High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is admitted with a
heart rate of 138/min. The provider prescribes diltiazem 0.25
mg/kg IV bolus. The patient weighs 176 lbs. The medication is
available as 25 mg/5 mL. How many mL will the nurse
administer? Round to the nearest tenth.
A) 2.0 mL
B) 4.0 mL
C) 8.0 mL
D) 10.0 mL
Correct Answer: B
Rationale: The correct answer is calculated by first converting
the patient's weight from pounds to kilograms (176 lbs / 2.2 =
80 kg). The dose is 0.25 mg/kg, so 0.25 mg * 80 kg = 20 mg. The
available concentration is 25 mg/5 mL, meaning there is 5 mg
per 1 mL (25 mg / 5 mL = 5 mg/mL). To administer 20 mg, the
nurse would give 20 mg / 5 mg/mL = 4.0 mL. Distractor A is half
the correct dose, likely from a miscalculation of weight or
concentration. Distractor C is double the dose, and distractor D
is the entire vial volume without calculating the dose. Clinical
Safety Tip: Always double-check weight-based calculations with
a second nurse for high-alert medications like IV diltiazem to
prevent toxicity or under-dosing.
Difficulty: Moderate
Bloom's: Application
,NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
2) A nurse is preparing to administer vancomycin 1 gram IV to a
patient for a methicillin-resistant Staphylococcus aureus (MRSA)
infection. Which action is most important for the nurse to take
prior to initiating the infusion?
A) Ensure a dedicated IV line for administration.
B) Obtain a peak serum level 30 minutes after infusion.
C) Assess the patient for a history of penicillin allergy.
D) Draw a trough serum level immediately before infusion.
Correct Answer: D
Rationale: Vancomycin requires therapeutic drug monitoring.
The trough level, drawn within 30 minutes before the next
dose, is critical to ensure the drug is within the therapeutic
range (typically 10-20 mcg/mL) to maximize efficacy and
minimize nephrotoxicity. While a dedicated line (A) is good
practice to avoid incompatibilities, it is not the most critical
prior to the first dose. Peak levels (B) are rarely monitored. A
penicillin allergy (C) is not a direct contraindication for
vancomycin, though cross-reactivity is possible; the more
critical action is assessing for prior vancomycin reactions.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Expected Actions/Outcomes
,3) A patient with type 1 diabetes is prescribed regular insulin via
continuous IV infusion at 8 units/hour. The pharmacy prepares
the infusion by adding 100 units of regular insulin to 100 mL of
0.9% sodium chloride. At what rate (mL/hr) should the nurse
set the IV pump to deliver the correct dose?
A) 4 mL/hr
B) 8 mL/hr
C) 10 mL/hr
D) 100 mL/hr
Correct Answer: B
Rationale: The concentration of the solution is 100 units/100
mL, which simplifies to 1 unit/mL. To deliver 8 units per hour,
the nurse must set the pump to deliver 8 mL/hour (8 units/hr ÷
1 unit/mL = 8 mL/hr). Distractor A is half the rate, distractor C is
a common default but incorrect rate, and distractor D would
deliver a dangerous overdose of 100 units/hour.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
4) A postoperative 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/minute. What is the nurse's priority action?
A) Administer the prescribed naloxone.
B) Stimulate the patient and instruct them to take deep breaths.
C) Discontinue the PCA pump immediately.
, D) Assess the patient's pain level.
Correct Answer: B
Rationale: The priority is to support the patient's respiratory
function. Stimulating the patient and cueing them to breathe
can often reverse mild respiratory depression without
pharmacological intervention and allows for continuous
assessment. Administering naloxone (A) is appropriate for
significant respiratory depression unresponsive to stimulation,
but it will also reverse all analgesia, causing severe pain and
potential withdrawal. Discontinuing the pump (C) stops further
medication but does not address the current sedation.
Assessing pain (D) is important but is not the priority over
airway and breathing.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Adverse Effects/Contraindications
5) A 55-year-old patient started on lithium carbonate for bipolar
disorder calls the clinic reporting nausea, diarrhea, and fine
hand tremors. What is the nurse's best response?
A) "These are expected side effects that will diminish over
time."
B) "Please go to the nearest emergency department for
evaluation."
C) "This indicates your dose is too high; hold your next dose and
call your psychiatrist tomorrow."
