Pharmacological Therapies
NCLEX-PN® practice.

Free practice set · 6 questions

6 more free pharmacological therapies NCLEX-PN® practice questions

Real questions from the same bank the app serves. Pick an answer in your head, then open the rationale to see why the correct option holds and why each other option falls short. No account needed for these.

1. Question 1 of 6 · Adult Wellness (Ages 18–64)

   An LPN is making a home health visit to an 82-year-old woman with rheumatoid arthritis and type 2 diabetes mellitus. The order reads: "Methotrexate 12.5 mg subcutaneously once weekly on Mondays for rheumatoid arthritis, Dr. Lang, today 0900." The client's chart lists an allergy to sulfa drugs with hives, and no other known drug allergies. Today's finger-stick glucose is 118 mg/dL, and a CBC drawn two days ago shows WBC 2.1 x10^3/µL (low) and platelets 90,000/µL (low). Before drawing up the dose, what is the nurse's priority action?

   1. ADraw up the dose using a 90-degree intramuscular injection angle into the deltoid.
   2. BVerify the order against the MAR using two client identifiers before preparing the dose.
   3. CAdminister the dose immediately since the finger-stick glucose is within normal range.
   4. DWithhold the medication because the client has a documented sulfa allergy.
   Show the answer and rationale

   Correct answer: B. Verify the order against the MAR using two client identifiers before preparing the dose.

   Safe medication administration begins with verifying the rights of medication administration, right client, drug, dose, route, and time, against the MAR and original order using two client identifiers before any dose is prepared. This foundational, non-negotiable step is performed for every medication, regardless of the drug's route, calculation, allergy profile, or lab parameters, and those checks come afterward. No calculation is required because the dose, 12.5 mg, is not being computed or converted; the focus is the sequence of the rights-verification step itself. Verifying the order against the MAR using two client identifiers is the priority first step. Drawing up the dose moves ahead to administration technique and uses the wrong route, angle, and site entirely, because methotrexate for RA is ordered subcutaneously, not IM into the deltoid, so this skips verification and violates route technique. The sulfa allergy does not require withholding methotrexate because methotrexate is not a sulfonamide and has no cross-reactivity with sulfa drugs. A normal glucose does not give permission to proceed, because verification must happen first and the concerning WBC and platelet results have not yet been addressed.

   A. Draw up the dose using a 90-degree intramuscular injection angle into the deltoid.

   Wrong: expands the "wrong route or wrong technique for the ordered route" error pattern. Skips verification and uses an incorrect IM technique/site for a subcutaneous methotrexate order, violating the "use correct technique for each administration route" rule.

   B. Verify the order against the MAR using two client identifiers before preparing the dose.

   Correct: satisfies the "follow the rights of medication administration every time" rule. Verifying the order against the MAR with two identifiers is the mandatory first step before any dose is drawn up, regardless of route or labs.

   C. Administer the dose immediately since the finger-stick glucose is within normal range.

   Wrong: expands the "administer despite a hold parameter being out of range" error pattern. Treats a normal glucose as clearance to give the dose while bypassing order verification and ignoring the abnormal WBC/platelet values that require hold-and-report.

   D. Withhold the medication because the client has a documented sulfa allergy.

   Wrong: expands the "miss a documented allergy or class cross-reactivity" error pattern. Methotrexate is not a sulfonamide, so there is no true cross-reactivity; this option misreads the allergy screen rather than performing the priority verification step.

2. Question 2 of 6 · Blood and Blood Products

   At a long-term care facility, the nurse is preparing morning medications for an 82-year-old male client with type 2 diabetes who uses insulin at home. He weighs 72 kg. The order dated 06/15/2026 at 0700 reads: “Insulin lispro U-100, 6 units subcutaneously before breakfast; hold for blood glucose less than 70 mg/dL; indication: diabetes mellitus; prescriber: M. Patel, APRN.” His glucose is 68 mg/dL today, down from 84 mg/dL yesterday; creatinine is 1.1 mg/dL. What should the nurse do?

   1. ARecord the glucose of 68 mg/dL in the medication record and administer the prescribed insulin.
   2. BAdminister 0.6 mL of U-100 insulin lispro subcutaneously after confirming the medication label.
   3. CGive the 6 units by intravenous push for faster correction before breakfast.
   4. DHold the insulin, verify the client and order, treat the low glucose per protocol, and report it to the RN before any later dose.
   Show the answer and rationale

   Correct answer: D. Hold the insulin, verify the client and order, treat the low glucose per protocol, and report it to the RN before any later dose.

