High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
Stem: A 62-year-old man (weight 82 kg) hospitalized for acute
myocardial infarction is started on IV metoprolol tartrate 5 mg
IV bolus every 5 minutes up to three doses if needed for
persistent tachycardia (HR >100). After the first 5 mg, his HR
drops from 110 to 86 and BP is 118/72 mm Hg. Which action
should the nurse take next?
A. Administer the second 5 mg bolus now.
B. Hold further metoprolol boluses and monitor.
C. Give 2.5 mg oral metoprolol immediately.
D. Call the provider to switch to atenolol.
Correct answer: B
Rationale:
• Why correct: The protocol allows repeat boluses only while
tachycardic. HR decreased to 86 (below the >100
threshold), so further IV boluses are unnecessary and
could precipitate bradycardia or hypotension. Monitoring
is appropriate.
• Why distractors are wrong: A is incorrect because further
bolus is indicated only if tachycardia persists. C is incorrect
— giving oral metoprolol immediately after IV bolus risks
additive effect and hypotension; transition to oral is
considered later when stable. D is incorrect — switching
, agents isn't indicated when the current drug is effective
and hemodynamically tolerated.
• Safety/teaching tip: Monitor HR and BP closely for 12–24
hours after IV beta-blocker dosing and educate the patient
to report dizziness or lightheadedness which may indicate
hypotension or bradycardia.
Difficulty: Easy
Bloom’s: Recall
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
2
Stem: A 70-year-old woman (weight 58 kg) is prescribed
gentamicin 3 mg/kg IV once daily. The pharmacy supplies
gentamicin at 80 mg/2 mL. What dose in milligrams should the
nurse prepare?
A. 120 mg
B. 174 mg
C. 200 mg
D. 1740 mg
Correct answer: B
Rationale:
, • Why correct: Calculate dose: 3 mg/kg × 58 kg = 174 mg.
Step-by-step: 58 × 3 = 174 mg. So prepare 174 mg (round
per facility policy—here use exact 174 mg).
• Why distractors are wrong: A (120 mg) equals 2.07 mg/kg
— too low. C (200 mg) would be 3.45 mg/kg — higher than
order. D (1740 mg) is 10× dosing error and dangerous.
• Safety/teaching tip: Verify weight units (kg not lb), confirm
dosing with pharmacist for rounding to nearest available
vial, and monitor trough levels and renal function
(BUN/creatinine) with gentamicin.
Difficulty: Moderate
Bloom’s: Application
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
3
Stem: A postoperative patient reports severe pain (8/10). The
provider orders morphine 4 mg IV push every 4 hours PRN for
severe pain. The nurse administers 4 mg at 0900. At 1030 the
patient requests more pain medication and appears somnolent
with RR 8 breaths/min. What is the best immediate nursing
action?
A. Administer another 4 mg morphine per order.
B. Stimulate the patient, stop opioid administration, and call
provider.
, C. Give naloxone IV now.
D. Increase oxygen to 4 L nasal cannula and reassess hourly.
Correct answer: B
Rationale:
• Why correct: Somnolence with RR 8 indicates opioid-
induced respiratory depression. Immediate actions:
stimulate (safety), stop further opioids, call provider for
orders (may include naloxone). Turning to naloxone
immediately without assessment or call is not always first
step unless apnea or severe hypoventilation present.
• Why distractors are wrong: A is unsafe — repeat dose
violates PRN frequency and worsens respiratory
depression. C may be required if respiratory depression
progresses to apnea or severe hypoxia, but Naloxone
administration should follow assessment and coordination
with provider in many acute settings (and titrated). D
provides oxygen but fails to address central respiratory
depression and continuing opioid effect; oxygen alone is
insufficient.
• Safety/teaching tip: Regularly assess sedation and
respiratory rate after opioid dosing; use sedation scales
and implement naloxone protocols if RR <8 or
unresponsive.
