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NCLEX Pharmacology Practice Questions

Practice medication safety, adverse effects, monitoring and nursing actions with original NCLEX-style questions. The goal is not to memorize a letter pattern. Read the stem, identify the clinical problem, decide what matters most for safety, and compare every option against that priority.

These questions are original Free NCLEX Prep educational items, not official NCSBN questions. Use each rationale to review why the best option fits and why the alternatives are less appropriate. For stronger learning, answer before opening the explanation, then write one short takeaway from any item you miss.

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Question 1 · moderate · Pharmacological and Parenteral Therapies

A nurse is preparing to administer digoxin 0.125 mg oral to an adult with heart failure. Which finding is the priority reason to hold the dose and notify the provider?

  1. Apical pulse 52/min
  2. Blood pressure 138/84 mm Hg
  3. Potassium 4.2 mEq/L
  4. Trace ankle edema
Show answer & rationale
Best answer: A — Apical pulse 52/min

Digoxin slows conduction. An apical rate below the hold parameter (commonly <60/min in adults, per order) is a reason to withhold and notify. Potassium of 4.2 is expected. Mild edema is consistent with treated HF. BP is not the primary hold trigger.

Question 2 · moderate · Pharmacological and Parenteral Therapies

A client taking warfarin for atrial fibrillation reports black, tarry stools. Which laboratory value best supports the nurse’s concern for over-anticoagulation?

  1. INR 5.4
  2. aPTT 38 seconds
  3. Platelets 220,000/mm³
  4. Hemoglobin 13.6 g/dL
Show answer & rationale
Best answer: A — INR 5.4

Warfarin is monitored with INR. An INR well above the typical AF target (often 2–3) plus melena suggests bleeding from excess effect. aPTT tracks unfractionated heparin. Platelets and hemoglobin here are not explanatory of the INR problem.

Question 3 · moderate · Pharmacological and Parenteral Therapies

The nurse is teaching a newly diagnosed adult about insulin safety. Which statements should the nurse include? Select all that apply.

  1. Do not mix insulin glargine with other insulins in the same syringe.
  2. Treat an unconscious client with oral orange juice first.
  3. Rapid-acting insulin has a faster onset than NPH.
  4. Store opened vials according to the product’s labeled room-temperature window.
  5. If two insulins are mixed, draw the cloudy NPH before the clear regular.
Show answer & rationale
Best answer: ['A', 'C', 'D'] —

Glargine is not mixed. Rapid-acting onset is faster than NPH. Opened insulin follows labeled dating. Unconscious hypoglycemia is not treated with oral liquids (aspiration). Clear regular is drawn before cloudy NPH if mixing is ordered.

Question 4 · moderate · Pharmacological and Parenteral Therapies

Fifteen minutes after a hydromorphone IV dose, an adult is difficult to arouse with a respiratory rate of 7/min and SpO2 88% on room air. What is the nurse’s first action?

  1. Call the family to stay at the bedside
  2. Open the airway and support ventilation while preparing naloxone per protocol
  3. Document the findings and reassess in 30 minutes
  4. Increase the next scheduled opioid dose for better pain control
Show answer & rationale
Best answer: B — Open the airway and support ventilation while preparing naloxone per protocol

Opioid-induced respiratory depression is an airway emergency. Stimulate, open the airway, support breathing, and give naloxone as ordered/protocol. Documentation waits. More opioid is harmful.

Question 5 · moderate · Pharmacological and Parenteral Therapies

A client started lisinopril 3 days ago and now has lip swelling and a hoarse voice. What should the nurse do first?

  1. Reassure that ACE cough is expected
  2. Hold the next dose and treat as possible angioedema
  3. Give an extra dose to overcome fluid retention
  4. Switch the client to an ARB independently
Show answer & rationale
Best answer: B — Hold the next dose and treat as possible angioedema

Facial/lip swelling and voice change after an ACE inhibitor suggest angioedema, a potentially airway-threatening reaction. Hold the drug and escalate. Isolated dry cough is different from angioedema. Nurses do not independently substitute ARBs.

Question 6 · moderate · Pharmacological and Parenteral Therapies

Unfractionated heparin infusion is running. Which laboratory result is the most appropriate monitoring value for this therapy?

  1. INR
  2. aPTT
  3. HbA1c
  4. Serum amylase
Show answer & rationale
Best answer: B — aPTT

Unfractionated heparin effect is followed with aPTT (or anti-Xa per protocol). INR monitors warfarin. HbA1c and amylase are unrelated.

Question 7 · moderate · Pharmacological and Parenteral Therapies

A client taking lithium carbonate reports nausea, coarse tremor, and mild confusion after a weekend of vomiting from gastroenteritis. Which interpretation is most accurate?

  1. Expected early therapeutic effects
  2. Possible lithium toxicity after volume loss
  3. Anticholinergic overdose
  4. Need to double the evening dose
Show answer & rationale
Best answer: B — Possible lithium toxicity after volume loss

Dehydration and sodium loss raise lithium levels. Coarse tremor, GI symptoms, and confusion are toxicity clues. The dose should not be increased.

Question 8 · moderate · Pharmacological and Parenteral Therapies

After two days of IV furosemide, a client with heart failure has new muscle cramps and a potassium of 2.8 mEq/L. Which electrocardiographic change is the nurse most concerned about?

  1. Peaked T waves
  2. U waves and flattened T waves
  3. Shortened QT interval only
  4. New left-bundle pattern as an expected diuretic effect
Show answer & rationale
Best answer: B — U waves and flattened T waves

Hypokalemia flattens T waves and may produce U waves and ventricular ectopy. Peaked T waves are hyperkalemia.

Question 9 · moderate · Pharmacological and Parenteral Therapies

Which instruction is most important when teaching levothyroxine administration?

  1. Take with a high-fiber breakfast to improve absorption
  2. Take on an empty stomach, typically 30–60 minutes before breakfast
  3. Stop the drug whenever energy improves
  4. Crush and mix with calcium-fortified juice daily
Show answer & rationale
Best answer: B — Take on an empty stomach, typically 30–60 minutes before breakfast

Levothyroxine absorption is best on an empty stomach. Fiber, calcium, and iron impair absorption. It is long-term replacement, not a stop-when-better drug.

Question 10 · moderate · Pharmacological and Parenteral Therapies

Vancomycin is infusing and the client develops flushing of the face and neck without airway compromise or hypotension. What is the priority nursing action?

  1. Stop and treat as anaphylaxis with IM epinephrine first
  2. Slow the infusion and notify the provider; this pattern suggests red-man (infusion) reaction
  3. Double the remaining rate to finish sooner
  4. Ignore flushing because it proves the drug is working
Show answer & rationale
Best answer: B — Slow the infusion and notify the provider; this pattern suggests red-man (infusion) reaction

Rapid vancomycin infusion can cause histamine release (red-man). Slowing the infusion is first-line when the airway is stable. True anaphylaxis with airway/hemodynamic collapse is a different pathway.

How to use this practice well

Start with one pass without notes. On review, separate a knowledge gap from a decision-making gap. If you did not know a fact, review that concept. If you knew the facts but chose the wrong action, identify the cue or priority rule you overlooked. This keeps practice focused on clinical reasoning instead of raw question volume.

Build a repeatable NCLEX routine

Mix focused practice with broader daily sets. Focused pages help repair a specific weakness; mixed sets test whether you can recognize the problem when the category is not announced. As your exam approaches, add timed work and longer sessions, but keep rationale review central. Accuracy, reasoning and consistency matter more than rushing through a large bank.

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