   Hold the insulin and report the low glucose before administering it. The order specifically requires withholding lispro when glucose is below 70 mg/dL, and the downward trend increases concern for hypoglycemia. If a new order later permits administration, calculate the volume as 6 units × (1 mL/100 units) = 0.06 mL. The units cancel, the leading zero is required, and a trailing zero is never used. Before any dose, independently verify the right client with two identifiers, drug, dose, route, time, reason, documentation, and response against the order and MAR. Option B gives ten times the ordered volume. Option C uses an unsafe, unauthorized route. Option A documents but fails to hold and report.

   A. Record the glucose of 68 mg/dL in the medication record and administer the prescribed insulin.

   Documentation is required but is not enough when a medication parameter is outside range. A glucose of 68 mg/dL requires holding the insulin, treating or monitoring the hypoglycemia according to protocol, and reporting it to the RN. Administering the dose misses the order’s timing and safety instruction.

   B. Administer 0.6 mL of U-100 insulin lispro subcutaneously after confirming the medication label.

   This calculation violates the dose and unit requirements. For U-100 insulin, 6 units × 1 mL/100 units equals 0.06 mL, not 0.6 mL. The proposed volume is ten times the prescribed dose, and the option also ignores the current glucose hold parameter.

   C. Give the 6 units by intravenous push for faster correction before breakfast.

   This violates the prescribed route and safe insulin technique. The order specifies subcutaneous administration; insulin lispro should not be given by intravenous push by the LPN/VN. It also disregards the instruction to hold the dose for glucose below 70 mg/dL.

   D. Hold the insulin, verify the client and order, treat the low glucose per protocol, and report it to the RN before any later dose.

   This is correct because the glucose is below the order’s hold parameter. The LPN/VN should withhold the dose, follow the facility’s hypoglycemia protocol, report the finding to the RN, and verify all medication rights before a later dose. If administration is subsequently authorized, 6 units of U-100 insulin equal 6 × 1/100 = 0.06 mL, written with a leading zero and no trailing zero.

3. Question 3 of 6 · Dosage Calculation

   The nurse is caring for a 68-year-old male in a long-term care facility with chronic atrial fibrillation and episodic rapid ventricular rates. The order reads: “Metoprolol succinate extended-release 50 mg orally once daily for ventricular-rate control; prescriber: J. Patel, APRN; ordered 06/18/2026 at 0800.” The record lists prior metoprolol-associated severe wheezing and bronchospasm. Today, his apical pulse is 54/min and blood pressure is 92/54 mm Hg. Recent results: potassium 5.7 mEq/L, glucose 118 mg/dL, INR 2.3, eGFR 38 mL/min/1.73 m².

   1. ACrush the extended-release tablet and mix it with food to make swallowing easier.
   2. BAdminister the tablet, then independently titrate an IV beta-blocker infusion until the apical pulse exceeds 60/min.
   3. CDocument the low pulse and prior wheezing in the MAR, then administer the scheduled dose as ordered.
   4. DUse two identifiers, compare the MAR with the original order, verify all medication rights and the reaction history, then hold and report the dose.
   Show the answer and rationale

   Correct answer: D. Use two identifiers, compare the MAR with the original order, verify all medication rights and the reaction history, then hold and report the dose.

   Hold the dose and report the findings after completing the medication-rights and safety check. The rights of medication administration require verification of the right client, drug, dose, route, time, reason, documentation, and response against the MAR and original order using two identifiers. The allergy and prior-reaction screen is also required before administration; this client previously developed severe bronchospasm with metoprolol. His pulse of 54/min and blood pressure of 92/54 mm Hg add immediate hold-and-report concerns. The potassium, glucose, INR, and renal results should be reviewed, but they do not override these findings. Titrating an IV infusion exceeds PN scope, and crushing an extended-release tablet changes its release.

   A. Crush the extended-release tablet and mix it with food to make swallowing easier.

   This violates the right route and technique. Metoprolol succinate is extended release and must not be crushed because crushing can release the medication too quickly and alter its effect. Even correct administration technique would not make this dose safe, however, because the reaction history and vital signs require holding and reporting first.

   B. Administer the tablet, then independently titrate an IV beta-blocker infusion until the apical pulse exceeds 60/min.

   This violates PN scope of practice. Independently titrating an IV beta-blocker infusion is an adjustment of a high-risk medication and belongs to the RN or another authorized clinician. The PN should collect the pulse and blood pressure, report the abnormal findings, and provide only care within scope; an out-of-scope titration is not a safe response to the low pulse.

   C. Document the low pulse and prior wheezing in the MAR, then administer the scheduled dose as ordered.

   This misses the allergy and contraindication screen and treats documentation as sufficient. Recording the prior bronchospasm and low pulse is necessary, but the hold-and-report rule requires stopping before administration when a serious prior reaction and concerning parameters are present. The PN must not give the dose merely because the order remains on the MAR.

   D. Use two identifiers, compare the MAR with the original order, verify all medication rights and the reaction history, then hold and report the dose.

