High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1. A 68-year-old man with hypertension and chronic kidney
disease (eGFR 38 mL/min) is started on lisinopril 10 mg PO
daily. He returns two weeks later complaining of a dry,
persistent cough and reports lightheadedness when
standing up quickly. Which action should the nurse
prioritize?
A. Advise the patient to take lisinopril at bedtime instead
of morning.
B. Hold the lisinopril and notify the prescriber; assess
orthostatic vitals and serum potassium.
C. Teach the patient that a cough is common and to
continue medication; schedule follow-up in one month.
D. Administer a PRN antihistamine for the cough and
encourage fluid intake for dizziness.
Correct answer: B
Rationale:
Lisinopril (an ACE inhibitor) can cause cough and orthostatic
hypotension and can increase serum potassium, especially in
CKD. Holding the medication and notifying the prescriber while
assessing orthostatic vitals and potassium is the safest
immediate step.
Options A and C risk continuing an offending medication when
adverse effects are present; changing dosing time does not
reliably reduce cough or hyperkalemia risk. Option D treats
,symptoms without addressing the likely drug cause and could
mask a serious adverse effect.
Safety/teaching tip: Teach patients to monitor for persistent
cough, dizziness, and avoid potassium supplements or high-
potassium salt substitutes; advise reporting these promptly.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity: Pharmacological and Parenteral Therapies
2. A 55-year-old woman with MRSA bacteremia is ordered
vancomycin 1 g IV diluted to 250 mL and infused over 90
minutes. What infusion pump rate (mL/hr) should the RN
set? (Show work and units.)
A. 100 mL/hr
B. 125 mL/hr
C. 167 mL/hr
D. 250 mL/hr
Correct answer: C
Rationale:
Step-by-step math: 90 minutes = 1.5 hours. Rate = total volume
÷ hours = 250 mL ÷ 1.5 hr = 166.666... mL/hr → round to 167
mL/hr. This ensures vancomycin is infused over the prescribed
90 minutes to reduce infusion-related reactions (e.g., Red Man
syndrome).
,Options A and B would deliver the dose too slowly/too quickly
relative to the order (A = 2.5 hr; B = 2 hr), and D would infuse in
1 hour (250 mL/hr), which is too fast and risks infusion
reactions.
Safety/teaching tip: Confirm dilution and infusion time with
prescriber if unclear; monitor for flushing, hypotension, and
infusion site for signs of extravasation.
Difficulty: Easy
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity: Pharmacological and Parenteral Therapies
3. A postoperative patient receiving morphine PCA becomes
difficult to arouse and respiratory rate drops from 14 to 6
breaths/min. Which action should the nurse take first?
A. Stimulate the patient, stop PCA, and administer oxygen
per protocol; prepare naloxone.
B. Immediately administer naloxone 0.4 mg IV push
without other interventions.
C. Call the rapid response team and chart the event; wait
for orders.
D. Lower the basal infusion rate on the PCA pump and
continue to monitor.
Correct answer: A
, Rationale:
The priority is airway and breathing: stimulate the patient, stop
the PCA to prevent further opioid administration, provide
oxygen, and be prepared to give naloxone if there’s inadequate
response. These steps follow airway-breathing-circulation (ABC)
priorities.
Option B may be necessary but administering naloxone
immediately without attempts at stimulation and oxygen may
be premature; also naloxone dosing may precipitate acute
pain/withdrawal. Option C delays immediate life-saving
interventions. Option D continues opioid exposure and is unsafe
when the patient is markedly hypoventilating.
Safety/teaching tip: After stabilization, educate
patients/families about PCA use, signs of overdose, and ensure
appropriate monitoring and dosing adjustments.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity: Reduction of Risk Potential
4. A 23-year-old woman on sertraline for major depressive
disorder presents with fever, agitation, tremor, and
hyperreflexia after adding linezolid for cellulitis two days
ago. What is the most appropriate nursing interpretation?
