NCLEX RN Pharmacological & Parenteral
Therapies Exam 3 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
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1. Medication Absorption and Food
The nurse is preparing to administer an oral antibiotic to a client with a
bacterial infection. The medication guide states that absorption is reduced
when taken with dairy products. Which instruction should the nurse
provide to the client?
A. Take the antibiotic with a full glass of milk to minimize gastric irritation.
B. Separate the antibiotic from dairy products by at least 2 hours before or
after.
C. Consume yogurt immediately after taking the medication to restore gut
flora.
D. Crush the antibiotic and mix it with ice cream to improve palatability.
Answer: B
Rationale: Dairy products such as milk, cheese, and yogurt contain calcium and
other divalent cations that can chelate certain antibiotics (e.g., tetracyclines,
fluoroquinolones), forming insoluble complexes that significantly decrease
absorption and therapeutic effectiveness. Spacing the antibiotic and dairy intake
by at least 2 hours before or after the dose minimizes the interaction and
ensures adequate drug bioavailability. Option A is incorrect because taking the
medication with milk will decrease absorption. Option C is not appropriate
immediately after the dose; probiotics should be separated in time to avoid
reducing antibiotic efficacy. Option D is contraindicated because crushing may
alter the drug’s pharmacokinetics, destroy enteric coating, or create an
,unpalatable mixture; ice cream is a dairy product that also impairs absorption.
The nurse must educate the client on timing of doses relative to food and
supplements to achieve optimal therapeutic outcomes.
2. IV Catheter Gauge Selection
A nurse must initiate IV access for a client requiring rapid administration of
packed red blood cells. Which IV catheter gauge is most appropriate for this
transfusion?
A. 24-gauge
B. 22-gauge
C. 20-gauge
D. 18-gauge
Answer: D
Rationale: Blood products should be administered through a large-bore catheter
to minimize hemolysis and allow rapid flow if needed. An 18-gauge catheter (or
larger, such as 16-gauge) is recommended for adult transfusions to prevent
damage to red blood cells and to accommodate the viscosity of blood products.
Smaller gauges (20, 22, 24) increase the risk of mechanical hemolysis and slow
the infusion rate, which may delay therapy in an emergent situation. While a 20-
gauge may be acceptable in some settings for routine transfusions, the best
choice for rapid administration is an 18-gauge. The nurse should also use Y-type
blood administration tubing with normal saline (0.9% sodium chloride) only,
never dextrose or lactated Ringer’s, to prevent hemolysis or clotting.
3. Calculating IV Flow Rate
A client is prescribed 1,000 mL of 0.9% sodium chloride to infuse over 8
hours. The IV tubing has a drop factor of 15 gtt/mL. The nurse should
regulate the flow to how many drops per minute? (Round to the nearest
whole number.)
A. 21 gtt/min
B. 31 gtt/min
C. 42 gtt/min
D. 125 gtt/min
,Answer: B
Rationale: The formula for gravity infusion is (Volume in mL × Drop factor) /
Time in minutes. Volume = 1,000 mL; drop factor = 15 gtt/mL; time = 8 hours ×
60 = 480 minutes. Calculation: (1,000 × 15) / 480 = 15, = 31.25, which
rounds to 31 gtt/min. 21 gtt/min would result from miscalculation (e.g., using 10
gtt/mL or 10 hours). 42 gtt/min corresponds to a drop factor of 20 gtt/mL. 125
gtt/min is the mL/hr rate (1,000 mL/8 hr = 125 mL/hr) if the pump were set in
mL/hr, not drops per minute. The nurse must distinguish between infusion pump
settings and manual gravity calculations to ensure safe fluid administration.
4. Extravasation of Vesicant Chemotherapy
A nurse is administering doxorubicin via a peripheral IV. The client reports
burning and stinging at the insertion site, and the nurse notes swelling and
lack of blood return. What is the priority nursing action?
A. Slow the infusion rate and apply a warm compress.
B. Aspirate residual drug from the line and apply ice.
C. Flush the IV line with normal saline to dilute the drug.
D. Elevate the extremity and continue the infusion.
Answer: B
Rationale: Doxorubicin is a vesicant chemotherapeutic agent; extravasation can
cause severe tissue necrosis. Immediate actions include stopping the infusion,
leaving the catheter in place to aspirate as much residual drug as possible, and
then removing the catheter. Ice (cryotherapy) is applied to the site for 15–20
minutes to cause vasoconstriction, limit spread of the drug, and reduce cellular
damage. Warm compresses are contraindicated because they vasodilate and
increase drug dispersion. Flushing the line would force more drug into tissues,
worsening injury. Continuing the infusion is unsafe. Following initial measures,
the nurse must notify the provider, document the extravasation, and arrange for
antidote administration if available (e.g., dexrazoxane for anthracycline
extravasation).
