High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is admitted with
an acute gastrointestinal bleed. Their home medications include
warfarin 5 mg daily. The nurse anticipates an order for which of
the following to reverse the effects of warfarin?
A) Protamine sulfate
B) Vitamin K
C) Naloxone
D) Flumazenil
Correct Answer: B
Rationale: Vitamin K is the specific antidote for warfarin
toxicity, as it is a necessary cofactor for the synthesis of vitamin
K-dependent clotting factors (II, VII, IX, X). Protamine sulfate is
the antidote for heparin, not warfarin. Naloxone is used for
opioid overdose, and flumazenil is used for benzodiazepine
overdose. Neither C nor D is relevant to this scenario.
Clinical Safety Tip: IV administration of Vitamin K can cause
anaphylactoid reactions; it should be administered by slow IV
infusion. The effect is not immediate, so fresh frozen plasma
(FFP) may also be required for rapid reversal in life-threatening
bleeding.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Adverse Effects/Contraindications/Side Effects/Interactions
,2) A postoperative patient is receiving a continuous IV infusion
of Regular insulin for hyperglycemia. The solution contains 100
units of Regular insulin in 100 mL of 0.9% sodium chloride. The
order states to administer insulin at 8 units/hour. At what rate
(mL/hr) should the nurse set the IV pump?
A) 4 mL/hr
B) 8 mL/hr
C) 10 mL/hr
D) 12 mL/hr
Correct Answer: B
Rationale: This is a simple ratio-proportion calculation. The
concentration is 100 units/100 mL = 1 unit/1 mL. If the patient
requires 8 units per hour, and 1 unit is in 1 mL, then the infusion
rate must be 8 mL/hr to deliver 8 units.
Clinical Safety Tip: Insulin infusions are high-alert medications.
Always use an infusion pump, label the line clearly, and monitor
blood glucose levels hourly. Ensure a secondary IV line is
running to prevent hypoglycemia if the infusion is interrupted.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
3) A patient diagnosed with schizophrenia has been taking
haloperidol for several weeks. The nurse notes that the patient
is having difficulty sitting still, is restless, and is constantly
pacing the hallway. This presentation is most consistent with
which adverse effect?
,A) Tardive dyskinesia
B) Neuroleptic malignant syndrome
C) Dystonia
D) Akathisia
Correct Answer: D
Rationale: Akathisia is a extrapyramidal symptom (EPS)
characterized by a subjective feeling of inner restlessness and
an objective observation of inability to sit or stand still, pacing,
and rocking. Tardive dyskinesia involves involuntary, repetitive
movements of the tongue, lips, and face. Dystonia involves
sustained, painful muscle spasms. Neuroleptic malignant
syndrome is a life-threatening reaction involving fever, muscle
rigidity, and autonomic instability.
Clinical Safety Tip: Akathisia is often mistaken for agitation or
anxiety. It is a strong reason for non-adherence. The nurse
should report this finding promptly, as a dosage adjustment or a
medication like propranolol or a benzodiazepine may be
prescribed to manage it.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Adverse Effects/Contraindications/Side Effects/Interactions
4) A patient with heart failure has been prescribed furosemide
40 mg IV twice daily. Which finding is the most accurate
indicator that the medication is having its desired therapeutic
effect?
A) A decrease in blood pressure
, B) A weight loss of 1 kg (2.2 lbs) in 24 hours
C) A decrease in respiratory rate
D) A serum potassium level of 3.8 mEq/L
Correct Answer: B
Rationale: The primary therapeutic goal of a loop diuretic like
furosemide in heart failure is to promote diuresis, reduce fluid
overload, and decrease peripheral edema and pulmonary
congestion. Daily weight is the most sensitive and accurate
indicator of fluid loss. A decrease in blood pressure may be an
effect but is not the primary goal and could be a sign of over-
diuresis. A decreased respiratory rate may follow reduced
pulmonary edema but is a less direct measure. A potassium
level is important to monitor for side effects (hypokalemia) but
does not indicate therapeutic efficacy.
Clinical Safety Tip: Teach patients to monitor their daily weight
at home on the same scale, at the same time of day, and to
report sudden weight gains as a sign of worsening heart failure.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Expected Actions/Outcomes
5) A nurse is preparing to administer vancomycin 1 gram IV to a
patient with a methicillin-resistant Staphylococcus
aureus (MRSA) infection. To minimize the risk of "Red Man
Syndrome," which action is most important?
A) Administer the dose over at least 60 minutes.
B) Administer an antihistamine 30 minutes prior to the dose.
