Pharmacology Mastery Test Bank: Medications & Dosages
1. A 68-year-old man with atrial fibrillation is admitted after a
minor ischemic stroke. He is started on an unfractionated
heparin infusion. The prescriber orders a bolus of 80
units/kg followed by an infusion of 18 units/kg/hr. The
patient weighs 82 kg. What is the correct bolus and
infusion rate to program on the IV pump?
A. Bolus 6,560 units; infusion 1,476 units/hr
B. Bolus 6,560 units; infusion 1,476 units/min
C. Bolus 6,560 units; infusion 1,656 units/hr
D. Bolus 6,560 units; infusion 1,476 mL/hr (infusion
contains 25,000 units in 250 mL)
Correct answer: A
Rationale:
• Why correct: Bolus: 80 units/kg × 82 kg = 6,560 units.
Infusion: 18 units/kg/hr × 82 kg = 1,476 units/hr. This
matches option A.
• Why distractors wrong: B is incorrect because infusion
units are per hour not per minute. C is incorrect—1,656
units/hr is 20.2 units/kg/hr, not the ordered 18
units/kg/hr. D is incorrect because it confuses units/hr with
mL/hr; to convert to mL/hr you must use the concentration
(see safety tip).
, • Safety/teaching tip: Always calculate both units/hr and
then convert to mL/hr using the syringe/pump
concentration. Example conversion for concentration in D:
25,000 units in 250 mL = 100 units/mL → 1,476 units/hr ÷
100 units/mL = 14.76 mL/hr (round per facility policy).
Double-check weight-based heparin calculations with an
independent RN verification.
Difficulty: Moderate
Bloom’s: Application
NCLEX: Physiological Integrity — Pharmacological and
Parenteral Therapies
2. A 55-year-old woman with MRSA bacteremia is receiving
vancomycin. Her trough (immediately before dose) returns
as 18 mcg/mL (goal 15–20 mcg/mL). She reports flushing
and pruritus during the infusion yesterday. Which action is
most appropriate now?
A. Continue the same dose; document red-man syndrome
and monitor.
B. Stop infusion, administer diphenhydramine PRN, and
notify prescriber to slow the infusion rate on future doses.
C. Stop vancomycin permanently; start linezolid for MRSA.
D. Increase infusion rate to shorten exposure and prevent
symptoms.
Correct answer: B
,Rationale:
• Why correct: Red-man (or red-neck) syndrome from rapid
vancomycin infusion causes histamine-mediated
flushing/pruritus. Management is to stop infusion for
severe symptoms, give an antihistamine (e.g.,
diphenhydramine), and slow subsequent infusion (no
faster than 60 min for typical doses; for large doses
longer). Trough 18 mcg/mL is within goal for serious
infections.
• Why distractors wrong: A is wrong because active
symptoms require intervention and documentation; simply
continuing risks worsening. C is premature—drug
substitution is reserved for true allergy or failure. D is
wrong—faster infusion increases risk of histamine release.
• Safety/teaching tip: Educate patients that symptoms
typically resolve with slowing infusion and antihistamine.
Always infuse vancomycin per facility rate guidelines and
check troughs as prescribed to balance efficacy and
toxicity.
Difficulty: Easy
Bloom’s: Recall/Application
NCLEX: Physiological Integrity — Pharmacological and
Parenteral Therapies
, 3. A 24-year-old woman presents with severe opioid
overdose after an intentional ingestion of unknown
amounts of extended-release oxycodone. She is apneic and
has pinpoint pupils. You administer naloxone 0.4 mg IV
with minimal response. The team asks for the next step.
Which is most appropriate?
A. Administer naloxone 2 mg IV and prepare for repeated
doses or infusion.
B. Give flumazenil IV to reverse combined benzodiazepine
effects.
C. Start dopamine infusion to treat hypotension from
overdose.
D. Give naloxone 0.1 mg IM and observe.
Correct answer: A
Rationale:
• Why correct: For severe opioid overdose, if initial naloxone
0.4 mg IV yields inadequate response, escalating to 2 mg IV
and being prepared for repeated doses or a continuous
infusion is appropriate—especially with long-
acting/extended-release opioids. Continuous infusion may
be necessary because naloxone’s half-life is shorter than
many opioids.
