# NCLEX-RN Pharmacology and Medication
Administration – High-Yield Practice Questions
with Rationales
## Length – 145 Questions
---
## Section 1: Cardiovascular Medications (Questions 1–25)
**1.** A client with heart failure is prescribed digoxin (Lanoxin) 0.125 mg daily. Which finding indicates
digoxin toxicity?
A) Heart rate 72 bpm
B) Serum potassium 4.0 mEq/L
C) Nausea, vomiting, and yellow-tinged vision (xanthopsia)
D) Blood pressure 120/80 mmHg
💡 **RATIONALE** – Digoxin toxicity manifests with GI symptoms (nausea, vomiting, anorexia), visual
disturbances (yellow-tinged vision, halos, blurred vision), and cardiac arrhythmias (bradycardia, heart
block, ventricular tachycardia). Hypokalemia (<3.5 mEq/L) increases toxicity risk.
✔️ **ANSWER** – C) Nausea, vomiting, and yellow-tinged vision (xanthopsia)
---
**2.** A client taking warfarin (Coumadin) has an INR of 4.8 (therapeutic range 2.0–3.0). The client
denies bleeding. Which action should the nurse take?
A) Administer vitamin K 10 mg IM immediately
,B) Hold the next dose of warfarin and notify the provider
C) Increase the warfarin dose by 25%
D) Administer fresh frozen plasma (FFP)
💡 **RATIONALE** – For an asymptomatic client with INR 4.8 (<5.0), standard management is to hold
the next dose of warfarin and notify the provider for dose adjustment. Vitamin K is reserved for INR >10
or active bleeding. FFP is for major bleeding.
✔️ **ANSWER** – B) Hold the next dose of warfarin and notify the provider
---
**3.** The nurse is teaching a client with angina about nitroglycerin (NTG) sublingual tablets. Which
instruction is correct?
A) "Take one tablet every 5 minutes until you have taken three tablets. If pain persists, go to the
emergency room."
B) "Take one tablet every 15 minutes until pain resolves. Do not exceed 10 tablets."
C) "Swallow the tablet with a full glass of water for faster absorption."
D) "Store the tablets in the refrigerator to maintain potency."
💡 **RATIONALE** – Standard nitroglycerin protocol: take one tablet sublingually (under tongue) every
5 minutes for up to 3 doses. If pain persists after 3 doses in 15 minutes, call 911. NTG degrades with
light, heat, and moisture; store in original dark glass container with tight cap. Replace every 6 months.
✔️ **ANSWER** – A) "Take one tablet every 5 minutes until you have taken three tablets. If pain
persists, go to the emergency room."
---
**4.** A client with hypertension is prescribed lisinopril (Zestril). Which adverse effect should the nurse
teach the client to report?
A) Dry, nonproductive cough
B) Weight gain
,C) Constipation
D) Frequent urination
💡 **RATIONALE** – Lisinopril (ACE inhibitor) commonly causes a dry, persistent cough due to
accumulation of bradykinin. If the cough becomes bothersome, the provider may switch to an
angiotensin II receptor blocker (ARB) like losartan.
✔️ **ANSWER** – A) Dry, nonproductive cough
---
**5.** The nurse is administering IV furosemide (Lasix) to a client with pulmonary edema. Which
assessment finding indicates the medication is effective?
A) Blood pressure decreases from 160/90 to 140/85 mmHg
B) Urine output increases to 200 mL over the next hour
C) Heart rate increases from 80 to 100 bpm
D) Respiratory rate increases from 20 to 28 breaths/min
💡 **RATIONALE** – Furosemide (loop diuretic) promotes diuresis (increased urine output), reducing
preload and relieving pulmonary congestion. Expected response: increased urine output, decreased
dyspnea, decreased crackles, and weight loss.
✔️ **ANSWER** – B) Urine output increases to 200 mL over the next hour
---
**6.** A client with atrial fibrillation is prescribed amiodarone (Cordarone). Which baseline and ongoing
monitoring tests are required?
