NCLEX RN Pharmacological & Parenteral
Therapies Exam 2 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
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1. A client is receiving a continuous IV infusion of heparin for a deep vein
thrombosis. The nurse notes that the client’s activated partial
thromboplastin time (aPTT) is 95 seconds (control 30 seconds). Which
action should the nurse take first?
A) Increase the heparin infusion rate per protocol.
B) Stop the heparin infusion immediately.
C) Administer protamine sulfate as prescribed.
D) Assess the client for signs of bleeding.
Answer: D. Assess the client for signs of bleeding.
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5
to 2.5 times the control value (45 to 75 seconds). An aPTT of 95 seconds is
supratherapeutic, placing the client at high risk for bleeding. The nurse’s first
action is to assess the client for any signs of active bleeding, such as hematuria,
melena, petechiae, or bleeding from IV sites, to determine the urgency of the
situation. After assessment, the nurse would notify the health care provider and
anticipate orders to stop or reduce the infusion and possibly administer protamine
sulfate. Stopping the infusion without assessing the client may be premature if no
bleeding is present and the provider is not yet notified. Administering protamine
sulfate is a subsequent step based on provider order. Increasing the rate would
worsen the risk.
, 2. The nurse prepares to administer 10 units of regular insulin and 25 units of
NPH insulin subcutaneously to a client with diabetes mellitus. Which action
is correct?
A) Draw up the NPH insulin first, then the regular insulin.
B) Inject air equal to the NPH dose into the NPH vial, then inject air equal to
the regular dose into the regular vial.
C) Draw up the regular insulin first, then the NPH insulin.
D) Administer the two insulins in separate syringes at different sites.
Answer: C. Draw up the regular insulin first, then the NPH insulin.
Rationale: When mixing short-acting (regular) and intermediate-acting (NPH)
insulin in the same syringe, the clear (regular) insulin is drawn up first to prevent
contamination of the regular insulin vial with NPH, which contains protamine and
can alter the action of regular insulin. The correct sequence is: inject air into the
NPH vial (cloudy), inject air into the regular vial (clear), draw up the regular
insulin, then draw up the NPH insulin. Option B describes injecting air into NPH
first, which is correct, but it does not specify drawing up; option C is the correct
answer because it identifies the proper drawing sequence. Separate syringes are
unnecessary unless the client prefers them or the total volume is too large;
however, mixing in one syringe is common practice.
3. A client receiving total parenteral nutrition (TPN) via a central venous
catheter suddenly develops fever, chills, and malaise. The nurse suspects a
catheter-related bloodstream infection. What is the priority nursing action?
A) Administer the prescribed antipyretic.
B) Discontinue the TPN infusion and cap the line.
C) Obtain blood cultures as ordered.
D) Change the TPN solution and tubing.
Answer: C. Obtain blood cultures as ordered.
Rationale: When a catheter-related bloodstream infection is suspected, obtaining
blood cultures (both peripheral and from the central line) is the priority to identify
the causative organism before initiating antibiotics. TPN should not be abruptly
discontinued without orders because sudden cessation can cause rebound
,hypoglycemia. The line may be removed later if infection is confirmed, but capping
it without cultures would delay diagnosis. Antipyretics can be given, but cultures
must be drawn first to avoid masking the infection. Changing the solution and
tubing is a standard infection prevention measure but not the first step in an acute
febrile episode.
4. A nurse is to administer furosemide 40 mg IV push to a client with
pulmonary edema. The medication is available as 10 mg/mL. How many
milliliters should the nurse administer?
A) 0.4 mL
B) 2 mL
C) 4 mL
D) 40 mL
Answer: C. 4 mL.
Rationale: The dose required is 40 mg, and the concentration is 10 mg/mL. Using
dimensional analysis: 40 mg ÷ 10 mg/mL = 4 mL. Furosemide is a loop diuretic
administered IV push slowly over 1–2 minutes. 0.4 mL would be 4 mg, 2 mL would
be 20 mg, and 40 mL would be an excessive volume for this concentration and
dose.
5. A client is receiving a blood transfusion. Thirty minutes after initiation, the
client reports chills, lower back pain, and a feeling of impending doom. Vital
signs show fever, tachycardia, and hypotension. What type of transfusion
reaction does the nurse suspect?
A) Febrile non-hemolytic reaction
B) Allergic reaction
C) Acute hemolytic reaction
D) Circulatory overload
Answer: C. Acute hemolytic reaction.
