High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
Stem: A 68-year-old male with hypertension and a history of
heart failure is started on lisinopril 10 mg PO daily. On day 5 his
serum potassium is 5.6 mEq/L (normal 3.5–5.0). He complains
of muscle weakness. Which action should the nurse take first?
A. Hold lisinopril and notify the provider.
B. Give oral sodium polystyrene sulfonate (kayexalate).
C. Start a 50% dextrose IV push and regular insulin IV.
D. Encourage the patient to increase dietary potassium.
Correct answer: A
Rationale:
• Why correct: ACE inhibitors (lisinopril) can cause
hyperkalemia by reducing aldosterone-mediated
potassium excretion. The immediate nursing action is to
hold the medication and notify the provider because the
medication is a likely cause and continuation may worsen
hyperkalemia.
• Why distractors are wrong: B (kayexalate) is a treatment
option but is not the first nursing action before contacting
the prescriber and assessing cause. C (dextrose + insulin) is
appropriate for severe, life-threatening hyperkalemia with
ECG changes, not the first action for an asymptomatic or
mildly symptomatic patient—also needs prescriber order.
D (increase dietary potassium) is contraindicated.
, • Safety/teaching tip: Teach patients on ACE inhibitors to
report muscle weakness, palpitations, or paresthesias and
avoid high-potassium salt substitutes.
Difficulty: Moderate
Bloom’s level: Application
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
2 — (IV infusion math)
Stem: A 55-year-old woman (weight 70 kg) is prescribed
vancomycin 1,000 mg IV to be infused over 90 minutes. The
nurse has 1 g (1000 mg) vial reconstituted in 100 mL normal
saline. What infusion rate in mL/hr should the nurse set on the
infusion pump?
A. 33 mL/hr
B. 44 mL/hr
C. 67 mL/hr
D. 100 mL/hr
Correct answer: B
Rationale:
• Why correct: Infusion rate (mL/hr) = total volume (mL) ÷
infusion time (hr). Volume = 100 mL; time = 90 minutes =
1.5 hours. Calculation: 100 mL ÷ 1.5 hr = 66.666... mL/hr.
Wait — note we must be careful: 90 minutes = 1.5 hr so
100 ÷ 1.5 = 66.666. However vancomycin should be
, infused over at least 60–120 minutes depending on dose;
many institutions round to clinical pump settings. But
answer choices show 44 mL/hr as B — let's recalc to match
correct choice: (Important correction) many labs use
concentration 1000 mg in 250 mL; but stem states 100 mL.
To match the provided correct answer, we'll show correct
math for 1,000 mg in 100 mL over 90 min: 100 mL ÷ 1.5 hr
= 66.67 mL/hr → closest choice C (67 mL/hr). Therefore
the correct answer is C (67 mL/hr). (Selecting the pump
setting closest to 66.7 mL/hr.)
(Adjusted) Correct answer: C
• Why distractors are wrong: A (33 mL/hr) is for 2-hour
infusion of 66 mL; B (44 mL/hr) equals 2.25 hr for 100 mL
— not 90 min; D (100 mL/hr) would deliver in 1 hour (60
min), too rapid for this ordered 90-minute infusion.
• Safety/teaching tip: Vancomycin must be infused slowly to
reduce infusion-related reactions (red man syndrome).
Always verify concentration and infusion time and monitor
for flushing, hypotension, or rash.
Difficulty: Moderate
Bloom’s level: Application
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
3
, Stem: A postoperative patient receiving PCA morphine reports
that after pressing the button they felt little pain relief and
pressed repeatedly. The nurse documents respiratory rate
10/min and O₂ saturation 95% on RA. Which is the best nursing
action?
A. Hold the PCA and call the provider to request naloxone.
B. Educate the patient on PCA use and return demonstration.
C. Increase the PCA basal infusion rate.
D. Encourage the patient to press the PCA more frequently.
Correct answer: B
Rationale:
• Why correct: Many PCA problems stem from improper use
(patient not understanding demand dosing vs basal). With
adequate oxygenation (SpO₂ 95%) and RR 10 (borderline
but acceptable with analgesia), first action is to reassess
understanding and provide education/demonstration so
patient can use the PCA effectively.
• Why distractors are wrong: A (hold and give naloxone) is
not warranted — patient shows analgesia concern, not
severe respiratory depression (SpO₂ normal). C (increase
basal infusion) could worsen respiratory depression
without addressing misuse. D (press more) is
instructionally wrong — teach correct technique instead.
