High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1. Clinical vignette: A 64-year-old man with hypertension and
new cough presents after starting lisinopril 10 mg PO daily
2 weeks ago. BP 130/78 mm Hg, HR 78, respirations 16.
Which action should the nurse take?
A. Tell him to stop lisinopril immediately and call 911.
B. Document the cough as an expected side effect and
notify the provider to consider switching to an ARB.
C. Instruct him to double the dose for 1 week and reassess
the cough.
D. Advise he take an over-the-counter cough suppressant
and continue lisinopril.
Correct answer: B
Rationale:
• Why correct: ACE inhibitors (like lisinopril) commonly
cause a dry, persistent cough due to increased bradykinin;
it often appears within days–weeks. The appropriate
nursing action is to document and notify the prescriber—
an ARB (e.g., losartan) is often substituted if cough is
intolerable.
• Why distractors are wrong: A is excessive — cough alone
(without respiratory distress) is not an emergency. C is
incorrect: increasing dose worsens adverse effects. D is
, incorrect: OTC cough suppressants may mask symptoms;
substitution by provider is appropriate.
• Safety/teaching tip: Teach the patient to report cough,
angioedema signs (facial swelling), or signs of hypotension;
advise not to stop medication abruptly without provider
guidance.
Difficulty: Easy
Bloom’s level: Recall
NCLEX client need category + subcategory: Physiological
Integrity — Pharmacological and Parenteral Therapies
2. Clinical vignette: A 58-year-old with MRSA bacteremia is
receiving IV vancomycin 1,500 mg q12h. Nurse notes
flushing and pruritus of neck and face during infusion. Vital
signs: BP 110/66, HR 86. Best next action?
A. Stop infusion immediately, administer epinephrine, call
code.
B. Slow infusion rate, administer IV diphenhydramine per
protocol, and notify prescriber.
C. Continue infusion at same rate because red man
syndrome is benign.
D. Switch to oral vancomycin to avoid reaction.
Correct answer: B
Rationale:
, • Why correct: Infusion-related “red man” or red neck
syndrome (histamine-mediated) occurs with rapid
vancomycin infusion. Management: stop or slow infusion,
give antihistamine (diphenhydramine) if ordered, notify
provider; future doses should be infused more slowly.
• Why distractors are wrong: A is for anaphylaxis —
epinephrine and code are unnecessary unless airway
compromise or severe hypotension. C is unsafe because
continuing at same rate can worsen symptoms. D is
incorrect: oral vancomycin is not appropriate for systemic
MRSA bacteremia (poor systemic absorption).
• Safety/teaching tip: Prior to next dose, ensure vancomycin
infused over ≥60 minutes (longer for larger doses) and
monitor for infusion reactions.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need category + subcategory: Physiological
Integrity — Pharmacological and Parenteral Therapies
3. Clinical vignette: A postoperative patient on morphine PCA
reports respiratory rate 8/min, O2 sat 88% on room air,
somnolent but arousable. PCA is delivering 1 mg IV bolus
with 8-minute lockout. What is the priority nursing action?
A. Give naloxone 0.4 mg IV push.
B. Stop the PCA pump and stimulate patient; prepare to
, administer naloxone if no improvement.
C. Increase supplemental oxygen to 6 L/min and
document.
D. Call respiratory therapy for bronchodilator treatment.
Correct answer: B
Rationale:
• Why correct: Signs indicate opioid-induced respiratory
depression. Priority: stop PCA, attempt verbal/tactile
stimulation, provide supplemental oxygen, and be ready to
give naloxone per protocol if respiratory status does not
improve. Immediate full naloxone without attempts at
stimulation can precipitate acute pain and withdrawal;
titrated naloxone may be used if needed.
• Why distractors are wrong: A — immediate push of
naloxone may be appropriate in severe apnea or
unresponsiveness, but first attempt stimulation and
support ventilation/O2; naloxone dosing should be
titrated. C — oxygen alone without stopping opioid source
is insufficient. D — bronchodilator unrelated.
• Safety/teaching tip: Implement PCA safety checks
(respiratory assessments q2h), educate patient/family
about reporting sedation, and verify PCA settings during
handoffs.
