53 Pharmacology Practice Questions & Answers
Every Pharmacology practice question from the NCLEX-RN Practice Test, with the correct answer and a short explanation.
Start practice test →1. A patient is prescribed metoprolol, a beta-blocker. Before giving the dose the nurse checks the apical pulse. Which finding should cause the nurse to HOLD the medication and notify the provider?
- A.Blood pressure 128/78 mm Hg
- B.Apical heart rate of 52 beats/min✓ Answer
- C.Temperature 98.6°F (37°C)
- D.Respiratory rate of 18 breaths/min
Beta-blockers (-olol) lower heart rate and blood pressure, so the nurse holds the dose when the apical pulse is below 60 beats/min or systolic BP is below 90 mm Hg to prevent symptomatic bradycardia and hypotension.
Source: U.S. nursing pharmacology standard: hold beta-blocker if apical HR <60 bpm or SBP <90 mm HgReport a problem with this question
2. A patient taking lisinopril reports a persistent dry cough. What is the nurse's BEST interpretation?
- A.This is an expected therapeutic effect that requires no action
- B.This indicates the drug is not working and the dose should be doubled
- C.This is a sign of an allergic reaction requiring epinephrine
- D.This is a known adverse effect of ACE inhibitors and should be reported to the provider✓ Answer
ACE inhibitors (-pril) increase bradykinin, which commonly causes a persistent dry cough; it is an adverse effect that should be reported, as the provider often switches the patient to an ARB (-sartan).
Source: FDA labeling, ACE inhibitor class: dry cough from bradykinin accumulationReport a problem with this question
3. A patient started on atorvastatin should be taught to promptly report which symptom?
- A.Increased appetite
- B.Occasional dry mouth
- C.Mild constipation
- D.Unexplained muscle pain, tenderness, or weakness✓ Answer
Statins (-statin) can cause myopathy that may progress to rhabdomyolysis; unexplained muscle pain, tenderness, or weakness must be reported so creatine kinase can be checked and the drug stopped if needed.
Source: FDA statin class labeling: myopathy/rhabdomyolysis warningReport a problem with this question
4. A patient has taken oral prednisone daily for several months. Which instruction is essential when the drug is being discontinued?
- A.The dose should be doubled on the last day
- B.The drug may be stopped immediately once symptoms improve
- C.The dose must be tapered gradually, never stopped abruptly✓ Answer
- D.Alcohol should be increased to speed clearance
Corticosteroids (-sone) suppress the adrenal axis; abrupt withdrawal after prolonged use can trigger acute adrenal insufficiency, so the dose must be tapered to let the adrenal glands resume cortisol production.
Source: FDA corticosteroid labeling: taper to avoid adrenal insufficiencyReport a problem with this question
5. A patient with type 2 diabetes taking metformin is scheduled for a CT scan with IV iodinated contrast. What is the priority nursing action?
- A.Encourage the patient to fast for 24 hours after the scan
- B.Withhold metformin around the time of contrast administration per protocol✓ Answer
- C.No action is needed; metformin does not interact with contrast
- D.Give an extra dose of metformin before the scan
Iodinated contrast can impair renal function, and metformin cleared by the kidneys can then accumulate and cause lactic acidosis, so metformin is withheld around contrast administration per institutional protocol.
Source: FDA metformin labeling: withhold with iodinated contrast (lactic acidosis risk)Report a problem with this question
6. How should the nurse instruct a patient to take levothyroxine?
- A.In the morning on an empty stomach, 30–60 minutes before breakfast✓ Answer
- B.At bedtime with a high-fat snack
- C.Only when feeling fatigued
- D.With calcium supplements to improve absorption
Levothyroxine absorption is reduced by food and by calcium or iron, so it is taken in the morning on an empty stomach 30–60 minutes before eating and consistently to maintain stable thyroid levels.
Source: FDA levothyroxine labeling: empty-stomach morning dosingReport a problem with this question
7. A patient uses both an albuterol inhaler and an inhaled corticosteroid. What is the correct sequence and follow-up?
- A.Use the corticosteroid first, then albuterol, and avoid rinsing
- B.Use the corticosteroid before exercise for quick relief
- C.Use only one inhaler per day to prevent overdose
- D.Use albuterol first, then the corticosteroid, and rinse the mouth afterward✓ Answer
The bronchodilator albuterol is used first to open the airways so the corticosteroid is better deposited; rinsing the mouth after the steroid prevents oral candidiasis (thrush).
