NCLEX RN Pharmacology 2025 — 65 Q&A Complete Test Bank
Verified Rationales NGN
Series:
CrashCourses Professional Study Series
Author:
Dr Z. Moomba, MBChB, MRCPsych | BethelWellness Ltd
Exam Target:
NCLEX RN
Year:
2025/2026
Format:
65 Questions with Verified Answers and Rationales
>
Author's Note:
This document is an original work produced for the CrashCourses Professional Study Series.
Clinical questions and professional scenarios were composed by Dr Z. Moomba based on current
exam objectives, published guidelines, and evidence-based sources (2024–2025). All patient
names, ages, and case details are fictional. Any resemblance to existing published Q&A banks is
coincidental. For personal study use only — not for reproduction or redistribution.
SECTION A — FOUNDATIONS
1. A 68-year-old client with heart failure is prescribed digoxin. During the morning assessment, the
client reports nausea, anorexia, and seeing "yellow halos" around lights. The nurse notes a heart rate
of 54 bpm. Which action should the nurse take first?
A. Administer an antiemetic for nausea.
B. Obtain a 12-lead ECG and withhold the digoxin.
C. Check the client's most recent potassium level.
D. Administer a stat dose of atropine.
Answer: B
,Rationale:
a) The client is exhibiting classic signs of digoxin toxicity (visual disturbances, GI symptoms,
bradycardia), requiring immediate withholding of the drug and cardiac assessment.
b) An ECG is the priority discriminating action to assess for life-threatening arrhythmias
associated with bradycardia and toxicity before any other intervention.
c) While checking potassium is vital because hypokalemia exacerbates digoxin toxicity,
withholding the drug and assessing cardiac rhythm (ECG) takes immediate precedence over lab
review.
d) Examiner Pearl: Always check the apical pulse for a full minute before administering digoxin;
hold if HR <60 in adults. [AHA Heart Failure Guidelines 2025].
2. A client with bipolar I disorder is maintained on lithium carbonate. The recent serum lithium level is
1.8 mEq/L. The client complains of fine hand tremors and mild thirst. What is the nurse's best
interpretation of these findings?
A. The client is experiencing early signs of severe lithium toxicity.
B. The level is subtherapeutic, and a dose increase is required.
C. The level represents mild toxicity, and the next dose should be held.
D. These are expected side effects within the therapeutic range.
Answer: C
Rationale:
a) A lithium level of 1.8 mEq/L is above the narrow therapeutic index (0.6–1.2 mEq/L), indicating
mild to moderate toxicity.
b) The discriminating feature is the serum level exceeding 1.5 mEq/L, paired with worsening
neuro-muscular signs (tremors usually worsen as levels rise).
c) Fine tremors and thirst are expected at therapeutic levels, but a level of 1.8 mEq/L is objectively
toxic and cannot be dismissed as a normal side effect.
d) Examiner Pearl: Lithium toxicity is heavily influenced by sodium and fluid balance; hyponatremia
increases lithium reabsorption, leading to toxicity. [APA Bipolar Guidelines].
3. A 55-year-old male with hypertension is started on lisinopril. Two weeks later, he visits the clinic
complaining of a persistent, dry, hacking cough that disrupts his sleep. What is the most appropriate
nursing response?
A. Advise the client to use over-the-counter cough suppressants.
,B. Inform the client that this is a common side effect and the provider may switch him to an ARB.
C. Instruct the client to immediately go to the emergency department for impending anaphylaxis.
D. Tell the client to stop taking the medication and double the dose of his diuretic.
Answer: B
Rationale:
a) ACE inhibitors commonly cause a dry, non-productive cough due to the accumulation of
bradykinin in the lungs.
b) Switching to an Angiotensin II Receptor Blocker (ARB) like losartan is the standard clinical
response, as ARBs do not inhibit kinase II and thus do not cause bradykinin buildup.
c) While angioedema is a life-threatening ACE inhibitor adverse effect requiring ED evaluation, a
dry cough alone is not an indicator of impending anaphylaxis.
d) Examiner Pearl: "ACE" = Angioedema, Cough, Elevated potassium. [JNC 8 / ACC/AHA
Hypertension 2024].
4. A nurse is reviewing the medication administration record (MAR) for a client with a history of
severe asthma and recent myocardial infarction. The provider has prescribed propranolol. What is
the nurse's priority action?