• Safety/teaching tip: Teach PCA patients the importance of
pressing only when pain is present, and demonstrate that
Pharmacology Mastery Test Bank: Medications & Dosages
Stem: A 68-year-old male with hypertension and a history of
heart failure is started on lisinopril 10 mg PO daily. On day 5 his
serum potassium is 5.6 mEq/L (normal 3.5–5.0). He complains
of muscle weakness. Which action should the nurse take first?
A. Hold lisinopril and notify the provider.
B. Give oral sodium polystyrene sulfonate (kayexalate).
C. Start a 50% dextrose IV push and regular insulin IV.
D. Encourage the patient to increase dietary potassium.
Correct answer: A
Rationale:
• Why correct: ACE inhibitors (lisinopril) can cause
hyperkalemia by reducing aldosterone-mediated
potassium excretion. The immediate nursing action is to
hold the medication and notify the provider because the
medication is a likely cause and continuation may worsen
hyperkalemia.
• Why distractors are wrong: B (kayexalate) is a treatment
option but is not the first nursing action before contacting
the prescriber and assessing cause. C (dextrose + insulin) is
appropriate for severe, life-threatening hyperkalemia with
ECG changes, not the first action for an asymptomatic or
mildly symptomatic patient—also needs prescriber order.
D (increase dietary potassium) is contraindicated.
, • Safety/teaching tip: Teach patients on ACE inhibitors to
report muscle weakness, palpitations, or paresthesias and
avoid high-potassium salt substitutes.
Difficulty: Moderate
Bloom’s level: Application
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
2 — (IV infusion math)
Stem: A 55-year-old woman (weight 70 kg) is prescribed
vancomycin 1,000 mg IV to be infused over 90 minutes. The
nurse has 1 g (1000 mg) vial reconstituted in 100 mL normal
saline. What infusion rate in mL/hr should the nurse set on the
infusion pump?
A. 33 mL/hr
B. 44 mL/hr
C. 67 mL/hr
D. 100 mL/hr
Correct answer: B
Rationale:
• Why correct: Infusion rate (mL/hr) = total volume (mL) ÷
infusion time (hr). Volume = 100 mL; time = 90 minutes =
1.5 hours. Calculation: 100 mL ÷ 1.5 hr = 66.666... mL/hr.
Wait — note we must be careful: 90 minutes = 1.5 hr so
100 ÷ 1.5 = 66.666. However vancomycin should be
, infused over at least 60–120 minutes depending on dose;
many institutions round to clinical pump settings. But
answer choices show 44 mL/hr as B — let's recalc to match
correct choice: (Important correction) many labs use
concentration 1000 mg in 250 mL; but stem states 100 mL.
To match the provided correct answer, we'll show correct
math for 1,000 mg in 100 mL over 90 min: 100 mL ÷ 1.5 hr
= 66.67 mL/hr → closest choice C (67 mL/hr). Therefore
the correct answer is C (67 mL/hr). (Selecting the pump
setting closest to 66.7 mL/hr.)
(Adjusted) Correct answer: C
• Why distractors are wrong: A (33 mL/hr) is for 2-hour
infusion of 66 mL; B (44 mL/hr) equals 2.25 hr for 100 mL
— not 90 min; D (100 mL/hr) would deliver in 1 hour (60
min), too rapid for this ordered 90-minute infusion.
• Safety/teaching tip: Vancomycin must be infused slowly to
reduce infusion-related reactions (red man syndrome).
Always verify concentration and infusion time and monitor
for flushing, hypotension, or rash.
Difficulty: Moderate
Bloom’s level: Application
NCLEX category: Physiological Integrity — Pharmacological and
Parenteral Therapies
3
, Stem: A postoperative patient receiving PCA morphine reports
that after pressing the button they felt little pain relief and
pressed repeatedly. The nurse documents respiratory rate
10/min and O₂ saturation 95% on RA. Which is the best nursing
action?
A. Hold the PCA and call the provider to request naloxone.
B. Educate the patient on PCA use and return demonstration.
C. Increase the PCA basal infusion rate.
D. Encourage the patient to press the PCA more frequently.
Correct answer: B
Rationale:
• Why correct: Many PCA problems stem from improper use
(patient not understanding demand dosing vs basal). With
adequate oxygenation (SpO₂ 95%) and RR 10 (borderline
but acceptable with analgesia), first action is to reassess
understanding and provide education/demonstration so
patient can use the PCA effectively.
• Why distractors are wrong: A (hold and give naloxone) is
not warranted — patient shows analgesia concern, not
severe respiratory depression (SpO₂ normal). C (increase
basal infusion) could worsen respiratory depression
without addressing misuse. D (press more) is
instructionally wrong — teach correct technique instead.
• Safety/teaching tip: Teach PCA patients the importance of
pressing only when pain is present, and demonstrate that
