Test Bank for Karch’s Focus on Nursing Pharmacology 10th Edition by Rebecca Tucker

Pharmacology is the science that nurses live with every single day.

Every medication administration is a clinical decision. Every drug interaction you recognize protects a patient. Every adverse effect you identify early prevents a complication. Every patient education conversation you conduct about a new medication is an act of clinical partnership that can determine whether a patient takes their medication safely — or does not take it at all.

Karch’s Focus on Nursing Pharmacology has been trusted by nursing students and nursing faculty for decades precisely because it never loses sight of what pharmacology is for — not just understanding drugs, but applying that understanding to safe, effective, patient-centered nursing practice. And the 10th Edition by Rebecca Tucker continues that legacy with the most current, most clinically relevant, and most nursing-process-integrated pharmacology content in the textbook’s history.

This comprehensive test bank is built for the 10th Edition of Karch’s Focus on Nursing Pharmacology by Rebecca Tucker. It is one of the most widely used and most nursing-focused pharmacology textbooks in undergraduate nursing education — and this test bank helps you master every chapter with the focused, drug-knowledge-driven, nursing-process-centered practice that clinical pharmacology mastery demands.

Whether you are preparing for a pharmacology course exam, an ATI pharmacology assessment, or the NCLEX-RN, this resource delivers the drug knowledge, clinical reasoning, and patient safety focus that Tucker and Karch have always built into this textbook — and that every patient deserves from their nurse.

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What’s Inside?

• Hundreds of practice questions covering every chapter
• Multiple-choice, select-all-that-apply, alternate-format, and clinical scenario questions
• Complete answer keys with thorough, clinically grounded pharmacological rationales
• Questions aligned with current NCLEX-RN and Next Generation NCLEX examination standards
• Coverage of all major drug classifications, nursing process applications, patient education priorities, and pharmacological safety across every body system

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Table of Contents 

PART 1 Introduction to Nursing Pharmacology  

Chapter 1: Introduction to Drugs

Chapter 2: Pharmacodynamics and Pharmacokinetics

Chapter 3: Adverse Reactions to Drugs

Chapter 4: The Nursing Process and Clinical Judgment Measurement Model (CJMM) Informing Drug Therapy and Patient Safety

Chapter 5: Drug Administration and Dosage Calculations

Chapter 6: Challenges to Safe and Effective Drug Therapy

 

PART 2 Chemotherapeutic Agents  

Chapter 7: Introduction to Cell Physiology

Chapter 8: Anti-Infective Agents

Chapter 9: Antibiotics

Chapter 10: Antiviral Agents

Chapter 11: Antifungal Agents

Chapter 12: Antiprotozoal Agents

Chapter 13: Anthelmintic Agents

Chapter 14: Antineoplastic Agents

 

PART 3 Drugs Acting on the Immune System  

Chapter 15: Introduction to the Immune Response and Inflammation

Chapter 16: Antiinflammatory, Antiarthritis, and Related Agents

Chapter 17: Immune Modulators

Chapter 18: Vaccines and Sera

 

PART 4 Drugs Acting on the Central and Peripheral Nervous Systems  

Chapter 19: Introduction to Nerves and the Nervous System

Chapter 20: Anxiolytic and Hypnotic Agents

Chapter 21: Antidepressant Agents

Chapter 22: Psychotherapeutic Agents

Chapter 23: Antiseizure Agents

Chapter 24: Antiparkinsonism Agents

Chapter 25: Muscle Relaxants

Chapter 26: Pain Management and Substance Use Disorder Treatment

Chapter 27: General and Local Anesthetic Agents

Chapter 28: Neuromuscular Junction Blocking Agents

 

PART 5 Drugs Acting on the Autonomic Nervous System  

Chapter 29: Introduction to the Autonomic Nervous System

Chapter 30: Adrenergic Agonists

Chapter 31: Adrenergic Antagonists

Chapter 32: Cholinergic Agonists

Chapter 33: Anticholinergic Agents

 

PART 6 Drugs Acting on the Endocrine System  

Chapter 34: Introduction to the Endocrine System

Chapter 35: Hypothalamic and Pituitary Agents

Chapter 36: Adrenocortical Agents

Chapter 37: Thyroid and Parathyroid Agents

Chapter 38: Agents to Control Blood Glucose Levels

 

