High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is admitted with a
heart rate of 148 bpm. The provider prescribes diltiazem 0.25
mg/kg IV bolus over 2 minutes. The patient weighs 176 lbs. How
many milligrams should the nurse administer? (Round to the
nearest tenth).
A) 20.0 mg
B) 19.0 mg
C) 17.5 mg
D) 22.5 mg
Correct Answer: A
Rationale: The correct answer is calculated by first converting
the patient's weight from pounds to kilograms (176 lbs / 2.2 =
80 kg). Then, multiply the weight in kg by the prescribed dose
(0.25 mg/kg): 80 kg * 0.25 mg/kg = 20 mg. Option B is incorrect
due to a miscalculation in the conversion. Option C is a simple
mathematical error. Option D results from using the weight in
pounds instead of kilograms. Clinical Safety Tip: Administer IV
diltiazem slowly over 2 minutes while continuously monitoring
the ECG and blood pressure for bradycardia or hypotension.
Have emergency equipment (e.g., atropine, IV fluids,
transcutaneous pacing) readily available.
Difficulty: Moderate
Bloom's: Application
,NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
2) A nurse is preparing to administer vancomycin 1 gram IV to a
patient for a methicillin-resistant Staphylococcus aureus (MRSA)
infection. Which action is most important for the nurse to take
prior to initiating the infusion?
A) Obtain a peak serum level 30 minutes after the infusion.
B) Ensure a trough serum level has been drawn and is within an
acceptable range.
C) Administer an IV bolus of normal saline to ensure adequate
hydration.
D) Premedicate with diphenhydramine to prevent a reaction.
Correct Answer: B
Rationale: Vancomycin requires therapeutic drug monitoring.
The trough level (drawn within 30 minutes prior to the next
scheduled dose) is the most accurate indicator of therapeutic
efficacy and is crucial for monitoring nephrotoxicity.
Administering a dose without checking a recent trough could
lead to subtherapeutic treatment or toxicity. Option A is
incorrect; peak levels are rarely used for vancomycin. Option C,
while good practice for renal protection, is not the most critical
step. Option D is not standard; premedication is only used if a
patient has a known history of red man syndrome, not
prophylactically for all patients.
Difficulty: Moderate
Bloom's: Application
,NCLEX Client Need: Pharmacological and Parenteral Therapies:
Expected Actions/Outcomes
3) A patient with type 1 diabetes is prescribed regular insulin via
continuous IV infusion at 8 units/hour. The pharmacy prepares
the infusion with 100 units of regular insulin in 100 mL of
normal saline. At what rate (mL/hr) should the nurse program
the infusion pump?
A) 4 mL/hr
B) 8 mL/hr
C) 10 mL/hr
D) 100 mL/hr
Correct Answer: B
Rationale: The concentration is 100 units/100 mL, which
simplifies to 1 unit/mL. To deliver 8 units per hour, the pump
must be set to deliver 8 mL/hour (8 units/hr ÷ 1 unit/mL = 8
mL/hr). Option A delivers only 4 units/hr. Option C delivers 10
units/hr. Option D would deliver a dangerous 100 units/hr.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
4) A postoperative patient is receiving morphine via a patient-
controlled analgesia (PCA) pump. The nurse finds the patient
somnolent and difficult to arouse with a respiratory rate of 8
breaths/minute. Which action should the nurse take first?
A) Administer naloxone per standing protocol.
, B) Stimulate the patient and instruct them to take deep breaths.
C) Discontinue the morphine infusion immediately.
D) Check the patient's oxygen saturation and blood pressure.
Correct Answer: B
Rationale: The first action for opioid-induced respiratory
depression is to stimulate the patient (e.g., verbal and tactile
stimulation) and encourage deep breathing. This non-
pharmacological intervention may be sufficient to reverse the
sedation without needing an antagonist. Option A is correct but
is not the first action; stimulation should be attempted first if
the patient is still responsive. Option C is important but
stopping the infusion alone does not reverse the effects of the
opioid already circulating. Option D is an assessment action, but
the patient's respiratory rate is already critically low, requiring
immediate intervention.
Difficulty: Hard
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Adverse Effects/Contraindications
5) A 55-year-old patient started on lisinopril for hypertension
calls the clinic to report a persistent, dry cough. What is the
nurse's best response?
A) "This is an expected side effect that will likely subside in a
few weeks."
B) "Stop taking the medication immediately and I will notify
your provider."
C) "This is a common, non-dangerous side effect of lisinopril.