Source: Respiratory inhaler technique standard: bronchodilator first, rinse after steroidReport a problem with this question
8. A patient asks how omeprazole helps their gastroesophageal reflux. Which explanation reflects the drug's therapeutic action?
- A.It coats and physically protects the esophagus
- B.It blocks the gastric proton pump, reducing stomach acid production✓ Answer
- C.It speeds gastric emptying to move acid downward
- D.It neutralizes acid instantly like an antacid
Proton pump inhibitors (-prazole) irreversibly inhibit the H+/K+ ATPase proton pump of gastric parietal cells, decreasing acid secretion; unlike antacids they do not neutralize existing acid instantly.
Source: FDA PPI class labeling: mechanism of gastric acid suppressionReport a problem with this question
9. Before giving digoxin, the nurse counts the apical pulse for one full minute and obtains 54 beats/min. What is the priority action?
- A.Hold the dose and notify the provider✓ Answer
- B.Give the dose with orange juice to raise the pulse
- C.Give half the dose and recheck in one hour
- D.Give the dose as ordered
Digoxin slows the heart rate, so the nurse holds the dose when the apical pulse is below 60 beats/min in an adult and notifies the provider, because giving it could cause dangerous bradycardia.
Source: High-alert drug standard: hold digoxin if adult apical pulse <60 bpmReport a problem with this question
10. A patient on digoxin reports nausea and seeing yellow-green halos around lights. These findings most likely indicate:
- A.A caffeine reaction
- B.Improved cardiac output
- C.Digoxin toxicity✓ Answer
- D.Normal expected side effects
Classic signs of digoxin toxicity include nausea, vomiting, and visual disturbances such as yellow-green vision or halos; the nurse should hold the drug, check the digoxin level and potassium, and notify the provider.
Source: Digoxin toxicity: GI symptoms + yellow-green/halo visual disturbanceReport a problem with this question
11. Which laboratory value would increase a patient's risk for digoxin toxicity?
- A.Potassium 4.2 mEq/L
- B.Calcium 9.0 mg/dL
- C.Sodium 140 mEq/L
- D.Potassium 2.9 mEq/L (hypokalemia)✓ Answer
Hypokalemia potentiates digoxin binding at its site of action and increases the risk of toxicity, which is why patients on both digoxin and potassium-wasting diuretics need close potassium monitoring.
Source: Digoxin–hypokalemia interaction: increased toxicity riskReport a problem with this question
12. A patient is receiving a continuous IV heparin infusion. Which laboratory test and antidote does the nurse associate with this drug?
- A.Digoxin level for monitoring; digoxin immune Fab as the antidote
- B.Blood glucose for monitoring; glucagon as the antidote
- C.aPTT for monitoring; protamine sulfate as the antidote✓ Answer
- D.INR for monitoring; vitamin K as the antidote
IV heparin is monitored with the aPTT (goal usually 1.5–2.5 times control) or anti-Xa level, and its specific reversal agent is protamine sulfate.
Source: Anticoagulant standard: heparin monitored by aPTT/anti-Xa, antidote protamine sulfateReport a problem with this question
13. A patient on warfarin has an INR of 2.4 for atrial fibrillation. Which statement is correct?
- A.This value indicates warfarin overdose requiring protamine
- B.The INR is irrelevant for warfarin monitoring
- C.This is dangerously low and heparin should be added immediately
- D.This is within the usual therapeutic range (about 2–3); vitamin K is the antidote✓ Answer
Warfarin is monitored by PT/INR, with a common therapeutic goal of about 2–3 for atrial fibrillation; vitamin K (phytonadione) reverses warfarin, while protamine reverses heparin.
Source: Anticoagulant standard: warfarin INR goal ~2–3, antidote vitamin KReport a problem with this question
14. Which dietary teaching is most appropriate for a patient taking warfarin?
- A.Take an extra warfarin dose after eating salad
- B.Eat as many leafy greens as possible to boost clotting
- C.Keep intake of vitamin K–rich green vegetables consistent from day to day✓ Answer
- D.Completely eliminate all green vegetables from the diet
Vitamin K antagonizes warfarin, so wide swings in intake of green leafy vegetables destabilize the INR; patients should keep vitamin K intake consistent rather than eliminate it.
