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These 10 free NCP questions are organized by exam domain, so you can see how each part of the Pharmacology Certification blueprint is tested. Reveal the answer and explanation under each question.
New nystagmus and an unsteady gait develop in an older adult taking phenytoin. The total phenytoin concentration is 14 mcg/mL, within the laboratory's 10-20 mcg/mL interval, but serum albumin is 2.0 g/dL. Which pharmacokinetic explanation best reconciles these findings?
Correct answer: C - Reduced protein binding can increase the active, unbound fraction of phenytoin.
A 5-year-old weighing 44 lb has an oral amoxicillin prescription for 45 mg/kg/day in two equal doses, 12 hours apart. The suspension contains 250 mg/5 mL. During teaching, the parent measures 18 mL for the first dose; none has been given. What correction is needed?
Correct answer: D - Give 9 mL every 12 hours; the calculated daily amount must be divided between two doses.
Thirty minutes after IV morphine, a patient who also takes diazepam regularly becomes difficult to awaken. Respirations are shallow at 6/min, the pulse is palpable, and oxygen saturation is 96% on supplemental oxygen. Emergency assistance has been summoned. Which response is most urgent?
Correct answer: B - Support ventilation and administer naloxone under the authorized emergency protocol.
"The voices are quieter, but I feel driven to keep moving," says a patient four days after a haloperidol dose increase. The patient repeatedly stands, paces, and shifts weight from foot to foot. There is no fever, sustained muscle spasm, or repetitive tongue movement. The nurse should recognize this pattern as:
Correct answer: C - Akathisia
A patient with potassium of 6.8 mEq/L and a widened QRS complex is receiving emergency treatment. The ECG improves after IV calcium gluconate. Why must the team still proceed with the prescribed potassium-lowering treatment?
Correct answer: D - Calcium protects cardiac cell membranes without lowering the serum potassium concentration.
"I eat a small spinach salad most days. Do I have to stop now?" asks a patient taking warfarin for atrial fibrillation. The prescribed INR target is 2.0-3.0, today's INR is 2.6, and there is no bleeding. Which instruction best addresses the patient's concern?
Correct answer: A - Keep the amount of vitamin K in your diet consistent while taking the prescribed warfarin dose.
Digoxin is given daily at 8:00 a.m. A routine blood sample collected at 9:00 a.m. reports 2.3 ng/mL. The patient has no nausea, visual symptoms, or new rhythm change. After reviewing the patient and the collection time, the prescriber requests a properly timed repeat level before deciding on a dose change. Which collection time is appropriate?
Correct answer: D - At 7:30 a.m. tomorrow, before the next scheduled dose.
Ciprofloxacin tablets are scheduled at 8:00 a.m. and 8:00 p.m. A patient also takes ferrous sulfate once daily. To limit the iron-ciprofloxacin absorption interaction without moving either antibiotic dose, when should the iron be scheduled?
Correct answer: B - At 1:00 p.m.
At an asthma follow-up visit, an adult develops mild wheezing but can speak in full sentences. Peak expiratory flow is 325 L/min; the personal best is 500 L/min. The written action plan prescribes albuterol for worsening symptoms and budesonide for daily control. No reliever has been used for this episode. Which zone-and-action pairing fits?
Correct answer: C - Yellow zone: use the prescribed albuterol and reassess the response.
Before a procedure, an adult with type 1 diabetes is fasting. The prescriber has entered an adjusted morning insulin glargine dose for the fasting period. The usual lispro order is for meal coverage. Blood glucose is 142 mg/dL, and the prescribed correction scale calls for no additional insulin. How should the morning insulin orders be carried out?
Correct answer: B - Give the adjusted glargine dose and omit the meal-related lispro while the patient is fasting.
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