider notified. Protamine sulfate is the specific antidote for
heparin.
Incorrect Options: A would aggravate the hemorrhage risk. B ignores a critically
dangerous laboratory value. D delays essential emergency response actions.
Question 8
A patient diagnosed with chronic atrial fibrillation has been prescribed oral warfarin
(Coumadin) therapy. Which laboratory test must be monitored regularly to evaluate the
therapeutic efficacy and safety of this drug?
A) Activated partial thromboplastin time (aPTT)
B) Platelet count
C) International Normalized Ratio (INR)
D) Bleeding time
Correct Answer: C) International Normalized Ratio (INR)
Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors. The
standard lab test used to monitor its efficacy and safety is the Prothrombin Time (PT)
reported alongside the International Normalized Ratio (INR). For standard atrial
fibrillation, the typical therapeutic INR goal is 2.0 to 3.0.
Incorrect Options: A is used primarily to monitor unfractionated heparin infusions. B
assesses thrombocytes, which are not directly targeted by warfarin's mechanism of
action. D is an obsolete assessment for platelet function.
Question 9
A patient is prescribed lithium carbonate for the management of bipolar disorder. Which
of the following dietary instructions is most critical for the nurse to include in the
discharge teaching?
A) Maintain a strict low-sodium diet to prevent fluid retention.
B) Maintain a consistent intake of sodium and fluids.
C) Restrict overall daily fluid intake to under 1,000 mL.
D) Eliminate caffeine and chocolate entirely from the diet.
Correct Answer: B) Maintain a consistent intake of sodium and fluids.
Rationale: Lithium is a monovalent cation that is handled by the kidneys in a manner
virtually identical to sodium. If sodium intake drops or if the patient becomes dehydrated
(low fluid intake/sweating), the kidneys will actively reabsorb lithium in place of sodium.
This leads to a rapid rise in serum lithium levels, precipitating severe lithium toxicity.
Incorrect Options: A is dangerous because a low-sodium diet directly induces lithium
toxicity. C would cause severe dehydration, also triggering toxicity. D is an unneeded
restriction, though moderate consistency with stimulants is advised.
Question 10
