High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
Clinical vignette: A 70-kg male with hypertensive emergency is
started on sodium nitroprusside. The infusion bag contains 50
mg nitroprusside in 250 mL D5W. The provider orders 3
mcg/kg/min. What IV infusion rate should the nurse set
(mL/hr)?
A. 31.5 mL/hr
B. 63 mL/hr
C. 126 mL/hr
D. 15.8 mL/hr
Correct answer: B
Rationale:
• Why correct: Calculate step-by-step. Dose = 3 mcg/kg/min
× 70 kg = 210 mcg/min. Convert to mg: 210 mcg ÷ 1000 =
0.210 mg/min. Concentration = 50 mg ÷ 250 mL = 0.2
mg/mL. Volume per minute = 0.210 mg/min ÷ 0.2 mg/mL
= 1.05 mL/min. Convert to mL/hr: 1.05 mL/min × 60
min/hr = 63 mL/hr.
• Why distractors are wrong: (A) 31.5 mL/hr is half the
correct rate — likely from halving the concentration or
weight. (C) 126 mL/hr doubles the correct value. (D) 15.8
mL/hr is far too low — calculation error converting mcg to
mg or minutes to hours.
, • Safety/teaching tip: Always show your calculation, label
units at each step, and have another nurse verify infusion
rates for potent vasoactive drugs. Frequent BP monitoring
is required when titrating nitroprusside.
Difficulty: Hard
Bloom’s taxonomy: Analysis
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2)
Clinical vignette: A 58-year-old woman with new hypertension
is prescribed an ACE inhibitor. Within hours she develops facial
swelling, stridor, and difficulty breathing. The nurse recognizes
this as most consistent with:
A. Angioedema from ACE inhibitor
B. Anaphylaxis to food allergen
C. Contact dermatitis
D. Acute heart failure
Correct answer: A
Rationale:
• Why correct: ACE inhibitors can cause angioedema
(bradykinin accumulation), often presenting quickly with
facial/lip/tongue swelling and airway compromise without
, urticaria. The temporal relationship to starting the ACE
inhibitor supports this diagnosis.
• Why distractors are wrong: (B) Anaphylaxis often includes
hypotension and urticaria and requires exposure to an
allergen; presentation here aligns more closely with
medication-induced angioedema. (C) Contact dermatitis is
localized and pruritic rather than causing airway
compromise. (D) Acute heart failure causes dyspnea and
crackles rather than isolated facial swelling/stridor.
• Safety/teaching tip: Stop the ACE inhibitor immediately,
secure the airway, and escalate care (IV epinephrine only if
anaphylaxis suspected; for ACE angioedema, airway
management and ICU observation are priority). Document
medication allergy and avoid ACE inhibitors in the future.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3)
Clinical vignette: A 68-kg adult is ordered gentamicin 2.5 mg/kg
IV once for a gram-negative infection. There is a vial labeled 80
mg/mL. What total dose (mg) should the nurse prepare?
A. 160 mg
B. 170 mg
, C. 136 mg
D. 200 mg
Correct answer: B
Rationale:
• Why correct: Step calculation: Dose = 2.5 mg/kg × 68 kg =
170.0 mg. So the nurse should prepare 170 mg. If vial is 80
mg/mL, volume to draw = 170 mg ÷ 80 mg/mL = 2.125 mL
(round per facility policy).
• Why distractors are wrong: (A) 160 mg would be 2.35
mg/kg — underdosing. (C) 136 mg corresponds to 2.0
mg/kg. (D) 200 mg equals ~2.94 mg/kg — overdosing
above order.
• Safety/teaching tip: Check renal function and monitor
trough levels for aminoglycosides; always calculate mg/kg
and double-check high-impact antibiotics with a second
nurse.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
4)
Clinical vignette: A patient on IV vancomycin for MRSA has a
pre-dose trough drawn. The trough returns at 28 mcg/mL
Pharmacology Mastery Test Bank: Medications & Dosages
Clinical vignette: A 70-kg male with hypertensive emergency is
started on sodium nitroprusside. The infusion bag contains 50
mg nitroprusside in 250 mL D5W. The provider orders 3
mcg/kg/min. What IV infusion rate should the nurse set
(mL/hr)?