Source: Warfarin–vitamin K interaction: maintain consistent dietary vitamin KReport a problem with this question
15. A patient on lithium has a level of 1.8 mEq/L and reports coarse tremor, ataxia, and confusion. What do these findings indicate?
- A.Lithium toxicity✓ Answer
- B.Hypoglycemia
- C.A common cold
- D.Therapeutic response
The therapeutic lithium range is about 0.6–1.2 mEq/L; a level of 1.8 mEq/L with coarse tremor, ataxia, and confusion signals toxicity, and the nurse should hold the drug and notify the provider.
Source: Lithium therapeutic range 0.6–1.2 mEq/L; >1.5 mEq/L toxicReport a problem with this question
16. Which teaching is essential for a patient starting lithium?
- A.Maintain consistent sodium and fluid intake and stay hydrated✓ Answer
- B.Follow a strict low-sodium crash diet
- C.Skip doses on hot days to avoid buildup
- D.Restrict all fluids to less than 500 mL per day
Lithium is handled by the kidney like sodium, so low sodium or dehydration causes lithium retention and toxicity; patients must keep sodium and fluid intake stable and stay well hydrated.
Source: Lithium safety: stable sodium/hydration prevents toxicityReport a problem with this question
17. An order reads: potassium chloride 20 mEq IV. The nurse notes it does not specify dilution. What is the correct nursing action?
- A.Give it undiluted but slowly over five minutes
- B.Administer it intramuscularly instead
- C.Never give potassium by IV push; clarify the order and infuse it diluted via pump✓ Answer
- D.Give it as a rapid IV push to correct potassium quickly
IV potassium is a high-alert drug that must never be given by IV push because it can cause fatal cardiac arrest; it must always be diluted and infused slowly via a pump (peripheral max about 10 mEq/hr).
Source: High-alert drug rule: IV potassium never by IV pushReport a problem with this question
18. A patient is receiving IV gentamicin, an aminoglycoside. Which assessments are the priority for monitoring toxicity?
- A.Thyroid levels and weight
- B.Renal function (creatinine) and hearing/balance✓ Answer
- C.Blood glucose and vision
- D.INR and gum bleeding
Aminoglycosides (-mycin such as gentamicin) are nephrotoxic and ototoxic, so the nurse monitors renal function and signs of hearing loss or balance problems, along with peak and trough levels.
Source: Aminoglycoside class: nephrotoxicity and ototoxicity monitoringReport a problem with this question
19. A patient starting ciprofloxacin should be taught to report which musculoskeletal symptom?
- A.Mild transient headache
- B.Warmth at the site of a healed scar
- C.Bruising after minor bumps
- D.Sudden pain, swelling, or a snap in a tendon such as the Achilles✓ Answer
Fluoroquinolones (-floxacin) carry a black-box warning for tendinitis and tendon rupture, most often the Achilles; sudden tendon pain or swelling should be reported and the drug stopped.
Source: FDA fluoroquinolone black-box warning: tendon ruptureReport a problem with this question
20. A patient taking an MAOI antidepressant is at risk for a hypertensive crisis if they consume which food?
- A.White rice
- B.Plain oatmeal
- C.Fresh apples
- D.Aged cheese and cured meats (high in tyramine)✓ Answer
MAOIs block the breakdown of tyramine; eating tyramine-rich foods like aged cheese and cured meats can cause a sudden dangerous rise in blood pressure (hypertensive crisis).
Source: MAOI–tyramine interaction: hypertensive crisisReport a problem with this question
21. A patient takes an SSRI and is started on another serotonergic drug. The nurse monitors for serotonin syndrome, which includes:
- A.Bradycardia and hypothermia only
- B.Gradual painless hair loss
- C.Isolated dry cough
- D.Agitation, hyperthermia, hyperreflexia, and tremor✓ Answer
Serotonin syndrome results from excess serotonergic activity and presents with agitation, hyperthermia, hyperreflexia, tremor, and autonomic instability; combining serotonergic drugs raises the risk.
Source: Drug interaction: SSRI + serotonergic agents → serotonin syndromeReport a problem with this question
22. A patient on an antipsychotic develops high fever, muscle rigidity, altered mental status, and unstable vital signs. What should the nurse suspect?
- A.Expected sedation from the drug
- B.Neuroleptic malignant syndrome (NMS), a medical emergency✓ Answer
- C.A mild allergic rash
- D.Simple dehydration
Neuroleptic malignant syndrome is a rare but life-threatening reaction to antipsychotics marked by hyperthermia, lead-pipe rigidity, altered consciousness, and autonomic instability; the drug is stopped immediately and emergency care given.
