Pharmacology – LPN Practice Questions

These practice questions are written at NCLEX-PN complexity: safe administration by oral and other basic routes, monitoring for expected and adverse effects, reinforcing teaching, and reporting findings to the registered nurse or provider. Actions outside the usual practical or vocational nurse scope, such as intravenous push medications and titration of continuous infusions, are not expected of the practical nurse; verify your state nurse practice act and facility policy. Options are numbered in the order A, B, C, D, E.

Question 1

The practical nurse is preparing to give digoxin 0.125 mg by mouth to an older adult. The apical pulse is 54 and regular. Which action should the nurse take?

1. Give the dose and document the pulse
2. Hold the dose and notify the registered nurse or provider
3. Give half of the ordered dose
4. Recheck the radial pulse and give the dose if it is above 60

Answer: 2 (B) Hold the dose and notify the registered nurse or provider.

Rationale: Digoxin is held in an adult when the apical pulse is below 60 beats per minute, and the finding is reported. The apical pulse is counted for a full minute before every dose. Option 1 risks worsening bradycardia. Option 3 is outside nursing scope, since a nurse never alters a prescribed dose. Option 4 is incorrect because the apical pulse, not the radial pulse, is the required measurement and it may underestimate the true rate.

Question 2

A client takes levothyroxine for hypothyroidism. Which statement by the client indicates a need for further teaching?

1. "I take it first thing in the morning with a full glass of water."
2. "I wait at least 30 minutes after taking it before I eat breakfast."
3. "I take my calcium supplement at the same time so I do not forget either one."
4. "I know I will need to take this medication for the rest of my life."

Answer: 3 (C) "I take my calcium supplement at the same time so I do not forget either one."

Rationale: Calcium, along with iron and antacids, binds levothyroxine and markedly reduces its absorption, so these should be separated by about 4 hours. Options 1, 2, and 4 all reflect correct understanding: levothyroxine is taken in the morning on an empty stomach, food is delayed at least 30 to 60 minutes, and therapy is usually lifelong.

Question 3

The practical nurse is administering oral medications. Which medication should the nurse not crush?

1. A plain acetaminophen 325 mg tablet
2. A metoprolol succinate extended-release tablet
3. A scored lisinopril 10 mg tablet
4. A chewable calcium carbonate tablet

Answer: 2 (B) A metoprolol succinate extended-release tablet.

Rationale: Extended-release and enteric-coated forms, labeled with abbreviations such as XL, XR, SR, CR, LA, and EC, must never be crushed, because crushing destroys the release mechanism and delivers the entire dose at once, which can cause profound bradycardia and hypotension with metoprolol. Options 1, 3, and 4 are immediate-release or chewable formulations. When a client cannot swallow, the nurse reports this and requests an alternative formulation rather than crushing.

Question 4

A client is taking prednisone 20 mg daily for a rheumatologic condition. Which client statement requires the nurse to intervene?

1. "I take it with breakfast so it does not upset my stomach."
2. "I am going to stop it on my own as soon as my joints feel better."
3. "I check my blood sugar because this medicine can raise it."
4. "I will call if I am around anyone with chickenpox or shingles."

Answer: 2 (B) "I am going to stop it on my own as soon as my joints feel better."

Rationale: Corticosteroids suppress the hypothalamic-pituitary-adrenal axis, and abrupt discontinuation after prolonged use can cause acute adrenal insufficiency, which is life-threatening. The dose must be tapered under provider direction. Options 1, 3, and 4 are all correct: steroids are taken with food, they raise blood glucose, and they suppress immunity so exposure to infection must be reported.

Question 5

A client receiving oral ferrous sulfate asks why the stools have turned black. What is the nurse's best response?

1. "This is an expected effect of iron and is not harmful."
2. "This means you are bleeding in your stomach and I will call the provider now."
3. "You should stop the iron immediately."
4. "This means the iron is not being absorbed."

Answer: 1 (A) "This is an expected effect of iron and is not harmful."

Rationale: Dark or black stools are an expected, harmless effect of oral iron therapy. Constipation is also common, so fluids and fiber are encouraged, and taking iron with a source of vitamin C improves absorption. Option 2 confuses this with melena from gastrointestinal bleeding; melena is tarry and foul smelling and is usually accompanied by other findings, and the nurse would report any concerning change. Options 3 and 4 are incorrect and would interrupt needed therapy.

Question 6

The nurse is teaching a client who is starting alendronate for osteoporosis. Which instruction is correct?

