Practice Pharmacological & Parenteral Therapies questions for the National Council Licensure Examination — RN. Every question includes a full explanation of why the correct answer is right and why the tempting distractors are wrong.
69 questions available · hard difficulty · NCLEX-RN · Free, no registration required
10 example questions with full explanations. Use the interactive practice above to work through the complete set.
Question 1medium
A nurse is caring for a client who takes digoxin 0.125 mg daily for heart failure. The morning laboratory results show a serum potassium level of 3.1 mEq/L. The client's apical pulse is 64 beats per minute. Which action should the nurse take FIRST?
- A.Encourage the client to eat a potassium-rich food such as a banana before giving digoxin
- B.Hold the digoxin and notify the healthcare provider of the potassium level✓
- C.Recheck the potassium level in four hours before making any clinical decision
- D.Administer the digoxin as scheduled since the heart rate is above 60 bpm
Correct answer: B
Hypokalemia (potassium < 3.5 mEq/L) increases the myocardium's sensitivity to digoxin, significantly raising the risk of digoxin toxicity even when serum digoxin levels appear therapeutic. The nurse should hold the dose and promptly notify the provider so potassium replacement and further orders can be addressed. Administering digoxin despite hypokalemia (Option D) ignores the drug-electrolyte interaction. Offering a banana (Option A) is insufficient to correct a potassium of 3.1 mEq/L quickly and does not constitute a safe nursing action before administering the drug. Waiting four hours (Option C) delays necessary intervention and puts the client at risk.
Question 2medium
A client who is 16 weeks pregnant is being treated for a deep vein thrombosis. The healthcare provider plans to initiate anticoagulation therapy. Which medication is safest to administer to this client?
- A.Rivaroxaban (Xarelto) administered orally
- B.Warfarin (Coumadin) administered orally
- C.Enoxaparin (Lovenox) administered subcutaneously✓
- D.Dabigatran (Pradaxa) administered orally
Correct answer: C
Enoxaparin, a low-molecular-weight heparin, does not cross the placental barrier and is considered safe for use during pregnancy. Warfarin (Option B) is a category X medication in the first trimester and is contraindicated throughout pregnancy due to its teratogenic effects and risk of fetal hemorrhage. Dabigatran (Option D) and rivaroxaban (Option A) are newer oral anticoagulants that are contraindicated in pregnancy due to insufficient safety data and potential fetal harm. Enoxaparin is the standard of care for anticoagulation management in pregnant clients.
Question 3medium
A client receiving a blood transfusion develops chills, flank pain, and dark-colored urine 30 minutes into the infusion. The nurse suspects a hemolytic transfusion reaction. After stopping the transfusion, which action should the nurse perform NEXT?
- A.Restart the transfusion at a slower rate and continue to monitor the client
- B.Obtain a urine specimen for culture and sensitivity to rule out a urinary tract infection
- C.Administer diphenhydramine (Benadryl) intravenously as prescribed to treat the reaction
- D.Maintain IV access with normal saline and notify the blood bank and healthcare provider✓
Correct answer: D
A hemolytic transfusion reaction is a life-threatening emergency caused by ABO incompatibility. After stopping the transfusion immediately, the nurse must keep the IV line open with normal saline (not the blood tubing), then notify the healthcare provider and blood bank so the blood product can be returned for analysis and further treatment can be initiated. Diphenhydramine (Option C) is used for allergic reactions, not hemolytic reactions. Restarting the transfusion at a slower rate (Option A) is dangerous and contraindicated when a hemolytic reaction is suspected. Obtaining a urine culture (Option B) is not the priority; the dark urine reflects hemoglobinuria from red cell destruction, not infection.
Question 4medium
A client is receiving TPN through a central venous catheter. During the shift, the nurse notes that the TPN bag has run out and a new bag is not yet available from the pharmacy. Which action should the nurse take?
