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 orally twice daily. The nurse is providing
medication education. Which statement by the patient indicates
a need for further teaching?
A) "I will use a soft-bristled toothbrush to brush my teeth."
B) "I should report any unusual bruising or bleeding to my
doctor right away."
C) "I can take aspirin for my occasional headaches if I need to."
D) "I will schedule regular appointments with my doctor for
blood tests."
Correct Answer: C
Rationale: Apixaban is a direct oral anticoagulant (DOAC).
Unlike warfarin, it does not require routine INR monitoring,
making D incorrect but not a critical safety issue. The major risk
with all anticoagulants is bleeding. Aspirin is an antiplatelet
agent, and its concurrent use with an anticoagulant like
apixaban significantly increases the risk of major bleeding
events without specific direction from a provider. Statements A
and B demonstrate good understanding of bleeding
precautions. A soft-bristled toothbrush minimizes gum irritation
and bleeding, and reporting signs of bleeding is crucial.
Clinical Safety Tip: Teach patients on anticoagulants to
recognize signs of bleeding (e.g., unusual bruising, pink/red
urine, tarry stools, headache/dizziness) and to seek immediate
,medical attention. They should carry a medication card and
inform all healthcare providers, including dentists, of their
anticoagulant use.
Difficulty: Moderate
Bloom's Taxonomy: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Medication Administration
2) A postoperative patient is receiving a continuous IV infusion
of heparin at 1,200 units/hour. The pharmacy supplies a bag of
25,000 units of heparin in 500 mL of D5W. At what rate (in
mL/hr) should the nurse set the infusion pump?
A) 12 mL/hr
B) 24 mL/hr
C) 30 mL/hr
D) 48 mL/hr
Correct Answer: B
Rationale: This is a dosage calculation problem. First, find the
concentration of the solution: 25,000 units / 500 mL = 50
units/mL. The patient requires 1,200 units/hour. To find the
mL/hour rate, divide the required dose by the concentration:
1,200 units/hr ÷ 50 units/mL = 24 mL/hr.
Clinical Safety Tip: Always double-check heparin calculations
with a second nurse due to its narrow therapeutic index and
high risk for causing bleeding. Use an infusion pump for all
continuous IV heparin infusions.
Difficulty: Moderate
Bloom's Taxonomy: Application
,NCLEX Client Need: Pharmacological and Parenteral Therapies;
Dosage Calculation
3) A 55-year-old patient with type 2 diabetes is prescribed
metformin 1,000 mg twice daily. The nurse should instruct the
patient to immediately report which potential adverse effect?
A) Mild nausea
B) Weight gain
C) Metallic taste
D) Chills and myalgia
Correct Answer: D
Rationale: Options A and C are common, typically transient side
effects of metformin. Weight gain is not associated with
metformin; it is often weight-neutral or can cause slight weight
loss. Option D, chills and myalgia (muscle pain), could be signs
of a rare but serious adverse effect called lactic acidosis. This is
a medical emergency and is more likely to occur in patients with
renal impairment, dehydration, or acute illness.
Clinical Safety Tip: Teach patients taking metformin to hold the
dose and contact their provider for any condition that can
predispose them to dehydration or acute renal issues, such as
vomiting, diarrhea, fever, or planned procedures with contrast
dye.
Difficulty: Moderate
Bloom's Taxonomy: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Adverse Effects/Contraindications
, 4) A patient is brought to the ED with suspected opioid
overdose. The patient has pinpoint pupils, respiratory
depression (rate of 6/min), and is unresponsive. Which antidote
will the nurse prepare to administer?
A) Flumazenil
B) Naloxone
C) Acetylcysteine
D) Activated charcoal
Correct Answer: B
Rationale: Naloxone is a competitive antagonist at opioid
receptor sites and is the specific antidote for opioid overdose,
rapidly reversing respiratory depression and sedation.
Flumazenil (A) is the antidote for benzodiazepine overdose.
Acetylcysteine (C) is the antidote for acetaminophen toxicity.
Activated charcoal (D) is used for ingestion of certain poisons to
prevent absorption but is not a specific antidote and is not the
first-line treatment in this acute respiratory emergency.
Clinical Safety Tip: Naloxone has a shorter half-life than many
opioids. Therefore, patients must be closely monitored for the
return of respiratory depression after the initial dose wears off,
and repeated doses may be necessary.
Difficulty: Easy
Bloom's Taxonomy: Recall
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Expected Actions/Outcomes
5) A nurse is caring for a patient with heart failure who is
receiving furosemide 40 mg IV twice daily. Which electrolyte
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is prescribed
apixaban 5 mg orally twice daily. The nurse is providing
medication education. Which statement by the patient indicates
a need for further teaching?
