Introduction
Medication administration and safety represents one of the most critical competencies tested on the NCLEX-RN examination, comprising 13-19% of all exam questions under the Pharmacological and Parenteral Therapies subcategory. This topic area encompasses the fundamental principles that ensure patient safety during medication delivery, including the Six Rights of medication administration, dosage calculations, adverse effect recognition, and proper administration techniques. Mastery of medication administration is essential not only for exam success but for preventing medication errors that can lead to serious patient harm or death. The NCLEX-RN emphasizes clinical judgment in medication scenarios, requiring nurses to make critical decisions about drug interactions, contraindications, and appropriate monitoring parameters. Understanding high-risk medications, such as anticoagulants, insulin, and opioids, is particularly important as these substances require heightened vigilance and specific safety protocols. Modern healthcare settings demand that nurses possess comprehensive knowledge of medication classifications, therapeutic effects, and potential complications to provide safe, effective patient care. The Next Generation NCLEX (NGN) format increasingly presents medication administration scenarios through unfolding case studies that test the nurse’s ability to prioritize interventions, recognize critical changes in patient condition, and implement appropriate safety measures. Success in this content area requires thorough understanding of pharmacokinetics, drug calculations, and the legal and ethical responsibilities associated with medication administration. These practice questions are designed to reinforce essential concepts and prepare candidates for the complex medication administration scenarios they will encounter on the NCLEX-RN examination.
Practice Questions
Question 1: A nurse is preparing to administer medication to a patient. Which of the following represents the correct “Six Rights” of medication administration?
A) Right patient, right drug, right dose, right route, right time, right reason
B) Right patient, right drug, right dose, right route, right time, right documentation
C) Right patient, right drug, right dose, right route, right time, right physician
D) Right patient, right drug, right dose, right route, right time, right location
Correct Answer: B
Explanation: The Six Rights of medication administration are: right patient, right drug, right dose, right route, right time, and right documentation. Documentation is essential for legal protection and continuity of care. While having the right reason is important, the sixth right specifically refers to proper documentation of the medication administration.
Question 2: A patient is prescribed digoxin 0.25 mg PO daily. Before administering this medication, what is the nurse’s priority assessment?
A) Blood pressure
B) Respiratory rate
C) Heart rate and rhythm
D) Temperature
Correct Answer: C
Explanation: Digoxin is a cardiac glycoside that affects heart rate and rhythm. The nurse must assess the apical pulse for one full minute before administration. If the heart rate is below 60 bpm (or the facility’s protocol), the medication should be withheld and the healthcare provider notified, as digoxin can cause dangerous bradycardia.
Question 3: A nurse is calculating the dosage for a pediatric patient who weighs 22 pounds and is prescribed a medication at 5 mg/kg/day divided into two doses. What is the correct single dose?
A) 25 mg
B) 50 mg
C) 55 mg
D) 110 mg
Correct Answer: A
Explanation: First convert pounds to kilograms: 22 lbs ÷ 2.2 = 10 kg. Then calculate total daily dose: 10 kg × 5 mg/kg = 50 mg/day. Since it’s divided into two doses: 50 mg ÷ 2 = 25 mg per dose.
Question 4: A patient receiving warfarin therapy has an INR result of 4.5. What is the nurse’s immediate priority action?
A) Administer the next scheduled dose as ordered
B) Hold the warfarin and notify the healthcare provider
C) Reduce the dose by half
D) Increase monitoring to every 6 hours
Correct Answer: B
Explanation: A therapeutic INR range for warfarin is typically 2.0-3.0 (may be 2.5-3.5 for some conditions). An INR of 4.5 indicates the patient is at high risk for bleeding complications. The nurse should hold the medication and immediately notify the healthcare provider for further instructions.
Question 5: Which statement by a patient indicates understanding of proper insulin administration technique?
A) “I should massage the injection site after giving the insulin”
B) “I can reuse my insulin needle up to 5 times”
C) “I need to rotate injection sites to prevent lipodystrophy”
D) “I should shake the insulin vial vigorously before drawing it up”
Correct Answer: C
Explanation: Rotating injection sites prevents lipodystrophy (changes in fatty tissue) that can affect insulin absorption. Massaging the injection site can increase absorption rate unpredictably. Needles should not be reused due to infection risk. Insulin should be gently rolled, not shaken, to prevent air bubbles and maintain effectiveness.
Question 6: A nurse is administering morphine sulfate 4 mg IV push for pain management. What is the most critical assessment parameter to monitor?
A) Blood pressure
B) Heart rate
C) Respiratory rate
D) Level of consciousness
Correct Answer: C
Explanation: While all parameters are important, respiratory depression is the most life-threatening adverse effect of opioid medications like morphine. The nurse must closely monitor respiratory rate, depth, and quality. Respiratory rates below 12 breaths per minute require immediate intervention and possible naloxone administration.
