Pharmacology Mastery Test Bank: Medications & Dosages
1. Clinical vignette: A 68-year-old man with a history of
hypertension and type 2 diabetes presents for a routine
clinic visit. Current meds: lisinopril 20 mg PO daily,
metformin. Serum potassium today is 5.6 mEq/L. He
reports new fatigue but no chest pain.
A. Immediately discontinue lisinopril and schedule ECG.
B. Continue lisinopril; repeat serum potassium in 1 month.
C. Hold lisinopril, obtain an immediate repeat potassium
and 12-lead ECG.
D. Start oral sodium polystyrene sulfonate (kayexalate) at
home and continue lisinopril.
Correct answer: C
Rationale:
Lisinopril (an ACE inhibitor) can raise potassium. A serum K of
5.6 mEq/L is clinically significant and requires prompt
verification and cardiac monitoring because hyperkalemia can
cause ECG changes and arrhythmias. Holding the medication
and obtaining a repeat potassium with ECG is the safest
immediate action.
Option A is incomplete—while discontinuation may be
appropriate, you need to confirm the value and check ECG
before assuming. Option B delays action in the setting of
,significant hyperkalemia. Option D inappropriately treats
without verifying and continuing lisinopril could worsen
hyperkalemia.
Safety/teaching tip: Teach patients on ACE inhibitors to avoid
potassium supplements and high-potassium salt substitutes and
to report symptoms like muscle weakness or palpitations.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2. Clinical vignette: A 70-kg adult is ordered vancomycin 15
mg/kg IV every 12 hours for MRSA bacteremia. What is the
correct dose to prepare? Show all calculations.
A. 750 mg IV
B. 1,050 mg IV
C. 1,500 mg IV
D. 2,250 mg IV
Correct answer: B
Rationale (with step-by-step math):
Step 1: Dose ordered = 15 mg/kg. Step 2: Weight = 70 kg. Step
3: 15 mg/kg × 70 kg = 1,050 mg. Therefore the correct single
dose is 1,050 mg IV. (15 × 70 = 1,050 mg.)
Why correct: This uses weight-based dosing exactly per the
order. Why distractors are wrong: A (750 mg) is too low and
,corresponds to ~10.7 mg/kg; C (1,500 mg) and D (2,250 mg) are
excessive relative to 15 mg/kg and could increase toxicity risk.
Safety/teaching tip: Confirm infusion time (usually over ≥60
minutes for doses ≥1 g to reduce infusion-related reactions) and
monitor renal function and trough levels per protocol.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3. Clinical vignette: A 55-year-old woman is receiving
morphine 4 mg IV every 4 hours PRN for severe pain after
abdominal surgery. She is drowsy and respiratory rate is 8
breaths/min. Which action should the nurse take first?
A. Give naloxone 0.4 mg IV push immediately.
B. Stimulate the patient to wake and call the practitioner if
no improvement.
C. Stop the morphine and put the patient in a side-lying
(recovery) position while monitoring respirations.
D. Administer oxygen via nasal cannula at 2 L/min and
reassess in 15 minutes.
Correct answer: C
Rationale:
The priority is airway/ breathing and safety: stop ongoing opioid
administration and secure airway position (side-lying) to reduce
, aspiration risk while continuously monitoring respirations and
level of consciousness. This addresses the immediate safety
need while preparing further interventions.
Option A (naloxone) may be necessary for severe respiratory
depression or apnea, but immediate naloxone without first
stopping the opioid and ensuring airway positioning could be
premature; naloxone dosing should be titrated to restore
adequate respirations while minimizing abrupt pain return.
Option B delays necessary action. Option D (oxygen) is
supportive but does not stop further opioid infusion or address
airway protection as first action.
Safety/teaching tip: Monitor opioid-receiving patients closely
for sedation and respiratory depression; use sedation scales and
document respiratory assessments frequently.
Difficulty: Moderate
Bloom’s taxonomy: Analysis
NCLEX client need: Physiological Integrity — Reduction of Risk
Potential
4. Clinical vignette: A 28-year-old with major depressive
disorder is started on sertraline 50 mg PO daily. Which
teaching point is most important during the first 3 weeks?
A. Expect immediate improvement in mood within 24–48
hours.
