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Nursing Pharmacology · Nursing Pharmacology NCLEX Practice Questions

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Showing all 15 practice questions with expert explanatory rationales.

Question 1 of 15

Case excerpt

A patient taking warfarin reports black, tarry stools and dizziness when standing. The latest INR is 5.2.

Which nursing action is the priority?

A. Administer the next dose with food
B. Give an over-the-counter aspirin for discomfort
C. Reassure the patient that dark stools are expected
D. Encourage the patient to increase leafy greens immediately
E. Hold the warfarin and promptly notify the prescriber

Expert Explanatory Rationale

Correct Answer: E. Hold the warfarin and promptly notify the prescriber

Melena and dizziness with a markedly elevated INR suggest significant bleeding. Hold the anticoagulant and urgently notify the prescriber for evaluation.

Question 2 of 15

Case excerpt

A patient with type 1 diabetes is NPO for a procedure and has a scheduled dose of rapid-acting insulin with breakfast.

In the case involving a patient with type 1 diabetes is npo for a procedure and has a scheduled dose of rapid-acting insulin with breakfast, what is the nurse's best response?

A. Withhold all insulin for the entire day
B. Give the full dose because it is scheduled
C. Give the dose after the procedure without checking glucose
D. Clarify the insulin order and coordinate glucose monitoring and nutrition status
E. Replace the insulin with a sulfonylurea

Expert Explanatory Rationale

Correct Answer: D. Clarify the insulin order and coordinate glucose monitoring and nutrition status

Rapid-acting mealtime insulin is linked to food intake. The nurse should clarify the plan and monitor glucose; basal insulin needs are considered separately.

Question 3 of 15

Case excerpt

A patient receiving IV vancomycin develops flushing and itching over the face and upper torso during infusion.

What is the most appropriate initial response?

A. Increase the infusion rate to finish sooner
B. Administer the next dose early
C. Stop or slow the infusion according to protocol and assess the patient
D. Document the reaction as an expected therapeutic effect
E. Encourage ambulation

Expert Explanatory Rationale

Correct Answer: C. Stop or slow the infusion according to protocol and assess the patient

Flushing and pruritus during vancomycin infusion may indicate an infusion-related reaction. Stop or slow the infusion and assess; follow orders and protocol.

Question 4 of 15

Case excerpt

A patient prescribed lisinopril reports swelling of the lips and tongue and difficulty swallowing.

Given the medication concern involving a patient prescribed lisinopril reports swelling of the lips and tongue and difficulty swallowing, which action should the nurse take?

A. Ask the patient to lie flat and wait 30 minutes
B. Treat this as possible angioedema and activate urgent emergency care
C. Document the symptom for the next routine visit
D. Tell the patient to take the next dose with food
E. Recommend an antacid

Expert Explanatory Rationale

Correct Answer: B. Treat this as possible angioedema and activate urgent emergency care

ACE inhibitor-associated angioedema can compromise the airway and requires immediate emergency assessment and discontinuation pending prescriber evaluation.

Question 5 of 15

Case excerpt

A patient taking digoxin has nausea, yellow-green halos around lights and a pulse of 48/min.

Which action is appropriate?

A. Hold the dose and notify the prescriber; anticipate a digoxin level and electrolyte assessment
B. Give an extra dose to improve cardiac output
C. Encourage a high-calcium diet
D. Recheck the pulse at the next appointment
E. Administer digoxin with a snack

Expert Explanatory Rationale

Correct Answer: A. Hold the dose and notify the prescriber; anticipate a digoxin level and electrolyte assessment

Bradycardia, gastrointestinal symptoms and visual changes suggest digoxin toxicity. Hold the medication and report promptly.

Question 6 of 15

Case excerpt

A patient with asthma uses an albuterol inhaler several times daily and reports increasing nighttime symptoms.

What should the nurse emphasize?

A. Double every dose without consulting the prescriber
B. Use albuterol only after an attack becomes severe
C. Frequent rescue-inhaler use indicates the need for reassessment of asthma control
D. Stop the inhaled corticosteroid when symptoms improve
E. Share the inhaler with family members

Expert Explanatory Rationale

Correct Answer: C. Frequent rescue-inhaler use indicates the need for reassessment of asthma control

Increasing rescue medication use and nighttime symptoms suggest poor control and require review of the treatment plan.

Question 7 of 15

Case excerpt

A patient receiving morphine after surgery is difficult to arouse, with a respiratory rate of 7/min.

Which medication should the nurse anticipate?

A. Protamine sulfate
B. Naloxone
C. Vitamin K
D. Atropine
E. Flumazenil

Expert Explanatory Rationale

Correct Answer: B. Naloxone

Naloxone is an opioid antagonist used for clinically significant opioid-induced respiratory depression. Support airway and breathing and monitor for recurrence.

Question 8 of 15

Case excerpt

A patient taking lithium for bipolar disorder develops diarrhea, coarse tremors and an unsteady gait after several days of vomiting.

In the case involving a patient taking lithium for bipolar disorder develops diarrhea, coarse tremors and an unsteady gait after several days of vomiting, what is the nurse's best response?