Question 7: A patient is prescribed metformin 500 mg PO twice daily. Which condition would be a contraindication for this medication?
A) Type 1 diabetes mellitus
B) Renal insufficiency with creatinine >1.5 mg/dL
C) Hypertension
D) Hyperlipidemia
Correct Answer: B
Explanation: Metformin is contraindicated in patients with renal insufficiency (creatinine >1.5 mg/dL in males, >1.4 mg/dL in females) due to the risk of lactic acidosis, a potentially fatal complication. The drug is eliminated through the kidneys, and impaired renal function can lead to dangerous accumulation.
Question 8: A nurse is preparing to administer a medication through a nasogastric tube. Which action is most appropriate?
A) Mix the medication with enteral feeding
B) Crush all medications together for easier administration
C) Flush the tube with 30 mL of water before and after medication
D) Administer medications immediately after tube feeding
Correct Answer: C
Explanation: Flushing the NG tube with 30 mL of water before and after medication administration prevents tube clogging and ensures the medication reaches the stomach. Medications should not be mixed with feeding, crushed together (some cannot be crushed), or given immediately after feeding without proper flushing.
Question 9: Which medication requires the nurse to monitor the patient for signs of serotonin syndrome?
A) Lisinopril (ACE inhibitor)
B) Fluoxetine (SSRI)
C) Metoprolol (beta-blocker)
D) Amlodipine (calcium channel blocker)
Correct Answer: B
Explanation: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that can cause serotonin syndrome, especially when combined with other serotonergic drugs. Signs include hyperthermia, altered mental status, muscle rigidity, tremor, and autonomic instability. This is a potentially life-threatening condition requiring immediate intervention.
Question 10: A patient is receiving heparin therapy. Which laboratory value should the nurse monitor to assess therapeutic effectiveness?
A) PT (Prothrombin Time)
B) INR (International Normalized Ratio)
C) aPTT (Activated Partial Thromboplastin Time)
D) PLT (Platelet count)
Correct Answer: C
Explanation: aPTT (activated partial thromboplastin time) is used to monitor heparin therapy effectiveness. The therapeutic range is typically 1.5-2.5 times the control value. PT and INR are used for warfarin monitoring. While platelet count should be monitored for heparin-induced thrombocytopenia, aPTT measures therapeutic effectiveness.
Question 11: A nurse discovers that a patient received the wrong medication 30 minutes ago. What is the nurse’s first priority action?
A) Complete an incident report
B) Notify the healthcare provider
C) Assess the patient’s current condition
D) Document the error in the medical record
Correct Answer: C
Explanation: The nurse’s first priority is to assess the patient for any adverse effects or changes in condition. Patient safety is paramount. After ensuring the patient is stable, the nurse should notify the healthcare provider, complete incident reports, and document appropriately. The patient’s immediate well-being takes precedence over documentation.
Question 12: Which technique is correct when administering an intramuscular injection in the ventrogluteal site?
A) Insert the needle at a 45-degree angle
B) Use a 1/2-inch needle for all adult patients
C) Insert the needle at a 90-degree angle
D) Massage the site vigorously after injection
Correct Answer: C
Explanation: Intramuscular injections should be administered at a 90-degree angle to ensure the medication reaches the muscle tissue. A 45-degree angle is used for subcutaneous injections. Needle length varies based on patient size (typically 1-1.5 inches for adults). Vigorous massage can damage tissue and affect absorption.
Question 13: A patient taking spironolactone should be monitored for which electrolyte imbalance?
A) Hyponatremia
B) Hyperkalemia
C) Hypocalcemia
D) Hypermagnesemia
Correct Answer: B
Explanation: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia (elevated potassium levels). The drug blocks aldosterone receptors, preventing potassium excretion. Patients should be monitored for signs of hyperkalemia including muscle weakness, cardiac arrhythmias, and paresthesias. Regular serum potassium levels are essential.
Question 14: When administering eye drops, which technique ensures proper medication delivery?
A) Have the patient look up and drop medication on the cornea
B) Pull down the lower eyelid and instill drops in the conjunctival sac
C) Have the patient close eyes tightly after instillation
D) Apply drops to the upper eyelid and have patient blink
Correct Answer: B
Explanation: The correct technique is to pull down the lower eyelid creating a pocket (conjunctival sac) and instill the prescribed number of drops. The patient should look up but medication should not be dropped directly on the cornea. After instillation, gentle pressure on the inner canthus prevents systemic absorption.
Question 15: A patient is prescribed albuterol inhaler for bronchospasm. Which side effect should the nurse expect to monitor for?
A) Bradycardia
B) Tachycardia
C) Hypotension
D) Sedation
Correct Answer: B
Explanation: Albuterol is a beta-2 agonist bronchodilator that can cause tachycardia as a common side effect due to its stimulating effects on the sympathetic nervous system. Other side effects may include tremor, nervousness, and increased blood pressure. The nurse should monitor heart rate and rhythm during treatment.