,Chapter 1 – Pharmacology and the Nursing Process in LPN
Practice
1. An 82-year-old client is prescribed digoxin 0.25 mg PO
daily. When the LPN reviews the MAR, which assessment
finding most clearly indicates the need to withhold the
dose and notify the RN?
A. Apical pulse 52 beats/min and irregular
B. Serum potassium 3.8 mEq/L
C. Client reports yellow–green halo around lights
D. Last dose documented 26 h ago
Correct Answer: A
Rationale: A heart rate below 60 beats/min (bradycardia) is a
classic sign of digoxin toxicity; withholding and reporting is
required.
Incorrect: B—Potassium is low-normal but not yet critical. C—
Visual halos suggest toxicity yet pulse is the priority before
giving the drug. D—A 2-hour delay does not contraindicate
administration.
Teaching Point: Always check apical pulse before giving digoxin;
hold if <60 bpm.
2. The LPN is preparing insulin aspart for a client with sliding-
scale coverage. Which action best demonstrates
adherence to the Six Rights of Medication Administration?
A. Drawing up the dose 30 minutes before the meal tray
arrives
, B. Comparing the MAR with the vial label three times
before injection
C. Selecting the abdomen because it has the fastest
absorption
D. Checking the client’s most recent HbA1c level
Correct Answer: B
Rationale: Triple-checking label against MAR fulfills the Right
Medication, Right Dose, and Right Route rights.
Incorrect: A—Aspart is rapid-acting and given within 5–10 min
of eating. C—Site selection affects absorption but is not one of
the Six Rights. D—HbA1c is valuable data but not part of the
immediate administration rights.
Teaching Point: Triple-check label, MAR, and client identifiers
every time.
3. A home-health LPN discovers that a client’s furosemide
tablets look different from the previous visit. The client
says, “The pharmacy switched generics.” What is the LPN’s
priority action?
A. Administer the medication as scheduled
B. Compare new tablets to a reliable drug reference source
C. Ask the client to return pills to the pharmacy
D. Document the color change in the nurse’s notes
Correct Answer: B
Rationale: Verifying the new tablet’s imprint code against a
reference confirms identity, dose, and safety before
administration.
, Incorrect: A—Unsafe without verification. C—Premature and
beyond LPN scope. D—Documentation follows verification, not
precedes it.
Teaching Point: Whenever pills change appearance, verify
identity before giving.
4. During morning med pass, the LPN notes a client’s BP is
88/52 mm Hg. Lisinopril 10 mg PO is due. What is the most
appropriate application of clinical judgment?
A. Give the dose and recheck BP in 1 hour
B. Hold the dose and inform the charge nurse immediately
C. Split the tablet to give 5 mg instead
D. Encourage fluids and then administer the full dose
Correct Answer: B
Rationale: Hypotension is a contraindication for ACE inhibitors;
holding the dose prevents further BP drop and allows RN
evaluation.
Incorrect: A—Exposes client to risk of syncope. C—Altering dose
without order is outside LPN scope. D—Fluids may help but do
not resolve potential drug-induced hypotension.
Teaching Point: Hold antihypertensives when systolic BP <90
mm Hg and notify RN.
5. The LPN is instructed to administer an ophthalmic
antibiotic. Which step indicates correct application of the
nursing process (assessment)?
A. Asking the client about allergies to sulfa drugs
B. Washing hands before opening the eye drop bottle
Practice
1. An 82-year-old client is prescribed digoxin 0.25 mg PO
daily. When the LPN reviews the MAR, which assessment
finding most clearly indicates the need to withhold the
dose and notify the RN?
A. Apical pulse 52 beats/min and irregular
B. Serum potassium 3.8 mEq/L
C. Client reports yellow–green halo around lights
D. Last dose documented 26 h ago
Correct Answer: A
Rationale: A heart rate below 60 beats/min (bradycardia) is a
classic sign of digoxin toxicity; withholding and reporting is
required.
Incorrect: B—Potassium is low-normal but not yet critical. C—
Visual halos suggest toxicity yet pulse is the priority before
giving the drug. D—A 2-hour delay does not contraindicate
administration.
Teaching Point: Always check apical pulse before giving digoxin;
hold if <60 bpm.
2. The LPN is preparing insulin aspart for a client with sliding-
scale coverage. Which action best demonstrates
adherence to the Six Rights of Medication Administration?
A. Drawing up the dose 30 minutes before the meal tray
arrives
, B. Comparing the MAR with the vial label three times
before injection
C. Selecting the abdomen because it has the fastest
absorption
D. Checking the client’s most recent HbA1c level
Correct Answer: B
Rationale: Triple-checking label against MAR fulfills the Right
Medication, Right Dose, and Right Route rights.
Incorrect: A—Aspart is rapid-acting and given within 5–10 min
of eating. C—Site selection affects absorption but is not one of
the Six Rights. D—HbA1c is valuable data but not part of the
immediate administration rights.
Teaching Point: Triple-check label, MAR, and client identifiers
every time.
3. A home-health LPN discovers that a client’s furosemide
tablets look different from the previous visit. The client
says, “The pharmacy switched generics.” What is the LPN’s
priority action?
A. Administer the medication as scheduled
B. Compare new tablets to a reliable drug reference source
C. Ask the client to return pills to the pharmacy
D. Document the color change in the nurse’s notes
Correct Answer: B
Rationale: Verifying the new tablet’s imprint code against a
reference confirms identity, dose, and safety before
administration.
, Incorrect: A—Unsafe without verification. C—Premature and
beyond LPN scope. D—Documentation follows verification, not
precedes it.
Teaching Point: Whenever pills change appearance, verify
identity before giving.
4. During morning med pass, the LPN notes a client’s BP is
88/52 mm Hg. Lisinopril 10 mg PO is due. What is the most
appropriate application of clinical judgment?
A. Give the dose and recheck BP in 1 hour
B. Hold the dose and inform the charge nurse immediately
C. Split the tablet to give 5 mg instead
D. Encourage fluids and then administer the full dose
Correct Answer: B
Rationale: Hypotension is a contraindication for ACE inhibitors;
holding the dose prevents further BP drop and allows RN
evaluation.
Incorrect: A—Exposes client to risk of syncope. C—Altering dose
without order is outside LPN scope. D—Fluids may help but do
not resolve potential drug-induced hypotension.
Teaching Point: Hold antihypertensives when systolic BP <90
mm Hg and notify RN.
5. The LPN is instructed to administer an ophthalmic
antibiotic. Which step indicates correct application of the
nursing process (assessment)?
A. Asking the client about allergies to sulfa drugs
B. Washing hands before opening the eye drop bottle
