Pharmacology is one of the most feared topics in nursing exams, but it’s also one of the most important for patient safety. These 30 questions focus on what nurses need to know: what to monitor, which side effects matter, and when to withhold and escalate.
Original revision questions, not real exam items. Always check your local formulary and prescriber instructions.
Cardiovascular drugs
1. Before giving a beta blocker such as bisoprolol, which assessment is most important?
- Temperature
- Heart rate and blood pressure
- Blood glucose
- Respiratory rate only
Answer: b. Beta blockers can cause bradycardia and hypotension.
2. A patient on digoxin reports nausea, loss of appetite and seeing yellow-green halos. What’s suspected?
- Migraine
- Digoxin toxicity
- Cataracts
- Gastroenteritis
Answer: b. Hypokalaemia increases the risk. Withhold and inform the prescriber.
3. Which is the most common side effect of ACE inhibitors such as ramipril?
- Weight gain
- Dry cough
- Hypoglycaemia
- Constipation
Answer: b. Also watch for hyperkalaemia, kidney function changes and angioedema.
4. A patient taking amlodipine has swollen ankles. This is:
- A sign of an allergic reaction
- A common side effect of calcium channel blockers
- Always heart failure
- Caused by low potassium
Answer: b. Report it, but it’s a known effect.
5. Before giving GTN (glyceryl trinitrate) for chest pain, the nurse should check:
- Blood pressure
- Blood glucose
- Temperature
- Weight
Answer: a. GTN can cause marked hypotension. Avoid if systolic BP is low or if the patient has recently taken a PDE-5 inhibitor such as sildenafil.
Anticoagulants
6. Which blood test monitors warfarin therapy?
- APTT
- INR
- Platelets
- Haemoglobin only
Answer: b.
7. What’s the antidote to warfarin?
- Protamine
- Vitamin K (with prothrombin complex concentrate in major bleeding)
- Naloxone
- Flumazenil
Answer: b.
8. What’s the antidote to unfractionated heparin?
- Vitamin K
- Protamine sulphate
- Calcium gluconate
- Glucagon
Answer: b.
9. Which advice is correct for a patient on warfarin?
- Take aspirin for headaches
- Keep vitamin K intake consistent, report bleeding and avoid starting new medicines without advice
- Avoid all vegetables
- Double the dose if one is missed
Answer: b.
Diabetes medicines
10. When should rapid-acting insulin (such as insulin aspart) usually be given?
- At bedtime only
- Just before or with meals
- Two hours after meals
- Once a week
Answer: b.
11. Which is a major risk of sulfonylureas like gliclazide?
- Hyperglycaemia
- Hypoglycaemia
- Hypertension
- Bradycardia
Answer: b.
12. Metformin should usually be withheld before iodinated contrast or when there’s:
- Mild headache
- Acute kidney injury, dehydration or severe illness
- A high appetite
- A cold
Answer: b. Because of the risk of lactic acidosis. Follow local guidance.
Antibiotics
13. Before giving the first dose of a penicillin, what must the nurse check?
- Blood pressure
- Allergy history
- Weight only
- Bowel movements
Answer: b.
14. Which side effects should be monitored with gentamicin?
- Weight gain
- Kidney damage and hearing loss (ototoxicity)
- Hair loss
- Constipation
Answer: b. Levels are monitored.
15. A patient on vancomycin develops flushing and a red rash on the upper body during a fast infusion. What’s this?
- Anaphylaxis always
- Vancomycin infusion reaction (previously called “red man syndrome”); slow the infusion and inform the prescriber
- Normal
- Sunburn
Answer: b. Distinguish it from anaphylaxis by assessing airway, breathing and circulation.
16. Patients on metronidazole should be advised to:
- Drink plenty of alcohol
- Avoid alcohol during treatment and for at least 48 hours afterwards
- Take it with grapefruit juice
- Stop when they feel better
Answer: b.
Analgesics and sedatives
17. Which is the most serious side effect of opioids?
- Constipation
- Respiratory depression
- Itching
- Nausea
Answer: b. Monitor respiratory rate and sedation. Constipation is the most common long-term side effect.
18. The antidote for opioid toxicity is:
- Flumazenil
- Naloxone
- Atropine
- Activated charcoal
Answer: b.
19. The antidote for benzodiazepine overdose is:
- Naloxone
- Flumazenil (used with caution)
- Protamine
- Vitamin K
Answer: b.
20. What’s the maximum daily dose of paracetamol for most adults over 50 kg?
- 2 g
- 4 g
- 6 g
- 8 g
Answer: b. Lower doses for low body weight, liver disease or other risk factors. The antidote for overdose is acetylcysteine.
21. Which patients are at increased risk from NSAIDs such as ibuprofen?
- Young healthy adults
- Older people and those with kidney disease, heart failure, peptic ulcer or asthma sensitivity
- People with a cold
- Children over 12
Answer: b.
Other important drugs
22. A patient on lithium has vomiting, diarrhoea, coarse tremor and confusion. What’s suspected?
- Gastroenteritis only
- Lithium toxicity
- Anxiety
- Hypoglycaemia
Answer: b. Dehydration and some drugs (such as NSAIDs and diuretics) raise lithium levels.
23. When should levothyroxine usually be taken?
- With a large meal
- On an empty stomach, usually in the morning
- With calcium supplements
- At midnight with milk
Answer: b.
24. Patients taking alendronic acid should:
- Lie down after taking it
- Take it with a full glass of water on an empty stomach and stay upright for at least 30 minutes
- Take it with orange juice
- Crush the tablet
Answer: b. Reduces the risk of oesophageal irritation.
25. Which drug requires monitoring for agranulocytosis with regular blood counts?
- Paracetamol
- Clozapine
- Amoxicillin
- Omeprazole
Answer: b. Also carbimazole: patients should report sore throat or fever urgently.
26. What’s the antidote for magnesium sulphate toxicity?
- Naloxone
- Calcium gluconate
- Vitamin K
- Protamine
Answer: b.
High-alert medicines and safety
27. Which of these is considered a high-alert medicine?
- Saline nasal spray
- Insulin
- Emollient cream
- Vitamin C tablets
Answer: b. Others include anticoagulants, opioids, concentrated potassium and chemotherapy.
28. Why should “U” not be used as an abbreviation for units?
- It’s too long
- It can be misread as 0 or 4, causing 10-fold or larger overdoses
- It isn’t a real unit
- It’s only used in the US
Answer: b. Always write “units” in full.
29. A patient says, “That’s not the tablet I usually take.” What should the nurse do?
- Tell the patient to take it anyway
- Stop, recheck the prescription, the medicine and the patient’s identity before giving it
- Give half
- Hide it in food
Answer: b. Listen to patients. They often spot errors.
30. Which drugs should never be crushed without checking with a pharmacist?
- All tablets
- Modified-release (MR, SR, XL) and enteric-coated tablets
- Paracetamol
- Vitamins
Answer: b. Crushing can release the full dose at once or destroy the coating.
Quick antidote table
| Drug | Antidote |
|---|---|
| Opioids | Naloxone |
| Benzodiazepines | Flumazenil |
| Paracetamol | Acetylcysteine |
| Warfarin | Vitamin K, prothrombin complex concentrate |
| Heparin | Protamine sulphate |
| Magnesium sulphate | Calcium gluconate |
| Digoxin | Digoxin-specific antibody fragments |
| Insulin / sulfonylureas | Glucose, glucagon |
| Beta blockers | Glucagon (specialist advice) |
| Organophosphates | Atropine (with pralidoxime where used) |