Pharmacology Mastery Test Bank: Medications & Dosages
Stem: A 68-year-old man with a history of hypertension and
chronic kidney disease (eGFR 35 mL/min/1.73m²) is started on
lisinopril 10 mg PO daily. Two weeks later he reports a
persistent dry cough and his serum potassium is 5.6 mEq/L.
What is the most appropriate immediate nursing action?
A. Instruct the patient to stop lisinopril and return to clinic
today.
B. Continue lisinopril and schedule routine follow-up potassium
in 2 weeks.
C. Give an oral potassium-binding resin (e.g., patiromer) now
and continue lisinopril.
D. Switch lisinopril to losartan without further workup.
Correct answer: A
Rationale:
• Why correct: ACE inhibitors (lisinopril) commonly cause a
dry cough and can increase serum potassium, especially in
patients with CKD. A potassium of 5.6 mEq/L is above
normal and may be clinically significant — stopping the
ACE inhibitor and notifying the prescriber for immediate
reassessment is appropriate.
• Why distractors are wrong: B delays needed action and
risks hyperkalemia complications. C is not appropriate as
, an immediate nurse-initiated action without prescriber
order and does not address the cough; patiromer is not an
acute rescue for hyperkalemia. D is premature: switching
to an ARB (losartan) may still allow hyperkalemia and must
be ordered by the prescriber after evaluation.
• Safety/teaching tip: Teach the patient to report any new
cough, dizziness, palpitations, or muscle weakness and to
avoid high-potassium salt substitutes while on ACE
inhibitors.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2
Stem: Vancomycin 1.5 g IV is ordered to be infused in 250 mL
D5W over 2 hours for a patient with sepsis. What infusion pump
rate (mL/hr) should the nurse program? Show step-by-step
math.
A. 75 mL/hr
B. 100 mL/hr
C. 125 mL/hr
D. 150 mL/hr
Correct answer: C
Rationale:
, • Why correct: Calculate infusion rate: total volume 250 mL
÷ total time 2 hours = 125 mL/hr. Step-by-step: 250 mL ÷ 2
hr = 125 mL/hr. Program pump to 125 mL/hr.
• Why distractors are wrong: A (75 mL/hr) and B (100 mL/hr)
underdeliver the medication and extend infusion time; D
(150 mL/hr) would deliver too quickly and increase risk of
infusion-related reactions (e.g., Red man syndrome).
• Safety/teaching tip: Monitor for infusion-related reactions;
vancomycin should be infused over at least 60–120
minutes depending on dose to reduce infusion reactions.
Ensure current weight-based dosing and trough monitoring
per facility protocol.
Difficulty: Easy
Bloom’s level: Recall/Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3
Stem: A postoperative 45-year-old woman receiving IV
morphine PCA reports sudden drowsiness; respiratory rate is 6
breaths/min, SpO₂ 86% on room air, and pupils are pinpoint.
Which action should the nurse perform first?
A. Administer naloxone 0.4 mg IV per protocol.
B. Stop the PCA pump and stimulate the patient verbally.
C. Place supplemental oxygen and call the rapid response team.
, D. Record findings and notify the prescriber during morning
rounds.
Correct answer: B
Rationale:
• Why correct: The immediate priority is to ensure
airway/breathing: stop the PCA to prevent further opioid
delivery and attempt to stimulate the patient to assess
responsiveness and airway reflexes. Simple stimulation and
stopping the infusion are immediate nurse actions while
preparing further interventions.
• Why distractors are wrong: A (administer naloxone) may
be necessary but must be done after initial immediate
steps (stop infusion, safety, call for help) and per institution
protocol—however some protocols allow nurse-
administered naloxone; choose local policy. C (oxygen and
calling rapid response) are important but initial action is to
stop the infusion and stimulate; oxygen should be applied
immediately after stopping PCA. D is inappropriate —
documentation alone delays critical interventions.
• Safety/teaching tip: For PCA patients, educate about
reporting sedation and ensure monitoring (RR, sedation
score, SpO₂). Have naloxone and reversal protocols
accessible.
