High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is prescribed
apixaban 5 mg twice daily. During discharge teaching, the
patient states, "I also take ginkgo biloba for my memory." Which
response by the nurse is most appropriate?
A) "That is a good choice, as it may also help prevent blood
clots."
B) "You should stop taking the apixaban if you plan to continue
the ginkgo biloba."
C) "It is important to avoid ginkgo biloba as it can increase your
risk of bleeding."
D) "You may take both, but be sure to take them at least 6 hours
apart."
Correct Answer: C
Rationale: Ginkgo biloba is known to have antiplatelet
properties, which can potentiate the effects of anticoagulants
like apixaban. This significantly increases the patient's risk of
bleeding complications, including life-threatening hemorrhages.
Option A is dangerously incorrect, as the combination increases
clot risk not through efficacy but through bleeding, negating any
benefit. Option B is wrong because abruptly stopping a
prescribed anticoagulant for atrial fibrillation dramatically
increases the risk of stroke. Option D is incorrect because the
pharmacokinetic interaction is not mitigated by separating the
administration times; the effects are systemic and
,prolonged. Clinical Safety Tip: A crucial part of discharge
teaching for patients on anticoagulants is a thorough review of
all medications, including over-the-counter drugs, herbs, and
supplements, to identify and advise against any that increase
bleeding risk (e.g., NSAIDs, garlic, ginkgo, vitamin E in high
doses).
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Medication Administration
2) A postoperative patient is receiving a continuous IV infusion
of Regular insulin for hyperglycemia at 12 units/hour. The
concentration of the solution is 100 units of Regular insulin in
100 mL of 0.9% sodium chloride. At how many mL/hr should
the infusion pump be set?
A) 1 mL/hr
B) 12 mL/hr
C) 100 mL/hr
D) 120 mL/hr
Correct Answer: B
Rationale: This is a simple ratio-proportion calculation. The
solution concentration is 100 units/100 mL, which simplifies to
1 unit/1 mL. Therefore, to deliver 12 units per hour, the pump
must be set to deliver 12 mL per hour. Option A would only
deliver 1 unit/hour. Option C would deliver 100 units/hour, a
massive and dangerous overdose. Option D is a miscalculation,
likely from misapplying the ratio. Clinical Safety Tip: Insulin is a
,high-alert medication. Independent double-checks of the
infusion rate and concentration by two nurses are mandatory
before initiating and during any titratable insulin drip to prevent
life-threatening hypoglycemia.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Dosage Calculation
3) A nurse is assessing a client 24 hours after initiating therapy
with vancomycin IV for a methicillin-resistant Staphylococcus
aureus (MRSA) wound infection. The nurse notes bright flushing
and erythema on the client's face, neck, and upper chest. The
client's heart rate is 88 bpm and blood pressure is 118/74
mmHg. What is the nurse's priority action?
A) Stop the vancomycin infusion immediately.
B) Slow the infusion rate and continue to monitor.
C) Administer prescribed diphenhydramine.
D) Check for a new order for a different antibiotic.
Correct Answer: B
Rationale: This scenario describes Red Man Syndrome, a
common, non-allergic histamine-mediated reaction to
vancomycin, often caused by too rapid an infusion. It is not a
true allergy. The priority action is to slow the infusion rate,
which will typically resolve the symptoms. The vital signs are
stable, indicating no anaphylaxis. Option A is incorrect; stopping
the essential antibiotic is not necessary for this expected
reaction. Option C might be a subsequent order for comfort,
, but it is not the initial priority. Option D is not indicated as the
reaction is not a failure of the drug's efficacy. Clinical Safety
Tip: Vancomycin should always be infused over at least 60
minutes (or per specific institution/order guidelines) to
minimize the risk of Red Man Syndrome and nephrotoxicity.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Adverse Effects/Contraindications
4) A client with bipolar disorder is stabilized on lithium 600 mg
PO daily. Which finding from recent lab work requires
immediate intervention by the nurse?
A) White blood cell count (WBC) of 11,000/mm³
B) Sodium level of 136 mEq/L
C) Lithium level of 1.8 mEq/L
D) Thyroid-stimulating hormone (TSH) of 4.5 mIU/L
Correct Answer: C
Rationale: The therapeutic range for lithium is narrow (0.6-1.2
mEq/L). A level of 1.8 mEq/L indicates lithium toxicity, which
can be life-threatening and requires immediate intervention
(e.g., holding the dose, notifying the provider, assessing for
symptoms like nausea, tremor, confusion). Option A is a mildly
elevated WBC, which is not directly related to lithium therapy.
Option B is a slightly low sodium level; dehydration and
hyponatremia can precipitate toxicity, but the critical value here
is the lithium level itself. Option D is a normal TSH; while lithium
can cause hypothyroidism, this is a chronic issue, not an acute
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is prescribed
apixaban 5 mg twice daily. During discharge teaching, the
patient states, "I also take ginkgo biloba for my memory." Which
response by the nurse is most appropriate?