PART 7 Drugs Acting on the Reproductive System  

Chapter 39: Introduction to the Reproductive System

Chapter 40: Drugs Affecting the Female Reproductive System

Chapter 41: Drugs Affecting the Male Reproductive System

 

PART 8 Drugs Acting on the Cardiovascular System  

Chapter 42: Introduction to the Cardiovascular System

Chapter 43: Drugs Affecting Blood Pressure

Chapter 44: Agents for Treating Heart Failure

Chapter 45: Antiarrhythmic Agents

Chapter 46: Antianginal Agents

Chapter 47: Lipid-Lowering Agents

Chapter 48: Drugs Affecting Blood Coagulation

Chapter 49: Drugs Used to Treat Anemias

 

PART 9 Drugs Acting on the Renal System  

Chapter 50: Introduction to the Renal System

Chapter 51: Agents Affecting Body Fluid Volume and Components

Chapter 52: Drugs Affecting the Urinary Tract and the Bladder

 

PART 10 Drugs Acting on the Respiratory System  

Chapter 53: Introduction to the Respiratory System

Chapter 54: Drugs Acting on the Upper Respiratory Tract

Chapter 55: Drugs Acting on the Lower Respiratory Tract

 

PART 11 Drugs Acting on the Gastrointestinal System  

Chapter 56: Introduction to the Gastrointestinal System

Chapter 57: Drugs Affecting Gastrointestinal Secretions and Absorption

Chapter 58: Drugs Affecting Gastrointestinal Motility

Chapter 59: Antiemetic Agents

Chapter 60: Vitamins, Minerals, and Complementary/Alternative Medications

Who Is This Test Bank For?

This resource is perfect for:

• Undergraduate RN and LPN nursing students in pharmacology courses using the 10th Edition
• NCLEX-RN and NCLEX-PN candidates seeking targeted pharmacology content review
• Nursing students completing ATI pharmacology proctored assessments
• Nursing faculty developing pharmacology course exams and unit assessments
• LPN-to-RN bridge students updating and expanding clinical pharmacology knowledge
• Nursing students in accelerated BSN or second-degree programs covering pharmacology
• New graduate nurses reinforcing foundational medication safety and drug therapy knowledge
• Students whose programs use Rebecca Tucker’s 10th Edition as their pharmacology course text

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Topics Covered Include:

• Introduction to pharmacology — drug sources, names, and development
• Pharmacokinetics — absorption, distribution, metabolism, and excretion
• Pharmacodynamics — drug-receptor interactions and dose-response relationships
• Medication safety — the rights of medication administration and error prevention
• The nursing process applied to pharmacological care — assessment through evaluation
• Drug interactions, adverse drug reactions, and hypersensitivity responses
• Lifespan pharmacological considerations — pediatric, geriatric, and pregnancy
• Drugs acting on the autonomic nervous system
• Analgesics — opioid and non-opioid pain management
• Anti-inflammatory and antirheumatic agents
• Antibiotics — major classifications, spectrum, and nursing implications
• Antivirals, antifungals, and antiparasitic agents
• Cardiovascular drug therapy — antihypertensives and vascular agents
• Cardiac glycosides and drugs for heart failure
• Antidysrhythmic drug therapy
• Anticoagulants, antiplatelets, and thrombolytic agents
• Diuretic therapy and renal pharmacology
• Central nervous system depressants and anxiolytics
• Antiepileptic drug therapy
• Antiparkinson drugs and CNS stimulants
• Psychotherapeutic agents — antidepressants, antipsychotics, and mood stabilizers
• Endocrine pharmacology — insulin, oral antidiabetics, thyroid, and adrenal agents
• Respiratory pharmacotherapy
• Gastrointestinal pharmacotherapy
• Reproductive and women’s health pharmacology
• Oncology pharmacology and immunological agents
• Dermatological, ophthalmic, and otic pharmacotherapy
• Vitamins, minerals, and alternative therapies

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Why This Test Bank Delivers Results

Rebecca Tucker’s 10th Edition of Karch’s Focus on Nursing Pharmacology honors the tradition that Amy Karch established and advances it into the most current pharmacological landscape — with updated drug content, new FDA approvals and safety communications, revised clinical guidelines, expanded patient education content, and the most comprehensive nursing process integration in the textbook’s history.

