High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1. Clinical vignette: A 62-year-old man with hypertension and
CKD stage 3 is started on lisinopril 10 mg PO daily. Which
finding is most important for the nurse to monitor before
the second dose?
A. Serum potassium 5.6 mEq/L
B. Blood pressure 150/88 mm Hg
C. Cough that started yesterday
D. Serum creatinine 1.3 mg/dL
Correct answer: A
Rationale:
• Why correct: ACE inhibitors (like lisinopril) can cause
hyperkalemia by decreasing aldosterone; a serum K of 5.6
mEq/L is clinically significant and increases risk for life-
threatening arrhythmias. The nurse should hold the dose
and notify the provider.
• Why distractors are wrong: Elevated BP (150/88) is
expected initially and not as immediately dangerous as
hyperkalemia. A new cough is a known side effect but not
an acute life threat. Serum creatinine 1.3 mg/dL may be
acceptable for CKD stage 3 and is less urgent than K >5.5.
• Safety/teaching tip: Teach the patient to avoid high-
potassium salt substitutes and report palpitations or
, muscle weakness; monitor K periodically after ACE
inhibitor initiation.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity — Pharmacological and Parenteral Therapies
(Medication monitoring)
2. Clinical vignette: A 34-year-old female with a severe MRSA
wound infection is receiving IV vancomycin. Which sign
most suggests the need to assess infusion rate and stop
the infusion if necessary?
A. Systolic BP increase from 118 to 130 mm Hg
B. New wheezing and flushing of the face and neck
C. Serum creatinine rise from 0.8 to 1.0 mg/dL
D. Mild nausea after infusion
Correct answer: B
Rationale:
• Why correct: Red man (or red neck) syndrome — flushing,
pruritus, hypotension, wheezing — is associated with rapid
vancomycin infusion. The infusion should be stopped or
slowed and antihistamines given if needed.
• Why distractors are wrong: A modest BP increase isn’t
typical for vancomycin infusion reaction. A small rise in
, creatinine should prompt monitoring but is not an acute
infusion reaction. Mild nausea is nonspecific.
• Safety/teaching tip: Infuse vancomycin over at least 60
minutes (longer for larger doses) and monitor for
flushing/respiratory changes; premedicate with
antihistamine if previous reaction occurred.
Difficulty: Easy
Bloom’s taxonomy level: Recall
NCLEX client need category + subcategory: Physiological
Integrity — Pharmacological and Parenteral Therapies (Adverse
effects/complications)
3. Clinical vignette: A postoperative patient on a morphine
PCA begins to have respiratory rate 6 breaths/min and
SpO₂ 86% on room air. The provider orders naloxone 0.4
mg IV push. Which is the nurse’s best immediate action?
A. Give naloxone 0.4 mg IV push and reassess respiratory
status.
B. Reposition the patient and provide oxygen at 2 L/min via
nasal cannula.
C. Hold the PCA and notify the provider without giving
naloxone.
D. Administer flumazenil IV to reverse sedation.
Correct answer: A
Rationale:
, • Why correct: The patient shows opioid-induced respiratory
depression (low RR, hypoxia). Naloxone is the opioid
antagonist of choice; 0.4 mg IV is an appropriate initial
dose for severe respiratory depression. Give promptly and
reassess.
• Why distractors are wrong: Repositioning and oxygen may
help but do not reverse opioid receptor effects. Holding
PCA and notifying provider wastes critical time. Flumazenil
reverses benzodiazepines, not opioids.
• Safety/teaching tip: After naloxone, monitor closely for
recurrence of respiratory depression (short naloxone
duration vs. long-acting opioid) and be prepared to repeat
doses or start continuous infusion per provider.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity — Reduction of Risk Potential (Acute care/antidotes)
4. Clinical vignette: A 28-year-old female on sertraline for
depression reports agitation, fever, tachycardia, and
tremor after starting linezolid for an infection. Which is the
most appropriate nursing interpretation?
A. The patient has serotonin syndrome from combined
serotonergic agents.
