Pharmacology Mastery Test Bank: Medications & Dosages
Stem: A 72-year-old female with chronic heart failure is
prescribed digoxin 0.125 mg PO daily. Her labs show serum
potassium 3.1 mEq/L. She reports nausea and seeing yellow
halos. Which action should the nurse take first?
A. Hold the digoxin and notify the provider.
B. Administer potassium chloride 40 mEq PO now.
C. Give the scheduled digoxin and recheck potassium in the
morning.
D. Obtain an ECG and give intravenous calcium gluconate.
Correct answer: A
Rationale:
Digoxin toxicity presents with GI symptoms (nausea), visual
disturbances (yellow halos), and is potentiated by hypokalemia;
holding the drug and notifying the provider is the priority to
prevent worsening toxicity.
Options B and D are incorrect as immediate corrective actions:
although potassium correction is indicated, initiating a 40 mEq
PO dose without provider orders and assessment of EKG is not
the priority when toxicity is suspected. IV calcium gluconate is
not a treatment for digoxin toxicity and may worsen
arrhythmias. Option C is unsafe — giving digoxin with signs of
,toxicity would risk life-threatening arrhythmias.
Safety/Teaching tip: Teach patients on digoxin to report GI
symptoms, visual changes, or palpitations immediately and to
have routine serum potassium monitoring; avoid potassium-
wasting diuretics without close monitoring.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2
Stem: The provider orders vancomycin 1 g IV in 250 mL D5W to
infuse over 90 minutes for a patient with MRSA. The IV pump
only displays mL/hr. What infusion rate should the nurse set?
A. 100 mL/hr
B. 150 mL/hr
C. 167 mL/hr
D. 250 mL/hr
Correct answer: C
Rationale:
Calculate rate: 250 mL ÷ 90 min = 2.777... mL/min. Convert to
mL/hr: 2.777... × 60 = 166.666... mL/hr → round to 167 mL/hr.
Infusion should be ~167 mL/hr to complete in 90 minutes.
Options A and B are too slow (100 mL/hr → 150 minutes; 150
mL/hr → 100 minutes) and risk prolonged low concentration; D
,is too fast (250 mL/hr → 60 minutes), increasing risk for Red
Man syndrome. Correct infusion time reduces infusion-related
reactions and ensures therapeutic levels.
Safety/Teaching tip: Vancomycin should be infused over ≥60
minutes (preferably 90–120 min for 1 g) to minimize Red Man
syndrome; monitor for flushing, hypotension, and administer
slower if reactions occur.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3
Stem: A postoperative patient on patient-controlled analgesia
(PCA) hydromorphone has respiratory rate 8 breaths/min,
oxygen saturation 86% on room air, and is drowsy. Which is the
best immediate action?
A. Administer naloxone 0.4 mg IV and stop the PCA.
B. Encourage deep breathing and give supplemental oxygen.
C. Decrease PCA basal rate by half and reassess in 15 minutes.
D. Call the provider and obtain an arterial blood gas.
Correct answer: A
Rationale:
This patient shows signs of opioid-induced respiratory
depression (RR <10, SpO₂ 86%). Immediate reversal with
, naloxone 0.4 mg IV and discontinuation of opioid infusion are
appropriate emergent actions to restore ventilation.
Option B (oxygen and breathing encouragement) is supportive
but not definitive for opioid effect; oxygen alone won’t reverse
opioid-induced hypoventilation. Option C is too slow —
decreasing basal rate is insufficient when respiratory rate is
dangerously low. Option D delays life-saving intervention.
Safety/Teaching tip: Naloxone dosing often starts at 0.04–0.4
mg IV titrated to effect for opioid reversal; monitor for acute
withdrawal and re-depression — observe for recurrence due to
shorter naloxone duration.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need: Physiological Integrity — Reduction of Risk
Potential
4
Stem: A 28-year-old patient started sertraline 50 mg daily 5
days ago calls with fever, agitation, hyperreflexia, and tremor.
Which response is most appropriate?
A. Advise discontinuing sertraline immediately and come to ED
for evaluation.
B. Recommend taking ibuprofen and monitoring symptoms at
home.