5. Total Parenteral Nutrition (TPN) Administration
A client is receiving central parenteral nutrition. The new bag of TPN is not
, ready from the pharmacy, and the current infusion is almost completed.
Which action should the nurse take to prevent hypoglycemia?
A. Hang 10% dextrose in water at the same rate until the TPN arrives.
B. Slow the TPN rate to half for the next hour to extend the remaining
volume.
C. Hang 0.9% sodium chloride at a keep-vein-open rate until the bag is
ready.
D. Discontinue the infusion and monitor blood glucose every hour.
Answer: A
Rationale: Abrupt discontinuation of TPN can lead to rebound hypoglycemia
because the high dextrose concentration stimulates endogenous insulin
secretion. The standard bridging solution is 10% dextrose in water (D10W)
infused at the same rate to maintain glucose levels until the next TPN bag is
available. Slowing the rate does not provide adequate carbohydrate to prevent
hypoglycemia. 0.9% sodium chloride contains no glucose and would not address
the risk. Discontinuing the infusion entirely is dangerous. The nurse must verify
agency policy, but D10W is an accepted temporary measure. Blood glucose
monitoring should also be continued.
6. Blood Transfusion Reaction
Fifteen minutes after starting a packed red blood cell transfusion, the client
develops chills, fever, flank pain, and dark urine. What type of transfusion
reaction does the nurse suspect?
A. Febrile nonhemolytic reaction
B. Allergic reaction
C. Acute hemolytic reaction
D. Circulatory overload
Answer: C
Rationale: Acute hemolytic transfusion reactions are most commonly caused by
ABO incompatibility, resulting in intravascular hemolysis. Signs and symptoms
include fever, chills, flank pain (due to renal involvement), hemoglobinuria (dark
urine), hypotension, and pain at the infusion site. This is a medical emergency;
Therapies Exam 3 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. Medication Absorption and Food
The nurse is preparing to administer an oral antibiotic to a client with a
bacterial infection. The medication guide states that absorption is reduced
when taken with dairy products. Which instruction should the nurse
provide to the client?
A. Take the antibiotic with a full glass of milk to minimize gastric irritation.
B. Separate the antibiotic from dairy products by at least 2 hours before or
after.
C. Consume yogurt immediately after taking the medication to restore gut
flora.
D. Crush the antibiotic and mix it with ice cream to improve palatability.
Answer: B
Rationale: Dairy products such as milk, cheese, and yogurt contain calcium and
other divalent cations that can chelate certain antibiotics (e.g., tetracyclines,
fluoroquinolones), forming insoluble complexes that significantly decrease
absorption and therapeutic effectiveness. Spacing the antibiotic and dairy intake
by at least 2 hours before or after the dose minimizes the interaction and
ensures adequate drug bioavailability. Option A is incorrect because taking the
medication with milk will decrease absorption. Option C is not appropriate
immediately after the dose; probiotics should be separated in time to avoid
reducing antibiotic efficacy. Option D is contraindicated because crushing may
alter the drug’s pharmacokinetics, destroy enteric coating, or create an
,unpalatable mixture; ice cream is a dairy product that also impairs absorption.
The nurse must educate the client on timing of doses relative to food and
supplements to achieve optimal therapeutic outcomes.
2. IV Catheter Gauge Selection
A nurse must initiate IV access for a client requiring rapid administration of
packed red blood cells. Which IV catheter gauge is most appropriate for this
transfusion?
A. 24-gauge
B. 22-gauge
C. 20-gauge
D. 18-gauge
Answer: D
Rationale: Blood products should be administered through a large-bore catheter
to minimize hemolysis and allow rapid flow if needed. An 18-gauge catheter (or
larger, such as 16-gauge) is recommended for adult transfusions to prevent
damage to red blood cells and to accommodate the viscosity of blood products.
