Pharmacology for Nurses — Practice Quiz

NCLEX-NG formative assessment covering pharmacokinetics, drug math, major drug classes, high-alert medication safety, adverse drug reactions, and case-based medication management for BSN students.

20 questions Pass: 75% 45 min

Question 0 of 20 answered 0%

A nurse is preparing to administer oral warfarin 5 mg to a patient. The patient states they have been eating large amounts of kale, spinach, and broccoli every day this week. The nurse's best response is to:

A Administer the warfarin as ordered and document the patient's dietary history B Hold the warfarin and notify the provider, as vitamin K–rich foods will increase the INR and raise bleeding risk C Administer the warfarin as ordered and teach the patient to maintain a consistent vitamin K intake rather than eliminating these foods D Hold the warfarin until a new INR is obtained and confirm with the provider

A nurse is preparing to administer furosemide 60 mg IV push. Available: furosemide 10 mg/mL. How many mL should the nurse administer?

A 4 mL B 5 mL C 6 mL D 10 mL

An 80-year-old patient with a creatinine clearance of 22 mL/min is prescribed enoxaparin for VTE prophylaxis. The nurse reviews the order and notes the standard prophylactic dose is 40 mg subcut daily. What is the nurse's best action?

A Administer the 40 mg dose as ordered — enoxaparin does not require renal dose adjustment B Hold the enoxaparin and notify the provider that renal dose adjustment is required for CrCl < 30 mL/min C Administer 20 mg subcut daily based on the nurse's own calculation D Switch to unfractionated heparin subcutaneously without a provider order

A nurse is caring for a patient who received morphine 4 mg IV for pain 30 minutes ago. On reassessment, the nurse finds: respiratory rate 8/min, SpO₂ 88%, RASS −3 (difficult to arouse). Which action is the nurse's immediate priority?

A Administer naloxone 0.4–2 mg IV and prepare to support ventilation B Decrease the supplemental oxygen to prevent over-suppression of the hypoxic drive C Obtain a stat ABG to confirm respiratory depression before intervening D Continue monitoring and reassess in 15 minutes as this is expected after IV morphine

A patient is ordered heparin 1,200 units/hour IV continuous infusion. The pharmacy delivers heparin 25,000 units in 500 mL NS. What infusion rate should the nurse program into the IV pump?

A 18 mL/hour B 20 mL/hour C 24 mL/hour D 30 mL/hour

A nurse is administering vancomycin 1 g IV over 60 minutes. Twenty minutes into the infusion, the patient develops diffuse facial flushing, pruritus, and a maculopapular rash across the face and upper torso. The patient denies dyspnea and has stable vital signs. The nurse's best action is to:

A Stop the infusion permanently and document a vancomycin allergy in the medical record B Stop the infusion, notify the provider, and administer diphenhydramine as ordered; plan to restart the infusion at a slower rate after premedication C Administer epinephrine 0.3 mg IM immediately — this is anaphylaxis D Continue the infusion at the same rate since the patient has no dyspnea

A nurse is preparing to administer metformin 1,000 mg PO to a patient scheduled for an abdominal CT scan with IV contrast in two hours. What is the nurse's priority action?

A Administer the metformin as scheduled — IV contrast does not interact with metformin B Hold the metformin and notify the provider and radiology department C Administer the metformin after the CT scan when contrast has cleared D Reduce the dose to 500 mg and administer before the scan

A patient is receiving amiodarone 200 mg PO daily for maintenance of sinus rhythm after atrial fibrillation. Which of the following assessment findings would the nurse prioritize as a potential adverse effect requiring provider notification?

A Patient reports mild constipation B Patient reports a new dry cough that has developed over the past two weeks C Patient's heart rate is 62 bpm D Patient's blood pressure is 112/70 mmHg

The nurse is caring for a patient who weighs 90 kg and is receiving a norepinephrine infusion at 8 mcg/min via an infusion pump. The standard pharmacy concentration is 4 mg norepinephrine in 250 mL D5W. The nurse needs to convert this to mL/hour for pump programming. What is the correct rate?

A 22 mL/hour B 28 mL/hour C 30 mL/hour D 16 mL/hour

A patient is prescribed ciprofloxacin 500 mg PO BID for a urinary tract infection. Which of the following patient education points is the highest priority for the nurse to include?

A Take ciprofloxacin with a full glass of milk to reduce GI upset B Report any tendon pain, swelling, or rupture — especially of the Achilles tendon — and stop the medication immediately C Ciprofloxacin can be safely taken with calcium supplements, antacids, and iron tablets at any time of day D Stop taking the medication once symptoms resolve, even if the full course is not complete

True or false: When administering subcutaneous enoxaparin (Lovenox), the nurse should aspirate the syringe before injecting to confirm the needle is not in a blood vessel.

T True F False

A patient with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium bromide 0.5 mg via nebulizer. The nurse knows that which of the following conditions in this patient's history requires special monitoring during therapy?

