Pharmacological therapies represent a critical component of the NCLEX-PN examination, accounting for 10-16% of all test questions and serving as a cornerstone of safe, effective nursing practice. As a Licensed Practical Nurse, your ability to safely administer medications, recognize adverse effects, and educate patients about their drug regimens directly impacts patient outcomes and safety. This content area encompasses essential skills including dosage calculations, understanding drug classifications and mechanisms of action, identifying contraindications, monitoring therapeutic responses, and recognizing signs of toxicity. Mastery of pharmacological principles is not merely about memorizing individual medications; rather, it requires understanding drug families, their common characteristics, and how they interact with various body systems. The NCLEX-PN emphasizes clinical judgment in medication administration, requiring you to prioritize interventions, recognize when to hold medications based on vital signs or lab values, and understand the nurse’s role in the medication administration process. High-alert medications such as insulin, anticoagulants, opioids, digoxin, and lithium receive particular attention on the exam due to their potential for serious harm if administered incorrectly. Additionally, you must demonstrate competency in patient education, ensuring clients understand why they’re taking medications, how to take them properly, and what side effects warrant immediate medical attention. The integration of pharmacology with other nursing concepts—such as infection control during IV medication administration or legal considerations regarding controlled substances—reflects the holistic nature of nursing practice. Understanding pharmacokinetics (absorption, distribution, metabolism, and excretion) and pharmacodynamics (how drugs affect the body) provides the foundation for making sound clinical decisions. Your success in this content area demonstrates your readiness to safely manage medication therapies as an entry-level practical nurse.
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 most appropriate nursing action?
- A) Administer the medication as ordered and document the pulse rate
- B) Hold the medication and notify the healthcare provider
- C) Administer half the dose and recheck the pulse in one hour
- D) Give the medication with food to minimize side effects
Correct Answer: B) Hold the medication and notify the healthcare provider
Explanation: Digoxin is a cardiac glycoside that slows the heart rate and increases the force of myocardial contractions. The nurse should hold digoxin if the apical pulse is below 60 beats per minute in adults (or below 70 in children) due to the risk of bradycardia and heart block. The healthcare provider must be notified before administering the medication when the pulse is below the established parameter. Option A is incorrect because administering the medication could cause dangerous bradycardia. Option C is incorrect because nurses cannot independently alter prescribed dosages. Option D does not address the critical issue of the low pulse rate, which is a contraindication for administration.
Question 2
A client receiving warfarin therapy has an INR of 4.5. Which assessment finding would be most concerning to the nurse?
- A) Bruising on the arms
- B) Tarry, black stools
- C) Mild headache
- D) Increased fatigue
Correct Answer: B) Tarry, black stools
Explanation: An INR of 4.5 is elevated (therapeutic range is typically 2.0-3.0 for most conditions), indicating the client is at increased risk for bleeding. Tarry, black stools (melena) indicate gastrointestinal bleeding, which is a serious complication requiring immediate intervention. This represents active internal bleeding and is the most concerning finding. While bruising (Option A) is also a sign of bleeding, it is less immediately life-threatening than GI bleeding. A mild headache (Option C) should be monitored but could indicate various conditions. Increased fatigue (Option D) is nonspecific and less urgent than signs of active bleeding. The nurse should notify the healthcare provider immediately about the melena and elevated INR.
Question 3
A nurse is teaching a client newly prescribed lisinopril for hypertension. Which statement by the client indicates understanding of the medication?
- A) “I should take this medication with grapefruit juice.”
- B) “I will change positions slowly when getting up.”
- C) “I can stop taking this medication once my blood pressure is normal.”
- D) “I should increase my intake of potassium-rich foods.”
Correct Answer: B) “I will change positions slowly when getting up.”
Explanation: Lisinopril is an ACE inhibitor used to treat hypertension. A common side effect is orthostatic hypotension, especially when therapy is initiated or the dose is increased. Clients should be taught to change positions slowly to prevent dizziness and falls. Option A is incorrect; grapefruit juice does not significantly interact with lisinopril (though it does with some calcium channel blockers). Option C is incorrect because antihypertensive medications typically require long-term use, and discontinuing them can cause rebound hypertension. Option D is incorrect because ACE inhibitors can cause hyperkalemia, so clients should avoid excessive potassium intake and potassium supplements unless specifically ordered.
