1
Pharmacology NCLEX Test Bank 2025–2026 | Medications, Side
Effects, Nursing Interventions & Rationales
❓Question 1 – Cardiovascular Meds / Beta-Blockers
A client with hypertension is prescribed metoprolol. After three days, the client reports feeling dizzy
and extremely fatigued. Upon assessment, the nurse notes a blood pressure of 92/56 mmHg and a heart
rate of 50 bpm. What is the nurse’s priority action?
A. Reassure the client and document the findings
B. Withhold the medication and notify the provider
C. Encourage fluid intake and monitor vital signs
D. Instruct the client to lie flat and take the medication
✅ Correct Answer: B. Withhold the medication and notify the provider
Rationale:
Metoprolol, a beta-blocker, can cause bradycardia and hypotension. A heart rate <60 bpm or systolic
BP <100 mmHg typically warrants withholding the dose and notifying the provider. Monitoring and
early intervention prevent adverse cardiac outcomes.
📚 Saunders 10th Ed., Ch. 46 – Antihypertensive Medications
❓Question 2 – Antibiotics / Aminoglycosides
A hospitalized client is receiving gentamicin IV for a severe infection. Which lab value should the
nurse prioritize to monitor for potential toxicity?
A. White blood cell count
B. Blood urea nitrogen (BUN) and creatinine
C. Potassium and sodium levels
D. Platelet count and hemoglobin
✅ Correct Answer: B. Blood urea nitrogen (BUN) and creatinine
,2
Rationale:
Aminoglycosides like gentamicin are nephrotoxic and ototoxic. Renal function must be closely
monitored. Elevated BUN and creatinine indicate kidney stress or damage.
📚 Saunders 10th Ed., Ch. 49 – Antiinfective Medications
❓Question 3 – Endocrine Meds / Insulin Therapy
A nurse is teaching a client with newly diagnosed type 1 diabetes about insulin lispro. Which
instruction is most important regarding this medication?
A. Take 30 minutes before meals
B. Administer only at bedtime
C. Inject immediately before meals
D. Use only if glucose is >250 mg/dL
✅ Correct Answer: C. Inject immediately before meals
Rationale:
Insulin lispro (Humalog) is a rapid-acting insulin with onset in 15 minutes. It must be given right
before eating to avoid hypoglycemia.
📚 Saunders 10th Ed., Ch. 47 – Endocrine Medications
❓Question 4 – Psych Meds / SSRIs
A client prescribed sertraline for major depressive disorder reports nausea and insomnia during the
first week of therapy. What is the best response by the nurse?
A. "These side effects are common and should subside."
B. "You should stop the medication immediately."
C. "Let me contact your provider for a dosage change."
D. "Take it with grapefruit juice to ease side effects."
✅ Correct Answer: A. "These side effects are common and should subside."
Rationale:
SSRIs commonly cause GI upset and sleep disturbances early in treatment. These effects usually
improve within 1–2 weeks. Education is key to medication adherence.
📚 Saunders 10th Ed., Ch. 50 – Psychiatric Medications
❓Question 5 – GI Meds / Proton Pump Inhibitors
A client with peptic ulcer disease is prescribed omeprazole. Which teaching should the nurse include?
A. "Take this medication with meals."
B. "Avoid taking with antacids."
,3
C. "Take once daily before breakfast."
D. "Expect black, tarry stools as normal."
✅ Correct Answer: C. "Take once daily before breakfast."
Rationale:
PPIs like omeprazole are most effective when taken on an empty stomach, typically 30–60 minutes
before the first meal. They reduce gastric acid secretion.
📚 Saunders 10th Ed., Ch. 45 – Gastrointestinal Medications
❓Question 6 – Respiratory Meds / Inhalers
A client with asthma is prescribed both albuterol (rescue inhaler) and fluticasone (steroid inhaler).
Which instruction is most appropriate?
A. "Use the steroid inhaler first, then the albuterol."
B. "Only use both if you have an asthma attack."
C. "Use the albuterol first, then wait 5 minutes before using fluticasone."
D. "You can use them in any order."
✅ Correct Answer: C. "Use the albuterol first, then wait 5 minutes before using fluticasone."
Rationale:
Albuterol is a bronchodilator, allowing better penetration of the steroid (fluticasone). Always use
bronchodilator first in combination therapy.
📚 Saunders 10th Ed., Ch. 44 – Respiratory Medications
❓Question 7 – Anticoagulants / Warfarin
A client on warfarin therapy has an INR of 4.5. What is the nurse’s priority action?
