NCLEX-RN PHARMACOLOGY & MEDICATION
ADMINISTRATION PRACTICE EXAMINATION 2026–
2027 — COMPREHENSIVE STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
1. A nurse is preparing to administer digoxin to a client with heart failure. The
client’s serum digoxin level is 2.5 ng/mL (therapeutic range 0.5–2.0 ng/mL).
Which assessment finding is most consistent with digoxin toxicity?
A) Hypertension and tachycardia
B) Visual disturbances such as yellow halos and anorexia
C) Hyperactive bowel sounds and diarrhea with hyperkalemia
D) Flushing and throbbing headache
Correct Answer: B
Digoxin toxicity commonly presents with gastrointestinal symptoms (anorexia,
nausea), visual changes (yellow or green halos, blurred vision), and cardiac
dysrhythmias. Hypokalemia, not hyperkalemia, potentiates digoxin toxicity.
Hypertension and tachycardia are not typical. Flushing and headache suggest
nitroglycerin or calcium channel blocker effects.
2. A client is prescribed warfarin for atrial fibrillation. The nurse should
instruct the client to avoid which over-the-counter medication due to
increased bleeding risk?
A) Acetaminophen
B) Ibuprofen
C) Calcium carbonate
D) Diphenhydramine
,Correct Answer: B
Ibuprofen is an NSAID that inhibits platelet aggregation and increases the risk of
bleeding when taken with warfarin. Acetaminophen is safer in moderation but
may affect INR at high doses. Calcium carbonate and diphenhydramine do not
significantly increase bleeding risk.
3. A client is receiving a continuous infusion of unfractionated heparin. The
aPTT is 90 seconds (control 30 seconds). The client has no signs of bleeding.
Which action should the nurse take?
A) Stop the infusion and administer protamine sulfate
B) Continue the infusion at the current rate
C) Reduce the infusion rate according to the titration nomogram and
recheck aPTT in 6 hours
D) Administer vitamin K orally
Correct Answer: C
The aPTT is supratherapeutic (3 times control). Without bleeding, the appropriate
action is to reduce the rate per protocol and recheck. Protamine is for severe
bleeding or overdose. Vitamin K reverses warfarin, not heparin. Continuing the
rate increases bleeding risk.
4. A nurse is teaching a client with type 2 diabetes who is prescribed
metformin. Which statement by the client indicates a need for further
teaching?
A) “I will take the medication with meals to reduce stomach upset.”
B) “I will stop the medication before any procedure that uses contrast dye.”
C) “I will have my kidney function checked regularly.”
D) “I can drink alcohol in moderation while taking this medication.”
Correct Answer: D
Alcohol can increase the risk of lactic acidosis with metformin and should be
limited or avoided. The other statements are correct: metformin should be held
before contrast procedures and renal function monitored.
, 5. A client with a history of asthma is prescribed propranolol for migraine
prophylaxis. What is the nurse’s priority action?
A) Administer the medication as prescribed
B) Hold the medication and notify the provider due to the risk of
bronchospasm
C) Give the medication with a bronchodilator
D) Reduce the dose by half and administer
Correct Answer: B
Propranolol is a nonselective beta-blocker that can cause bronchospasm in clients
with asthma and is contraindicated. The nurse should hold the medication and
notify the provider. Administering risks respiratory distress. The nurse cannot alter
the dose or give with a bronchodilator without an order.
6. A nurse is preparing to administer levothyroxine to a client with
hypothyroidism. Which client statement indicates the client understands
how to take the medication?
A) “I will take it with a glass of milk at bedtime.”
B) “I will take it on an empty stomach in the morning.”
C) “I will take it with an antacid to prevent upset stomach.”
D) “I will take it with food to improve absorption.”
Correct Answer: B
Levothyroxine is best absorbed on an empty stomach, preferably in the morning,
30–60 minutes before breakfast. Milk, antacids, and food interfere with
absorption.
7. A client is prescribed furosemide for heart failure. Which laboratory value
requires immediate notification of the provider before administering the
dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
, Correct Answer: A
Furosemide is a loop diuretic that causes potassium loss. A potassium of 3.1 mEq/L
is hypokalemic and increases the risk of cardiac dysrhythmias, especially in heart
failure. The provider should be notified before giving the dose. The other values
are within normal limits.
8. A client is receiving vancomycin intravenously for a methicillin-resistant
Staphylococcus aureus infection. The nurse notes the client is flushed, has
pruritus, and has a blood pressure of 90/50 mm Hg during the infusion.
Which action should the nurse take first?
A) Stop the infusion and notify the provider
B) Slow the infusion rate and monitor closely
C) Administer epinephrine intramuscularly
D) Apply a cold compress and continue the infusion
Correct Answer: A
Red man syndrome is a histamine-mediated reaction to rapid vancomycin infusion;
symptoms include flushing, pruritus, and hypotension. The infusion should be
stopped and the provider notified. Slowing may be appropriate for mild flushing,
but hypotension requires stopping. Epinephrine is for anaphylaxis. Continuing is
unsafe.
9. A nurse is preparing to administer potassium chloride intravenously to a
client with a potassium level of 2.9 mEq/L. Which action is correct?
A) Administer the dose by rapid IV push
B) Infuse the medication undiluted through a peripheral line
C) Use an infusion pump and verify the concentration does not exceed the
recommended rate
D) Give the medication intramuscularly to avoid vein irritation
Correct Answer: C
IV potassium must be diluted and infused slowly using an infusion pump to prevent
hyperkalemia and cardiac arrest. Rapid IV push and undiluted administration are
never safe. Potassium is not given IM.