Difficulty: Moderate
Bloom’s level: Application
Pharmacology Mastery Test Bank: Medications & Dosages
1. Clinical vignette: A 64-year-old man with hypertension and
new cough presents after starting lisinopril 10 mg PO daily
2 weeks ago. BP 130/78 mm Hg, HR 78, respirations 16.
Which action should the nurse take?
A. Tell him to stop lisinopril immediately and call 911.
B. Document the cough as an expected side effect and
notify the provider to consider switching to an ARB.
C. Instruct him to double the dose for 1 week and reassess
the cough.
D. Advise he take an over-the-counter cough suppressant
and continue lisinopril.
Correct answer: B
Rationale:
• Why correct: ACE inhibitors (like lisinopril) commonly
cause a dry, persistent cough due to increased bradykinin;
it often appears within days–weeks. The appropriate
nursing action is to document and notify the prescriber—
an ARB (e.g., losartan) is often substituted if cough is
intolerable.
• Why distractors are wrong: A is excessive — cough alone
(without respiratory distress) is not an emergency. C is
incorrect: increasing dose worsens adverse effects. D is
, incorrect: OTC cough suppressants may mask symptoms;
substitution by provider is appropriate.
• Safety/teaching tip: Teach the patient to report cough,
angioedema signs (facial swelling), or signs of hypotension;
advise not to stop medication abruptly without provider
guidance.
Difficulty: Easy
Bloom’s level: Recall
NCLEX client need category + subcategory: Physiological
Integrity — Pharmacological and Parenteral Therapies
2. Clinical vignette: A 58-year-old with MRSA bacteremia is
receiving IV vancomycin 1,500 mg q12h. Nurse notes
flushing and pruritus of neck and face during infusion. Vital
signs: BP 110/66, HR 86. Best next action?
A. Stop infusion immediately, administer epinephrine, call
code.
B. Slow infusion rate, administer IV diphenhydramine per
protocol, and notify prescriber.
C. Continue infusion at same rate because red man
syndrome is benign.
D. Switch to oral vancomycin to avoid reaction.
Correct answer: B
Rationale:
, • Why correct: Infusion-related “red man” or red neck
syndrome (histamine-mediated) occurs with rapid
vancomycin infusion. Management: stop or slow infusion,
give antihistamine (diphenhydramine) if ordered, notify
provider; future doses should be infused more slowly.
• Why distractors are wrong: A is for anaphylaxis —
epinephrine and code are unnecessary unless airway
compromise or severe hypotension. C is unsafe because
continuing at same rate can worsen symptoms. D is
incorrect: oral vancomycin is not appropriate for systemic
MRSA bacteremia (poor systemic absorption).
• Safety/teaching tip: Prior to next dose, ensure vancomycin
infused over ≥60 minutes (longer for larger doses) and
monitor for infusion reactions.
Difficulty: Moderate
Bloom’s level: Application
NCLEX client need category + subcategory: Physiological
Integrity — Pharmacological and Parenteral Therapies
3. Clinical vignette: A postoperative patient on morphine PCA
reports respiratory rate 8/min, O2 sat 88% on room air,
somnolent but arousable. PCA is delivering 1 mg IV bolus
with 8-minute lockout. What is the priority nursing action?
A. Give naloxone 0.4 mg IV push.
B. Stop the PCA pump and stimulate patient; prepare to
, administer naloxone if no improvement.
C. Increase supplemental oxygen to 6 L/min and
document.
D. Call respiratory therapy for bronchodilator treatment.
Correct answer: B
Rationale:
• Why correct: Signs indicate opioid-induced respiratory
depression. Priority: stop PCA, attempt verbal/tactile
stimulation, provide supplemental oxygen, and be ready to
give naloxone per protocol if respiratory status does not
improve. Immediate full naloxone without attempts at
stimulation can precipitate acute pain and withdrawal;
titrated naloxone may be used if needed.
• Why distractors are wrong: A — immediate push of
naloxone may be appropriate in severe apnea or
unresponsiveness, but first attempt stimulation and
support ventilation/O2; naloxone dosing should be
titrated. C — oxygen alone without stopping opioid source
is insufficient. D — bronchodilator unrelated.
• Safety/teaching tip: Implement PCA safety checks
(respiratory assessments q2h), educate patient/family
about reporting sedation, and verify PCA settings during
handoffs.
Difficulty: Moderate
Bloom’s level: Application
