High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
Stem: A 68-year-old man with chronic heart failure (EF 28%) is
prescribed IV furosemide 40 mg twice daily for acute
decompensation. On assessment he has BP 100/62 mmHg, HR
94/min, O₂ sat 93% on 2 L NC, and serum creatinine 1.8 mg/dL
(baseline 1.2). Which nursing action is most important before
administering this dose?
A. Administer the dose and check urine output in 4 hours.
B. Check serum potassium and withhold if K⁺ <3.5 mEq/L.
C. Hold dose and notify provider because BP is <110/70 mmHg.
D. Give half the dose (20 mg) to reduce hypotension risk.
Correct answer: B
Rationale:
Why correct: Loop diuretics cause potassium wasting and can
precipitate arrhythmias, especially in patients with renal
impairment. Checking the current serum potassium and
withholding if hypokalemic (<3.5 mEq/L) is clinically appropriate
and safe before giving another loop dose.
Why distractors are wrong: A (waiting 4 hours before checking
urine is unsafe — urine output should be monitored
immediately after administration); C (BP 100/62 is low-normal
but not an absolute contraindication — action depends on
trend & symptoms, not an automatic hold); D (arbitrary dose
,reduction without provider order is inappropriate).
Safety/teaching tip: If K⁺ is low, notify prescriber and anticipate
potassium replacement or order adjustment; teach patient to
avoid excess licorice and report muscle weakness or
palpitations.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2)
Stem: A 70-kg adult is prescribed gentamicin 2.5 mg/kg IV once
for severe gram-negative infection. Vial concentration available:
80 mg in 2 mL. Calculate the total drug dose (mg) and the
volume (mL) to draw up. Then identify the correct nursing
action.
A. Dose 175 mg; draw up 4.38 mL; administer IV bolus over 1
minute.
B. Dose 175 mg; draw up 4.38 mL; dilute and infuse over 30–60
minutes.
C. Dose 140 mg; draw up 3.5 mL; give IM as single dose.
D. Dose 140 mg; draw up 3.5 mL; infuse over 15 minutes.
Correct answer: B
Rationale:
Why correct & math (step-by-step): Dose = 2.5 mg/kg × 70 kg =
,2.5 × 70 = 175.0 mg. Vial concentration = 80 mg / 2 mL → 80 ÷ 2
= 40 mg/mL. Volume to draw = dose ÷ concentration = 175 mg
÷ 40 mg/mL = 4.375 mL (round to facility policy → 4.38 mL).
Gentamicin should be diluted and infused over 30–60 minutes
to reduce nephrotoxicity and ototoxicity risk.
Why distractors are wrong: A (IV bolus over 1 minute is unsafe
— aminoglycosides require slow infusion); C and D (incorrect
dose calculation of 140 mg is wrong; IM route or 15-minute
infusion are not standard for serious infections needing
controlled IV infusion).
Safety/teaching tip: Verify recent renal function and calculate
dosing per renal function; monitor trough levels per facility
protocol and report tinnitus, hearing changes, or decreased
urine output.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3)
Stem: A postoperative patient receiving IV morphine via PCA
has respiratory rate of 8/min and O₂ sat 88% on room air. The
PCA settings: basal 0 mg/hr, demand dose 1 mg, lockout 10
minutes, total attempts recorded 8 in last hour with 5 successful
deliveries. Which action is highest priority?
A. Administer naloxone 0.4 mg IV push.
, B. Encourage deep breathing and document findings.
C. Stop the PCA and stimulate the patient; call provider for
naloxone order if needed.
D. Decrease the demand dose to 0.5 mg.
Correct answer: C
Rationale:
Why correct: Respiratory depression (RR <10, O₂ sat 88%) with
multiple recent PCA doses requires immediate cessation of
opioid delivery (stop PCA), stimulation, apply supplemental
oxygen, and notify provider — naloxone may be needed but
only after assessment and provider orders in many settings.
Why distractors are wrong: A (give naloxone only if
prescribed/after assessment — automatic push may precipitate
severe pain and withdrawal; but if patient’s life threatened,
naloxone would be given); B (encouragement alone is
insufficient for RR 8 and hypoxia); D (changing dose without
stopping PCA is insufficient).
Safety/teaching tip: Always monitor respiratory rate and O₂
saturation frequently with PCA use; educate patient/family
about reporting excessive drowsiness or difficulty breathing.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need: Physiological Integrity — Reduction of Risk
Potential
Pharmacology Mastery Test Bank: Medications & Dosages
Stem: A 68-year-old man with chronic heart failure (EF 28%) is
prescribed IV furosemide 40 mg twice daily for acute
decompensation. On assessment he has BP 100/62 mmHg, HR
94/min, O₂ sat 93% on 2 L NC, and serum creatinine 1.8 mg/dL
(baseline 1.2). Which nursing action is most important before
administering this dose?
