Pharmacology Mastery Test Bank: Medications & Dosages
A 58-year-old post-operative patient becomes somnolent with a
respiratory rate of 6 breaths/min and pinpoint pupils after
patient-controlled analgesia (PCA) with morphine. Which action
should the nurse take first?
A. Give naloxone 0.4 mg IV and reassess respirations.
B. Stop the PCA and call the provider for an order to discontinue
opioid.
C. Stimulate the patient (sternal rub) and encourage deep
breaths.
D. Administer oxygen via nonrebreather at 15 L/min.
Correct answer: A
Rationale:
Naloxone is the opioid antagonist of choice for suspected
opioid-induced respiratory depression and should be
administered promptly to reverse life-threatening
hypoventilation. IV naloxone has rapid onset and can restore
respiratory drive while monitoring for return of pain or
withdrawal.
Stopping the PCA (B) is appropriate but not the first immediate
action because the patient needs an urgent reversal of
respiratory depression. Stimulation (C) alone is insufficient for
,severe opioid respiratory depression and may delay reversal.
While oxygen (D) is reasonable, it does not reverse opioid
receptor–mediated respiratory depression and should not
replace naloxone.
Clinical tip: After naloxone, monitor closely for return of
sedation as naloxone’s duration may be shorter than long-acting
opioids — be prepared to repeat doses or start an infusion per
protocol.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Pharmacological and Parenteral Therapies:
Medication Safety
Q2 — Morphine monitoring and anticipated side effects
A patient with acute pulmonary edema is receiving IV morphine
2 mg every 5–10 minutes PRN for anxiety and dyspnea. Which
finding most concerns the nurse as an adverse effect of
morphine?
A. Blood pressure decreased from 160/92 to 138/82 mm Hg.
B. Respiratory rate decreased from 24 to 10 breaths/min and O₂
saturation 88%.
C. Patient reports decreased chest tightness and says anxiety is
better.
D. Pupils are equal, round, and reactive to light.
Correct answer: B
,Rationale:
A decrease in respiratory rate to 10 and an O₂ saturation of 88%
indicate clinically significant respiratory depression and
hypoxemia — a dangerous opioid adverse effect requiring
immediate intervention (stop morphine, stimulate, give oxygen,
consider naloxone per protocol). A modest drop in BP (A) can be
expected due to morphine’s vasodilatory effect and may even
benefit pulmonary edema, but the magnitude here is not
immediately critical compared with hypoventilation. Improved
symptoms and decreased anxiety (C) are expected therapeutic
effects. Normal pupils (D) do not exclude respiratory
depression; therefore respirations and oxygenation are higher
priority.
Clinical tip: Always monitor respiratory rate and oxygen
saturation closely after IV morphine, especially in older adults
or those with cardiopulmonary disease.
Difficulty: Easy
Bloom’s level: Recall/Application
NCLEX client need: Pharmacological and Parenteral Therapies:
Medication Safety
Q3 — Warfarin management and antidote
A 72-year-old admitted for atrial fibrillation is taking warfarin.
His INR this morning is 4.8 (therapeutic goal 2.0–3.0). He has no
bleeding. Which action is correct?
A. Give vitamin K (phytonadione) orally and hold warfarin.
, B. Give fresh frozen plasma (FFP) immediately.
C. Continue warfarin and re-check INR in 24 hours.
D. Give a single dose of protamine sulfate IV.
Correct answer: A
Rationale:
For an elevated INR >4.5 without major bleeding, current
guidelines recommend holding warfarin and administering low-
dose oral vitamin K (e.g., 1–2.5 mg) to lower bleeding risk. FFP
(B) is reserved for major bleeding or need for urgent reversal for
procedures. Continuing warfarin (C) when INR is
supratherapeutic is inappropriate due to bleeding risk.
Protamine sulfate (D) reverses heparin, not warfarin, so it is
incorrect.
Clinical tip: When giving vitamin K orally, document dose,
monitor INR serially, and counsel patient to avoid vitamin K–rich
foods causing INR fluctuations.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Pharmacological and Parenteral Therapies:
Medication Safety
Q4 — Heparin infusion calculation (step-by-step math shown)
A 85 kg patient is started on a heparin infusion. The pharmacy
supplied heparin 25,000 units in 250 mL (concentration = 100
A 58-year-old post-operative patient becomes somnolent with a
respiratory rate of 6 breaths/min and pinpoint pupils after
patient-controlled analgesia (PCA) with morphine. Which action
should the nurse take first?
