Pharmacology Final Exam 2026/2027:
NCLEX-Style Test||Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Total Questions: 210
Format: Multiple choice, select all that apply, ordered response, and hot spots.
Focus Areas: Biologics, gene therapy, antimicrobial stewardship, anticoagulants,
mental health meds, endocrine, cardiac, and patient safety.
Section 1: Cardiovascular Pharmacology (30 Questions)
1. A patient with heart failure (HFrEF) is started on sacubitril/valsartan
(Entresto). Which lab value requires closest monitoring?
A. Serum potassium
B. Serum sodium
C. BUN
D. Creatinine
Correct Answer: A. Serum potassium
Rationale: Sacubitril/valsartan is an ARNI. It blocks aldosterone, increasing risk of
hyperkalemia. Potassium must be checked within 2 weeks of initiation and after
dose changes.
2. A patient on apixaban (Eliquis) for atrial fibrillation presents with acute
onset of severe headache and vomiting. Which action is most important?
A. Administer vitamin K
B. Draw a PTT level
C. Hold next dose of apixaban
D. Obtain a stat non-contrast head CT
, Correct Answer: D. Obtain a stat non-contrast head CT
Rationale: Symptoms suggest intracranial hemorrhage. DOACs like apixaban
increase bleeding risk. CT is priority to rule out bleed before reversal (andexanet
alfa if needed).
3. A nurse is administering digoxin. Which finding indicates toxicity?
A. Heart rate 68 bpm
B. Serum digoxin 1.2 ng/mL
C. Yellow-tinged vision (xanthopsia)
D. BP 120/80 mmHg
Correct Answer: C. Yellow-tinged vision (xanthopsia)
Rationale: Xanthopsia is a classic sign of digoxin toxicity. Therapeutic digoxin
level is 0.5–0.9 ng/mL; >2.0 ng/mL is toxic.
(Questions 4–30 continue in same format but truncated for space here; full list
available upon request. Below is a representative sample of remaining sections.)
Section 2: Antimicrobials & Stewardship (25 Questions)
31. A patient with MRSA pneumonia is receiving linezolid. Which adverse
effect is most concerning after 14 days of therapy?
A. Diarrhea
B. Thrombocytopenia
C. Rash
D. Headache
Correct Answer: B. Thrombocytopenia
Rationale: Linezolid causes dose- and duration-dependent myelosuppression,
especially thrombocytopenia after >14 days. Monitor CBC twice weekly.
32. Which antibiotic requires a 30-minute IV infusion and is contraindicated
with tigecycline due to increased mortality?
A. Meropenem
B. Daptomycin
NCLEX-Style Test||Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Total Questions: 210
Format: Multiple choice, select all that apply, ordered response, and hot spots.
Focus Areas: Biologics, gene therapy, antimicrobial stewardship, anticoagulants,
mental health meds, endocrine, cardiac, and patient safety.
Section 1: Cardiovascular Pharmacology (30 Questions)
1. A patient with heart failure (HFrEF) is started on sacubitril/valsartan
(Entresto). Which lab value requires closest monitoring?
A. Serum potassium
B. Serum sodium
C. BUN
D. Creatinine
Correct Answer: A. Serum potassium
Rationale: Sacubitril/valsartan is an ARNI. It blocks aldosterone, increasing risk of
hyperkalemia. Potassium must be checked within 2 weeks of initiation and after
dose changes.
2. A patient on apixaban (Eliquis) for atrial fibrillation presents with acute
onset of severe headache and vomiting. Which action is most important?
A. Administer vitamin K
B. Draw a PTT level
C. Hold next dose of apixaban
D. Obtain a stat non-contrast head CT
, Correct Answer: D. Obtain a stat non-contrast head CT
Rationale: Symptoms suggest intracranial hemorrhage. DOACs like apixaban
increase bleeding risk. CT is priority to rule out bleed before reversal (andexanet
alfa if needed).
3. A nurse is administering digoxin. Which finding indicates toxicity?
A. Heart rate 68 bpm
B. Serum digoxin 1.2 ng/mL
C. Yellow-tinged vision (xanthopsia)
D. BP 120/80 mmHg
Correct Answer: C. Yellow-tinged vision (xanthopsia)
Rationale: Xanthopsia is a classic sign of digoxin toxicity. Therapeutic digoxin
level is 0.5–0.9 ng/mL; >2.0 ng/mL is toxic.
(Questions 4–30 continue in same format but truncated for space here; full list
available upon request. Below is a representative sample of remaining sections.)
Section 2: Antimicrobials & Stewardship (25 Questions)
31. A patient with MRSA pneumonia is receiving linezolid. Which adverse
effect is most concerning after 14 days of therapy?
A. Diarrhea
B. Thrombocytopenia
C. Rash
D. Headache
Correct Answer: B. Thrombocytopenia
Rationale: Linezolid causes dose- and duration-dependent myelosuppression,
especially thrombocytopenia after >14 days. Monitor CBC twice weekly.
32. Which antibiotic requires a 30-minute IV infusion and is contraindicated
with tigecycline due to increased mortality?
A. Meropenem
B. Daptomycin
