High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1. A 68-year-old man with a history of atrial fibrillation is
admitted after a transient ischemic attack. The physician
prescribes warfarin (Coumadin) and orders baseline labs.
The nurse notes the patient takes amiodarone at home.
Which intervention should the nurse prioritize?
A. Start warfarin at the standard dose and recheck INR in 7
days.
B. Hold amiodarone and start warfarin at the standard
dose.
C. Notify the prescriber — consider a lower initial warfarin
dose or more frequent INR monitoring.
D. Begin warfarin and add vitamin K prophylactically to
prevent high INR.
Correct answer: C
Rationale:
Warfarin is highly affected by drug interactions. Amiodarone
inhibits warfarin metabolism and increases warfarin effect,
raising bleeding risk; therefore the prescriber should be notified
to consider a lower initial dose or more frequent INR checks.
This is the safest and most evidence-based action.
Option A is unsafe because a standard warfarin dose with
concurrent amiodarone can produce supratherapeutic INR and
bleeding. Option B (holding amiodarone) is inappropriate
,without prescriber order and may destabilize the patient’s
arrhythmia. Option D (adding vitamin K prophylactically) is not
standard practice and could prevent therapeutic
anticoagulation.
Teaching tip: Always review home meds for interactions before
initiating warfarin; when interacting agents (e.g., amiodarone,
TMP-SMX, metronidazole) are present, plan for lower warfarin
starting doses and INR monitoring within 24–72 hours.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Safe and Effective Care Environment —
Safety and Infection Control (Medication safety) / Physiological
Integrity — Pharmacological and Parenteral Therapies
2. A 54-year-old woman with newly diagnosed type 1
diabetes is to receive regular insulin IV for diabetic
ketoacidosis (DKA). The order is: regular insulin bolus 0.1
units/kg, followed by infusion 0.1 units/kg/hr. The patient
weighs 70 kg. How many units will the nurse give for the
bolus and what will be the infusion rate (units/hr)? Show
steps.
A. Bolus 7 units; infusion 0.7 units/hr
B. Bolus 7 units; infusion 7 units/hr
C. Bolus 0.7 units; infusion 0.7 units/hr
D. Bolus 7 units; infusion 70 units/hr
,Correct answer: B
Rationale:
Calculate step-by-step: Bolus = 0.1 units/kg × 70 kg = 7.0 units.
Infusion = 0.1 units/kg/hr × 70 kg = 7.0 units/hr. Therefore give
a bolus of 7 units of regular insulin followed by an infusion at 7
units/hr. This is standard DKA insulin dosing.
Distractors: Option A incorrectly places decimal for infusion
(0.7) — likely from dividing by 10 a second time. Option C
confuses bolus magnitude (0.7 is 0.01 × weight). Option D (70
units/hr) is 10× the correct infusion and would cause severe
hypoglycemia.
Clinical safety tip: Program insulin infusion pumps carefully,
double-check weight-based calculations with a second nurse,
and monitor bedside glucose every 1–2 hours to adjust infusion
and prevent hypoglycemia.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Basic Care and
Comfort / Pharmacological and Parenteral Therapies
3. A 72-year-old man with chronic heart failure is admitted
for exacerbation and receives furosemide IV. After 48
hours he reports muscle cramps and weakness. Labs: Na+
138 mEq/L, K+ 2.8 mEq/L, Mg2+ 1.4 mg/dL (low). Which
statement by the nurse is most appropriate?
, A. “Your potassium is slightly low; continue the current
dose of furosemide.”
B. “We need to start potassium replacement and consider
magnesium replacement.”
C. “Low potassium is expected — no intervention needed
unless arrhythmias occur.”
D. “I will stop the furosemide permanently.”
Correct answer: B
Rationale:
Loop diuretics like furosemide cause renal loss of potassium and
magnesium. The patient’s K+ is 2.8 mEq/L (clinically significant
hypokalemia) and Mg2+ is low — both should be corrected
because low magnesium impairs potassium repletion. Starting
K+ replacement and considering Mg2+ replacement is
appropriate.
Option A is incorrect — continuing the same diuretic dose
without correction risks arrhythmias. Option C is unsafe; waiting
for arrhythmia is reactive and dangerous. Option D (stopping
furosemide permanently) may worsen fluid overload; instead
adjust dose and replace electrolytes as clinically indicated.
Teaching tip: When correcting hypokalemia due to diuretics,
check and correct magnesium simultaneously; monitor cardiac
rhythm during replacement.
