NCLEX-PN Pharmacological Therapies Practice Questions

Safe medication administration — oral, IM, SubQ, and select IV drugs — within the PN scope. It sits under Physiological Integrity on the NCLEX-PN test plan and carries an approximate weight of 13% of the exam.

Below are 10 practice questions for this domain — 6 multiple-choice and 4 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-PN 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 Select all that apply

1. Acetaminophen — over-the-counter safety

A client with osteoarthritis tells the nurse about taking over-the-counter acetaminophen for joint pain most days, along with a nighttime multi-symptom cold medicine when needed.

Which information should the nurse reinforce? Select all that apply.

  1. Take no more than 4 grams (4,000 mg) of acetaminophen in 24 hours from all sources combined.
  2. Check the labels of cold and combination pain products for hidden acetaminophen.
  3. Report dark urine, yellowing of the skin or eyes, or pain in the upper right abdomen.
  4. Expect the acetaminophen to reduce the swelling in the joints.
  5. A few alcoholic drinks each evening are safe while taking this medication.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Exceeding about 4 grams per day risks severe liver damage, and the limit is lower for clients with liver disease or regular alcohol use. Every product containing acetaminophen counts toward the total.
  • B. Correct . Many multi-symptom cold and sleep products also contain acetaminophen, so using them alongside plain acetaminophen can cause an accidental overdose.
  • C. Correct . These are warning signs of liver injury, the most serious toxicity of acetaminophen, and they require prompt evaluation by the provider.
  • D. Incorrect . Acetaminophen relieves pain and fever but has no meaningful anti-inflammatory effect — unlike NSAIDs, it will not reduce joint swelling.
  • E. Incorrect . The FDA liver warning states that severe liver damage may occur with three or more alcoholic drinks daily while using acetaminophen. Regular alcohol use with daily acetaminophen must be discussed with the provider.

Reference: FDA OTC acetaminophen labeling and organ-specific warnings; MedlinePlus drug information (acetaminophen)

Easy Multiple choice

2. Albuterol — inhaler sequence teaching

A nurse is reinforcing teaching that the RN began for a client with asthma who has new prescriptions for an albuterol metered-dose inhaler and a fluticasone (inhaled corticosteroid) metered-dose inhaler, both scheduled twice daily.

Which statement by the client indicates understanding of the teaching?

  1. I will use the albuterol inhaler first, then the fluticasone inhaler, and rinse my mouth afterward.
  2. I will use the fluticasone inhaler first because steroids work faster.
  3. I will rinse my mouth right after the albuterol to keep from getting an infection.
  4. I will save the fluticasone inhaler for times when I suddenly feel short of breath.
Show the answer and rationales

Correct answer: A

  • A. Correct . The short-acting bronchodilator is used first to open the airways so the corticosteroid can reach deeper into the lungs. Rinsing the mouth after the corticosteroid helps prevent oral thrush.
  • B. Incorrect . Inhaled corticosteroids do not act quickly — albuterol is the fast-acting drug and is used first so the bronchodilated airways let the corticosteroid penetrate better.
  • C. Incorrect . Mouth rinsing is needed after the inhaled corticosteroid, which can cause oral candidiasis. Albuterol does not require rinsing.
  • D. Incorrect . Fluticasone is a daily controller medication and does not relieve acute symptoms. Albuterol is the rescue inhaler for sudden shortness of breath.

Reference: MedlinePlus drug information (fluticasone oral inhalation; albuterol oral inhalation); Asthma and Allergy Foundation of America inhaler guidance

Medium Select all that apply

3. Heparin — subcutaneous injection technique

A nurse is preparing to administer heparin 5,000 units subcutaneously to a client on bed rest for venous thromboembolism prophylaxis.

