Pharmacology Mastery Test Bank: Medications & Dosages
Stem: A 68-year-old man with chronic heart failure is prescribed
lisinopril 10 mg PO daily. He reports a new, persistent dry cough
that started 3 weeks after beginning the medication. Vital signs
are stable. Which action should the nurse take first?
A. Encourage the patient to drink more fluids and use cough
drops.
B. Suggest switching to an angiotensin II receptor blocker (ARB).
C. Notify the prescriber and prepare to hold the lisinopril.
D. Advise the patient that the cough typically resolves in 2–3
days.
Correct answer letter: C
Rationale:
Lisinopril (an ACE inhibitor) commonly causes a dry, persistent
cough due to increased bradykinin. When a patient on an ACE
inhibitor develops a new persistent cough, the nurse should
notify the prescriber and expect the medication to be
discontinued or substituted; holding the dose and contacting
the prescriber is appropriate initial action.
Options A and D are incorrect because simple symptomatic
measures or reassurance are inappropriate when the cough is
an ACE inhibitor adverse effect that often requires medication
change. Option B (switching to an ARB) may be clinically
,appropriate, but the nurse should first contact the prescriber
rather than unilaterally suggest a specific change.
Safety/teaching tip: Teach patients to report any new,
persistent cough after starting ACE inhibitors; document
onset/time and any breathing difficulty.
Difficulty: Easy
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity: Pharmacological and Parenteral Therapies —
Medication administration and effects
2)
Stem: A 24-year-old with bacterial pneumonia is receiving
gentamicin. The most recent plasma trough level returns at 3.2
mcg/mL (therapeutic trough goal typically <2 mcg/mL). Which
nursing action is most appropriate?
A. Continue current dose and monitor renal function.
B. Hold the next dose and notify the prescriber.
C. Draw an immediate peak level and continue infusion.
D. Administer a bolus of IV fluids to reduce concentration.
Correct answer letter: B
Rationale:
A gentamicin trough of 3.2 mcg/mL is above typical safe trough
targets and increases risk of nephrotoxicity and ototoxicity. The
appropriate action is to hold further dosing and notify the
,prescriber so the dose or interval can be adjusted.
Option A is wrong — continuing the dose risks toxicity. Option C
is wrong because a trough level is used to guide dosing; drawing
a peak when a trough is high is not the priority. Option D
(administering a fluid bolus) is not an appropriate or effective
immediate intervention to correct an excessive aminoglycoside
trough.
Safety/teaching tip: Ensure appropriate timing of trough levels
(usually just before next dose) and monitor renal function and
auditory symptoms while on aminoglycosides.
Difficulty: Moderate
Bloom’s taxonomy level: Analysis
NCLEX client need category + subcategory: Physiological
Integrity: Reduction of Risk Potential — Diagnostic tests and
monitoring
3)
Stem: A postoperative patient is receiving morphine IV PCA
(patient-controlled analgesia). The nurse notes the patient is
drowsy but arousable and respiratory rate is 8 breaths/min.
What is the nurse’s best immediate action?
A. Reduce the PCA basal rate by half.
B. Stimulate the patient, assess airway and give oxygen; prepare
naloxone if needed.
C. Document findings and continue to monitor every hour.
, D. Hold the PCA and call the prescriber to discontinue
immediately.
Correct answer letter: B
Rationale:
A respiratory rate of 8 with drowsiness indicates opioid-induced
respiratory depression. Immediate priority is airway/breathing:
stimulate the patient, assess airway, apply oxygen, and prepare
naloxone (opioid antagonist) for administration if respiratory
depression continues or worsens. This addresses the immediate
safety risk.
Option A (simply reducing basal rate) delays immediate
respiratory support. Option C (only documentation) is unsafe.
Option D (holding PCA and calling prescriber) omits immediate
respiratory interventions and may delay reversal.
Safety/teaching tip: Educate patients/families about risks of
sedation and the need to call for help; assess sedation scale and
respiratory status frequently with opioid PCA.