A History of seasonal allergies B Benign prostatic hyperplasia (BPH) and narrow-angle glaucoma C History of hypertension currently well controlled on amlodipine D Mild renal insufficiency with eGFR of 55 mL/min

A nurse is reviewing morning laboratory values for a patient on digoxin 0.25 mg PO daily for heart failure with reduced ejection fraction. The results show: Na⁺ 138, K⁺ 3.0 mEq/L, Mg²⁺ 1.4 mg/dL, digoxin level 1.8 ng/mL. The patient reports new nausea, and assessment reveals a heart rate of 52 bpm. What is the nurse's priority action?

A Administer the digoxin as scheduled since the level is within the therapeutic range of 0.5–2.0 ng/mL B Hold the digoxin, notify the provider, and report the hypokalemia, hypomagnesemia, bradycardia, and GI symptoms C Administer potassium chloride 40 mEq PO and then give the digoxin D Obtain a 12-lead ECG and then administer the digoxin if no arrhythmia is detected

A nurse is preparing to administer a dose of IV insulin regular 10 units via a dedicated IV line. Available is a 1:1 concentration (1 unit/mL). Which of the following actions reflects evidence-based safe practice before administration?

A Administer after confirming blood glucose is above 200 mg/dL B Ensure an independent double-check of the insulin type, dose, and concentration has been completed by a second licensed nurse C Document the administration before drawing up the dose to save time during a busy shift D Prepare the insulin in the same syringe as the patient's IV fluids to simplify administration

A patient is starting linezolid for a vancomycin-resistant Enterococcus (VRE) infection. The patient's home medication list includes sertraline 100 mg PO daily (SSRI), tramadol 50 mg PO every 6 hours PRN (weak opioid + SNRI activity), and metoprolol 25 mg PO BID. Which drug interaction requires the most urgent provider notification before starting linezolid?

A Linezolid and metoprolol — risk of severe bradycardia B Linezolid and sertraline — risk of serotonin syndrome due to linezolid's MAOI activity C Linezolid and tramadol — risk of increased tramadol clearance leading to under-treatment D Linezolid and metoprolol — risk of hypertensive crisis

A patient is prescribed phenytoin 300 mg PO daily for seizure prophylaxis. The nurse is reviewing the morning labs and notes a phenytoin level of 22 mcg/mL (therapeutic range: 10–20 mcg/mL). The patient's albumin is 2.1 g/dL (normal: 3.5–5.0 g/dL). What is the nurse's best interpretation of this result?

A The level is toxic and the nurse should hold phenytoin and notify the provider immediately B The level appears elevated but likely represents a normal free (unbound) phenytoin level given the patient's hypoalbuminemia — consult the provider for a free phenytoin level C The level is only slightly above the upper limit; administer the dose and recheck in 24 hours D Phenytoin levels are not affected by albumin; this value is accurate and represents true toxicity

The nurse is preparing to administer acetaminophen 1,000 mg PO to a patient who also received acetaminophen 500 mg as part of a hydrocodone/acetaminophen (Vicodin) tablet 2 hours ago, and has a scheduled dose of acetaminophen 650 mg IV infusing via a piggyback ordered for tonight's temperature. How many total mg of acetaminophen will this patient have received within a 24-hour window if all doses are given as ordered?

A patient with a history of asthma is newly prescribed metoprolol succinate 25 mg PO daily for hypertension. The nurse should:

A Administer the medication as ordered — metoprolol is cardioselective and is safe for all asthma patients B Hold the medication and notify the provider, as all beta-blockers are absolutely contraindicated in asthma C Administer the medication as ordered but monitor closely for bronchospasm, and ensure the patient's rescue inhaler is accessible and the provider is aware of the asthma history D Substitute a calcium channel blocker for metoprolol without a provider order, as CCBs are preferred in asthma

A nurse administers a scheduled dose of metoclopramide to a patient who has been receiving it three times daily for eight weeks for gastroparesis. On assessment, the nurse notices new repetitive, involuntary lip-smacking movements and tongue protrusion. The nurse's priority action is to:

A Document the findings and continue the medication as ordered B Hold the metoclopramide, notify the provider, and document the finding as a potential tardive dyskinesia adverse effect C Administer diphenhydramine to treat the extrapyramidal symptoms and continue metoclopramide D Reassess in 4 hours to determine if the movements are transient before notifying the provider

A nurse is educating a patient newly prescribed apixaban (Eliquis) for atrial fibrillation. Which of the following statements by the patient indicates a need for further teaching?

A 'I should tell my dentist that I take apixaban before any dental procedures.' B 'I will need to get my blood checked weekly to make sure the medication is at the right level.' C 'If I notice blood in my urine or have unusual bruising, I should contact my provider.' D 'I should not take ibuprofen or aspirin without talking to my provider first.'

Pharmacology for Nurses — Practice Quiz

Review Your Answers