A. Administer the medication and monitor heart rate closely.
B. Ensure a rescue inhaler is at the bedside before administration.
C. Hold the medication and contact the provider to question the prescription.
D. Assess the client's blood pressure prior to giving the dose.
Answer: C
Rationale:
a) Propranolol is a non-selective beta-blocker that blocks both beta-1 (cardiac) and beta-2
(pulmonary) receptors, causing bronchoconstriction.
b) The discriminating feature is the client's history of severe asthma, which makes a non-selective
beta-blocker absolutely contraindicated.
c) Having a rescue inhaler nearby does not justify administering a contraindicated medication that
could trigger a fatal status asthmaticus.
d) Examiner Pearl: In asthmatics needing beta-blockers, cardio-selective agents (metoprolol,
atenolol) are preferred, remembering they only act on beta-1 at standard doses. [GINA Guidelines
2025].
, 5. A client is receiving a continuous IV infusion of heparin for a deep vein thrombosis (DVT). The
latest activated partial thromboplastin time (aPTT) is 120 seconds. The control value is 30 seconds.
Which action should the nurse take?
A. Maintain the current infusion rate.
B. Increase the infusion rate according to protocol.
C. Stop the infusion and prepare to administer protamine sulfate if ordered.
D. Administer vitamin K immediately.
Answer: C
Rationale:
a) An aPTT of 120 seconds is dangerously prolonged (therapeutic is typically 1.5 to 2.5 times the
control, meaning 45-75 seconds).
b) The discriminating action for a critically high aPTT on a heparin drip is to immediately stop the
infusion to prevent spontaneous hemorrhage.
c) Vitamin K is the antidote for warfarin, not heparin; giving it would be an ineffective and incorrect
intervention.
d) Examiner Pearl: Protamine sulfate is the specific reversal agent for unfractionated heparin and
LMWH. [CHEST Antithrombotic Guidelines].
6. A client with type 1 diabetes is prescribed subcutaneous insulin lispro at 08:00. The client's
breakfast arrives at 08:30. What is the most appropriate action by the nurse?
A. Administer the insulin exactly at 08:00.
B. Hold the insulin until the client has finished eating.
C. Administer the insulin when the breakfast tray is in front of the client.
D. Mix the insulin lispro with insulin glargine to delay the onset.
Answer: C
Rationale:
a) Insulin lispro is a rapid-acting insulin with an onset of 10-15 minutes, requiring food to be
immediately available to prevent hypoglycemia.
b) Timing rapid-acting insulin with the physical presence of the food tray ensures peak action
coincides with postprandial glucose spikes.
Verified Rationales NGN
Series:
CrashCourses Professional Study Series
Author:
Dr Z. Moomba, MBChB, MRCPsych | BethelWellness Ltd
Exam Target:
NCLEX RN
Year:
2025/2026
Format:
65 Questions with Verified Answers and Rationales
>
Author's Note:
This document is an original work produced for the CrashCourses Professional Study Series.
Clinical questions and professional scenarios were composed by Dr Z. Moomba based on current
exam objectives, published guidelines, and evidence-based sources (2024–2025). All patient
names, ages, and case details are fictional. Any resemblance to existing published Q&A banks is
coincidental. For personal study use only — not for reproduction or redistribution.
SECTION A — FOUNDATIONS
1. A 68-year-old client with heart failure is prescribed digoxin. During the morning assessment, the
client reports nausea, anorexia, and seeing "yellow halos" around lights. The nurse notes a heart rate
of 54 bpm. Which action should the nurse take first?
A. Administer an antiemetic for nausea.
B. Obtain a 12-lead ECG and withhold the digoxin.
C. Check the client's most recent potassium level.
D. Administer a stat dose of atropine.
Answer: B
,Rationale:
a) The client is exhibiting classic signs of digoxin toxicity (visual disturbances, GI symptoms,
bradycardia), requiring immediate withholding of the drug and cardiac assessment.
b) An ECG is the priority discriminating action to assess for life-threatening arrhythmias
associated with bradycardia and toxicity before any other intervention.
c) While checking potassium is vital because hypokalemia exacerbates digoxin toxicity,
withholding the drug and assessing cardiac rhythm (ECG) takes immediate precedence over lab
review.
d) Examiner Pearl: Always check the apical pulse for a full minute before administering digoxin;
hold if HR <60 in adults. [AHA Heart Failure Guidelines 2025].
2. A client with bipolar I disorder is maintained on lithium carbonate. The recent serum lithium level is
1.8 mEq/L. The client complains of fine hand tremors and mild thirst. What is the nurse's best
interpretation of these findings?
