NCLEX Nursing Pharmacology Mastery Challenge Exam

Questions include multiple-choice, select-all-that-apply (SATA), and basic calculations to mimic Next-Gen NCLEX formats.

Instructions:

• Time Limit: Aim for 1 minute per question (total ~50 minutes), but no strict timer—practice at your pace.
• Scoring: Self-assess at the end (answers with detailed rationales provided). 80%+ (40/50) indicates strong readiness; below 70% (35/50)? Review weak areas like high-alert meds or insulin dosing.
  

• Tips: Use the nursing process (ADPIE), focus on ABCs for priorities, and recall mnemonics (e.g., “Beta-blockers: Bradycardia, Bronchospasm”).
  

• Categories: Questions are grouped by topic for focused review (e.g., 10 on Antibiotics, 10 on Cardiovascular).

Take the quiz first (cover answers), then check rationales. Ready? Let’s master pharmacology!Section 1: Antibiotics & Anti-Infectives (Questions 1–10)

1. A client with a penicillin allergy is prescribed clindamycin for a skin infection. The nurse knows clindamycin works by:
   a) Inhibiting cell wall synthesis
   b) Blocking peptide elongation by binding to the 50S ribosome site
   c) Disrupting folic acid synthesis
   d) Inhibiting protein synthesis at the 30S ribosome
2. SATA: Which adverse effects should the nurse monitor in a client taking vancomycin IV? (Select all that apply.)
   a) Red man syndrome (flushing, hypotension)
   b) Ototoxicity (hearing loss)
   c) Nephrotoxicity (elevated BUN/creatinine)
   d) Hyperkalemia
   e) Thrombophlebitis at infusion site
3. A client on gentamicin has a trough level of 2.5 mcg/mL (therapeutic: 0.5–2 mcg/mL). The nurse should:
   a) Administer the next dose immediately
   b) Withhold the dose and notify the provider
   c) Increase the dose by 50%
   d) Switch to oral form
4. The nurse is educating a client on sulfamethoxazole-trimethoprim (Bactrim) for a UTI. Which statement by the client indicates understanding?
   a) “I should take it with antacids to reduce stomach upset.”
   b) “I need to drink plenty of fluids to prevent crystalluria.”
   c) “It’s safe to take with warfarin without interactions.”
   d) “I can stop taking it once symptoms resolve.”
5. A child weighing 44 lbs (20 kg) is prescribed cefazolin 50 mg/kg/day divided q8h. How many mg per dose? (Round to nearest whole number.)
   a) 167 mg
   b) 333 mg
   c) 500 mg
   d) 1,000 mg
6. Which lab value requires immediate intervention for a client on amphotericin B?
   a) Potassium 4.0 mEq/L
   b) BUN 28 mg/dL (elevated)
   c) WBC 12,000/mm³
   d) Hemoglobin 13 g/dL
7. The nurse identifies a potential interaction when administering levofloxacin to a client on:
   a) Multivitamins
   b) Antacids containing magnesium
   c) Acetaminophen
   d) Ibuprofen
8. A client with TB is on isoniazid. The nurse should teach the client to:
   a) Take it on an empty stomach
   b) Avoid cheese and red wine to prevent hypertensive crisis
   c) Expect orange urine as a side effect
   d) Monitor for hypoglycemia
9. SATA: Teaching points for a client starting linezolid include: (Select all that apply.)
   a) Avoid tyramine-rich foods (e.g., aged cheese) to prevent serotonin syndrome
   b) Report any vision changes immediately
   c) It can be taken with warfarin safely
   d) Use barrier contraception during therapy
   e) Expect blue-green urine
10. The peak level for tobramycin should be drawn:
    a) 30 minutes before the next dose
    b) 30 minutes after IV infusion ends
    c) Immediately upon starting infusion
    d) 1 hour before the next dose

Section 2: Cardiovascular Drugs (Questions 11–20)

