NURS 261 – Fundamentals of Nursing Practice – Academic Year 2025/2026 –
Comprehensive Final Exam Study Material PDF
NCLEX-RN PRACTICE EXAMINATION (75 Questions) - REVISED
PHARMACOLOGY & MEDICATION ADMINISTRATION
1. The nurse is preparing to administer digoxin 0.25 mg PO to a patient with atrial
fibrillation. Which finding requires the nurse to withhold the medication and notify
the provider?
A. Blood pressure 138/84 mmHg
B. Heart rate 52 beats/minute
C. Potassium level 4.2 mEq/L
D. Digoxin level 1.8 ng/mL
Correct Answer: B
Explainer:
Correct: The therapeutic range for digoxin is 0.5-2.0 ng/mL, but the critical
safety parameter is the apical heart rate. Withhold digoxin if the apical pulse
is <60 bpm (adults) due to risk of severe bradycardia or heart block.
Incorrect A: This is a normal blood pressure reading.
Incorrect C: Normal potassium is 3.5-5.0 mEq/L; hypokalemia increases
digoxin toxicity risk, but this value is normal.
Incorrect D: This is within the therapeutic range (0.5-2.0 ng/mL).
2. A patient with deep vein thrombosis is receiving a heparin infusion at 1,200
units/hour. The laboratory reports an aPTT of 90 seconds (control 30 seconds).
What is the nurse's priority action?
A. Stop the infusion and notify the provider
B. Increase the infusion rate by 100 units/hour
C. Continue the current infusion rate
D. Decrease the infusion rate and recheck aPTT in 2 hours
,Correct Answer: D
Explainer:
Correct: The therapeutic aPTT range for heparin therapy is typically 1.5-2.5
times the control (45-75 seconds). 90 seconds represents supratherapeutic
anticoagulation (3x control), increasing bleeding risk. The nurse should
decrease the rate and recheck.
Incorrect A: Stopping completely is unnecessary; dose adjustment is
appropriate unless active bleeding occurs.
Incorrect B: This would worsen the supratherapeutic level.
Incorrect C: This would maintain dangerous over-anticoagulation.
3. The nurse is reviewing a medication label for a patient with diabetes. [Image
description: Insulin vial labeled "Humulin R U-100, 10 mL, 100 units/mL"] The
provider orders 15 units subcutaneous. How many mL should the nurse
administer?
A. 0.25 mL
B. 0.5 mL
C. 0.15 mL
D. 1.5 mL
Correct Answer: C
Explainer:
Correct: U-100 means 100 units/mL. Using the formula: Dose ordered (15
units) ÷ Concentration (100 units/mL) = 0.15 mL.
Incorrect A: 0.25 mL would be 25 units.
Incorrect B: 0.5 mL would be 50 units.
Incorrect D: 1.5 mL would be 150 units, a dangerous overdose.
4. A patient receiving morphine sulfate 4 mg IV every 4 hours for postoperative
pain reports a pain level of 8/10. The nurse notes respiratory rate of 10
,breaths/minute and oxygen saturation 89%. What is the priority nursing
intervention?
A. Administer the prescribed morphine dose
B. Encourage deep breathing and coughing
C. Administer naloxone 0.4 mg IV per protocol
D. Position the patient in high Fowler's
Correct Answer: C
Explainer:
Correct: Respiratory rate <12 and SpO2 <90% indicate opioid-induced
respiratory depression. Naloxone is the antidote for opioid overdose and
reverses respiratory depression.
Incorrect A: Giving more morphine would worsen respiratory depression.
Incorrect B: This is inappropriate for respiratory depression; the patient
needs reversal agent.
Incorrect D: Positioning helps but does not address the life-threatening
respiratory depression.
5. The nurse is teaching a patient about warfarin therapy. Which statement by the
patient indicates understanding of dietary considerations?
A. "I should avoid all green vegetables completely"
B. "I can increase my vitamin K when my INR is high"
C. "I need to maintain consistent vitamin K intake"
D. "I should take vitamin K supplements daily"
Correct Answer: C
Explainer:
Correct: Consistent vitamin K intake (not avoidance or variable intake)
allows stable warfarin dosing. Sudden increases or decreases in vitamin K
foods alter INR unpredictably.
Incorrect A: Complete avoidance is unnecessary and unhealthy; consistency
is key.
, Incorrect B: Increasing vitamin K would lower INR, counteracting
anticoagulation.
Incorrect D: Supplements would interfere with warfarin therapy and are
contraindicated unless treating warfarin toxicity.
6. A patient is prescribed levothyroxine 100 mcg PO daily. The nurse observes the
patient taking the medication with breakfast. What is the appropriate nursing
intervention?
A. Document the administration as given
B. Instruct the patient to take it with food to prevent nausea
C. Crush the tablet and mix with applesauce
D. Advise the patient to take it on an empty stomach 30-60 minutes before
breakfast
Correct Answer: D
Explainer:
Correct: Levothyroxine absorption is decreased by food, calcium, iron, and
antacids. It should be taken on an empty stomach (30-60 minutes before or 4
hours after meals) for optimal absorption.
Incorrect A: Documentation without correcting the administration error is
inappropriate.
Incorrect B: Food decreases absorption by approximately 40%.
Incorrect C: Levothyroxine tablets should not be crushed; they can be split
if scored.
7. The nurse is caring for a patient with heart failure who is receiving furosemide
40 mg IV twice daily. Which laboratory finding requires immediate intervention?
