NCLEX-RN and Critical Care Ultimate Master
Bundle: Pharmacology, NGN Clinical Judgment,
and ECMO Management
1. A patient with heart failure is prescribed digoxin. Which finding indicates early toxicity
requiring the nurse to hold the medication?
A. Heart rate of 68 bpm
B. Serum potassium of 4.0 mEq/L
C. Anorexia and nausea
D. Blood pressure of 130/80 mmHg
Answer: C. Rationale: Early signs of digoxin toxicity include GI symptoms like anorexia, nausea,
and vomiting, as well as visual disturbances (yellow/green halos). Bradycardia (<60 bpm) is a
later sign. Hypokalemia potentiates toxicity, but a K+ of 4.0 is normal.
2. A patient is receiving IV heparin for a pulmonary embolism. The aPTT is 110 seconds
(normal 25-35). What is the priority nursing action?
A. Increase the heparin drip rate.
B. Administer Vitamin K.
C. Stop the infusion and notify the provider.
D. Draw a stat platelet count.
Answer: C. Rationale: Therapeutic aPTT for heparin is typically 1.5 to 2.5 times the normal
(roughly 60-80 seconds). An aPTT of 110 indicates a high risk for bleeding. The infusion must be
stopped immediately. Protamine sulfate, not Vitamin K (which is for warfarin), is the antidote.
3. A patient on a beta-blocker (metoprolol) reports dizziness and has a BP of 88/52 mmHg.
Which suffix indicates this drug class, and what is your priority?
A. "-pril"; Administer IV fluids.
B. "-lol"; Hold the medication and notify the provider.
C. "-dipine"; Administer atropine.
D. "-sartan"; Lower the head of the bed.
Answer: B. Rationale: "-lol" is the suffix for beta-blockers. They can cause severe bradycardia
and hypotension. The priority is to hold the next dose and contact the provider for an order
adjustment.
4. Which diuretic is most commonly used to manage increased intracranial pressure (ICP)?
A. Furosemide (Lasix)
B. Hydrochlorothiazide (HCTZ)
,C. Spironolactone (Aldactone)
D. Mannitol (Osmitrol)
Answer: D. Rationale: Mannitol is an osmotic diuretic that draws fluid from the brain tissue into
the vascular space, reducing cerebral edema and ICP. It is given IV rapidly.
5. A patient is prescribed amiodarone for ventricular tachycardia. The nurse knows this drug
can cause which serious adverse effect requiring baseline monitoring?
A. Ototoxicity
B. Pulmonary fibrosis
C. Nephrotoxicity
D. Hepatomegaly
Answer: B. Rationale: Amiodarone is highly lipophilic and can deposit in the lungs, causing
interstitial pulmonary fibrosis. Baseline chest X-rays and pulmonary function tests are required.
6. A patient with myasthenia gravis is given neostigmine. The patient suddenly develops
excessive salivation, bradycardia, and muscle fasciculations. This is indicative of:
A. A myasthenic crisis.
B. A cholinergic crisis.
C. An anaphylactic reaction.
D. A hyperkalemic episode.
Answer: B. Rationale: Neostigmine is a cholinesterase inhibitor. Overdose leads to cholinergic
crisis (SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis). Atropine is the
antidote.
7. A patient is on a continuous nicardipine (Cardene) drip for hypertensive emergency. The
nurse should monitor for which therapeutic effect?
A. Increased heart rate
B. Decreased systemic vascular resistance (SVR)
C. Increased cardiac contractility
D. Bronchodilation
Answer: B. Rationale: Nicardipine is a calcium channel blocker (CCB, "-dipine") that causes
potent arterial vasodilation, decreasing SVR and afterload, which lowers blood pressure.
