NCLEX Pharmacological and Parenteral Therapies Practice Test
What is in this test
| Topic | Focus | Items |
|---|---|---|
| Medication Administration | Routes, rights and high-alert handling | 7 |
| Cardiovascular Medications | Digoxin, beta blockers, ACE inhibitors and nitrates | 4 |
| Dosage Calculation | Formulas that cover almost every item | 4 |
| Anti-Infective Therapy | Antibiotics, antifungals, antivirals and antitubercular drugs | 4 |
| Pain Management and Sedation | Opioids, adjuncts and monitoring | 3 |
| IV Therapy, Blood Products and TPN | Solutions, complications and transfusion safety | 3 |
| Psychotropic Medications | Antidepressants, mood stabilisers and antipsychotics | 3 |
| Anticoagulants and Antiplatelets | Monitoring, antidotes and bleeding precautions | 2 |
Item formats in this test: Multiple choice, Fill in the blank, Select all that apply, Ordered response, Audio item, Video item. This is test 5 of 9 — there is one for every client-need category.
The 30 questions
A nurse is preparing to administer digoxin to an adult client. The apical pulse is 54 beats per minute. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Hold the dose and notify the provider
Digoxin slows conduction through the atrioventricular node. An apical pulse below 60 in an adult means the dose is held and the provider is notified, because giving it risks profound bradycardia and heart block.
Why the other options are wrong
- A. Giving a rate-slowing drug to a client who is already bradycardic worsens the problem.
- C. Nurses do not alter prescribed doses.
- D. Food changes absorption speed but does not make the dose safe at this heart rate.
A provider prescribes 375 milligrams of an oral suspension. The pharmacy supplies 125 milligrams in 5 millilitres. How many millilitres should the nurse administer? Record your answer as a whole number.
Show answer and rationale
Answer: 15
Desired divided by Have, multiplied by Quantity: 375 divided by 125 equals 3, multiplied by 5 millilitres equals 15 millilitres.
A nurse finds a client’s spouse pressing the patient-controlled analgesia button while the client sleeps. Which action should the nurse take first?
Show answer and rationale
Correct answer: B. Ask the spouse to stop and explain why only the client may press the button
Only the client may press the button, because a sedated client cannot self-administer and this built-in safeguard is what prevents overdose. The nurse stops the behaviour immediately and teaches the reason.
Why the other options are wrong
- A. Documentation follows the intervention; it does not stop the immediate risk.
- C. Removing effective analgesia punishes the client for the family’s misunderstanding.
- D. Changing the route is not indicated when teaching will resolve the problem.
A nurse is preparing to give an intramuscular injection to a 4-month-old infant. Which site should the nurse select?
Show answer and rationale
Correct answer: C. Vastus lateralis
The vastus lateralis is the preferred intramuscular site for infants because it is the largest developed muscle at that age and contains no major nerves or vessels.
Why the other options are wrong
- A. The deltoid is too small in an infant and accommodates only tiny volumes even in adults.
- B. The dorsogluteal site is no longer recommended at any age because of sciatic nerve risk.
- D. The ventrogluteal site is excellent in older children and adults but the gluteal muscles are underdeveloped in infants.
A nurse is teaching a client about sublingual nitroglycerin for angina. Which statement indicates correct understanding?
Show answer and rationale
Correct answer: B. "If the pain is not gone after one tablet, I will call emergency services."
Current teaching is to call emergency services if chest pain is unrelieved five minutes after the first dose, then continue up to three doses five minutes apart while help is on the way.
Why the other options are wrong
- A. Swallowing destroys the sublingual route and delays the effect through first-pass metabolism.
- C. Hourly dosing delays emergency care during a possible myocardial infarction.
- D. Light and heat degrade nitroglycerin. It is kept in its original dark container away from light.
A client is prescribed both an albuterol inhaler and a fluticasone inhaler. Which instruction should the nurse give?
Show answer and rationale
Correct answer: B. "Use the albuterol first, wait a few minutes, then use the fluticasone and rinse your mouth."
