Medication administration NCLEX-RN Practice Questions

Medication administration NCLEX-RN Practice Questions

by

Medication Administration NCLEX-RN Practice Questions

Medication administration is a cornerstone of safe nursing practice within Pharmacological and Parenteral Therapies. This topic-wise question bank helps you sharpen clinical judgment on high-alert medications, dosing calculations, infusion principles, IV/IM/SQ routes, insulin safety, PCA monitoring, and medication teaching. You’ll navigate real-world scenarios like preventing adverse reactions, handling incompatible orders, evaluating therapeutic responses, and administering drugs via enteral tubes and transdermal systems. These NCLEX-RN–level questions emphasize the “rights” of medication administration, patient safety priorities, and interprofessional communication. Ideal for M. Pharma students and nursing candidates aiming for mastery, these questions will reinforce best practices, evidence-based rationale, and error prevention across acute and community care settings.

Q1. A provider order reads “MSO4 2 mg IV q4h PRN severe pain.” What is the nurse’s best action before administering the dose?

  • Contact the prescriber to clarify the medication name with no abbreviations and confirm the dose
  • Administer the medication as written because the dose is within range
  • Substitute magnesium sulfate 2 mg IV since MSO4 commonly means magnesium sulfate
  • Ask another nurse what MSO4 typically means on the unit

Correct Answer: Contact the prescriber to clarify the medication name with no abbreviations and confirm the dose

Q2. The nurse is preparing to administer digoxin 0.125 mg PO. The client’s apical heart rate is 54 bpm and serum potassium is 3.1 mEq/L. The client reports seeing yellow halos. What is the priority action?

  • Hold the digoxin dose and notify the provider of possible toxicity
  • Administer the digoxin and recheck the heart rate in 30 minutes
  • Give the digoxin with orange juice to raise potassium
  • Administer potassium after digoxin to avoid interaction

Correct Answer: Hold the digoxin dose and notify the provider of possible toxicity

Q3. Which technique reflects correct preparation of mixed insulin (NPH and Regular) in one syringe?

  • Inject air into NPH, then Regular; withdraw Regular first, then NPH
  • Inject air into Regular, then NPH; withdraw NPH first, then Regular
  • Withdraw NPH first to avoid contaminating long-acting insulin
  • Mix glargine with Regular to reduce injections

Correct Answer: Inject air into NPH, then Regular; withdraw Regular first, then NPH

Q4. Which instruction is correct for administering subcutaneous heparin?

  • Administer into the abdomen at least 2 inches from the umbilicus; do not aspirate or massage
  • Administer into the deltoid; aspirate for blood return; massage site for absorption
  • Choose the vastus lateralis; use a 1.5-inch needle; massage site
  • Administer into the forearm; insert at a 10-degree angle

Correct Answer: Administer into the abdomen at least 2 inches from the umbilicus; do not aspirate or massage

Q5. A client on a morphine PCA reports pain relief. Which assessment is the priority for safe medication administration?

  • Respiratory rate and level of sedation
  • Urine output and bowel sounds
  • Liver function tests
  • Skin turgor and oral mucosa

Correct Answer: Respiratory rate and level of sedation

Q6. An IV vesicant medication is infusing when the client reports burning at the site; blanching and edema are noted. What is the nurse’s first action?

  • Stop the infusion, leave the catheter in place, and attempt to aspirate residual drug
  • Remove the catheter and apply a warm compress immediately
  • Decrease the infusion rate and elevate the extremity
  • Flush the line with NS to dilute the medication

Correct Answer: Stop the infusion, leave the catheter in place, and attempt to aspirate residual drug

Q7. During vancomycin infusion, the client develops flushing and hypotension. What is the appropriate nursing action?

  • Slow or stop the infusion and notify the provider; restart at a slower rate once symptoms resolve
  • Bolus the remaining dose rapidly to complete therapy
  • Administer diphenhydramine and continue the infusion at the same rate
  • Switch to intramuscular dosing immediately

Correct Answer: Slow or stop the infusion and notify the provider; restart at a slower rate once symptoms resolve

Q8. Which statement indicates correct teaching for a client starting warfarin therapy?