A) Serum glucose and HbA1c
B) Liver function tests (LFTs), thyroid function tests (TFTs), chest X-ray, and ECG
C) Complete blood count (CBC) and urinalysis
D) Serum electrolytes only
, 💡 **RATIONALE** – Amiodarone causes potentially fatal toxicities: pulmonary fibrosis (chest X-ray,
PFTs), hepatotoxicity (LFTs), thyroid dysfunction (TFTs – hyper or hypothyroidism), corneal
microdeposits (eye exam), and photosensitivity. Baseline and ongoing monitoring every 3–6 months is
required.
✔️ **ANSWER** – B) Liver function tests (LFTs), thyroid function tests (TFTs), chest X-ray, and ECG
---
**7.** The nurse is teaching a client with hyperlipidemia about atorvastatin (Lipitor). Which statement
indicates correct understanding?
A) "I will take this medication with grapefruit juice to increase absorption."
B) "I will report any unexplained muscle pain, tenderness, or weakness to my provider."
C) "I can stop this medication when my cholesterol levels are normal."
D) "I will take this medication on an empty stomach."
💡 **RATIONALE** – Statins (atorvastatin) can cause myopathy and rhabdomyolysis (muscle
breakdown), which can lead to acute kidney injury. Clients should report muscle pain, tenderness, or
weakness (especially with dark urine or malaise). Grapefruit juice increases statin levels and toxicity risk.
✔️ **ANSWER** – B) "I will report any unexplained muscle pain, tenderness, or weakness to my
provider."
---
**8.** A client is receiving a continuous infusion of heparin for deep vein thrombosis (DVT). The client's
aPTT is 110 seconds (control 30 seconds, therapeutic range 60–80 seconds). Which action should the
nurse take?
A) Continue the infusion as ordered
B) Increase the infusion rate by 2 mL/hr
C) Stop the infusion and notify the provider
D) Administer protamine sulfate immediately
Administration – High-Yield Practice Questions
with Rationales
## Length – 145 Questions
---
## Section 1: Cardiovascular Medications (Questions 1–25)
**1.** A client with heart failure is prescribed digoxin (Lanoxin) 0.125 mg daily. Which finding indicates
digoxin toxicity?
A) Heart rate 72 bpm
B) Serum potassium 4.0 mEq/L
C) Nausea, vomiting, and yellow-tinged vision (xanthopsia)
D) Blood pressure 120/80 mmHg
💡 **RATIONALE** – Digoxin toxicity manifests with GI symptoms (nausea, vomiting, anorexia), visual
disturbances (yellow-tinged vision, halos, blurred vision), and cardiac arrhythmias (bradycardia, heart
block, ventricular tachycardia). Hypokalemia (<3.5 mEq/L) increases toxicity risk.
✔️ **ANSWER** – C) Nausea, vomiting, and yellow-tinged vision (xanthopsia)
---
**2.** A client taking warfarin (Coumadin) has an INR of 4.8 (therapeutic range 2.0–3.0). The client
denies bleeding. Which action should the nurse take?
A) Administer vitamin K 10 mg IM immediately
,B) Hold the next dose of warfarin and notify the provider
C) Increase the warfarin dose by 25%
D) Administer fresh frozen plasma (FFP)
💡 **RATIONALE** – For an asymptomatic client with INR 4.8 (<5.0), standard management is to hold
the next dose of warfarin and notify the provider for dose adjustment. Vitamin K is reserved for INR >10
or active bleeding. FFP is for major bleeding.
✔️ **ANSWER** – B) Hold the next dose of warfarin and notify the provider
---
**3.** The nurse is teaching a client with angina about nitroglycerin (NTG) sublingual tablets. Which
instruction is correct?
A) "Take one tablet every 5 minutes until you have taken three tablets. If pain persists, go to the
emergency room."
