I'm a Licensed Practical Nurse candidate and I've been studying for the NCLEX-PN for about 6 weeks now. I keep getting destroyed by pharmacology questions — specifically cardiac meds and psychiatric medication interactions. My overall practice scores are sitting at 72–75% which I've heard is passing range, but pharm is pulling that average down.
I've been using ATI and Saunders and doing about 100 practice questions a day. The problem isn't drug names — I've got those memorized. It's the clinical reasoning questions where they describe symptoms and you have to decide what the nurse should do next. I'm second-guessing myself constantly on those.
Is 72–75% on ATI actually a reliable passing predictor? And does anyone have a system for tackling the "what should the nurse do first" type questions? I've been told to think ABCs and Maslow but it doesn't always feel straightforward when there are four plausible-looking answers.
For cardiac pharm specifically — know your antidysrhythmics and what toxicity looks like for digoxin and lithium. Those two get tested constantly because the toxicity symptoms are counterintuitive. Digoxin GI symptoms presenting before cardiac symptoms is something a lot of people miss.
The psychiatric med interactions section is rough. Know MAOI interactions cold — there are usually 2–3 questions on it and they're specific about what you can and can't combine. Tyramine foods and serotonin syndrome symptoms are both fair game.
I used the Hurst Review for weak areas and found it better than Saunders for explaining the reasoning behind answers. Passed with 85 questions on my first attempt after struggling the same way you're describing. The NGN-style questions get easier once you stop second-guessing and commit to the first answer that fits the framework.
72–75% on ATI is solid — most sources put the safe zone at 65%+ so you're above that. For priority questions, the ABC/Maslow framework is right but you have to apply it strictly. If any answer involves airway or breathing, that wins unless it's already being actively managed.
I failed my first attempt and pharmacology was a huge part of why. What I changed the second time was stopping the random review and actually focusing on drug categories instead of individual meds — once you understand how beta blockers work as a class, the specific drug questions get way easier. I also drilled a ton of application-style questions rather than just memorizing side effects, and that shift made a real difference for the cardiac stuff especially.
For psych meds and interactions specifically, you've got to know your MAOIs cold because those interaction questions show up constantly. I'd also say don't sleep on health monitoring content — I did a bunch of practice with free lpn health evaluation monitoring questions and it helped me understand how the monitoring side connects to the pharmacology. At 72-75% you're closer than you think, it's really just about tightening up your weak spots before test day.
Quick update for anyone following this thread — I just finished a 75-question practice block and scored 79%, which is the highest I've hit so far. Honestly didn't think it was possible two weeks ago when I was stuck in the low 70s. The cardiac meds stuff finally started clicking after I stopped trying to memorize everything and just focused on the mechanisms. Once you understand why a beta blocker does what it does, the interactions make way more sense.
I'm sitting for the real exam on August 12th, so I've got about three weeks left. Still shaky on psych meds honestly, but I'm not panicking anymore. If you're in the same boat just keep grinding the practice questions and read every single rationale even when you get it right. That's what's been moving the needle for me.
Pharmacology was my nemesis too, especially cardiac meds. I work full-time as a CNA so I was studying in 20-30 minute chunks whenever I could — lunch breaks, after the kids went to bed, you name it. What actually helped me was stopping the passive reading and just drilling questions obsessively. I'd do a set, fail miserably, then read the rationale for every single wrong answer before moving on. That's it. No fancy system.
For the drug interactions stuff specifically, I found that grouping meds by what they do to the body made it click faster than memorizing each one separately. Also don't sleep on wound care practice — it shows up more than people expect and it's honestly easier points if you're consistent with it. I used lpn/questions/wound care and skin integrity 2 to hammer those questions and it gave me a confidence boost when I needed it. Your 72-75% range is solid, so you're not as lost as you feel. Just keep drilling and trust your rationales.