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

  1. Inject into the abdomen at least 2 inches away from the umbilicus.
  2. Insert the needle at a 90-degree angle into a pinched fold of tissue.
  3. Rotate injection sites with each dose.
  4. Observe the client for unusual bruising or bleeding gums.
  5. Aspirate for blood return before injecting the medication.
  6. Massage the site after the injection to speed absorption.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . The abdominal fat layer is the preferred site for subcutaneous heparin, and staying at least 2 inches from the umbilicus avoids the denser periumbilical tissue and vessels.
  • B. Correct . Pinching up a skinfold and inserting the short subcutaneous needle at 90 degrees deposits the drug into fatty tissue. A 45-degree angle may be used for a very thin client.
  • C. Correct . Rotating sites prevents repeated trauma, bruising, and tissue changes at any single location.
  • D. Correct . Bleeding is the chief adverse effect of any anticoagulant. New bruising, bleeding gums, or blood in urine or stool should be reported to the RN.
  • E. Incorrect . Aspiration is not done with subcutaneous heparin — it can damage the small vessels in the tissue and cause a hematoma.
  • F. Incorrect . Massaging the site after heparin promotes bruising and hematoma formation. Apply gentle pressure only if the site bleeds.

Reference: DailyMed prescribing information (heparin sodium injection); OpenStax Clinical Nursing Skills (subcutaneous injections)

Medium Select all that apply

4. Lithium — toxicity prevention teaching

A nurse is reinforcing teaching for a client with bipolar disorder who began taking lithium two weeks ago. The most recent lithium level is 0.8 mEq/L.

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

  1. Keep your daily salt intake about the same from day to day.
  2. Drink about 2.5 to 3 liters of fluid each day while the dose is being stabilized.
  3. Call the provider if vomiting, diarrhea, or heavy sweating develops.
  4. Keep all appointments to have your lithium blood level drawn.
  5. Switch to a low-sodium diet to protect your kidneys.
  6. Take over-the-counter ibuprofen as needed for headaches.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . The kidneys handle lithium and sodium similarly, so a drop in sodium intake causes lithium retention and raises the level toward toxicity. Consistent salt intake keeps the level stable.
  • B. Correct . Adequate fluid intake prevents the dehydration that concentrates lithium in the blood. Labeling recommends 2.5 to 3 liters daily at least during initial stabilization.
  • C. Correct . Fluid and sodium losses from GI illness or sweating can push the lithium level into the toxic range — and vomiting and diarrhea are themselves early signs of toxicity — so these symptoms must be reported.
  • D. Correct . Lithium has a narrow therapeutic range of 0.6 to 1.2 mEq/L, so regular level monitoring is essential to detect drift toward toxicity before symptoms appear.
  • E. Incorrect . Restricting sodium does the opposite of protecting the client — low sodium intake increases lithium reabsorption and raises the risk of toxicity. Sodium intake should stay consistent, not low.
  • F. Incorrect . NSAIDs such as ibuprofen reduce renal clearance of lithium and can raise the level significantly. The client should check with the provider before using NSAIDs; acetaminophen is usually the safer choice.

Reference: FDA prescribing information (lithium carbonate); MedlinePlus drug information (lithium)

Medium Multiple choice

5. Metformin — CT scan with IV contrast

A client with type 2 diabetes is scheduled for a CT scan with IV iodinated contrast at 1000. The morning medication record includes metformin 500 mg PO with breakfast, and the chart shows an eGFR of 28 mL/min/1.73 m2 on yesterday's labs.

Which action should the nurse take?

  1. Withhold the metformin and notify the RN before the client leaves for the scan.
  2. Administer the metformin with breakfast as scheduled.
  3. Hold the morning dose and give it as soon as the client returns from the scan.
  4. Ask dietary to hold breakfast so the metformin can be given on an empty stomach.
Show the answer and rationales

Correct answer: A

  • A. Correct . Metformin must be held when iodinated contrast is given to a client with significantly reduced kidney function, because the combination raises the risk of lactic acidosis and acute kidney injury — and an eGFR below 30 makes metformin contraindicated outright. Withholding the dose and reporting to the RN keeps the team and provider informed.
  • B. Incorrect . Giving metformin to a client with an eGFR of 28 who is about to receive IV contrast exposes the client to a preventable risk of lactic acidosis. The dose should be held, not given.
  • C. Incorrect . Labeling directs that kidney function be re-evaluated about 48 hours after the contrast procedure and metformin restarted only if renal function is stable. Giving the drug immediately after the scan carries the same lactic acidosis risk as giving it before.
  • D. Incorrect . Food timing is not the issue — metformin is normally taken with meals to reduce GI upset. The safety concern is the combination of contrast dye and poor kidney function, which requires the dose to be withheld.