11. A client on digoxin has a heart rate of 52 bpm and nausea. The apical pulse should be held if below:
    a) 60 bpm
    b) 72 bpm
    c) 90 bpm
    d) 100 bpm
12. SATA: Signs of digoxin toxicity include: (Select all that apply.)
    a) Xanthopsia (yellow vision)
    b) Bradycardia
    c) Hyperkalemia
    d) Tinnitus
    e) Anorexia
13. Nitroglycerin sublingual is prescribed PRN for angina. The nurse instructs the client to:
    a) Swallow the tablet whole
    b) Take up to 5 doses 5 minutes apart
    c) Lie down after taking to avoid orthostasis
    d) Store in a cool, dark place
14. A client on warfarin has an INR of 3.8 (therapeutic: 2–3). The nurse should:
    a) Administer the next dose
    b) Hold the dose and notify provider
    c) Give vitamin K 10 mg IV
    d) Increase the dose
15. Calculate the heparin infusion rate: Order is 1,000 units/hr; bag has 25,000 units in 500 mL. (Drop factor: 60 gtt/mL).
    a) 20 gtt/min
    b) 30 gtt/min
    c) 40 gtt/min
    d) 50 gtt/min
16. The nurse monitors for which adverse effect of amiodarone?
    a) Hypothyroidism
    b) Pulmonary fibrosis
    c) Both a and b
    d) Neither
17. A client on lisinopril reports a dry cough. The nurse recognizes this as:
    a) An expected side effect due to bradykinin accumulation
    b) A sign of infection
    c) Hypersensitivity reaction
    d) Unrelated to the drug
18. Beta-blockers like metoprolol are contraindicated in clients with:
    a) Hypertension
    b) Second-degree heart block
    c) Angina
    d) Hyperthyroidism
19. SATA: Teaching for a client on clopidogrel (Plavix): (Select all that apply.)
    a) Use a soft toothbrush to prevent bleeding
    b) Avoid aspirin unless prescribed
    c) Report black, tarry stools
    d) It can be stopped before dental work
    e) Take with antacids
20. The antidote for enoxaparin overdose is:
    a) Vitamin K
    b) Protamine sulfate
    c) Fresh frozen plasma
    d) Atropine

Section 3: Endocrine & Antidiabetics (Questions 21–30)

21. A client on regular insulin has a blood glucose of 55 mg/dL. The nurse should first:
    a) Administer glucagon IM
    b) Give 15 g fast-acting carbs
    c) Recheck in 15 minutes
    d) Call the provider
22. SATA: Hypoglycemia symptoms include: (Select all that apply.)
    a) Shakiness
    b) Diaphoresis
    c) Polyuria
    d) Tachycardia
    e) Confusion
23. Metformin is held before which procedure due to contrast dye?
    a) MRI
    b) CT scan with IV contrast
    c) X-ray
    d) Ultrasound
24. A client on levothyroxine should take it:
    a) At bedtime
    b) With food
    c) On an empty stomach in the morning
    d) With calcium supplements
25. Calculate insulin dose: Sliding scale for BS 250 mg/dL is 8 units. Client weighs 80 kg; basal is 0.5 units/kg/day divided bid. Basal dose?
    a) 20 units
    b) 40 units
    c) 10 units
    d) 80 units
26. The nurse teaches a client on corticosteroids to:
    a) Stop abruptly after short-term use
    b) Increase dose during stress
    c) Take at night to mimic cortisol rhythm
    d) Expect weight loss
27. Hyperglycemia is a side effect of which class?
    a) Beta-blockers
    b) Thiazide diuretics
    c) ACE inhibitors
    d) Calcium channel blockers
28. SATA: Monitor for in a client on propylthiouracil (PTU): (Select all that apply.)
    a) Agranulocytosis (fever, sore throat)
    b) Hepatotoxicity
    c) Hypoglycemia
    d) Rash
    e) Bradycardia
29. A client with Addison’s disease on fludrocortisone should monitor for:
    a) Hypokalemia
    b) Hypernatremia
    c) Both
    d) Neither
30. The onset of action for lispro insulin is:
    a) 15 minutes
    b) 1–2 hours
    c) 3–4 hours
    d) 6 hours

Section 4: Pain Management & Anti-Inflammatories (Questions 31–35)