A. Hold lithium and promptly report possible toxicity for assessment and serum level testing
B. Give the next dose with extra water
C. Encourage strenuous exercise
D. Recommend an over-the-counter antidiarrheal and continue lithium
E. Restrict fluids for 24 hours

Expert Explanatory Rationale

Correct Answer: A. Hold lithium and promptly report possible toxicity for assessment and serum level testing

Dehydration and sodium loss can increase lithium levels. Coarse tremor, diarrhea and ataxia are concerning for toxicity.

Question 9 of 15

Case excerpt

A patient is starting warfarin for a new diagnosis of venous thromboembolism.

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

A. Report unusual bruising or bleeding
B. Double the next dose after a missed dose
C. Check with the prescriber before starting new medicines or supplements
D. Keep vitamin K intake reasonably consistent
E. Use a soft toothbrush and an electric razor when appropriate
F. Attend scheduled INR monitoring

Expert Explanatory Rationale

Correct Answer: A. Report unusual bruising or bleeding; C. Check with the prescriber before starting new medicines or supplements; D. Keep vitamin K intake reasonably consistent; E. Use a soft toothbrush and an electric razor when appropriate; F. Attend scheduled INR monitoring

Warfarin requires consistent vitamin K intake, INR monitoring and precautions to reduce bleeding; medication interactions must be reviewed.

Question 10 of 15

Case excerpt

A nurse is reviewing a medication list for a patient prescribed an ACE inhibitor.

Which findings require follow-up? Select all that apply.

A. Mild temporary taste preference change
B. Potassium of 5.7 mEq/L
C. Persistent dry cough
D. Blood pressure of 118/72 mmHg without symptoms
E. New dizziness with a marked blood pressure drop
F. Lip or tongue swelling

Expert Explanatory Rationale

Correct Answer: B. Potassium of 5.7 mEq/L; C. Persistent dry cough; E. New dizziness with a marked blood pressure drop; F. Lip or tongue swelling

Angioedema, hyperkalemia, cough and symptomatic hypotension are clinically important ACE inhibitor concerns.

Question 11 of 15

Case excerpt

A patient is receiving opioid analgesia after major surgery.

Which assessments help identify opioid-related complications? Select all that apply.

A. Bowel function
B. Level of sedation and responsiveness
C. Hair color
D. Respiratory rate and depth
E. Pain relief and functional response
F. Oxygenation as clinically indicated

Expert Explanatory Rationale

Correct Answer: A. Bowel function; B. Level of sedation and responsiveness; D. Respiratory rate and depth; E. Pain relief and functional response; F. Oxygenation as clinically indicated

Opioid monitoring includes respiratory and sedation status, therapeutic response, oxygenation when indicated and bowel effects.

Question 12 of 15

Case excerpt

A patient with type 1 diabetes is learning to manage hypoglycemia.

Which instructions are appropriate? Select all that apply.

A. Wear medical identification
B. If awake and able to swallow, treat a low glucose with fast-acting carbohydrate
C. Use glucagon when severe hypoglycemia prevents safe oral intake, as prescribed
D. Skip all future insulin doses after one low reading
E. Carry a rapid source of glucose
F. Recheck glucose after treatment according to the plan

Expert Explanatory Rationale

Correct Answer: A. Wear medical identification; B. If awake and able to swallow, treat a low glucose with fast-acting carbohydrate; C. Use glucagon when severe hypoglycemia prevents safe oral intake, as prescribed; E. Carry a rapid source of glucose; F. Recheck glucose after treatment according to the plan

Preparedness includes rapid carbohydrate, reassessment, glucagon for severe episodes and medical identification; insulin changes require clinical guidance.

Question 13 of 15

Case excerpt

A patient is prescribed an inhaled corticosteroid for persistent asthma.

Which teaching should the nurse provide? Select all that apply.

A. Use it regularly as prescribed for controller therapy
B. Rinse the mouth and spit after each use
C. Stop it as soon as one symptom-free day occurs
D. Use the prescribed spacer if appropriate for the device
E. Do not use it as the only treatment for sudden severe bronchospasm
F. Review inhaler technique periodically

Expert Explanatory Rationale

Correct Answer: A. Use it regularly as prescribed for controller therapy; B. Rinse the mouth and spit after each use; D. Use the prescribed spacer if appropriate for the device; E. Do not use it as the only treatment for sudden severe bronchospasm; F. Review inhaler technique periodically

Inhaled corticosteroids are controller medicines; mouth rinsing, correct technique and ongoing use help reduce adverse effects and improve control.

Question 14 of 15

Case excerpt

A patient receives 750 mg of an antibiotic. The vial contains 500 mg per 2 mL after reconstitution.

How many milliliters should the nurse administer? Enter a number only.

Expert Explanatory Rationale

Correct Answer: 3

750 mg ÷ 500 mg × 2 mL = 3 mL.

Question 15 of 15

Case excerpt

A patient with suspected opioid toxicity is being treated in the emergency department.

Arrange the nursing actions in the safest sequence.

A. Reassess respiratory effort and level of consciousness
B. Administer naloxone according to order or protocol
C. Recognize respiratory depression and call for emergency support
D. Support airway and ventilation as needed

Expert Explanatory Rationale

Correct Answer: C. Recognize respiratory depression and call for emergency support; D. Support airway and ventilation as needed; B. Administer naloxone according to order or protocol; A. Reassess respiratory effort and level of consciousness

Recognition and emergency activation are followed by airway support, antidote administration and ongoing reassessment.

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