Pharmacological and Parenteral Therapies represents one of the most critical and heavily tested content areas on the NCLEX-RN examination, comprising 13-19% of all exam questions. This domain encompasses essential nursing competencies including medication administration, dosage calculations, adverse effects monitoring, drug interactions, and parenteral therapy management. Mastery of this content area is fundamental to safe nursing practice, as medication errors remain a leading cause of patient harm in healthcare settings. The Next Generation NCLEX (NGN) format has further emphasized clinical judgment in pharmacological scenarios, requiring nurses to recognize medication-related cues, analyze patient responses, and prioritize interventions effectively. Understanding therapeutic drug levels, contraindications, and proper administration techniques is essential for preventing adverse drug events and ensuring optimal patient outcomes. This content area frequently intersects with priority questions that test your ability to identify the most appropriate first action in medication-related emergencies. Strong performance in pharmacological questions often correlates with overall NCLEX success, as these scenarios require integration of pathophysiology, nursing process, and critical thinking skills. The complexity of modern polypharmacy, especially in elderly patients, makes this knowledge area increasingly vital for entry-level nursing practice. Questions in this domain often involve real-world scenarios where nurses must demonstrate competency in medication reconciliation, patient education, and interdisciplinary communication regarding drug therapy.
Practice Questions
Question 1:
A nurse is preparing to administer digoxin 0.25 mg PO to a client with heart failure. The client’s apical pulse is 58 beats per minute. What is the nurse’s priority action?
A) Administer the medication as ordered
B) Hold the medication and notify the healthcare provider
C) Recheck the pulse in 30 minutes
D) Administer half the prescribed dose
Correct Answer: B) Hold the medication and notify the healthcare provider
Explanation: Digoxin should be held if the apical pulse is below 60 bpm in adults, as it can cause further bradycardia and heart block. The healthcare provider must be notified to reassess the client’s condition and potentially adjust the medication regimen.
Question 2:
A client receiving heparin therapy has a partial thromboplastin time (PTT) of 120 seconds. What is the nurse’s immediate priority?
A) Continue the current heparin infusion rate
B) Increase the heparin infusion rate
C) Stop the heparin infusion and notify the provider
D) Administer protamine sulfate immediately
Correct Answer: C) Stop the heparin infusion and notify the provider
Explanation: A PTT of 120 seconds is dangerously elevated (normal therapeutic range is 60-80 seconds). The infusion must be stopped immediately to prevent bleeding complications, and the provider must be notified for further orders.
Question 3:
A nurse is teaching a client about warfarin therapy. Which statement by the client indicates understanding of the teaching?
A) “I can take aspirin for headaches while on this medication”
B) “I should eat more green leafy vegetables for better nutrition”
C) “I will use a soft toothbrush and electric razor”
D) “I can stop taking this medication when I feel better”
Correct Answer: C) “I will use a soft toothbrush and electric razor”
Explanation: Clients on warfarin have increased bleeding risk and should use soft toothbrushes and electric razors to prevent cuts. Aspirin increases bleeding risk, green leafy vegetables contain vitamin K which antagonizes warfarin, and the medication should not be stopped abruptly.
Question 4:
A client is receiving morphine sulfate 4 mg IV every 4 hours for post-operative pain. The nurse notes the client’s respiratory rate is 8 breaths per minute. What is the priority intervention?
A) Administer naloxone (Narcan) 0.4 mg IV
B) Encourage deep breathing exercises
C) Reduce the next morphine dose by half
D) Continue monitoring and document findings
Correct Answer: A) Administer naloxone (Narcan) 0.4 mg IV
Explanation: A respiratory rate of 8 breaths per minute indicates respiratory depression from opioid overdose. Naloxone is the antidote for opioid toxicity and should be administered immediately to reverse respiratory depression.
Question 5:
A nurse is preparing to administer insulin lispro (Humalog) to a diabetic client. When should this medication be administered?
A) 30 minutes before meals
B) 15 minutes before meals
C) With meals
D) 2 hours after meals
Correct Answer: B) 15 minutes before meals
Explanation: Insulin lispro is a rapid-acting insulin that should be administered 15 minutes before meals to prevent hypoglycemia. It has an onset of 15 minutes and peaks in 1-2 hours.
Question 6:
A client taking furosemide (Lasix) reports muscle weakness and cramping. Which laboratory value should the nurse check first?
A) Sodium level
B) Potassium level
C) Chloride level
D) Magnesium level
Correct Answer: B) Potassium level
Explanation: Furosemide is a loop diuretic that causes potassium loss. Muscle weakness and cramping are classic signs of hypokalemia, which can lead to dangerous cardiac arrhythmias if not corrected.
Question 7:
A nurse is administering phenytoin (Dilantin) IV to a client with seizures. Which action is most important during administration?
