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 ibuprofen for my arthritis pain."
Which response by the nurse is most appropriate?
A) "That is fine to take together; just ensure you take them with
food."
B) "You should switch to taking acetaminophen for pain relief
instead."
C) "You will need to double your apixaban dose on days you
take ibuprofen."
D) "Take the ibuprofen at least 6 hours after your apixaban
dose."
Correct Answer: B
Rationale: Apixaban is an anticoagulant (direct factor Xa
inhibitor) that increases the risk of bleeding. Ibuprofen is a
nonsteroidal anti-inflammatory drug (NSAID) that also inhibits
platelet function and can cause gastric erosion, significantly
compounding the risk of life-threatening bleeding. The correct
action is to recommend a safer alternative analgesic like
acetaminophen, which does not affect coagulation or the
gastric mucosa. Distractor A is dangerous as it does not mitigate
the drug interaction risk. Distractor C is extremely hazardous
and not supported by any clinical protocol. Distractor D is
incorrect because the interaction is pharmacodynamic
,(affecting the body's systems) and not pharmacokinetic (based
on timing of absorption); the drugs will still interact regardless
of administration timing.
Clinical Safety Tip: Always assess a patient on anticoagulants for
concomitant use of OTC NSAIDs, antiplatelets (like aspirin or
clopidogrel), and other medications that increase bleeding risk.
Patient education must include explicit instructions to avoid
these products unless approved by their provider.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
2) A 55-year-old patient is receiving a continuous intravenous
heparin infusion for a pulmonary embolism. The protocol
specifies a maintenance dose of 18 units/kg/hr. The patient
weighs 187 lbs. The heparin is supplied as 25,000 units in 500
mL of D5W. At what rate should the infusion pump be set (in
mL/hr)?
A) 11 mL/hr
B) 15 mL/hr
C) 22 mL/hr
D) 31 mL/hr
Correct Answer: B
Rationale: Step 1: Convert weight to kg: 187 lbs / 2.2 lbs/kg =
85 kg. Step 2: Calculate hourly dose: 18 units/kg/hr * 85 kg =
1,530 units/hr. Step 3: Determine concentration of heparin bag:
25,000 units / 500 mL = 50 units/mL. Step 4: Calculate mL/hr
,rate: (1,530 units/hr) / (50 units/mL) = 30.6 mL/hr, which
rounds to 31 mL/hr.
Clinical Safety Tip: Heparin is a high-alert medication. Always
double-check weight-based calculations with a second nurse
and use an infusion pump for administration. Monitor activated
partial thromboplastin time (aPTT) per protocol.
Difficulty: Hard
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
3) A nurse is preparing to administer vancomycin 1 gram IV to
a patient with a methicillin-resistant Staphylococcus
aureus (MRSA) infection. The pharmacy supplies the drug in a
250 mL bag to be infused over 90 minutes. What is the correct
infusion rate in mL/hr?
A) 125 mL/hr
B) 167 mL/hr
C) 200 mL/hr
D) 250 mL/hr
Correct Answer: B
Rationale: To calculate the mL/hr rate, divide the total volume
by the number of hours. 90 minutes is 1.5 hours. The
calculation is: 250 mL / 1.5 hours = 166.66 mL/hr, which rounds
to 167 mL/hr.
Clinical Safety Tip: Vancomycin must be infused slowly over at
least 60 minutes (for a 1g dose) to avoid "Red Man Syndrome,"
a histamine-mediated reaction causing profound hypotension
, and flushing. Always use an infusion pump.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
4) A patient with type 1 diabetes has orders for sliding scale
insulin aspart (a rapid-acting analog) based on fingerstick
blood glucose readings. The patient's pre-lunch blood glucose
is 243 mg/dL. The sliding scale order is: 151-200: 2 units; 201-
250: 4 units; 251-300: 6 units; 301-350: 8 units. How many
units should the nurse administer?
A) 2 units
B) 4 units
C) 6 units
D) 8 units
Correct Answer: B
Rationale: The patient's blood glucose of 243 mg/dL falls within
the 201-250 mg/dL range, which corresponds to 4 units of
insulin aspart.
Clinical Safety Tip: Always verify the blood glucose value and
the corresponding scale with a second nurse if required by
policy. Administer rapid-acting insulin immediately (within 15
minutes) before a meal to prevent post-prandial hyperglycemia
and subsequent hypoglycemia.
Difficulty: Easy
Bloom's: Recall
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 ibuprofen for my arthritis pain."
