Question 1
PharmacologyA patient is prescribed digoxin 0.25 mg PO daily for heart failure. Before administering the medication, what is the MOST important assessment the nurse should perform?
✅ Correct Answer: B
Rationale: Before administering digoxin (a cardiac glycoside), the nurse MUST assess the apical pulse for 1 full minute. If the pulse is <60 bpm in adults, HOLD the medication and notify the provider due to risk of bradycardia and heart block.
Why other answers are wrong:
- A) Blood pressure monitoring is important but NOT the priority for digoxin
- C) Respiratory rate is not directly affected by digoxin
- D) Pupil response is unrelated to digoxin administration
🎯 NCLEX Tip: For cardiac medications, always think "What vital sign does this drug affect?" Digoxin = HEART RATE (pulse check required).
Question 2
PharmacologyA patient receiving warfarin (Coumadin) therapy should avoid which of the following foods?
✅ Correct Answer: C
Rationale: Warfarin is a Vitamin K antagonist. Foods HIGH in Vitamin K (spinach, kale, broccoli, Brussels sprouts) can DECREASE warfarin effectiveness, increasing clot risk. Patients should maintain CONSISTENT Vitamin K intake (not eliminate, but stay consistent).
Why other answers are wrong:
- A) Bananas/oranges are high in potassium (relevant for ACE inhibitors, not warfarin)
- B) Dairy/eggs don't significantly interact with warfarin
- D) Meat doesn't affect warfarin (protein is fine)
🎯 NCLEX Tip: Warfarin + Vitamin K = ANTAGONIST relationship. Green leafy vegetables = HIGH Vitamin K.
Question 3
PharmacologyA patient with type 2 diabetes is prescribed metformin (Glucophage). The nurse should teach the patient to report which side effect immediately?
✅ Correct Answer: A
Rationale: Muscle pain and weakness can indicate LACTIC ACIDOSIS, a rare but life-threatening complication of metformin. Other signs include hyperventilation, abdominal pain, and extreme fatigue. This requires IMMEDIATE discontinuation and emergency treatment.
Why other answers are wrong:
- B) Mild GI upset (nausea, diarrhea) is COMMON and expected with metformin
- C) Increased urination is not a metformin side effect (think diabetes itself or SGLT2 inhibitors)
- D) Dry mouth is unrelated to metformin
🎯 NCLEX Tip: Metformin's serious complication = LACTIC ACIDOSIS. Watch for muscle pain, SOB, slow heart rate.
Question 4
PharmacologyA patient is receiving an IV infusion of heparin. Which laboratory value should the nurse monitor to evaluate the effectiveness of the medication?
✅ Correct Answer: D
Rationale: aPTT (activated partial thromboplastin time) is the lab test used to monitor IV HEPARIN therapy. Therapeutic range is 1.5-2.5 times the control value (typically 60-80 seconds). aPTT measures intrinsic pathway of coagulation.
Why other answers are wrong:
- A) Platelet count monitors for HIT (heparin-induced thrombocytopenia), not effectiveness
- B) INR monitors WARFARIN (oral anticoagulant), not heparin
- C) H&H monitors for bleeding complications, not drug effectiveness
🎯 NCLEX Tip: Remember: HEPARIN = aPTT | WARFARIN = INR/PT. Don't confuse these!
Question 5
PharmacologyA patient taking lisinopril (Zestril) for hypertension develops a persistent dry cough. What should the nurse do FIRST?
✅ Correct Answer: B
Rationale: Persistent dry cough is a COMMON side effect of ACE inhibitors (drugs ending in -pril). It's caused by bradykinin buildup. The nurse should notify the provider, who may switch the patient to an ARB (angiotensin receptor blocker like losartan), which doesn't cause cough.
Why other answers are wrong:
- A) Cough syrup won't help drug-induced cough (needs medication change)
- C) Fluids won't resolve ACE inhibitor cough
- D) Don't hold medication without provider order (BP control needed)
🎯 NCLEX Tip: ACE inhibitors (-pril) = DRY COUGH (common, non-dangerous). Switch to ARB (-sartan) if intolerable.
Question 6
PharmacologyA patient receiving morphine sulfate for post-operative pain has a respiratory rate of 8 breaths/minute. What is the nurse's PRIORITY action?
✅ Correct Answer: C
Rationale: Respiratory rate <12 breaths/minute indicates OPIOID-INDUCED RESPIRATORY DEPRESSION — a life-threatening emergency. Naloxone (Narcan) is the opioid antagonist that reverses respiratory depression immediately. ABC priority: AIRWAY/BREATHING comes first!
Why other answers are wrong:
- A) Monitoring is inadequate when respiratory rate is critically low (patient could stop breathing)
- B) Decreasing dose doesn't reverse existing respiratory depression
- D) You should notify provider AFTER giving naloxone (don't delay life-saving treatment)
🎯 NCLEX Tip: Opioid overdose = Naloxone IMMEDIATELY. Respiratory rate <12 = DANGER ZONE.
