NCLEX-RN Pharmacological and Parenteral Therapies Practice Questions

Drug classes, mechanisms of action, and nursing considerations for the NCLEX — as searchable word puzzles. It sits under Physiological Integrity on the NCLEX-RN test plan and carries an approximate weight of 15% of the exam.

Below are 13 practice questions for this domain — 8 multiple-choice and 5 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-RN the distractors are usually plausible actions that are simply lower priority, so knowing why an answer is wrong is worth as much as knowing why one is right.

How to use this page. Read the vignette, commit to an answer, and only then open “Show the answer and rationales”. Reading the worked answer first feels productive and teaches almost nothing — the recall attempt is what makes it stick.

Select-all-that-apply items are graded all-or-nothing: partial credit does not exist, so a single missed option loses the whole question.

Easy Multiple choice

1. Ondansetron — finding to report before administering

A nurse is preparing to give IV ondansetron for postoperative nausea. While reviewing the chart, the nurse notes the client's most recent ECG and electrolyte results before giving the dose.

Which finding should the nurse report to the provider before giving the ondansetron?

  1. A prolonged QT interval noted on the client's ECG.
  2. A blood pressure of 122/76 mm Hg.
  3. A report of mild constipation.
  4. A temperature of 37.0 degrees Celsius.
Show the answer and rationales

Correct answer: A

  • A. Correct . Ondansetron can prolong the QT interval and increase the risk of torsades de pointes. A baseline prolonged QT must be reported before giving the drug so the provider can reassess.
  • B. Incorrect . This is a normal blood pressure and does not contraindicate ondansetron.
  • C. Incorrect . Constipation is a common, non-urgent side effect of ondansetron. It is managed but does not require holding the dose or notifying the provider first.
  • D. Incorrect . This is a normal temperature and is unrelated to the safety of giving ondansetron.

Reference: FDA prescribing information (ondansetron)

Medium Select all that apply

2. Ciprofloxacin — medication teaching

A nurse is teaching a client who is starting oral ciprofloxacin for a urinary tract infection. The client takes a calcium supplement and an antacid at home and exercises regularly.

Which instructions should the nurse include in the teaching? Select all that apply.

  1. Separate this antibiotic from dairy products, calcium, and antacids by taking it at least 2 hours before or 6 hours after them.
  2. Stop the medication and report any tendon pain, swelling, or the inability to bear weight.
  3. Drink plenty of fluids while taking this medication.
  4. Spend extended time in direct sunlight to help the medication work.
  5. Take this medication with your morning calcium supplement so you do not forget it.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Calcium and other cations chelate ciprofloxacin and sharply reduce its absorption, so the doses must be spaced 2 hours before or 6 hours after.
  • B. Correct . Ciprofloxacin carries a boxed warning for tendinitis and tendon rupture, most often the Achilles tendon, so these symptoms warrant holding the drug and notifying the provider.
  • C. Correct . Adequate hydration helps prevent crystalluria and supports treatment of the urinary infection.
  • D. Incorrect . Fluoroquinolones cause photosensitivity, so clients should limit sun exposure and use protection, not seek more sun.
  • E. Incorrect . Taking it with calcium causes chelation that blocks absorption, defeating the therapy. The doses must be separated.

Reference: FDA prescribing information (ciprofloxacin)

Medium Multiple choice

3. Digoxin toxicity — first action

A nurse is caring for a client with heart failure who takes digoxin 0.25 mg PO daily. The client reports nausea and seeing yellow halos around lights. This morning's serum potassium is 3.1 mEq/L and the apical pulse is 52/min.

Which action should the nurse take first?

  1. Withhold the digoxin dose and notify the provider.
  2. Administer the digoxin with a full glass of water.
  3. Encourage the client to eat potassium-rich foods.
  4. Document the findings and reassess in one hour.
Show the answer and rationales

Correct answer: A

  • A. Correct . Nausea, visual changes (yellow halos), and bradycardia are classic signs of digoxin toxicity, and hypokalemia (K+ 3.1 mEq/L) potentiates it. The dose must be held and the provider notified before anything else.
  • B. Incorrect . Giving the dose would worsen the toxicity the client is already showing signs of — administration is contraindicated here.
  • C. Incorrect . Dietary potassium is far too slow to correct hypokalemia in the setting of active toxicity signs, and it does not address the held dose or the need to notify the provider.
  • D. Incorrect . Waiting delays intervention for a potentially serious toxicity — documentation alone is not a sufficient response to these findings.