The bronchodilator opens the airways so that the corticosteroid can reach the smaller airways. Rinsing after the steroid prevents oral candidiasis.
Why the other options are wrong
- A. Giving the steroid into constricted airways reduces the amount that reaches the lung.
- C. Simultaneous use is not possible with metered-dose inhalers and provides no benefit.
- D. Fluticasone is a controller medication taken on schedule, not a rescue inhaler.
A client taking digoxin reports several new symptoms. Which findings suggest digoxin toxicity? Select all that apply.
- ANausea and loss of appetite
- BSeeing yellow-green halos around lights
- CA persistent dry cough
- DNew irregular heartbeat
- EIncreased urine output with clear urine
Show answer and rationale
Correct answers: A. Nausea and loss of appetite; B. Seeing yellow-green halos around lights; D. New irregular heartbeat
Gastrointestinal upset with anorexia, visual disturbance including yellow-green or halo vision, and new dysrhythmias are the classic triad of digoxin toxicity.
Why the other options are wrong
- C. A dry persistent cough is characteristic of ACE inhibitors, not digoxin.
- E. Increased dilute urine output is not a feature of digoxin toxicity.
A client is to receive 1,000 millilitres of intravenous fluid over 8 hours. The administration set delivers 15 drops per millilitre. How many drops per minute should the nurse set? Record your answer as a whole number.
Show answer and rationale
Answer: 31
Volume times drop factor divided by time in minutes: 1,000 times 15 equals 15,000, divided by 480 minutes equals 31.25, which rounds to 31 drops per minute.
A child weighs 44 pounds. The prescribed dose is 15 milligrams per kilogram per dose. How many milligrams should the nurse administer for one dose? Record your answer as a whole number.
Show answer and rationale
Answer: 300
Convert 44 pounds to kilograms by dividing by 2.2, which gives 20 kilograms. Multiply 20 by 15 milligrams per kilogram to get 300 milligrams.
A client is prescribed an infusion of 500 millilitres to run over 4 hours by pump. At how many millilitres per hour should the nurse set the pump? Record your answer as a whole number.
Show answer and rationale
Answer: 125
Total volume divided by total hours: 500 millilitres divided by 4 hours equals 125 millilitres per hour.
A client receiving a continuous heparin infusion has a platelet count that has fallen from 240,000 to 105,000 per cubic millimetre over three days. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Notify the provider immediately, as this suggests heparin-induced thrombocytopenia
A fall in platelets of roughly 50 percent from baseline during heparin therapy suggests heparin-induced thrombocytopenia, a paradoxical prothrombotic state. All heparin, including flushes, must stop and an alternative anticoagulant is required.
Why the other options are wrong
- A. Waiting allows a potentially limb-threatening or life-threatening thrombosis to develop.
- C. Increasing heparin worsens the immune reaction driving the platelet drop.
- D. Protamine reverses bleeding from heparin; it does not treat heparin-induced thrombocytopenia and is not given prophylactically.
A nurse is teaching a client newly prescribed warfarin. Which client statement indicates correct understanding?
Show answer and rationale
Correct answer: B. "I will keep the amount of leafy greens I eat about the same each week."
Warfarin works by antagonising vitamin K. The goal is consistency of vitamin K intake, not elimination, so that the international normalised ratio remains stable between checks.
Why the other options are wrong
- A. Eliminating green vegetables removes valuable nutrition and causes the international normalised ratio to swing when the client inevitably eats them again.
- C. Doubling up increases bleeding risk. A missed dose is reported and taken according to instruction, not doubled.
- D. Non-steroidal anti-inflammatory drugs increase bleeding risk and gastrointestinal irritation on warfarin.
Fifteen minutes into a transfusion, a client develops chills, fever and back pain. Place the nursing actions in the correct order, from first to last.
- AStop the transfusion
- BInfuse normal saline through new tubing to keep the line open
- CObtain vital signs and remain with the client
- DNotify the provider and the blood bank
Show answer and rationale
Correct order: 1) A. Stop the transfusion 2) B. Infuse normal saline through new tubing to keep the line open 3) C. Obtain vital signs and remain with the client 4) D. Notify the provider and the blood bank
Stopping the transfusion halts further exposure. New tubing prevents pushing more of the implicated blood into the client while keeping venous access. Assessment and staying with the client come next, then notification.