Reference: FDA prescribing information (metformin hydrochloride); ACR Manual on Contrast Media

Medium Multiple choice

6. Regular insulin — hypoglycemia first action

A client with type 2 diabetes received regular insulin subcutaneously at 0730 with breakfast. At 1100 the nurse finds the client awake but diaphoretic and shaky, reporting a headache. The fingerstick blood glucose is 58 mg/dL.

Which action should the nurse take first?

  1. Give 15 grams of fast-acting carbohydrate, such as 4 ounces of fruit juice.
  2. Notify the RN and wait for direction before treating the client.
  3. Prepare to administer glucagon intramuscularly.
  4. Offer a snack of peanut butter crackers and a glass of milk.
Show the answer and rationales

Correct answer: A

  • A. Correct . A blood glucose below 70 mg/dL with symptoms is hypoglycemia, and the timing fits the peak of regular insulin (about 3 hours after the dose). Because the client is awake and able to swallow, the 15-15 rule applies — give 15 grams of fast-acting carbohydrate, then recheck the glucose in 15 minutes.
  • B. Incorrect . Hypoglycemia protocols allow immediate treatment of a conscious client who can swallow. Waiting to treat lets the glucose fall further; the RN is informed while or right after treatment begins, not before.
  • C. Incorrect . Glucagon is reserved for clients who are unconscious or unable to swallow safely. This client is awake, so oral fast-acting carbohydrate is the appropriate first treatment.
  • D. Incorrect . Protein and fat slow glucose absorption, so a mixed snack does not raise the blood glucose quickly enough during acute hypoglycemia. A snack may follow once the glucose is above 70 mg/dL if the next meal is more than an hour away.

Reference: CDC hypoglycemia treatment guidance (15-15 rule); FDA prescribing information (Humulin R regular insulin)

Medium Multiple choice

7. Warfarin — statement needing further teaching

A nurse is reinforcing discharge teaching for a client who is starting warfarin therapy after a deep vein thrombosis. The most recent INR is 2.4.

Which statement by the client indicates a need for further teaching?

  1. I will take ibuprofen whenever my arthritis flares up.
  2. I will use a soft toothbrush and an electric razor.
  3. I will keep the amount of leafy green vegetables I eat about the same each week.
  4. I will call the provider right away if I notice black, tarry stools.
Show the answer and rationales

Correct answer: A

  • A. Correct . NSAIDs such as ibuprofen increase the anticoagulant effect of warfarin and the risk of serious GI bleeding, so they should not be taken unless the provider specifically approves. This statement shows a knowledge gap that must be corrected.
  • B. Incorrect . This is correct self-care — soft-bristle brushing and electric shaving reduce the chance of gum and skin bleeding while anticoagulated, so no further teaching is needed.
  • C. Incorrect . Vitamin K intake does not need to be eliminated, only kept consistent, because sudden changes shift the INR. This statement reflects accurate understanding.
  • D. Incorrect . Black, tarry stools suggest GI bleeding, a serious complication of anticoagulation that must be reported immediately. This statement shows the client understood the teaching.

Reference: MedlinePlus drug information (warfarin); American Heart Association guide to taking warfarin

Hard Select all that apply

8. IV potassium — safe administration

A client with a serum potassium of 3.0 mEq/L has a new prescription for potassium chloride 10 mEq in 100 mL of normal saline IV to infuse over one hour. The client also takes digoxin daily for heart failure.

Which actions by the nurse are appropriate? Select all that apply.

