NCLEX-RN Pharmacology Practice Questions | 20 ATI & NGN-
Style
Introduction to Pharmacology MCQs with Detailed Rationales
| Nursing Exam Prep 2026
Question 1
Clinical Scenario
A 72-year-old woman is admitted to the medical-surgical unit
with community-acquired pneumonia. Her history includes
hypertension, osteoarthritis, chronic kidney disease stage 3,
and type 2 diabetes mellitus. During admission, the nurse
reviews her home medications and notes she takes lisinopril,
metformin, ibuprofen as needed, and an over-the-counter
herbal supplement for "memory support." The provider
prescribes intravenous ceftriaxone. Before administering the
first dose, the nurse asks the client about medication allergies.
The client reports developing hives and difficulty breathing after
receiving penicillin several years ago.
,Question Stem
Which nursing action is the priority before administering the
prescribed antibiotic?
A. Administer the antibiotic because ceftriaxone is a different
drug class.
B. Verify the reported allergy, assess the reaction details, and
notify the provider before administration.
C. Administer diphenhydramine before giving the antibiotic.
D. Delay the antibiotic until culture results are available.
Correct Answer
Correct Answer: B. Verify the reported allergy, assess the
reaction details, and notify the provider before
administration.
Detailed Rationale
Medication safety begins with confirming allergies before
administering any medication. The client's history of hives and
difficulty breathing suggests a previous IgE-mediated
(anaphylactic-type) hypersensitivity reaction to penicillin.
Although cross-reactivity between penicillins and third-
generation cephalosporins such as ceftriaxone is relatively low,
,a history of severe immediate hypersensitivity requires careful
evaluation and communication with the prescribing provider
before administration. The nurse should verify the allergy,
document the reaction accurately, and collaborate with the
provider regarding alternative therapy or additional
precautions.
Option A is incorrect because assuming safety based solely on
drug class may expose the patient to unnecessary risk. Allergy
severity—not simply medication class—guides decision-making.
Option C is incorrect because administering diphenhydramine
does not prevent anaphylaxis and should never be used to
justify giving a potentially contraindicated medication.
Option D is incorrect because delaying empiric antibiotics for
pneumonia without clinical justification may worsen outcomes.
The appropriate action is to promptly clarify the allergy while
facilitating timely treatment.
This scenario also illustrates the importance of obtaining a
complete medication history, including prescription drugs, over-
the-counter medications, and herbal supplements, as part of
safe medication administration and medication reconciliation.
Learning Objectives
After completing this question, the learner should be able to:
, • Differentiate between medication intolerance and true
allergic reactions.
• Prioritize nursing actions when a severe medication allergy
is identified.
• Apply medication reconciliation principles before
medication administration.
• Promote safe antibiotic administration through
appropriate assessment.
Difficulty Level
Moderate
NCLEX Client Need Category
Safe and Effective Care Environment
Cognitive Level (Bloom)
Analyze
NCLEX Clinical Judgment Skill
Take Action
Style
Introduction to Pharmacology MCQs with Detailed Rationales
| Nursing Exam Prep 2026
Question 1
Clinical Scenario
A 72-year-old woman is admitted to the medical-surgical unit
with community-acquired pneumonia. Her history includes
hypertension, osteoarthritis, chronic kidney disease stage 3,
and type 2 diabetes mellitus. During admission, the nurse
reviews her home medications and notes she takes lisinopril,
metformin, ibuprofen as needed, and an over-the-counter
herbal supplement for "memory support." The provider
prescribes intravenous ceftriaxone. Before administering the
first dose, the nurse asks the client about medication allergies.
The client reports developing hives and difficulty breathing after
receiving penicillin several years ago.
,Question Stem
Which nursing action is the priority before administering the
prescribed antibiotic?
A. Administer the antibiotic because ceftriaxone is a different
drug class.
B. Verify the reported allergy, assess the reaction details, and
notify the provider before administration.
C. Administer diphenhydramine before giving the antibiotic.
D. Delay the antibiotic until culture results are available.
Correct Answer
Correct Answer: B. Verify the reported allergy, assess the
reaction details, and notify the provider before
administration.
Detailed Rationale
Medication safety begins with confirming allergies before
administering any medication. The client's history of hives and
difficulty breathing suggests a previous IgE-mediated
(anaphylactic-type) hypersensitivity reaction to penicillin.
Although cross-reactivity between penicillins and third-
generation cephalosporins such as ceftriaxone is relatively low,
,a history of severe immediate hypersensitivity requires careful
evaluation and communication with the prescribing provider
before administration. The nurse should verify the allergy,
document the reaction accurately, and collaborate with the
provider regarding alternative therapy or additional
precautions.
Option A is incorrect because assuming safety based solely on
drug class may expose the patient to unnecessary risk. Allergy
severity—not simply medication class—guides decision-making.
Option C is incorrect because administering diphenhydramine
does not prevent anaphylaxis and should never be used to
justify giving a potentially contraindicated medication.
Option D is incorrect because delaying empiric antibiotics for
pneumonia without clinical justification may worsen outcomes.
The appropriate action is to promptly clarify the allergy while
facilitating timely treatment.
This scenario also illustrates the importance of obtaining a
complete medication history, including prescription drugs, over-
the-counter medications, and herbal supplements, as part of
safe medication administration and medication reconciliation.
Learning Objectives
After completing this question, the learner should be able to:
, • Differentiate between medication intolerance and true
allergic reactions.
• Prioritize nursing actions when a severe medication allergy
is identified.
• Apply medication reconciliation principles before
medication administration.
• Promote safe antibiotic administration through
appropriate assessment.
Difficulty Level
Moderate
NCLEX Client Need Category
Safe and Effective Care Environment
Cognitive Level (Bloom)
Analyze
NCLEX Clinical Judgment Skill
Take Action
