High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with type 2 diabetes is prescribed
neutral protamine Hagedorn (NPH) insulin 15 units
subcutaneous daily every morning. The nurse should instruct
the patient that the most likely time for a hypoglycemic
reaction to occur is:
A) 2-4 hours after administration.
B) 6-8 hours after administration.
C) 12-16 hours after administration.
D) Immediately after administration.
Correct Answer: B
Rationale: NPH insulin is an intermediate-acting insulin with an
onset of 1-2 hours, a peak of 4-12 hours (with the most
common peak effect around 6-8 hours), and a duration of 12-18
hours. Hypoglycemic reactions are most likely to occur at the
time of peak action. Option A describes the peak time for rapid-
acting insulins (e.g., lispro). Option C describes the total
duration of action, not the peak. Option D is incorrect as no
insulin type acts immediately; rapid-acting insulins have an
onset of about 15 minutes.
Clinical Safety Tip: Teach patients to recognize the signs of
hypoglycemia (shakiness, diaphoresis, confusion) and to always
have a fast-acting carbohydrate source, like 4 oz of fruit juice or
glucose tablets, readily available, especially during peak insulin
times.
,Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Medication Administration
2) A postoperative patient is receiving a morphine sulfate
patient-controlled analgesia (PCA) pump. The nurse enters the
room and finds the patient somnolent with a respiratory rate of
8 breaths/minute. Which action should the nurse take first?
A) Administer prescribed naloxone.
B) Stimulate the patient by calling their name and shaking their
shoulder.
C) Discontinue the PCA infusion.
D) Obtain a pulse oximetry reading.
Correct Answer: B
Rationale: The first action should always be to stimulate the
patient, as this may be sufficient to increase the respiratory rate
and arousal level without immediately requiring
pharmacological reversal. This is a non-invasive, rapid first step.
While naloxone (A) is the antidote, it should be administered
only if respiratory depression persists after stimulation, as it will
precipitate acute withdrawal and reverse analgesia.
Discontinuing the PCA (C) is important but not the immediate
first step for patient safety. Obtaining a pulse ox reading (D) is
an assessment action, but the low respiratory rate is already
confirmed, and action is required.
,Clinical Safety Tip: When using opioid PCA pumps, always
ensure the patient is the only one pressing the button. Family
members or nurses administering doses for the patient
significantly increases the risk of oversedation and respiratory
depression.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Adverse Effects/Contraindications
3) A provider orders digoxin 0.125 mg IV daily for a patient with
heart failure. The pharmacy supplies digoxin in a vial with a
concentration of 0.25 mg/mL. How many mL should the nurse
draw up for one dose?
A) 0.5 mL
B) 1.0 mL
C) 1.5 mL
D) 2.0 mL
Correct Answer: A
Rationale: This is a simple dosage calculation. Use the formula:
Dose desired / Dose on hand × Volume = mL to administer.
0.125 mg / 0.25 mg × 1 mL = 0.5 mL. The other options result
from mathematical errors (e.g., 1.0 mL would be the volume for
a 0.25 mg dose).
Clinical Safety Tip: Always double-check digoxin doses with a
, second nurse before administration due to its narrow
therapeutic index. Always assess the apical pulse for one full
minute before giving digoxin; hold the dose and notify the
provider if the pulse is less than 60 bpm in an adult.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Dosage Calculation
4) A patient with a history of bipolar disorder taking lithium is
admitted with diarrhea, coarse hand tremors, and confusion.
The nurse anticipates that the provider will order which of the
following?
A) Measurement of serum lithium level
B) An increase in lithium dosage
C) Administration of activated charcoal
D) Immediate hemodialysis
Correct Answer: A
Rationale: The symptoms described (diarrhea, coarse tremors,
confusion) are classic signs of lithium toxicity. The first and
most critical step is to confirm toxicity by checking the serum
lithium level. Hemodialysis (D) may be necessary for severe
toxicity but is not the first order; it is initiated based on the
serum level and clinical presentation. Increasing the dose (B)
would be catastrophic. Activated charcoal (C) is not effective for
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with type 2 diabetes is prescribed
neutral protamine Hagedorn (NPH) insulin 15 units
subcutaneous daily every morning. The nurse should instruct
the patient that the most likely time for a hypoglycemic
reaction to occur is:
A) 2-4 hours after administration.