A) "That is a good choice, as it may also help prevent blood
clots."
B) "You should stop taking the apixaban if you plan to continue
the ginkgo biloba."
C) "It is important to avoid ginkgo biloba as it can increase your
risk of bleeding."
D) "You may take both, but be sure to take them at least 6 hours
apart."
Correct Answer: C
Rationale: Ginkgo biloba is known to have antiplatelet
properties, which can potentiate the effects of anticoagulants
like apixaban. This significantly increases the patient's risk of
bleeding complications, including life-threatening hemorrhages.
Option A is dangerously incorrect, as the combination increases
clot risk not through efficacy but through bleeding, negating any
benefit. Option B is wrong because abruptly stopping a
prescribed anticoagulant for atrial fibrillation dramatically
increases the risk of stroke. Option D is incorrect because the
pharmacokinetic interaction is not mitigated by separating the
administration times; the effects are systemic and
,prolonged. Clinical Safety Tip: A crucial part of discharge
teaching for patients on anticoagulants is a thorough review of
all medications, including over-the-counter drugs, herbs, and
supplements, to identify and advise against any that increase
bleeding risk (e.g., NSAIDs, garlic, ginkgo, vitamin E in high
doses).
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Medication Administration
2) A postoperative patient is receiving a continuous IV infusion
of Regular insulin for hyperglycemia at 12 units/hour. The
concentration of the solution is 100 units of Regular insulin in
100 mL of 0.9% sodium chloride. At how many mL/hr should
the infusion pump be set?
A) 1 mL/hr
B) 12 mL/hr
C) 100 mL/hr
D) 120 mL/hr
Correct Answer: B
Rationale: This is a simple ratio-proportion calculation. The
solution concentration is 100 units/100 mL, which simplifies to
1 unit/1 mL. Therefore, to deliver 12 units per hour, the pump
must be set to deliver 12 mL per hour. Option A would only
deliver 1 unit/hour. Option C would deliver 100 units/hour, a
massive and dangerous overdose. Option D is a miscalculation,
likely from misapplying the ratio. Clinical Safety Tip: Insulin is a
,high-alert medication. Independent double-checks of the
infusion rate and concentration by two nurses are mandatory
before initiating and during any titratable insulin drip to prevent
life-threatening hypoglycemia.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Dosage Calculation
3) A nurse is assessing a client 24 hours after initiating therapy
with vancomycin IV for a methicillin-resistant Staphylococcus
aureus (MRSA) wound infection. The nurse notes bright flushing
and erythema on the client's face, neck, and upper chest. The
client's heart rate is 88 bpm and blood pressure is 118/74
mmHg. What is the nurse's priority action?
A) Stop the vancomycin infusion immediately.
B) Slow the infusion rate and continue to monitor.
C) Administer prescribed diphenhydramine.
D) Check for a new order for a different antibiotic.
Correct Answer: B
Rationale: This scenario describes Red Man Syndrome, a
common, non-allergic histamine-mediated reaction to
vancomycin, often caused by too rapid an infusion. It is not a
true allergy. The priority action is to slow the infusion rate,
which will typically resolve the symptoms. The vital signs are
stable, indicating no anaphylaxis. Option A is incorrect; stopping
the essential antibiotic is not necessary for this expected
reaction. Option C might be a subsequent order for comfort,
, but it is not the initial priority. Option D is not indicated as the
reaction is not a failure of the drug's efficacy. Clinical Safety
Tip: Vancomycin should always be infused over at least 60
minutes (or per specific institution/order guidelines) to
minimize the risk of Red Man Syndrome and nephrotoxicity.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Adverse Effects/Contraindications
4) A client with bipolar disorder is stabilized on lithium 600 mg
PO daily. Which finding from recent lab work requires
immediate intervention by the nurse?
A) White blood cell count (WBC) of 11,000/mm³
B) Sodium level of 136 mEq/L
C) Lithium level of 1.8 mEq/L
D) Thyroid-stimulating hormone (TSH) of 4.5 mIU/L
Correct Answer: C
Rationale: The therapeutic range for lithium is narrow (0.6-1.2
mEq/L). A level of 1.8 mEq/L indicates lithium toxicity, which
can be life-threatening and requires immediate intervention
(e.g., holding the dose, notifying the provider, assessing for
symptoms like nausea, tremor, confusion). Option A is a mildly
elevated WBC, which is not directly related to lithium therapy.
Option B is a slightly low sodium level; dehydration and
hyponatremia can precipitate toxicity, but the critical value here
is the lithium level itself. Option D is a normal TSH; while lithium
can cause hypothyroidism, this is a chronic issue, not an acute