Source: Antipsychotic adverse effect: neuroleptic malignant syndromeReport a problem with this question
23. A patient on long-term phenytoin should be taught which important self-care measure?
- A.Double the dose if a seizure occurs
- B.Stop the drug as soon as seizures stop
- C.Avoid all dental care while on the drug
- D.Practice good oral hygiene and see the dentist regularly to reduce gum overgrowth✓ Answer
Phenytoin (therapeutic range about 10–20 mcg/mL) commonly causes gingival hyperplasia, so good oral hygiene and regular dental visits are taught; the drug must never be stopped abruptly because of seizure risk.
Source: Phenytoin therapeutic range 10–20 mcg/mL; gingival hyperplasia teachingReport a problem with this question
24. Which type of insulin is the ONLY one that can be given intravenously?
- A.Insulin glargine (long-acting)
- B.70/30 premixed insulin
- C.NPH (intermediate-acting) insulin
- D.Regular (short-acting) insulin✓ Answer
Only regular (short-acting) insulin is formulated for IV administration; cloudy suspensions such as NPH and long-acting analogs like glargine must never be given IV.
Source: Insulin administration: only regular insulin is IV-compatibleReport a problem with this question
25. A patient on furosemide, a loop diuretic, should be monitored for which electrolyte imbalance?
- A.Hyperkalemia
- B.Hypernatremia
- C.Hypercalcemia
- D.Hypokalemia✓ Answer
Loop diuretics like furosemide increase renal excretion of potassium, causing hypokalemia; the nurse monitors potassium and watches for muscle weakness and cardiac dysrhythmias.
Source: Loop diuretic effect: potassium wasting (hypokalemia)Report a problem with this question
26. A patient takes spironolactone, a potassium-sparing diuretic. Which teaching is correct?
- A.Eat large amounts of bananas and oranges to prevent low potassium
- B.Avoid potassium-based salt substitutes to prevent hyperkalemia✓ Answer
- C.Take a potassium supplement daily with the drug
- D.Increase salt substitute use to protect the kidneys
Potassium-sparing diuretics such as spironolactone retain potassium, so patients must avoid potassium supplements and potassium-based salt substitutes to prevent hyperkalemia.
Source: Potassium-sparing diuretic: hyperkalemia risk teachingReport a problem with this question
27. What is the maximum recommended daily dose of acetaminophen for a healthy adult, and its antidote in overdose?
- A.Unlimited; no antidote exists
- B.About 500 mg/day; antidote is vitamin K
- C.About 10 grams/day; antidote is naloxone
- D.About 4 grams/day; antidote is N-acetylcysteine✓ Answer
The usual maximum acetaminophen dose is about 4 grams per day for healthy adults (lower, around 3 grams, in liver disease); its specific antidote for hepatotoxic overdose is N-acetylcysteine.
Source: Acetaminophen max ~4 g/day; antidote N-acetylcysteineReport a problem with this question
28. Before administering morphine to a postoperative patient, the nurse assesses a respiratory rate of 9 breaths/min. What is the priority action?
- A.Encourage the patient to hold their breath
- B.Hold the morphine and notify the provider✓ Answer
- C.Give a double dose to improve comfort
- D.Give the morphine as ordered
Opioids cause respiratory depression; the nurse holds morphine when the respiratory rate is below 12 breaths/min and notifies the provider, since giving it could cause life-threatening hypoventilation.
Source: Opioid safety: hold morphine if respiratory rate <12/minReport a problem with this question
29. A patient is found sedated with a respiratory rate of 6 after receiving opioids. Which medication is the antidote the nurse anticipates?
- A.Flumazenil
- B.Naloxone✓ Answer
- C.Vitamin K
- D.Protamine sulfate
Naloxone is the opioid antagonist used to reverse opioid-induced respiratory depression and sedation; flumazenil reverses benzodiazepines, not opioids.
Source: Opioid antidote: naloxone (opioid antagonist)Report a problem with this question
30. A patient on around-the-clock opioids for cancer pain is most likely to need which additional intervention?
- A.Strict bed rest with no fluids
- B.An as-needed cough suppressant only
- C.A scheduled bowel regimen with a stool softener/laxative✓ Answer
- D.A daily antidote injection
Opioids slow gastrointestinal motility and constipation is an expected, non-tolerating effect, so a scheduled stool softener/laxative regimen is started proactively rather than waiting until constipation occurs.
