High-Yield NCLEX-RN Test Bank
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with heart failure is admitted with
acute decompensation. Their home medications include
lisinopril 20 mg daily, furosemide 40 mg daily, and metoprolol
succinate 50 mg daily. On assessment, the nurse notes a
respiratory rate of 28/min, SpO2 90% on room air, bibasilar
crackles, and +3 pitting edema in the lower extremities. The
healthcare provider initiates an IV infusion of furosemide 10
mg/hr. The pharmacy delivers a 250 mL bag of D5W containing
250 mg of furosemide. At what rate (mL/hr) should the nurse
set the infusion pump?
A) 5 mL/hr
B) 10 mL/hr
C) 15 mL/hr
D) 20 mL/hr
Correct Answer: B) 10 mL/hr
Rationale: The correct rate is calculated by first determining the
concentration of the solution: 250 mg / 250 mL = 1 mg/mL. The
prescribed dose is 10 mg/hr. To deliver 10 mg per hour using a 1
mg/mL solution, the nurse must set the pump to 10 mL/hr (10
mg/hr ÷ 1 mg/mL = 10 mL/hr). Distractor A is incorrect as it
would only deliver 5 mg/hr. Distractor C (15 mL/hr) would
deliver 15 mg/hr, and distractor D (20 mL/hr) would deliver 20
mg/hr, both exceeding the prescribed dose and increasing the
risk of dehydration and electrolyte imbalances. A key clinical
,safety tip for administering IV loop diuretics is to monitor the
patient's urine output, electrolytes (particularly potassium and
sodium), and blood pressure closely to prevent acute kidney
injury and hypotension.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
2) A 25-year-old female is prescribed sumatriptan 6 mg
subcutaneously for an acute migraine. The medication is
available in a prefilled auto-injector containing 6 mg/0.5 mL.
Which patient statement indicates a need for further teaching
about this medication?
A) "I will inject this into the fatty tissue of my thigh."
B) "I should use this at the first sign of a migraine headache."
C) "If the first dose doesn't work, I can give a second injection in
one hour."
D) "This medication might make me feel flushed or dizzy for a
short time."
Correct Answer: C) "If the first dose doesn't work, I can give a
second injection in one hour."
Rationale: The correct answer is C because the dosing
instructions for sumatriptan state that if there is no response to
the first dose, a second dose may be considered, but not until at
least 1 hour has passed for the subcutaneous formulation;
however, the maximum subcutaneous dose in 24 hours is 12
,mg, and repeating it in one hour could risk exceeding this limit
and is not standard advice without provider consultation.
Option A is correct technique for a subcutaneous injection.
Option B is correct, as triptans are most effective when used
early in a migraine attack. Option D is correct, as feelings of
chest pressure, flushing, dizziness, and injection site reactions
are common, transient side effects. The nurse should teach the
patient about the risk of medication-overuse headaches and
the contraindication of using triptans in patients with
uncontrolled hypertension or coronary artery disease.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Medication Administration
3) A nurse is caring for a patient receiving a continuous IV
heparin infusion for a pulmonary embolism. The protocol
specifies a therapeutic goal of an aPTT of 60-80 seconds. The
patient's current aPTT is 45 seconds. Which action should the
nurse take?
A) Continue the infusion at the current rate.
B) Increase the infusion rate per the protocol.
C) Decrease the infusion rate per the protocol.
D) Stop the infusion and notify the provider.
Correct Answer: B) Increase the infusion rate per the protocol.
Rationale: An aPTT of 45 seconds is subtherapeutic for most
protocols (goal typically 1.5-2.5 times the control value).
, Therefore, the standard heparin protocol would dictate an
increase in the infusion rate to achieve therapeutic
anticoagulation and prevent further clot extension. Continuing
the current rate (A) would maintain a subtherapeutic and
ineffective level. Decreasing the rate (C) would make the aPTT
even lower. Stopping the infusion (D) is not indicated for a
subtherapeutic value and would leave the patient unprotected
against clot propagation. The nurse must be proficient in
following institution-specific IV heparin protocols, which include
rate adjustments based on aPTT results and frequent
monitoring for signs of bleeding.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Expected Actions/Outcomes
4) A patient with type 1 diabetes mellitus is ordered 10 units of
regular insulin subcutaneous now. The available vial is labeled
U-100. Which syringe must the nurse use?