A. Patient likely has serotonin syndrome from interaction
of sertraline and linezolid; discontinue linezolid and
Pharmacology Mastery Test Bank: Medications & Dosages
1. A 68-year-old man with hypertension and chronic kidney
disease (eGFR 38 mL/min) is started on lisinopril 10 mg PO
daily. He returns two weeks later complaining of a dry,
persistent cough and reports lightheadedness when
standing up quickly. Which action should the nurse
prioritize?
A. Advise the patient to take lisinopril at bedtime instead
of morning.
B. Hold the lisinopril and notify the prescriber; assess
orthostatic vitals and serum potassium.
C. Teach the patient that a cough is common and to
continue medication; schedule follow-up in one month.
D. Administer a PRN antihistamine for the cough and
encourage fluid intake for dizziness.
Correct answer: B
Rationale:
Lisinopril (an ACE inhibitor) can cause cough and orthostatic
hypotension and can increase serum potassium, especially in
CKD. Holding the medication and notifying the prescriber while
assessing orthostatic vitals and potassium is the safest
immediate step.
Options A and C risk continuing an offending medication when
adverse effects are present; changing dosing time does not
reliably reduce cough or hyperkalemia risk. Option D treats
,symptoms without addressing the likely drug cause and could
mask a serious adverse effect.
Safety/teaching tip: Teach patients to monitor for persistent
cough, dizziness, and avoid potassium supplements or high-
potassium salt substitutes; advise reporting these promptly.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity: Pharmacological and Parenteral Therapies
2. A 55-year-old woman with MRSA bacteremia is ordered
vancomycin 1 g IV diluted to 250 mL and infused over 90
minutes. What infusion pump rate (mL/hr) should the RN
set? (Show work and units.)
A. 100 mL/hr
B. 125 mL/hr
C. 167 mL/hr
D. 250 mL/hr
Correct answer: C
Rationale:
Step-by-step math: 90 minutes = 1.5 hours. Rate = total volume
÷ hours = 250 mL ÷ 1.5 hr = 166.666... mL/hr → round to 167
mL/hr. This ensures vancomycin is infused over the prescribed
90 minutes to reduce infusion-related reactions (e.g., Red Man
syndrome).
,Options A and B would deliver the dose too slowly/too quickly
relative to the order (A = 2.5 hr; B = 2 hr), and D would infuse in
1 hour (250 mL/hr), which is too fast and risks infusion
reactions.
Safety/teaching tip: Confirm dilution and infusion time with
prescriber if unclear; monitor for flushing, hypotension, and
infusion site for signs of extravasation.
Difficulty: Easy
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity: Pharmacological and Parenteral Therapies
3. A postoperative patient receiving morphine PCA becomes
difficult to arouse and respiratory rate drops from 14 to 6
breaths/min. Which action should the nurse take first?
A. Stimulate the patient, stop PCA, and administer oxygen
per protocol; prepare naloxone.
B. Immediately administer naloxone 0.4 mg IV push
without other interventions.
C. Call the rapid response team and chart the event; wait
for orders.
D. Lower the basal infusion rate on the PCA pump and
continue to monitor.
Correct answer: A
, Rationale:
The priority is airway and breathing: stimulate the patient, stop
the PCA to prevent further opioid administration, provide
oxygen, and be prepared to give naloxone if there’s inadequate
response. These steps follow airway-breathing-circulation (ABC)
priorities.
Option B may be necessary but administering naloxone
immediately without attempts at stimulation and oxygen may
be premature; also naloxone dosing may precipitate acute
pain/withdrawal. Option C delays immediate life-saving
interventions. Option D continues opioid exposure and is unsafe
when the patient is markedly hypoventilating.
Safety/teaching tip: After stabilization, educate
patients/families about PCA use, signs of overdose, and ensure
appropriate monitoring and dosing adjustments.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity: Reduction of Risk Potential
4. A 23-year-old woman on sertraline for major depressive
disorder presents with fever, agitation, tremor, and
hyperreflexia after adding linezolid for cellulitis two days
ago. What is the most appropriate nursing interpretation?
A. Patient likely has serotonin syndrome from interaction
of sertraline and linezolid; discontinue linezolid and
