Here are some free nclex practice questions with a focus on pharmacology!

1. Your client has a diagnosis of schizophrenia.   Among his other medications, he has been taking clozapine for the past 8 months.  This morning your client’s temperature is 102.  You should give priority to:

  1. re-assess his temperature in 3-4 hours
  2. notify the physician immediately
  3. leave a note in the client’s chart for the doctor to review when he makes rounds
  4. ask the client if he has been feeling ill

 2. Your client is in active labor and has an order for Demerol 75mg.  The order states that it should be administered IM 10 minutes before delivery.  The nurse should:

  1. Question the order
  2. Give the medication as ordered
  3. Give the medication IM during the delivery to prevent increased perineal pain
  4. Wait until the client is placed on the delivery table and then administer the medication
  1. The physician has ordered intravenous fluid with potassium for a client admitted with dehydration and gastroenteritis.  Which of the following should the nurse do before adding potassium to the IV fluid?
  1. Obtain arterial blood gases
  2. Obtain a stool culture
  3. Assess the urinary output
  4. Perform a dextrostick
  1. A two-month old has just received his first tetramune injection.  What should the nurse tell the mother about the injection?
  1. Is one of a series of injections that protects against diphtheria, pertussis, tetanus, and H. influenzae B
  2. Will need to be repeated when the child is 4-yrs-old
  3. Is given to determine whether the child is susceptible to pertussis
  4. Is a one-time injection that protects against measles, mumps, rubella, and varicella
  1.   While working the psychiatric unit, a nurse approaches a client who has a diagnosis of paranoid schizophrenia.  The client refuses his medication and begins to accuse the nurse of trying to kill him.  The best approach for the nurse would be to tell the client:
  1. “You must take the medication.  It is your choice whether you take it by mouth or by  injection.”
  2. “It’s not going to kill you; just take the medication.”
  3. “I understand you don’t want to take the medication right now and it’s alright.”
  4. “I will have to call the doctor and order a sedative to calm you down.”
  1. Your client has been receiving urokinase.  She has a very large, bloody bowel movement.  What would be the most appropriate immediate action for you to take?
  1. Reduce the urokinase and administer heparin
  2. Administer Vitamin K IM
  3. Stop the urokinase and call the doctor
  4. Stop the urokinase
  1. Your patient has been prescribed Flagyl for treatment of a duodenal ulcer.  When teaching about this medication, the nurse would include:
  1. While taking this medication, you do not have to be concerned about being in the sun
  2. This medication should be stopped when you begin to feel better
  3. While taking this medication, avoid any beverages that contain alcohol
  4. This medication should be taken on an empty stomach to help increase absorption
  1. Before administering oral Methyltrexate to a client with cancer, the nurse should check:
  1. Blood gases
  2. Vital signs
  3. IV site
  4. Electrolytes

9. A client with osteomyelitis has an order for a Gentamycin trough level to be done.  When should the nurse call the lab to obtain the trough level?

  1. 30 minutes before the first dose
  2. Before the first dose
  3. 30 minutes before the fourth dose
  4. 30 minutes after the first dose
  1. Your patient has been admitted from the emergency room.  She has multiple injuries sustained from an auto accident.  The physician has ordered a histamine blocker.  What is the likely reason for this order?
  1. correct electrolyte imbalance
  2. treat nausea
  3. treat general discomfort
  4. prevent stress ulcers
  1. Your client is taking prednisone 7.5 mg po each morning for a diagnosis of SLE.  Which of the following statements best describes the reason for taking the prednisone in the morning?
  1. Taking prednisone in the morning helps there to be less fluid retention
  2. Taking in the morning mimics the body’s natural secretion of corticosteroid
  3. It is easier to remember to take medication in the mornings
  4. Prednisone is more easily absorbed with the morning meal
  1. The physician has ordered Theodur for a 12 yr. old girl being treated for asthma.  Before administering Theodur, the nurse should check:
  1. Temperature
  2. Pulse
  3. Blood pressure
  4. Urinary output
  1. Your client is currently prescribed tranylcypromine sulfate (Parnate).  When educating the client, you instruct him to refrain from eating foods that contain tyramine because it may cause:
  1. hypotension
  2. urinary retention
  3. hyperthermia
  4. hypertension

14. Erythromycin ointment is placed in the newborn’s eyes to prevent infection.  Which of the following is the correct area of the eye to place the ointment?