A nurse assesses a peripheral intravenous site and finds the area cool, pale and swollen, with the infusion slowing. Which complication does this describe?
Show answer and rationale
Correct answer: B. Infiltration
Infiltration is leakage of non-vesicant fluid into surrounding tissue, producing coolness, pallor, swelling and a slowing infusion. The infusion is stopped and the catheter removed.
Why the other options are wrong
- A. Phlebitis is inflammation of the vein and presents as warmth, redness and a palpable cord along the vein.
- C. Air embolism presents with sudden dyspnoea, chest pain and hypotension, not local site changes.
- D. Bloodstream infection presents with fever and systemic signs, often with purulent drainage at the site.
A nurse is caring for a client receiving intravenous morphine after surgery. Which assessment finding requires immediate action?
Show answer and rationale
Correct answer: A. Respiratory rate of 7 breaths per minute with difficulty rousing the client
A respiratory rate of 7 with increasing sedation indicates opioid-induced respiratory depression. The nurse stops the opioid, stimulates the client, supports ventilation and prepares naloxone.
Why the other options are wrong
- B. Itching is a common histamine-related opioid effect and is uncomfortable rather than dangerous.
- C. Constipation is expected with opioids and requires a bowel regimen, but not immediate action.
- D. Pain at 3 out of 10 suggests the analgesia is working.
A client has difficulty swallowing tablets. Which medications must the nurse never crush? Select all that apply.
- AAn enteric-coated tablet
- BAn extended-release tablet
- CA scored immediate-release tablet
- DA sublingual tablet
- EA standard uncoated tablet
Show answer and rationale
Correct answers: A. An enteric-coated tablet; B. An extended-release tablet; D. A sublingual tablet
Enteric coatings protect the drug from stomach acid or protect the stomach from the drug. Extended-release forms deliver the entire dose at once if crushed. Sublingual tablets are designed to dissolve under the tongue and bypass first-pass metabolism.
Why the other options are wrong
- C. A scored immediate-release tablet is designed to be divided and may usually be crushed.
- E. A standard uncoated tablet may generally be crushed unless the manufacturer states otherwise.
A client taking lithium develops vomiting and diarrhoea from a stomach virus. Which instruction should the nurse give?
Show answer and rationale
Correct answer: B. "Contact your provider now, because dehydration can raise your lithium level."
Lithium is excreted by the kidneys and competes with sodium for reabsorption. Fluid and sodium loss from vomiting and diarrhoea raises the lithium level and can precipitate toxicity, so the client contacts the provider promptly.
Why the other options are wrong
- A. Doubling the dose during dehydration is a direct route to toxicity.
- C. Fluid restriction worsens dehydration and further concentrates the lithium.
- D. Non-steroidal anti-inflammatory drugs reduce lithium clearance and raise the level.
Twenty minutes into an intravenous vancomycin infusion, a client develops flushing of the face and upper torso with pruritus. Blood pressure is 108/64 mmHg. Which action should the nurse take first?
Show answer and rationale
Correct answer: B. Slow or pause the infusion and notify the provider
Flushing of the face and torso during a vancomycin infusion is an infusion-rate-related histamine release rather than a true allergy. Slowing or pausing the infusion and notifying the provider is the appropriate first response, and the drug is usually continued over a longer period.
Why the other options are wrong
- A. Labelling it an allergy removes an important antibiotic from the client’s options for life, and this reaction is rate-related.
- C. Epinephrine is for anaphylaxis with airway compromise or shock, which is not present here.
- D. Continuing at the same rate worsens the histamine release.
A client starting rifampin for tuberculosis asks about side effects. Which statement by the nurse is accurate?
Show answer and rationale
Correct answer: A. "Your urine, sweat and tears may turn orange, which is expected."
Rifampin causes a harmless orange-red discoloration of urine, sweat, tears and saliva. Clients need to know this in advance, and that soft contact lenses may be permanently stained.