A. Administer the dose and check urine output in 4 hours.
B. Check serum potassium and withhold if K⁺ <3.5 mEq/L.
C. Hold dose and notify provider because BP is <110/70 mmHg.
D. Give half the dose (20 mg) to reduce hypotension risk.
Correct answer: B
Rationale:
Why correct: Loop diuretics cause potassium wasting and can
precipitate arrhythmias, especially in patients with renal
impairment. Checking the current serum potassium and
withholding if hypokalemic (<3.5 mEq/L) is clinically appropriate
and safe before giving another loop dose.
Why distractors are wrong: A (waiting 4 hours before checking
urine is unsafe — urine output should be monitored
immediately after administration); C (BP 100/62 is low-normal
but not an absolute contraindication — action depends on
trend & symptoms, not an automatic hold); D (arbitrary dose
,reduction without provider order is inappropriate).
Safety/teaching tip: If K⁺ is low, notify prescriber and anticipate
potassium replacement or order adjustment; teach patient to
avoid excess licorice and report muscle weakness or
palpitations.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
2)
Stem: A 70-kg adult is prescribed gentamicin 2.5 mg/kg IV once
for severe gram-negative infection. Vial concentration available:
80 mg in 2 mL. Calculate the total drug dose (mg) and the
volume (mL) to draw up. Then identify the correct nursing
action.
A. Dose 175 mg; draw up 4.38 mL; administer IV bolus over 1
minute.
B. Dose 175 mg; draw up 4.38 mL; dilute and infuse over 30–60
minutes.
C. Dose 140 mg; draw up 3.5 mL; give IM as single dose.
D. Dose 140 mg; draw up 3.5 mL; infuse over 15 minutes.
Correct answer: B
Rationale:
Why correct & math (step-by-step): Dose = 2.5 mg/kg × 70 kg =
,2.5 × 70 = 175.0 mg. Vial concentration = 80 mg / 2 mL → 80 ÷ 2
= 40 mg/mL. Volume to draw = dose ÷ concentration = 175 mg
÷ 40 mg/mL = 4.375 mL (round to facility policy → 4.38 mL).
Gentamicin should be diluted and infused over 30–60 minutes
to reduce nephrotoxicity and ototoxicity risk.
Why distractors are wrong: A (IV bolus over 1 minute is unsafe
— aminoglycosides require slow infusion); C and D (incorrect
dose calculation of 140 mg is wrong; IM route or 15-minute
infusion are not standard for serious infections needing
controlled IV infusion).
Safety/teaching tip: Verify recent renal function and calculate
dosing per renal function; monitor trough levels per facility
protocol and report tinnitus, hearing changes, or decreased
urine output.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need: Physiological Integrity — Pharmacological
and Parenteral Therapies
3)
Stem: A postoperative patient receiving IV morphine via PCA
has respiratory rate of 8/min and O₂ sat 88% on room air. The
PCA settings: basal 0 mg/hr, demand dose 1 mg, lockout 10
minutes, total attempts recorded 8 in last hour with 5 successful
deliveries. Which action is highest priority?
A. Administer naloxone 0.4 mg IV push.
, B. Encourage deep breathing and document findings.
C. Stop the PCA and stimulate the patient; call provider for
naloxone order if needed.
D. Decrease the demand dose to 0.5 mg.
Correct answer: C
Rationale:
Why correct: Respiratory depression (RR <10, O₂ sat 88%) with
multiple recent PCA doses requires immediate cessation of
opioid delivery (stop PCA), stimulation, apply supplemental
oxygen, and notify provider — naloxone may be needed but
only after assessment and provider orders in many settings.
Why distractors are wrong: A (give naloxone only if
prescribed/after assessment — automatic push may precipitate
severe pain and withdrawal; but if patient’s life threatened,
naloxone would be given); B (encouragement alone is
insufficient for RR 8 and hypoxia); D (changing dose without
stopping PCA is insufficient).
Safety/teaching tip: Always monitor respiratory rate and O₂
saturation frequently with PCA use; educate patient/family
about reporting excessive drowsiness or difficulty breathing.
Difficulty: Moderate
Bloom’s level: Analysis
NCLEX client need: Physiological Integrity — Reduction of Risk
Potential