Difficulty: Moderate
Bloom’s: Analysis
Pharmacology Mastery Test Bank: Medications & Dosages
Stem: A 62-year-old man (weight 82 kg) hospitalized for acute
myocardial infarction is started on IV metoprolol tartrate 5 mg
IV bolus every 5 minutes up to three doses if needed for
persistent tachycardia (HR >100). After the first 5 mg, his HR
drops from 110 to 86 and BP is 118/72 mm Hg. Which action
should the nurse take next?
A. Administer the second 5 mg bolus now.
B. Hold further metoprolol boluses and monitor.
C. Give 2.5 mg oral metoprolol immediately.
D. Call the provider to switch to atenolol.
Correct answer: B
Rationale:
• Why correct: The protocol allows repeat boluses only while
tachycardic. HR decreased to 86 (below the >100
threshold), so further IV boluses are unnecessary and
could precipitate bradycardia or hypotension. Monitoring
is appropriate.
• Why distractors are wrong: A is incorrect because further
bolus is indicated only if tachycardia persists. C is incorrect
— giving oral metoprolol immediately after IV bolus risks
additive effect and hypotension; transition to oral is
considered later when stable. D is incorrect — switching
, agents isn't indicated when the current drug is effective
and hemodynamically tolerated.
• Safety/teaching tip: Monitor HR and BP closely for 12–24
hours after IV beta-blocker dosing and educate the patient
to report dizziness or lightheadedness which may indicate
hypotension or bradycardia.
Difficulty: Easy
Bloom’s: Recall
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
2
Stem: A 70-year-old woman (weight 58 kg) is prescribed
gentamicin 3 mg/kg IV once daily. The pharmacy supplies
gentamicin at 80 mg/2 mL. What dose in milligrams should the
nurse prepare?
A. 120 mg
B. 174 mg
C. 200 mg
D. 1740 mg
Correct answer: B
Rationale:
, • Why correct: Calculate dose: 3 mg/kg × 58 kg = 174 mg.
Step-by-step: 58 × 3 = 174 mg. So prepare 174 mg (round
per facility policy—here use exact 174 mg).
• Why distractors are wrong: A (120 mg) equals 2.07 mg/kg
— too low. C (200 mg) would be 3.45 mg/kg — higher than
order. D (1740 mg) is 10× dosing error and dangerous.
• Safety/teaching tip: Verify weight units (kg not lb), confirm
dosing with pharmacist for rounding to nearest available
vial, and monitor trough levels and renal function
(BUN/creatinine) with gentamicin.
Difficulty: Moderate
Bloom’s: Application
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
3
Stem: A postoperative patient reports severe pain (8/10). The
provider orders morphine 4 mg IV push every 4 hours PRN for
severe pain. The nurse administers 4 mg at 0900. At 1030 the
patient requests more pain medication and appears somnolent
with RR 8 breaths/min. What is the best immediate nursing
action?
A. Administer another 4 mg morphine per order.
B. Stimulate the patient, stop opioid administration, and call
provider.
, C. Give naloxone IV now.
D. Increase oxygen to 4 L nasal cannula and reassess hourly.
Correct answer: B
Rationale:
• Why correct: Somnolence with RR 8 indicates opioid-
induced respiratory depression. Immediate actions:
stimulate (safety), stop further opioids, call provider for
orders (may include naloxone). Turning to naloxone
immediately without assessment or call is not always first
step unless apnea or severe hypoventilation present.
• Why distractors are wrong: A is unsafe — repeat dose
violates PRN frequency and worsens respiratory
depression. C may be required if respiratory depression
progresses to apnea or severe hypoxia, but Naloxone
administration should follow assessment and coordination
with provider in many acute settings (and titrated). D
provides oxygen but fails to address central respiratory
depression and continuing opioid effect; oxygen alone is
insufficient.
• Safety/teaching tip: Regularly assess sedation and
respiratory rate after opioid dosing; use sedation scales
and implement naloxone protocols if RR <8 or
unresponsive.
Difficulty: Moderate
Bloom’s: Analysis