A. Sodium 138 mEq/L
B. BUN 22 mg/dL
C. Potassium 2.8 mEq/L
D. Creatinine 1.2 mg/dL
Comprehensive Final Exam Study Material PDF
NCLEX-RN PRACTICE EXAMINATION (75 Questions) - REVISED
PHARMACOLOGY & MEDICATION ADMINISTRATION
1. The nurse is preparing to administer digoxin 0.25 mg PO to a patient with atrial
fibrillation. Which finding requires the nurse to withhold the medication and notify
the provider?
A. Blood pressure 138/84 mmHg
B. Heart rate 52 beats/minute
C. Potassium level 4.2 mEq/L
D. Digoxin level 1.8 ng/mL
Correct Answer: B
Explainer:
Correct: The therapeutic range for digoxin is 0.5-2.0 ng/mL, but the critical
safety parameter is the apical heart rate. Withhold digoxin if the apical pulse
is <60 bpm (adults) due to risk of severe bradycardia or heart block.
Incorrect A: This is a normal blood pressure reading.
Incorrect C: Normal potassium is 3.5-5.0 mEq/L; hypokalemia increases
digoxin toxicity risk, but this value is normal.
Incorrect D: This is within the therapeutic range (0.5-2.0 ng/mL).
2. A patient with deep vein thrombosis is receiving a heparin infusion at 1,200
units/hour. The laboratory reports an aPTT of 90 seconds (control 30 seconds).
What is the nurse's priority action?
A. Stop the infusion and notify the provider
B. Increase the infusion rate by 100 units/hour
C. Continue the current infusion rate
D. Decrease the infusion rate and recheck aPTT in 2 hours
,Correct Answer: D
Explainer:
Correct: The therapeutic aPTT range for heparin therapy is typically 1.5-2.5
times the control (45-75 seconds). 90 seconds represents supratherapeutic
anticoagulation (3x control), increasing bleeding risk. The nurse should
decrease the rate and recheck.
Incorrect A: Stopping completely is unnecessary; dose adjustment is
appropriate unless active bleeding occurs.
Incorrect B: This would worsen the supratherapeutic level.
Incorrect C: This would maintain dangerous over-anticoagulation.
3. The nurse is reviewing a medication label for a patient with diabetes. [Image
description: Insulin vial labeled "Humulin R U-100, 10 mL, 100 units/mL"] The
provider orders 15 units subcutaneous. How many mL should the nurse
administer?
A. 0.25 mL
B. 0.5 mL
C. 0.15 mL
D. 1.5 mL
Correct Answer: C
Explainer:
Correct: U-100 means 100 units/mL. Using the formula: Dose ordered (15
units) ÷ Concentration (100 units/mL) = 0.15 mL.
Incorrect A: 0.25 mL would be 25 units.
Incorrect B: 0.5 mL would be 50 units.
Incorrect D: 1.5 mL would be 150 units, a dangerous overdose.
4. A patient receiving morphine sulfate 4 mg IV every 4 hours for postoperative
pain reports a pain level of 8/10. The nurse notes respiratory rate of 10
,breaths/minute and oxygen saturation 89%. What is the priority nursing
intervention?
A. Administer the prescribed morphine dose
B. Encourage deep breathing and coughing
C. Administer naloxone 0.4 mg IV per protocol
D. Position the patient in high Fowler's
Correct Answer: C
Explainer:
Correct: Respiratory rate <12 and SpO2 <90% indicate opioid-induced
respiratory depression. Naloxone is the antidote for opioid overdose and
reverses respiratory depression.
Incorrect A: Giving more morphine would worsen respiratory depression.
Incorrect B: This is inappropriate for respiratory depression; the patient
needs reversal agent.
Incorrect D: Positioning helps but does not address the life-threatening
respiratory depression.
5. The nurse is teaching a patient about warfarin therapy. Which statement by the
patient indicates understanding of dietary considerations?
A. "I should avoid all green vegetables completely"
B. "I can increase my vitamin K when my INR is high"
C. "I need to maintain consistent vitamin K intake"
D. "I should take vitamin K supplements daily"
Correct Answer: C
Explainer:
Correct: Consistent vitamin K intake (not avoidance or variable intake)
allows stable warfarin dosing. Sudden increases or decreases in vitamin K
foods alter INR unpredictably.
Incorrect A: Complete avoidance is unnecessary and unhealthy; consistency
is key.
, Incorrect B: Increasing vitamin K would lower INR, counteracting
anticoagulation.
Incorrect D: Supplements would interfere with warfarin therapy and are
contraindicated unless treating warfarin toxicity.
6. A patient is prescribed levothyroxine 100 mcg PO daily. The nurse observes the
patient taking the medication with breakfast. What is the appropriate nursing
intervention?
A. Document the administration as given
B. Instruct the patient to take it with food to prevent nausea
C. Crush the tablet and mix with applesauce
D. Advise the patient to take it on an empty stomach 30-60 minutes before
breakfast
Correct Answer: D
Explainer:
Correct: Levothyroxine absorption is decreased by food, calcium, iron, and
antacids. It should be taken on an empty stomach (30-60 minutes before or 4
hours after meals) for optimal absorption.
Incorrect A: Documentation without correcting the administration error is
inappropriate.
Incorrect B: Food decreases absorption by approximately 40%.
Incorrect C: Levothyroxine tablets should not be crushed; they can be split
if scored.
7. The nurse is caring for a patient with heart failure who is receiving furosemide
40 mg IV twice daily. Which laboratory finding requires immediate intervention?
A. Sodium 138 mEq/L
B. BUN 22 mg/dL
C. Potassium 2.8 mEq/L
D. Creatinine 1.2 mg/dL