B) "Take one tablet every 15 minutes until pain resolves. Do not exceed 10 tablets."
C) "Swallow the tablet with a full glass of water for faster absorption."
D) "Store the tablets in the refrigerator to maintain potency."
💡 **RATIONALE** – Standard nitroglycerin protocol: take one tablet sublingually (under tongue) every
5 minutes for up to 3 doses. If pain persists after 3 doses in 15 minutes, call 911. NTG degrades with
light, heat, and moisture; store in original dark glass container with tight cap. Replace every 6 months.
✔️ **ANSWER** – A) "Take one tablet every 5 minutes until you have taken three tablets. If pain
persists, go to the emergency room."
---
**4.** A client with hypertension is prescribed lisinopril (Zestril). Which adverse effect should the nurse
teach the client to report?
A) Dry, nonproductive cough
B) Weight gain
,C) Constipation
D) Frequent urination
💡 **RATIONALE** – Lisinopril (ACE inhibitor) commonly causes a dry, persistent cough due to
accumulation of bradykinin. If the cough becomes bothersome, the provider may switch to an
angiotensin II receptor blocker (ARB) like losartan.
✔️ **ANSWER** – A) Dry, nonproductive cough
---
**5.** The nurse is administering IV furosemide (Lasix) to a client with pulmonary edema. Which
assessment finding indicates the medication is effective?
A) Blood pressure decreases from 160/90 to 140/85 mmHg
B) Urine output increases to 200 mL over the next hour
C) Heart rate increases from 80 to 100 bpm
D) Respiratory rate increases from 20 to 28 breaths/min
💡 **RATIONALE** – Furosemide (loop diuretic) promotes diuresis (increased urine output), reducing
preload and relieving pulmonary congestion. Expected response: increased urine output, decreased
dyspnea, decreased crackles, and weight loss.
✔️ **ANSWER** – B) Urine output increases to 200 mL over the next hour
---
**6.** A client with atrial fibrillation is prescribed amiodarone (Cordarone). Which baseline and ongoing
monitoring tests are required?
A) Serum glucose and HbA1c
B) Liver function tests (LFTs), thyroid function tests (TFTs), chest X-ray, and ECG
C) Complete blood count (CBC) and urinalysis
D) Serum electrolytes only
, 💡 **RATIONALE** – Amiodarone causes potentially fatal toxicities: pulmonary fibrosis (chest X-ray,
PFTs), hepatotoxicity (LFTs), thyroid dysfunction (TFTs – hyper or hypothyroidism), corneal
microdeposits (eye exam), and photosensitivity. Baseline and ongoing monitoring every 3–6 months is
required.
✔️ **ANSWER** – B) Liver function tests (LFTs), thyroid function tests (TFTs), chest X-ray, and ECG
---
**7.** The nurse is teaching a client with hyperlipidemia about atorvastatin (Lipitor). Which statement
indicates correct understanding?
A) "I will take this medication with grapefruit juice to increase absorption."
B) "I will report any unexplained muscle pain, tenderness, or weakness to my provider."
C) "I can stop this medication when my cholesterol levels are normal."
D) "I will take this medication on an empty stomach."
💡 **RATIONALE** – Statins (atorvastatin) can cause myopathy and rhabdomyolysis (muscle
breakdown), which can lead to acute kidney injury. Clients should report muscle pain, tenderness, or
weakness (especially with dark urine or malaise). Grapefruit juice increases statin levels and toxicity risk.
✔️ **ANSWER** – B) "I will report any unexplained muscle pain, tenderness, or weakness to my
provider."
---
**8.** A client is receiving a continuous infusion of heparin for deep vein thrombosis (DVT). The client's
aPTT is 110 seconds (control 30 seconds, therapeutic range 60–80 seconds). Which action should the
nurse take?
A) Continue the infusion as ordered
B) Increase the infusion rate by 2 mL/hr
C) Stop the infusion and notify the provider
D) Administer protamine sulfate immediately