Question 4
A client with type 1 diabetes is prescribed NPH insulin 20 units subcutaneously every morning. When should the nurse monitor the client most closely for hypoglycemia?
- A) 30 minutes after administration
- B) 2-4 hours after administration
- C) 6-12 hours after administration
- D) 18-24 hours after administration
Correct Answer: C) 6-12 hours after administration
Explanation: NPH insulin is an intermediate-acting insulin with an onset of 1-2 hours, peak action at 6-12 hours, and duration of 18-24 hours. The client is at highest risk for hypoglycemia during the peak action time when insulin activity is greatest. If NPH is given in the morning, the peak occurs in the late afternoon or early evening. Option A corresponds to rapid-acting insulin timing. Option B corresponds to regular (short-acting) insulin peak. Option D represents the duration rather than peak time. Understanding insulin pharmacokinetics is essential for preventing and recognizing hypoglycemic episodes.
Question 5
A nurse is caring for a client receiving morphine sulfate via PCA pump. Which assessment finding requires immediate intervention?
- A) Client reports pain level of 4 on a 0-10 scale
- B) Respiratory rate of 8 breaths per minute
- C) Client is drowsy but arousable
- D) Blood pressure of 110/70 mmHg
Correct Answer: B) Respiratory rate of 8 breaths per minute
Explanation: Morphine sulfate is an opioid analgesic that can cause respiratory depression, the most serious adverse effect. A respiratory rate below 12 breaths per minute in an adult indicates significant respiratory depression and requires immediate intervention, including stopping the PCA pump, stimulating the client, and potentially administering naloxone (Narcan). Option A indicates the pain is being managed but not completely eliminated, which is acceptable. Option C describes expected sedation from opioid therapy; drowsiness is common but the client should remain arousable. Option D represents normal blood pressure. The nurse must prioritize airway and breathing (ABCs) when assessing clients receiving opioids.
Question 6
A client taking phenytoin for seizure control should be monitored for which adverse effect?
- A) Gingival hyperplasia
- B) Urinary retention
- C) Constipation
- D) Bradycardia
Correct Answer: A) Gingival hyperplasia
Explanation: Phenytoin (Dilantin) is an anticonvulsant medication commonly associated with gingival hyperplasia (overgrowth of gum tissue), which occurs in approximately 50% of clients taking the medication long-term. Clients should be taught to practice meticulous oral hygiene and have regular dental checkups. Other common side effects of phenytoin include hirsutism, ataxia, nystagmus, and drowsiness. Options B, C, and D are not characteristic side effects of phenytoin. The nurse should also monitor therapeutic drug levels (10-20 mcg/mL) and assess for signs of toxicity including ataxia, slurred speech, and nystagmus.
Question 7
A nurse is preparing to administer a subcutaneous injection of enoxaparin. Which action is correct?
- A) Aspirate before injecting the medication
- B) Massage the site after injection
- C) Inject into the abdomen at least 2 inches from the umbilicus
- D) Use the deltoid muscle for injection
Correct Answer: C) Inject into the abdomen at least 2 inches from the umbilicus
Explanation: Enoxaparin (Lovenox) is a low-molecular-weight heparin administered subcutaneously, preferably in the abdomen at least 2 inches (5 cm) away from the umbilicus. This area provides consistent absorption and minimizes the risk of hematoma formation. Option A is incorrect; the nurse should NOT aspirate before injecting enoxaparin as this can cause tissue trauma and bruising. Option B is incorrect; the injection site should NOT be massaged as this can cause bruising and affect absorption. Option D is incorrect; enoxaparin is given subcutaneously in the abdomen, not intramuscularly in the deltoid. The nurse should also rotate injection sites and avoid areas with bruising or scarring.
Question 8
A client prescribed metformin for type 2 diabetes should be instructed to report which symptom immediately?
