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NCLEX-RN Adverse effects and interactions 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.

What this topic covers

Adverse effects and interactions sits inside the Pharmacological and Parenteral Therapies category of the NCLEX-RN. Our bank holds 33 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Adverse effects and interactions sample questions

Question 1

A 68-year-old male client with atrial fibrillation is taking warfarin 5 mg daily. He is admitted for a urinary tract infection and is started on trimethoprim-sulfamethoxazole. The nurse reviews his international normalized ratio (INR) which is 4.2. The client has no signs of bleeding. What is the nurse's priority action?

  1. A Increase the warfarin dose to 7.5 mg to maintain anticoagulation during the infection.
  2. B Administer vitamin K 10 mg orally as a one-time dose to reverse the warfarin effect.
  3. C Administer the trimethoprim-sulfamethoxazole as prescribed and recheck the INR in 24 hours.
  4. D Hold the warfarin and notify the healthcare provider of the elevated INR and the new antibiotic.
Show the answer and explanation

Correct answer: D

Trimethoprim-sulfamethoxazole inhibits warfarin metabolism and raises the INR. With an INR of 4.2, the nurse holds the warfarin and notifies the provider of both the value and the interaction so the regimen can be adjusted.

Why the other options are wrong:
A: Increasing the dose would raise the INR further and increase bleeding risk.
B: Vitamin K is not routinely given for this INR without bleeding, and it requires a prescription.
C: Continuing as usual ignores the elevated INR and the interaction that is driving it.

Question 2

A 72-year-old client in a long-term care facility who takes warfarin 5 mg daily is prescribed a 7-day course of levofloxacin for a urinary tract infection. The nurse reviews the most recent international normalized ratio (INR) result of 2.4. Which finding requires the nurse to notify the provider immediately?

  1. A The client reports a new onset of mild lower back pain and dark-colored urine.
  2. B The client's white blood cell count is 11,500 cells/mcL and temperature is 37.6°C.
  3. C The client's blood pressure is 142/78 mm Hg and heart rate is 88 beats per minute.
  4. D The client's serum creatinine level is 1.1 mg/dL and blood urea nitrogen is 18 mg/dL.
Show the answer and explanation

Correct answer: A

Levofloxacin can increase warfarin's effect and raise the INR. New back pain with dark urine may signal bleeding, such as hematuria or retroperitoneal bleeding, so the provider must be notified immediately.

Why the other options are wrong:
B: A slightly high white count and low-grade temperature are expected with a urinary tract infection.
C: This blood pressure and heart rate do not suggest acute bleeding.
D: These kidney function values are within normal limits.

Question 3

A 45-year-old client in the outpatient clinic is prescribed a new angiotensin-converting enzyme (ACE) inhibitor for hypertension. The client also takes over-the-counter ibuprofen 400 mg three times daily for chronic knee pain. The nurse reviews the client's laboratory results. Which finding would the nurse identify as most concerning for a potential adverse interaction?

  1. A Hemoglobin 13.2 g/dL.
  2. B Serum potassium 5.6 mEq/L.
  3. C Serum creatinine 1.0 mg/dL.
  4. D Platelet count 210,000/mm³.
Show the answer and explanation

Correct answer: B

ACE inhibitors reduce aldosterone and raise potassium, and NSAIDs such as ibuprofen further impair renal potassium excretion and kidney blood flow. A potassium of 5.6 mEq/L is above normal and can cause dysrhythmias, making it the most concerning finding for this interaction.

Why the other options are wrong:
A: A hemoglobin of 13.2 g/dL is within or near normal limits and does not suggest an interaction effect.
C: A creatinine of 1.0 mg/dL is normal, so there is no sign yet of the kidney injury this combination can cause.
D: A platelet count of 210,000/mm³ is normal; ibuprofen affects platelet function, not platelet count.

Question 4

A 75-year-old client with heart failure is receiving digoxin and furosemide. Which laboratory value requires the nurse's immediate action?

  1. A A serum potassium level of 3.1 mEq/L.
  2. B A serum digoxin level of 1.2 ng/mL.
  3. C A serum creatinine level of 1.0 mg/dL.
  4. D A serum sodium level of 138 mEq/L.
Show the answer and explanation

Correct answer: A

Furosemide causes potassium loss, and a potassium of 3.1 mEq/L is below normal. Hypokalemia increases the heart's sensitivity to digoxin and raises the risk of digoxin toxicity and dangerous dysrhythmias, so this value requires immediate action.

Why the other options are wrong:
B: A digoxin level of 1.2 ng/mL is within the commonly cited therapeutic range and does not indicate toxicity.
C: A creatinine of 1.0 mg/dL is normal and indicates adequate renal clearance of digoxin.
D: A sodium of 138 mEq/L is within the normal range of 135 to 145 mEq/L.

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