   This is correct. The rights of medication administration require independent verification with two identifiers, and the allergy/contraindication screen must occur before the dose. A pulse of 54/min, low blood pressure, and a documented severe metoprolol reaction require the PN to hold the medication, document appropriately, and report to the RN or health care provider rather than administer it.

4. Question 4 of 6 · Medication Administration & Safety

   An LPN in an outpatient cardiology clinic prepares to administer a scheduled dose to Mrs. Alvarez, a 68-year-old woman with atrial fibrillation and heart failure. The order reads: "Digoxin 0.125 mg PO daily for atrial fibrillation rate control, Dr. Chen, today 0900." Today's labs are potassium 4.0 mEq/L, digoxin level 1.1 ng/mL, and an apical pulse of 52 beats/min taken for one full minute. Her daughter, who helps manage medications at home, is present in the room. Before drawing up the digoxin oral solution, what should the nurse do first?

   1. ADraw up the dose and ask the daughter to confirm her mother's name before giving it.
   2. BVerify the client's identity and confirm the order against the MAR using two identifiers.
   3. CAdminister the dose since the digoxin level and potassium are within normal limits.
   4. DChart the apical pulse and lab values, then proceed with giving the dose as scheduled.
   Show the answer and rationale

   Correct answer: B. Verify the client's identity and confirm the order against the MAR using two identifiers.

   Before any medication is drawn up, the LPN/VN must independently verify the rights of administration, right client (using two identifiers such as name and date of birth), right drug, right dose, right route, right time, and right documentation, against the MAR and the original order (the "follow the rights of medication administration every time" rule). This verification must occur before preparing or drawing up the dose, not after, and it is the nurse's responsibility, not a family member's. Verifying the client's identity and confirming the order against the MAR using two identifiers completes this first safety step independently of any helper. Asking the daughter to confirm identity substitutes a family member's word for the nurse's own two-identifier check, which is an unsafe practice shortcut. Administering the dose based on lab review alone skips the rights-verification step and prematurely assumes proceeding is appropriate, while also ignoring that apical pulse must be checked before this specific drug is given. Charting findings without first completing the required identity and order verification is a documentation-only response, and documentation never substitutes for the necessary safety check that must occur first. The earliest safety checkpoint must occur before any calculation or clinical-parameter decision (such as holding for bradycardia) can be made.

   A. Draw up the dose and ask the daughter to confirm her mother's name before giving it.

   Wrong technique for identity verification, delegating identity confirmation to the daughter bypasses the nurse's own two-identifier check, violating the rights-verification rule.

   B. Verify the client's identity and confirm the order against the MAR using two identifiers.

   Correct: the nurse independently verifies right client, drug, dose, route, and time against the MAR/order using two identifiers before drawing up any dose, satisfying the "follow the rights of medication administration every time" rule.

   C. Administer the dose since the digoxin level and potassium are within normal limits.

   Proceeds to administration based on labs alone, skipping the required rights verification step and ignoring that other hold parameters (apical pulse) still need checking.

   D. Chart the apical pulse and lab values, then proceed with giving the dose as scheduled.

   Documents findings but takes no verification action first; charting is necessary but not sufficient and does not substitute for confirming the rights before preparing the dose.

5. Question 5 of 6 · Adverse Effects, Contraindications & Interactions

   A 68-year-old woman on a medical-surgical unit has chronic atrial fibrillation with intermittent rapid ventricular response. Metoprolol succinate extended-release 50 mg orally daily is newly prescribed. The record documents severe wheezing and bronchospasm after metoprolol and anaphylaxis to penicillin. Apical pulse is 54/min, blood pressure 92/54 mm Hg, potassium 5.7 mEq/L, glucose 118 mg/dL, INR 2.3, and eGFR 38 mL/min/1.73 m². Her medications include warfarin, ibuprofen as needed, and ginkgo. Which action should the LPN/VN take?

   1. AGive metoprolol after confirming the penicillin allergy does not involve beta-blockers.
   2. BVerify the medication history, withhold metoprolol, document findings, and report the concerns before administration.
   3. CIndependently reduce the metoprolol dose and resume it when the apical pulse exceeds 60/min.
   4. DAdminister metoprolol because the rhythm remains intermittently rapid and the order is active.
   Show the answer and rationale

   Correct answer: B. Verify the medication history, withhold metoprolol, document findings, and report the concerns before administration.

   Withholding and reporting is the correct first action because this client has multiple medication-safety concerns. Her apical pulse is 54/min and systolic blood pressure is 92 mm Hg, both unsafe parameters for administering a rate-controlling antihypertensive without clarification. She also previously developed severe wheezing and bronchospasm from metoprolol, which requires verification before re-exposure. The LPN/VN must review the medication list for interactions, including warfarin with ibuprofen and ginkgo, and consider the elevated potassium and reduced eGFR when reporting. The penicillin anaphylaxis must remain documented, although it does not establish a beta-blocker allergy. The LPN/VN does not independently change or resume the prescription.

