High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with heart failure is admitted with
nausea, vomiting, and blurred vision. Their home medications
include digoxin 0.125 mg daily, furosemide 40 mg daily, and
lisinopril 10 mg daily. The nurse obtains a digoxin level, which is
reported as 3.2 ng/mL. Which assessment finding is
the priority for the nurse to report to the provider?
A) Apical pulse of 52 beats per minute
B) Crackles in the lower lung fields bilaterally
C) Report of nausea and anorexia
D) Potassium level of 3.0 mEq/L
Correct Answer: A
Rationale: The correct answer is A. A heart rate of 52 bpm
indicates significant bradycardia, a classic and dangerous sign of
digoxin toxicity that can rapidly progress to life-threatening
complete heart block or asystole. While nausea and anorexia
(C) are common early signs of toxicity, the cardiac dysrhythmia
is the most immediate threat to safety. Crackles (B) suggest
pulmonary edema from worsening heart failure, which is
important but not the direct result of the toxic digoxin level.
Hypokalemia (D) is a critical finding because low potassium
potentiates digoxin toxicity; however, the manifested symptom
of bradycardia requires more urgent intervention to stabilize
the cardiac rhythm.
Clinical Safety Tip: Always assess the apical pulse for a full
,minute before administering digoxin. Withhold the dose and
notify the provider if the pulse is less than 60 bpm in an adult.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
2) A nurse is preparing to administer a first dose of vancomycin
1 gram IV to a patient with a methicillin-
resistant Staphylococcus aureus (MRSA) wound infection. Which
action is most important for the nurse to take during the
infusion?
A) Infuse the medication over no less than 60 minutes.
B) Apply a pulse oximeter to monitor for hypoxia.
C) Ensure a dedicated IV line for administration.
D) Assess for pain and redness at the IV site.
Correct Answer: A
Rationale: The correct answer is A. Vancomycin must be infused
over at least 60 minutes (for a 1g dose) to prevent a reaction
known as "Red Man Syndrome," which is characterized by
profound hypotension, flushing, and rash. This is not a true
allergy but a rate-related histamine release. While monitoring
the IV site (D) is important for any infusion, the specific risk with
vancomycin is related to infusion speed. Hypoxia (B) is not a
primary concern. A dedicated line (C) is not required for
intermittent infusions.
Clinical Safety Tip: The standard infusion time for vancomycin is
1 gram per hour. Always use an infusion pump and follow
,facility policy regarding the maximum concentration and rate.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
3) A postoperative patient is receiving a continuous IV heparin
infusion at 1,200 units/hour. The pharmacy supplies heparin
25,000 units in 500 mL of D5W. The infusion pump should be
set to deliver how many mL/hour? (Round to the nearest whole
number).
A) 12 mL/hour
B) 24 mL/hour
C) 48 mL/hour
D) 60 mL/hour
Correct Answer: B
Rationale: The correct answer is B. This is calculated using
dimensional analysis.
First, find the concentration of the solution: 25,000 units / 500
mL = 50 units/mL.
The patient needs 1,200 units per hour. To find the mL/hour:
Dose desired (1,200 units/hr) divided by Dose on hand (50
units/mL) equals Volume required.
(1,200 units/hr) / (50 units/mL) = 24 mL/hr.
A) 12 mL/hr would deliver only 600 units/hr. C) 48 mL/hr would
deliver 2,400 units/hr, a dangerous overdose. D) 60 mL/hr
would deliver 3,000 units/hr.
Clinical Safety Tip: Always have two nurses independently
, double-check the calculation and pump settings for high-alert
medications like heparin.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
4) A patient with type 1 diabetes mellitus is prescribed regular
insulin via continuous subcutaneous insulin pump. The patient
calls the clinic reporting nausea, weakness, and diaphoresis.
What is the nurse's first action?
A) Instruct the patient to check their blood glucose level.
B) Tell the patient to administer a bolus dose of insulin.
C) Advise the patient to drink 4 ounces of orange juice.
D) Direct the patient to go to the nearest emergency room.
Correct Answer: A
Rationale: The correct answer is A. The symptoms described
(nausea, weakness, diaphoresis) are classic signs of
hypoglycemia, which is a medical emergency. The nurse's first
action is to have the patient confirm this suspicion by checking
their blood glucose level. This data is required before any
intervention. Administering insulin (B) would be catastrophic if
the patient is hypoglycemic. Advising juice (C) is the correct
action for confirmed hypoglycemia, but acting without
confirmation could cause hyperglycemia if the symptoms were
due to another cause like the flu. Going to the ER (D) may be
necessary later but is not the first step.