1. "Take it at bedtime with a snack."
2. "Take it in the morning with a full glass of plain water and stay upright for at least 30 minutes."
3. "Crush the tablet and mix it with applesauce."
4. "Take it with your morning coffee and calcium supplement."

Answer: 2 (B) "Take it in the morning with a full glass of plain water and stay upright for at least 30 minutes."

Rationale: Bisphosphonates can cause severe esophageal irritation and ulceration, so the client takes the tablet on an empty stomach with 6 to 8 ounces of plain water, remains upright for at least 30 minutes, and takes nothing else by mouth during that period. Options 1, 3, and 4 all increase esophageal risk or interfere with absorption; coffee, food, and calcium substantially reduce absorption.

Question 7

A client with chronic obstructive pulmonary disease is prescribed both an albuterol inhaler and a fluticasone inhaler. Which instruction should the nurse reinforce?

1. "Use the fluticasone first, then the albuterol."
2. "Use the albuterol first, wait as directed, then use the fluticasone, and rinse your mouth afterward."
3. "Use both inhalers at the same time."
4. "Use the fluticasone only when you feel short of breath."

Answer: 2 (B) "Use the albuterol first, wait as directed, then use the fluticasone, and rinse your mouth afterward."

Rationale: The bronchodilator is used first to open the airways so the inhaled corticosteroid is deposited more effectively. Rinsing the mouth after the corticosteroid prevents oral candidiasis and hoarseness. Option 1 reverses the order. Option 3 does not allow the bronchodilator to act. Option 4 confuses the controller with the rescue drug; fluticasone is scheduled and is not a rescue medication.

Question 8

A client with type 1 diabetes is alert and reports feeling shaky, sweaty, and confused. The fingerstick glucose is 54 mg/dL. What should the nurse do first?

1. Give the client 4 ounces of fruit juice
2. Administer the client's scheduled dose of insulin glargine
3. Call the registered nurse and wait for direction before acting
4. Give the client a peanut butter sandwich and recheck in one hour

Answer: 1 (A) Give the client 4 ounces of fruit juice.

Rationale: For a conscious client with hypoglycemia, treatment is 15 grams of fast-acting carbohydrate, such as 4 ounces of juice or regular soda, 3 to 4 glucose tablets, or a tablespoon of honey, followed by a recheck in 15 minutes and repeat treatment if the glucose is still low. Once it normalizes, a protein-containing snack helps sustain it if a meal is not due. Option 2 would deepen the hypoglycemia. Option 3 delays urgent treatment, though the nurse does report the event promptly after treating. Option 4 acts too slowly as initial treatment because fat and protein delay glucose absorption.

Question 9

A client is prescribed metronidazole for a bacterial infection. Which instruction is most important?

1. "Take it on an empty stomach for best absorption."
2. "Avoid all alcohol during therapy and for at least 3 days after your last dose."
3. "Stop the medication once your symptoms improve."
4. "Take it with a dairy product to reduce stomach upset."

Answer: 2 (B) "Avoid all alcohol during therapy and for at least 3 days after your last dose."

Rationale: Metronidazole with alcohol produces a disulfiram-like reaction with severe nausea, vomiting, flushing, headache, and palpitations. Clients should also be told to check mouthwashes and liquid cold preparations for alcohol content. A metallic taste and dark urine are expected and harmless. Option 1 is incorrect since it may be taken with food to reduce upset. Option 3 is wrong for any antibiotic course. Option 4 is not required and dairy interferes with other antibiotics such as tetracyclines rather than helping here.

Question 10

A client on isoniazid and rifampin for tuberculosis calls the clinic. Which report requires the nurse to notify the registered nurse or provider promptly?

1. The urine and tears have turned orange
2. Yellowing of the sclera with nausea, dark urine, and right upper quadrant discomfort
3. A mild metallic taste in the mouth
4. A request for the next appointment reminder

Answer: 2 (B) Yellowing of the sclera with nausea, dark urine, and right upper quadrant discomfort.

Rationale: These findings suggest drug-induced hepatitis, a serious adverse effect of both isoniazid and rifampin, and require immediate reporting and liver function testing. Option 1 is the expected orange discoloration of body fluids from rifampin, which also permanently stains soft contact lenses and reduces the effectiveness of oral contraceptives. Options 3 and 4 are not urgent. Clients on isoniazid also receive pyridoxine, which is vitamin B6, to prevent peripheral neuropathy.

Question 11

Select all that apply. Which actions are appropriate for the practical nurse when administering medications on a medical-surgical unit?