Rationale: Symptoms of an acute hemolytic reaction include chills, fever, lower
back pain (due to hemoglobinuria and renal vasoconstriction), feeling of
impending doom, tachycardia, hypotension, and dark urine. This is a medical
emergency resulting from ABO incompatibility, causing rapid destruction of donor
, red blood cells. Febrile non-hemolytic reaction presents with fever and chills but no
back pain or hypotension. Allergic reaction typically involves hives, itching, and
flushing. Circulatory overload causes dyspnea, crackles, and hypertension. The
priority is to stop the transfusion immediately, maintain IV access with normal
saline, and notify the provider.
6. The nurse is caring for a client receiving lithium carbonate for bipolar
disorder. Which finding should alert the nurse to possible lithium toxicity?
A) Fine hand tremor and polyuria
B) Dry mouth and constipation
C) Tinnitus and blurred vision
D) Vomiting, diarrhea, and slurred speech
Answer: D. Vomiting, diarrhea, and slurred speech.
Rationale: Early signs of lithium toxicity include gastrointestinal symptoms such as
vomiting and diarrhea, followed by neuromuscular symptoms like slurred speech,
muscle weakness, and coarse tremor. Fine hand tremor and polyuria are common
side effects at therapeutic levels, not necessarily toxicity. Dry mouth and
constipation are anticholinergic effects not typical of lithium. Tinnitus and blurred
vision may occur but GI and slurred speech are hallmark early toxic signs. The
nurse should hold the dose, check the lithium level, and notify the provider.
7. A client with a history of asthma is prescribed propranolol for hypertension.
What is the nurse’s priority concern?
A) Orthostatic hypotension
B) Bronchoconstriction
C) Masked hypoglycemia
D) Fluid retention
Answer: B. Bronchoconstriction.
Rationale: Propranolol is a non-selective beta-blocker that blocks both beta-1
(cardiac) and beta-2 (pulmonary) receptors. In a client with asthma, beta-2
blockade can cause bronchoconstriction and precipitate an asthma attack.
Cardioselective beta-1 blockers (e.g., atenolol) are preferred. Orthostatic
hypotension and masked hypoglycemia are concerns with beta-blockers but are
Therapies Exam 2 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A client is receiving a continuous IV infusion of heparin for a deep vein
thrombosis. The nurse notes that the client’s activated partial
thromboplastin time (aPTT) is 95 seconds (control 30 seconds). Which
action should the nurse take first?
A) Increase the heparin infusion rate per protocol.
B) Stop the heparin infusion immediately.
C) Administer protamine sulfate as prescribed.
D) Assess the client for signs of bleeding.
Answer: D. Assess the client for signs of bleeding.
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5
to 2.5 times the control value (45 to 75 seconds). An aPTT of 95 seconds is
supratherapeutic, placing the client at high risk for bleeding. The nurse’s first
action is to assess the client for any signs of active bleeding, such as hematuria,
melena, petechiae, or bleeding from IV sites, to determine the urgency of the
situation. After assessment, the nurse would notify the health care provider and
anticipate orders to stop or reduce the infusion and possibly administer protamine
sulfate. Stopping the infusion without assessing the client may be premature if no
bleeding is present and the provider is not yet notified. Administering protamine
sulfate is a subsequent step based on provider order. Increasing the rate would
worsen the risk.
, 2. The nurse prepares to administer 10 units of regular insulin and 25 units of
NPH insulin subcutaneously to a client with diabetes mellitus. Which action
is correct?
A) Draw up the NPH insulin first, then the regular insulin.
B) Inject air equal to the NPH dose into the NPH vial, then inject air equal to
the regular dose into the regular vial.
C) Draw up the regular insulin first, then the NPH insulin.
D) Administer the two insulins in separate syringes at different sites.
Answer: C. Draw up the regular insulin first, then the NPH insulin.
Rationale: When mixing short-acting (regular) and intermediate-acting (NPH)
insulin in the same syringe, the clear (regular) insulin is drawn up first to prevent
contamination of the regular insulin vial with NPH, which contains protamine and
can alter the action of regular insulin. The correct sequence is: inject air into the
NPH vial (cloudy), inject air into the regular vial (clear), draw up the regular
insulin, then draw up the NPH insulin. Option B describes injecting air into NPH
first, which is correct, but it does not specify drawing up; option C is the correct
answer because it identifies the proper drawing sequence. Separate syringes are
unnecessary unless the client prefers them or the total volume is too large;
however, mixing in one syringe is common practice.