Reference: FDA prescribing information (digoxin); 2020 AHA ACLS bradycardia guidance

Medium Multiple choice

4. Insulin-induced hypoglycemia — first action

A client with type 1 diabetes received subcutaneous regular insulin 30 minutes before lunch but then left the unit and missed the meal. The client is now diaphoretic, shaky, and reports feeling dizzy. A bedside fingerstick glucose reads 54 mg/dL. The client is alert and able to swallow.

Which action should the nurse take first?

  1. Give 15 grams of a fast-acting oral carbohydrate, such as 4 ounces of fruit juice.
  2. Administer intramuscular glucagon.
  3. Give a peanut butter and cheese snack to sustain the glucose level.
  4. Recheck the glucose in 30 minutes before intervening.
Show the answer and rationales

Correct answer: A

  • A. Correct . For a conscious client who can swallow with glucose below 70 mg/dL, the ADA 15-15 rule directs giving 15 grams of fast-acting carbohydrate, then rechecking glucose in 15 minutes. This is the priority action.
  • B. Incorrect . Glucagon is reserved for hypoglycemia when the client is unconscious or unable to safely swallow. This client is alert and can take oral carbohydrate, which is faster and less invasive.
  • C. Incorrect . Foods high in fat and protein slow carbohydrate absorption and delay correction. They are not used for the initial treatment of acute hypoglycemia.
  • D. Incorrect . Waiting allows the glucose to fall further while symptoms are already present. Treatment must come first; the recheck occurs 15 minutes after giving carbohydrate, not before treating.

Reference: American Diabetes Association Standards of Care in Diabetes 2026 (hypoglycemia)

Medium Select all that apply

5. Levothyroxine — discharge teaching

A nurse is providing discharge teaching to a client newly prescribed levothyroxine for hypothyroidism. The nurse wants to confirm the client understands how to take the medication safely.

Which client statements indicate correct understanding of the teaching? Select all that apply.

  1. I will take this pill in the morning on an empty stomach, 30 to 60 minutes before breakfast.
  2. I will separate this medication from my calcium and iron supplements by several hours.
  3. I will report a racing or pounding heartbeat to my provider.
  4. I should stop the medication once I start to feel better.
  5. I can take this medication with my morning antacid for my heartburn.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Taking levothyroxine on an empty stomach 30 to 60 minutes before eating gives consistent absorption, which is essential for stable thyroid levels.
  • B. Correct . Calcium and iron bind levothyroxine and markedly reduce its absorption, so they must be spaced several hours apart.
  • C. Correct . Palpitations and tachycardia can signal over-replacement and should be reported so the dose and TSH can be reassessed.
  • D. Incorrect . Hypothyroidism usually requires lifelong therapy. Stopping when symptoms improve causes the deficiency and symptoms to return.
  • E. Incorrect . Antacids interfere with levothyroxine absorption and should be separated from the dose, not taken together.

Reference: FDA prescribing information (levothyroxine); MedlinePlus (levothyroxine)

Medium Multiple choice

6. Lisinopril — finding to report immediately

A nurse is assessing four clients on a medical unit. Each client is taking lisinopril for hypertension. The nurse reviews the latest findings for each client.

Which finding requires the nurse to intervene immediately?

  1. A client with new swelling of the lips and tongue and a muffled voice.
  2. A client reporting a persistent dry, nagging cough.
  3. A client whose blood pressure decreased from 158/94 to 132/82 mm Hg.
  4. A client who reports mild dizziness when first standing after the initial dose.
Show the answer and rationales

Correct answer: A

  • A. Correct . Swelling of the lips and tongue with voice changes signals angioedema, a life-threatening airway emergency. The drug must be stopped and emergency help summoned immediately because the airway can close rapidly.
  • B. Incorrect . A dry cough is a common, expected ACE inhibitor effect. It warrants follow-up and possible drug change but is not an emergency.
  • C. Incorrect . This is the intended therapeutic effect of the drug and is a desirable, expected response, not a problem.
  • D. Incorrect . First-dose orthostatic hypotension can occur; it is managed with safety teaching and slow position changes. It is far less urgent than airway compromise from angioedema.

Reference: FDA prescribing information (lisinopril); MedlinePlus (ACE inhibitor angioedema)

Medium Multiple choice

7. Metformin and iodinated contrast

A client who takes metformin for type 2 diabetes is scheduled for a CT scan with IV iodinated contrast. The client's most recent eGFR is 26 mL/min/1.73m2. The client asks the nurse whether to take the usual morning metformin dose.

Which response by the nurse is most appropriate?

