Evolve NCLEX Prep Q&A Pharmacology – NCLEX Pharmacology
Practice Questions and Answers
Section 1: Principles of Pharmacology & Medication Administration
Question 1
A nurse is preparing to administer digoxin to a client. Which of the following
should the nurse assess before administration?
A. Blood glucose level
B. Apical pulse for 1 full minute
C. Respiratory rate and depth
D. Serum potassium level
Correct Answer: B. Apical pulse for 1 full minute
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and
increases contractility. Before administration, the nurse must assess the apical
pulse for a full minute. If the heart rate is below 60 beats/min in an adult, the
nurse should withhold the dose and notify the provider. While serum potassium
levels are important to monitor for clients on digoxin (hypokalemia increases
toxicity risk), the priority pre-administration assessment is the apical pulse.
Question 2
Which of the following are appropriate nursing actions to prevent medication
errors? (Select all that apply.)
A. Use abbreviations whenever possible to save time.
B. Clarify any unclear medication orders with the prescriber.
C. Administer medications prepared by another nurse.
D. Follow the "five rights" of medication administration.
E. Document medication administration immediately after giving the dose.
Correct Answers: B, D, E
, Rationale: Clarifying unclear orders (B), following the five rights (D), and
documenting immediately (E) are key safety practices that prevent medication
errors. Using abbreviations should be avoided to prevent misinterpretation (A is
incorrect). Medications should not be administered if prepared by another nurse
unless they have been properly verified according to facility policy (C is incorrect).
Question 3
A client is prescribed a medication that is highly protein-bound. The nurse
should monitor the client for which potential effect?
A. Increased risk of drug toxicity if the client has low albumin levels.
B. Decreased therapeutic effect due to rapid excretion.
C. Increased risk of allergic reaction.
D. Decreased risk of drug-drug interactions.
Correct Answer: A. Increased risk of drug toxicity if the client has low
albumin levels.
Rationale: Highly protein-bound drugs bind to albumin in the
bloodstream. If albumin levels are low (e.g., in malnutrition, liver disease, or
nephrotic syndrome), more free, unbound drug is available in the bloodstream,
increasing the risk of toxicity. The unbound drug is the pharmacologically active
form.
Question 4
A nurse is teaching a client about a new prescription for a transdermal patch.
Which instruction is most important for the nurse to include?
A. "Apply the patch to the same site every day."
B. "Remove the old patch before applying a new one."
C. "Cut the patch in half if you feel the dose is too strong."
D. "Apply the patch to hairy areas for better absorption."
, Correct Answer: B. "Remove the old patch before applying a new one."
Rationale: Removing the old patch prevents cumulative dosing and
potential toxicity. The patch should be applied to a different site each time to
prevent skin irritation (A is incorrect). Patches should never be cut as this can
cause rapid release of the entire dose (C is incorrect). They should be applied to a
clean, hairless area for proper absorption (D is incorrect).
Question 5
Which route of medication administration has the fastest onset of action?
A. Oral
B. Subcutaneous
C. Intramuscular
D. Intravenous
Correct Answer: D. Intravenous
Rationale: The intravenous route bypasses the absorption process
entirely, delivering the medication directly into the bloodstream, resulting in the
fastest onset of action. The order from fastest to slowest onset is generally: IV >
IM > SC > PO.
Question 6
A nurse is reviewing a client's medication list and notes a prescription for a drug
with a narrow therapeutic index. This means the nurse should:
A. Administer the drug with food to prevent GI upset.
B. Monitor the client closely for signs of toxicity.
C. Expect a wide margin of safety for the medication.
D. Teach the client to double the dose if a dose is missed.
Correct Answer: B. Monitor the client closely for signs of toxicity.
, Rationale: A narrow therapeutic index means there is a small difference
between a therapeutic dose and a toxic dose. Therefore, careful monitoring for
signs of toxicity and frequent serum drug level monitoring are essential.
Question 7
A client has an order for "ASA 81 mg PO daily." The nurse correctly interprets
this as:
A. Acetaminophen 81 mg by mouth daily.
B. Aspirin 81 mg by mouth daily.
C. A saline solution 81 mg by mouth daily.
D. Atenolol 81 mg by mouth daily.
Correct Answer: B. Aspirin 81 mg by mouth daily.
Rationale: "ASA" is the standard abbreviation for acetylsalicylic acid, or
aspirin. PO means by mouth. This low dose is commonly used for its antiplatelet
effects in cardiovascular protection.
Question 8
A nurse is preparing to administer an intramuscular (IM) injection to an adult
client. Which site is generally preferred for this injection?
A. Deltoid muscle
B. Ventrogluteal muscle
C. Dorsogluteal muscle
D. Vastus lateralis muscle
Correct Answer: B. Ventrogluteal muscle
Rationale: The ventrogluteal site is the preferred site for IM injections in
adults because it is free of major blood vessels and nerves and has a well-
developed muscle mass. The dorsogluteal site is no longer recommended due to
the risk of sciatic nerve injury. The deltoid is used for smaller volumes, and the
vastus lateralis is preferred for infants.
