**The Pharmacology Power-Drill:
Advanced Drug Mastery for NCLEX**
1. A patient is receiving IV digoxin for heart failure. Which finding indicates digoxin toxicity?
A) Heart rate 62 bpm
B) Serum potassium 4.0 mEq/L
C) Visual halos (yellow-green) around lights
D) Blood pressure 130/80 mmHg
💫RATIONALE✔️✔️: Visual disturbances (yellow-green halos, blurring) are classic signs of digoxin toxicity.
Bradycardia is an effect but not diagnostic; hypokalemia increases risk.
💫ANSWER✔️✔️: C) Visual halos (yellow-green) around lights
---
2. A patient with asthma is prescribed a beta-blocker for hypertension. Which beta-blocker is most
cardioselective and safest in asthma?
A) Propranolol
B) Metoprolol
C) Carvedilol
D) Nadolol
💫RATIONALE✔️✔️: Metoprolol and atenolol are beta-1 selective (cardioselective) and have less risk of
bronchospasm than non-selective beta-blockers (propranolol, nadolol, carvedilol). Use with caution still.
💫ANSWER✔️✔️: B) Metoprolol
---
3. A patient on warfarin has an INR of 1.2. The patient is scheduled for surgery tomorrow. What is the
most appropriate action?
A) Administer vitamin K 10 mg PO
,B) Hold warfarin for 3 days and recheck INR
C) Administer fresh frozen plasma
D) Give enoxaparin 40 mg SQ daily
💫RATIONALE✔️✔️: INR of 1.2 is subtherapeutic and indicates warfarin is not at therapeutic level. Hold
warfarin; INR will normalize without reversal. Vitamin K is for elevated INR with bleeding.
💫ANSWER✔️✔️: B) Hold warfarin for 3 days and recheck INR
---
4. A patient is prescribed furosemide 40 mg IV for heart failure. Which laboratory value should the nurse
monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
💫RATIONALE✔️✔️: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia increases
the risk of dysrhythmias, especially in patients on digoxin.
💫ANSWER✔️✔️: B) Serum potassium
---
5. A patient with tuberculosis is started on rifampin. The nurse teaches that this medication causes
which harmless but alarming side effect?
A) Orange-red discoloration of urine and tears
B) Blurred vision and yellow halos
C) Metallic taste in the mouth
D) Photosensitivity rash
💫RATIONALE✔️✔️: Rifampin causes harmless orange-red discoloration of body fluids (urine, sweat,
tears). Patients must be warned to prevent unnecessary concern.
💫ANSWER✔️✔️: A) Orange-red discoloration of urine and tears
---
,6. A patient with a history of opioid use disorder is prescribed buprenorphine/naloxone (Suboxone). The
nurse explains that the naloxone component:
A) Prevents intravenous abuse by causing withdrawal
B) Enhances the analgesic effect of buprenorphine
C) Prolongs the half-life of buprenorphine
D) Blocks the mu-opioid receptor
💫RATIONALE✔️✔️: Naloxone has poor sublingual absorption but when injected IV, it precipitates
withdrawal. This deters misuse. Buprenorphine itself is a partial agonist.
💫ANSWER✔️✔️: A) Prevents intravenous abuse by causing withdrawal
---
7. A patient on lithium therapy has a level of 1.8 mEq/L and reports nausea, coarse tremor, and
confusion. What is the priority action?
A) Administer a stat dose of lithium
B) Hold lithium and notify the provider
C) Increase the patient's fluid intake
D) Draw a stat lithium level
💫RATIONALE✔️✔️: Lithium level 1.5-2.0 with symptoms indicates moderate toxicity. Hold lithium, notify
provider, and prepare for IV fluids to enhance excretion.
💫ANSWER✔️✔️: B) Hold lithium and notify the provider
---
8. A patient is prescribed metformin for type 2 diabetes. Which instruction is most important to prevent
a serious adverse effect?
A) "Take metformin with food to prevent stomach upset."
B) "Hold metformin before a CT scan with IV contrast."
C) "Monitor your blood glucose daily."
D) "Report any weight gain to your provider."
💫RATIONALE✔️✔️: Metformin must be held before and for 48 hours after IV contrast dye to prevent
lactic acidosis, a rare but serious complication. Kidney function is assessed before restarting.
, 💫ANSWER✔️✔️: B) "Hold metformin before a CT scan with IV contrast."
---
9. A patient receiving IV vancomycin reports flushing of the face, neck, and upper chest. What is the
priority action?
A) Stop the infusion and notify the provider of an allergic reaction
B) Slow the infusion rate and reassure the patient
C) Administer diphenhydramine 25 mg IV push
D) Obtain a stat serum vancomycin level
💫RATIONALE✔️✔️: Red Man Syndrome is a histamine reaction (not an IgE allergy) caused by rapid
infusion. Slowing the infusion rate resolves symptoms. Do not stop unless severe.
💫ANSWER✔️✔️: B) Slow the infusion rate and reassure the patient
---
10. A patient with a history of seizures is prescribed phenytoin. Which finding indicates a therapeutic
serum level?
A) 8 mcg/mL
B) 12 mcg/mL
C) 18 mcg/mL
D) 25 mcg/mL
💫RATIONALE✔️✔️: Therapeutic phenytoin level is 10-20 mcg/mL. Levels <10 are subtherapeutic; >20
cause toxicity (nystagmus, ataxia, sedation).
💫ANSWER✔️✔️: C) 18 mcg/mL
---
11. A patient with angina is prescribed nitroglycerin sublingual. Which instruction is correct?
A) "Swallow the tablet with water for faster effect."
B) "Take one tablet every 5 minutes for up to 3 doses for chest pain."
C) "Store the tablets in the refrigerator to keep them fresh."
D) "If you have a headache, stop taking the medication."