What has always made Karch’s Focus on Nursing Pharmacology stand apart from other pharmacology textbooks is its unwavering focus — the title says it perfectly. Not pharmacology for pharmacists. Not pharmacology for physicians. Pharmacology for nurses. Every drug discussion is organized around what nurses specifically need to know — the nursing-focused assessment, the nursing diagnoses that guide monitoring, the nursing interventions that ensure safe administration, and the patient education that promotes therapeutic adherence and safety in the community.

This test bank is built to develop exactly that nursing-focused pharmacological competency.

Every question is constructed around the nursing process framework that Tucker maintains throughout the 10th Edition. You will not simply identify what a drug does — you will apply the nursing process to a patient receiving that drug. You will assess for contraindications and baseline parameters before administration. You will recognize the early signs of an adverse effect that demands immediate nursing action. You will evaluate whether the patient’s clinical response indicates therapeutic success or treatment failure. You will educate a patient in language that is accurate, accessible, and actionable.

The NCLEX-RN tests pharmacology this way — not as isolated drug facts, but as integrated nursing decisions embedded in patient care scenarios. The Next Generation NCLEX requires even deeper clinical judgment — recognizing pharmacological cues, analyzing drug-related clinical information, prioritizing hypotheses about adverse effects, and evaluating therapeutic outcomes. This test bank prepares you for both — with questions that range from foundational drug classification knowledge to complex NGN-aligned pharmacological clinical scenarios.

Detailed rationales explain the pharmacological mechanisms, nursing process applications, patient safety principles, and clinical reasoning behind every correct answer. The 10th Edition’s most current content is fully reflected — including updated black box warnings, revised dosing guidelines, and new FDA safety communications.

Questions are organized chapter by chapter for structured, systematic study. Target drug classes where your knowledge is weakest. Build the medication safety competency that every patient deserves from their nurse.

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Sample Questions

Question 1
A nurse is preparing to administer heparin 5,000 units subcutaneously to a patient for deep vein thrombosis prophylaxis following orthopedic surgery. The nurse notes the patient’s most recent platelet count — drawn this morning — has decreased from 245,000/mm³ on admission four days ago to 68,000/mm³ today. The patient reports no signs of active bleeding. Which nursing action most accurately reflects safe clinical pharmacology practice?

• A) Administer the heparin as ordered since the patient has no signs of active bleeding and the drug is prescribed for prophylaxis
• B) Hold the heparin, notify the provider immediately of the platelet count drop, and assess the patient for signs of heparin-induced thrombocytopenia including new clot formation
• C) Administer half the prescribed heparin dose since the platelet count is low and a reduced dose reduces bleeding risk
• D) Switch the administration route from subcutaneous to IV to achieve better bioavailability and reduce the platelet count decline

Correct Answer: B
Rationale: This scenario requires the nurse to apply pharmacological knowledge about heparin-induced thrombocytopenia — one of the most dangerous and counterintuitive drug-related adverse effects in nursing practice. HIT is an immune-mediated adverse reaction to heparin in which antibodies against platelet factor 4-heparin complexes are formed, activating platelets and generating a paradoxical prothrombotic state. HIT is clinically defined by a platelet count fall of 50% or more from baseline occurring 5–10 days after heparin initiation — in this patient, the platelet count has fallen from 245,000 to 68,000/mm³, a reduction of approximately 72% from baseline, occurring on day four of therapy. This falls squarely within the HIT timing and magnitude criteria, making HIT a high-priority clinical concern. The paradoxical danger of HIT is that despite thrombocytopenia — low platelets — the primary risk is thrombosis, not bleeding. Activated platelets generate thrombin, leading to new arterial and venous clots that can cause stroke, pulmonary embolism, limb ischemia, and death. Continuing heparin in a patient with probable HIT can be fatal. The nurse must hold the heparin immediately and notify the provider for urgent evaluation including HIT antibody testing and consideration of an alternative non-heparin anticoagulant. Administering a reduced dose does not eliminate the immunological mechanism driving HIT and would continue the platelet-activating process. Route change does not address the pharmacological mechanism of HIT.

