High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is admitted with
nausea, vomiting, and blurred vision. Their home medications
include digoxin 0.125 mg daily, furosemide 40 mg daily, and
potassium chloride 20 mEq daily. Their heart rate is 52 beats
per minute and rhythm is irregular. Serum labs reveal a
potassium level of 5.8 mEq/L and a digoxin level of 3.2 ng/mL.
Which finding is the most likely cause of this patient's
symptoms?
A) Hypokalemia from furosemide therapy
B) Digoxin toxicity
C) Hyperkalemia from potassium supplements
D) Underlying atrial fibrillation
Correct Answer: B
Rationale: The patient's symptoms (nausea, vomiting, blurred
vision, bradycardia) and lab values are classic signs of digoxin
toxicity. The elevated digoxin level (therapeutic range 0.5-2.0
ng/mL) confirms this. While the hyperkalemia (A) is a
contributing factor and a consequence of digoxin toxicity (as
digoxin inhibits the Na+/K+ ATPase pump), it is not the primary
cause; the toxic digoxin level is. The potassium supplement (C)
is likely prescribed to counteract the potassium-wasting effects
of furosemide, but the elevated level here is more indicative of
the toxic digoxin state than over-supplementation. The
underlying atrial fibrillation (D) would not cause these specific
,symptoms.
Clinical Safety Tip: Always assess for digoxin toxicity in patients
taking this medication, especially when they also take diuretics.
Monitor apical pulse for one full minute before administration;
hold the dose and notify the provider if the pulse is less than 60
bpm in an adult or if signs of toxicity are present.
Difficulty: Moderate
Bloom's Taxonomy: Analysis
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
2) A nurse is preparing to administer vancomycin 1 gram IV to a
patient with a methicillin-resistant Staphylococcus
aureus (MRSA) infection. The pharmacy sends a 1-gram vial
with instructions to reconstitute with 20 mL of Sterile Water for
Injection to yield a solution of 50 mg/mL. How many mL should
the nurse draw up to administer the correct dose?
A) 10 mL
B) 20 mL
C) 30 mL
D) 40 mL
Correct Answer: B
Rationale: The dose required is 1 gram, which is 1000 mg. The
concentration after reconstitution is 50 mg/mL. To find the
volume, use the formula: Dose / Concentration = Volume. So,
1000 mg / 50 mg/mL = 20 mL. A) 10 mL would only deliver 500
mg. C) 30 mL would deliver 1500 mg. D) 40 mL would deliver
2000 mg, both of which are incorrect and potentially dangerous
,overdoses.
Clinical Safety Tip: Vancomycin must be infused slowly over at
least 60 minutes to avoid "Red Man Syndrome," a histamine-
mediated reaction causing flushing, pruritus, and hypotension.
Always monitor the patient's blood pressure and IV site during
the infusion.
Difficulty: Easy
Bloom's Taxonomy: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
3) A post-operative patient is receiving morphine via a Patient-
Controlled Analgesia (PCA) pump. The nurse enters the room
and finds the patient somnolent with a respiratory rate of 8
breaths per minute. Which action should the nurse take first?
A) Administer naloxone per standing protocol
B) Stimulate the patient and instruct them to take deep breaths
C) Discontinue the PCA pump
D) Check the patient's oxygen saturation
Correct Answer: B
Rationale: The first action for a somnolent patient with
respiratory depression is to provide non-pharmacological
stimulation (e.g., shaking the shoulder, calling their name) and
coach them to breathe. This is the least invasive and fastest
intervention. If this is ineffective, the nurse would then proceed
to D) assess oxygen saturation and prepare to administer the
antidote A) naloxone. C) Discontinuing the pump stops further
medication delivery but does not address the current
, respiratory depression caused by the opioid already in the
patient's system.
Clinical Safety Tip: When using opioid PCA pumps, always
monitor the patient's respiratory rate, sedation level, and pain
score. Ensure the patient is the only one pressing the button to
demand a dose to prevent family-member-activated overdose.
Difficulty: Moderate
Bloom's Taxonomy: Application
NCLEX Client Need: Physiological Integrity: Reduction of Risk
Potential
4) A patient with bipolar disorder has been stabilized on lithium
600 mg PO TID. Which laboratory result requires immediate
notification of the provider?
A) White blood cell count: 11,000/mm³
B) Sodium level: 136 mEq/L
C) Lithium level: 1.8 mEq/L
D) Fasting blood glucose: 110 mg/dL
Correct Answer: C
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L. A
level of 1.8 mEq/L is toxic and can lead to severe neurological
and renal damage. This requires immediate intervention. A) is a
mildly elevated WBC, which could indicate infection or stress
but is not immediately critical. B) is a slightly low sodium level;
since lithium is a salt, sodium and water balance must be
maintained, but this level is only mildly concerning. D) is a
slightly elevated fasting glucose but is not an emergency.
