High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1. A 64-year-old man with newly diagnosed hypertension is
started on lisinopril 10 mg PO daily. He returns 2 weeks
later reporting a persistent dry cough and lightheadedness
on standing. BP today is 112/68 mm Hg (baseline 142/88).
A. Continue lisinopril; cough will resolve spontaneously.
B. Discontinue lisinopril and start losartan.
C. Reduce lisinopril dose to 5 mg and add a beta blocker.
D. Switch to a thiazide diuretic immediately.
Correct answer: B
Rationale:
Lisinopril (an ACE inhibitor) commonly causes a persistent dry
cough in some patients due to increased bradykinin; switching
to an ARB (losartan) eliminates the cough while maintaining
RAAS blockade.
A is incorrect because the cough is a known adverse effect and
often persists; it’s not advisable to continue if bothersome. C is
incorrect because reducing dose may reduce cough but
switching classes is standard when cough is intolerable; adding
a beta blocker without addressing the cough isn't appropriate.
D is incorrect because switching straight to a thiazide is a
therapeutic option but ARBs are usually first-line alternatives
for ACE inhibitor intolerance.
Safety/teaching tip: Teach the patient to report persistent
,coughs or angioedema and to avoid NSAIDs which can blunt
ACE/ARB renal effects.
Difficulty: Easy
Bloom’s taxonomy level: Recall
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2. A 72-year-old woman is started on a diltiazem continuous
IV infusion to control atrial fibrillation with rapid
ventricular response. The pharmacy sends a premixed bag
containing diltiazem 250 mg in 250 mL NS. The provider
orders diltiazem 5 mg/hr. Calculate the infusion rate in
mL/hr.
A. 1 mL/hr
B. 5 mL/hr
C. 25 mL/hr
D. 0.5 mL/hr
Correct answer: B
Rationale:
Step-by-step math: concentration = 250 mg / 250 mL = 1
mg/mL. Ordered dose = 5 mg/hr. Rate (mL/hr) = ordered mg/hr
÷ (mg/mL) = 5 mg/hr ÷ 1 mg/mL = 5 mL/hr. Therefore B is
correct.
Options A, C, and D are incorrect because they result from
incorrect arithmetic or wrong interpretation of concentration
,(e.g., treating 250 mg/250 mL as 0.01 mg/mL or misplacing
decimal).
Safety/teaching tip: Always verify concentration and perform
dose-to-volume conversion aloud; have another RN double-
check high-risk infusion rates.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3. A 58-year-old man with MRSA bacteremia is prescribed
vancomycin 1 g IV every 12 hours. The nurse is preparing
to give the first dose. Which action is the priority?
A. Administer the dose as a bolus over 5 minutes.
B. Infuse the dose over at least 60 minutes and monitor for
flushing.
C. Mix vancomycin with dopamine to improve infusion.
D. Give vancomycin intramuscularly to reduce infection
risk.
Correct answer: B
Rationale:
Vancomycin must be infused slowly (typically over at least 60
minutes for doses ≤1 g) to reduce risk of “red man syndrome”
(histamine-mediated flushing, hypotension). Monitoring during
infusion is essential.
, A is incorrect because rapid bolus increases risk of severe
hypotension and red man syndrome. C is incorrect and
potentially dangerous — vancomycin should not be mixed with
other incompatible drugs in the same syringe/tubing without
checking compatibility. D is incorrect because IM vancomycin is
not used for serious systemic infections.
Safety/teaching tip: Inform patient about possible
flushing/itching; stop infusion if severe reaction occurs and
notify provider.
Difficulty: Easy
Bloom’s taxonomy level: Recall/Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
4. A 45-year-old patient receives gentamicin 80 mg IV every 8
hours for nosocomial infection. Trough level drawn just
prior to the 3rd dose is 3.2 µg/mL (therapeutic trough goal:
<2 µg/mL). What action should the nurse anticipate?
A. Continue current dosing; level is acceptable.
B. Hold the next dose and notify prescriber for dose
adjustment.
C. Increase the dose because the trough is low.
D. Obtain a peak level immediately and give a loading
dose.