31. The nurse assesses pain using which tool for a nonverbal client?
    a) Numeric scale
    b) Wong-Baker FACES
    c) Verbal descriptor
    d) Visual analog
32. Morphine IV is ordered for post-op pain. The peak effect is:
    a) 5–10 minutes
    b) 30–60 minutes
    c) 1–2 hours
    d) 4–6 hours
33. SATA: Opioid antagonists like naloxone reverse: (Select all that apply.)
    a) Respiratory depression
    b) Constipation
    c) Sedation
    d) Miosis
    e) Hypotension
34. Ibuprofen is contraindicated in clients with:
    a) Peptic ulcer disease
    b) Asthma (if sensitive)
    c) Both
    d) Neither
35. The nurse administers acetaminophen to a client with liver failure cautiously because of risk for:
    a) Hepatotoxicity
    b) Nephrotoxicity
    c) Cardiotoxicity
    d) Ototoxicity

Section 5: Antipsychotics, Antidepressants & Psychotropics (Questions 36–40)

36. A client on haloperidol reports muscle stiffness. The nurse recognizes this as:
    a) Tardive dyskinesia
    b) Acute dystonia
    c) Neuroleptic malignant syndrome
    d) Akathisia
37. SATA: Monitor for serotonin syndrome in a client on SSRIs: (Select all that apply.)
    a) Hyperthermia
    b) Rigidity
    c) Diarrhea
    d) Tachycardia
    e) Hypotension
38. Lithium therapeutic level is:
    a) 0.2–0.8 mEq/L
    b) 0.8–1.2 mEq/L
    c) 1.5–2.0 mEq/L
    d) 2.5–3.0 mEq/L
39. The nurse teaches a client on bupropion to avoid:
    a) Tyramine foods
    b) Grapefruit juice
    c) Sudden discontinuation (seizure risk)
    d) Alcohol
40. Clozapine requires monitoring for:
    a) Agranulocytosis (WBC weekly)
    b) Weight gain
    c) Both
    d) Neither

Section 6: Calculations, High-Alert Meds & Misc (Questions 41–50)

41. Order: Dopamine 5 mcg/kg/min IV; client 70 kg; bag 400 mg/250 mL. Infusion rate?
    a) 5 mL/hr
    b) 10.5 mL/hr
    c) 21 mL/hr
    d) 52.5 mL/hr
42. SATA: High-alert meds include: (Select all that apply.)
    a) Insulin
    b) Opioids
    c) Potassium chloride IV
    d) Amoxicillin
    e) Epinephrine
43. A client on theophylline has a level of 25 mcg/mL (therapeutic: 10–20). Action?
    a) Continue and monitor
    b) Hold and notify
    c) Double dose
    d) Switch to oral
44. The nurse questions aspirin in a client with:
    a) Peptic ulcer
    b) Recent MI
    c) Both
    d) Neither
45. Calculate: Fentanyl patch 25 mcg/hr for 72 hours. Total dose?
    a) 1,800 mcg
    b) 3,600 mcg
    c) 5,400 mcg
    d) 7,200 mcg
46. SATA: Teaching for atropine: (Select all that apply.)
    a) Dry mouth is expected
    b) Avoid heat (overheating risk)
    c) Report urinary retention
    d) Take with food
    e) Monitor HR (tachycardia)
47. A client on phenytoin has a level of 8 mcg/mL (therapeutic: 10–20). The nurse:
    a) Administers as ordered
    b) Withholds and notifies
    c) Gives loading dose
    d) Checks trough
48. Albuterol is a:
    a) Beta-1 agonist
    b) Beta-2 agonist
    c) Alpha agonist
    d) Muscarinic agonist
49. The antidote for benzodiazepine overdose is:
    a) Flumazenil
    b) Naloxone
    c) Epinephrine
    d) Atropine
50. SATA: Client education for statins like atorvastatin: (Select all that apply.)
    a) Take in evening
    b) Report muscle pain (rhabdomyolysis)
    c) Expect weight gain
    d) Monitor liver function
    e) Safe with grapefruit

Answer Key with RationalesScroll down only after completing the quiz! Each rationale explains the correct answer, why distractors are wrong, and NCLEX ties (e.g., safety, client education). References from reliable sources like Nurseslabs and SimpleNursing.