**The Pharmacology & Safe Medication
Administration Proctored: NGN NCLEX
Mastery**
1. A nurse is administering digoxin to a client with heart failure. Which finding requires withholding the
medication and notifying the provider?
A) Heart rate 62 bpm
B) Serum potassium 3.2 mEq/L
C) Blood pressure 118/76 mmHg
D) Complaint of mild fatigue
💫RATIONALE✔️✔️: Hypokalemia increases the risk of digoxin toxicity; hold digoxin and notify provider to
correct potassium first.
💫ANSWER✔️✔️: B) Serum potassium 3.2 mEq/L
---
2. A client is prescribed warfarin for atrial fibrillation. Which laboratory value indicates a therapeutic
effect?
A) aPTT 60 seconds
B) INR 2.5
C) Platelets 150,000/mm³
D) PT 12 seconds
💫RATIONALE✔️✔️: For atrial fibrillation, therapeutic INR range is 2.0-3.0; 2.5 is within target.
💫ANSWER✔️✔️: B) INR 2.5
---
,3. A nurse is teaching a client about a new prescription for levothyroxine. Which statement indicates
understanding?
A) “I will take this medication with dinner to avoid stomach upset”
B) “I will take it on an empty stomach in the morning, at least 30 minutes before breakfast”
C) “If I miss a dose, I will double the next day’s dose”
D) “I will stop taking it when my thyroid levels are normal”
💫RATIONALE✔️✔️: Levothyroxine is best absorbed on an empty stomach; consistent daily dosing is
required for life.
💫ANSWER✔️✔️: B) “I will take it on an empty stomach in the morning, at least 30 minutes before
breakfast”
---
4. A client is receiving IV heparin. Which finding indicates a potential adverse reaction requiring
immediate action?
A) aPTT 70 seconds (control 30)
B) Platelet count drop from 250,000 to 80,000/mm³
C) INR 2.0
D) Hemoglobin 12 g/dL
💫RATIONALE✔️✔️: A sharp drop in platelets suggests heparin-induced thrombocytopenia (HIT), a
prothrombotic emergency.
💫ANSWER✔️✔️: B) Platelet count drop from 250,000 to 80,000/mm³
---
5. A nurse is preparing to administer furosemide IV. Which laboratory value should the nurse check
before administration?
A) Serum creatinine
B) Serum potassium
C) Hemoglobin
D) White blood cell count
💫RATIONALE✔️✔️: Furosemide is a loop diuretic that causes hypokalemia; check potassium to prevent
dysrhythmias.
,💫ANSWER✔️✔️: B) Serum potassium
---
6. A client with type 2 diabetes is prescribed metformin. Which instruction is most important?
A) “Take this medication 30 minutes before meals”
B) “Report any muscle pain or dark urine to your provider”
C) “Expect to gain weight while taking this medication”
D) “You may stop taking it when your blood glucose is normal”
💫RATIONALE✔️✔️: Muscle pain and dark urine indicate lactic acidosis, a rare but life-threatening side
effect of metformin.
💫ANSWER✔️✔️: B) “Report any muscle pain or dark urine to your provider”
---
7. A nurse is administering IV vancomycin. Which finding requires slowing the infusion rate?
A) Blood pressure 130/80 mmHg
B) Red rash on the face, neck, and upper chest
C) Heart rate 88 bpm
D) Respiratory rate 18 breaths/min
💫RATIONALE✔️✔️: Red man syndrome (flushing, rash) is caused by rapid vancomycin infusion; slow the
rate over 60 minutes.
💫ANSWER✔️✔️: B) Red rash on the face, neck, and upper chest
---
8. A client with bipolar disorder is taking lithium. Which serum level indicates toxicity?
A) 0.8 mEq/L
B) 1.2 mEq/L
C) 1.8 mEq/L
D) 0.4 mEq/L
, 💫RATIONALE✔️✔️: Therapeutic lithium level is 0.6-1.2 mEq/L; level >1.5 mEq/L indicates toxicity with
risk of seizures and coma.
💫ANSWER✔️✔️: C) 1.8 mEq/L
---
9. A nurse is teaching a client about a new prescription for albuterol metered-dose inhaler. Which
statement indicates correct use?
A) “I will use this inhaler every day even if I have no symptoms”
B) “I will shake the inhaler well before each use”
C) “I will exhale completely after inhaling the medication”
D) “I will store the inhaler in the refrigerator”
💫RATIONALE✔️✔️: Shaking the inhaler ensures proper dispersion of the medication; albuterol is a rescue
inhaler, not daily controller.
💫ANSWER✔️✔️: B) “I will shake the inhaler well before each use”
---
10. A client is prescribed enoxaparin subcutaneously after hip surgery. Which instruction is correct?
A) “Massage the injection site after administration to prevent bruising”
B) “Expel the air bubble from the prefilled syringe before injecting”
C) “Inject the medication into the abdomen, at least 2 inches from the umbilicus”
D) “Use a 1-inch needle and inject at a 15-degree angle”
💫RATIONALE✔️✔️: Enoxaparin is given subcutaneously in the abdomen; do not expel the air bubble and
do not massage the site.
💫ANSWER✔️✔️: C) “Inject the medication into the abdomen, at least 2 inches from the umbilicus”
---
11. A nurse is administering fentanyl via patient-controlled analgesia (PCA). The client’s respiratory rate
is 8 breaths/min. Which medication should the nurse prepare?
