NCLEX-RN category
Quick answer
Pharmacological and Parenteral Therapies makes up 13 to 19% of the NCLEX-RN, which puts it second only to Management of Care. Expect roughly 11 to 28 questions on medications, IV therapy and dosage calculations, depending on how long your exam runs.
Most students fail pharmacology questions not because they forgot a drug, but because they chose the answer that sounded safe instead of the one that was safe. The exam rarely asks you to recite a dose. It asks what you would check first, what you would hold, and what you would teach. The ten questions below are written in that style. Work through them before you look at the answers, then read the rationale even when you got it right. Knowing why the three wrong options are wrong is where the marks are.
A client with atrial fibrillation is prescribed warfarin. Which lab value tells the nurse the dose is in the therapeutic range?
Answer: B
For atrial fibrillation the INR target is 2.0 to 3.0, so 2.5 sits in range.
Why the others are wrong
aPTT monitors heparin, not warfarin. Platelets and hemoglobin are worth watching for bleeding but do not tell you whether the warfarin dose is right.
A client is receiving digoxin. Before giving the next dose, the nurse finds an apical pulse of 54 beats per minute and a potassium of 3.1 mEq/L. What should the nurse do first?
Answer: C
Hold for a pulse under 60, and a low potassium raises the risk of digoxin toxicity on top of that. Both findings need the prescriber.
Why the others are wrong
Giving the drug with a pulse of 54 risks further bradycardia. Nurses do not cut doses on their own. Potassium replacement needs an order and does not make the bradycardia safe.
A client is started on lisinopril for hypertension. Which statement by the client shows the teaching was understood?
Answer: B
ACE inhibitors cause first-dose hypotension, so slow position changes are correct teaching.
Why the others are wrong
Most salt substitutes are potassium chloride, and ACE inhibitors already raise potassium. A dry cough is a known side effect, not an allergy, and the client should report it rather than stop. Antihypertensives are taken daily regardless of a single reading.
A client with type 1 diabetes takes regular insulin at 0730. At what time should the nurse be most alert for hypoglycemia?
Answer: B
Regular insulin peaks 2 to 3 hours after injection, so 0930 to 1030 is the danger window.
Why the others are wrong
15 minutes is too early for regular insulin to act (that would fit lispro). The afternoon and evening fall after the peak and closer to the duration limit of about 6 to 8 hours.
The nurse is preparing to give IV potassium chloride to a client with a potassium of 2.9 mEq/L. Which action is essential?
Answer: B
Potassium is never given IV push. It is diluted, infused by pump at no more than 10 mEq/hr on a general unit, and the site is watched because it irritates veins.
Why the others are wrong
IV push potassium can cause fatal arrhythmia. Food has no bearing on IV potassium. Shaking the bag is unnecessary and distracts from the real safety steps.
A client is receiving vancomycin IV. Which finding should the nurse report before the next dose?
Answer: A
Vancomycin is nephrotoxic. Creatinine doubling signals kidney injury and the dose or drug needs review, usually along with a trough level.
Why the others are wrong
A near-normal temperature and a normal white count suggest the infection is responding. Mild nausea is worth noting but not a reason to withhold an antibiotic.
Order: amoxicillin 500 mg PO every 8 hours. Available: amoxicillin oral suspension 250 mg per 5 mL. How many mL should the nurse give per dose?
Answer: C
500 mg divided by 250 mg equals 2, and 2 multiplied by 5 mL equals 10 mL.
Why the others are wrong
5 mL delivers only 250 mg. 7.5 mL gives 375 mg. 20 mL doubles the ordered dose.
A client with a new opioid prescription for cancer pain asks how to manage side effects. Which side effect does NOT lessen over time and needs a standing plan?
Answer: C
Tolerance develops to most opioid effects but not to constipation, so a bowel regimen (fluids, fiber, stool softener plus stimulant laxative) starts with the first dose.
Why the others are wrong
Nausea, sedation and itching usually fade within days as the body adjusts.
A client on an IV heparin infusion develops bleeding gums and a large bruise on the hip. Which medication should the nurse have ready?
Answer: B
Protamine sulfate reverses heparin.
Why the others are wrong
Vitamin K reverses warfarin. Naloxone reverses opioids. Flumazenil reverses benzodiazepines. The exam loves this antidote matching set, so learn all four together.
A client taking metformin is scheduled for a CT scan with IV contrast tomorrow. What should the nurse anticipate?
Answer: B
Contrast can impair kidney function, and metformin given to a client with reduced kidney clearance risks lactic acidosis. The usual practice is to hold it at the time of the scan and restart once kidney function is confirmed.
Why the others are wrong
Extra metformin increases the risk. A permanent switch is not needed. Saying there is no interaction misses a well-known precaution.
Pharmacological and Parenteral Therapies is weighted at 13 to 19%. On an 85-question exam that is about 11 to 16 questions; on the full 150 it can reach 28.
Rarely. You need to know therapeutic ranges for a few high-alert drugs (digoxin, lithium, warfarin via INR), common side effects, what to hold, and how to calculate a dose from an order. Exact adult doses for hundreds of drugs are not tested.
Do questions daily rather than reading drug lists. Each wrong answer teaches you a class, a side effect or a safety check you will see again. Ten focused questions a day for a month covers more than most study guides.
Practice 10 free NCLEX questions every day in the DrillRN app
Every question comes with a full rationale that explains the right answer and why each wrong option is wrong.