A) "I will use a soft-bristled toothbrush to brush my teeth."
B) "I should report any unusual bruising or bleeding to my
doctor right away."
C) "I can take aspirin for my occasional headaches if I need to."
D) "I will schedule regular appointments with my doctor for
blood tests."
Correct Answer: C
Rationale: Apixaban is a direct oral anticoagulant (DOAC).
Unlike warfarin, it does not require routine INR monitoring,
making D incorrect but not a critical safety issue. The major risk
with all anticoagulants is bleeding. Aspirin is an antiplatelet
agent, and its concurrent use with an anticoagulant like
apixaban significantly increases the risk of major bleeding
events without specific direction from a provider. Statements A
and B demonstrate good understanding of bleeding
precautions. A soft-bristled toothbrush minimizes gum irritation
and bleeding, and reporting signs of bleeding is crucial.
Clinical Safety Tip: Teach patients on anticoagulants to
recognize signs of bleeding (e.g., unusual bruising, pink/red
urine, tarry stools, headache/dizziness) and to seek immediate
,medical attention. They should carry a medication card and
inform all healthcare providers, including dentists, of their
anticoagulant use.
Difficulty: Moderate
Bloom's Taxonomy: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Medication Administration
2) A postoperative patient is receiving a continuous IV infusion
of heparin at 1,200 units/hour. The pharmacy supplies a bag of
25,000 units of heparin in 500 mL of D5W. At what rate (in
mL/hr) should the nurse set the infusion pump?
A) 12 mL/hr
B) 24 mL/hr
C) 30 mL/hr
D) 48 mL/hr
Correct Answer: B
Rationale: This is a dosage calculation problem. First, find the
concentration of the solution: 25,000 units / 500 mL = 50
units/mL. The patient requires 1,200 units/hour. To find the
mL/hour rate, divide the required dose by the concentration:
1,200 units/hr ÷ 50 units/mL = 24 mL/hr.
Clinical Safety Tip: Always double-check heparin calculations
with a second nurse due to its narrow therapeutic index and
high risk for causing bleeding. Use an infusion pump for all
continuous IV heparin infusions.
Difficulty: Moderate
Bloom's Taxonomy: Application
,NCLEX Client Need: Pharmacological and Parenteral Therapies;
Dosage Calculation
3) A 55-year-old patient with type 2 diabetes is prescribed
metformin 1,000 mg twice daily. The nurse should instruct the
patient to immediately report which potential adverse effect?
A) Mild nausea
B) Weight gain
C) Metallic taste
D) Chills and myalgia
Correct Answer: D
Rationale: Options A and C are common, typically transient side
effects of metformin. Weight gain is not associated with
metformin; it is often weight-neutral or can cause slight weight
loss. Option D, chills and myalgia (muscle pain), could be signs
of a rare but serious adverse effect called lactic acidosis. This is
a medical emergency and is more likely to occur in patients with
renal impairment, dehydration, or acute illness.
Clinical Safety Tip: Teach patients taking metformin to hold the
dose and contact their provider for any condition that can
predispose them to dehydration or acute renal issues, such as
vomiting, diarrhea, fever, or planned procedures with contrast
dye.
Difficulty: Moderate
Bloom's Taxonomy: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Adverse Effects/Contraindications
, 4) A patient is brought to the ED with suspected opioid
overdose. The patient has pinpoint pupils, respiratory
depression (rate of 6/min), and is unresponsive. Which antidote
will the nurse prepare to administer?
A) Flumazenil
B) Naloxone
C) Acetylcysteine
D) Activated charcoal
Correct Answer: B
Rationale: Naloxone is a competitive antagonist at opioid
receptor sites and is the specific antidote for opioid overdose,
rapidly reversing respiratory depression and sedation.
Flumazenil (A) is the antidote for benzodiazepine overdose.
Acetylcysteine (C) is the antidote for acetaminophen toxicity.
Activated charcoal (D) is used for ingestion of certain poisons to
prevent absorption but is not a specific antidote and is not the
first-line treatment in this acute respiratory emergency.
Clinical Safety Tip: Naloxone has a shorter half-life than many
opioids. Therefore, patients must be closely monitored for the
return of respiratory depression after the initial dose wears off,
and repeated doses may be necessary.
Difficulty: Easy
Bloom's Taxonomy: Recall
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Expected Actions/Outcomes
5) A nurse is caring for a patient with heart failure who is
receiving furosemide 40 mg IV twice daily. Which electrolyte