Question 7
PharmacologyA patient with hypothyroidism is prescribed levothyroxine (Synthroid). When should the nurse instruct the patient to take this medication?
✅ Correct Answer: A
Rationale: Levothyroxine should be taken in the MORNING on an EMPTY STOMACH (30-60 minutes before breakfast) for maximum absorption. Food, calcium, and iron supplements decrease absorption.
Why other answers are wrong:
- B) Food decreases absorption significantly
- C) Bedtime dosing can cause insomnia (thyroid hormone increases energy)
- D) Milk/antacids contain calcium which blocks absorption
🎯 NCLEX Tip: Levothyroxine = Morning + Empty stomach + Wait 30 min before eating.
Question 8
PharmacologyA patient taking furosemide (Lasix) should be monitored for which electrolyte imbalance?
✅ Correct Answer: D
Rationale: Furosemide (Lasix) is a LOOP DIURETIC that causes potassium LOSS. Patients are at risk for HYPOKALEMIA (low potassium), which can cause cardiac arrhythmias, muscle weakness, and cramping. Monitor potassium levels and teach patients to eat potassium-rich foods (bananas, oranges, potatoes).
Why other answers are wrong:
- A) Loop diuretics WASTE potassium (not retain it)
- B) Sodium is also lost, causing HYPOnatremia (not hyper)
- C) Calcium levels aren't significantly affected by furosemide
🎯 NCLEX Tip: Loop diuretics (Lasix, Bumex) = WASTE potassium. Potassium-sparing diuretics (spironolactone) = RETAIN potassium.
Question 9
PharmacologyA patient is prescribed prednisone 40 mg PO daily for an acute asthma exacerbation. The nurse should teach the patient to take this medication:
✅ Correct Answer: B
Rationale: Corticosteroids like prednisone should be taken WITH FOOD or MILK to minimize GI irritation and ulcer risk. Steroids increase stomach acid production and can cause gastric bleeding if taken on empty stomach.
Why other answers are wrong:
- A) Empty stomach increases GI upset and ulcer risk
- C) Bedtime dosing can cause insomnia (steroids are stimulating)
- D) Grapefruit juice interacts with many medications but isn't recommended here
🎯 NCLEX Tip: Steroids = Take with FOOD + Morning dose (avoid insomnia) + NEVER stop abruptly (taper needed).
Question 10
PharmacologyA patient receiving IV potassium chloride (KCl) complains of burning pain at the IV site. What should the nurse do FIRST?
✅ Correct Answer: A
Rationale: Burning pain during IV potassium infusion indicates possible INFILTRATION or PHLEBITIS. Potassium is highly irritating to tissues and can cause severe damage if infiltrated. STOP the infusion IMMEDIATELY, assess the site, and notify the provider.
Why other answers are wrong:
- B) Slowing the rate doesn't address infiltration/phlebitis risk
- C) Don't apply heat before assessing for infiltration
- D) Documentation is important but NOT the first action (patient safety first!)
🎯 NCLEX Tip: IV potassium = NEVER give IV push (fatal arrhythmia risk). Must dilute + infuse slowly via pump. Burning = STOP!
Question 11
Medical-SurgicalA patient with COPD has an oxygen saturation of 88% on room air. What is the MOST appropriate oxygen delivery device?
✅ Correct Answer: C
Rationale: COPD patients are HYPOXIC DRIVE breathers — their respiratory drive is triggered by LOW oxygen (not high CO2 like normal). High-flow oxygen can SUPPRESS their drive to breathe! Use LOW-FLOW oxygen (1-3 L/min nasal cannula) with target SpO2 88-92% (NOT 95%+).
Why other answers are wrong:
- A) Non-rebreather = TOO MUCH oxygen for COPD (can stop breathing!)
- B) 8 L/min is too high for COPD patients
- D) 50% FiO2 is excessive for COPD (start low, titrate up slowly)
🎯 NCLEX Tip: COPD = LOW-flow O2 (1-3 L/min). Target SpO2 = 88-92% (NOT 95%+). Too much O2 = respiratory arrest!
Question 12
Medical-SurgicalA patient with heart failure has +3 pitting edema in both ankles. Which dietary instruction is MOST important?
✅ Correct Answer: B
Rationale: Heart failure patients MUST restrict sodium (2 grams/day or less) because sodium causes fluid retention, worsening edema and heart workload. Teach patients to avoid processed foods, canned soups, deli meats, and added salt.
Why other answers are wrong:
- A) Protein intake isn't the primary concern for edema
- C) Dairy restriction isn't necessary (unless lactose intolerant)
- D) INCREASING fluids worsens heart failure! Should RESTRICT fluids (1.5-2 L/day max)
🎯 NCLEX Tip: Heart failure = Low sodium + Fluid restriction + Daily weights + Elevate legs.