ADMINISTRATION PRACTICE EXAMINATION 2026–
2027 — COMPREHENSIVE STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
1. A nurse is preparing to administer digoxin to a client with heart failure. The
client’s serum digoxin level is 2.5 ng/mL (therapeutic range 0.5–2.0 ng/mL).
Which assessment finding is most consistent with digoxin toxicity?
A) Hypertension and tachycardia
B) Visual disturbances such as yellow halos and anorexia
C) Hyperactive bowel sounds and diarrhea with hyperkalemia
D) Flushing and throbbing headache
Correct Answer: B
Digoxin toxicity commonly presents with gastrointestinal symptoms (anorexia,
nausea), visual changes (yellow or green halos, blurred vision), and cardiac
dysrhythmias. Hypokalemia, not hyperkalemia, potentiates digoxin toxicity.
Hypertension and tachycardia are not typical. Flushing and headache suggest
nitroglycerin or calcium channel blocker effects.
2. A client is prescribed warfarin for atrial fibrillation. The nurse should
instruct the client to avoid which over-the-counter medication due to
increased bleeding risk?
A) Acetaminophen
B) Ibuprofen
C) Calcium carbonate
D) Diphenhydramine
,Correct Answer: B
Ibuprofen is an NSAID that inhibits platelet aggregation and increases the risk of
bleeding when taken with warfarin. Acetaminophen is safer in moderation but
may affect INR at high doses. Calcium carbonate and diphenhydramine do not
significantly increase bleeding risk.
3. A client is receiving a continuous infusion of unfractionated heparin. The
aPTT is 90 seconds (control 30 seconds). The client has no signs of bleeding.
Which action should the nurse take?
A) Stop the infusion and administer protamine sulfate
B) Continue the infusion at the current rate
C) Reduce the infusion rate according to the titration nomogram and
recheck aPTT in 6 hours
D) Administer vitamin K orally
Correct Answer: C
The aPTT is supratherapeutic (3 times control). Without bleeding, the appropriate
action is to reduce the rate per protocol and recheck. Protamine is for severe
bleeding or overdose. Vitamin K reverses warfarin, not heparin. Continuing the
rate increases bleeding risk.
4. A nurse is teaching a client with type 2 diabetes who is prescribed
metformin. Which statement by the client indicates a need for further
teaching?
A) “I will take the medication with meals to reduce stomach upset.”
B) “I will stop the medication before any procedure that uses contrast dye.”
C) “I will have my kidney function checked regularly.”
D) “I can drink alcohol in moderation while taking this medication.”
Correct Answer: D
Alcohol can increase the risk of lactic acidosis with metformin and should be
limited or avoided. The other statements are correct: metformin should be held
before contrast procedures and renal function monitored.
, 5. A client with a history of asthma is prescribed propranolol for migraine
prophylaxis. What is the nurse’s priority action?
A) Administer the medication as prescribed
B) Hold the medication and notify the provider due to the risk of
bronchospasm
C) Give the medication with a bronchodilator
D) Reduce the dose by half and administer
Correct Answer: B
Propranolol is a nonselective beta-blocker that can cause bronchospasm in clients
with asthma and is contraindicated. The nurse should hold the medication and
notify the provider. Administering risks respiratory distress. The nurse cannot alter
the dose or give with a bronchodilator without an order.
6. A nurse is preparing to administer levothyroxine to a client with
hypothyroidism. Which client statement indicates the client understands
how to take the medication?
A) “I will take it with a glass of milk at bedtime.”
B) “I will take it on an empty stomach in the morning.”
C) “I will take it with an antacid to prevent upset stomach.”
D) “I will take it with food to improve absorption.”
Correct Answer: B
Levothyroxine is best absorbed on an empty stomach, preferably in the morning,
30–60 minutes before breakfast. Milk, antacids, and food interfere with
absorption.
7. A client is prescribed furosemide for heart failure. Which laboratory value
requires immediate notification of the provider before administering the
dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
, Correct Answer: A
Furosemide is a loop diuretic that causes potassium loss. A potassium of 3.1 mEq/L
is hypokalemic and increases the risk of cardiac dysrhythmias, especially in heart
failure. The provider should be notified before giving the dose. The other values
are within normal limits.
8. A client is receiving vancomycin intravenously for a methicillin-resistant
Staphylococcus aureus infection. The nurse notes the client is flushed, has
pruritus, and has a blood pressure of 90/50 mm Hg during the infusion.
Which action should the nurse take first?
A) Stop the infusion and notify the provider
B) Slow the infusion rate and monitor closely
C) Administer epinephrine intramuscularly
D) Apply a cold compress and continue the infusion
Correct Answer: A
Red man syndrome is a histamine-mediated reaction to rapid vancomycin infusion;
symptoms include flushing, pruritus, and hypotension. The infusion should be
stopped and the provider notified. Slowing may be appropriate for mild flushing,
but hypotension requires stopping. Epinephrine is for anaphylaxis. Continuing is
unsafe.
9. A nurse is preparing to administer potassium chloride intravenously to a
client with a potassium level of 2.9 mEq/L. Which action is correct?
A) Administer the dose by rapid IV push
B) Infuse the medication undiluted through a peripheral line
C) Use an infusion pump and verify the concentration does not exceed the
recommended rate
D) Give the medication intramuscularly to avoid vein irritation
Correct Answer: C
IV potassium must be diluted and infused slowly using an infusion pump to prevent
hyperkalemia and cardiac arrest. Rapid IV push and undiluted administration are
never safe. Potassium is not given IM.