A. 31.5 mL/hr
B. 63 mL/hr
C. 126 mL/hr
D. 15.8 mL/hr
Correct answer: B
Rationale:
• Why correct: Calculate step-by-step. Dose = 3 mcg/kg/min
× 70 kg = 210 mcg/min. Convert to mg: 210 mcg ÷ 1000 =
0.210 mg/min. Concentration = 50 mg ÷ 250 mL = 0.2
mg/mL. Volume per minute = 0.210 mg/min ÷ 0.2 mg/mL
= 1.05 mL/min. Convert to mL/hr: 1.05 mL/min × 60
min/hr = 63 mL/hr.
• Why distractors are wrong: (A) 31.5 mL/hr is half the
correct rate — likely from halving the concentration or
weight. (C) 126 mL/hr doubles the correct value. (D) 15.8
mL/hr is far too low — calculation error converting mcg to
mg or minutes to hours.
, • Safety/teaching tip: Always show your calculation, label
units at each step, and have another nurse verify infusion
rates for potent vasoactive drugs. Frequent BP monitoring
is required when titrating nitroprusside.
Difficulty: Hard
Bloom’s taxonomy: Analysis
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2)
Clinical vignette: A 58-year-old woman with new hypertension
is prescribed an ACE inhibitor. Within hours she develops facial
swelling, stridor, and difficulty breathing. The nurse recognizes
this as most consistent with:
A. Angioedema from ACE inhibitor
B. Anaphylaxis to food allergen
C. Contact dermatitis
D. Acute heart failure
Correct answer: A
Rationale:
• Why correct: ACE inhibitors can cause angioedema
(bradykinin accumulation), often presenting quickly with
facial/lip/tongue swelling and airway compromise without
, urticaria. The temporal relationship to starting the ACE
inhibitor supports this diagnosis.
• Why distractors are wrong: (B) Anaphylaxis often includes
hypotension and urticaria and requires exposure to an
allergen; presentation here aligns more closely with
medication-induced angioedema. (C) Contact dermatitis is
localized and pruritic rather than causing airway
compromise. (D) Acute heart failure causes dyspnea and
crackles rather than isolated facial swelling/stridor.
• Safety/teaching tip: Stop the ACE inhibitor immediately,
secure the airway, and escalate care (IV epinephrine only if
anaphylaxis suspected; for ACE angioedema, airway
management and ICU observation are priority). Document
medication allergy and avoid ACE inhibitors in the future.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3)
Clinical vignette: A 68-kg adult is ordered gentamicin 2.5 mg/kg
IV once for a gram-negative infection. There is a vial labeled 80
mg/mL. What total dose (mg) should the nurse prepare?
A. 160 mg
B. 170 mg
, C. 136 mg
D. 200 mg
Correct answer: B
Rationale:
• Why correct: Step calculation: Dose = 2.5 mg/kg × 68 kg =
170.0 mg. So the nurse should prepare 170 mg. If vial is 80
mg/mL, volume to draw = 170 mg ÷ 80 mg/mL = 2.125 mL
(round per facility policy).
• Why distractors are wrong: (A) 160 mg would be 2.35
mg/kg — underdosing. (C) 136 mg corresponds to 2.0
mg/kg. (D) 200 mg equals ~2.94 mg/kg — overdosing
above order.
• Safety/teaching tip: Check renal function and monitor
trough levels for aminoglycosides; always calculate mg/kg
and double-check high-impact antibiotics with a second
nurse.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
4)
Clinical vignette: A patient on IV vancomycin for MRSA has a
pre-dose trough drawn. The trough returns at 28 mcg/mL