Smaller gauges (20, 22, 24) increase the risk of mechanical hemolysis and slow
the infusion rate, which may delay therapy in an emergent situation. While a 20-
gauge may be acceptable in some settings for routine transfusions, the best
choice for rapid administration is an 18-gauge. The nurse should also use Y-type
blood administration tubing with normal saline (0.9% sodium chloride) only,
never dextrose or lactated Ringer’s, to prevent hemolysis or clotting.
3. Calculating IV Flow Rate
A client is prescribed 1,000 mL of 0.9% sodium chloride to infuse over 8
hours. The IV tubing has a drop factor of 15 gtt/mL. The nurse should
regulate the flow to how many drops per minute? (Round to the nearest
whole number.)
A. 21 gtt/min
B. 31 gtt/min
C. 42 gtt/min
D. 125 gtt/min
,Answer: B
Rationale: The formula for gravity infusion is (Volume in mL × Drop factor) /
Time in minutes. Volume = 1,000 mL; drop factor = 15 gtt/mL; time = 8 hours ×
60 = 480 minutes. Calculation: (1,000 × 15) / 480 = 15, = 31.25, which
rounds to 31 gtt/min. 21 gtt/min would result from miscalculation (e.g., using 10
gtt/mL or 10 hours). 42 gtt/min corresponds to a drop factor of 20 gtt/mL. 125
gtt/min is the mL/hr rate (1,000 mL/8 hr = 125 mL/hr) if the pump were set in
mL/hr, not drops per minute. The nurse must distinguish between infusion pump
settings and manual gravity calculations to ensure safe fluid administration.
4. Extravasation of Vesicant Chemotherapy
A nurse is administering doxorubicin via a peripheral IV. The client reports
burning and stinging at the insertion site, and the nurse notes swelling and
lack of blood return. What is the priority nursing action?
A. Slow the infusion rate and apply a warm compress.
B. Aspirate residual drug from the line and apply ice.
C. Flush the IV line with normal saline to dilute the drug.
D. Elevate the extremity and continue the infusion.
Answer: B
Rationale: Doxorubicin is a vesicant chemotherapeutic agent; extravasation can
cause severe tissue necrosis. Immediate actions include stopping the infusion,
leaving the catheter in place to aspirate as much residual drug as possible, and
then removing the catheter. Ice (cryotherapy) is applied to the site for 15–20
minutes to cause vasoconstriction, limit spread of the drug, and reduce cellular
damage. Warm compresses are contraindicated because they vasodilate and
increase drug dispersion. Flushing the line would force more drug into tissues,
worsening injury. Continuing the infusion is unsafe. Following initial measures,
the nurse must notify the provider, document the extravasation, and arrange for
antidote administration if available (e.g., dexrazoxane for anthracycline
extravasation).
5. Total Parenteral Nutrition (TPN) Administration
A client is receiving central parenteral nutrition. The new bag of TPN is not
, ready from the pharmacy, and the current infusion is almost completed.
Which action should the nurse take to prevent hypoglycemia?
A. Hang 10% dextrose in water at the same rate until the TPN arrives.
B. Slow the TPN rate to half for the next hour to extend the remaining
volume.
C. Hang 0.9% sodium chloride at a keep-vein-open rate until the bag is
ready.
D. Discontinue the infusion and monitor blood glucose every hour.
Answer: A
Rationale: Abrupt discontinuation of TPN can lead to rebound hypoglycemia
because the high dextrose concentration stimulates endogenous insulin
secretion. The standard bridging solution is 10% dextrose in water (D10W)
infused at the same rate to maintain glucose levels until the next TPN bag is
available. Slowing the rate does not provide adequate carbohydrate to prevent
hypoglycemia. 0.9% sodium chloride contains no glucose and would not address
the risk. Discontinuing the infusion entirely is dangerous. The nurse must verify
agency policy, but D10W is an accepted temporary measure. Blood glucose
monitoring should also be continued.
6. Blood Transfusion Reaction
Fifteen minutes after starting a packed red blood cell transfusion, the client
develops chills, fever, flank pain, and dark urine. What type of transfusion
reaction does the nurse suspect?
A. Febrile nonhemolytic reaction
B. Allergic reaction
C. Acute hemolytic reaction
D. Circulatory overload
Answer: C
Rationale: Acute hemolytic transfusion reactions are most commonly caused by
ABO incompatibility, resulting in intravascular hemolysis. Signs and symptoms
include fever, chills, flank pain (due to renal involvement), hemoglobinuria (dark
urine), hypotension, and pain at the infusion site. This is a medical emergency;