- A) Mild nausea after meals
- B) Muscle pain and weakness
- C) Increased urination
- D) Dry mouth
Correct Answer: B) Muscle pain and weakness
Explanation: Muscle pain and weakness can indicate lactic acidosis, a rare but serious complication of metformin therapy. Lactic acidosis is a medical emergency with symptoms including muscle pain, weakness, difficulty breathing, unusual fatigue, dizziness, and abdominal discomfort. Clients should be instructed to report these symptoms immediately. Option A (mild nausea) is a common, expected side effect that often improves with continued use and can be minimized by taking the medication with food. Options C and D are symptoms of hyperglycemia, not metformin side effects. Metformin should be held before procedures involving contrast dye and in clients with renal impairment due to increased risk of lactic acidosis.
Question 9
A nurse is teaching a client about newly prescribed albuterol inhaler. Which statement by the client indicates correct understanding?
- A) “I will use this inhaler every day to prevent asthma attacks.”
- B) “I should rinse my mouth after using this inhaler.”
- C) “I will use this inhaler when I have difficulty breathing.”
- D) “I should use my steroid inhaler first, then this one.”
Correct Answer: C) “I will use this inhaler when I have difficulty breathing.”
Explanation: Albuterol is a short-acting beta-2 agonist bronchodilator used as a rescue medication for acute bronchospasm and difficulty breathing. It provides rapid relief of symptoms within minutes. Option A is incorrect; albuterol is not used for daily prevention (long-acting bronchodilators or corticosteroids are used for maintenance). Option B is incorrect; mouth rinsing is necessary after corticosteroid inhalers (like fluticasone) to prevent oral candidiasis, not after albuterol. Option D is incorrect; the correct sequence is bronchodilator first (to open airways), then corticosteroid inhaler (to reduce inflammation in the now-open airways). Clients should be taught proper inhaler technique and to seek medical attention if they need to use albuterol more frequently than prescribed.
Question 10
A client receiving gentamicin IV should be monitored for which potential adverse effect?
- A) Hepatotoxicity
- B) Nephrotoxicity
- C) Cardiotoxicity
- D) Bone marrow suppression
Correct Answer: B) Nephrotoxicity
Explanation: Gentamicin is an aminoglycoside antibiotic with two major adverse effects: nephrotoxicity (kidney damage) and ototoxicity (hearing loss and vestibular dysfunction). The nurse should monitor renal function by assessing BUN, creatinine, and urinary output. Peak and trough drug levels should be monitored to ensure therapeutic levels while minimizing toxicity. Clients should be assessed for signs of ototoxicity including tinnitus, vertigo, and hearing loss. Option A (hepatotoxicity) is not a primary concern with gentamicin. Option C (cardiotoxicity) is associated with drugs like doxorubicin. Option D (bone marrow suppression) is associated with chemotherapy agents and some antibiotics like chloramphenicol, but not gentamicin.
Question 11
A nurse is caring for a client taking spironolactone. Which laboratory value requires immediate notification of the healthcare provider?
- A) Sodium 138 mEq/L
- B) Potassium 6.2 mEq/L
- C) Chloride 100 mEq/L
- D) Calcium 9.5 mg/dL
Correct Answer: B) Potassium 6.2 mEq/L
Explanation: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia (elevated potassium levels). Normal potassium range is 3.5-5.0 mEq/L; a level of 6.2 mEq/L is dangerously elevated and can cause life-threatening cardiac arrhythmias. This requires immediate notification of the healthcare provider. Clients taking spironolactone should avoid potassium supplements and excessive dietary potassium. Option A shows a normal sodium level (135-145 mEq/L). Option C shows a normal chloride level (98-106 mEq/L). Option D shows a normal calcium level (8.5-10.5 mg/dL). The nurse should monitor ECG changes associated with hyperkalemia including tall, peaked T waves, widened QRS complex, and potential cardiac arrest.
Question 12
A client prescribed levothyroxine for hypothyroidism asks when to take the medication. What is the nurse’s best response?
- A) “Take it at bedtime with a snack.”