• Why distractors wrong: B is contraindicated here—
flumazenil reverses benzodiazepines and can precipitate
seizures in mixed overdose. C addresses hypotension but
not the primary opioid receptor antagonism needed. D is
1. A 68-year-old man with atrial fibrillation is admitted after a
minor ischemic stroke. He is started on an unfractionated
heparin infusion. The prescriber orders a bolus of 80
units/kg followed by an infusion of 18 units/kg/hr. The
patient weighs 82 kg. What is the correct bolus and
infusion rate to program on the IV pump?
A. Bolus 6,560 units; infusion 1,476 units/hr
B. Bolus 6,560 units; infusion 1,476 units/min
C. Bolus 6,560 units; infusion 1,656 units/hr
D. Bolus 6,560 units; infusion 1,476 mL/hr (infusion
contains 25,000 units in 250 mL)
Correct answer: A
Rationale:
• Why correct: Bolus: 80 units/kg × 82 kg = 6,560 units.
Infusion: 18 units/kg/hr × 82 kg = 1,476 units/hr. This
matches option A.
• Why distractors wrong: B is incorrect because infusion
units are per hour not per minute. C is incorrect—1,656
units/hr is 20.2 units/kg/hr, not the ordered 18
units/kg/hr. D is incorrect because it confuses units/hr with
mL/hr; to convert to mL/hr you must use the concentration
(see safety tip).
, • Safety/teaching tip: Always calculate both units/hr and
then convert to mL/hr using the syringe/pump
concentration. Example conversion for concentration in D:
25,000 units in 250 mL = 100 units/mL → 1,476 units/hr ÷
100 units/mL = 14.76 mL/hr (round per facility policy).
Double-check weight-based heparin calculations with an
independent RN verification.
Difficulty: Moderate
Bloom’s: Application
NCLEX: Physiological Integrity — Pharmacological and
Parenteral Therapies
2. A 55-year-old woman with MRSA bacteremia is receiving
vancomycin. Her trough (immediately before dose) returns
as 18 mcg/mL (goal 15–20 mcg/mL). She reports flushing
and pruritus during the infusion yesterday. Which action is
most appropriate now?
A. Continue the same dose; document red-man syndrome
and monitor.
B. Stop infusion, administer diphenhydramine PRN, and
notify prescriber to slow the infusion rate on future doses.
C. Stop vancomycin permanently; start linezolid for MRSA.
D. Increase infusion rate to shorten exposure and prevent
symptoms.
Correct answer: B
,Rationale:
• Why correct: Red-man (or red-neck) syndrome from rapid
vancomycin infusion causes histamine-mediated
flushing/pruritus. Management is to stop infusion for
severe symptoms, give an antihistamine (e.g.,
diphenhydramine), and slow subsequent infusion (no
faster than 60 min for typical doses; for large doses
longer). Trough 18 mcg/mL is within goal for serious
infections.
• Why distractors wrong: A is wrong because active
symptoms require intervention and documentation; simply
continuing risks worsening. C is premature—drug
substitution is reserved for true allergy or failure. D is
wrong—faster infusion increases risk of histamine release.
• Safety/teaching tip: Educate patients that symptoms
typically resolve with slowing infusion and antihistamine.
Always infuse vancomycin per facility rate guidelines and
check troughs as prescribed to balance efficacy and
toxicity.
Difficulty: Easy
Bloom’s: Recall/Application
NCLEX: Physiological Integrity — Pharmacological and
Parenteral Therapies
, 3. A 24-year-old woman presents with severe opioid
overdose after an intentional ingestion of unknown
amounts of extended-release oxycodone. She is apneic and
has pinpoint pupils. You administer naloxone 0.4 mg IV
with minimal response. The team asks for the next step.
Which is most appropriate?
A. Administer naloxone 2 mg IV and prepare for repeated
doses or infusion.
B. Give flumazenil IV to reverse combined benzodiazepine
effects.
C. Start dopamine infusion to treat hypotension from
overdose.
D. Give naloxone 0.1 mg IM and observe.
Correct answer: A
Rationale:
• Why correct: For severe opioid overdose, if initial naloxone
0.4 mg IV yields inadequate response, escalating to 2 mg IV
and being prepared for repeated doses or a continuous
infusion is appropriate—especially with long-
acting/extended-release opioids. Continuous infusion may
be necessary because naloxone’s half-life is shorter than
many opioids.
• Why distractors wrong: B is contraindicated here—
flumazenil reverses benzodiazepines and can precipitate
seizures in mixed overdose. C addresses hypotension but
not the primary opioid receptor antagonism needed. D is