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Question 2
A nurse is teaching a patient newly prescribed atorvastatin 40 mg orally at bedtime for hyperlipidemia. The patient asks whether they can take the medication in the morning since they frequently forget evening medications. Which nursing response reflects the most accurate pharmacological patient education?

• A) “Morning administration is preferred for all statins since cholesterol levels are highest during waking hours.”
• B) “For atorvastatin specifically, timing is less critical than for some other statins because of its longer half-life — morning or evening administration is acceptable, though consistency in timing is important. Evening administration is traditionally recommended because hepatic cholesterol synthesis peaks overnight.”
• C) “You should never change the timing of a statin medication without a provider’s written order — take it at bedtime as prescribed regardless of your schedule.”
• D) “Take the atorvastatin whenever you remember each day since statins have no preferred administration timing.”

Correct Answer: B
Rationale: This patient education question requires pharmacokinetically accurate information about atorvastatin specifically — not all statins. The traditional recommendation to take statins in the evening is based on the pharmacological principle that hepatic HMG-CoA reductase activity — the enzyme statins inhibit — peaks during the overnight fasting period when de novo cholesterol synthesis is greatest. Evening administration maximizes the drug’s presence during peak enzyme activity. However, this timing principle varies by statin pharmacokinetics. Short-acting statins — such as simvastatin, pravastatin, and lovastatin — have shorter half-lives that make evening administration more clinically meaningful for maximizing inhibition during the overnight synthesis peak. Atorvastatin, by contrast, has a significantly longer half-life of approximately 14 hours, producing active metabolites with even longer activity. This extended half-life means that atorvastatin maintains consistent HMG-CoA reductase inhibition throughout the dosing interval regardless of timing — making morning administration pharmacokinetically acceptable for atorvastatin. Consistency of timing — taking the medication at the same time each day — is important for maintaining steady-state plasma levels and supporting adherence. Accommodating the patient’s preference for morning administration improves adherence, which is more clinically important than optimizing the theoretical timing advantage of evening dosing for a long-acting statin. Dismissing the patient’s scheduling concern without pharmacological rationale undermines therapeutic partnership and may reduce adherence.

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Question 3
A nurse is caring for a patient receiving lithium carbonate 300 mg three times daily for bipolar I disorder. The patient has been stable on this regimen for eight months. The patient presents to the clinic reporting three days of profuse diarrhea and vomiting from a gastrointestinal illness, decreased oral intake, and now reports feeling confused and unsteady when walking. The nurse obtains a serum lithium level — result is 1.9 mEq/L. Which clinical understanding and nursing action is most appropriate?

• A) Reassure the patient that lithium levels of 1.9 mEq/L are within the therapeutic range and the symptoms are unrelated to lithium therapy
• B) Recognize that this patient’s gastrointestinal illness has caused sodium and fluid depletion — enhancing renal lithium reabsorption and elevating lithium to a toxic level — hold the lithium, notify the provider urgently, initiate IV fluid resuscitation to support renal lithium clearance, and monitor for progression of toxicity
• C) Administer an additional lithium dose to compensate for potential medication malabsorption during the gastrointestinal illness
• D) Reduce the lithium dose by half independently and monitor the level again in one week without provider notification