Why the other options are wrong
- B. Blue-grey skin discoloration is associated with long-term amiodarone.
- C. Ototoxicity is characteristic of aminoglycosides and vancomycin.
- D. Gingival hyperplasia is characteristic of phenytoin.
A nurse is mixing regular insulin and NPH insulin in one syringe. Place the steps in the correct order, from first to last.
- AInject air equal to the dose into the NPH vial without touching the solution
- BInject air equal to the dose into the regular insulin vial
- CWithdraw the regular insulin dose
- DWithdraw the NPH insulin dose
Show answer and rationale
Correct order: 1) A. Inject air equal to the dose into the NPH vial without touching the solution 2) B. Inject air equal to the dose into the regular insulin vial 3) C. Withdraw the regular insulin dose 4) D. Withdraw the NPH insulin dose
Air is injected into the cloudy NPH vial first, then into the clear regular vial. Regular insulin is then drawn up before NPH so that no cloudy suspension contaminates the clear vial.
A client receives NPH insulin at 0700. At which time should the nurse be most alert for signs of hypoglycaemia?
Show answer and rationale
Correct answer: C. 1100 to 1900
NPH is an intermediate-acting insulin with an onset of one to two hours and a peak of roughly 4 to 12 hours. Given at 0700, that peak falls across late morning through early evening.
Why the other options are wrong
- A. This window matches a rapid-acting analogue such as lispro, not NPH.
- B. This is closer to the peak of regular insulin given at 0700.
- D. This is beyond the usual NPH peak, though a residual effect may persist.
A provider prescribes blood cultures and an intravenous antibiotic for a client with suspected sepsis. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Draw the blood cultures first, then start the antibiotic without delay
Cultures are obtained before the first antibiotic dose because prior exposure can suppress growth and produce a false negative. Obtaining them must not meaningfully delay antibiotic administration in sepsis.
Why the other options are wrong
- A. Giving the antibiotic first risks a negative culture and losing the chance to target therapy.
- C. A culture drawn after antibiotic exposure is unreliable.
- D. Waiting days for culture results in sepsis dramatically increases mortality.
A provider prescribes potassium chloride 20 mEq for a client with a potassium level of 3.0 mEq/L. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Dilute it and infuse it on a pump, verifying adequate urine output first
Potassium is always diluted and infused on a pump at a controlled rate. Adequate urine output is confirmed first, because potassium is excreted renally and giving it to an anuric client causes dangerous accumulation.
Why the other options are wrong
- A. Intravenous push potassium causes cardiac arrest and is never done.
- C. A central line does not make undiluted potassium safe.
- D. Uncontrolled gravity infusion of potassium risks a rapid, fatal rise in serum potassium.
A client who began lisinopril two days ago presents with swelling of the lips and tongue. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Assess the airway and notify the provider immediately, anticipating the drug will be stopped
Angioedema from an ACE inhibitor can progress to complete airway obstruction. The airway is assessed immediately, the provider is notified, the drug is stopped and the class is contraindicated for the client thereafter.
Why the other options are wrong
- A. A dry cough is the common effect. Angioedema is uncommon and potentially fatal.
- C. Food does not alter an immune-mediated reaction, and continuing the drug is dangerous.
- D. Substituting a drug is a prescribing decision and requires provider evaluation.
A client is prescribed acetaminophen 650 milligrams every 6 hours as needed and also takes an over-the-counter cold remedy containing 325 milligrams of acetaminophen per dose four times daily. Which nursing action is most appropriate?
Show answer and rationale
Correct answer: B. Calculate the total daily acetaminophen and discuss the combined intake with the provider
Hidden acetaminophen in combination products is a leading cause of unintentional hepatotoxicity. The total from all sources must stay within the daily maximum, so the nurse calculates the combined dose and involves the provider.
Why the other options are wrong
- A. Each product alone may be within limits while the combination is not.
- C. Deciding which prescription to stop is outside the nurse’s scope.
- D. Taking both together compounds the very problem being assessed.