B) 6-8 hours after administration.
C) 12-16 hours after administration.
D) Immediately after administration.
Correct Answer: B
Rationale: NPH insulin is an intermediate-acting insulin with an
onset of 1-2 hours, a peak of 4-12 hours (with the most
common peak effect around 6-8 hours), and a duration of 12-18
hours. Hypoglycemic reactions are most likely to occur at the
time of peak action. Option A describes the peak time for rapid-
acting insulins (e.g., lispro). Option C describes the total
duration of action, not the peak. Option D is incorrect as no
insulin type acts immediately; rapid-acting insulins have an
onset of about 15 minutes.
Clinical Safety Tip: Teach patients to recognize the signs of
hypoglycemia (shakiness, diaphoresis, confusion) and to always
have a fast-acting carbohydrate source, like 4 oz of fruit juice or
glucose tablets, readily available, especially during peak insulin
times.
,Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Medication Administration
2) A postoperative patient is receiving a morphine sulfate
patient-controlled analgesia (PCA) pump. The nurse enters the
room and finds the patient somnolent with a respiratory rate of
8 breaths/minute. Which action should the nurse take first?
A) Administer prescribed naloxone.
B) Stimulate the patient by calling their name and shaking their
shoulder.
C) Discontinue the PCA infusion.
D) Obtain a pulse oximetry reading.
Correct Answer: B
Rationale: The first action should always be to stimulate the
patient, as this may be sufficient to increase the respiratory rate
and arousal level without immediately requiring
pharmacological reversal. This is a non-invasive, rapid first step.
While naloxone (A) is the antidote, it should be administered
only if respiratory depression persists after stimulation, as it will
precipitate acute withdrawal and reverse analgesia.
Discontinuing the PCA (C) is important but not the immediate
first step for patient safety. Obtaining a pulse ox reading (D) is
an assessment action, but the low respiratory rate is already
confirmed, and action is required.
,Clinical Safety Tip: When using opioid PCA pumps, always
ensure the patient is the only one pressing the button. Family
members or nurses administering doses for the patient
significantly increases the risk of oversedation and respiratory
depression.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Adverse Effects/Contraindications
3) A provider orders digoxin 0.125 mg IV daily for a patient with
heart failure. The pharmacy supplies digoxin in a vial with a
concentration of 0.25 mg/mL. How many mL should the nurse
draw up for one dose?
A) 0.5 mL
B) 1.0 mL
C) 1.5 mL
D) 2.0 mL
Correct Answer: A
Rationale: This is a simple dosage calculation. Use the formula:
Dose desired / Dose on hand × Volume = mL to administer.
0.125 mg / 0.25 mg × 1 mL = 0.5 mL. The other options result
from mathematical errors (e.g., 1.0 mL would be the volume for
a 0.25 mg dose).
Clinical Safety Tip: Always double-check digoxin doses with a
, second nurse before administration due to its narrow
therapeutic index. Always assess the apical pulse for one full
minute before giving digoxin; hold the dose and notify the
provider if the pulse is less than 60 bpm in an adult.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies;
Dosage Calculation
4) A patient with a history of bipolar disorder taking lithium is
admitted with diarrhea, coarse hand tremors, and confusion.
The nurse anticipates that the provider will order which of the
following?
A) Measurement of serum lithium level
B) An increase in lithium dosage
C) Administration of activated charcoal
D) Immediate hemodialysis
Correct Answer: A
Rationale: The symptoms described (diarrhea, coarse tremors,
confusion) are classic signs of lithium toxicity. The first and
most critical step is to confirm toxicity by checking the serum
lithium level. Hemodialysis (D) may be necessary for severe
toxicity but is not the first order; it is initiated based on the
serum level and clinical presentation. Increasing the dose (B)
would be catastrophic. Activated charcoal (C) is not effective for