- B) “Take it in the morning on an empty stomach.”
- C) “Take it with your other morning medications.”
- D) “Take it with milk to prevent stomach upset.”
Correct Answer: B) “Take it in the morning on an empty stomach.”
Explanation: Levothyroxine (Synthroid) should be taken in the morning on an empty stomach, at least 30-60 minutes before breakfast, to maximize absorption. Consistent timing is important for maintaining stable thyroid hormone levels. Option A is incorrect; taking it at bedtime may interfere with sleep due to its stimulating effects. Option C is incorrect; many medications and supplements (especially calcium, iron, and antacids) interfere with levothyroxine absorption and should be separated by at least 4 hours. Option D is incorrect; dairy products contain calcium which significantly reduces levothyroxine absorption. Clients should be taught that it may take several weeks to feel the full effects and that thyroid function tests will be monitored regularly to adjust dosing.
Question 13
A nurse is administering an IV antibiotic to a client. Fifteen minutes after starting the infusion, the client develops hives, wheezing, and hypotension. What is the priority nursing action?
- A) Slow the IV infusion rate
- B) Stop the infusion immediately
- C) Administer an antihistamine
- D) Document the reaction in the chart
Correct Answer: B) Stop the infusion immediately
Explanation: The client is experiencing anaphylaxis, a severe allergic reaction that is life-threatening. The priority action is to stop the infusion immediately to prevent further exposure to the allergen. After stopping the infusion, the nurse should maintain the IV line with normal saline, call for help, assess airway/breathing/circulation, prepare to administer epinephrine as ordered, and notify the healthcare provider. Option A is incorrect; slowing the infusion continues to expose the client to the allergen. Option C may be appropriate but is not the priority action; stopping the allergen exposure comes first. Option D is important but not the immediate priority when the client is experiencing a life-threatening reaction. The nurse must follow the ABCs (airway, breathing, circulation) and recognize that anaphylaxis requires immediate intervention.
Question 14
A client taking an MAOI antidepressant should avoid which food?
- A) Fresh vegetables
- B) Aged cheese
- C) White bread
- D) Chicken breast
Correct Answer: B) Aged cheese
Explanation: Clients taking MAOI (monoamine oxidase inhibitor) antidepressants must avoid foods high in tyramine, which can cause a hypertensive crisis. Aged cheese is high in tyramine and should be strictly avoided. Other high-tyramine foods include aged/cured meats, fermented foods, draft beer, red wine, soy sauce, and overripe fruits. A hypertensive crisis presents with severe headache, palpitations, neck stiffness, nausea, and dangerously elevated blood pressure, requiring emergency treatment. Options A, C, and D are low in tyramine and safe to consume. Clients should also be taught to avoid certain medications including decongestants, other antidepressants, and meperidine. MAOIs have largely been replaced by safer antidepressants but are still used for treatment-resistant depression.
Question 15
A nurse is preparing to administer a medication via a nasogastric tube. Which action should the nurse take first?
- A) Flush the tube with 30 mL of water
- B) Verify tube placement
- C) Crush the medication into a fine powder
- D) Clamp the tube for 30 minutes after administration
Correct Answer: B) Verify tube placement
Explanation: Before administering any medication or fluid through a nasogastric tube, the nurse must first verify proper tube placement to prevent aspiration or administration into the lungs. Placement can be verified by aspirating gastric contents and checking pH (should be acidic, pH 0-4), measuring the external tube length and comparing to the documented length at insertion, or obtaining an x-ray confirmation. Option A is important but comes after verifying placement. Option C is appropriate for most medications (except enteric-coated or extended-release formulations) but should be done after confirming placement. Option D is incorrect; the tube should be flushed after medication administration, not clamped. The nurse should also check for gastric residual volume before administering medications or feedings to assess gastric emptying.
Summary
These 15 practice questions cover essential pharmacological concepts tested on the NCLEX-PN examination, including medication administration safety, recognition of adverse effects, patient education, drug classifications, and clinical judgment in medication management. Mastering these concepts will strengthen your readiness for the pharmacological therapies portion of the NCLEX-PN exam.