Pharmacology Questions for the Prometric Nursing Exam 2026: 20 MCQs with Answers on High-Alert Drugs, Side Effects, Monitoring, Antidotes and Nursing Considerations

Pharmacology is 10 to 15% of the nursing paper, and the questions are predictable: what to check before giving a drug, what side effect to watch for, when to hold a dose, and which antidote to reach for. This set covers the drugs that recur. Calculations are in a separate article (drug calculation problems).

High-alert medicines

Question 1

Before giving a scheduled dose of regular insulin, the nurse should check:

1. Only the patient's name
2. Blood glucose, that a meal is available or imminent, and the dose against the prescription with a second nurse, using an insulin syringe
3. Blood pressure
4. Nothing; insulin is routine

Answer: B. Insulin is a high-alert drug: independent double-checking, correct syringe and timing with food prevent hypoglycaemia. Rapid-acting analogues are given within 15 minutes of eating.

Question 2

A patient on an intravenous heparin infusion has an aPTT of 110 seconds (target 60 to 80) and is oozing from the cannula site. The nurse should:

1. Increase the rate
2. Stop or reduce the infusion per protocol, notify the doctor, and prepare protamine sulfate if significant bleeding occurs
3. Give vitamin K
4. Give aspirin

Answer: B. Protamine reverses heparin; vitamin K reverses warfarin. Platelet counts are also monitored for heparin-induced thrombocytopenia.

Question 3

A patient on warfarin has an INR of 6.5 with no bleeding. The expected management is:

1. Continue the same dose
2. Withhold warfarin, consider low-dose oral vitamin K per protocol, recheck INR, and educate the patient about interacting drugs and foods
3. Give protamine
4. Double the dose

Answer: B. Antibiotics, amiodarone and reduced vitamin K intake raise the INR; green leafy vegetables lower it. Major bleeding is treated with prothrombin complex concentrate.

Question 4

Before giving digoxin, the nurse should hold the dose and notify the doctor if:

1. The apical pulse is below 60 per minute in an adult, or the patient has nausea, visual disturbance or a potassium below 3.5 mmol/L
2. The blood pressure is 130/80
3. The patient has eaten
4. The pulse is 72

Answer: A. Hypokalaemia potentiates digoxin toxicity; the therapeutic range is narrow (0.5 to 2 ng/mL). Digoxin-specific antibody fragments treat severe toxicity.

Question 5

A patient receiving morphine via patient-controlled analgesia has a respiratory rate of 7 per minute and is difficult to rouse. The nurse should:

1. Continue the PCA and recheck in an hour
2. Stop the PCA, stimulate the patient, give oxygen, administer naloxone per protocol and call for help, then monitor because naloxone's effect is shorter than morphine's
3. Give more morphine for pain
4. Give flumazenil

Answer: B. Naloxone reverses opioids; flumazenil reverses benzodiazepines. Repeat doses or an infusion may be needed.

Question 6

Concentrated potassium chloride for intravenous use must:

1. Be given as an undiluted IV push in an emergency
2. Never be given as a bolus; it is diluted, infused by pump at a rate not usually exceeding 10 mmol per hour peripherally (20 mmol per hour centrally with monitoring), and stored separately from other vials
3. Be given intramuscularly
4. Be mixed in the ward by hand

Answer: B. Potassium bolus causes fatal arrhythmia. Pre-mixed bags and locked storage are standard safety measures audited in Gulf hospitals.

Cardiovascular and renal drugs

Question 7

A patient started on an ACE inhibitor should be told to report:

1. Increased appetite
2. A persistent dry cough and any swelling of the lips, tongue or face (angioedema), and should have potassium and renal function checked after starting
3. Hair growth
4. Improved sleep

Answer: B. ACE inhibitors cause cough, hyperkalaemia and rarely angioedema; they are contraindicated in pregnancy.

Question 8

Before giving a dose of metoprolol, the nurse should check:

1. Temperature only
2. Apical pulse and blood pressure, holding the dose and notifying if the pulse is below 60 or systolic pressure below about 90 to 100 per order, and watching for wheeze in asthmatic patients
3. Urine output only
4. Pain score

Answer: B. Beta blockers cause bradycardia, hypotension and bronchospasm; they are never stopped abruptly after long-term use because of rebound tachycardia.

Question 9

A patient on furosemide 80 mg daily reports muscle cramps and weakness. The most likely cause and nursing action are:

1. Dehydration from drinking too much; restrict fluids
2. Hypokalaemia; check electrolytes, encourage potassium-rich foods, administer prescribed supplements, and monitor for digoxin toxicity if co-prescribed
3. Hyperkalaemia; give calcium
4. Hypoglycaemia; give glucose

Answer: B. Loop and thiazide diuretics waste potassium; spironolactone retains it. Furosemide is also ototoxic when given rapidly intravenously.

Question 10

Sublingual glyceryl trinitrate should be given:

1. Swallowed with water
2. Under the tongue with the patient seated, repeated at 5-minute intervals up to three doses for chest pain, with blood pressure monitored and no concurrent sildenafil
3. Only once a day
4. Intramuscularly

Answer: B. Nitrates cause hypotension and headache; phosphodiesterase inhibitors within 24 to 48 hours cause profound hypotension.

Antibiotics, steroids and anticonvulsants

Question 11

Which antibiotic requires monitoring of trough levels and renal function because of nephrotoxicity and ototoxicity?

1. Amoxicillin
2. Gentamicin (and vancomycin for nephrotoxicity)
3. Azithromycin
4. Cefalexin

Answer: B. Aminoglycoside and vancomycin dosing is guided by levels; vancomycin infused too fast causes "red man" flushing.