Client taking ciprofloxacin — transcript
Listen to the recorded client statement, then choose the nurse’s best response.
Show answer and rationale
Correct answer: B. "Stop taking the ciprofloxacin and contact your provider today, because this may be tendon inflammation."
Fluoroquinolones such as ciprofloxacin carry a risk of tendinitis and tendon rupture, most commonly of the Achilles tendon. New tendon pain without injury is reported immediately and the drug is usually stopped.
Why the other options are wrong
- A. Dismissing the symptom risks a complete tendon rupture.
- C. Continuing to load an inflamed tendon increases rupture risk, and non-steroidal anti-inflammatories may add to it.
- D. The symptom is a recognised effect of the class and must not be dismissed.
Subcutaneous enoxaparin administration — transcript
Watch the demonstration of a subcutaneous enoxaparin injection, then identify the technique error.
Show answer and rationale
Correct answer: B. The air bubble was expelled and the site was massaged afterwards
The air bubble in a prefilled enoxaparin syringe ensures the full dose is delivered and seals the tract, so it is not expelled. Massaging the site afterwards increases bruising and haematoma formation and is avoided.
Why the other options are wrong
- A. Five centimetres from the umbilicus is an appropriate abdominal site.
- C. With a skin fold held, a 90 degree angle is correct for enoxaparin.
- D. Holding a skin fold is the recommended technique for this injection.
A client is prescribed a monoamine oxidase inhibitor. Which foods should the nurse teach the client to avoid? Select all that apply.
- AAged cheddar cheese
- BFresh chicken breast
- CSalami and other cured meats
- DDraught beer
- EWhite rice
Show answer and rationale
Correct answers: A. Aged cheddar cheese; C. Salami and other cured meats; D. Draught beer
Aged cheeses, cured and fermented meats, and tap or draught beer are high in tyramine. With monoamine oxidase inhibited, tyramine causes a surge in norepinephrine and can trigger a hypertensive crisis.
Why the other options are wrong
- B. Fresh unprocessed meat is low in tyramine and is permitted.
- E. Plain rice contains no tyramine.
A client is receiving total parenteral nutrition. The next bag is delayed in the pharmacy and the current bag is nearly empty. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Hang 10 percent dextrose in water at the same rate
Abrupt cessation of total parenteral nutrition can cause rebound hypoglycaemia because the pancreas is still producing insulin in response to the high glucose load. Hanging 10 percent dextrose maintains the glucose supply until the next bag arrives.
Why the other options are wrong
- A. Stopping abruptly is precisely what causes rebound hypoglycaemia.
- C. Deliberately slowing the rate delivers less glucose than the client is adapted to and also risks hypoglycaemia.
- D. Normal saline contains no glucose and does not prevent the rebound.
A client taking haloperidol develops a temperature of 40 degrees Celsius, generalised muscle rigidity, confusion and a blood pressure that is fluctuating widely. Which action should the nurse take first?
Show answer and rationale
Correct answer: B. Withhold the haloperidol and notify the provider immediately
Fever, lead-pipe rigidity, altered mental status and autonomic instability describe neuroleptic malignant syndrome, a life-threatening reaction. The antipsychotic is stopped at once and the provider is notified so supportive treatment can begin.
Why the other options are wrong
- A. Continuing the causative drug worsens a potentially fatal reaction.
- C. Diphenhydramine treats acute dystonia, which presents as muscle spasm without fever or autonomic instability.
- D. Cooling is part of supportive care, but delaying notification for an hour in a life-threatening syndrome is unsafe.
What to do with your score
A single 30-item set is too short to predict a pass, so treat the number as a pointer rather than a verdict. What is worth acting on is the pattern: go back through every item you missed, and write down whether you lacked the fact, misread what the item asked for, or knew the fact and still picked second-best. Those three failures need three different fixes — more content review, slower reading, or priority-framework drilling.
Read the rationale on the items you got right too. On a well-written item you can arrive at the correct option for the wrong reason, and that will not survive a harder version of the same question.
More NCLEX practice and review
Everything on this site tagged NCLEX lives in the NCLEX category.
Sources