Pharmacological and Parenteral Therapies — NCLEX-RN Practice
Covers safe medication administration, IV and parenteral therapy, blood product administration, dosage calculation, and recognizing expected versus adverse effects.
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What you must know about Pharmacological and Parenteral Therapies
The "rights" of medication administration (right client, drug, dose, route, time, plus right documentation and reason) underpin most safety questions.
Adverse-effect questions expect the nurse to recognize the earliest sign of toxicity for high-alert drugs (digoxin, lithium, warfarin, heparin, insulin).
IV therapy questions test recognizing infiltration versus phlebitis versus extravasation, and the correct immediate action for each.
Blood transfusion questions almost always test the first 15 minutes — the highest-risk window for a reaction.
NCLEX Exam Tips
How this category appears on the NCLEX-RN exam
For high-alert medications, know both the therapeutic range and the antidote — both are frequently tested.
If a transfusion reaction is described, stopping the transfusion and keeping the line open with normal saline comes before any other action.
Practice Questions
Test yourself — 10 questions
Practice questions written to the NCSBN NCLEX-RN test plan. The NCSBN does not publish real exam items, so no provider has genuine NCLEX past questions. Every question here comes with a full written rationale.
A 68-year-old male with a history of chronic heart failure is admitted to the hospital with worsening dyspnea and edema. His current medications include furosemide, lisinopril, and metoprolol. The nurse reviews his laboratory results and notes a potassium level of 3.0 mEq/L. Which action should the nurse take next?
Rationale
The correct action is to hold the furosemide and notify the healthcare provider, as furosemide can further lower the potassium level, which is already critically low. Administering furosemide (option A) could worsen hypokalemia. Administering potassium chloride orally (option C) might be appropriate, but only after consulting with the healthcare provider. Encouraging the patient to drink orange juice (option D) is not an immediate or sufficient intervention for hypokalemia of this severity.
A 45-year-old female with rheumatoid arthritis is prescribed methotrexate. During a follow-up visit, she complains of fatigue and mouth sores. What is the most appropriate action for the nurse to take?
Rationale
The correct action is to instruct the patient to take folic acid supplements as prescribed, which can help reduce the side effects of methotrexate, such as fatigue and mouth sores. Increasing the dose of methotrexate (option A) would likely worsen symptoms. Rest and mouthwash (option C) do not directly address the cause of symptoms. Discontinuing methotrexate (option D) is not done without consulting the healthcare provider and assessing the benefit-risk balance.
A 32-year-old patient with a history of type 1 diabetes is admitted to the emergency department with nausea, vomiting, and abdominal pain. The nurse notes a fruity odor on the patient's breath and a blood glucose level of 450 mg/dL. Which medication should the nurse anticipate administering?
Rationale
The correct intervention is to administer regular insulin intravenously to reduce the high blood glucose level and treat diabetic ketoacidosis (DKA). Administering 50% dextrose (option B) would worsen hyperglycemia. Metformin (option C) is inappropriate for acute management and is not used in type 1 diabetes. Glucagon (option D) is used for hypoglycemia, not hyperglycemia.
A nurse is preparing to administer a scheduled dose of vancomycin to a 60-year-old patient with a severe bacterial infection. The nurse reviews the patient's current laboratory results and notes a creatinine level of 2.5 mg/dL. What should the nurse do next?
Rationale
The nurse should hold the vancomycin and notify the healthcare provider because the elevated creatinine level indicates possible renal impairment, and vancomycin is nephrotoxic. Administering the drug as scheduled (option A) without adjustment could cause further damage. Checking urine output (option B) is important but does not address the immediate risk. Diluting the drug (option D) does not mitigate its nephrotoxic effects.
A 65-year-old male with a history of congestive heart failure is admitted to the hospital with shortness of breath and peripheral edema. He is prescribed furosemide. Which laboratory result should the nurse monitor closely after administering the medication?
Rationale
Furosemide is a loop diuretic that can cause hypokalemia by promoting potassium excretion in the urine. Therefore, monitoring serum potassium levels is crucial. Serum sodium, calcium, and magnesium levels may also be affected, but the most immediate concern with furosemide is potassium depletion.
A patient with diabetes mellitus type 2 is started on metformin. Which of the following statements made by the patient indicates a need for further teaching?
Rationale
Metformin does not typically cause hypoglycemia when used alone. Options A, B, and C are correct statements about metformin use. Taking the medication with meals can improve absorption and gastrointestinal tolerance, avoiding alcohol is advised to reduce the risk of lactic acidosis, and metformin helps manage blood sugar levels.
A 45-year-old female is receiving an intravenous infusion of vancomycin for a severe bacterial infection. Which adverse effect should the nurse monitor for during the infusion?
Rationale
Red man syndrome is a known adverse effect of vancomycin when it is infused too rapidly. It is characterized by flushing and/or an erythematous rash on the face, neck, and upper torso. Hypertension, thrombocytopenia, and seizures are not commonly associated with the infusion of vancomycin.
A patient is ordered to receive 20 units of regular insulin subcutaneously before meals. The nurse reviews the patient’s fingerstick blood glucose level, which is 80 mg/dL. What should the nurse do next?
Rationale
With a blood glucose level of 80 mg/dL, administering 20 units of regular insulin could potentially cause hypoglycemia. The nurse should hold the insulin and notify the healthcare provider for further instructions. Options A, C, and D could lead to inappropriate management of the patient’s glucose levels.
A 32-year-old female with asthma is prescribed albuterol via a metered-dose inhaler. Which instruction should the nurse give to the patient to ensure proper use?
Rationale
Proper technique for using a metered-dose inhaler involves exhaling completely, placing the mouthpiece in the mouth, and inhaling slowly while pressing down on the inhaler. Shaking is done before the first puff, not between every puff. Holding the breath should ideally be for about 10 seconds if possible, and using the inhaler before physical activity is only advised if prescribed for exercise-induced bronchospasm.
A patient is started on warfarin for atrial fibrillation. What is the most important action the nurse should take when providing discharge teaching?
Rationale
Regular monitoring of INR levels is crucial for patients on warfarin to ensure therapeutic anticoagulation and to adjust dosing as needed. Patients should not necessarily avoid all green leafy vegetables, but they should maintain a consistent intake. Warfarin can be taken with or without food, and acetaminophen is generally safe but should be used with caution and discussed with a provider.
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