A) Flumazenil
B) Naloxone
Administration Proctored: NGN NCLEX
Mastery**
1. A nurse is administering digoxin to a client with heart failure. Which finding requires withholding the
medication and notifying the provider?
A) Heart rate 62 bpm
B) Serum potassium 3.2 mEq/L
C) Blood pressure 118/76 mmHg
D) Complaint of mild fatigue
💫RATIONALE✔️✔️: Hypokalemia increases the risk of digoxin toxicity; hold digoxin and notify provider to
correct potassium first.
💫ANSWER✔️✔️: B) Serum potassium 3.2 mEq/L
---
2. A client is prescribed warfarin for atrial fibrillation. Which laboratory value indicates a therapeutic
effect?
A) aPTT 60 seconds
B) INR 2.5
C) Platelets 150,000/mm³
D) PT 12 seconds
💫RATIONALE✔️✔️: For atrial fibrillation, therapeutic INR range is 2.0-3.0; 2.5 is within target.
💫ANSWER✔️✔️: B) INR 2.5
---
,3. A nurse is teaching a client about a new prescription for levothyroxine. Which statement indicates
understanding?
A) “I will take this medication with dinner to avoid stomach upset”
B) “I will take it on an empty stomach in the morning, at least 30 minutes before breakfast”
C) “If I miss a dose, I will double the next day’s dose”
D) “I will stop taking it when my thyroid levels are normal”
💫RATIONALE✔️✔️: Levothyroxine is best absorbed on an empty stomach; consistent daily dosing is
required for life.
💫ANSWER✔️✔️: B) “I will take it on an empty stomach in the morning, at least 30 minutes before
breakfast”
---
4. A client is receiving IV heparin. Which finding indicates a potential adverse reaction requiring
immediate action?
A) aPTT 70 seconds (control 30)
B) Platelet count drop from 250,000 to 80,000/mm³
C) INR 2.0
D) Hemoglobin 12 g/dL
💫RATIONALE✔️✔️: A sharp drop in platelets suggests heparin-induced thrombocytopenia (HIT), a
prothrombotic emergency.
💫ANSWER✔️✔️: B) Platelet count drop from 250,000 to 80,000/mm³
---
5. A nurse is preparing to administer furosemide IV. Which laboratory value should the nurse check
before administration?
A) Serum creatinine
B) Serum potassium
C) Hemoglobin
D) White blood cell count
💫RATIONALE✔️✔️: Furosemide is a loop diuretic that causes hypokalemia; check potassium to prevent
dysrhythmias.
,💫ANSWER✔️✔️: B) Serum potassium
---
6. A client with type 2 diabetes is prescribed metformin. Which instruction is most important?
A) “Take this medication 30 minutes before meals”
B) “Report any muscle pain or dark urine to your provider”
C) “Expect to gain weight while taking this medication”
D) “You may stop taking it when your blood glucose is normal”
💫RATIONALE✔️✔️: Muscle pain and dark urine indicate lactic acidosis, a rare but life-threatening side
effect of metformin.
💫ANSWER✔️✔️: B) “Report any muscle pain or dark urine to your provider”
---
7. A nurse is administering IV vancomycin. Which finding requires slowing the infusion rate?
A) Blood pressure 130/80 mmHg
B) Red rash on the face, neck, and upper chest
C) Heart rate 88 bpm
D) Respiratory rate 18 breaths/min
💫RATIONALE✔️✔️: Red man syndrome (flushing, rash) is caused by rapid vancomycin infusion; slow the
rate over 60 minutes.
💫ANSWER✔️✔️: B) Red rash on the face, neck, and upper chest
---
8. A client with bipolar disorder is taking lithium. Which serum level indicates toxicity?
A) 0.8 mEq/L
B) 1.2 mEq/L
C) 1.8 mEq/L
D) 0.4 mEq/L
, 💫RATIONALE✔️✔️: Therapeutic lithium level is 0.6-1.2 mEq/L; level >1.5 mEq/L indicates toxicity with
risk of seizures and coma.
💫ANSWER✔️✔️: C) 1.8 mEq/L
---
9. A nurse is teaching a client about a new prescription for albuterol metered-dose inhaler. Which
statement indicates correct use?
A) “I will use this inhaler every day even if I have no symptoms”
B) “I will shake the inhaler well before each use”
C) “I will exhale completely after inhaling the medication”
D) “I will store the inhaler in the refrigerator”
💫RATIONALE✔️✔️: Shaking the inhaler ensures proper dispersion of the medication; albuterol is a rescue
inhaler, not daily controller.
💫ANSWER✔️✔️: B) “I will shake the inhaler well before each use”
---
10. A client is prescribed enoxaparin subcutaneously after hip surgery. Which instruction is correct?
A) “Massage the injection site after administration to prevent bruising”
B) “Expel the air bubble from the prefilled syringe before injecting”
C) “Inject the medication into the abdomen, at least 2 inches from the umbilicus”
D) “Use a 1-inch needle and inject at a 15-degree angle”
💫RATIONALE✔️✔️: Enoxaparin is given subcutaneously in the abdomen; do not expel the air bubble and
do not massage the site.
💫ANSWER✔️✔️: C) “Inject the medication into the abdomen, at least 2 inches from the umbilicus”
---
11. A nurse is administering fentanyl via patient-controlled analgesia (PCA). The client’s respiratory rate
is 8 breaths/min. Which medication should the nurse prepare?
A) Flumazenil
B) Naloxone