Which response by the nurse is most appropriate?
A) "That is fine to take together; just ensure you take them with
food."
B) "You should switch to taking acetaminophen for pain relief
instead."
C) "You will need to double your apixaban dose on days you
take ibuprofen."
D) "Take the ibuprofen at least 6 hours after your apixaban
dose."
Correct Answer: B
Rationale: Apixaban is an anticoagulant (direct factor Xa
inhibitor) that increases the risk of bleeding. Ibuprofen is a
nonsteroidal anti-inflammatory drug (NSAID) that also inhibits
platelet function and can cause gastric erosion, significantly
compounding the risk of life-threatening bleeding. The correct
action is to recommend a safer alternative analgesic like
acetaminophen, which does not affect coagulation or the
gastric mucosa. Distractor A is dangerous as it does not mitigate
the drug interaction risk. Distractor C is extremely hazardous
and not supported by any clinical protocol. Distractor D is
incorrect because the interaction is pharmacodynamic
,(affecting the body's systems) and not pharmacokinetic (based
on timing of absorption); the drugs will still interact regardless
of administration timing.
Clinical Safety Tip: Always assess a patient on anticoagulants for
concomitant use of OTC NSAIDs, antiplatelets (like aspirin or
clopidogrel), and other medications that increase bleeding risk.
Patient education must include explicit instructions to avoid
these products unless approved by their provider.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
2) A 55-year-old patient is receiving a continuous intravenous
heparin infusion for a pulmonary embolism. The protocol
specifies a maintenance dose of 18 units/kg/hr. The patient
weighs 187 lbs. The heparin is supplied as 25,000 units in 500
mL of D5W. At what rate should the infusion pump be set (in
mL/hr)?
A) 11 mL/hr
B) 15 mL/hr
C) 22 mL/hr
D) 31 mL/hr
Correct Answer: B
Rationale: Step 1: Convert weight to kg: 187 lbs / 2.2 lbs/kg =
85 kg. Step 2: Calculate hourly dose: 18 units/kg/hr * 85 kg =
1,530 units/hr. Step 3: Determine concentration of heparin bag:
25,000 units / 500 mL = 50 units/mL. Step 4: Calculate mL/hr
,rate: (1,530 units/hr) / (50 units/mL) = 30.6 mL/hr, which
rounds to 31 mL/hr.
Clinical Safety Tip: Heparin is a high-alert medication. Always
double-check weight-based calculations with a second nurse
and use an infusion pump for administration. Monitor activated
partial thromboplastin time (aPTT) per protocol.
Difficulty: Hard
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
3) A nurse is preparing to administer vancomycin 1 gram IV to
a patient with a methicillin-resistant Staphylococcus
aureus (MRSA) infection. The pharmacy supplies the drug in a
250 mL bag to be infused over 90 minutes. What is the correct
infusion rate in mL/hr?
A) 125 mL/hr
B) 167 mL/hr
C) 200 mL/hr
D) 250 mL/hr
Correct Answer: B
Rationale: To calculate the mL/hr rate, divide the total volume
by the number of hours. 90 minutes is 1.5 hours. The
calculation is: 250 mL / 1.5 hours = 166.66 mL/hr, which rounds
to 167 mL/hr.
Clinical Safety Tip: Vancomycin must be infused slowly over at
least 60 minutes (for a 1g dose) to avoid "Red Man Syndrome,"
a histamine-mediated reaction causing profound hypotension
, and flushing. Always use an infusion pump.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
4) A patient with type 1 diabetes has orders for sliding scale
insulin aspart (a rapid-acting analog) based on fingerstick
blood glucose readings. The patient's pre-lunch blood glucose
is 243 mg/dL. The sliding scale order is: 151-200: 2 units; 201-
250: 4 units; 251-300: 6 units; 301-350: 8 units. How many
units should the nurse administer?
A) 2 units
B) 4 units
C) 6 units
D) 8 units
Correct Answer: B
Rationale: The patient's blood glucose of 243 mg/dL falls within
the 201-250 mg/dL range, which corresponds to 4 units of
insulin aspart.
Clinical Safety Tip: Always verify the blood glucose value and
the corresponding scale with a second nurse if required by
policy. Administer rapid-acting insulin immediately (within 15
minutes) before a meal to prevent post-prandial hyperglycemia
and subsequent hypoglycemia.
Difficulty: Easy
Bloom's: Recall