Practice Questions and Answers
Section 1: Principles of Pharmacology & Medication Administration
Question 1
A nurse is preparing to administer digoxin to a client. Which of the following
should the nurse assess before administration?
A. Blood glucose level
B. Apical pulse for 1 full minute
C. Respiratory rate and depth
D. Serum potassium level
Correct Answer: B. Apical pulse for 1 full minute
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and
increases contractility. Before administration, the nurse must assess the apical
pulse for a full minute. If the heart rate is below 60 beats/min in an adult, the
nurse should withhold the dose and notify the provider. While serum potassium
levels are important to monitor for clients on digoxin (hypokalemia increases
toxicity risk), the priority pre-administration assessment is the apical pulse.
Question 2
Which of the following are appropriate nursing actions to prevent medication
errors? (Select all that apply.)
A. Use abbreviations whenever possible to save time.
B. Clarify any unclear medication orders with the prescriber.
C. Administer medications prepared by another nurse.
D. Follow the "five rights" of medication administration.
E. Document medication administration immediately after giving the dose.
Correct Answers: B, D, E
, Rationale: Clarifying unclear orders (B), following the five rights (D), and
documenting immediately (E) are key safety practices that prevent medication
errors. Using abbreviations should be avoided to prevent misinterpretation (A is
incorrect). Medications should not be administered if prepared by another nurse
unless they have been properly verified according to facility policy (C is incorrect).
Question 3
A client is prescribed a medication that is highly protein-bound. The nurse
should monitor the client for which potential effect?
A. Increased risk of drug toxicity if the client has low albumin levels.
B. Decreased therapeutic effect due to rapid excretion.
C. Increased risk of allergic reaction.
D. Decreased risk of drug-drug interactions.
Correct Answer: A. Increased risk of drug toxicity if the client has low
albumin levels.
Rationale: Highly protein-bound drugs bind to albumin in the
bloodstream. If albumin levels are low (e.g., in malnutrition, liver disease, or
nephrotic syndrome), more free, unbound drug is available in the bloodstream,
increasing the risk of toxicity. The unbound drug is the pharmacologically active
form.
Question 4
A nurse is teaching a client about a new prescription for a transdermal patch.
Which instruction is most important for the nurse to include?
A. "Apply the patch to the same site every day."
B. "Remove the old patch before applying a new one."
C. "Cut the patch in half if you feel the dose is too strong."
D. "Apply the patch to hairy areas for better absorption."
, Correct Answer: B. "Remove the old patch before applying a new one."
Rationale: Removing the old patch prevents cumulative dosing and
potential toxicity. The patch should be applied to a different site each time to
prevent skin irritation (A is incorrect). Patches should never be cut as this can
cause rapid release of the entire dose (C is incorrect). They should be applied to a
clean, hairless area for proper absorption (D is incorrect).
Question 5
Which route of medication administration has the fastest onset of action?
A. Oral
B. Subcutaneous
C. Intramuscular
D. Intravenous
Correct Answer: D. Intravenous
Rationale: The intravenous route bypasses the absorption process
entirely, delivering the medication directly into the bloodstream, resulting in the
fastest onset of action. The order from fastest to slowest onset is generally: IV >
IM > SC > PO.
Question 6
A nurse is reviewing a client's medication list and notes a prescription for a drug
with a narrow therapeutic index. This means the nurse should:
A. Administer the drug with food to prevent GI upset.
B. Monitor the client closely for signs of toxicity.
C. Expect a wide margin of safety for the medication.
D. Teach the client to double the dose if a dose is missed.
Correct Answer: B. Monitor the client closely for signs of toxicity.
, Rationale: A narrow therapeutic index means there is a small difference
between a therapeutic dose and a toxic dose. Therefore, careful monitoring for
signs of toxicity and frequent serum drug level monitoring are essential.
Question 7
A client has an order for "ASA 81 mg PO daily." The nurse correctly interprets
this as:
A. Acetaminophen 81 mg by mouth daily.
B. Aspirin 81 mg by mouth daily.
C. A saline solution 81 mg by mouth daily.
D. Atenolol 81 mg by mouth daily.
Correct Answer: B. Aspirin 81 mg by mouth daily.
Rationale: "ASA" is the standard abbreviation for acetylsalicylic acid, or
aspirin. PO means by mouth. This low dose is commonly used for its antiplatelet
effects in cardiovascular protection.
Question 8
A nurse is preparing to administer an intramuscular (IM) injection to an adult
client. Which site is generally preferred for this injection?
A. Deltoid muscle
B. Ventrogluteal muscle
C. Dorsogluteal muscle
D. Vastus lateralis muscle
Correct Answer: B. Ventrogluteal muscle
Rationale: The ventrogluteal site is the preferred site for IM injections in
adults because it is free of major blood vessels and nerves and has a well-
developed muscle mass. The dorsogluteal site is no longer recommended due to
the risk of sciatic nerve injury. The deltoid is used for smaller volumes, and the
vastus lateralis is preferred for infants.
