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NCLEX-RN Pharmacological and Parenteral Therapies practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

Practice by topic

Topics come from the tags on our own items, so this list reflects what the bank actually covers in Pharmacological and Parenteral Therapies rather than a generic syllabus.

Insulin 49 in the bank Dosage calculation 44 in the bank IV therapy 38 in the bank Adverse effects and interactions 33 in the bank Blood transfusion reaction 33 in the bank Central venous access 33 in the bank Heparin 33 in the bank

Pharmacological and Parenteral Therapies sample questions

Question 1

A 58-year-old client in the intensive care unit is receiving a continuous intravenous infusion of unfractionated heparin for a deep vein thrombosis. The current aPTT is 95 seconds; the prescribed therapeutic range is 60 to 80 seconds. The nurse's priority action is to:

  1. A Decrease the heparin infusion rate by 2 mL/hr and recheck the aPTT in 6 hours.
  2. B Stop the heparin infusion immediately and notify the healthcare provider of the aPTT value.
  3. C Administer protamine sulfate 25 mg intravenously over 10 minutes as a stat dose.
  4. D Continue the infusion at the current rate and document the aPTT result in the electronic record.
Show the answer and explanation

Correct answer: B

The correct answer is to stop the heparin infusion immediately and notify the healthcare provider because the aPTT of 95 seconds is above the therapeutic range, placing the client at high risk for bleeding. The nurse must hold the infusion to prevent hemorrhage and then obtain further orders. Decreasing the infusion rate (the option "Decrease the heparin infusion rate by 2 mL/hr and recheck the aPTT in 6 hours." may be considered after notification, but immediate discontinuation is the safest first step. Administering protamine sulfate (the option "Administer protamine sulfate 25 mg intravenously over 10 minutes as a stat dose." is reserved for reversal of heparin in life-threatening bleeding, not for a supratherapeutic aPTT without signs of bleeding. Continuing the infusion (the option "Continue the infusion at the current rate and document the aPTT result in the electronic r..." ignores the elevated aPTT and exposes the client to unnecessary bleeding risk.

Question 2

A 58-year-old client with type 1 diabetes mellitus is admitted with nausea, vomiting, and abdominal pain. Blood glucose is 420 mg/dL, serum potassium is 5.8 mEq/L, and arterial pH is 7.18. The nurse administers intravenous fluids and an insulin drip as prescribed. Which laboratory value requires the nurse's immediate reassessment after starting the insulin infusion?

  1. A Serum potassium level
  2. B White blood cell count
  3. C Hemoglobin A1c level
  4. D Serum creatinine level
Show the answer and explanation

Correct answer: A

Insulin drives potassium into the cells, so the initial hyperkalemia of diabetic ketoacidosis can quickly turn into hypokalemia once the insulin infusion starts. Close potassium monitoring is essential to prevent life-threatening dysrhythmias and to guide potassium replacement.

Why the other options are wrong:
B: The white blood cell count may be elevated from stress or infection, but it is not changed by the insulin infusion.
C: Hemoglobin A1c reflects average glucose over about 3 months and has no role in acute DKA management.
D: Creatinine reflects kidney function and should be monitored, but it does not shift rapidly with insulin the way potassium does.

Question 3

A 34-year-old female client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis. The nurse initiates an intravenous insulin infusion at 0.1 units/kg/hr per protocol. The client's blood glucose is 520 mg/dL. One hour later, the blood glucose is 490 mg/dL. Which action should the nurse take?

  1. A Increase the insulin infusion to 0.14 units/kg/hr and recheck the blood glucose in 1 hour.
  2. B Continue the current infusion rate and monitor the blood glucose level every 2 hours.
  3. C Administer a 10-unit intravenous bolus of regular insulin and continue the current infusion.
  4. D Decrease the insulin infusion to 0.05 units/kg/hr to prevent hypoglycemia and recheck in 2 hours.
Show the answer and explanation

Correct answer: A

In DKA, glucose should fall about 50 to 75 mg/dL per hour. A drop of only 30 mg/dL in the first hour is inadequate, so the infusion is titrated upward per protocol and glucose is rechecked hourly.

Why the other options are wrong:
B: Keeping the same rate ignores an inadequate response, and checks every 2 hours are too infrequent during an insulin infusion.
C: A fixed 10-unit bolus is not weight-based and is not the protocol's titration step; it would need a separate prescription.
D: Decreasing the rate would slow glucose and ketone correction further when the response is already too slow.

