High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1. A 68-year-old man with a history of chronic atrial
fibrillation is prescribed warfarin 5 mg PO nightly. His INR
today is 4.5 (therapeutic goal 2.0–3.0). He has no bleeding.
Which is the best immediate nursing action?
A. Hold the warfarin and notify the prescriber.
B. Administer the warfarin and recheck INR in 48 hours.
C. Give vitamin K 5 mg PO immediately.
D. Give fresh frozen plasma (FFP) now.
Correct answer: A
Rationale:
Warfarin with INR 4.5 and no bleeding: the appropriate
immediate action is to hold the dose and notify the prescriber
so they can decide on dose adjustment or vitamin K. This
prevents further anticoagulation until provider evaluates risk vs
benefit.
Options B, C, D: B (administer and recheck) risks increasing INR
further; C (give vitamin K) and D (FFP) are reserved for clinically
significant bleeding or very high INR depending on protocol —
not first-line for asymptomatic INR 4.5.
Safety/teaching tip: Teach the patient to report
bleeding/bruising and to maintain consistent dietary vitamin K
intake; document INR trend and any medication or diet changes
that may affect warfarin.
,Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
2. A 7-year-old child (weight 18 kg) is prescribed ampicillin 50
mg/kg IV every 6 hours for bacterial meningitis. How many
milligrams per dose should the nurse prepare? Show full
math.
A. 900 mg
B. 500 mg
C. 1,200 mg
D. 450 mg
Correct answer: A
Rationale:
Step-by-step math: Dose (mg) = ordered mg/kg × weight (kg).
Perform digit-by-digit: 50 × 18 = (50×10) + (50×8) = 500 + 400 =
900 mg. So prepare 900 mg per dose.
Why distractors wrong: B (500 mg) would be underdosing
(corresponds to 27.8 mg/kg), C (1,200 mg) is higher than 50
mg/kg (would be 66.7 mg/kg), D (450 mg) is incorrect
calculation.
Safety/teaching tip: Always verify pediatric weight in kg,
double-check math with a second nurse for high-risk pediatric
dosing, and ensure correct diluent and infusion rate per agency
protocol.
,Difficulty: Easy
Bloom’s taxonomy: Recall/Application
NCLEX category: Physiological Integrity — Reduction of Risk
Potential
3. A client with CHF receives furosemide 40 mg IV bolus.
Which lab value change should the nurse monitor closely
within 24 hours?
A. Serum potassium decrease from 4.0 to 3.2 mEq/L
B. Serum glucose decrease from 110 to 90 mg/dL
C. Serum sodium increase from 136 to 145 mEq/L
D. Hemoglobin increase from 12 to 15 g/dL
Correct answer: A
Rationale:
Loop diuretics like furosemide promote potassium excretion; a
drop from 4.0 to 3.2 mEq/L is clinically significant and increases
risk for arrhythmias — this requires monitoring and possible
replacement.
Distractors: B (glucose change) is unlikely and less relevant to
furosemide; C (sodium increase) is not the typical immediate
effect — diuretics more often concentrate or lower sodium
depending on diuresis; D (hemoglobin increase) is unrelated.
Safety/teaching tip: Teach patients to report muscle weakness
or palpitations; monitor electrolytes, replace potassium as
ordered, and review concurrent digoxin use which increases
arrhythmia risk with hypokalemia.
, Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX category: Physiological Integrity — Reduction of Risk
Potential
4. A postoperative patient is receiving morphine IV PCA.
Respiratory rate decreases from 14 to 8 breaths/min and
SpO₂ falls to 88%. What is the nurse’s priority action?
A. Stop the PCA infusion and stimulate the patient to
breathe.
B. Administer Naloxone 0.4 mg IV push immediately.
C. Increase oxygen to 6 L/min by nasal cannula.
D. Document findings and check vital signs in 10 minutes.
Correct answer: A
Rationale:
Priority is to stop opioid delivery (stop PCA) and immediately
stimulate the patient to improve ventilation; this is the fastest
bedside action to prevent further respiratory depression.
Distractors: B (naloxone) may be necessary if respiratory
depression is severe or unresponsive to stimulation, but giving
naloxone immediately without attempting to stop infusion and
stimulate is not the very first bedside step in most protocols. C
(increase oxygen) supports oxygenation but does not address
hypoventilation caused by opioids. D (wait) is unsafe.