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is admitted with
an acute gastrointestinal bleed. Their home medications include
warfarin 5 mg daily. The nurse anticipates an order for which of
the following to reverse the effects of warfarin?
A) Protamine sulfate
B) Vitamin K
C) Naloxone
D) Flumazenil
Correct Answer: B
Rationale: Vitamin K is the specific antidote for warfarin
toxicity, as it is a necessary cofactor for the synthesis of vitamin
K-dependent clotting factors (II, VII, IX, X). Protamine sulfate is
the antidote for heparin, not warfarin. Naloxone is used for
opioid overdose, and flumazenil is used for benzodiazepine
overdose. Neither C nor D is relevant to this scenario.
Clinical Safety Tip: IV administration of Vitamin K can cause
anaphylactoid reactions; it should be administered by slow IV
infusion. The effect is not immediate, so fresh frozen plasma
(FFP) may also be required for rapid reversal in life-threatening
bleeding.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Adverse Effects/Contraindications/Side Effects/Interactions
,2) A postoperative patient is receiving a continuous IV infusion
of Regular insulin for hyperglycemia. The solution contains 100
units of Regular insulin in 100 mL of 0.9% sodium chloride. The
order states to administer insulin at 8 units/hour. At what rate
(mL/hr) should the nurse set the IV pump?
A) 4 mL/hr
B) 8 mL/hr
C) 10 mL/hr
D) 12 mL/hr
Correct Answer: B
Rationale: This is a simple ratio-proportion calculation. The
concentration is 100 units/100 mL = 1 unit/1 mL. If the patient
requires 8 units per hour, and 1 unit is in 1 mL, then the infusion
rate must be 8 mL/hr to deliver 8 units.
Clinical Safety Tip: Insulin infusions are high-alert medications.
Always use an infusion pump, label the line clearly, and monitor
blood glucose levels hourly. Ensure a secondary IV line is
running to prevent hypoglycemia if the infusion is interrupted.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
3) A patient diagnosed with schizophrenia has been taking
haloperidol for several weeks. The nurse notes that the patient
is having difficulty sitting still, is restless, and is constantly
pacing the hallway. This presentation is most consistent with
which adverse effect?
,A) Tardive dyskinesia
B) Neuroleptic malignant syndrome
C) Dystonia
D) Akathisia
Correct Answer: D
Rationale: Akathisia is a extrapyramidal symptom (EPS)
characterized by a subjective feeling of inner restlessness and
an objective observation of inability to sit or stand still, pacing,
and rocking. Tardive dyskinesia involves involuntary, repetitive
movements of the tongue, lips, and face. Dystonia involves
sustained, painful muscle spasms. Neuroleptic malignant
syndrome is a life-threatening reaction involving fever, muscle
rigidity, and autonomic instability.
Clinical Safety Tip: Akathisia is often mistaken for agitation or
anxiety. It is a strong reason for non-adherence. The nurse
should report this finding promptly, as a dosage adjustment or a
medication like propranolol or a benzodiazepine may be
prescribed to manage it.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Adverse Effects/Contraindications/Side Effects/Interactions
4) A patient with heart failure has been prescribed furosemide
40 mg IV twice daily. Which finding is the most accurate
indicator that the medication is having its desired therapeutic
effect?
A) A decrease in blood pressure
, B) A weight loss of 1 kg (2.2 lbs) in 24 hours
C) A decrease in respiratory rate
D) A serum potassium level of 3.8 mEq/L
Correct Answer: B
Rationale: The primary therapeutic goal of a loop diuretic like
furosemide in heart failure is to promote diuresis, reduce fluid
overload, and decrease peripheral edema and pulmonary
congestion. Daily weight is the most sensitive and accurate
indicator of fluid loss. A decrease in blood pressure may be an
effect but is not the primary goal and could be a sign of over-
diuresis. A decreased respiratory rate may follow reduced
pulmonary edema but is a less direct measure. A potassium
level is important to monitor for side effects (hypokalemia) but
does not indicate therapeutic efficacy.
Clinical Safety Tip: Teach patients to monitor their daily weight
at home on the same scale, at the same time of day, and to
report sudden weight gains as a sign of worsening heart failure.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Expected Actions/Outcomes
5) A nurse is preparing to administer vancomycin 1 gram IV to a
patient with a methicillin-resistant Staphylococcus
aureus (MRSA) infection. To minimize the risk of "Red Man
Syndrome," which action is most important?
A) Administer the dose over at least 60 minutes.
B) Administer an antihistamine 30 minutes prior to the dose.