Question 4

A 60-year-old male in the medical-surgical unit with type 2 diabetes mellitus is receiving insulin glargine 30 units subcutaneously at bedtime. At 0600, the nurse obtains a fingerstick glucose of 185 mg/dL. The sliding scale order is: for glucose 151-200 mg/dL, give 3 units of insulin aspart subcutaneously. Which action should the nurse take?

  1. A Give 30 units of insulin aspart subcutaneously now and discontinue the glargine
  2. B Administer 3 units of insulin aspart subcutaneously and hold the next glargine dose
  3. C Administer 3 units of insulin aspart subcutaneously now and continue the glargine at bedtime
  4. D Hold the insulin aspart and increase the glargine dose to 35 units tonight
Show the answer and explanation

Correct answer: C

The glucose of 185 mg/dL falls in the 151 to 200 mg/dL range, so 3 units of insulin aspart are given as prescribed. Glargine provides basal coverage and continues as ordered; it is not changed because of a single reading.

Why the other options are wrong:
A: Thirty units is ten times the prescribed correction dose and could cause severe hypoglycemia, and glargine should not be stopped.
B: Holding glargine removes basal insulin and leads to hyperglycemia.
D: Holding the correction dose leaves the hyperglycemia untreated, and nurses cannot change the glargine dose.

Question 5

The nurse is caring for four clients on a medical-surgical unit. Which client requires the most immediate assessment?

  1. A A 65-year-old receiving IV antibiotics has new crackles in the lung bases and BP 100/68 mmHg.
  2. B A 60-year-old with IV 0.9% NaCl at 125 mL/hr has urine output 30 mL over 2 hours.
  3. C A 72-year-old with a central venous catheter has a temperature of 99.2°F.
  4. D A 68-year-old with a peripheral IV reports pain and redness at the insertion site.
Show the answer and explanation

Correct answer: A

New crackles in the lung bases suggest fluid in the alveoli, such as pulmonary edema from fluid overload, which threatens breathing and gas exchange. Following airway, breathing, and circulation priorities, this client needs assessment first.

Why the other options are wrong:
B: Urine output of 15 mL/hr is low and needs prompt follow-up, but it ranks after a new breathing problem.
C: A temperature of 99.2°F is only slightly elevated; it warrants monitoring for catheter infection but is not urgent.
D: Pain and redness at the IV site suggest phlebitis, which needs the site changed but is not life-threatening.

Question 6

A nurse is preparing to administer intravenous vancomycin 1 g every 12 hours to a 45-year-old client with methicillin-resistant Staphylococcus aureus (MRSA) sepsis. The client's current creatinine level is 2.8 mg/dL (baseline 1.0 mg/dL). Which action should the nurse take before administering the scheduled dose?

  1. A Administer the dose with a loop diuretic to prevent nephrotoxicity.
  2. B Administer the dose over at least 60 minutes as ordered without delay.
  3. C Mix the vancomycin in 0.9% sodium chloride and infuse via a rapid IV push.
  4. D Hold the dose and request a trough vancomycin level and a repeat creatinine.
Show the answer and explanation

Correct answer: D

A rise in creatinine from 1.0 to 2.8 mg/dL indicates acute kidney injury, and vancomycin is cleared by the kidneys and is itself nephrotoxic. The nurse should hold the dose and obtain a drug level and repeat creatinine so the provider or pharmacist can adjust dosing.

Why the other options are wrong:
A: Loop diuretics do not prevent vancomycin nephrotoxicity and may worsen kidney injury by depleting volume.
B: Giving the scheduled dose without reassessment risks drug accumulation and further kidney damage.
C: Vancomycin is never given by rapid IV push; it must be infused over at least 60 minutes to prevent infusion reactions.

Question 7

A 45-year-old female in the oncology unit is prescribed ondansetron 0.15 mg/kg intravenously 30 minutes before chemotherapy. The client weighs 70 kg. The pharmacy supplies ondansetron as 2 mg/mL in a 4 mL vial. How many milliliters should the nurse administer?

  1. A 4.50 mL
  2. B 5.25 mL
  3. C 2.50 mL
  4. D 3.75 mL
Show the answer and explanation

Correct answer: B

Dose: 0.15 mg/kg x 70 kg = 10.5 mg. Volume: 10.5 mg divided by 2 mg/mL = 5.25 mL.