  1. under the eyelid
  2. on the cornea.
  3. in the lower conjunctival sac
  4. by the optic disc.
  1. The most important instructions a nurse can give a patient regarding the use of the antibiotic ampicillin are to:
  1. call the physician if she has any breathing difficulties.
  2. take it with meals so it doesn’t cause an upset stomach.
  3. take all of the medication prescribed even if the symptoms stop sooner.
  4. not share the pills with anyone else.
  1. The nurse is administering an antibiotic to her pediatric patient. She checks the patient’s armband and verifies the correct medication by checking the physician’s order, medication kardex, and vial. Which of the following is not considered one of the five “rights” of drug administration?
  1. Right dose
  2. Right route
  3. Right frequency
  4. Right time
  1. A nurse is planning dietary counseling for the client taking triamterene (Dyrenium).  Which of the following should be included in a list of foods that are acceptable?
  1. baked potato
  2. bananas
  3. oranges
  4. pears canned in water
  1. A client has been taking benzonatate (Tessalon) as ordered. The nurse tells the client that this medication should do which of the following?
  1. take away nausea and vomiting
  2. calm the persistent cough
  3. decrease anxiety level
  4. increase comfort level
  1. The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is:
  1. only the nurse’s—she should have checked the allergies before administering the medication.
  2. only the physician’s—she gave the order; the nurse is obligated to follow it.
  3. only the pharmacist’s—he should alert the floor to possible allergic reactions.
  4. the pharmacist, physician, and nurse are all liable for the mistake

20. Mrs. Jane Gately has been admitted to the oncology unit for pain management.  Her primary diagnosis is uterine cancer. Her vital signs on admission are BP 110/64, pulse 78, respirations 18, and temperature 99.2 F. Morphine sulfate 6mg IV, q 4 hours, prn has been ordered. During your assessment after lunch, your findings are: BP 92/60, pulse 66, respirations 10, and temperature 98.8. Mrs. Gately is crying and tells you she is still experiencing severe pain. Your action should be to

  1. give her the next ordered dose of MS.
  2. give her a back rub, put on some light music, and dim the lights in the room.
  3. report your findings to the MD, requesting an alternate medication order to be obtained from the physician.
  4. call her daughter to come and sit with her.
  1. A client with histoplasmosis has an order for ketoconazole (Nizoral). What is the correct teaching related to this medication? 
  1. take the medication on an empty stomach
  2. take the medication with an antacid
  3. avoid exposure to sunlight
  4. limit alcohol to 2 ounces per day 
  1. A female client tells the clinic nurse that her skin is very dry and irritated. Which product would the nurse suggest that the client apply to the dry skin?
  1. glycerin emollient
  2. aspercreame
  3. myoflex
  4. acetic acid solution
  1. You are the nurse administering a dose of digoxin to one of your geriatric patients. The woman asks why she takes a different pill than her niece, who also has heart trouble. You reply that as people get older, liver and kidney function decline, and if the dose is as high as her niece’s, the drug will tend to:
  1. have a shorter half-life.
  2. accumulate.
  3. have decreased distribution.
  4. have increased absorption.
  1. When counseling a patient who is starting to take MAO (monoamine oxidase) inhibitors such as Nardil for depression, it is essential that they be warned not to eat foods containing tyramine, such as:
  1. Roquefort, cheddar, or Camembert cheese.
  2. grape juice, orange juice, or raisins.
  3. onions, garlic, or scallions.
  4. ground beef, turkey, or pork.

25. After teaching a client who is taking a xanthine bronchodilator about beverages to avoid. The nurse determines that the client understands the information if the client chooses which of the following beverages from the dietary menu?