   A. Give metoprolol after confirming the penicillin allergy does not involve beta-blockers.

   This option focuses on the wrong allergy and fails to act on the documented severe wheezing and bronchospasm caused by metoprolol itself. A complete allergy and prior-reaction review is required before giving the drug, regardless of the separate penicillin allergy.

   B. Verify the medication history, withhold metoprolol, document findings, and report the concerns before administration.

   This action follows the safety screen: verify the documented bronchospasm and allergies, review warfarin, ibuprofen, and ginkgo, withhold the dose for pulse 54 and systolic pressure 92, and report before administration. The LPN/VN collects data and communicates concerns without changing the order.

   C. Independently reduce the metoprolol dose and resume it when the apical pulse exceeds 60/min.

   The LPN/VN may withhold, document, and report an unsafe finding, but may not independently reduce or restart a prescription. Dose changes and resumption require a new order or direction from the authorized prescriber through the appropriate nursing chain.

   D. Administer metoprolol because the rhythm remains intermittently rapid and the order is active.

   An active order and intermittent tachycardia do not override a pulse of 54/min and systolic pressure of 92 mm Hg. Administering the dose misses the hold-and-report requirement and could worsen bradycardia or hypotension.

6. Question 6 of 6 · Parenteral / Intravenous Therapies

   A 22-year-old male in a long-term care facility receives enoxaparin for limited mobility related to muscular dystrophy managed at home. The order reads: “Enoxaparin (generic) 40 mg subcutaneously every 24 hours at 2100 for venous thromboembolism prophylaxis; prescriber: J. Patel, provider; ordered 04/20/2026 at 0800.” He has pork-derived products allergy causing hives and no medication allergies. Platelets declined from 118,000/mm³ yesterday to 92,000/mm³ today; the order says to hold and notify the health care provider if below 100,000/mm³. What should the LPN/VN do?

   1. AAdminister the 0.4-mL subcutaneous dose because the platelet count is acceptable and the pork allergy is unrelated.
   2. BAdminister 4 mL subcutaneously because 40 mg is ordered from an 80 mg/0.8 mL syringe.
   3. CHold the dose, document the finding, and notify the RN or health care provider before administration.
   4. DAdminister 0.4 mL intramuscularly in the deltoid using a 45-degree angle.
   Show the answer and rationale

   Correct answer: C. Hold the dose, document the finding, and notify the RN or health care provider before administration.

   Hold the enoxaparin, document the platelet decline, and notify the RN or health care provider before giving it. The current platelet count of 92,000/mm³ is below the order’s explicit hold threshold of 100,000/mm³, so the dose cannot be administered until a new direction is obtained. The medication rights still require checking the client, drug, dose, route, time, reason, response, and documentation against the original order using two identifiers. If administration is later authorized, 40 mg × (0.8 mL ÷ 80 mg) = 0.4 mL, given subcutaneously at the appropriate angle, not intramuscularly. A pork-product reaction also requires clarification before exposure.

   A. Administer the 0.4-mL subcutaneous dose because the platelet count is acceptable and the pork allergy is unrelated.

   This option proceeds despite a parameter that is clearly outside range: 92,000/mm³ is below 100,000/mm³. It misses the right response to an abnormal safety finding, hold, document, and report. In addition, a documented reaction to pork-derived products should not be dismissed without clarification because enoxaparin is derived from animal tissue. The dose calculation alone does not authorize administration.

   B. Administer 4 mL subcutaneously because 40 mg is ordered from an 80 mg/0.8 mL syringe.

   This is a decimal and dose-volume error. The dimensional analysis is 40 mg × 0.8 mL/80 mg = 0.4 mL; the milligrams cancel. Giving 4 mL is ten times the calculated volume and fails the right-dose requirement. It would also be unsafe to administer while the platelet count remains below the ordered hold threshold.

   C. Hold the dose, document the finding, and notify the RN or health care provider before administration.

   This is correct because the platelet result is below the order’s hold parameter. The LPN/VN should verify the order and client with two identifiers, withhold the dose, document the assessment, and report promptly. Administration can resume only after an authorized new direction; the six medication rights are not satisfied when the ordered safety parameter is not met.

   D. Administer 0.4 mL intramuscularly in the deltoid using a 45-degree angle.

   This violates the ordered subcutaneous route and appropriate technique. Enoxaparin should not be injected intramuscularly, and a 45-degree angle is not the appropriate choice for this medication in this situation. The wrong route can increase tissue injury and bleeding risk. The option also ignores the platelet-based hold instruction.