NCLEX pharmacology practice questions

For each high-alert drug class, know what to check before giving it, the dangerous side effect and the antidote. That covers most pharmacology questions.

1. Question 1

   A client with anaphylaxis from a bee sting receives epinephrine 0.5 mg IM. Five minutes later, which findings show that the epinephrine is having its intended effect? Select all that apply.

   Select all that apply.

   • A.Blood pressure rose from 78/44 to 106/68 mmHg
   • B.Heart rate increased to 132/min
   • C.Wheezing has decreased
   • D.The client feels anxious and shaky
   • E.Oxygen saturation dropped from 91% to 88%
   • F.Swelling of the lips is going down
   Show answer and explanation

   Answer: A, C, F

   Epinephrine is the first-line drug for anaphylaxis. Alpha effects raise blood pressure and reduce swelling; beta2 effects open the airways. Beta1 effects raise the heart rate and cause anxiety and tremor, which are expected side effects. The dose may be repeated every 5 to 15 minutes if needed.

   • A. Correct. Alpha stimulation constricts blood vessels and raises blood pressure.
   • B. Tachycardia is a side effect of epinephrine, not a sign that it is treating anaphylaxis.
   • C. Correct. Epinephrine relaxes bronchial smooth muscle through beta2 stimulation.
   • D. Anxiety and tremor are common side effects, not therapeutic effects.
   • E. Falling oxygen saturation means the client is getting worse.
   • F. Correct. Vasoconstriction reduces capillary leak and swelling.

   Key concept: Judge epinephrine by better breathing, blood pressure and swelling, not by heart rate.

   Tip: Epinephrine fixes the 'A, B, C' of anaphylaxis: airway swelling, breathing, circulation.

2. Question 2

   An 82-year-old client with heart failure is receiving a second unit of packed red blood cells. One hour into the unit, the client has new crackles, distended neck veins and shortness of breath. Blood pressure is 168/94 mmHg, up from 132/76. The nurse stops the transfusion and raises the head of the bed. Which prescription should the nurse anticipate?

   • A.Furosemide IV
   • B.Diphenhydramine IV
   • C.Epinephrine IM
   • D.A 500 mL bolus of 0.9% sodium chloride
   Show answer and explanation

   Answer: A

   Transfusion-associated circulatory overload (TACO) happens when blood is given faster than the heart can handle, especially in older adults and clients with heart or kidney disease. Signs are dyspnea, crackles, distended neck veins and hypertension. Prevention includes giving one unit at a time slowly, sometimes with a diuretic between units.

   • A. Correct. These findings show transfusion-associated circulatory overload. A loop diuretic removes the excess fluid.
   • B. Antihistamines treat allergic reactions such as hives, which are not present.
   • C. Epinephrine treats anaphylaxis, which causes low, not high, blood pressure.
   • D. More fluid would worsen the overload.

   Key concept: TACO = fluid overload from a transfusion; treat with stopping the blood, sitting upright, oxygen and a diuretic.

   Tip: TACO: high pressure, wet lungs, give a 'water pill'.

3. Question 3

   A client has a continuous epidural infusion of bupivacaine and fentanyl after abdominal surgery. Which actions should the nurse include in the plan of care? Select all that apply.

   Select all that apply.

   • A.Give additional IV opioids as needed without consulting the anesthesia team
   • B.Label the epidural tubing and do not connect any other infusion to it
   • C.Give enoxaparin at any time the catheter is in place without checking timing
   • D.Monitor blood pressure for hypotension
   • E.Check sensory level and leg movement on a set schedule
   • F.Assess sedation level and respiratory rate regularly
   Show answer and explanation

   Answer: B, D, E, F

   Epidural analgesia gives excellent pain relief but requires close monitoring: blood pressure (sympathetic block), sedation and breathing (opioid), sensory and motor function (block level and hematoma), the insertion site, and careful timing of anticoagulants. Epidural tubing is clearly labeled and has no injection ports.

   • A. Extra systemic opioids add to the epidural opioid and increase respiratory depression risk. They are given only per the anesthesia plan.
   • B. Correct. Giving IV drugs into the epidural space by mistake can be fatal.
   • C. Anticoagulants must be timed carefully around epidural catheter placement and removal to prevent epidural hematoma.
   • D. Correct. Local anesthetics block sympathetic nerves and cause vasodilation and hypotension.
   • E. Correct. A rising sensory block or new leg weakness can signal a high block, catheter migration or an epidural hematoma.
   • F. Correct. The epidural opioid can cause sedation and respiratory depression.

   Key concept: Epidural care: watch BP, breathing, sensory and motor level; label the line; coordinate anticoagulant timing.

   Tip: Epidural checks: 'Pressure, Breathing, Legs, Line'.

4. Question 4

   The nurse prepares to give enoxaparin 40 mg subcutaneously from a prefilled syringe to a postoperative client. Which action is correct?

   • A.Expel the small air bubble from the syringe before injecting
   • B.Pull back on the plunger to check for blood before injecting
   • C.Inject into the abdomen at least 2 inches (5 cm) away from the umbilicus
   • D.Massage the site for 1 minute after removing the needle
   Show answer and explanation

   Answer: C

   Low-molecular-weight heparins are given deep subcutaneously into the abdominal fat, rotating left and right sides, at least 2 inches from the umbilicus. The nurse does not expel the air bubble, does not aspirate and does not rub the site.

   • A. The air bubble in a prefilled enoxaparin syringe should stay in. It follows the drug and helps keep the medication in the tissue.
   • B. Aspiration is not done with anticoagulant injections because it increases tissue damage and bruising.
   • C. Correct. The abdominal fat away from the umbilicus is the preferred site. It gives reliable absorption and avoids large vessels near the navel.
   • D. Massage increases bruising and hematoma formation. The site should not be rubbed.

   Key concept: Anticoagulant injections: no expelling the bubble, no aspirating, no rubbing.

   Tip: Enoxaparin rule of 'No': no bubble out, no pull back, no rub.

5. Question 5

   A client with iron deficiency anemia has taken ferrous sulfate for 4 weeks. Which findings are expected? Select all that apply.

   Select all that apply.

   • A.Steadily falling hemoglobin
   • B.Hemoglobin rising toward normal
   • C.Less fatigue and shortness of breath on exertion
   • D.Increase in reticulocyte count
   • E.Red-colored urine
   • F.Dark green or black stools
   Show answer and explanation

   Answer: B, C, D, F

   Oral iron is best absorbed on an empty stomach with vitamin C, though it may be taken with food if GI upset occurs. Expected findings include darker stools, constipation or nausea, a rising reticulocyte count within 1 to 2 weeks and rising hemoglobin over weeks. Therapy usually continues for months to refill iron stores.

   • A. A falling hemoglobin suggests ongoing blood loss or poor absorption and needs follow-up.
   • B. Correct. Iron allows the marrow to make hemoglobin; levels typically rise about 1 to 2 g/dL over 3 to 4 weeks.
   • C. Correct. Better oxygen-carrying capacity reduces anemia symptoms.
   • D. Correct. Young red cells increase within 1 to 2 weeks, an early sign of response.
   • E. Oral iron does not cause red urine. Red urine needs evaluation for blood.
   • F. Correct. Unabsorbed iron darkens stools. This is harmless, but black tarry stools with other bleeding signs still need evaluation.

   Key concept: Iron therapy works when reticulocytes and hemoglobin rise; dark stools are expected.

   Tip: Iron: 'dark stools, rising retics'.