High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with heart failure is admitted with
acute decompensation. The nurse assesses bibasilar crackles,
jugular venous distention to the angle of the jaw, and +3 pitting
edema in the lower extremities. The patient's home
medications include lisinopril 20 mg daily, metoprolol succinate
50 mg daily, and furosemide 40 mg twice daily. The provider
orders intravenous furosemide 80 mg now. Which assessment is
most critical for the nurse to perform within one hour of
administering the IV diuretic?
A) Check for pupil dilation and light reactivity.
B) Auscultate bowel sounds in all four quadrants.
C) Monitor the patient's oxygen saturation via pulse oximetry.
D) Obtain a full set of vital signs, including orthostatic blood
pressures.
Correct Answer: D
Rationale: Intravenous loop diuretics like furosemide cause a
rapid and significant diuresis, which can lead to profound
hypotension, especially in a volume-overloaded patient who
may have compensatory mechanisms. Obtaining vital signs,
including orthostatic measurements, is crucial to assess for fluid
volume depletion and hypotension resulting from the diuresis.
Option A is unrelated to furosemide's mechanism; it is more
pertinent for neurological or opioid assessments. Option B,
,assessing bowel sounds, is not a priority action following
diuretic administration. Option C, monitoring oxygen saturation,
is important for a patient with heart failure and pulmonary
edema, but the most direct and immediate risk from the
diuretic itself is hemodynamic instability (hypotension), not a
direct change in oxygenation.
Clinical Safety Tip: Always assess a patient's fluid status (e.g.,
weight, edema, lung sounds, intake/output) before and after
administering diuretics. Teach patients to monitor their daily
weight at home and to report significant changes to their
provider.
Difficulty: Moderate
Bloom's Taxonomy: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Medication Administration
2) A nurse is preparing to administer a scheduled dose of
vancomycin 1 gram IV to a patient with a methicillin-
resistant Staphylococcus aureus (MRSA) infection. The
pharmacy has sent a 250 mL bag of D5W with the vancomycin
to be infused over 90 minutes. Prior to initiation, what is the
priority nursing action?
A) Obtain a peak serum level 30 minutes after the infusion
completes.
B) Check the patient's most recent trough vancomycin level.
C) Assess the patient for a history of penicillin allergy.
D) Flush the IV line with 10 mL of normal saline.
Correct Answer: B
,Rationale: Vancomycin dosing and timing are guided by trough
serum levels to ensure efficacy and prevent nephrotoxicity. A
trough level should be drawn immediately (within 30 minutes)
before the next scheduled dose. Administering a dose without
checking a pending trough level could result in toxic
accumulation or subtherapeutic dosing. Option A is incorrect
because the peak level is not routinely monitored for
vancomycin; the trough is the standard. Option C is not directly
relevant; while cross-reactivity can occur, a penicillin allergy
does not automatically preclude vancomycin use. Option D is a
standard practice for IV administration but is not
the priority over ensuring safe drug levels.
Clinical Safety Tip: To obtain an accurate vancomycin trough,
draw the blood sample from a different site than the infusion,
and draw it within 30 minutes before the next dose is scheduled
to be administered.
Difficulty: Moderate
Bloom's Taxonomy: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Expected Actions/Outcomes
3) A patient with type 1 diabetes mellitus has an order for
regular insulin by continuous IV infusion at 8 units/hour. The
infusion is prepared by the pharmacy with 100 units of regular
insulin in 100 mL of 0.9% normal saline. The nurse should
program the infusion pump to deliver how many mL/hour?
A) 0.5 mL/hour
B) 8 mL/hour
, C) 10 mL/hour
D) 100 mL/hour
Correct Answer: B
Rationale: This is a dosage calculation problem. The
concentration is 100 units/100 mL, which simplifies to 1 unit/1
mL. If the patient requires 8 units per hour, and 1 unit is
contained in 1 mL, then the nurse must set the pump to deliver
8 mL per hour to administer the correct dose. Option A (0.5 mL)
would deliver only 0.5 units. Option C (10 mL) would deliver 10
units. Option D (100 mL) would deliver 100 units, a dangerous
overdose.
Clinical Safety Tip: Insulin infusions are high-alert medications.
Always verify the concentration and infusion rate with a second
nurse. Monitor the patient's blood glucose per protocol (often
hourly) and be prepared to titrate the infusion based on the
results.
Difficulty: Easy
Bloom's Taxonomy: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Dosage Calculation
4) A postoperative patient is receiving morphine via a Patient-
Controlled Analgesia (PCA) pump. The nurse enters the room
and finds the patient somnolent and difficult to arouse with a
respiratory rate of 6 breaths per minute. Which action should
the nurse take first?
A) Administer the prescribed naloxone.
B) Stimulate the patient and instruct them to take deep breaths.