Difficulty: Moderate
Bloom’s level: Application
Stem: A 68-year-old man with a history of hypertension and
chronic kidney disease (eGFR 35 mL/min/1.73m²) is started on
lisinopril 10 mg PO daily. Two weeks later he reports a
persistent dry cough and his serum potassium is 5.6 mEq/L.
What is the most appropriate immediate nursing action?
A. Instruct the patient to stop lisinopril and return to clinic
today.
B. Continue lisinopril and schedule routine follow-up potassium
in 2 weeks.
C. Give an oral potassium-binding resin (e.g., patiromer) now
and continue lisinopril.
D. Switch lisinopril to losartan without further workup.
Correct answer: A
Rationale:
• Why correct: ACE inhibitors (lisinopril) commonly cause a
dry cough and can increase serum potassium, especially in
patients with CKD. A potassium of 5.6 mEq/L is above
normal and may be clinically significant — stopping the
ACE inhibitor and notifying the prescriber for immediate
reassessment is appropriate.
• Why distractors are wrong: B delays needed action and
risks hyperkalemia complications. C is not appropriate as
, an immediate nurse-initiated action without prescriber
order and does not address the cough; patiromer is not an
acute rescue for hyperkalemia. D is premature: switching
to an ARB (losartan) may still allow hyperkalemia and must
be ordered by the prescriber after evaluation.
• Safety/teaching tip: Teach the patient to report any new
cough, dizziness, palpitations, or muscle weakness and to
avoid high-potassium salt substitutes while on ACE
inhibitors.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2
Stem: Vancomycin 1.5 g IV is ordered to be infused in 250 mL
D5W over 2 hours for a patient with sepsis. What infusion pump
rate (mL/hr) should the nurse program? Show step-by-step
math.
A. 75 mL/hr
B. 100 mL/hr
C. 125 mL/hr
D. 150 mL/hr
Correct answer: C
Rationale:
, • Why correct: Calculate infusion rate: total volume 250 mL
÷ total time 2 hours = 125 mL/hr. Step-by-step: 250 mL ÷ 2
hr = 125 mL/hr. Program pump to 125 mL/hr.
• Why distractors are wrong: A (75 mL/hr) and B (100 mL/hr)
underdeliver the medication and extend infusion time; D
(150 mL/hr) would deliver too quickly and increase risk of
infusion-related reactions (e.g., Red man syndrome).
• Safety/teaching tip: Monitor for infusion-related reactions;
vancomycin should be infused over at least 60–120
minutes depending on dose to reduce infusion reactions.
Ensure current weight-based dosing and trough monitoring
per facility protocol.
Difficulty: Easy
Bloom’s level: Recall/Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3
Stem: A postoperative 45-year-old woman receiving IV
morphine PCA reports sudden drowsiness; respiratory rate is 6
breaths/min, SpO₂ 86% on room air, and pupils are pinpoint.
Which action should the nurse perform first?
A. Administer naloxone 0.4 mg IV per protocol.
B. Stop the PCA pump and stimulate the patient verbally.
C. Place supplemental oxygen and call the rapid response team.
, D. Record findings and notify the prescriber during morning
rounds.
Correct answer: B
Rationale:
• Why correct: The immediate priority is to ensure
airway/breathing: stop the PCA to prevent further opioid
delivery and attempt to stimulate the patient to assess
responsiveness and airway reflexes. Simple stimulation and
stopping the infusion are immediate nurse actions while
preparing further interventions.
• Why distractors are wrong: A (administer naloxone) may
be necessary but must be done after initial immediate
steps (stop infusion, safety, call for help) and per institution
protocol—however some protocols allow nurse-
administered naloxone; choose local policy. C (oxygen and
calling rapid response) are important but initial action is to
stop the infusion and stimulate; oxygen should be applied
immediately after stopping PCA. D is inappropriate —
documentation alone delays critical interventions.
• Safety/teaching tip: For PCA patients, educate about
reporting sedation and ensure monitoring (RR, sedation
score, SpO₂). Have naloxone and reversal protocols
accessible.
Difficulty: Moderate
Bloom’s level: Application