Question 12

A patient on long-term prednisolone should be taught to:

1. Stop it immediately if feeling better
2. Never stop abruptly, take it with food in the morning, report signs of infection, monitor blood glucose, and carry a steroid alert card because of adrenal suppression
3. Take it at bedtime
4. Avoid all calcium

Answer: B. Steroids cause hyperglycaemia, osteoporosis, gastric irritation and immunosuppression, and mask infection. Doses are tapered.

Question 13

A patient on phenytoin should be monitored for:

1. Increased hair loss only
2. Gingival hyperplasia, ataxia and nystagmus (toxicity), and drug levels, with awareness that it interacts with many drugs including warfarin and oral contraceptives
3. Weight loss
4. Nothing specific

Answer: B. Phenytoin has a narrow therapeutic range and non-linear kinetics; intravenous phenytoin is given slowly with cardiac monitoring.

Question 14

Which drug combination can cause serotonin syndrome?

1. Paracetamol and ibuprofen
2. An SSRI with tramadol, a MAOI, linezolid or another serotonergic drug, presenting with agitation, hyperreflexia, clonus, fever and sweating
3. Amoxicillin and omeprazole
4. Insulin and metformin

Answer: B. Nurses recognise the triad of mental change, autonomic instability and neuromuscular excitation and escalate immediately.

Antidotes and emergency drugs

Question 15

Match the antidote: paracetamol overdose is treated with:

1. Naloxone
2. N-acetylcysteine, started within 8 hours for best effect, guided by the paracetamol level and nomogram
3. Flumazenil
4. Atropine

Answer: B. The table below lists the antidotes that appear on every paper.

Poison or drug	Antidote
Opioids	Naloxone
Benzodiazepines	Flumazenil (with caution)
Heparin	Protamine sulfate
Warfarin	Vitamin K; prothrombin complex concentrate for major bleeding
Paracetamol	N-acetylcysteine
Digoxin	Digoxin-specific antibody fragments
Magnesium sulfate toxicity	Calcium gluconate
Organophosphates	Atropine and pralidoxime
Iron	Desferrioxamine
Local anaesthetic toxicity	20% lipid emulsion
Beta blockers	Glucagon, high-dose insulin
Methotrexate	Folinic acid

Question 16

A woman receiving magnesium sulfate for pre-eclampsia has absent patellar reflexes and a respiratory rate of 10. The nurse should:

1. Increase the infusion
2. Stop the infusion, give oxygen, call for help and administer calcium gluconate 10% as the antidote
3. Give more magnesium
4. Give naloxone

Answer: B. Loss of reflexes precedes respiratory depression; reflexes, respiratory rate and urine output are checked hourly during infusion.

Question 17

The first-line drug and route for anaphylaxis in an adult is:

1. Intravenous hydrocortisone
2. Adrenaline 0.5 mg (0.5 mL of 1 mg/mL) intramuscularly into the anterolateral thigh, repeated after 5 minutes if needed
3. Oral antihistamine
4. Salbutamol nebuliser only

Answer: B. Steroids and antihistamines are adjuncts. Intravenous adrenaline is only for experienced staff with monitoring.

Safe administration

Question 18

Which practice is correct when administering oral medication through a nasogastric tube?

1. Crush enteric-coated and modified-release tablets together
2. Confirm tube position, use liquid forms where available, crush only immediate-release tablets individually, flush with water before and after each drug, and hold feeds around drugs such as phenytoin that interact with feed
3. Mix all drugs in the feed bag
4. Give drugs without flushing

Answer: B. Modified-release and enteric-coated products must never be crushed; the pharmacist advises on alternatives.

Question 19

A nurse preparing intravenous chemotherapy should:

1. Prepare it at the bedside without gloves
2. Use a biological safety cabinet or closed-system transfer device, wear chemotherapy-rated gloves and gown, check the prescription against protocol with a second nurse, verify extravasation plans and dispose of waste as cytotoxic
3. Reuse syringes
4. Give it as a rapid bolus for all agents

Answer: B. Vesicant extravasation (for example anthracyclines, vinca alkaloids) is a medical emergency with drug-specific management.

Question 20

A patient asks why their morning levothyroxine must be taken on an empty stomach. The correct explanation is:

1. It tastes bad with food
2. Food, calcium, iron and antacids reduce its absorption, so it is taken 30 to 60 minutes before breakfast with water, and TSH is monitored to adjust the dose
3. It causes vomiting with food
4. No reason; it can be taken any time

Answer: B. Over-replacement causes palpitations, tremor and weight loss; under-replacement causes fatigue and weight gain.

How to practise

• Build one card per high-alert drug: check before giving, main side effects, when to hold, antidote.
• Memorise the antidote table; it is pure recall and appears on every paper.
• Link each drug to its monitoring: digoxin and potassium, warfarin and INR, gentamicin and levels, steroids and glucose.

Pharmacology items with explanations are throughout the Registered Nurse bank; related sets are the nursing sample questions, ECG questions and infection control questions. The syllabus weighting is in the DHA nursing syllabus.

Frequently asked questions

How many pharmacology questions are in the Prometric nursing exam?

Usually 15 to 22 of 150, including 8 to 15 calculations.

Which drugs come up most?

Insulin, heparin and warfarin, digoxin, opioids, potassium, antihypertensives, diuretics, steroids, anticonvulsants and the common antidotes.

What is the antidote for heparin?

Protamine sulfate. Vitamin K reverses warfarin.

Do I need to know drug doses?

Standard doses of emergency drugs such as adrenaline for anaphylaxis and naloxone, and the therapeutic ranges of digoxin, phenytoin and the INR.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.