  • Maintain a consistent intake of green leafy vegetables and keep INR monitoring appointments
  • Take ibuprofen as needed for headaches to improve pain control
  • Double the dose if you miss yesterday’s dose
  • Stop warfarin once your INR reaches 2.0

Correct Answer: Maintain a consistent intake of green leafy vegetables and keep INR monitoring appointments

Q9. A client prescribed doxycycline for acne needs education. Which instruction is correct?

  • Take on an empty stomach with a full glass of water; avoid dairy and antacids
  • Take with milk to minimize GI upset and improve absorption
  • Take immediately before bedtime and lie down to rest
  • Avoid sunscreen because photosensitivity is not expected

Correct Answer: Take on an empty stomach with a full glass of water; avoid dairy and antacids

Q10. Which instruction is essential when administering alendronate for osteoporosis?

  • Take first thing in the morning with a full glass of water and remain upright for at least 30 minutes
  • Take with breakfast to prevent GI upset and lie down to rest
  • Crush the tablet and mix with applesauce if difficulty swallowing
  • Take with calcium and iron supplements simultaneously

Correct Answer: Take first thing in the morning with a full glass of water and remain upright for at least 30 minutes

Q11. The provider orders phenytoin via a PEG tube. The client is receiving continuous enteral feeding. What is the best nursing action?

  • Hold tube feeding 1–2 hours before and after phenytoin administration
  • Administer phenytoin with the feeding to improve absorption
  • Mix phenytoin with the tube feed for fewer interruptions
  • Stop the feed only after giving phenytoin

Correct Answer: Hold tube feeding 1–2 hours before and after phenytoin administration

Q12. Which is correct when administering medications through a nasogastric tube used for feeding?

  • Flush the tube before and after each medication and give medications separately
  • Crush all medications together to reduce clogging
  • Administer extended-release tablets if finely crushed
  • Leave the tube feed running during medication administration

Correct Answer: Flush the tube before and after each medication and give medications separately

Q13. Which IM site is preferred for a 3-mL volume in an adult?

  • Ventrogluteal site using a 1.5-inch needle
  • Deltoid site using a 1-inch needle
  • Dorsogluteal site to avoid nerves and vessels
  • Vastus lateralis using a 5/8-inch needle

Correct Answer: Ventrogluteal site using a 1.5-inch needle

Q14. The nurse is administering iron dextran IM. Which technique is appropriate?

  • Use Z-track method and do not massage the site
  • Aspirate for a full minute and massage vigorously
  • Use the deltoid muscle to minimize pain
  • Administer subcutaneously for fewer adverse effects

Correct Answer: Use Z-track method and do not massage the site

Q15. Which instruction is correct for administering ophthalmic drops?

  • Place drops into the conjunctival sac, avoid touching the eye, and apply nasolacrimal occlusion
  • Place drops directly on the cornea for fastest absorption
  • Touch the dropper to the eyelid to stabilize and avoid contamination
  • Ask the client to blink rapidly to distribute medication

Correct Answer: Place drops into the conjunctival sac, avoid touching the eye, and apply nasolacrimal occlusion

Q16. The nurse is administering otic drops to a 2-year-old child. What is the correct technique?

  • Pull the pinna down and back and warm the solution before instillation
  • Pull the pinna up and back and cool the solution
  • Insert the dropper tip into the canal to ensure correct placement
  • Position the ear upward and massage the tragus only after standing

Correct Answer: Pull the pinna down and back and warm the solution before instillation

Q17. Which instruction is essential for nitroglycerin transdermal patch use?

  • Remove the old patch before applying a new one and rotate sites; ensure a daily nitrate-free interval
  • Cut patches to adjust the dose as needed
  • Apply over areas with hair to improve adhesion
  • Keep patches on continuously to prevent rebound angina

Correct Answer: Remove the old patch before applying a new one and rotate sites; ensure a daily nitrate-free interval

Q18. Which statement indicates correct handling of a transdermal fentanyl patch?

  • Apply to intact, non-irritated skin; do not cut the patch; avoid external heat sources
  • Cut the patch to titrate the dose for breakthrough pain
  • Place heating pads over the patch for better absorption
  • Apply to broken skin to increase analgesic effect

Correct Answer: Apply to intact, non-irritated skin; do not cut the patch; avoid external heat sources

Q19. A client receiving gentamicin has a trough level scheduled. When should the nurse draw the trough?