8. A nurse is administering furosemide (Lasix) IV push. To prevent ototoxicity, the nurse
should:
A. Administer over 1-2 minutes.
B. Push rapidly to achieve peak effect.
C. Mix it with normal saline in a mini-bag.
D. Administer over 20 mg/min to a maximum rate of 4 mg/min.
, Answer: A. Rationale: IV furosemide must be pushed slowly (no faster than 20 mg/min, typically
over 1-2 minutes). Rapid IV push can cause irreversible ototoxicity (tinnitus/hearing loss).
9. Which medication is the antidote for a heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Flumazenil
Answer: B. Rationale: Protamine sulfate is a positively charged molecule that binds to negatively
charged heparin, forming a stable complex and neutralizing its anticoagulant effects.
10. A patient is started on lisinopril. Which adverse effect requires immediate nursing
intervention due to the risk of anaphylaxis?
A. Dry cough
B. Angioedema (swelling of lips/tongue)
C. Hyperkalemia
D. Orthostatic hypotension
Answer: B. Rationale: ACE inhibitors (-pril) can cause angioedema due to bradykinin
accumulation. This causes rapid swelling of the airway, which is life-threatening and requires
immediate epinephrine and airway management. A dry cough is common but not immediately
life-threatening.
11. A patient with status epilepticus is unresponsive to lorazepam. Which medication should
the nurse prepare to administer next?
A. Phenytoin (Dilantin)
B. Levetiracetam (Keppra)
C. Valproic acid (Depakote)
D. Phenobarbital
Answer: A. Rationale: The standard algorithm for status epilepticus is: 1) Benzodiazepine
(Lorazepam), 2) Phenytoin/Fosphenytoin load, 3) Phenobarbital or induction of anesthesia.
12. Which statin is considered the most potent for lowering LDL and requires administration
at bedtime?
A. Atorvastatin (Lipitor)
B. Simvastatin (Zocor)
C. Rosuvastatin (Crestor)
D. Pravastatin (Pravachol)
Answer: B. Rationale: Simvastatin has a short half-life and works best when taken in the evening
because cholesterol synthesis is highest at night. Atorvastatin and Rosuvastatin have longer half-
lives and can be taken any time.
Bundle: Pharmacology, NGN Clinical Judgment,
and ECMO Management
1. A patient with heart failure is prescribed digoxin. Which finding indicates early toxicity
requiring the nurse to hold the medication?
A. Heart rate of 68 bpm
B. Serum potassium of 4.0 mEq/L
C. Anorexia and nausea
D. Blood pressure of 130/80 mmHg
Answer: C. Rationale: Early signs of digoxin toxicity include GI symptoms like anorexia, nausea,
and vomiting, as well as visual disturbances (yellow/green halos). Bradycardia (<60 bpm) is a
later sign. Hypokalemia potentiates toxicity, but a K+ of 4.0 is normal.
2. A patient is receiving IV heparin for a pulmonary embolism. The aPTT is 110 seconds
(normal 25-35). What is the priority nursing action?
A. Increase the heparin drip rate.
B. Administer Vitamin K.
C. Stop the infusion and notify the provider.
D. Draw a stat platelet count.
Answer: C. Rationale: Therapeutic aPTT for heparin is typically 1.5 to 2.5 times the normal
(roughly 60-80 seconds). An aPTT of 110 indicates a high risk for bleeding. The infusion must be
stopped immediately. Protamine sulfate, not Vitamin K (which is for warfarin), is the antidote.
3. A patient on a beta-blocker (metoprolol) reports dizziness and has a BP of 88/52 mmHg.
Which suffix indicates this drug class, and what is your priority?
A. "-pril"; Administer IV fluids.
B. "-lol"; Hold the medication and notify the provider.
C. "-dipine"; Administer atropine.
D. "-sartan"; Lower the head of the bed.
Answer: B. Rationale: "-lol" is the suffix for beta-blockers. They can cause severe bradycardia
and hypotension. The priority is to hold the next dose and contact the provider for an order
adjustment.