  1. The metformin will be held at the time of the scan and for 48 hours after, then restarted only once kidney function is rechecked and stable.
  2. Take the metformin as usual because it does not interact with contrast dye.
  3. Stop the metformin permanently because contrast exposure makes it unsafe forever.
  4. Double the metformin dose before the scan to keep the glucose controlled.
Show the answer and rationales

Correct answer: A

  • A. Correct . With an eGFR below 30, ACR guidance directs holding metformin at the time of contrast and for 48 hours afterward, restarting only after renal function is reassessed and remains stable, to reduce the risk of lactic acidosis.
  • B. Incorrect . In this client with an eGFR below 30, contrast-related kidney injury can impair metformin clearance and raise lactic acidosis risk, so the drug is held rather than continued.
  • C. Incorrect . The hold is temporary. Metformin is resumed after 48 hours if renal function is rechecked and stable, not discontinued permanently.
  • D. Incorrect . Increasing the dose is unsafe and never indicated around contrast. The correct action is to hold the drug per protocol.

Reference: ACR Manual on Contrast Media (metformin and iodinated contrast); FDA prescribing information (metformin)

Medium Multiple choice

8. Naloxone — monitoring for re-sedation

A client who received IV morphine for postoperative pain becomes difficult to arouse with a respiratory rate of 6/min and pinpoint pupils. The nurse administers IV naloxone as ordered, and within minutes the client's respiratory rate improves to 16/min and the client is awake.

Which statement should guide the nurse's next priority?

  1. Continue close monitoring because naloxone may wear off before the morphine and respiratory depression can return.
  2. Document the response and discharge the client to the unit without further checks.
  3. Restart the morphine infusion now that the client is alert.
  4. Reassure the family that a single naloxone dose fully and permanently reverses the opioid.
Show the answer and rationales

Correct answer: A

  • A. Correct . Naloxone has a shorter duration of action (about 30 to 90 minutes) than most opioids, so re-sedation and respiratory depression can recur once it wears off. Continued surveillance and possible repeat doses are required.
  • B. Incorrect . Stopping monitoring is unsafe because the opioid effect outlasts the naloxone. The client must be watched for the return of respiratory depression.
  • C. Incorrect . Resuming the opioid would re-create the respiratory depression that was just reversed. Any further opioid requires provider reassessment and careful titration.
  • D. Incorrect . One dose does not provide lasting reversal. Because naloxone is short-acting, the client remains at risk and needs ongoing monitoring.

Reference: FDA prescribing information (naloxone hydrochloride injection)

Medium Multiple choice

9. Prednisone — need for further teaching

A client has been taking oral prednisone daily for several months to manage an autoimmune condition. The nurse is reviewing the medication plan with the client before discharge.

Which client statement indicates a need for further teaching?

  1. When my refills run low, I will just stop the prednisone since I am feeling much better now.
  2. I will take this medication with food to protect my stomach.
  3. I will monitor my blood sugar because this drug can raise it.
  4. I will report any signs of infection such as fever or sore throat to my provider.
Show the answer and rationales

Correct answer: A

  • A. Correct . This statement is incorrect and needs correction. Long-term corticosteroids suppress the adrenal axis, so abrupt discontinuation can trigger a life-threatening adrenal crisis. The dose must be tapered under provider guidance.
  • B. Incorrect . This is correct. Taking prednisone with food helps reduce gastric irritation, so no further teaching is needed about this point.
  • C. Incorrect . This is correct. Corticosteroids cause hyperglycemia, so monitoring blood glucose shows accurate understanding.
  • D. Incorrect . This is correct. Prednisone is immunosuppressive and can mask infection, so promptly reporting infection signs is appropriate.

Reference: FDA prescribing information (prednisone); MedlinePlus (prednisone, adrenal insufficiency)

Hard Multiple choice

10. Furosemide — which client to assess first

A nurse on a cardiac unit is starting the shift and reviewing four clients who all receive IV furosemide for fluid overload. The nurse must decide which client to assess first.

Which client should the nurse assess first?

  1. A client who also takes digoxin and whose serum potassium is 2.9 mEq/L.
  2. A client who reports increased urination after the morning dose.
  3. A client whose blood pressure decreased from 150/90 to 134/82 mm Hg.
  4. A client asking when the next scheduled dose is due.
Show the answer and rationales

Correct answer: A

  • A. Correct . Furosemide-induced hypokalemia (potassium 2.9 mEq/L) potentiates digoxin and greatly increases the risk of life-threatening dysrhythmias and digoxin toxicity. This combination makes this client the highest priority.
  • B. Incorrect . Increased urine output is the expected therapeutic effect of a loop diuretic, not a danger requiring urgent assessment.
  • C. Incorrect . This blood pressure change is a desirable response and is not urgent.
  • D. Incorrect . A routine question about timing has no urgency compared with a client at risk for digoxin toxicity from severe hypokalemia.