C. Increase hydration and continue medication; symptoms will
Stem: A 72-year-old female with chronic heart failure is
prescribed digoxin 0.125 mg PO daily. Her labs show serum
potassium 3.1 mEq/L. She reports nausea and seeing yellow
halos. Which action should the nurse take first?
A. Hold the digoxin and notify the provider.
B. Administer potassium chloride 40 mEq PO now.
C. Give the scheduled digoxin and recheck potassium in the
morning.
D. Obtain an ECG and give intravenous calcium gluconate.
Correct answer: A
Rationale:
Digoxin toxicity presents with GI symptoms (nausea), visual
disturbances (yellow halos), and is potentiated by hypokalemia;
holding the drug and notifying the provider is the priority to
prevent worsening toxicity.
Options B and D are incorrect as immediate corrective actions:
although potassium correction is indicated, initiating a 40 mEq
PO dose without provider orders and assessment of EKG is not
the priority when toxicity is suspected. IV calcium gluconate is
not a treatment for digoxin toxicity and may worsen
arrhythmias. Option C is unsafe — giving digoxin with signs of
,toxicity would risk life-threatening arrhythmias.
Safety/Teaching tip: Teach patients on digoxin to report GI
symptoms, visual changes, or palpitations immediately and to
have routine serum potassium monitoring; avoid potassium-
wasting diuretics without close monitoring.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2
Stem: The provider orders vancomycin 1 g IV in 250 mL D5W to
infuse over 90 minutes for a patient with MRSA. The IV pump
only displays mL/hr. What infusion rate should the nurse set?
A. 100 mL/hr
B. 150 mL/hr
C. 167 mL/hr
D. 250 mL/hr
Correct answer: C
Rationale:
Calculate rate: 250 mL ÷ 90 min = 2.777... mL/min. Convert to
mL/hr: 2.777... × 60 = 166.666... mL/hr → round to 167 mL/hr.
Infusion should be ~167 mL/hr to complete in 90 minutes.
Options A and B are too slow (100 mL/hr → 150 minutes; 150
mL/hr → 100 minutes) and risk prolonged low concentration; D
,is too fast (250 mL/hr → 60 minutes), increasing risk for Red
Man syndrome. Correct infusion time reduces infusion-related
reactions and ensures therapeutic levels.
Safety/Teaching tip: Vancomycin should be infused over ≥60
minutes (preferably 90–120 min for 1 g) to minimize Red Man
syndrome; monitor for flushing, hypotension, and administer
slower if reactions occur.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3
Stem: A postoperative patient on patient-controlled analgesia
(PCA) hydromorphone has respiratory rate 8 breaths/min,
oxygen saturation 86% on room air, and is drowsy. Which is the
best immediate action?
A. Administer naloxone 0.4 mg IV and stop the PCA.
B. Encourage deep breathing and give supplemental oxygen.
C. Decrease PCA basal rate by half and reassess in 15 minutes.
D. Call the provider and obtain an arterial blood gas.
Correct answer: A
Rationale:
This patient shows signs of opioid-induced respiratory
depression (RR <10, SpO₂ 86%). Immediate reversal with
, naloxone 0.4 mg IV and discontinuation of opioid infusion are
appropriate emergent actions to restore ventilation.
Option B (oxygen and breathing encouragement) is supportive
but not definitive for opioid effect; oxygen alone won’t reverse
opioid-induced hypoventilation. Option C is too slow —
decreasing basal rate is insufficient when respiratory rate is
dangerously low. Option D delays life-saving intervention.
Safety/Teaching tip: Naloxone dosing often starts at 0.04–0.4
mg IV titrated to effect for opioid reversal; monitor for acute
withdrawal and re-depression — observe for recurrence due to
shorter naloxone duration.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need: Physiological Integrity — Reduction of Risk
Potential
4
Stem: A 28-year-old patient started sertraline 50 mg daily 5
days ago calls with fever, agitation, hyperreflexia, and tremor.
Which response is most appropriate?
A. Advise discontinuing sertraline immediately and come to ED
for evaluation.
B. Recommend taking ibuprofen and monitoring symptoms at
home.
C. Increase hydration and continue medication; symptoms will