1. Verify the client using two identifiers such as name and date of birth
2. Check the medication label three times before administration
3. Document the medication in the record immediately after it is given
4. Administer a medication that another nurse has already poured into a cup
5. Titrate a continuous intravenous heparin infusion based on the aPTT result
6. Report a new rash and itching after an antibiotic dose to the registered nurse

Answer: 1, 2, 3, and 6 (A, B, C, F).

Rationale: Two identifiers, the three label checks, immediate documentation after administration, and prompt reporting of a possible allergic reaction are all core safe-practice actions. Option 4 is never acceptable, because the nurse who administers the medication must be the nurse who prepared and verified it. Option 5 is outside the usual practical or vocational nurse scope; titration of a continuous anticoagulant infusion based on laboratory values requires the assessment and clinical judgment of the registered nurse.

Question 12

A client taking furosemide daily should be taught to include which foods in the diet?

1. White rice, apples, and cucumbers
2. Bananas, oranges, potatoes, and spinach
3. Cheese, cured meats, and canned soup
4. Bread, pasta, and butter

Answer: 2 (B) Bananas, oranges, potatoes, and spinach.

Rationale: Loop diuretics such as furosemide cause potassium loss, so potassium-rich foods are encouraged unless the client is on a potassium-sparing agent or has kidney disease. The nurse also teaches taking the dose in the morning to avoid nighttime urination, daily weights with reporting of a gain of about 2 to 3 pounds in a day, and rising slowly to reduce orthostatic dizziness. Options 1 and 4 are low in potassium. Option 3 is high in sodium, which works against the therapeutic goal.

Question 13

The nurse is applying a new transdermal fentanyl patch for a client with chronic cancer pain. Which action is essential?

1. Apply the new patch directly over the old one for a consistent dose
2. Remove the old patch, cleanse the area, apply the new patch to a different site, and document removal of the old patch
3. Cut the patch in half if the client reports drowsiness
4. Apply the patch to an area of broken or irritated skin so it adheres better

Answer: 2 (B) Remove the old patch, cleanse the area, apply the new patch to a different site, and document removal of the old patch.

Rationale: Failure to remove the previous patch is a well-documented cause of opioid overdose. Sites are rotated, the skin must be intact, clean, and dry, and removal of the old patch is documented. Option 1 causes stacked dosing. Option 3 is unsafe and can release the entire drug reservoir at once, and a nurse never alters a dose. Option 4 increases absorption unpredictably. Heat sources such as heating pads also increase absorption and must be avoided.

Question 14

A client receiving oral morphine for chronic pain reports no bowel movement in three days. What is the nurse's best action?

1. Reassure the client that this is temporary and tolerance will develop
2. Withhold the next morphine dose until the client has a bowel movement
3. Report the finding to the registered nurse and reinforce teaching about fluids, fiber, activity, and the prescribed bowel regimen
4. Encourage the client to take an over-the-counter NSAID for the discomfort

Answer: 3 (C) Report the finding to the registered nurse and reinforce teaching about fluids, fiber, activity, and the prescribed bowel regimen.

Rationale: Constipation is the one opioid adverse effect to which tolerance does not develop, so it must be managed proactively with a stimulant laxative and stool softener regimen, hydration, fiber, and mobility as tolerated. Option 1 is factually wrong. Option 2 withholds a prescribed analgesic without an order and undertreats pain. Option 4 does not treat constipation and adds gastrointestinal bleeding risk.

Question 15

The nurse is about to administer a medication and notices the order reads "digoxin .25 mg PO daily." Which action is correct?

1. Give 0.25 mg since that is clearly what was intended
2. Give 25 mg as written
3. Contact the prescriber to clarify and have the order rewritten with a leading zero
4. Ask another nurse what the usual dose is and give that

Answer: 3 (C) Contact the prescriber to clarify and have the order rewritten with a leading zero.

Rationale: A decimal without a leading zero is an error-prone format that has caused tenfold overdoses, and an unclear or incorrectly written order must be clarified with the prescriber before administration. The correct convention is a leading zero before a decimal, such as 0.25 mg, and no trailing zero, such as 5 mg rather than 5.0 mg. Options 1 and 4 involve assumption rather than verification. Option 2 would deliver a one hundred fold overdose.

This page is independent study material for nursing licensure exam preparation. NCLEX-RN® and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing (NCSBN). This content is not produced, reviewed, or endorsed by NCSBN. Always verify clinical information against current facility policy, drug references, and your nursing program's curriculum before applying it in practice.