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with heart failure is admitted with
acute decompensation. The nurse assesses bibasilar crackles,
jugular venous distention to the angle of the jaw, and +3 pitting
edema in the lower extremities. The patient's home
medications include lisinopril 20 mg daily, metoprolol succinate
50 mg daily, and furosemide 40 mg twice daily. The provider
orders intravenous furosemide 80 mg now. Which assessment is
most critical for the nurse to perform within one hour of
administering the IV diuretic?
A) Check for pupil dilation and light reactivity.
B) Auscultate bowel sounds in all four quadrants.
C) Monitor the patient's oxygen saturation via pulse oximetry.
D) Obtain a full set of vital signs, including orthostatic blood
pressures.
Correct Answer: D
Rationale: Intravenous loop diuretics like furosemide cause a
rapid and significant diuresis, which can lead to profound
hypotension, especially in a volume-overloaded patient who
may have compensatory mechanisms. Obtaining vital signs,
including orthostatic measurements, is crucial to assess for fluid
volume depletion and hypotension resulting from the diuresis.
Option A is unrelated to furosemide's mechanism; it is more
pertinent for neurological or opioid assessments. Option B,
,assessing bowel sounds, is not a priority action following
diuretic administration. Option C, monitoring oxygen saturation,
is important for a patient with heart failure and pulmonary
edema, but the most direct and immediate risk from the
diuretic itself is hemodynamic instability (hypotension), not a
direct change in oxygenation.
Clinical Safety Tip: Always assess a patient's fluid status (e.g.,
weight, edema, lung sounds, intake/output) before and after
administering diuretics. Teach patients to monitor their daily
weight at home and to report significant changes to their
provider.
Difficulty: Moderate
Bloom's Taxonomy: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Medication Administration
2) A nurse is preparing to administer a scheduled dose of
vancomycin 1 gram IV to a patient with a methicillin-
resistant Staphylococcus aureus (MRSA) infection. The
pharmacy has sent a 250 mL bag of D5W with the vancomycin
to be infused over 90 minutes. Prior to initiation, what is the
priority nursing action?
A) Obtain a peak serum level 30 minutes after the infusion
completes.
B) Check the patient's most recent trough vancomycin level.
C) Assess the patient for a history of penicillin allergy.
D) Flush the IV line with 10 mL of normal saline.
Correct Answer: B
,Rationale: Vancomycin dosing and timing are guided by trough
serum levels to ensure efficacy and prevent nephrotoxicity. A
trough level should be drawn immediately (within 30 minutes)
before the next scheduled dose. Administering a dose without
checking a pending trough level could result in toxic
accumulation or subtherapeutic dosing. Option A is incorrect
because the peak level is not routinely monitored for
vancomycin; the trough is the standard. Option C is not directly
relevant; while cross-reactivity can occur, a penicillin allergy
does not automatically preclude vancomycin use. Option D is a
standard practice for IV administration but is not
the priority over ensuring safe drug levels.
Clinical Safety Tip: To obtain an accurate vancomycin trough,
draw the blood sample from a different site than the infusion,
and draw it within 30 minutes before the next dose is scheduled
to be administered.
Difficulty: Moderate
Bloom's Taxonomy: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Expected Actions/Outcomes
3) A patient with type 1 diabetes mellitus has an order for
regular insulin by continuous IV infusion at 8 units/hour. The
infusion is prepared by the pharmacy with 100 units of regular
insulin in 100 mL of 0.9% normal saline. The nurse should
program the infusion pump to deliver how many mL/hour?
A) 0.5 mL/hour
B) 8 mL/hour
, C) 10 mL/hour
D) 100 mL/hour
Correct Answer: B
Rationale: This is a dosage calculation problem. The
concentration is 100 units/100 mL, which simplifies to 1 unit/1
mL. If the patient requires 8 units per hour, and 1 unit is
contained in 1 mL, then the nurse must set the pump to deliver
8 mL per hour to administer the correct dose. Option A (0.5 mL)
would deliver only 0.5 units. Option C (10 mL) would deliver 10
units. Option D (100 mL) would deliver 100 units, a dangerous
overdose.
Clinical Safety Tip: Insulin infusions are high-alert medications.
Always verify the concentration and infusion rate with a second
nurse. Monitor the patient's blood glucose per protocol (often
hourly) and be prepared to titrate the infusion based on the
results.
Difficulty: Easy
Bloom's Taxonomy: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Dosage Calculation
4) A postoperative patient is receiving morphine via a Patient-
Controlled Analgesia (PCA) pump. The nurse enters the room
and finds the patient somnolent and difficult to arouse with a
respiratory rate of 6 breaths per minute. Which action should
the nurse take first?
A) Administer the prescribed naloxone.
B) Stimulate the patient and instruct them to take deep breaths.