  • Immediately before the next dose
  • Thirty minutes after the infusion starts
  • Midway through the dosing interval
  • Two hours after the infusion ends

Correct Answer: Immediately before the next dose

Q20. A hospitalized client with type 1 diabetes is NPO for a procedure. Which insulin administration is appropriate?

  • Administer basal insulin as prescribed and hold prandial insulin
  • Hold all insulin until the client resumes eating
  • Administer prandial insulin based on usual doses
  • Double the basal insulin dose to prevent hyperglycemia

Correct Answer: Administer basal insulin as prescribed and hold prandial insulin

Q21. The order is to infuse 500 mL of NS over 4 hours using a 15 gtt/mL set. What is the infusion rate in gtt/min?

  • 31 gtt/min
  • 21 gtt/min
  • 38 gtt/min
  • 15 gtt/min

Correct Answer: 31 gtt/min

Q22. A client receiving IV morphine has a respiratory rate of 8/min and is difficult to arouse. What is the nurse’s priority action?

  • Stop the opioid, support airway and breathing, and prepare to administer naloxone
  • Decrease the next dose and continue current infusion
  • Call a rapid response after finishing the current dose
  • Place the client supine and reassess in 30 minutes

Correct Answer: Stop the opioid, support airway and breathing, and prepare to administer naloxone

Q23. Which statement is correct regarding IV potassium chloride administration?

  • Never administer IV potassium as a bolus or IV push; use a pump and dilute appropriately
  • IV push potassium is safe if the client has a central line
  • Peripheral infusion rates may exceed 40 mEq/hr if ECG monitored
  • Do not dilute potassium to prevent fluid overload

Correct Answer: Never administer IV potassium as a bolus or IV push; use a pump and dilute appropriately

Q24. Teaching for oral liquid iron supplementation should include which instruction?

  • Use a straw to prevent tooth staining and take with vitamin C to enhance absorption
  • Take with milk to reduce GI upset and improve absorption
  • Expect green stools as a dangerous sign of toxicity
  • Brush teeth immediately after dosing with baking soda

Correct Answer: Use a straw to prevent tooth staining and take with vitamin C to enhance absorption

Q25. Which teaching is most important for a client starting methotrexate for rheumatoid arthritis?

  • Avoid pregnancy and live vaccines; report signs of infection promptly
  • Increase alcohol intake to reduce joint inflammation
  • Discontinue folic acid supplementation to improve drug efficacy
  • Expect severe mouth sores as a harmless side effect

Correct Answer: Avoid pregnancy and live vaccines; report signs of infection promptly

Q26. A client on enalapril reports swelling of the lips and face and difficulty breathing. What is the nurse’s priority action?

  • Hold the medication and treat for possible angioedema
  • Encourage fluids and continue the medication
  • Administer potassium supplements and monitor ECG
  • Apply ice packs to reduce swelling

Correct Answer: Hold the medication and treat for possible angioedema

Q27. The nurse is preparing crushed medications for a client with dysphagia. Which medication should not be crushed?

  • Enteric-coated aspirin
  • Immediate-release acetaminophen
  • Plain metoprolol tablets
  • Chewable calcium carbonate

Correct Answer: Enteric-coated aspirin

Q28. The client uses both albuterol and fluticasone inhalers. Which instruction is correct?

  • Use albuterol first, wait several minutes, then use fluticasone; rinse mouth after steroid
  • Use fluticasone first to reduce airway edema, then albuterol
  • Use both inhalers back-to-back without spacing to improve adherence
  • Do not rinse after fluticasone to prolong effect

Correct Answer: Use albuterol first, wait several minutes, then use fluticasone; rinse mouth after steroid

Q29. After naloxone administration for opioid toxicity, which action is most important?

  • Monitor for re-sedation and repeat naloxone dosing as needed
  • Discontinue all monitoring once LOC improves
  • Administer a long-acting benzodiazepine to prevent agitation
  • Restart the opioid infusion immediately at the same rate

Correct Answer: Monitor for re-sedation and repeat naloxone dosing as needed

Q30. Which statement reflects correct TPN line management regarding medication administration?

  • Use a dedicated central line lumen for TPN and do not administer other medications through it
  • Mix IV antibiotics with TPN to reduce line entries
  • Flush TPN with dextrose 50% to maintain patency before IV push meds
  • Administer blood products through the TPN line to conserve access

Correct Answer: Use a dedicated central line lumen for TPN and do not administer other medications through it

Leave a Comment