3. A client receiving total parenteral nutrition (TPN) via a central venous
catheter suddenly develops fever, chills, and malaise. The nurse suspects a
catheter-related bloodstream infection. What is the priority nursing action?
A) Administer the prescribed antipyretic.
B) Discontinue the TPN infusion and cap the line.
C) Obtain blood cultures as ordered.
D) Change the TPN solution and tubing.
Answer: C. Obtain blood cultures as ordered.
Rationale: When a catheter-related bloodstream infection is suspected, obtaining
blood cultures (both peripheral and from the central line) is the priority to identify
the causative organism before initiating antibiotics. TPN should not be abruptly
discontinued without orders because sudden cessation can cause rebound
,hypoglycemia. The line may be removed later if infection is confirmed, but capping
it without cultures would delay diagnosis. Antipyretics can be given, but cultures
must be drawn first to avoid masking the infection. Changing the solution and
tubing is a standard infection prevention measure but not the first step in an acute
febrile episode.
4. A nurse is to administer furosemide 40 mg IV push to a client with
pulmonary edema. The medication is available as 10 mg/mL. How many
milliliters should the nurse administer?
A) 0.4 mL
B) 2 mL
C) 4 mL
D) 40 mL
Answer: C. 4 mL.
Rationale: The dose required is 40 mg, and the concentration is 10 mg/mL. Using
dimensional analysis: 40 mg ÷ 10 mg/mL = 4 mL. Furosemide is a loop diuretic
administered IV push slowly over 1–2 minutes. 0.4 mL would be 4 mg, 2 mL would
be 20 mg, and 40 mL would be an excessive volume for this concentration and
dose.
5. A client is receiving a blood transfusion. Thirty minutes after initiation, the
client reports chills, lower back pain, and a feeling of impending doom. Vital
signs show fever, tachycardia, and hypotension. What type of transfusion
reaction does the nurse suspect?
A) Febrile non-hemolytic reaction
B) Allergic reaction
C) Acute hemolytic reaction
D) Circulatory overload
Answer: C. Acute hemolytic reaction.
Rationale: Symptoms of an acute hemolytic reaction include chills, fever, lower
back pain (due to hemoglobinuria and renal vasoconstriction), feeling of
impending doom, tachycardia, hypotension, and dark urine. This is a medical
emergency resulting from ABO incompatibility, causing rapid destruction of donor
, red blood cells. Febrile non-hemolytic reaction presents with fever and chills but no
back pain or hypotension. Allergic reaction typically involves hives, itching, and
flushing. Circulatory overload causes dyspnea, crackles, and hypertension. The
priority is to stop the transfusion immediately, maintain IV access with normal
saline, and notify the provider.
6. The nurse is caring for a client receiving lithium carbonate for bipolar
disorder. Which finding should alert the nurse to possible lithium toxicity?
A) Fine hand tremor and polyuria
B) Dry mouth and constipation
C) Tinnitus and blurred vision
D) Vomiting, diarrhea, and slurred speech
Answer: D. Vomiting, diarrhea, and slurred speech.
Rationale: Early signs of lithium toxicity include gastrointestinal symptoms such as
vomiting and diarrhea, followed by neuromuscular symptoms like slurred speech,
muscle weakness, and coarse tremor. Fine hand tremor and polyuria are common
side effects at therapeutic levels, not necessarily toxicity. Dry mouth and
constipation are anticholinergic effects not typical of lithium. Tinnitus and blurred
vision may occur but GI and slurred speech are hallmark early toxic signs. The
nurse should hold the dose, check the lithium level, and notify the provider.
7. A client with a history of asthma is prescribed propranolol for hypertension.
What is the nurse’s priority concern?
A) Orthostatic hypotension
B) Bronchoconstriction
C) Masked hypoglycemia
D) Fluid retention
Answer: B. Bronchoconstriction.
Rationale: Propranolol is a non-selective beta-blocker that blocks both beta-1
(cardiac) and beta-2 (pulmonary) receptors. In a client with asthma, beta-2
blockade can cause bronchoconstriction and precipitate an asthma attack.
Cardioselective beta-1 blockers (e.g., atenolol) are preferred. Orthostatic
hypotension and masked hypoglycemia are concerns with beta-blockers but are