B. Stop the medication if you develop sexual side effects.
C. Watch for agitation, hyperreflexia, fever, and rapid heart
1. Clinical vignette: A 68-year-old man with a history of
hypertension and type 2 diabetes presents for a routine
clinic visit. Current meds: lisinopril 20 mg PO daily,
metformin. Serum potassium today is 5.6 mEq/L. He
reports new fatigue but no chest pain.
A. Immediately discontinue lisinopril and schedule ECG.
B. Continue lisinopril; repeat serum potassium in 1 month.
C. Hold lisinopril, obtain an immediate repeat potassium
and 12-lead ECG.
D. Start oral sodium polystyrene sulfonate (kayexalate) at
home and continue lisinopril.
Correct answer: C
Rationale:
Lisinopril (an ACE inhibitor) can raise potassium. A serum K of
5.6 mEq/L is clinically significant and requires prompt
verification and cardiac monitoring because hyperkalemia can
cause ECG changes and arrhythmias. Holding the medication
and obtaining a repeat potassium with ECG is the safest
immediate action.
Option A is incomplete—while discontinuation may be
appropriate, you need to confirm the value and check ECG
before assuming. Option B delays action in the setting of
,significant hyperkalemia. Option D inappropriately treats
without verifying and continuing lisinopril could worsen
hyperkalemia.
Safety/teaching tip: Teach patients on ACE inhibitors to avoid
potassium supplements and high-potassium salt substitutes and
to report symptoms like muscle weakness or palpitations.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2. Clinical vignette: A 70-kg adult is ordered vancomycin 15
mg/kg IV every 12 hours for MRSA bacteremia. What is the
correct dose to prepare? Show all calculations.
A. 750 mg IV
B. 1,050 mg IV
C. 1,500 mg IV
D. 2,250 mg IV
Correct answer: B
Rationale (with step-by-step math):
Step 1: Dose ordered = 15 mg/kg. Step 2: Weight = 70 kg. Step
3: 15 mg/kg × 70 kg = 1,050 mg. Therefore the correct single
dose is 1,050 mg IV. (15 × 70 = 1,050 mg.)
Why correct: This uses weight-based dosing exactly per the
order. Why distractors are wrong: A (750 mg) is too low and
,corresponds to ~10.7 mg/kg; C (1,500 mg) and D (2,250 mg) are
excessive relative to 15 mg/kg and could increase toxicity risk.
Safety/teaching tip: Confirm infusion time (usually over ≥60
minutes for doses ≥1 g to reduce infusion-related reactions) and
monitor renal function and trough levels per protocol.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3. Clinical vignette: A 55-year-old woman is receiving
morphine 4 mg IV every 4 hours PRN for severe pain after
abdominal surgery. She is drowsy and respiratory rate is 8
breaths/min. Which action should the nurse take first?
A. Give naloxone 0.4 mg IV push immediately.
B. Stimulate the patient to wake and call the practitioner if
no improvement.
C. Stop the morphine and put the patient in a side-lying
(recovery) position while monitoring respirations.
D. Administer oxygen via nasal cannula at 2 L/min and
reassess in 15 minutes.
Correct answer: C
Rationale:
The priority is airway/ breathing and safety: stop ongoing opioid
administration and secure airway position (side-lying) to reduce
, aspiration risk while continuously monitoring respirations and
level of consciousness. This addresses the immediate safety
need while preparing further interventions.
Option A (naloxone) may be necessary for severe respiratory
depression or apnea, but immediate naloxone without first
stopping the opioid and ensuring airway positioning could be
premature; naloxone dosing should be titrated to restore
adequate respirations while minimizing abrupt pain return.
Option B delays necessary action. Option D (oxygen) is
supportive but does not stop further opioid infusion or address
airway protection as first action.
Safety/teaching tip: Monitor opioid-receiving patients closely
for sedation and respiratory depression; use sedation scales and
document respiratory assessments frequently.
Difficulty: Moderate
Bloom’s taxonomy: Analysis
NCLEX client need: Physiological Integrity — Reduction of Risk
Potential
4. Clinical vignette: A 28-year-old with major depressive
disorder is started on sertraline 50 mg PO daily. Which
teaching point is most important during the first 3 weeks?
A. Expect immediate improvement in mood within 24–48
hours.
B. Stop the medication if you develop sexual side effects.
C. Watch for agitation, hyperreflexia, fever, and rapid heart
