NCLEX-RN, Medical exams, 13–19%

Pharmacological and Parenteral Therapies

The second-highest weighted subcategory: giving medications and parenteral therapies safely, calculating doses, recognizing expected effects, adverse effects, and interactions, and managing blood products, central lines, and total parenteral nutrition.

Position: 6 of 8 client needs categories
Published weighting: 13–19% in the official framework
Topics covered: 5 topics in this guide

What is covered

Topics inside this client needs category.

These topics describe the scope students most often review for this part of NCLEX-RN. Treat them as a study checklist rather than an exhaustive list of what a single exam form can sample.

Medication administration and dosage calculation: The rights of administration, routes, and weight-based and infusion-rate calculations.
Adverse effects and interactions: High-alert drugs, toxicity signs, and the monitoring each drug needs.
Blood and blood products: Compatibility checks, transfusion reactions, and the first action when one starts.
Central venous access and parenteral nutrition: Line care, complications, and glucose monitoring during total parenteral nutrition.
Pain management with medications: Opioid safety, respiratory depression, and patient-controlled analgesia.

Study tips

How to practice Pharmacology.

Section-specific guidance that follows from how this material is usually tested.

Group drugs by class and learn one prototype per class with its key monitoring point.
Practice a few dosage calculations every day so accuracy holds under time pressure.
Memorize the laboratory values that decide whether to give or hold a drug.

Where this fits

Pharmacological and Parenteral Therapies is 6 of 8 client needs categories in the NCLEX-RN guide, and it carries a published weighting of 13–19% in the official framework. Use the full guide to balance it against everything else you have to review.

Back to the NCLEX-RN guide Official exam information

Sample Pharmacology questions

Practice questions, not yet expert-reviewed

Original practice questions written to the published framework for this section. No expert has reviewed them, and they are not taken from any official exam. Try each one before you open the answer.

Question 1Foundational
Which laboratory value should the nurse check before giving warfarin?
1. AActivated partial thromboplastin time (aPTT)
2. BSerum potassium
3. CHemoglobin A1C
4. DInternational normalized ratio (INR)
Show answer
Answer: D. International normalized ratio (INR)
Warfarin's effect is monitored with the prothrombin time and INR. The aPTT monitors unfractionated heparin.
Key insight: Warfarin goes with the INR; heparin goes with the aPTT.
Question 2Foundational
Before giving digoxin to an adult, the nurse counts an apical pulse of 52 beats per minute. What should the nurse do?
1. AGive half the dose
2. BGive the dose with food
3. CHold the dose and notify the provider
4. DGive the dose and recheck the pulse in an hour
Show answer
Answer: C. Hold the dose and notify the provider
Digoxin slows the heart rate. An adult apical pulse below 60 beats per minute is a reason to hold the dose and notify the provider, since bradycardia can signal toxicity.
Key insight: Hold digoxin for an adult apical pulse below 60.
Question 3Intermediate
What should the nurse do first when a client receiving a blood transfusion develops chills and back pain?
1. ARecheck the vital signs in 15 minutes
2. BStop the transfusion
3. CSlow the transfusion rate
4. DGive acetaminophen
Show answer
Answer: B. Stop the transfusion
Chills, fever, and back pain early in a transfusion suggest an acute hemolytic reaction. The nurse stops the transfusion, keeps the line open with normal saline through new tubing, and notifies the provider and blood bank.
Key insight: Any suspected transfusion reaction: stop the transfusion first.
Question 4Intermediate
A provider orders 500 mL of normal saline to infuse over 4 hours. At what rate in milliliters per hour should the nurse set the pump?
1. A125 mL/hour
2. B100 mL/hour
3. C150 mL/hour
4. D250 mL/hour
Show answer
Answer: A. 125 mL/hour
The rate is the volume divided by the time: 500 mL divided by 4 hours is 125 mL per hour.
Key insight: Infusion rate equals volume divided by hours.
Question 5Advanced
Which finding in a client receiving an opioid by patient-controlled analgesia requires the nurse's immediate action?
1. APain rated 4 out of 10
2. BMild itching
3. CConstipation
4. DA respiratory rate of 8 breaths per minute
Show answer
Answer: D. A respiratory rate of 8 breaths per minute
Respiratory depression is the most dangerous adverse effect of opioids. A rate of 8 needs immediate action, such as stopping the infusion, stimulating the client, and giving naloxone as ordered.
Key insight: Respiratory depression is the opioid emergency.

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Pharmacological and Parenteral Therapies