LPN/LVN Pharmacology Competency
Exam — Code: LPN-PHARMA-COMP |
100-Question Advanced Practice Exam
2026 | Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1. A patient receiving digoxin has an apical pulse of 54/min before
administration. What should the LPN/LVN do first?
A. Administer the medication and reassess later
B. Hold the dose and notify the healthcare provider
C. Give the medication with food
D. Administer half the prescribed dose
Answer: B. Hold the dose and notify the healthcare provider
Rationale: Digoxin can significantly decrease heart rate. An apical pulse below
the facility-defined safe parameter, commonly below 60/min in adults, requires
withholding the medication and notifying the provider.
, 2. A patient taking warfarin has an INR of 5.8 and reports bleeding gums.
Which action is most appropriate?
A. Administer the scheduled dose
B. Encourage foods high in vitamin K immediately
C. Hold warfarin and notify the healthcare provider promptly
D. Administer aspirin for discomfort
Answer: C. Hold warfarin and notify the healthcare provider promptly
Rationale: An elevated INR with active bleeding indicates excessive
anticoagulation and increased hemorrhage risk. Warfarin should be held while
the provider evaluates the patient.
3. A patient receiving IV furosemide reports muscle weakness and
palpitations. Which laboratory value is most concerning?
A. Sodium 138 mEq/L
B. Calcium 9.2 mg/dL
C. Potassium 2.8 mEq/L
D. Chloride 101 mEq/L
Answer: C. Potassium 2.8 mEq/L
Rationale: Furosemide promotes potassium loss. Severe hypokalemia can cause
muscle weakness and potentially life-threatening dysrhythmias.
4. A patient taking lisinopril develops swelling of the lips and tongue. What is
the priority action?
A. Give the next dose with food
B. Place the patient flat
C. Hold the medication and obtain immediate emergency assistance
D. Encourage oral fluids
Answer: C. Hold the medication and obtain immediate emergency assistance
,Rationale: Facial, lip, and tongue swelling may indicate angioedema, a
potentially fatal adverse effect of ACE inhibitors that can rapidly compromise
the airway.
5. Which instruction is most appropriate for a patient taking levothyroxine?
A. Take it with calcium supplements
B. Take it immediately after breakfast
C. Take it consistently on an empty stomach, usually in the morning
D. Stop taking it when symptoms improve
Answer: C. Take it consistently on an empty stomach, usually in the morning
Rationale: Levothyroxine absorption is improved when taken consistently on an
empty stomach. Calcium and iron can interfere with absorption.
6. A patient taking metformin is scheduled for a procedure involving iodinated
contrast. Which action is appropriate?
A. Give an additional dose of metformin
B. Notify the healthcare provider because metformin may need to be
temporarily withheld
C. Substitute insulin without an order
D. Give metformin with orange juice
Answer: B. Notify the healthcare provider because metformin may need to be
temporarily withheld
Rationale: Metformin may be temporarily withheld around certain contrast
studies depending on renal function and the specific procedure because
impaired renal function can increase the risk of metformin-associated lactic
acidosis.
7. A patient receiving morphine becomes difficult to arouse and has
respirations of 7/min. Which medication should the nurse anticipate?
A. Flumazenil
B. Protamine sulfate
, C. Vitamin K
D. Naloxone
Answer: D. Naloxone
Rationale: Naloxone is an opioid antagonist used to reverse opioid-induced
respiratory depression. Airway and ventilation support remain priorities.
8. Which assessment is most important before administering an opioid
analgesic?
A. Bowel sounds only
B. Skin temperature
C. Respiratory rate and level of consciousness
D. Visual acuity
Answer: C. Respiratory rate and level of consciousness
Rationale: Opioids can cause sedation and respiratory depression. Respiratory
status and level of consciousness must be assessed before administration.
9. A patient receiving vancomycin develops flushing and erythema of the face
and neck during the infusion. What complication should the nurse suspect?
A. Stevens-Johnson syndrome
B. Infusion-related vancomycin reaction
C. Hypoglycemia
D. Serotonin syndrome
Answer: B. Infusion-related vancomycin reaction
Rationale: Rapid vancomycin infusion can cause flushing, erythema, pruritus,
and hypotension. The infusion may need to be slowed or stopped according to
the clinical situation and orders.
10.Which medication requires monitoring for ototoxicity and nephrotoxicity?
