& Rationales
Welcome to this focused pharmacology practice exam for NCLEX-RN 2026. This resource contains 180 high-
yield questions covering medication safety, side effects, contraindications, nursing interventions and drug
classifications you will encounter on the NCLEX. Use this exam to master pharmacology and pass with
confidence.
Key Topics Covered
❖ Medication Safety – Rights of administration, high-alert meds, error prevention
❖ Insulin & Diabetes Drugs – Types, peak times, mixing, hypoglycemia management
❖ Cardiac Medications – Antihypertensives, antiarrhythmics, digoxin, anticoagulants
❖ Antibiotics – Penicillins, cephalosporins, aminoglycosides, vancomycin, tetracyclines
❖ Psych Meds – Antidepressants, antipsychotics, lithium, benzodiazepines, MAOIs
❖ Nursing Interventions – Monitoring, patient teaching, adverse effects, drug interactions
1. A client with type 1 diabetes is prescribed insulin lispro. The nurse knows that this insulin should
be administered at which time relative to meals?
A) 30 minutes before a meal
B) Immediately before a meal (0–15 minutes)
C) 1 hour after a meal
D) At bedtime regardless of meals
Answer B: Immediately before a meal (0–15 minutes)
Rationale: Insulin lispro is rapid-acting with onset of 15 minutes; give just before eating to match
postprandial glucose rise. Delaying injection increases risk of hypoglycemia because it peaks quickly. Never
mix lispro with NPH in the same syringe without checking compatibility.
2. A client with heart failure is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate of 62 bpm and blood pressure 120/80
B) Nausea, vomiting, and yellow-green halos around lights
C) Dry cough and angioedema
, D) Hyperkalemia and muscle cramps
Answer B: Nausea, vomiting, and yellow-green halos around lights
Rationale: Visual disturbances (yellow/green halos) and GI symptoms are classic digoxin toxicity signs.
Digoxin toxicity also causes bradycardia, arrhythmias, and fatigue. Check digoxin level (normal 0.5-2 ng/mL)
and hold dose if toxic.
3. A client is prescribed warfarin for atrial fibrillation. Which instruction should the nurse provide?
A) “Avoid eating large amounts of leafy green vegetables”
B) “Take ibuprofen for headaches”
C) “Get your INR checked every 6 months”
D) “Stop warfarin if you notice bruising”
Answer A: “Avoid eating large amounts of leafy green vegetables”
Rationale: Vitamin K-rich foods (spinach, kale) antagonize warfarin effect; consistent intake is key, not
complete avoidance. INR is monitored frequently (weekly to monthly); never stop warfarin without provider
order. Ibuprofen increases bleeding risk; use acetaminophen instead.
4. A client with major depressive disorder is started on fluoxetine. The nurse should instruct the
client that therapeutic effects may take:
A) 2–4 days
B) 1–2 weeks
C) 4–6 weeks
D) 24 hours
Answer C: 4–6 weeks
Rationale: SSRIs like fluoxetine require 4–6 weeks for full antidepressant effect; early side effects may occur
sooner. Patients must continue medication even if no immediate improvement. Suicide risk may increase
during first weeks; monitor closely.
5. A client is receiving IV vancomycin. Which adverse effect requires immediate nursing action?
A) Red man syndrome (flushing, rash on upper body)
B) Nausea and metallic taste
C) Ototoxicity and nephrotoxicity
D) Phlebitis at the IV site
Answer C: Ototoxicity and nephrotoxicity
Welcome to this focused pharmacology practice exam for NCLEX-RN 2026. This resource contains 180 high-
yield questions covering medication safety, side effects, contraindications, nursing interventions and drug
classifications you will encounter on the NCLEX. Use this exam to master pharmacology and pass with
confidence.
Key Topics Covered
❖ Medication Safety – Rights of administration, high-alert meds, error prevention
❖ Insulin & Diabetes Drugs – Types, peak times, mixing, hypoglycemia management
❖ Cardiac Medications – Antihypertensives, antiarrhythmics, digoxin, anticoagulants
❖ Antibiotics – Penicillins, cephalosporins, aminoglycosides, vancomycin, tetracyclines
❖ Psych Meds – Antidepressants, antipsychotics, lithium, benzodiazepines, MAOIs
❖ Nursing Interventions – Monitoring, patient teaching, adverse effects, drug interactions
1. A client with type 1 diabetes is prescribed insulin lispro. The nurse knows that this insulin should
be administered at which time relative to meals?
A) 30 minutes before a meal
B) Immediately before a meal (0–15 minutes)
C) 1 hour after a meal
D) At bedtime regardless of meals
Answer B: Immediately before a meal (0–15 minutes)
Rationale: Insulin lispro is rapid-acting with onset of 15 minutes; give just before eating to match
postprandial glucose rise. Delaying injection increases risk of hypoglycemia because it peaks quickly. Never
mix lispro with NPH in the same syringe without checking compatibility.
2. A client with heart failure is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate of 62 bpm and blood pressure 120/80
B) Nausea, vomiting, and yellow-green halos around lights
C) Dry cough and angioedema
, D) Hyperkalemia and muscle cramps
Answer B: Nausea, vomiting, and yellow-green halos around lights
Rationale: Visual disturbances (yellow/green halos) and GI symptoms are classic digoxin toxicity signs.
Digoxin toxicity also causes bradycardia, arrhythmias, and fatigue. Check digoxin level (normal 0.5-2 ng/mL)
and hold dose if toxic.
3. A client is prescribed warfarin for atrial fibrillation. Which instruction should the nurse provide?
A) “Avoid eating large amounts of leafy green vegetables”
B) “Take ibuprofen for headaches”
C) “Get your INR checked every 6 months”
D) “Stop warfarin if you notice bruising”
Answer A: “Avoid eating large amounts of leafy green vegetables”
Rationale: Vitamin K-rich foods (spinach, kale) antagonize warfarin effect; consistent intake is key, not
complete avoidance. INR is monitored frequently (weekly to monthly); never stop warfarin without provider
order. Ibuprofen increases bleeding risk; use acetaminophen instead.
4. A client with major depressive disorder is started on fluoxetine. The nurse should instruct the
client that therapeutic effects may take:
A) 2–4 days
B) 1–2 weeks
C) 4–6 weeks
D) 24 hours
Answer C: 4–6 weeks
Rationale: SSRIs like fluoxetine require 4–6 weeks for full antidepressant effect; early side effects may occur
sooner. Patients must continue medication even if no immediate improvement. Suicide risk may increase
during first weeks; monitor closely.
5. A client is receiving IV vancomycin. Which adverse effect requires immediate nursing action?
A) Red man syndrome (flushing, rash on upper body)
B) Nausea and metallic taste
C) Ototoxicity and nephrotoxicity
D) Phlebitis at the IV site
Answer C: Ototoxicity and nephrotoxicity