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with atrial fibrillation is admitted with a
heart rate of 148 bpm. The provider prescribes diltiazem 0.25
mg/kg IV bolus over 2 minutes. The patient weighs 176 lbs. How
many milligrams should the nurse administer? (Round to the
nearest tenth).
A) 20.0 mg
B) 19.0 mg
C) 17.5 mg
D) 22.5 mg
Correct Answer: A
Rationale: The correct answer is calculated by first converting
the patient's weight from pounds to kilograms (176 lbs / 2.2 =
80 kg). Then, multiply the weight in kg by the prescribed dose
(0.25 mg/kg): 80 kg * 0.25 mg/kg = 20 mg. Option B is incorrect
due to a miscalculation in the conversion. Option C is a simple
mathematical error. Option D results from using the weight in
pounds instead of kilograms. Clinical Safety Tip: Administer IV
diltiazem slowly over 2 minutes while continuously monitoring
the ECG and blood pressure for bradycardia or hypotension.
Have emergency equipment (e.g., atropine, IV fluids,
transcutaneous pacing) readily available.
Difficulty: Moderate
Bloom's: Application
,NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
2) A nurse is preparing to administer vancomycin 1 gram IV to a
patient for a methicillin-resistant Staphylococcus aureus (MRSA)
infection. Which action is most important for the nurse to take
prior to initiating the infusion?
A) Obtain a peak serum level 30 minutes after the infusion.
B) Ensure a trough serum level has been drawn and is within an
acceptable range.
C) Administer an IV bolus of normal saline to ensure adequate
hydration.
D) Premedicate with diphenhydramine to prevent a reaction.
Correct Answer: B
Rationale: Vancomycin requires therapeutic drug monitoring.
The trough level (drawn within 30 minutes prior to the next
scheduled dose) is the most accurate indicator of therapeutic
efficacy and is crucial for monitoring nephrotoxicity.
Administering a dose without checking a recent trough could
lead to subtherapeutic treatment or toxicity. Option A is
incorrect; peak levels are rarely used for vancomycin. Option C,
while good practice for renal protection, is not the most critical
step. Option D is not standard; premedication is only used if a
patient has a known history of red man syndrome, not
prophylactically for all patients.
Difficulty: Moderate
Bloom's: Application
,NCLEX Client Need: Pharmacological and Parenteral Therapies:
Expected Actions/Outcomes
3) A patient with type 1 diabetes is prescribed regular insulin via
continuous IV infusion at 8 units/hour. The pharmacy prepares
the infusion with 100 units of regular insulin in 100 mL of
normal saline. At what rate (mL/hr) should the nurse program
the infusion pump?
A) 4 mL/hr
B) 8 mL/hr
C) 10 mL/hr
D) 100 mL/hr
Correct Answer: B
Rationale: The concentration is 100 units/100 mL, which
simplifies to 1 unit/mL. To deliver 8 units per hour, the pump
must be set to deliver 8 mL/hour (8 units/hr ÷ 1 unit/mL = 8
mL/hr). Option A delivers only 4 units/hr. Option C delivers 10
units/hr. Option D would deliver a dangerous 100 units/hr.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
4) A postoperative patient is receiving morphine via a patient-
controlled analgesia (PCA) pump. The nurse finds the patient
somnolent and difficult to arouse with a respiratory rate of 8
breaths/minute. Which action should the nurse take first?
A) Administer naloxone per standing protocol.
, B) Stimulate the patient and instruct them to take deep breaths.
C) Discontinue the morphine infusion immediately.
D) Check the patient's oxygen saturation and blood pressure.
Correct Answer: B
Rationale: The first action for opioid-induced respiratory
depression is to stimulate the patient (e.g., verbal and tactile
stimulation) and encourage deep breathing. This non-
pharmacological intervention may be sufficient to reverse the
sedation without needing an antagonist. Option A is correct but
is not the first action; stimulation should be attempted first if
the patient is still responsive. Option C is important but
stopping the infusion alone does not reverse the effects of the
opioid already circulating. Option D is an assessment action, but
the patient's respiratory rate is already critically low, requiring
immediate intervention.
Difficulty: Hard
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Adverse Effects/Contraindications
5) A 55-year-old patient started on lisinopril for hypertension
calls the clinic to report a persistent, dry cough. What is the
nurse's best response?
A) "This is an expected side effect that will likely subside in a
few weeks."
B) "Stop taking the medication immediately and I will notify
your provider."
C) "This is a common, non-dangerous side effect of lisinopril.
