NCLEX Medication Safety questions
The PrepScore bank has 109 Medication Safety questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Take action and Recognize cues, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Catch the dangerous medication moments — wrong dose, wrong patient, wrong timing, missed contraindications, and reactions that look like one thing but are another.
Three worked questions
Q1. A nurse is preparing to administer digoxin 0.25 mg PO. The client's apical pulse is 54 bpm. Which action is appropriate?
- A. Administer the dose and recheck in 1 hour
- B. Hold the medication and notify the provider
- C. Give half the dose and document
- D. Administer with a glass of orange juice
Show answer and rationale
Answer: Hold the medication and notify the provider
Hold digoxin if apical HR < 60 (adult) or < 90-110 (peds) and notify provider. Bradycardia is a sign of dig toxicity.
Q2. Which laboratory finding requires the nurse to HOLD furosemide?
- A. K+ 4.0
- B. K+ 2.8
- C. Na+ 140
- D. BUN 18
Show answer and rationale
Answer: K+ 2.8
Furosemide depletes K+ further. Hold if K+ < 3.5 and notify provider. Replace K+ before continuing.
Q3. Which signs/symptoms indicate lithium toxicity? Select all that apply.
- A. Coarse tremor
- B. Vomiting + diarrhea
- C. Ataxia + slurred speech
- D. Improved mood + clearer thinking
- E. Lithium level 2.5 mEq/L
Show answer and rationale
Answer: Coarse tremorVomiting + diarrheaAtaxia + slurred speechLithium level 2.5 mEq/L
Lithium toxicity > 1.5 mEq/L: GI + neuro symptoms + coarse tremor. Therapeutic 0.6-1.2.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Any diabetic on insulin who becomes acutely confused, agitated, or unresponsive needs a finger-stick blood glucose BEFORE a neuro workup or stroke alert. Insulin given without food is the most common preventable hypoglycemia in the hospital. Lispro and aspart peak within 30 minutes to 2.5 hours; regular insulin peaks 2–4 hours; NPH peaks 4–12 hours.
Before each digoxin dose: apical pulse for a full minute. Hold for apical pulse <60 (adults). Always know the K and Mg levels — both low K and low Mg amplify digoxin's cardiac effect, so 'therapeutic' digoxin levels can be functionally toxic. Watch for early toxicity: nausea, anorexia, vision changes (yellow halos), bradycardia, arrhythmias.
Orthostatic hypotension with tachycardia in an anticoagulated patient is a bleed until proven otherwise. Compare today's hemoglobin to yesterday's, not to the 'normal range.' Hold the anticoagulant, assess for bleeding sources (GI, GU, intracranial, retroperitoneal), and notify the provider before treating dehydration.
Heparin-induced thrombocytopenia (HIT) presents typically 5–14 days after starting heparin with a >50% drop in platelets from baseline, often with new thrombosis. STOP heparin immediately. Switch to a non-heparin anticoagulant (argatroban, bivalirudin, fondaparinux). Do NOT transfuse platelets. Do NOT restart heparin in this patient — ever.
When a new drug + hives + airway involvement + hypotension appear together — that is anaphylaxis. First action: STOP the infusion (do not flush). Then: IM epinephrine 0.3–0.5 mg into the lateral thigh, call rapid response, apply oxygen, IV fluids. Antihistamines and steroids are adjuncts — they do not reverse anaphylaxis.
Lithium therapeutic range is 0.6–1.2 mEq/L. Things that raise levels: NSAIDs, ACE inhibitors, thiazide diuretics, low sodium diet, dehydration, vomiting/diarrhea. New coarse tremor, slurred speech, ataxia, GI symptoms, or confusion in a lithium patient — check the level before assuming a psychiatric episode.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Medication Safety questions does the bank have?
109 multiple-choice items, plus 10 unfolding cases in the Medication Safety pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Take action and Recognize cues, though every step appears.
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