Difficulty: Moderate
Bloom’s taxonomy level: Analysis
NCLEX client need category + subcategory: Physiological
Integrity: Pharmacological and Parenteral Therapies —
Management of care/medication administration
4)
Stem: A 68-year-old man with chronic heart failure is prescribed
lisinopril 10 mg PO daily. He reports a new, persistent dry cough
that started 3 weeks after beginning the medication. Vital signs
are stable. Which action should the nurse take first?
A. Encourage the patient to drink more fluids and use cough
drops.
B. Suggest switching to an angiotensin II receptor blocker (ARB).
C. Notify the prescriber and prepare to hold the lisinopril.
D. Advise the patient that the cough typically resolves in 2–3
days.
Correct answer letter: C
Rationale:
Lisinopril (an ACE inhibitor) commonly causes a dry, persistent
cough due to increased bradykinin. When a patient on an ACE
inhibitor develops a new persistent cough, the nurse should
notify the prescriber and expect the medication to be
discontinued or substituted; holding the dose and contacting
the prescriber is appropriate initial action.
Options A and D are incorrect because simple symptomatic
measures or reassurance are inappropriate when the cough is
an ACE inhibitor adverse effect that often requires medication
change. Option B (switching to an ARB) may be clinically
,appropriate, but the nurse should first contact the prescriber
rather than unilaterally suggest a specific change.
Safety/teaching tip: Teach patients to report any new,
persistent cough after starting ACE inhibitors; document
onset/time and any breathing difficulty.
Difficulty: Easy
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity: Pharmacological and Parenteral Therapies —
Medication administration and effects
2)
Stem: A 24-year-old with bacterial pneumonia is receiving
gentamicin. The most recent plasma trough level returns at 3.2
mcg/mL (therapeutic trough goal typically <2 mcg/mL). Which
nursing action is most appropriate?
A. Continue current dose and monitor renal function.
B. Hold the next dose and notify the prescriber.
C. Draw an immediate peak level and continue infusion.
D. Administer a bolus of IV fluids to reduce concentration.
Correct answer letter: B
Rationale:
A gentamicin trough of 3.2 mcg/mL is above typical safe trough
targets and increases risk of nephrotoxicity and ototoxicity. The
appropriate action is to hold further dosing and notify the
,prescriber so the dose or interval can be adjusted.
Option A is wrong — continuing the dose risks toxicity. Option C
is wrong because a trough level is used to guide dosing; drawing
a peak when a trough is high is not the priority. Option D
(administering a fluid bolus) is not an appropriate or effective
immediate intervention to correct an excessive aminoglycoside
trough.
Safety/teaching tip: Ensure appropriate timing of trough levels
(usually just before next dose) and monitor renal function and
auditory symptoms while on aminoglycosides.
Difficulty: Moderate
Bloom’s taxonomy level: Analysis
NCLEX client need category + subcategory: Physiological
Integrity: Reduction of Risk Potential — Diagnostic tests and
monitoring
3)
Stem: A postoperative patient is receiving morphine IV PCA
(patient-controlled analgesia). The nurse notes the patient is
drowsy but arousable and respiratory rate is 8 breaths/min.
What is the nurse’s best immediate action?
A. Reduce the PCA basal rate by half.
B. Stimulate the patient, assess airway and give oxygen; prepare
naloxone if needed.
C. Document findings and continue to monitor every hour.
, D. Hold the PCA and call the prescriber to discontinue
immediately.
Correct answer letter: B
Rationale:
A respiratory rate of 8 with drowsiness indicates opioid-induced
respiratory depression. Immediate priority is airway/breathing:
stimulate the patient, assess airway, apply oxygen, and prepare
naloxone (opioid antagonist) for administration if respiratory
depression continues or worsens. This addresses the immediate
safety risk.
Option A (simply reducing basal rate) delays immediate
respiratory support. Option C (only documentation) is unsafe.
Option D (holding PCA and calling prescriber) omits immediate
respiratory interventions and may delay reversal.
Safety/teaching tip: Educate patients/families about risks of
sedation and the need to call for help; assess sedation scale and
respiratory status frequently with opioid PCA.
Difficulty: Moderate
Bloom’s taxonomy level: Analysis
NCLEX client need category + subcategory: Physiological
Integrity: Pharmacological and Parenteral Therapies —
Management of care/medication administration
4)