B. The patient is having an allergic reaction to linezolid.
Pharmacology Mastery Test Bank: Medications & Dosages
1. Clinical vignette: A 62-year-old man with hypertension and
CKD stage 3 is started on lisinopril 10 mg PO daily. Which
finding is most important for the nurse to monitor before
the second dose?
A. Serum potassium 5.6 mEq/L
B. Blood pressure 150/88 mm Hg
C. Cough that started yesterday
D. Serum creatinine 1.3 mg/dL
Correct answer: A
Rationale:
• Why correct: ACE inhibitors (like lisinopril) can cause
hyperkalemia by decreasing aldosterone; a serum K of 5.6
mEq/L is clinically significant and increases risk for life-
threatening arrhythmias. The nurse should hold the dose
and notify the provider.
• Why distractors are wrong: Elevated BP (150/88) is
expected initially and not as immediately dangerous as
hyperkalemia. A new cough is a known side effect but not
an acute life threat. Serum creatinine 1.3 mg/dL may be
acceptable for CKD stage 3 and is less urgent than K >5.5.
• Safety/teaching tip: Teach the patient to avoid high-
potassium salt substitutes and report palpitations or
, muscle weakness; monitor K periodically after ACE
inhibitor initiation.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity — Pharmacological and Parenteral Therapies
(Medication monitoring)
2. Clinical vignette: A 34-year-old female with a severe MRSA
wound infection is receiving IV vancomycin. Which sign
most suggests the need to assess infusion rate and stop
the infusion if necessary?
A. Systolic BP increase from 118 to 130 mm Hg
B. New wheezing and flushing of the face and neck
C. Serum creatinine rise from 0.8 to 1.0 mg/dL
D. Mild nausea after infusion
Correct answer: B
Rationale:
• Why correct: Red man (or red neck) syndrome — flushing,
pruritus, hypotension, wheezing — is associated with rapid
vancomycin infusion. The infusion should be stopped or
slowed and antihistamines given if needed.
• Why distractors are wrong: A modest BP increase isn’t
typical for vancomycin infusion reaction. A small rise in
, creatinine should prompt monitoring but is not an acute
infusion reaction. Mild nausea is nonspecific.
• Safety/teaching tip: Infuse vancomycin over at least 60
minutes (longer for larger doses) and monitor for
flushing/respiratory changes; premedicate with
antihistamine if previous reaction occurred.
Difficulty: Easy
Bloom’s taxonomy level: Recall
NCLEX client need category + subcategory: Physiological
Integrity — Pharmacological and Parenteral Therapies (Adverse
effects/complications)
3. Clinical vignette: A postoperative patient on a morphine
PCA begins to have respiratory rate 6 breaths/min and
SpO₂ 86% on room air. The provider orders naloxone 0.4
mg IV push. Which is the nurse’s best immediate action?
A. Give naloxone 0.4 mg IV push and reassess respiratory
status.
B. Reposition the patient and provide oxygen at 2 L/min via
nasal cannula.
C. Hold the PCA and notify the provider without giving
naloxone.
D. Administer flumazenil IV to reverse sedation.
Correct answer: A
Rationale:
, • Why correct: The patient shows opioid-induced respiratory
depression (low RR, hypoxia). Naloxone is the opioid
antagonist of choice; 0.4 mg IV is an appropriate initial
dose for severe respiratory depression. Give promptly and
reassess.
• Why distractors are wrong: Repositioning and oxygen may
help but do not reverse opioid receptor effects. Holding
PCA and notifying provider wastes critical time. Flumazenil
reverses benzodiazepines, not opioids.
• Safety/teaching tip: After naloxone, monitor closely for
recurrence of respiratory depression (short naloxone
duration vs. long-acting opioid) and be prepared to repeat
doses or start continuous infusion per provider.
Difficulty: Moderate
Bloom’s taxonomy level: Application
NCLEX client need category + subcategory: Physiological
Integrity — Reduction of Risk Potential (Acute care/antidotes)
4. Clinical vignette: A 28-year-old female on sertraline for
depression reports agitation, fever, tachycardia, and
tremor after starting linezolid for an infection. Which is the
most appropriate nursing interpretation?
A. The patient has serotonin syndrome from combined
serotonergic agents.
B. The patient is having an allergic reaction to linezolid.