Source: Opioid nursing care: prophylactic bowel regimen for constipationReport a problem with this question
31. A family member offers to press the button on a patient's PCA (patient-controlled analgesia) pump while the patient sleeps. What should the nurse do?
- A.Remove the pump so the family can give oral pills instead
- B.Thank the family and let them dose the patient
- C.Encourage the family to press it every hour
- D.Instruct the family that only the patient may press the PCA button✓ Answer
PCA safety depends on only the patient pressing the button; if the patient is too sedated to press it, they cannot self-dose, which is a built-in safeguard against overdose. Family dosing (PCA by proxy) can cause fatal respiratory depression.
Source: PCA safety rule: only the patient presses the buttonReport a problem with this question
32. Which opioid is generally avoided for ongoing pain management because of a neurotoxic metabolite?
- A.Meperidine✓ Answer
- B.Hydromorphone
- C.Fentanyl
- D.Morphine
Meperidine is largely avoided, especially for repeated or long-term dosing and in older or renally impaired patients, because its metabolite normeperidine accumulates and can cause seizures and neurotoxicity.
Source: Analgesia standard: meperidine avoided (normeperidine neurotoxicity)Report a problem with this question
33. When applying the rights of medication administration, how should the nurse verify the RIGHT patient?
- A.Use the room number as the sole identifier
- B.Rely on the patient being in the assigned bed
- C.Use at least two patient identifiers, such as name and date of birth✓ Answer
- D.Ask another patient to confirm the identity
The right patient is confirmed using at least two identifiers (such as name and date of birth), never the room or bed number, to prevent giving a medication to the wrong person.
Source: Rights of medication administration: two-identifier patient verificationReport a problem with this question
34. A competent, alert patient refuses their scheduled antihypertensive medication. What is the nurse's appropriate action?
- A.Tell the patient they have no choice
- B.Hide the medication in food and give it anyway
- C.Chart that the medication was given
- D.Respect the right to refuse, educate on risks/benefits, and document and notify the provider✓ Answer
A competent patient has the right to refuse medication; the nurse educates the patient about the consequences, honors the decision, documents the refusal, and notifies the provider.
Source: Rights of medication administration: right to refuseReport a problem with this question
35. An order reads 'digoxin 0.25 mg PO daily' for a patient whose potassium is 2.8 mEq/L and apical pulse is 56. What should the nurse do FIRST?
- A.Ignore the potassium since it is unrelated
- B.Hold the dose and clarify the order with the provider✓ Answer
- C.Give the dose and add a potassium binder
- D.Give the dose exactly as written
Both a low apical pulse (below 60) and hypokalemia increase the danger of digoxin, so the nurse recognizes an unsafe situation, holds the dose, and clarifies the order rather than administering it.
Source: Clinical judgment: hold/clarify unsafe order (low pulse + hypokalemia)Report a problem with this question
36. The nurse is administering an IM iron injection. Which technique reduces skin staining and irritation?
- A.The Z-track method✓ Answer
- B.Using the shortest possible needle
- C.Injecting into subcutaneous fat
- D.Massaging the site vigorously afterward
The Z-track technique displaces the skin laterally before injection so the needle track seals when released, preventing irritating or staining medications like iron from leaking into subcutaneous tissue; the site is not massaged.
Source: IM injection technique: Z-track for irritant/staining drugsReport a problem with this question
37. When instilling ear drops in an ADULT, how should the nurse position the ear canal?
- A.Pull the pinna down and back
- B.Pull the pinna up and back✓ Answer
- C.No repositioning is needed
- D.Push the pinna forward and down
In adults the ear canal is straightened by pulling the pinna up and back; in children under three it is pulled down and back because of the different canal anatomy.
Source: Otic administration technique: adult pinna up and backReport a problem with this question
38. A patient has difficulty swallowing an extended-release (ER) tablet. What is the correct nursing action?
- A.Dissolve it in hot water first
- B.Crush the tablet and mix it in applesauce
- C.Cut the tablet into small pieces
- D.Do not crush the ER tablet; contact the provider for an alternative formulation✓ Answer
Extended-release and enteric-coated tablets must not be crushed or cut because it destroys the controlled-release mechanism and can cause a dangerous dose dump; the nurse requests an alternative form.
