🎯 High-Yield Points for This Topic
- Know drug class first: -olol = beta blocker, -pril = ACE inhibitor, -sartan = ARB, -statin = statin
- Anticoagulants: warfarin antidote = vitamin K; heparin antidote = protamine sulphate
- Opioids: monitor respiratory rate; antidote = naloxone (Narcan)
- Digoxin: hold if HR <60 or K+ <3.5; therapeutic level 0.5-2 ng/mL
- Always check five rights: right patient, drug, dose, route, time + document after
[Infographic: Pharmacology NCLEX Practice Questions Key Concepts — Clinical Manifestations, Nursing Interventions, Priority Actions]
Practice Questions
Question 1
A client is prescribed warfarin for atrial fibrillation. Which laboratory value most directly monitors the therapeutic effect of this medication?
✓ Correct: International Normalised Ratio (INR)
INR monitors warfarin (Coumadin) therapy. Therapeutic INR for atrial fibrillation is 2.0-3.0. INR measures the extrinsic coagulation pathway (affected by warfarin). aPTT monitors heparin therapy (intrinsic pathway). CBC and platelets are important but do not directly measure warfarin's anticoagulant effect.
INR monitors warfarin (Coumadin) therapy. Therapeutic INR for atrial fibrillation is 2.0-3.0. INR measures the extrinsic coagulation pathway (affected by warfarin). aPTT monitors heparin therapy (intrinsic pathway). CBC and platelets are important but do not directly measure warfarin's anticoagulant effect.
Question 2
A nurse is preparing to administer heparin IV. Which action is correct?
✓ Correct: Use a dedicated infusion pump and verify dose with another nurse
Heparin must be administered via an infusion pump (not gravity) for precise dose control. Most institutions require two-nurse verification due to heparin's high-alert medication status. Heparin should never be co-infused with other medications due to incompatibilities. Rapid IV bolus of high-dose heparin can cause dangerous bleeding. Do not shake heparin vials.
Heparin must be administered via an infusion pump (not gravity) for precise dose control. Most institutions require two-nurse verification due to heparin's high-alert medication status. Heparin should never be co-infused with other medications due to incompatibilities. Rapid IV bolus of high-dose heparin can cause dangerous bleeding. Do not shake heparin vials.
Question 3
A client taking metformin for type 2 diabetes is scheduled for a contrast CT scan. Which action is MOST appropriate?
✓ Correct: Hold metformin 24-48 hours before the procedure and for 48 hours after
Metformin must be held before and after IV contrast dye administration. IV contrast can cause acute kidney injury, and if kidneys are impaired, metformin accumulates leading to lactic acidosis — a potentially fatal complication. Standard protocol is to hold metformin 24-48 hours before contrast and restart only after kidney function is confirmed normal (typically 48 hours post-procedure).
Metformin must be held before and after IV contrast dye administration. IV contrast can cause acute kidney injury, and if kidneys are impaired, metformin accumulates leading to lactic acidosis — a potentially fatal complication. Standard protocol is to hold metformin 24-48 hours before contrast and restart only after kidney function is confirmed normal (typically 48 hours post-procedure).
Question 4
A client is receiving morphine PCA (patient-controlled analgesia). Which assessment finding requires immediate nursing intervention?
✓ Correct: Respiratory rate of 8 breaths per minute
A respiratory rate of 8 breaths per minute indicates opioid-induced respiratory depression — a medical emergency. Normal respiratory rate is 12-20 breaths/minute. The nurse must: stop the PCA, stimulate the patient, apply oxygen, and prepare naloxone (Narcan) for administration. Pain 3/10 means the medication is working. Nausea and mild drowsiness are expected side effects of opioids.
A respiratory rate of 8 breaths per minute indicates opioid-induced respiratory depression — a medical emergency. Normal respiratory rate is 12-20 breaths/minute. The nurse must: stop the PCA, stimulate the patient, apply oxygen, and prepare naloxone (Narcan) for administration. Pain 3/10 means the medication is working. Nausea and mild drowsiness are expected side effects of opioids.
Question 5
A client taking lithium for bipolar disorder reports 'my hands are trembling and I feel confused.' Which action is the PRIORITY?
✓ Correct: Check the serum lithium level immediately
Confusion and tremors in a client on lithium suggest lithium toxicity. The therapeutic range is 0.6-1.2 mEq/L; toxicity occurs above 1.5 mEq/L. Immediately checking the serum level allows for confirmation and appropriate intervention (which may include hydration, diuresis, or dialysis in severe cases). This is not a normal side effect — it requires urgent assessment.
Confusion and tremors in a client on lithium suggest lithium toxicity. The therapeutic range is 0.6-1.2 mEq/L; toxicity occurs above 1.5 mEq/L. Immediately checking the serum level allows for confirmation and appropriate intervention (which may include hydration, diuresis, or dialysis in severe cases). This is not a normal side effect — it requires urgent assessment.
Want 20+ More Pharmacology NCLEX Practice Questions Questions?
Our complete question bank has 500+ NCLEX questions with topic filters, difficulty settings, and NGN case studies.
Access Full Question Bank — Ksh 12,000Key Nursing Concepts: Pharmacology NCLEX Practice Questions
[Clinical Concept Map: Pharmacology NCLEX Practice Questions — Pathophysiology, Assessment Findings, Nursing Actions]