Reference: FDA prescribing information (furosemide; digoxin)

Hard Select all that apply

11. Heparin — bleeding precautions

A nurse is caring for a client receiving a continuous IV heparin infusion for a deep vein thrombosis. The most recent aPTT is 95 seconds (therapeutic range for this protocol is 46 to 70 seconds).

Which actions should the nurse take? Select all that apply.

  1. Stop or slow the infusion per the facility's heparin protocol.
  2. Notify the provider of the aPTT result.
  3. Assess the client for signs of bleeding, including the gums and urine.
  4. Prepare to administer vitamin K.
  5. Administer the next scheduled dose early to maintain a steady level.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . An aPTT of 95 seconds is well above the therapeutic range — the protocol-driven response is to pause or reduce the infusion rate.
  • B. Correct . A critically supratherapeutic aPTT requires provider notification so orders (rate change, repeat labs, possible reversal) can be adjusted.
  • C. Correct . Excess anticoagulation raises bleeding risk — assessment for bleeding (gums, urine, stool, bruising, neuro changes) is a priority.
  • D. Incorrect . Vitamin K reverses warfarin, not heparin. The antidote for heparin overdose is protamine sulfate.
  • E. Incorrect . Giving more heparin while the aPTT is supratherapeutic would increase the bleeding risk — additional dosing is contraindicated.

Reference: FDA prescribing information (heparin sodium; protamine sulfate)

Hard Select all that apply

12. Mixing NPH and regular insulin in one syringe

A provider orders NPH insulin 20 units and regular insulin 8 units to be drawn up together in a single syringe and given subcutaneously before breakfast. The nurse is preparing the dose.

Which actions are appropriate when preparing this combined insulin dose? Select all that apply.

  1. Inject air into the NPH (cloudy) vial first, then air into the regular (clear) vial.
  2. Withdraw the regular (clear) insulin into the syringe before the NPH.
  3. Have a second nurse independently verify the insulin doses.
  4. Withdraw the NPH (cloudy) insulin into the syringe before the regular.
  5. Vigorously shake the NPH vial to fully dissolve the suspension.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Air is injected into the cloudy vial first and the clear vial second so that the regular vial is entered last and stays uncontaminated when insulin is withdrawn.
  • B. Correct . Clear before cloudy: the regular insulin is drawn up first so a few units of NPH suspension cannot contaminate the clear regular vial.
  • C. Correct . Insulin is a high-alert medication, so an independent double-check of the drug and dose is standard practice to prevent errors.
  • D. Incorrect . Drawing the cloudy NPH first risks contaminating the regular vial with the longer-acting suspension, which can alter the action of future doses.
  • E. Incorrect . NPH is gently rolled between the palms to resuspend it. Shaking introduces air bubbles and froth that make accurate dosing difficult.

Reference: FDA prescribing information (NPH and regular insulin); ATI Pharmacology for Nursing Care

Hard Select all that apply

13. Vancomycin infusion reaction — interventions

Thirty minutes into an IV vancomycin 1 gram infusion ordered to run over 60 minutes, a client develops flushing and an erythematous rash over the face, neck, and upper trunk along with itching. Blood pressure is 96/58 mm Hg. The client reports no throat tightness and is breathing comfortably.

Which actions are appropriate for the nurse to take? Select all that apply.

  1. Stop or pause the vancomycin infusion.
  2. Notify the provider and anticipate an order for an antihistamine such as diphenhydramine.
  3. Plan to resume the infusion at a slower rate, such as over 2 hours, once symptoms resolve.
  4. Increase the infusion rate to finish the dose quickly and end the exposure.
  5. Document the event as a true penicillin-type allergy and flag vancomycin as contraindicated for life.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . The flushing reaction (formerly red man syndrome) is rate-related histamine release. Stopping or slowing the infusion is the first step to control the reaction.
  • B. Correct . Diphenhydramine counteracts the histamine release driving the flushing and itching, and the provider should be informed so orders can be adjusted.
  • C. Correct . Because the reaction is infusion-rate dependent, extending the infusion well beyond the original 60 minutes (for example, 2 hours) reduces histamine release and lets therapy continue safely after the reaction settles.
  • D. Incorrect . A faster rate releases more histamine and worsens the reaction. Slowing, not speeding, the infusion is correct.
  • E. Incorrect . The flushing reaction is an anaphylactoid, rate-related response, not an IgE-mediated allergy. Vancomycin can usually be continued at a slower rate rather than being permanently avoided.

Reference: FDA prescribing information (vancomycin hydrochloride); ASHP/IDSA vancomycin guidance

Keep practising

These same questions are mixed into the interactive quizzes for this domain, where they are graded and feed your spaced-repetition schedule. The timed mock exam draws from every domain at its real test-plan weight.

Study sets in this domain