Correct Answer: B
Rationale: This scenario requires integrating pharmacokinetic knowledge about lithium’s unique sodium-dependent renal handling with clinical recognition of early lithium toxicity. Lithium has a narrow therapeutic index — therapeutic range 0.6–1.2 mEq/L for maintenance therapy — making it one of the most pharmacologically sensitive medications in psychiatric practice. The critical pharmacokinetic principle governing this scenario is that lithium and sodium compete for reabsorption in the renal proximal tubule. When sodium is depleted — as occurs during significant vomiting, diarrhea, and reduced fluid intake — the kidney compensates by increasing proximal tubule sodium reabsorption. Because lithium competes with sodium at this transporter, increased sodium reabsorption drives concurrent lithium reabsorption, reducing renal lithium clearance and causing accumulation. A level of 1.9 mEq/L significantly exceeds the therapeutic range and, combined with the clinical symptoms of confusion and ataxia — classic early-to-moderate lithium toxicity manifestations — confirms clinically significant toxicity. This is an urgent situation — lithium toxicity can progress rapidly to severe neurological compromise, seizures, cardiovascular instability, and death without prompt intervention. The provider must be notified immediately, lithium must be held, and IV fluid resuscitation with normal saline supports sodium repletion and restores renal lithium clearance capacity. Administering additional lithium in a toxic patient would be catastrophically harmful. Self-adjusting the dose without provider notification is outside the nurse’s independent scope of practice.

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Question 4
A nurse is reviewing the medication administration record for a 78-year-old patient admitted for a urinary tract infection who is currently receiving ciprofloxacin 500 mg orally twice daily. The nurse notes the patient also takes warfarin 3 mg daily for chronic atrial fibrillation and that today’s INR result is 4.6 — up from 2.4 one week ago. The patient has no signs of active bleeding. Which pharmacological understanding most accurately explains this clinical finding?

• A) The UTI itself has caused the elevated INR by producing inflammatory mediators that directly enhance warfarin’s anticoagulant effect
• B) Ciprofloxacin inhibits CYP1A2 and CYP3A4 enzymes responsible for warfarin metabolism, reducing warfarin clearance and elevating plasma warfarin levels — significantly increasing anticoagulant effect and INR
• C) The patient has been non-compliant with warfarin and has taken double doses, elevating the INR independently of the antibiotic therapy
• D) Ciprofloxacin directly activates clotting factor inhibitors, producing anticoagulation that adds to warfarin’s effect through a separate mechanism

Correct Answer: B
Rationale: This scenario illustrates one of the most clinically important drug interactions in nursing pharmacology — the well-documented interaction between fluoroquinolone antibiotics and warfarin. Ciprofloxacin is a fluoroquinolone antibiotic that inhibits hepatic cytochrome P450 enzymes — particularly CYP1A2 and to a lesser extent CYP3A4 — that are responsible for the metabolism of warfarin’s S-enantiomer, the more pharmacologically potent form. When ciprofloxacin inhibits these enzymes, warfarin clearance is reduced, causing drug accumulation and elevated plasma warfarin concentrations — producing the elevated INR of 4.6 observed here, up from a previously therapeutic 2.4. This elevation represents a nearly twofold increase in anticoagulant effect and carries significant risk of serious or fatal hemorrhage. The nurse must notify the provider immediately for urgent warfarin dose adjustment and increased INR monitoring. The antibiotic may additionally reduce gut flora that produce vitamin K, further contributing to the elevated INR through a separate mechanism. While acute infection can affect INR in patients with hepatic involvement, the primary explanation here is the pharmacokinetic drug-drug interaction through CYP enzyme inhibition — a mechanism specific to the fluoroquinolone class. Patient non-compliance cannot be assumed without evidence and should not be the initial clinical explanation. Ciprofloxacin does not directly activate clotting factor inhibitors — its effect on warfarin is pharmacokinetic, not pharmacodynamic through a separate anticoagulant pathway.

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Question 5
A nurse is providing discharge education to a patient who has been prescribed prednisone 40 mg orally daily for two weeks for an acute COPD exacerbation. The patient asks whether they can stop taking the medication early if they feel completely recovered after one week. Which nursing response most accurately reflects the pharmacological rationale for completing the prescribed course?

• A) “Yes — if you feel completely recovered you can stop the prednisone early since the inflammation has resolved.”
• B) “You should complete the full prescribed course and not stop early without provider guidance — but since this is a two-week course, abrupt discontinuation after one week carries low risk since you will not have been on it long enough for significant adrenal suppression.”
• C) “You must complete the full prescribed course — stopping prednisone abruptly, even after one week at a therapeutic dose, risks an acute COPD relapse from rebound inflammation and should only be adjusted with provider guidance.”
• D) “You can stop early but should cut your dose in half on the last day to taper off safely.”