A) Monitor blood pressure continuously
B) Administer through a large-bore IV catheter
C) Mix with dextrose solution for compatibility
D) Administer at a rate of 100 mg/minute
Correct Answer: B) Administer through a large-bore IV catheter
Explanation: Phenytoin is highly alkaline and can cause severe tissue necrosis if it infiltrates. It should be administered through a large-bore IV catheter, never mixed with dextrose, and given no faster than 50 mg/minute.
Question 8:
A client prescribed lisinopril (Prinivil) for hypertension reports a persistent dry cough. What should the nurse understand about this symptom?
A) It indicates an allergic reaction requiring immediate discontinuation
B) It is a common side effect that may require medication change
C) It will resolve with continued use of the medication
D) It suggests the medication dose needs to be increased
Correct Answer: B) It is a common side effect that may require medication change
Explanation: A persistent dry cough is a common side effect of ACE inhibitors like lisinopril, occurring in 10-15% of patients. The healthcare provider may need to switch to an ARB (angiotensin receptor blocker) which doesn’t typically cause cough.
Question 9:
A nurse is preparing to administer vancomycin IV to a client. Which assessment is most important before administration?
A) Blood pressure and pulse
B) Hearing and kidney function
C) Liver enzymes and bilirubin
D) Blood glucose and electrolytes
Correct Answer: B) Hearing and kidney function
Explanation: Vancomycin is ototoxic and nephrotoxic. Baseline hearing assessment and kidney function (creatinine, BUN) must be evaluated before administration and monitored throughout therapy to prevent permanent damage.
Question 10:
A client receiving chemotherapy develops severe nausea and vomiting. The nurse prepares to administer ondansetron (Zofran). What is the most appropriate route for this medication?
A) Oral tablet
B) Intramuscular injection
C) Intravenous push
D) Sublingual tablet
Correct Answer: C) Intravenous push
Explanation: For severe nausea and vomiting, especially in chemotherapy patients, IV administration of ondansetron provides the fastest onset and most reliable absorption when oral routes may not be tolerated.
Question 11:
A nurse is teaching a client about metformin (Glucophage) therapy. Which instruction is most important to include?
A) “Take this medication with food to reduce stomach upset”
B) “Monitor your blood sugar three times daily”
C) “Stop taking this medication if you become ill”
D) “Increase your fluid intake while taking this medication”
Correct Answer: C) “Stop taking this medication if you become ill”
Explanation: Metformin should be held during illness, surgery, or any condition that may cause dehydration or kidney impairment due to the risk of lactic acidosis, a potentially fatal complication.
Question 12:
A client is prescribed albuterol (ProAir) inhaler for asthma. Which technique indicates proper inhaler use?
A) Inhaling quickly and deeply through the mouth
B) Exhaling completely, then inhaling slowly and deeply
C) Taking multiple puffs in rapid succession
D) Holding breath for 5 seconds after inhalation
Correct Answer: B) Exhaling completely, then inhaling slowly and deeply
Explanation: Proper inhaler technique requires exhaling completely first, then inhaling slowly and deeply to ensure medication reaches the lower airways. The breath should be held for 10 seconds if possible, not 5 seconds.
Question 13:
A nurse is monitoring a client receiving IV potassium chloride. Which assessment finding requires immediate intervention?
A) Urine output of 40 mL/hour
B) Serum potassium level of 4.5 mEq/L
C) Complaint of burning at the IV site
D) Heart rate of 88 beats per minute
Correct Answer: C) Complaint of burning at the IV site
Explanation: Potassium chloride is highly irritating to tissues and can cause severe tissue necrosis if it infiltrates. Burning at the IV site suggests possible infiltration and requires immediate assessment and intervention.
Question 14:
A client taking warfarin has an INR of 4.5. Which medication should the nurse anticipate administering?
A) Protamine sulfate
B) Vitamin K (phytonadione)
C) Fresh frozen plasma
D) Platelets
Correct Answer: B) Vitamin K (phytonadione)
Explanation: An INR of 4.5 indicates excessive anticoagulation with warfarin (therapeutic range is 2.0-3.0). Vitamin K is the antidote for warfarin toxicity and will help reverse the anticoagulant effect.
Question 15:
A nurse is preparing to administer nitroglycerin sublingual to a client with chest pain. Which assessment must be completed first?
A) Pain level using 0-10 scale
B) Blood pressure measurement
C) Heart rate and rhythm
D) Oxygen saturation level
Correct Answer: B) Blood pressure measurement
Explanation: Nitroglycerin causes vasodilation and can significantly lower blood pressure. Blood pressure must be assessed before administration to ensure it’s not already low, as nitroglycerin could cause dangerous hypotension.