A. Give the scheduled warfarin dose
B. Hold the dose and notify the provider
C. Administer an extra dose to increase INR
D. Give vitamin D to help clotting
✅ Correct Answer: B. Hold the dose and notify the provider
Rationale:
An INR >4.0 is above therapeutic range, increasing risk of bleeding. The nurse should hold the dose
and contact the provider for possible dose adjustment or reversal.
📚 Saunders 10th Ed., Ch. 51 – Anticoagulant and Thrombolytic Medications
❓Question 8 – Diuretics / Furosemide
A client taking furosemide complains of muscle cramps and weakness. What lab value should the
nurse check first?
, 4
A. Sodium
B. Hemoglobin
C. Potassium
D. Glucose
✅ Correct Answer: C. Potassium
Rationale:
Furosemide is a loop diuretic that causes potassium loss, leading to hypokalemia, which presents as
muscle cramps, weakness, and dysrhythmias.
📚 Saunders 10th Ed., Ch. 46 – Cardiovascular Medications
❓Question 9 – Pain Meds / Opioids
A post-op client receiving morphine IV reports itching and nausea. What is the nurse’s best action?
A. Document as normal side effects and monitor
B. Discontinue morphine and notify the provider
C. Administer diphenhydramine as prescribed
D. Give naloxone immediately
✅ Correct Answer: C. Administer diphenhydramine as prescribed
Rationale:
Itching and nausea are common opioid side effects, not necessarily allergic reactions.
Diphenhydramine (Benadryl) is often given for opioid-induced pruritus.
📚 Saunders 10th Ed., Ch. 53 – Pain Medications
❓Question 10 – Antidiabetics / Oral Agents
A client with type 2 diabetes is prescribed glipizide. Which client statement requires further
teaching?
A. “I’ll take it 30 minutes before meals.”
B. “It’s okay to drink alcohol occasionally.”
C. “I’ll watch for signs of low blood sugar.”
D. “I need to check my blood glucose regularly.”
✅ Correct Answer: B. “It’s okay to drink alcohol occasionally.”
Rationale:
Glipizide (a sulfonylurea) can cause severe hypoglycemia when taken with alcohol, due to a
disulfiram-like reaction. The client should avoid alcohol completely.
📚 Saunders 10th Ed., Ch. 47 – Endocrine Medications
Pharmacology NCLEX Test Bank 2025–2026 | Medications, Side
Effects, Nursing Interventions & Rationales
❓Question 1 – Cardiovascular Meds / Beta-Blockers
A client with hypertension is prescribed metoprolol. After three days, the client reports feeling dizzy
and extremely fatigued. Upon assessment, the nurse notes a blood pressure of 92/56 mmHg and a heart
rate of 50 bpm. What is the nurse’s priority action?
A. Reassure the client and document the findings
B. Withhold the medication and notify the provider
C. Encourage fluid intake and monitor vital signs
D. Instruct the client to lie flat and take the medication
✅ Correct Answer: B. Withhold the medication and notify the provider
Rationale:
Metoprolol, a beta-blocker, can cause bradycardia and hypotension. A heart rate <60 bpm or systolic
BP <100 mmHg typically warrants withholding the dose and notifying the provider. Monitoring and
early intervention prevent adverse cardiac outcomes.
📚 Saunders 10th Ed., Ch. 46 – Antihypertensive Medications
❓Question 2 – Antibiotics / Aminoglycosides
A hospitalized client is receiving gentamicin IV for a severe infection. Which lab value should the
nurse prioritize to monitor for potential toxicity?
A. White blood cell count
B. Blood urea nitrogen (BUN) and creatinine
C. Potassium and sodium levels
D. Platelet count and hemoglobin
✅ Correct Answer: B. Blood urea nitrogen (BUN) and creatinine
,2
Rationale:
Aminoglycosides like gentamicin are nephrotoxic and ototoxic. Renal function must be closely
monitored. Elevated BUN and creatinine indicate kidney stress or damage.
📚 Saunders 10th Ed., Ch. 49 – Antiinfective Medications
❓Question 3 – Endocrine Meds / Insulin Therapy
A nurse is teaching a client with newly diagnosed type 1 diabetes about insulin lispro. Which
instruction is most important regarding this medication?
A. Take 30 minutes before meals
B. Administer only at bedtime
C. Inject immediately before meals
D. Use only if glucose is >250 mg/dL
✅ Correct Answer: C. Inject immediately before meals
Rationale:
Insulin lispro (Humalog) is a rapid-acting insulin with onset in 15 minutes. It must be given right
before eating to avoid hypoglycemia.