A. The client is experiencing early signs of severe lithium toxicity.
B. The level is subtherapeutic, and a dose increase is required.
C. The level represents mild toxicity, and the next dose should be held.
D. These are expected side effects within the therapeutic range.
Answer: C
Rationale:
a) A lithium level of 1.8 mEq/L is above the narrow therapeutic index (0.6–1.2 mEq/L), indicating
mild to moderate toxicity.
b) The discriminating feature is the serum level exceeding 1.5 mEq/L, paired with worsening
neuro-muscular signs (tremors usually worsen as levels rise).
c) Fine tremors and thirst are expected at therapeutic levels, but a level of 1.8 mEq/L is objectively
toxic and cannot be dismissed as a normal side effect.
d) Examiner Pearl: Lithium toxicity is heavily influenced by sodium and fluid balance; hyponatremia
increases lithium reabsorption, leading to toxicity. [APA Bipolar Guidelines].
3. A 55-year-old male with hypertension is started on lisinopril. Two weeks later, he visits the clinic
complaining of a persistent, dry, hacking cough that disrupts his sleep. What is the most appropriate
nursing response?
A. Advise the client to use over-the-counter cough suppressants.
,B. Inform the client that this is a common side effect and the provider may switch him to an ARB.
C. Instruct the client to immediately go to the emergency department for impending anaphylaxis.
D. Tell the client to stop taking the medication and double the dose of his diuretic.
Answer: B
Rationale:
a) ACE inhibitors commonly cause a dry, non-productive cough due to the accumulation of
bradykinin in the lungs.
b) Switching to an Angiotensin II Receptor Blocker (ARB) like losartan is the standard clinical
response, as ARBs do not inhibit kinase II and thus do not cause bradykinin buildup.
c) While angioedema is a life-threatening ACE inhibitor adverse effect requiring ED evaluation, a
dry cough alone is not an indicator of impending anaphylaxis.
d) Examiner Pearl: "ACE" = Angioedema, Cough, Elevated potassium. [JNC 8 / ACC/AHA
Hypertension 2024].
4. A nurse is reviewing the medication administration record (MAR) for a client with a history of
severe asthma and recent myocardial infarction. The provider has prescribed propranolol. What is
the nurse's priority action?
A. Administer the medication and monitor heart rate closely.
B. Ensure a rescue inhaler is at the bedside before administration.
C. Hold the medication and contact the provider to question the prescription.
D. Assess the client's blood pressure prior to giving the dose.
Answer: C
Rationale:
a) Propranolol is a non-selective beta-blocker that blocks both beta-1 (cardiac) and beta-2
(pulmonary) receptors, causing bronchoconstriction.
b) The discriminating feature is the client's history of severe asthma, which makes a non-selective
beta-blocker absolutely contraindicated.
c) Having a rescue inhaler nearby does not justify administering a contraindicated medication that
could trigger a fatal status asthmaticus.
d) Examiner Pearl: In asthmatics needing beta-blockers, cardio-selective agents (metoprolol,
atenolol) are preferred, remembering they only act on beta-1 at standard doses. [GINA Guidelines
2025].
, 5. A client is receiving a continuous IV infusion of heparin for a deep vein thrombosis (DVT). The
latest activated partial thromboplastin time (aPTT) is 120 seconds. The control value is 30 seconds.
Which action should the nurse take?
A. Maintain the current infusion rate.
B. Increase the infusion rate according to protocol.
C. Stop the infusion and prepare to administer protamine sulfate if ordered.
D. Administer vitamin K immediately.
Answer: C
Rationale:
a) An aPTT of 120 seconds is dangerously prolonged (therapeutic is typically 1.5 to 2.5 times the
control, meaning 45-75 seconds).
b) The discriminating action for a critically high aPTT on a heparin drip is to immediately stop the
infusion to prevent spontaneous hemorrhage.
c) Vitamin K is the antidote for warfarin, not heparin; giving it would be an ineffective and incorrect
intervention.
d) Examiner Pearl: Protamine sulfate is the specific reversal agent for unfractionated heparin and
LMWH. [CHEST Antithrombotic Guidelines].
6. A client with type 1 diabetes is prescribed subcutaneous insulin lispro at 08:00. The client's
breakfast arrives at 08:30. What is the most appropriate action by the nurse?
A. Administer the insulin exactly at 08:00.
B. Hold the insulin until the client has finished eating.
C. Administer the insulin when the breakfast tray is in front of the client.
D. Mix the insulin lispro with insulin glargine to delay the onset.
Answer: C
Rationale:
a) Insulin lispro is a rapid-acting insulin with an onset of 10-15 minutes, requiring food to be
immediately available to prevent hypoglycemia.
b) Timing rapid-acting insulin with the physical presence of the food tray ensures peak action
coincides with postprandial glucose spikes.