Why the other options are wrong:
A: 4.50 mL delivers only 9 mg, the dose for a 60-kg client, so the weight was likely misapplied.
C: 2.50 mL delivers only 5 mg, less than half of the calculated 10.5-mg dose.
D: 3.75 mL delivers 7.5 mg, which matches a 50-kg weight rather than 70 kg.

Question 8

A 60-year-old client in the intensive care unit has a right subclavian central venous catheter. The nurse notes that the catheter insertion site is red, warm, and has purulent drainage. The client's temperature is 38.9°C (102°F). Which action should the nurse take first?

  1. A Obtain a blood culture from the catheter and from a peripheral vein as ordered.
  2. B Remove the central venous catheter immediately and send the tip for culture.
  3. C Apply a topical antibiotic ointment to the insertion site and cover with a new dressing.
  4. D Increase the IV fluid rate to treat potential sepsis and notify the provider.
Show the answer and explanation

Correct answer: A

Redness, warmth, purulent drainage, and a fever of 38.9°C suggest a catheter-related bloodstream infection. Paired blood cultures, one drawn through the catheter and one from a peripheral vein, should be obtained as ordered before antibiotics are started or the line is removed, so the organism and source can be identified.

Why the other options are wrong:
B: The catheter will likely be removed, but cultures should be drawn first, and removal requires a provider order.
C: Topical antibiotic ointment does not treat a bloodstream infection and is not recommended on central line sites.
D: Changing the IV rate requires an order, and extra fluid does not identify or treat the infection.

Question 9

A 72-year-old client in the medical-surgical unit is receiving a transfusion of packed red blood cells. Fifteen minutes after the infusion begins, the client reports chills, lower back pain, and feels warm. The client's vital signs are: blood pressure 90/58 mm Hg, heart rate 112/min, respiratory rate 24/min, temperature 38.9°C (102°F). The nurse's first action is to:

  1. A Stop the transfusion immediately and maintain intravenous access with 0.9% sodium chloride.
  2. B Administer diphenhydramine 50 mg intravenously as prescribed for allergic symptoms.
  3. C Slow the transfusion rate to 50 mL/hr and notify the healthcare provider immediately.
  4. D Obtain a urine specimen to check for hemoglobinuria before taking any further action.
Show the answer and explanation

Correct answer: A

The correct first action is to stop the transfusion immediately and maintain intravenous access with 0.9% sodium chloride because the client's symptoms (chills, back pain, fever, hypotension, tachycardia) suggest an acute hemolytic transfusion reaction, which can be life-threatening. The priority is to stop the infusion of the incompatible blood product and keep the vein open for emergency medications. Administering diphenhydramine (the option "Administer diphenhydramine 50 mg intravenously as prescribed for allergic symptoms." may be appropriate for allergic reactions but is not the first action and does not address the hemolytic process. Slowing the transfusion (the option "Slow the transfusion rate to 50 mL/hr and notify the healthcare provider immediately." would continue exposing the client to the offending blood product and is unsafe. Obtaining a urine specimen (the option "Obtain a urine specimen to check for hemoglobinuria before taking any further action." is important after stopping the transfusion but should not delay the immediate discontinuation of the blood.

Question 10

A 64-year-old client with short bowel syndrome is receiving total parenteral nutrition (TPN) through a peripherally inserted central catheter (PICC) at 80 mL/hr. The nurse notes that the TPN bag is empty and the next bag has not arrived from the pharmacy. Which action should the nurse take first?

  1. A Slow the TPN rate to 40 mL/hr to prolong the infusion until the new bag arrives.
  2. B Discontinue the PICC line and start a peripheral IV line for maintenance fluids.
  3. C Hang a bag of 10% dextrose in water (D10W) at 80 mL/hr until TPN is available.
  4. D Flush the PICC line with normal saline and wait for the pharmacy to deliver TPN.
Show the answer and explanation

Correct answer: C

TPN contains concentrated dextrose, and stopping it suddenly can cause rebound hypoglycemia as insulin levels remain high. Infusing D10W at the same rate maintains a glucose supply until the next TPN bag arrives.

Why the other options are wrong:
A: The bag is already empty, so it cannot be slowed; the client needs a dextrose source now.
B: Removing a functioning PICC is unnecessary and invasive and gives up the access needed for TPN.
D: Flushing and waiting leaves the client without a glucose source and risks rebound hypoglycemia.

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