A) A 1 mL syringe
B) A tuberculin syringe
C) A 3 mL syringe
D) A U-100 insulin syringe
Correct Answer: D) A U-100 insulin syringe
Rationale: U-100 insulin must always be drawn up in a U-100
insulin syringe to ensure accurate dosing. These syringes are
specifically calibrated for U-100 concentration (100 units per 1
Pharmacology Mastery Test Bank: Medications & Dosages
1) A 68-year-old patient with heart failure is admitted with
acute decompensation. Their home medications include
lisinopril 20 mg daily, furosemide 40 mg daily, and metoprolol
succinate 50 mg daily. On assessment, the nurse notes a
respiratory rate of 28/min, SpO2 90% on room air, bibasilar
crackles, and +3 pitting edema in the lower extremities. The
healthcare provider initiates an IV infusion of furosemide 10
mg/hr. The pharmacy delivers a 250 mL bag of D5W containing
250 mg of furosemide. At what rate (mL/hr) should the nurse
set the infusion pump?
A) 5 mL/hr
B) 10 mL/hr
C) 15 mL/hr
D) 20 mL/hr
Correct Answer: B) 10 mL/hr
Rationale: The correct rate is calculated by first determining the
concentration of the solution: 250 mg / 250 mL = 1 mg/mL. The
prescribed dose is 10 mg/hr. To deliver 10 mg per hour using a 1
mg/mL solution, the nurse must set the pump to 10 mL/hr (10
mg/hr ÷ 1 mg/mL = 10 mL/hr). Distractor A is incorrect as it
would only deliver 5 mg/hr. Distractor C (15 mL/hr) would
deliver 15 mg/hr, and distractor D (20 mL/hr) would deliver 20
mg/hr, both exceeding the prescribed dose and increasing the
risk of dehydration and electrolyte imbalances. A key clinical
,safety tip for administering IV loop diuretics is to monitor the
patient's urine output, electrolytes (particularly potassium and
sodium), and blood pressure closely to prevent acute kidney
injury and hypotension.
Difficulty: Moderate
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Dosage Calculation
2) A 25-year-old female is prescribed sumatriptan 6 mg
subcutaneously for an acute migraine. The medication is
available in a prefilled auto-injector containing 6 mg/0.5 mL.
Which patient statement indicates a need for further teaching
about this medication?
A) "I will inject this into the fatty tissue of my thigh."
B) "I should use this at the first sign of a migraine headache."
C) "If the first dose doesn't work, I can give a second injection in
one hour."
D) "This medication might make me feel flushed or dizzy for a
short time."
Correct Answer: C) "If the first dose doesn't work, I can give a
second injection in one hour."
Rationale: The correct answer is C because the dosing
instructions for sumatriptan state that if there is no response to
the first dose, a second dose may be considered, but not until at
least 1 hour has passed for the subcutaneous formulation;
however, the maximum subcutaneous dose in 24 hours is 12
,mg, and repeating it in one hour could risk exceeding this limit
and is not standard advice without provider consultation.
Option A is correct technique for a subcutaneous injection.
Option B is correct, as triptans are most effective when used
early in a migraine attack. Option D is correct, as feelings of
chest pressure, flushing, dizziness, and injection site reactions
are common, transient side effects. The nurse should teach the
patient about the risk of medication-overuse headaches and
the contraindication of using triptans in patients with
uncontrolled hypertension or coronary artery disease.
Difficulty: Moderate
Bloom's: Analysis
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Medication Administration
3) A nurse is caring for a patient receiving a continuous IV
heparin infusion for a pulmonary embolism. The protocol
specifies a therapeutic goal of an aPTT of 60-80 seconds. The
patient's current aPTT is 45 seconds. Which action should the
nurse take?
A) Continue the infusion at the current rate.
B) Increase the infusion rate per the protocol.
C) Decrease the infusion rate per the protocol.
D) Stop the infusion and notify the provider.
Correct Answer: B) Increase the infusion rate per the protocol.
Rationale: An aPTT of 45 seconds is subtherapeutic for most
protocols (goal typically 1.5-2.5 times the control value).
, Therefore, the standard heparin protocol would dictate an
increase in the infusion rate to achieve therapeutic
anticoagulation and prevent further clot extension. Continuing
the current rate (A) would maintain a subtherapeutic and
ineffective level. Decreasing the rate (C) would make the aPTT
even lower. Stopping the infusion (D) is not indicated for a
subtherapeutic value and would leave the patient unprotected
against clot propagation. The nurse must be proficient in
following institution-specific IV heparin protocols, which include
rate adjustments based on aPTT results and frequent
monitoring for signs of bleeding.
Difficulty: Easy
Bloom's: Application
NCLEX Client Need: Pharmacological and Parenteral Therapies:
Expected Actions/Outcomes
4) A patient with type 1 diabetes mellitus is ordered 10 units of
regular insulin subcutaneous now. The available vial is labeled
U-100. Which syringe must the nurse use?
A) A 1 mL syringe
B) A tuberculin syringe
C) A 3 mL syringe
D) A U-100 insulin syringe
Correct Answer: D) A U-100 insulin syringe
Rationale: U-100 insulin must always be drawn up in a U-100
insulin syringe to ensure accurate dosing. These syringes are
specifically calibrated for U-100 concentration (100 units per 1