- A.Infuse 10% dextrose in water (D10W) at the same rate as the TPN until the new bag arrives✓
- B.Administer a 50% dextrose bolus to prevent hypoglycemia while waiting for TPN
- C.Flush the central line with heparin and cap it until the new TPN bag is available
- D.Infuse normal saline at the same rate as the TPN until the new bag arrives
Correct answer: A
When TPN is interrupted or unavailable, a 10% dextrose solution should be infused at the same rate to prevent rebound hypoglycemia, which occurs because the body continues producing excess insulin in response to the high glucose load of TPN. Normal saline (Option D) contains no dextrose and will not prevent hypoglycemia in a client whose pancreas is still secreting high levels of insulin. Capping the line (Option C) leaves the client with no glucose source and risks severe hypoglycemia, in addition to increasing central line occlusion risk.B50% dextrose bolus (Option B) would cause a dangerous hyperglycemic spike and is not the appropriate intervention.
Question 5hard
A nurse is preparing to administer the morning insulin to a client with type 1 diabetes. The medication administration record orders 18 units of insulin glargine and 6 units of insulin lispro before breakfast. The client's breakfast tray has not yet arrived. Which action by the nurse reflects the BEST clinical judgment?
- A.Administer insulin lispro now because rapid-acting insulin has a delayed onset of at least 30 minutes, providing time for the tray to arrive.
- B.Administer insulin glargine now and hold insulin lispro until the meal tray arrives and the client is ready to eat.✓
- C.Administer both insulin glargine and insulin lispro now, then ensure the breakfast tray arrives within 30 minutes.
- D.Hold both insulins until the breakfast tray is present, as neither should be given without food available.
Correct answer: B
Insulin glargine is a long-acting basal insulin with no pronounced peak; it provides a steady background insulin level and is given regardless of meal timing, typically once daily. It does not require a meal to be present. Insulin lispro is a rapid-acting analog with an onset of approximately 15 minutes and a peak of 30–90 minutes; it must be administered immediately before eating (or with a meal) to match the postprandial glucose rise and prevent hypoglycemia. Therefore, the correct action is to give the basal insulin glargine now and withhold lispro until the meal tray is present. Option B is dangerous because giving lispro without food risks severe hypoglycemia. Option D is incorrect because glargine does not require meal timing. Option A is factually wrong — lispro's onset is approximately 15 minutes, not 30+ minutes, and administering it without food present is unsafe.
Question 6hard
A nurse is administering a chemotherapy infusion of doxorubicin through a peripheral IV when the client reports burning pain at the IV site. The nurse assesses the site and notes swelling, pallor, and absence of blood return on aspiration. The infusion pump shows no occlusion alarm. Which sequence of actions reflects CORRECT priority management of this situation?
- A.Stop the infusion immediately, remove the catheter, apply ice to the site, restart the infusion in a new site, and document the occurrence.
- B.Stop the infusion, flush the catheter with 20 mL of normal saline to clear the drug, remove the catheter, and apply a warm compress.
- C.Stop the infusion, leave the IV catheter in place, aspirate as much drug as possible through the catheter, administer the appropriate antidote per protocol, and notify the provider and pharmacy.✓
- D.Slow the infusion rate, apply a warm compress to the site to dilute the drug, reassess in 15 minutes, and notify the provider if symptoms worsen.
Correct answer: C
The clinical picture — burning pain, swelling, pallor, and no blood return — indicates extravasation of a vesicant chemotherapy agent (doxorubicin is a vesicant that causes severe tissue necrosis). The correct management of vesicant extravasation is: (1) STOP the infusion immediately, (2) leave the catheter in place to aspirate residual drug and administer antidote if applicable, (3) aspirate as much drug as possible through the catheter, (4) administer the specific antidote per protocol (dexrazoxane is the antidote for anthracycline/doxorubicin extravasation), and (5) notify the provider and pharmacy/oncology team. The catheter must NOT be removed before aspiration and antidote administration because the catheter provides direct access to the extravasation site. Option D is dangerously wrong — the infusion must be stopped immediately and warm compresses are not appropriate for doxorubicin (cold is used). Option A incorrectly removes the catheter before aspirating the drug and misses antidote administration. Option B incorrectly flushes with saline, which would push more drug into the tissue.