A. Give naloxone 0.4 mg IV and reassess respirations.
B. Stop the PCA and call the provider for an order to discontinue
opioid.
C. Stimulate the patient (sternal rub) and encourage deep
breaths.
D. Administer oxygen via nonrebreather at 15 L/min.
Correct answer: A
Rationale:
Naloxone is the opioid antagonist of choice for suspected
opioid-induced respiratory depression and should be
administered promptly to reverse life-threatening
hypoventilation. IV naloxone has rapid onset and can restore
respiratory drive while monitoring for return of pain or
withdrawal.
Stopping the PCA (B) is appropriate but not the first immediate
action because the patient needs an urgent reversal of
respiratory depression. Stimulation (C) alone is insufficient for
,severe opioid respiratory depression and may delay reversal.
While oxygen (D) is reasonable, it does not reverse opioid
receptor–mediated respiratory depression and should not
replace naloxone.
Clinical tip: After naloxone, monitor closely for return of
sedation as naloxone’s duration may be shorter than long-acting
opioids — be prepared to repeat doses or start an infusion per
protocol.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Pharmacological and Parenteral Therapies:
Medication Safety
Q2 — Morphine monitoring and anticipated side effects
A patient with acute pulmonary edema is receiving IV morphine
2 mg every 5–10 minutes PRN for anxiety and dyspnea. Which
finding most concerns the nurse as an adverse effect of
morphine?
A. Blood pressure decreased from 160/92 to 138/82 mm Hg.
B. Respiratory rate decreased from 24 to 10 breaths/min and O₂
saturation 88%.
C. Patient reports decreased chest tightness and says anxiety is
better.
D. Pupils are equal, round, and reactive to light.
Correct answer: B
,Rationale:
A decrease in respiratory rate to 10 and an O₂ saturation of 88%
indicate clinically significant respiratory depression and
hypoxemia — a dangerous opioid adverse effect requiring
immediate intervention (stop morphine, stimulate, give oxygen,
consider naloxone per protocol). A modest drop in BP (A) can be
expected due to morphine’s vasodilatory effect and may even
benefit pulmonary edema, but the magnitude here is not
immediately critical compared with hypoventilation. Improved
symptoms and decreased anxiety (C) are expected therapeutic
effects. Normal pupils (D) do not exclude respiratory
depression; therefore respirations and oxygenation are higher
priority.
Clinical tip: Always monitor respiratory rate and oxygen
saturation closely after IV morphine, especially in older adults
or those with cardiopulmonary disease.
Difficulty: Easy
Bloom’s level: Recall/Application
NCLEX client need: Pharmacological and Parenteral Therapies:
Medication Safety
Q3 — Warfarin management and antidote
A 72-year-old admitted for atrial fibrillation is taking warfarin.
His INR this morning is 4.8 (therapeutic goal 2.0–3.0). He has no
bleeding. Which action is correct?
A. Give vitamin K (phytonadione) orally and hold warfarin.
, B. Give fresh frozen plasma (FFP) immediately.
C. Continue warfarin and re-check INR in 24 hours.
D. Give a single dose of protamine sulfate IV.
Correct answer: A
Rationale:
For an elevated INR >4.5 without major bleeding, current
guidelines recommend holding warfarin and administering low-
dose oral vitamin K (e.g., 1–2.5 mg) to lower bleeding risk. FFP
(B) is reserved for major bleeding or need for urgent reversal for
procedures. Continuing warfarin (C) when INR is
supratherapeutic is inappropriate due to bleeding risk.
Protamine sulfate (D) reverses heparin, not warfarin, so it is
incorrect.
Clinical tip: When giving vitamin K orally, document dose,
monitor INR serially, and counsel patient to avoid vitamin K–rich
foods causing INR fluctuations.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Pharmacological and Parenteral Therapies:
Medication Safety
Q4 — Heparin infusion calculation (step-by-step math shown)
A 85 kg patient is started on a heparin infusion. The pharmacy
supplied heparin 25,000 units in 250 mL (concentration = 100