Safety/teaching tip: Monitor sedation scores and respiratory
Pharmacology Mastery Test Bank: Medications & Dosages
1. A 68-year-old man with a history of chronic atrial
fibrillation is prescribed warfarin 5 mg PO nightly. His INR
today is 4.5 (therapeutic goal 2.0–3.0). He has no bleeding.
Which is the best immediate nursing action?
A. Hold the warfarin and notify the prescriber.
B. Administer the warfarin and recheck INR in 48 hours.
C. Give vitamin K 5 mg PO immediately.
D. Give fresh frozen plasma (FFP) now.
Correct answer: A
Rationale:
Warfarin with INR 4.5 and no bleeding: the appropriate
immediate action is to hold the dose and notify the prescriber
so they can decide on dose adjustment or vitamin K. This
prevents further anticoagulation until provider evaluates risk vs
benefit.
Options B, C, D: B (administer and recheck) risks increasing INR
further; C (give vitamin K) and D (FFP) are reserved for clinically
significant bleeding or very high INR depending on protocol —
not first-line for asymptomatic INR 4.5.
Safety/teaching tip: Teach the patient to report
bleeding/bruising and to maintain consistent dietary vitamin K
intake; document INR trend and any medication or diet changes
that may affect warfarin.
,Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
2. A 7-year-old child (weight 18 kg) is prescribed ampicillin 50
mg/kg IV every 6 hours for bacterial meningitis. How many
milligrams per dose should the nurse prepare? Show full
math.
A. 900 mg
B. 500 mg
C. 1,200 mg
D. 450 mg
Correct answer: A
Rationale:
Step-by-step math: Dose (mg) = ordered mg/kg × weight (kg).
Perform digit-by-digit: 50 × 18 = (50×10) + (50×8) = 500 + 400 =
900 mg. So prepare 900 mg per dose.
Why distractors wrong: B (500 mg) would be underdosing
(corresponds to 27.8 mg/kg), C (1,200 mg) is higher than 50
mg/kg (would be 66.7 mg/kg), D (450 mg) is incorrect
calculation.
Safety/teaching tip: Always verify pediatric weight in kg,
double-check math with a second nurse for high-risk pediatric
dosing, and ensure correct diluent and infusion rate per agency
protocol.
,Difficulty: Easy
Bloom’s taxonomy: Recall/Application
NCLEX category: Physiological Integrity — Reduction of Risk
Potential
3. A client with CHF receives furosemide 40 mg IV bolus.
Which lab value change should the nurse monitor closely
within 24 hours?
A. Serum potassium decrease from 4.0 to 3.2 mEq/L
B. Serum glucose decrease from 110 to 90 mg/dL
C. Serum sodium increase from 136 to 145 mEq/L
D. Hemoglobin increase from 12 to 15 g/dL
Correct answer: A
Rationale:
Loop diuretics like furosemide promote potassium excretion; a
drop from 4.0 to 3.2 mEq/L is clinically significant and increases
risk for arrhythmias — this requires monitoring and possible
replacement.
Distractors: B (glucose change) is unlikely and less relevant to
furosemide; C (sodium increase) is not the typical immediate
effect — diuretics more often concentrate or lower sodium
depending on diuresis; D (hemoglobin increase) is unrelated.
Safety/teaching tip: Teach patients to report muscle weakness
or palpitations; monitor electrolytes, replace potassium as
ordered, and review concurrent digoxin use which increases
arrhythmia risk with hypokalemia.
, Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX category: Physiological Integrity — Reduction of Risk
Potential
4. A postoperative patient is receiving morphine IV PCA.
Respiratory rate decreases from 14 to 8 breaths/min and
SpO₂ falls to 88%. What is the nurse’s priority action?
A. Stop the PCA infusion and stimulate the patient to
breathe.
B. Administer Naloxone 0.4 mg IV push immediately.
C. Increase oxygen to 6 L/min by nasal cannula.
D. Document findings and check vital signs in 10 minutes.
Correct answer: A
Rationale:
Priority is to stop opioid delivery (stop PCA) and immediately
stimulate the patient to improve ventilation; this is the fastest
bedside action to prevent further respiratory depression.
Distractors: B (naloxone) may be necessary if respiratory
depression is severe or unresponsive to stimulation, but giving
naloxone immediately without attempting to stop infusion and
stimulate is not the very first bedside step in most protocols. C
(increase oxygen) supports oxygenation but does not address
hypoventilation caused by opioids. D (wait) is unsafe.
Safety/teaching tip: Monitor sedation scores and respiratory