Correct answer: B
Pharmacology Mastery Test Bank: Medications & Dosages
1. A 64-year-old man with newly diagnosed hypertension is
started on lisinopril 10 mg PO daily. He returns 2 weeks
later reporting a persistent dry cough and lightheadedness
on standing. BP today is 112/68 mm Hg (baseline 142/88).
A. Continue lisinopril; cough will resolve spontaneously.
B. Discontinue lisinopril and start losartan.
C. Reduce lisinopril dose to 5 mg and add a beta blocker.
D. Switch to a thiazide diuretic immediately.
Correct answer: B
Rationale:
Lisinopril (an ACE inhibitor) commonly causes a persistent dry
cough in some patients due to increased bradykinin; switching
to an ARB (losartan) eliminates the cough while maintaining
RAAS blockade.
A is incorrect because the cough is a known adverse effect and
often persists; it’s not advisable to continue if bothersome. C is
incorrect because reducing dose may reduce cough but
switching classes is standard when cough is intolerable; adding
a beta blocker without addressing the cough isn't appropriate.
D is incorrect because switching straight to a thiazide is a
therapeutic option but ARBs are usually first-line alternatives
for ACE inhibitor intolerance.
Safety/teaching tip: Teach the patient to report persistent
,coughs or angioedema and to avoid NSAIDs which can blunt
ACE/ARB renal effects.
Difficulty: Easy
Bloom’s taxonomy level: Recall
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2. A 72-year-old woman is started on a diltiazem continuous
IV infusion to control atrial fibrillation with rapid
ventricular response. The pharmacy sends a premixed bag
containing diltiazem 250 mg in 250 mL NS. The provider
orders diltiazem 5 mg/hr. Calculate the infusion rate in
mL/hr.
A. 1 mL/hr
B. 5 mL/hr
C. 25 mL/hr
D. 0.5 mL/hr
Correct answer: B
Rationale:
Step-by-step math: concentration = 250 mg / 250 mL = 1
mg/mL. Ordered dose = 5 mg/hr. Rate (mL/hr) = ordered mg/hr
÷ (mg/mL) = 5 mg/hr ÷ 1 mg/mL = 5 mL/hr. Therefore B is
correct.
Options A, C, and D are incorrect because they result from
incorrect arithmetic or wrong interpretation of concentration
,(e.g., treating 250 mg/250 mL as 0.01 mg/mL or misplacing
decimal).
Safety/teaching tip: Always verify concentration and perform
dose-to-volume conversion aloud; have another RN double-
check high-risk infusion rates.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3. A 58-year-old man with MRSA bacteremia is prescribed
vancomycin 1 g IV every 12 hours. The nurse is preparing
to give the first dose. Which action is the priority?
A. Administer the dose as a bolus over 5 minutes.
B. Infuse the dose over at least 60 minutes and monitor for
flushing.
C. Mix vancomycin with dopamine to improve infusion.
D. Give vancomycin intramuscularly to reduce infection
risk.
Correct answer: B
Rationale:
Vancomycin must be infused slowly (typically over at least 60
minutes for doses ≤1 g) to reduce risk of “red man syndrome”
(histamine-mediated flushing, hypotension). Monitoring during
infusion is essential.
, A is incorrect because rapid bolus increases risk of severe
hypotension and red man syndrome. C is incorrect and
potentially dangerous — vancomycin should not be mixed with
other incompatible drugs in the same syringe/tubing without
checking compatibility. D is incorrect because IM vancomycin is
not used for serious systemic infections.
Safety/teaching tip: Inform patient about possible
flushing/itching; stop infusion if severe reaction occurs and
notify provider.
Difficulty: Easy
Bloom’s taxonomy level: Recall/Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
4. A 45-year-old patient receives gentamicin 80 mg IV every 8
hours for nosocomial infection. Trough level drawn just
prior to the 3rd dose is 3.2 µg/mL (therapeutic trough goal:
<2 µg/mL). What action should the nurse anticipate?
A. Continue current dosing; level is acceptable.
B. Hold the next dose and notify prescriber for dose
adjustment.
C. Increase the dose because the trough is low.
D. Obtain a peak level immediately and give a loading
dose.
Correct answer: B