Question 7medium
A nurse is caring for a patient receiving a continuous heparin infusion who suddenly becomes unresponsive with a blood pressure of 70/40 mmHg and diffuse bleeding from IV sites. The nurse suspects heparin-induced bleeding. Which medication should the nurse prepare to administer?
- A.Flumazenil
- B.Vitamin K (phytonadione)
- C.Naloxone (Narcan)
- D.Protamine sulfate✓
Correct answer: D
Protamine sulfate is the specific antidote for heparin overdose. It binds to heparin and neutralizes its anticoagulant effect, making it the correct choice in a heparin-induced bleeding emergency. Vitamin K is the antidote for warfarin, not heparin, making option B incorrect. Naloxone reverses opioid toxicity, and flumazenil reverses benzodiazepine toxicity — neither is relevant to anticoagulant overdose.
Question 8medium
A nurse is assessing a patient's peripheral IV site and notes that the area surrounding the catheter is cool, pale, swollen, and the infusion rate has slowed. The patient denies pain at the site. Which condition does the nurse recognize, and what is the priority action?
- A.Infiltration; discontinue the IV and restart it in a new site✓
- B.Extravasation; administer the appropriate antidote through the existing catheter
- C.Phlebitis; apply a warm compress and continue the infusion at a slower rate
- D.Air embolism; place the patient in Trendelenburg position and notify the provider
Correct answer: A
The signs described — coolness, pallor, swelling, and slowed infusion — are classic indicators of infiltration, which occurs when non-vesicant IV fluid leaks into surrounding tissue. The priority action is to discontinue the IV immediately and restart it at a new site to prevent further tissue damage. Phlebitis presents with warmth, redness, and tenderness along the vein, ruling out option C. Extravasation involves vesicant medications and causes tissue necrosis, but the scenario does not specify a vesicant drug, ruling out option B. Option D describes a different complication unrelated to the findings.
Question 9medium
A nurse is preparing to administer a scheduled dose of oral morphine to a patient with chronic pain. Before giving the medication, the nurse notes the patient's respiratory rate is 10 breaths/min and the patient is difficult to arouse. What is the nurse's priority action?
- A.Administer naloxone and then give the scheduled morphine dose
- B.Withhold the medication and notify the provider immediately✓
- C.Administer the dose as scheduled since the patient has a prescription for it
- D.Reduce the dose by half and document the clinical findings
Correct answer: B
A respiratory rate of 10 breaths/min combined with decreased level of arousal indicates opioid-induced respiratory depression, and the nurse must withhold the medication and notify the provider immediately to prevent life-threatening respiratory failure. Administering the scheduled dose (option C) or a reduced dose (option D) would worsen the patient's condition. Naloxone (option A) is indicated for existing opioid overdose reversal, but giving it and then administering more morphine is contradictory and unsafe; the provider must be notified before any further opioid is given.
Question 10medium
A nurse is about to administer an afternoon dose of insulin lispro to a patient whose lunch tray has not yet arrived. The patient's blood glucose is 210 mg/dL. What is the most appropriate nursing action?
- A.Administer the insulin lispro now so it is ready to act when the meal arrives
- B.Administer half the prescribed dose now and the other half when the tray arrives
- C.Hold the insulin lispro until the meal tray arrives and the patient begins eating✓
- D.Substitute regular insulin for insulin lispro since the meal is delayed
Correct answer: C
Insulin lispro is a rapid-acting insulin with an onset of approximately 15 minutes and a peak of 30–90 minutes. It must be administered when the patient is ready to eat or has food immediately available to prevent hypoglycemia. Giving it before the meal tray arrives (option A) risks dangerous hypoglycemia if food is delayed further. Substituting a different insulin type (option D) requires a provider's order and is not within the nurse's independent scope. Splitting the dose (option B) is not a standard or safe practice and is not provider-ordered.