4. Which diuretic is most commonly used to manage increased intracranial pressure (ICP)?
A. Furosemide (Lasix)
B. Hydrochlorothiazide (HCTZ)
,C. Spironolactone (Aldactone)
D. Mannitol (Osmitrol)
Answer: D. Rationale: Mannitol is an osmotic diuretic that draws fluid from the brain tissue into
the vascular space, reducing cerebral edema and ICP. It is given IV rapidly.
5. A patient is prescribed amiodarone for ventricular tachycardia. The nurse knows this drug
can cause which serious adverse effect requiring baseline monitoring?
A. Ototoxicity
B. Pulmonary fibrosis
C. Nephrotoxicity
D. Hepatomegaly
Answer: B. Rationale: Amiodarone is highly lipophilic and can deposit in the lungs, causing
interstitial pulmonary fibrosis. Baseline chest X-rays and pulmonary function tests are required.
6. A patient with myasthenia gravis is given neostigmine. The patient suddenly develops
excessive salivation, bradycardia, and muscle fasciculations. This is indicative of:
A. A myasthenic crisis.
B. A cholinergic crisis.
C. An anaphylactic reaction.
D. A hyperkalemic episode.
Answer: B. Rationale: Neostigmine is a cholinesterase inhibitor. Overdose leads to cholinergic
crisis (SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis). Atropine is the
antidote.
7. A patient is on a continuous nicardipine (Cardene) drip for hypertensive emergency. The
nurse should monitor for which therapeutic effect?
A. Increased heart rate
B. Decreased systemic vascular resistance (SVR)
C. Increased cardiac contractility
D. Bronchodilation
Answer: B. Rationale: Nicardipine is a calcium channel blocker (CCB, "-dipine") that causes
potent arterial vasodilation, decreasing SVR and afterload, which lowers blood pressure.
8. A nurse is administering furosemide (Lasix) IV push. To prevent ototoxicity, the nurse
should:
A. Administer over 1-2 minutes.
B. Push rapidly to achieve peak effect.
C. Mix it with normal saline in a mini-bag.
D. Administer over 20 mg/min to a maximum rate of 4 mg/min.
, Answer: A. Rationale: IV furosemide must be pushed slowly (no faster than 20 mg/min, typically
over 1-2 minutes). Rapid IV push can cause irreversible ototoxicity (tinnitus/hearing loss).
9. Which medication is the antidote for a heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Flumazenil
Answer: B. Rationale: Protamine sulfate is a positively charged molecule that binds to negatively
charged heparin, forming a stable complex and neutralizing its anticoagulant effects.
10. A patient is started on lisinopril. Which adverse effect requires immediate nursing
intervention due to the risk of anaphylaxis?
A. Dry cough
B. Angioedema (swelling of lips/tongue)
C. Hyperkalemia
D. Orthostatic hypotension
Answer: B. Rationale: ACE inhibitors (-pril) can cause angioedema due to bradykinin
accumulation. This causes rapid swelling of the airway, which is life-threatening and requires
immediate epinephrine and airway management. A dry cough is common but not immediately
life-threatening.
11. A patient with status epilepticus is unresponsive to lorazepam. Which medication should
the nurse prepare to administer next?
A. Phenytoin (Dilantin)
B. Levetiracetam (Keppra)
C. Valproic acid (Depakote)
D. Phenobarbital
Answer: A. Rationale: The standard algorithm for status epilepticus is: 1) Benzodiazepine
(Lorazepam), 2) Phenytoin/Fosphenytoin load, 3) Phenobarbital or induction of anesthesia.
12. Which statin is considered the most potent for lowering LDL and requires administration
at bedtime?
A. Atorvastatin (Lipitor)
B. Simvastatin (Zocor)
C. Rosuvastatin (Crestor)
D. Pravastatin (Pravachol)
Answer: B. Rationale: Simvastatin has a short half-life and works best when taken in the evening
because cholesterol synthesis is highest at night. Atorvastatin and Rosuvastatin have longer half-
lives and can be taken any time.