D) "Increase your fluid intake with electrolyte replacement
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is admitted with a
heart rate of 138/min. The provider prescribes diltiazem 0.25
mg/kg IV bolus. The patient weighs 176 lbs. The medication is
available as 25 mg/5 mL. How many mL will the nurse
administer? Round to the nearest tenth.
A) 2.0 mL
B) 4.0 mL
C) 8.0 mL
D) 10.0 mL
Correct Answer: B
Rationale: The correct answer is calculated by first converting
the patient's weight from pounds to kilograms (176 lbs / 2.2 =
80 kg). The dose is 0.25 mg/kg, so 0.25 mg * 80 kg = 20 mg. The
available concentration is 25 mg/5 mL, meaning there is 5 mg
per 1 mL (25 mg / 5 mL = 5 mg/mL). To administer 20 mg, the
nurse would give 20 mg / 5 mg/mL = 4.0 mL. Distractor A is half
the correct dose, likely from a miscalculation of weight or
concentration. Distractor C is double the dose, and distractor D
is the entire vial volume without calculating the dose. Clinical
Safety Tip: Always double-check weight-based calculations with
a second nurse for high-alert medications like IV diltiazem to
prevent toxicity or under-dosing.
Difficulty: Moderate
Bloom's: Application
,NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
2) A nurse is preparing to administer vancomycin 1 gram IV to a
patient for a methicillin-resistant Staphylococcus aureus (MRSA)
infection. Which action is most important for the nurse to take
prior to initiating the infusion?
A) Ensure a dedicated IV line for administration.
B) Obtain a peak serum level 30 minutes after infusion.
C) Assess the patient for a history of penicillin allergy.
D) Draw a trough serum level immediately before infusion.
Correct Answer: D
Rationale: Vancomycin requires therapeutic drug monitoring.
The trough level, drawn within 30 minutes before the next
dose, is critical to ensure the drug is within the therapeutic
range (typically 10-20 mcg/mL) to maximize efficacy and
minimize nephrotoxicity. While a dedicated line (A) is good
practice to avoid incompatibilities, it is not the most critical
prior to the first dose. Peak levels (B) are rarely monitored. A
penicillin allergy (C) is not a direct contraindication for
vancomycin, though cross-reactivity is possible; the more
critical action is assessing for prior vancomycin reactions.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Expected Actions/Outcomes
,3) A patient with type 1 diabetes is prescribed regular insulin via
continuous IV infusion at 8 units/hour. The pharmacy prepares
the infusion by adding 100 units of regular insulin to 100 mL of
0.9% sodium chloride. At what rate (mL/hr) should the nurse
set the IV pump to deliver the correct dose?
A) 4 mL/hr
B) 8 mL/hr
C) 10 mL/hr
D) 100 mL/hr
Correct Answer: B
Rationale: The concentration of the solution is 100 units/100
mL, which simplifies to 1 unit/mL. To deliver 8 units per hour,
the nurse must set the pump to deliver 8 mL/hour (8 units/hr ÷
1 unit/mL = 8 mL/hr). Distractor A is half the rate, distractor C is
a common default but incorrect rate, and distractor D would
deliver a dangerous overdose of 100 units/hour.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
4) A postoperative 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/minute. What is the nurse's priority action?
A) Administer the prescribed naloxone.
B) Stimulate the patient and instruct them to take deep breaths.
C) Discontinue the PCA pump immediately.
, D) Assess the patient's pain level.
Correct Answer: B
Rationale: The priority is to support the patient's respiratory
function. Stimulating the patient and cueing them to breathe
can often reverse mild respiratory depression without
pharmacological intervention and allows for continuous
assessment. Administering naloxone (A) is appropriate for
significant respiratory depression unresponsive to stimulation,
but it will also reverse all analgesia, causing severe pain and
potential withdrawal. Discontinuing the pump (C) stops further
medication but does not address the current sedation.
Assessing pain (D) is important but is not the priority over
airway and breathing.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Adverse Effects/Contraindications
5) A 55-year-old patient started on lithium carbonate for bipolar
disorder calls the clinic reporting nausea, diarrhea, and fine
hand tremors. What is the nurse's best response?
A) "These are expected side effects that will diminish over
time."
B) "Please go to the nearest emergency department for
evaluation."
C) "This indicates your dose is too high; hold your next dose and
call your psychiatrist tomorrow."
D) "Increase your fluid intake with electrolyte replacement