  1. Verify the potassium infuses through an infusion pump.
  2. Report burning or pain at the IV site to the RN.
  3. Monitor urine output and report output below 30 mL/hr.
  4. Watch the client for nausea and visual changes until the potassium level is corrected.
  5. Administer the potassium by slow IV push if the infusion pump is unavailable.
  6. Add the next dose of potassium chloride directly to the hanging IV bag.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . IV potassium must run at a slow, controlled rate — usually no faster than 10 mEq per hour through a peripheral line — so a calibrated infusion pump is required.
  • B. Correct . Potassium is very irritating to veins. Pain or burning may signal phlebitis or infiltration, so the infusion needs to be stopped and the site evaluated.
  • C. Correct . Potassium is excreted by the kidneys. Oliguria during potassium replacement allows the level to climb and risks hyperkalemia, so low urine output must be reported.
  • D. Correct . Hypokalemia potentiates digoxin toxicity, which presents with nausea, visual changes such as yellow halos, and arrhythmias. Close observation is warranted while the potassium is low.
  • E. Incorrect . Potassium is never given by IV push under any circumstance — rapid IV potassium can cause fatal cardiac arrest. It must always be diluted and infused on a pump.
  • F. Incorrect . Adding potassium to a bag that is already infusing risks uneven mixing and delivery of a concentrated bolus. Only thoroughly mixed, pharmacy-prepared bags should be used.

Reference: DailyMed prescribing information (potassium chloride injection); FDA prescribing information (digoxin)

Hard Multiple choice

9. Lisinopril — which client to see first

A nurse on a medical unit receives report on four assigned clients at the start of the shift.

Which client should the nurse collect data on first?

  1. A client who started lisinopril yesterday and now reports that the lips and tongue feel swollen.
  2. A client whose apical pulse was 58/min before a scheduled dose of metoprolol.
  3. A client taking levothyroxine who reports feeling cold and tired for the past month.
  4. A client who used an albuterol inhaler 20 minutes ago and reports feeling jittery with a fine hand tremor.
Show the answer and rationales

Correct answer: A

  • A. Correct . Swelling of the lips and tongue in a client on an ACE inhibitor suggests angioedema, a life-threatening emergency that can obstruct the airway. This client must be seen first and the findings reported to the RN immediately.
  • B. Incorrect . A pulse below 60 means the metoprolol dose should be held and reported, but a stable client with mild bradycardia and no distress is not in immediate danger.
  • C. Incorrect . Cold intolerance and fatigue suggest the hypothyroidism is undertreated, which warrants reporting and likely TSH testing — a routine follow-up concern, not an emergency.
  • D. Incorrect . Tremor and jitteriness are expected side effects of a beta-2 agonist like albuterol. The finding should be documented but does not require urgent attention.

Reference: MedlinePlus drug information (lisinopril); FDA prescribing information (lisinopril; metoprolol tartrate)

Hard Multiple choice

10. Morphine — respiratory depression response

One hour after the RN administers morphine 4 mg IV to a postoperative client, the nurse collects data and finds the client difficult to arouse with a respiratory rate of 7/min, oxygen saturation of 88% on room air, and pinpoint pupils.

Which action should the nurse take first?

  1. Stay with the client, attempt to rouse the client, and have the RN notified immediately.
  2. Administer naloxone by IV push from the unit medication supply.
  3. Lower the head of the bed and allow the client to sleep off the medication.
  4. Document the findings and recheck the client in 30 minutes.
Show the answer and rationales

Correct answer: A

  • A. Correct . Sedation, a respiratory rate below 12/min, low oxygen saturation, and pinpoint pupils indicate opioid-induced respiratory depression. Remaining with the unstable client and providing stimulation supports breathing while the RN is alerted to obtain orders and prepare naloxone.
  • B. Incorrect . Naloxone is the correct reversal agent, but it requires a provider order or protocol activation, and IV push medication administration is generally outside the LPN/PN scope of practice. The nurse anticipates the RN or provider giving it.
  • C. Incorrect . A respiratory rate of 7/min is not normal sleep — it is respiratory depression that can progress to arrest. Leaving the client to sleep delays a life-saving intervention.
  • D. Incorrect . Documentation alone is not a sufficient response to respiratory depression. Waiting 30 minutes could allow the client to deteriorate into respiratory arrest.

Reference: FDA prescribing information (morphine sulfate; naloxone hydrochloride); NCSBN practical nurse scope of practice 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

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