  1. chocolate milk
  2. cranberry juice
  3. coffee
  4. cola

Answers and Rationales

  1. The correct answer is B.  Elevated temperatures in the client receiving antipsychotics should be immediately reported to the physician.  Answers A and C are incorrect because they jeopardize the safety of the client.  D is incorrect because a client with schizophrenia is unaware of his condition; therefore, the nurse must rely upon objective signs of illness.  
  2. The correct answer is A.  The order should be questioned.  Giving a narcotic so close to delivery can result in newborn respiratory distress.  Answers B, C, and D are all incorrect because administering the medication so close to delivery could result in respiratory depression in the newborn.
  3. The correct answer is C.  The kidneys compensate for electrolyte imbalance by retaining potassium when dehydration occurs.  For this reason, urinary output should be checked before adding potassium to the IV fluid.  Answer A is incorrect because it measures respiratory compensation that may be caused by dehydration.  Answers B and D do not apply to the use of IV fluid containing potassium; therefore, they are incorrect.
  4. The correct answer is A.  This immunization protets against diphtheria, tetanus, pertussis, and H. influenzae B.  Answer B is incorrect because a second injection is given before 4 years of age.  C is not a true statement.  D is incorrect because this is not a one-time injection and it does not protect against measles, mumps, rubella, or varicella.
  1. The correct answer is A.  The patient must take his medication.  However, giving him a choice of how the medication will be administered gives him a sense of control while diffusing the possibility of an escalated incident, as the patient is already agitated.    B is incorrect; telling the client “it’s not poison” is going to do little to calm him as he has a diagnosis of paranoia.  C is
  2. The correct answer is C.  Urokinase is a thrombolytic that is used to destroy a clot following a myocardial infarction.  B is incorrect because vitamin K is not the antidote for urokinase.  D is incorrect because stopping the urokinase is not enough to stop bleeding.  A is incorrect because administering heparin may increase bleeding.
  1. The correct answer is C.  When taking Flagyl, alcohol will cause extreme nausea and stomach upset.  A is incorrect because flagyl may cause photosensitivity, therefore sunlight should be avoided.  B is incorrect because the medication should be taken until all gone.  D is incorrect because Flagyl should be taken with meals and a full 8 oz glass of water.
  2. The correct answer is B.  Vital signs should be taken before any chemotherapy agent, no matter the route used to administer it.  A and D are incorrect because electrolytes and blood gases do not need to be checked.  C is incorrect because, in this question, the chemotherapy is being administered orally.
  3. The correct answer is C.  Trough levels are the lowest blood levels and should be done 30 minutes before the fourth IM dose or 30 minutes before the third IV dose.  Answers A, B, and D are incorrect.
  4. The correct answer is D.  Histamine blockers are often ordered for clients who are hospitalized for long times or in stressful situations.  Answers A, B, and C are incorrect because histamine blockers are not used to treat discomfort, nausea, or to correct electrolyte imbalance.
  5. The correct answer is B.  Taking corticosteroids in the morning mimcs the body’s natural release of cortisol.  Answer A is not always true.  Answers C and D are not true.
  6. The correct answer is B.  Theodur is a bronchodilator, and a side affect may include tachycardia.  Therefore, checking the pulse is important.  Answers A, C, and D are not necessary.
  7. The correct answer is D.  If the client eats foods high in tyramine, she may experience malignant hypertension.  Answers A, B, and C are not related to the question.
  8. The correct answer is C.  The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well distributed.
  9. The correct answer is C.  The patient should take all of the medication prescribed even if the symptoms stop sooner.  Frequently patients do not complete an entire course of antibiotic therapy, and the bacteria are not destroyed.
  10. The correct answer is C.   The five rights of medication administration are right drug, right dose, right route, right time, right patient. Frequency is not included.
  11. The correct answer is D.    Triamterene is a potassium-sparing diuretic, and clients taking this medication should be cautioned against eating foods that are high in potassium, including many vegetables, fruits, and fresh meats. Because potassium is very water-soluble, foods that are prepared in water are often lower in potassium.
  1. The correct answer is B.  Benzonatate is a locally acting antitussive. Its effectiveness is measured by the degree to which it decreases the intensity and frequency of cough, without eliminating the cough reflex.
  2. The correct answer is D.   The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.
  3. The correct answer is A.     Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be notified.
  4. The correct answer is C.    The client should be taught that ketoconazole is an antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases photosensitivity.
  5. The correct answer is A.     Glycerin is an emollient that is used for dry, cracked, and irritated skin. Aspercreme and Myoflex are used to treat muscular aches. Acetic acid solution is used for irrigating, cleansing, and packing wounds infected by Pseudomonas aeruginosa.
  6. The correct answer is B.     The decreased circulation to the kidney and reduced liver function tend to allow drugs to accumulate and have toxic effects.
  7. The correct answer is A.     Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously high blood pressure. Aged cheeses are all high in this amino acid; the other foods are not.
  1. The correct answer is B.     Cola, coffee, and chocolate contain xanthine and should be avoided by the client taking a xanthine bronchodilator. This could lead to an increased incidence of cardiovascular and central nervous system side effects that can occur with the use of these types of bronchodilators.

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