Clinical Safety Tip: Teach patients on lithium to maintain
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is admitted with
nausea, vomiting, and blurred vision. Their home medications
include digoxin 0.125 mg daily, furosemide 40 mg daily, and
potassium chloride 20 mEq daily. Their heart rate is 52 beats
per minute and rhythm is irregular. Serum labs reveal a
potassium level of 5.8 mEq/L and a digoxin level of 3.2 ng/mL.
Which finding is the most likely cause of this patient's
symptoms?
A) Hypokalemia from furosemide therapy
B) Digoxin toxicity
C) Hyperkalemia from potassium supplements
D) Underlying atrial fibrillation
Correct Answer: B
Rationale: The patient's symptoms (nausea, vomiting, blurred
vision, bradycardia) and lab values are classic signs of digoxin
toxicity. The elevated digoxin level (therapeutic range 0.5-2.0
ng/mL) confirms this. While the hyperkalemia (A) is a
contributing factor and a consequence of digoxin toxicity (as
digoxin inhibits the Na+/K+ ATPase pump), it is not the primary
cause; the toxic digoxin level is. The potassium supplement (C)
is likely prescribed to counteract the potassium-wasting effects
of furosemide, but the elevated level here is more indicative of
the toxic digoxin state than over-supplementation. The
underlying atrial fibrillation (D) would not cause these specific
,symptoms.
Clinical Safety Tip: Always assess for digoxin toxicity in patients
taking this medication, especially when they also take diuretics.
Monitor apical pulse for one full minute before administration;
hold the dose and notify the provider if the pulse is less than 60
bpm in an adult or if signs of toxicity are present.
Difficulty: Moderate
Bloom's Taxonomy: Analysis
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
2) A nurse is preparing to administer vancomycin 1 gram IV to a
patient with a methicillin-resistant Staphylococcus
aureus (MRSA) infection. The pharmacy sends a 1-gram vial
with instructions to reconstitute with 20 mL of Sterile Water for
Injection to yield a solution of 50 mg/mL. How many mL should
the nurse draw up to administer the correct dose?
A) 10 mL
B) 20 mL
C) 30 mL
D) 40 mL
Correct Answer: B
Rationale: The dose required is 1 gram, which is 1000 mg. The
concentration after reconstitution is 50 mg/mL. To find the
volume, use the formula: Dose / Concentration = Volume. So,
1000 mg / 50 mg/mL = 20 mL. A) 10 mL would only deliver 500
mg. C) 30 mL would deliver 1500 mg. D) 40 mL would deliver
2000 mg, both of which are incorrect and potentially dangerous
,overdoses.
Clinical Safety Tip: Vancomycin must be infused slowly over at
least 60 minutes to avoid "Red Man Syndrome," a histamine-
mediated reaction causing flushing, pruritus, and hypotension.
Always monitor the patient's blood pressure and IV site during
the infusion.
Difficulty: Easy
Bloom's Taxonomy: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
3) A post-operative patient is receiving morphine via a Patient-
Controlled Analgesia (PCA) pump. The nurse enters the room
and finds the patient somnolent with a respiratory rate of 8
breaths per minute. Which action should the nurse take first?
A) Administer naloxone per standing protocol
B) Stimulate the patient and instruct them to take deep breaths
C) Discontinue the PCA pump
D) Check the patient's oxygen saturation
Correct Answer: B
Rationale: The first action for a somnolent patient with
respiratory depression is to provide non-pharmacological
stimulation (e.g., shaking the shoulder, calling their name) and
coach them to breathe. This is the least invasive and fastest
intervention. If this is ineffective, the nurse would then proceed
to D) assess oxygen saturation and prepare to administer the
antidote A) naloxone. C) Discontinuing the pump stops further
medication delivery but does not address the current
, respiratory depression caused by the opioid already in the
patient's system.
Clinical Safety Tip: When using opioid PCA pumps, always
monitor the patient's respiratory rate, sedation level, and pain
score. Ensure the patient is the only one pressing the button to
demand a dose to prevent family-member-activated overdose.
Difficulty: Moderate
Bloom's Taxonomy: Application
NCLEX Client Need: Physiological Integrity: Reduction of Risk
Potential
4) A patient with bipolar disorder has been stabilized on lithium
600 mg PO TID. Which laboratory result requires immediate
notification of the provider?
A) White blood cell count: 11,000/mm³
B) Sodium level: 136 mEq/L
C) Lithium level: 1.8 mEq/L
D) Fasting blood glucose: 110 mg/dL
Correct Answer: C
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L. A
level of 1.8 mEq/L is toxic and can lead to severe neurological
and renal damage. This requires immediate intervention. A) is a
mildly elevated WBC, which could indicate infection or stress
but is not immediately critical. B) is a slightly low sodium level;
since lithium is a salt, sodium and water balance must be
maintained, but this level is only mildly concerning. D) is a
slightly elevated fasting glucose but is not an emergency.
Clinical Safety Tip: Teach patients on lithium to maintain