Exam — Code: LPN-PHARMA-COMP |
100-Question Advanced Practice Exam
2026 | Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1. A patient receiving digoxin has an apical pulse of 54/min before
administration. What should the LPN/LVN do first?
A. Administer the medication and reassess later
B. Hold the dose and notify the healthcare provider
C. Give the medication with food
D. Administer half the prescribed dose
Answer: B. Hold the dose and notify the healthcare provider
Rationale: Digoxin can significantly decrease heart rate. An apical pulse below
the facility-defined safe parameter, commonly below 60/min in adults, requires
withholding the medication and notifying the provider.
, 2. A patient taking warfarin has an INR of 5.8 and reports bleeding gums.
Which action is most appropriate?
A. Administer the scheduled dose
B. Encourage foods high in vitamin K immediately
C. Hold warfarin and notify the healthcare provider promptly
D. Administer aspirin for discomfort
Answer: C. Hold warfarin and notify the healthcare provider promptly
Rationale: An elevated INR with active bleeding indicates excessive
anticoagulation and increased hemorrhage risk. Warfarin should be held while
the provider evaluates the patient.
3. A patient receiving IV furosemide reports muscle weakness and
palpitations. Which laboratory value is most concerning?
A. Sodium 138 mEq/L
B. Calcium 9.2 mg/dL
C. Potassium 2.8 mEq/L
D. Chloride 101 mEq/L
Answer: C. Potassium 2.8 mEq/L
Rationale: Furosemide promotes potassium loss. Severe hypokalemia can cause
muscle weakness and potentially life-threatening dysrhythmias.
4. A patient taking lisinopril develops swelling of the lips and tongue. What is
the priority action?
A. Give the next dose with food
B. Place the patient flat
C. Hold the medication and obtain immediate emergency assistance
D. Encourage oral fluids
Answer: C. Hold the medication and obtain immediate emergency assistance
,Rationale: Facial, lip, and tongue swelling may indicate angioedema, a
potentially fatal adverse effect of ACE inhibitors that can rapidly compromise
the airway.
5. Which instruction is most appropriate for a patient taking levothyroxine?
A. Take it with calcium supplements
B. Take it immediately after breakfast
C. Take it consistently on an empty stomach, usually in the morning
D. Stop taking it when symptoms improve
Answer: C. Take it consistently on an empty stomach, usually in the morning
Rationale: Levothyroxine absorption is improved when taken consistently on an
empty stomach. Calcium and iron can interfere with absorption.
6. A patient taking metformin is scheduled for a procedure involving iodinated
contrast. Which action is appropriate?
A. Give an additional dose of metformin
B. Notify the healthcare provider because metformin may need to be
temporarily withheld
C. Substitute insulin without an order
D. Give metformin with orange juice
Answer: B. Notify the healthcare provider because metformin may need to be
temporarily withheld
Rationale: Metformin may be temporarily withheld around certain contrast
studies depending on renal function and the specific procedure because
impaired renal function can increase the risk of metformin-associated lactic
acidosis.
7. A patient receiving morphine becomes difficult to arouse and has
respirations of 7/min. Which medication should the nurse anticipate?
A. Flumazenil
B. Protamine sulfate
, C. Vitamin K
D. Naloxone
Answer: D. Naloxone
Rationale: Naloxone is an opioid antagonist used to reverse opioid-induced
respiratory depression. Airway and ventilation support remain priorities.
8. Which assessment is most important before administering an opioid
analgesic?
A. Bowel sounds only
B. Skin temperature
C. Respiratory rate and level of consciousness
D. Visual acuity
Answer: C. Respiratory rate and level of consciousness
Rationale: Opioids can cause sedation and respiratory depression. Respiratory
status and level of consciousness must be assessed before administration.
9. A patient receiving vancomycin develops flushing and erythema of the face
and neck during the infusion. What complication should the nurse suspect?
A. Stevens-Johnson syndrome
B. Infusion-related vancomycin reaction
C. Hypoglycemia
D. Serotonin syndrome
Answer: B. Infusion-related vancomycin reaction
Rationale: Rapid vancomycin infusion can cause flushing, erythema, pruritus,
and hypotension. The infusion may need to be slowed or stopped according to
the clinical situation and orders.
10.Which medication requires monitoring for ototoxicity and nephrotoxicity?