Source: Medication administration rule: do not crush ER/enteric-coated tabletsReport a problem with this question
39. A pediatric drug is dosed by weight. A child weighs 44 pounds. Conceptually, what weight should the nurse use for a mg/kg calculation?
- A.44 kg (use pounds directly)
- B.22 kg (divide by 2)
- C.96.8 kg (multiply by 2.2)
- D.20 kg (divide pounds by 2.2)✓ Answer
Since 1 kg equals 2.2 pounds, the nurse converts by dividing pounds by 2.2 (44 ÷ 2.2 = 20 kg) before applying a weight-based mg/kg dose and verifying it is within the safe range.
Source: Dosage calculation: 1 kg = 2.2 lb weight conversionReport a problem with this question
40. Following safe medication-writing standards, which way of writing a dose is correct?
- A.0.5 mg (leading zero, no trailing zero)✓ Answer
- B.0.50 mg (trailing zero)
- C.5.0 mg (trailing zero)
- D..5 mg (no leading zero)
To prevent tenfold dosing errors, a leading zero is always placed before a decimal point (0.5 mg) and a trailing zero is never used (avoid 5.0 mg), because a missed decimal can be misread.
Source: ISMP safe dosing: leading zero required, no trailing zeroReport a problem with this question
41. To calculate the gtt/min for a gravity IV infusion, which formula does the nurse use?
- A.(Time in minutes × drop factor) ÷ total volume
- B.(Total volume in mL × drop factor) ÷ time in minutes✓ Answer
- C.Total volume ÷ drop factor
- D.Drop factor ÷ total volume
The drip rate in gtt/min equals the total volume in mL multiplied by the tubing's drop factor (gtt/mL), divided by the total infusion time in minutes.
Source: IV flow rate formula: gtt/min = (volume × drop factor) / time in minutesReport a problem with this question
42. A peripheral IV site is cool, swollen, and pale, and the pump is alarming for occlusion. The IV fluid is a non-vesicant. What complication is this and the FIRST action?
- A.Infiltration; stop the infusion, remove the catheter, and elevate the limb✓ Answer
- B.Air embolism; place in high-Fowler's position
- C.Infection; increase the infusion rate
- D.Phlebitis; apply heparin and continue the infusion
Cool, swollen, pale tissue with leaking of a non-vesicant fluid indicates infiltration; the nurse stops the infusion, removes the catheter, and elevates the limb (extravasation is the same but with a vesicant/tissue-damaging drug).
Source: IV complication: infiltration recognition and first actionReport a problem with this question
43. An IV site is warm, red, and tender with a palpable cord along the vein. What is the correct nursing action?
- A.Speed up the infusion to flush the vein
- B.Do nothing; this is a normal finding
- C.Discontinue the IV and apply a warm compress (phlebitis)✓ Answer
- D.Elevate the limb and apply a cold compress and keep the IV
Warmth, redness, tenderness, and a palpable venous cord indicate phlebitis (vein inflammation); the nurse discontinues the IV, restarts it elsewhere, and applies a warm compress. This distinguishes it from the cool, pale swelling of infiltration.
Source: IV complication: phlebitis recognition and warm compressReport a problem with this question
44. Which intravenous solution is isotonic and appropriate for volume replacement?
- A.D10W
- B.0.9% sodium chloride (normal saline)✓ Answer
- C.0.45% sodium chloride
- D.3% sodium chloride
0.9% sodium chloride (normal saline) is isotonic and expands intravascular volume without shifting fluid across cell membranes; 0.45% saline is hypotonic and 3% saline and D10W are hypertonic.
Source: IV fluid tonicity: 0.9% NaCl isotonic for volume replacementReport a problem with this question
45. A patient is receiving 3% sodium chloride (hypertonic saline). What is the priority nursing consideration?
- A.Give it through a small-gauge scalp vein without a pump
- B.Infuse slowly via pump and monitor for fluid overload and pulmonary edema✓ Answer
- C.Infuse rapidly to correct sodium quickly
- D.No special monitoring is required
Hypertonic saline pulls fluid into the vascular space, so it is infused slowly via pump with close monitoring for fluid overload, pulmonary edema, and rapid sodium shifts.
Source: Hypertonic IV fluid: slow infusion, monitor for fluid overloadReport a problem with this question
46. During an IV infusion a patient develops crackles, dyspnea, bounding pulse, and neck vein distention. What is the priority nursing action?