Advanced Drug Mastery for NCLEX**
1. A patient is receiving IV digoxin for heart failure. Which finding indicates digoxin toxicity?
A) Heart rate 62 bpm
B) Serum potassium 4.0 mEq/L
C) Visual halos (yellow-green) around lights
D) Blood pressure 130/80 mmHg
💫RATIONALE✔️✔️: Visual disturbances (yellow-green halos, blurring) are classic signs of digoxin toxicity.
Bradycardia is an effect but not diagnostic; hypokalemia increases risk.
💫ANSWER✔️✔️: C) Visual halos (yellow-green) around lights
---
2. A patient with asthma is prescribed a beta-blocker for hypertension. Which beta-blocker is most
cardioselective and safest in asthma?
A) Propranolol
B) Metoprolol
C) Carvedilol
D) Nadolol
💫RATIONALE✔️✔️: Metoprolol and atenolol are beta-1 selective (cardioselective) and have less risk of
bronchospasm than non-selective beta-blockers (propranolol, nadolol, carvedilol). Use with caution still.
💫ANSWER✔️✔️: B) Metoprolol
---
3. A patient on warfarin has an INR of 1.2. The patient is scheduled for surgery tomorrow. What is the
most appropriate action?
A) Administer vitamin K 10 mg PO
,B) Hold warfarin for 3 days and recheck INR
C) Administer fresh frozen plasma
D) Give enoxaparin 40 mg SQ daily
💫RATIONALE✔️✔️: INR of 1.2 is subtherapeutic and indicates warfarin is not at therapeutic level. Hold
warfarin; INR will normalize without reversal. Vitamin K is for elevated INR with bleeding.
💫ANSWER✔️✔️: B) Hold warfarin for 3 days and recheck INR
---
4. A patient is prescribed furosemide 40 mg IV for heart failure. Which laboratory value should the nurse
monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
💫RATIONALE✔️✔️: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia increases
the risk of dysrhythmias, especially in patients on digoxin.
💫ANSWER✔️✔️: B) Serum potassium
---
5. A patient with tuberculosis is started on rifampin. The nurse teaches that this medication causes
which harmless but alarming side effect?
A) Orange-red discoloration of urine and tears
B) Blurred vision and yellow halos
C) Metallic taste in the mouth
D) Photosensitivity rash
💫RATIONALE✔️✔️: Rifampin causes harmless orange-red discoloration of body fluids (urine, sweat,
tears). Patients must be warned to prevent unnecessary concern.
💫ANSWER✔️✔️: A) Orange-red discoloration of urine and tears
---
,6. A patient with a history of opioid use disorder is prescribed buprenorphine/naloxone (Suboxone). The
nurse explains that the naloxone component:
A) Prevents intravenous abuse by causing withdrawal
B) Enhances the analgesic effect of buprenorphine
C) Prolongs the half-life of buprenorphine
D) Blocks the mu-opioid receptor
💫RATIONALE✔️✔️: Naloxone has poor sublingual absorption but when injected IV, it precipitates
withdrawal. This deters misuse. Buprenorphine itself is a partial agonist.
💫ANSWER✔️✔️: A) Prevents intravenous abuse by causing withdrawal
---
7. A patient on lithium therapy has a level of 1.8 mEq/L and reports nausea, coarse tremor, and
confusion. What is the priority action?
A) Administer a stat dose of lithium
B) Hold lithium and notify the provider
C) Increase the patient's fluid intake
D) Draw a stat lithium level
💫RATIONALE✔️✔️: Lithium level 1.5-2.0 with symptoms indicates moderate toxicity. Hold lithium, notify
provider, and prepare for IV fluids to enhance excretion.
💫ANSWER✔️✔️: B) Hold lithium and notify the provider
---
8. A patient is prescribed metformin for type 2 diabetes. Which instruction is most important to prevent
a serious adverse effect?
A) "Take metformin with food to prevent stomach upset."
B) "Hold metformin before a CT scan with IV contrast."
C) "Monitor your blood glucose daily."
D) "Report any weight gain to your provider."
💫RATIONALE✔️✔️: Metformin must be held before and for 48 hours after IV contrast dye to prevent
lactic acidosis, a rare but serious complication. Kidney function is assessed before restarting.
, 💫ANSWER✔️✔️: B) "Hold metformin before a CT scan with IV contrast."
---
9. A patient receiving IV vancomycin reports flushing of the face, neck, and upper chest. What is the
priority action?
A) Stop the infusion and notify the provider of an allergic reaction
B) Slow the infusion rate and reassure the patient
C) Administer diphenhydramine 25 mg IV push
D) Obtain a stat serum vancomycin level
💫RATIONALE✔️✔️: Red Man Syndrome is a histamine reaction (not an IgE allergy) caused by rapid
infusion. Slowing the infusion rate resolves symptoms. Do not stop unless severe.
💫ANSWER✔️✔️: B) Slow the infusion rate and reassure the patient
---
10. A patient with a history of seizures is prescribed phenytoin. Which finding indicates a therapeutic
serum level?
A) 8 mcg/mL
B) 12 mcg/mL
C) 18 mcg/mL
D) 25 mcg/mL
💫RATIONALE✔️✔️: Therapeutic phenytoin level is 10-20 mcg/mL. Levels <10 are subtherapeutic; >20
cause toxicity (nystagmus, ataxia, sedation).
💫ANSWER✔️✔️: C) 18 mcg/mL
---
11. A patient with angina is prescribed nitroglycerin sublingual. Which instruction is correct?
A) "Swallow the tablet with water for faster effect."
B) "Take one tablet every 5 minutes for up to 3 doses for chest pain."
C) "Store the tablets in the refrigerator to keep them fresh."
D) "If you have a headache, stop taking the medication."