Correct Answer: C
Rationale: This patient education response requires accurate pharmacological knowledge about systemic corticosteroid therapy. Prednisone is a synthetic glucocorticoid that suppresses the inflammatory cascade through multiple mechanisms — inhibiting arachidonic acid release, reducing cytokine production, decreasing vascular permeability, and suppressing immune cell activation. In acute COPD exacerbation, this anti-inflammatory action is the primary therapeutic mechanism — reducing airway inflammation that is driving the exacerbation. The critical patient education point is that stopping prednisone abruptly before completing the prescribed course risks rebound inflammation — the inflammatory processes that were suppressed by the corticosteroid can resurge rapidly when the drug is discontinued, precipitating a COPD relapse that may be more severe than the original exacerbation. The patient feeling well after one week does not mean the underlying inflammatory process has fully resolved — corticosteroids are suppressing the inflammation, not curing it. Completing the prescribed course allows the inflammation to fully subside before the anti-inflammatory suppression is removed. While longer-term systemic corticosteroid use raises the additional concern of HPA axis suppression requiring a taper, a two-week course at moderate doses carries primarily the rebound inflammation risk rather than significant HPA suppression — making the core education point about completing the course and not stopping early without provider consultation the most clinically important message. Self-tapering by halving the last dose without provider guidance is outside the patient’s safe self-management scope.

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Frequently Asked Questions (FAQs)

What edition does this test bank cover?
This test bank is written specifically for the 10th Edition of Karch’s Focus on Nursing Pharmacology by Rebecca Tucker. All questions are fully aligned with the current edition’s chapter organization, updated drug content, current FDA safety communications, revised clinical guidelines, and current NCLEX-RN and Next Generation NCLEX examination standards.

How are the questions organized?
Questions are arranged chapter by chapter, allowing you to study systematically through all nursing pharmacology content or focus on specific drug classes — such as cardiovascular agents, antibiotics, CNS medications, or endocrine agents — based on your course exam schedule or NCLEX preparation priorities. The nursing process framework is integrated throughout every chapter’s question set.

Is this test bank aligned with the NCLEX and Next Generation NCLEX?
Yes. Questions are written to reflect current NCLEX-RN and NCLEX-PN examination standards and incorporate the clinical judgment emphasis of the Next Generation NCLEX framework. Pharmacological and parenteral therapy is one of the most heavily weighted NCLEX content categories — this test bank directly targets that content with the nursing-focused clinical reasoning depth the examination demands.

How does this test bank differ from the Lilley or McCuistion pharmacology test banks?
This test bank is written specifically for the 10th Edition of Karch’s Focus on Nursing Pharmacology by Rebecca Tucker. While all nursing pharmacology textbooks cover similar drug content, they differ significantly in organizational framework, nursing process integration depth, clinical focus, and pedagogical approach. Students using Karch’s 10th Edition will find this test bank most accurately aligned with their specific chapter assignments and the nursing-focused pharmacology framework Tucker maintains throughout.

Is this test bank useful for both RN and LPN students?
Absolutely. Karch’s Focus on Nursing Pharmacology is used in both RN and PN-level nursing programs. This test bank is equally relevant for LPN students — covering foundational pharmacokinetics, drug classification, nursing implications, and patient education content that the NCLEX-PN tests extensively across pharmacological client needs categories.

How quickly can I access the test bank after purchase?
Immediately. As soon as your purchase is complete, you receive instant digital access with no waiting period. Study on your own schedule, at your own pace, from any device.

Are the rationales detailed enough to support genuine pharmacological learning?
Yes. Every rationale explains the pharmacological mechanisms, nursing process application, patient safety principles, and clinical reasoning behind the correct answer — not just identifies it. This approach builds the nursing-focused drug knowledge that Karch and Tucker have always emphasized — and that medication-safe nursing practice demands at every level of clinical care.

Can nursing faculty use this test bank for course assessments?
Absolutely. The chapter-by-chapter organization, nursing process integration, NGN-aligned question formats, and clinical scenario emphasis make this an outstanding resource for faculty building unit exams, ATI-style proctored assessments, and comprehensive pharmacology course finals for undergraduate nursing programs at both the RN and PN level.