- A.Increase the IV rate to improve perfusion
- B.Slow the IV rate, place in high-Fowler's position, and notify the provider✓ Answer
- C.Disconnect the IV and discard the catheter
- D.Lay the patient flat and elevate the legs
These are signs of fluid volume overload; the nurse slows (does not stop the line) the infusion, positions the patient upright in high-Fowler's to ease breathing, and notifies the provider, anticipating diuretics.
Source: IV complication: fluid overload — slow rate, high-Fowler's, notifyReport a problem with this question
47. Which IV solution must be used to prime the tubing and infuse with packed red blood cells?
- A.Lactated Ringer's
- B.0.9% sodium chloride (normal saline) only✓ Answer
- C.0.45% sodium chloride
- D.5% dextrose in water (D5W)
Only 0.9% normal saline is compatible with blood; dextrose solutions cause red cells to clump and hemolyze, and calcium-containing fluids like lactated Ringer's can cause clotting, so both are contraindicated.
Source: Transfusion standard: only 0.9% NaCl compatible with blood productsReport a problem with this question
48. Fifteen minutes into a blood transfusion, the patient develops fever, chills, low back pain, hypotension, and dark urine. What is the nurse's FIRST action?
- A.Slow the transfusion and continue observing
- B.Give acetaminophen and keep the blood running
- C.Flush the line with the same blood tubing
- D.Stop the transfusion immediately✓ Answer
These are signs of an acute hemolytic transfusion reaction; the first action for any transfusion reaction is to stop the blood immediately, then keep the line open with normal saline via new tubing and notify the provider.
Source: Transfusion reaction: STOP the transfusion firstReport a problem with this question
49. Before initiating a blood transfusion, what verification is required?
- A.Two qualified staff verify patient identity and blood-unit compatibility at the bedside✓ Answer
- B.The patient verifies their own blood type from memory
- C.No verification is needed if the label matches the chart
- D.One nurse checks the unit number only
Blood is a high-alert product, so two qualified staff members must verify patient identifiers and unit/blood-type compatibility at the bedside before starting; the nurse also stays with the patient for the first 15 minutes.
Source: Transfusion safety: two-person bedside verification, first 15-minute monitoringReport a problem with this question
50. A patient has an implanted venous access port. Which type of needle must be used to access it?
- A.Any 18-gauge needle
- B.A standard hypodermic needle
- C.A butterfly needle
- D.A non-coring (Huber) needle✓ Answer
An implanted port must be accessed only with a non-coring (Huber) needle, whose deflected tip prevents coring out pieces of the septum and preserves the port for long-term use.
Source: CVAD standard: implanted port requires non-coring (Huber) needleReport a problem with this question
51. A newly inserted central venous catheter is ordered. What must be confirmed BEFORE the first infusion?
- A.Correct catheter tip placement verified by chest x-ray✓ Answer
- B.That the patient reports no pain
- C.Only that blood returns when aspirated
- D.That the dressing looks dry
Before using a newly placed central line, tip placement must be confirmed by chest x-ray to ensure the catheter is correctly positioned (typically at the superior vena cava) and not in an artery or the pleural space.
Source: CVAD standard: confirm tip placement by chest x-ray before useReport a problem with this question
52. A patient's central line becomes disconnected and the nurse suspects an air embolism. What is the priority position?
- A.Right lateral upright position
- B.Prone position
- C.Left lateral (left side-lying) Trendelenburg position✓ Answer
- D.High-Fowler's position
If air embolism is suspected, the patient is placed in a left lateral Trendelenburg position to trap air in the right atrium away from the pulmonary outflow, and the line is clamped while oxygen is given.
Source: CVAD emergency: air embolism — left lateral TrendelenburgReport a problem with this question
53. A patient's total parenteral nutrition (TPN) bag is nearly empty and the next bag is not yet available. What should the nurse do?
- A.Hang 10% dextrose (D10W) as ordered to prevent rebound hypoglycemia✓ Answer
- B.Switch to normal saline at a keep-open rate only
- C.Abruptly stop the infusion and wait for the next bag
- D.Slow the current bag to make it last longer
TPN is a high-dextrose solution, so it must never be stopped abruptly; if the next bag is delayed, 10% dextrose is hung per protocol to prevent rebound hypoglycemia, and TPN is always given through a central line with blood-glucose monitoring.
Source: TPN safety: taper/D10W bridge to prevent rebound hypoglycemia; central line onlyReport a problem with this question
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