Difficulty: Moderate
Bloom’s taxonomy: Application
Pharmacology Mastery Test Bank: Medications & Dosages
1. A 68-year-old man with a history of atrial fibrillation is
admitted after a transient ischemic attack. The physician
prescribes warfarin (Coumadin) and orders baseline labs.
The nurse notes the patient takes amiodarone at home.
Which intervention should the nurse prioritize?
A. Start warfarin at the standard dose and recheck INR in 7
days.
B. Hold amiodarone and start warfarin at the standard
dose.
C. Notify the prescriber — consider a lower initial warfarin
dose or more frequent INR monitoring.
D. Begin warfarin and add vitamin K prophylactically to
prevent high INR.
Correct answer: C
Rationale:
Warfarin is highly affected by drug interactions. Amiodarone
inhibits warfarin metabolism and increases warfarin effect,
raising bleeding risk; therefore the prescriber should be notified
to consider a lower initial dose or more frequent INR checks.
This is the safest and most evidence-based action.
Option A is unsafe because a standard warfarin dose with
concurrent amiodarone can produce supratherapeutic INR and
bleeding. Option B (holding amiodarone) is inappropriate
,without prescriber order and may destabilize the patient’s
arrhythmia. Option D (adding vitamin K prophylactically) is not
standard practice and could prevent therapeutic
anticoagulation.
Teaching tip: Always review home meds for interactions before
initiating warfarin; when interacting agents (e.g., amiodarone,
TMP-SMX, metronidazole) are present, plan for lower warfarin
starting doses and INR monitoring within 24–72 hours.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Safe and Effective Care Environment —
Safety and Infection Control (Medication safety) / Physiological
Integrity — Pharmacological and Parenteral Therapies
2. A 54-year-old woman with newly diagnosed type 1
diabetes is to receive regular insulin IV for diabetic
ketoacidosis (DKA). The order is: regular insulin bolus 0.1
units/kg, followed by infusion 0.1 units/kg/hr. The patient
weighs 70 kg. How many units will the nurse give for the
bolus and what will be the infusion rate (units/hr)? Show
steps.
A. Bolus 7 units; infusion 0.7 units/hr
B. Bolus 7 units; infusion 7 units/hr
C. Bolus 0.7 units; infusion 0.7 units/hr
D. Bolus 7 units; infusion 70 units/hr
,Correct answer: B
Rationale:
Calculate step-by-step: Bolus = 0.1 units/kg × 70 kg = 7.0 units.
Infusion = 0.1 units/kg/hr × 70 kg = 7.0 units/hr. Therefore give
a bolus of 7 units of regular insulin followed by an infusion at 7
units/hr. This is standard DKA insulin dosing.
Distractors: Option A incorrectly places decimal for infusion
(0.7) — likely from dividing by 10 a second time. Option C
confuses bolus magnitude (0.7 is 0.01 × weight). Option D (70
units/hr) is 10× the correct infusion and would cause severe
hypoglycemia.
Clinical safety tip: Program insulin infusion pumps carefully,
double-check weight-based calculations with a second nurse,
and monitor bedside glucose every 1–2 hours to adjust infusion
and prevent hypoglycemia.
Difficulty: Moderate
Bloom’s taxonomy: Application
NCLEX client need: Physiological Integrity — Basic Care and
Comfort / Pharmacological and Parenteral Therapies
3. A 72-year-old man with chronic heart failure is admitted
for exacerbation and receives furosemide IV. After 48
hours he reports muscle cramps and weakness. Labs: Na+
138 mEq/L, K+ 2.8 mEq/L, Mg2+ 1.4 mg/dL (low). Which
statement by the nurse is most appropriate?
, A. “Your potassium is slightly low; continue the current
dose of furosemide.”
B. “We need to start potassium replacement and consider
magnesium replacement.”
C. “Low potassium is expected — no intervention needed
unless arrhythmias occur.”
D. “I will stop the furosemide permanently.”
Correct answer: B
Rationale:
Loop diuretics like furosemide cause renal loss of potassium and
magnesium. The patient’s K+ is 2.8 mEq/L (clinically significant
hypokalemia) and Mg2+ is low — both should be corrected
because low magnesium impairs potassium repletion. Starting
K+ replacement and considering Mg2+ replacement is
appropriate.
Option A is incorrect — continuing the same diuretic dose
without correction risks arrhythmias. Option C is unsafe; waiting
for arrhythmia is reactive and dangerous. Option D (stopping
furosemide permanently) may worsen fluid overload; instead
adjust dose and replace electrolytes as clinically indicated.
Teaching tip: When correcting hypokalemia due to diuretics,
check and correct magnesium simultaneously; monitor cardiac
rhythm during replacement.
Difficulty: Moderate
Bloom’s taxonomy: Application