Clinical Safety Tip: The rule for treating hypoglycemia is "15-
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with heart failure is admitted with
nausea, vomiting, and blurred vision. Their home medications
include digoxin 0.125 mg daily, furosemide 40 mg daily, and
lisinopril 10 mg daily. The nurse obtains a digoxin level, which is
reported as 3.2 ng/mL. Which assessment finding is
the priority for the nurse to report to the provider?
A) Apical pulse of 52 beats per minute
B) Crackles in the lower lung fields bilaterally
C) Report of nausea and anorexia
D) Potassium level of 3.0 mEq/L
Correct Answer: A
Rationale: The correct answer is A. A heart rate of 52 bpm
indicates significant bradycardia, a classic and dangerous sign of
digoxin toxicity that can rapidly progress to life-threatening
complete heart block or asystole. While nausea and anorexia
(C) are common early signs of toxicity, the cardiac dysrhythmia
is the most immediate threat to safety. Crackles (B) suggest
pulmonary edema from worsening heart failure, which is
important but not the direct result of the toxic digoxin level.
Hypokalemia (D) is a critical finding because low potassium
potentiates digoxin toxicity; however, the manifested symptom
of bradycardia requires more urgent intervention to stabilize
the cardiac rhythm.
Clinical Safety Tip: Always assess the apical pulse for a full
,minute before administering digoxin. Withhold the dose and
notify the provider if the pulse is less than 60 bpm in an adult.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
2) A nurse is preparing to administer a first dose of vancomycin
1 gram IV to a patient with a methicillin-
resistant Staphylococcus aureus (MRSA) wound infection. Which
action is most important for the nurse to take during the
infusion?
A) Infuse the medication over no less than 60 minutes.
B) Apply a pulse oximeter to monitor for hypoxia.
C) Ensure a dedicated IV line for administration.
D) Assess for pain and redness at the IV site.
Correct Answer: A
Rationale: The correct answer is A. Vancomycin must be infused
over at least 60 minutes (for a 1g dose) to prevent a reaction
known as "Red Man Syndrome," which is characterized by
profound hypotension, flushing, and rash. This is not a true
allergy but a rate-related histamine release. While monitoring
the IV site (D) is important for any infusion, the specific risk with
vancomycin is related to infusion speed. Hypoxia (B) is not a
primary concern. A dedicated line (C) is not required for
intermittent infusions.
Clinical Safety Tip: The standard infusion time for vancomycin is
1 gram per hour. Always use an infusion pump and follow
,facility policy regarding the maximum concentration and rate.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
3) A postoperative patient is receiving a continuous IV heparin
infusion at 1,200 units/hour. The pharmacy supplies heparin
25,000 units in 500 mL of D5W. The infusion pump should be
set to deliver how many mL/hour? (Round to the nearest whole
number).
A) 12 mL/hour
B) 24 mL/hour
C) 48 mL/hour
D) 60 mL/hour
Correct Answer: B
Rationale: The correct answer is B. This is calculated using
dimensional analysis.
First, find the concentration of the solution: 25,000 units / 500
mL = 50 units/mL.
The patient needs 1,200 units per hour. To find the mL/hour:
Dose desired (1,200 units/hr) divided by Dose on hand (50
units/mL) equals Volume required.
(1,200 units/hr) / (50 units/mL) = 24 mL/hr.
A) 12 mL/hr would deliver only 600 units/hr. C) 48 mL/hr would
deliver 2,400 units/hr, a dangerous overdose. D) 60 mL/hr
would deliver 3,000 units/hr.
Clinical Safety Tip: Always have two nurses independently
, double-check the calculation and pump settings for high-alert
medications like heparin.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Physiological Integrity: Pharmacological and
Parenteral Therapies
4) A patient with type 1 diabetes mellitus is prescribed regular
insulin via continuous subcutaneous insulin pump. The patient
calls the clinic reporting nausea, weakness, and diaphoresis.
What is the nurse's first action?
A) Instruct the patient to check their blood glucose level.
B) Tell the patient to administer a bolus dose of insulin.
C) Advise the patient to drink 4 ounces of orange juice.
D) Direct the patient to go to the nearest emergency room.
Correct Answer: A
Rationale: The correct answer is A. The symptoms described
(nausea, weakness, diaphoresis) are classic signs of
hypoglycemia, which is a medical emergency. The nurse's first
action is to have the patient confirm this suspicion by checking
their blood glucose level. This data is required before any
intervention. Administering insulin (B) would be catastrophic if
the patient is hypoglycemic. Advising juice (C) is the correct
action for confirmed hypoglycemia, but acting without
confirmation could cause hyperglycemia if the symptoms were
due to another cause like the flu. Going to the ER (D) may be
necessary later but is not the first step.
Clinical Safety Tip: The rule for treating hypoglycemia is "15-