📚 Saunders 10th Ed., Ch. 47 – Endocrine Medications
❓Question 4 – Psych Meds / SSRIs
A client prescribed sertraline for major depressive disorder reports nausea and insomnia during the
first week of therapy. What is the best response by the nurse?
A. "These side effects are common and should subside."
B. "You should stop the medication immediately."
C. "Let me contact your provider for a dosage change."
D. "Take it with grapefruit juice to ease side effects."
✅ Correct Answer: A. "These side effects are common and should subside."
Rationale:
SSRIs commonly cause GI upset and sleep disturbances early in treatment. These effects usually
improve within 1–2 weeks. Education is key to medication adherence.
📚 Saunders 10th Ed., Ch. 50 – Psychiatric Medications
❓Question 5 – GI Meds / Proton Pump Inhibitors
A client with peptic ulcer disease is prescribed omeprazole. Which teaching should the nurse include?
A. "Take this medication with meals."
B. "Avoid taking with antacids."
,3
C. "Take once daily before breakfast."
D. "Expect black, tarry stools as normal."
✅ Correct Answer: C. "Take once daily before breakfast."
Rationale:
PPIs like omeprazole are most effective when taken on an empty stomach, typically 30–60 minutes
before the first meal. They reduce gastric acid secretion.
📚 Saunders 10th Ed., Ch. 45 – Gastrointestinal Medications
❓Question 6 – Respiratory Meds / Inhalers
A client with asthma is prescribed both albuterol (rescue inhaler) and fluticasone (steroid inhaler).
Which instruction is most appropriate?
A. "Use the steroid inhaler first, then the albuterol."
B. "Only use both if you have an asthma attack."
C. "Use the albuterol first, then wait 5 minutes before using fluticasone."
D. "You can use them in any order."
✅ Correct Answer: C. "Use the albuterol first, then wait 5 minutes before using fluticasone."
Rationale:
Albuterol is a bronchodilator, allowing better penetration of the steroid (fluticasone). Always use
bronchodilator first in combination therapy.
📚 Saunders 10th Ed., Ch. 44 – Respiratory Medications
❓Question 7 – Anticoagulants / Warfarin
A client on warfarin therapy has an INR of 4.5. What is the nurse’s priority action?
A. Give the scheduled warfarin dose
B. Hold the dose and notify the provider
C. Administer an extra dose to increase INR
D. Give vitamin D to help clotting
✅ Correct Answer: B. Hold the dose and notify the provider
Rationale:
An INR >4.0 is above therapeutic range, increasing risk of bleeding. The nurse should hold the dose
and contact the provider for possible dose adjustment or reversal.
📚 Saunders 10th Ed., Ch. 51 – Anticoagulant and Thrombolytic Medications
❓Question 8 – Diuretics / Furosemide
A client taking furosemide complains of muscle cramps and weakness. What lab value should the
nurse check first?
, 4
A. Sodium
B. Hemoglobin
C. Potassium
D. Glucose
✅ Correct Answer: C. Potassium
Rationale:
Furosemide is a loop diuretic that causes potassium loss, leading to hypokalemia, which presents as
muscle cramps, weakness, and dysrhythmias.
📚 Saunders 10th Ed., Ch. 46 – Cardiovascular Medications
❓Question 9 – Pain Meds / Opioids
A post-op client receiving morphine IV reports itching and nausea. What is the nurse’s best action?
A. Document as normal side effects and monitor
B. Discontinue morphine and notify the provider
C. Administer diphenhydramine as prescribed
D. Give naloxone immediately
✅ Correct Answer: C. Administer diphenhydramine as prescribed
Rationale:
Itching and nausea are common opioid side effects, not necessarily allergic reactions.
Diphenhydramine (Benadryl) is often given for opioid-induced pruritus.
📚 Saunders 10th Ed., Ch. 53 – Pain Medications
❓Question 10 – Antidiabetics / Oral Agents
A client with type 2 diabetes is prescribed glipizide. Which client statement requires further
teaching?
A. “I’ll take it 30 minutes before meals.”
B. “It’s okay to drink alcohol occasionally.”
C. “I’ll watch for signs of low blood sugar.”
D. “I need to check my blood glucose regularly.”
✅ Correct Answer: B. “It’s okay to drink alcohol occasionally.”
Rationale:
Glipizide (a sulfonylurea) can cause severe hypoglycemia when taken with alcohol, due to a
disulfiram-like reaction. The client should avoid alcohol completely.
📚 Saunders 10th Ed., Ch. 47 – Endocrine Medications
