NCLEX Pharmacology Exam Guide: Your Complete Study Resource

Pharmacology is one of the most tested—and most intimidating—NCLEX areas. The good news? You don’t need every drug memorized. Focus on high-yield classes, safety-first nursing actions, and pattern recognition. Use NGN-style practice to train your clinical judgment and you’ll walk in confident.

Core drug classes & nursing actions

Cardiovascular

ACE inhibitors (-pril: lisinopril, enalapril)

• Check BP before/after; watch dry cough, hyperkalemia.

• Red flag: facial/tongue swelling (angioedema) → emergency.

• Teach: rise slowly; avoid potassium salt substitutes.

Beta-blockers (-lol: metoprolol, atenolol, propranolol)

• Take apical pulse 1 full minute; hold if <60 bpm (per policy).

• Monitor BP; can mask hypoglycemia.

• Teach: never stop abruptly (rebound tachy/HTN).

Calcium channel blockers (amlodipine, diltiazem, verapamil)

• Monitor HR/BP, edema; constipation (verapamil).

• Teach: avoid grapefruit juice; change positions slowly.

Fluids & electrolytes

Loop diuretics (furosemide, bumetanide)

• Daily weights, I&O; check K⁺/Na⁺, BUN/Cr; orthostasis.

• Teach: take AM; eat K⁺ foods; report cramps/weakness.

Thiazides (HCTZ, chlorthalidone)

• Watch hypokalemia, hyponatremia, ↑uric acid, ↑glucose.

• Photosensitivity precautions.

Anti-infectives (principles)

• Verify allergies; obtain cultures before first dose.

• Monitor for superinfection (C. diff, thrush).

• Finish the entire course; report rash or hives.

Class cues:

• Penicillins (-cillin): allergy risk; some on empty stomach.

• Macrolides (-mycin): check LFTs, interactions.

• Fluoroquinolones (-floxacin): tendon rupture risk; no dairy/antacids around dose.

• Aminoglycosides (gentamicin): nephro-/ototoxic → monitor levels, hearing, kidneys.

High-alert meds (extra vigilance)

Insulin

• Double-check dose & type; insulin syringe only.

• Check glucose pre/post; have glucagon available.

• Signs of hypoglycemia: shaky, sweaty, confused, tachy.

Anticoagulants

• Heparin: monitor aPTT (goal ≈1.5–2.5×), platelets (HIT). Antidote protamine.

• Warfarin: monitor INR (goal 2–3), interactions; consistent vitamin K. Medical ID.

Opioids

• Check RR & sedation; hold if RR <12 (per policy). Antidote naloxone.

Digoxin

• Apical pulse 1 min; hold if HR <60 adults (<90–110 pedi).

• Therapeutic 0.8–2.0 ng/mL; toxicity: yellow-green halos, N/V, brady/arrhythmias.

Memory aids (quick wins)

• ACE → the HACK: Hyperkalemia, Angioedema, Cough, Kidney (AKI risk).

• Beta-blockers: “LOL slows the soul.” Check HR/BP.

• Digoxin: VAIN → Visual changes, Arrhythmias, Intestinal upset, Neurologic.

Suffix map (spot the class fast):
-pril (ACE-I), -sartan (ARB), -lol (beta-blocker), -dipine (DHP CCB), -statin (lipids), -prazole (PPI), -pam/-lam (benzos), -azole (antifungal), -cillin/-mycin/-floxacin (antibiotics).

Test strategy (NGN-ready)

• Prioritize safety: hold/assess when vital signs are unsafe or red-flag effects appear.

• Read stems for “priority/initial/best”—address airway, perfusion, toxicity first.

• In SATA, treat each option true/false independently.

• For calc/fill-in: label units; re-check plausibility.

NCLEX-style mini-set (practice now)

1. A client on lisinopril reports swollen lips and difficulty swallowing. Priority action?
   A. Provide lozenges
   B. Administer PRN acetaminophen
   C. Hold drug and notify provider immediately
   D. Encourage fluids
   Correct: C

2. Before giving metoprolol, which assessment is essential?
   A. Blood glucose
   B. Bowel sounds
   C. Respiratory rate
   D. Apical pulse for 1 minute
   Correct: D

3. Which finding requires urgent action in a client on furosemide?
   A. 1 lb weight loss in 24 hr
   B. Potassium 2.9 mEq/L
   C. Mild dizziness on standing
   D. Sodium 135 mEq/L
   Correct: B

4. Teaching for warfarin should include:
   A. Increase kale intake for better effect
   B. Skip INR checks if you feel well
   C. Keep vitamin K intake consistent and monitor INR
   D. Take ibuprofen freely for pain
   Correct: C

5. A client on digoxin has N/V and sees yellow halos. First action?
   A. Give next dose early
   B. Hold dose and check serum level/EKG
   C. Encourage fluids
   D. Administer ondansetron and continue therapy
   Correct: B

Further Reading

• Next Gen NCLEX: Question Types & Strategies 

• High-Alert Medications: Safety Playbook 

• Delegation & Prioritization for NCLEX 

• Lab Values You Really Need to Know

Reference 

• NCSBN NCLEX Test Plan Overview (official)