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The RNPHARM exam has 75 questions and runs 1 hour 30 minutes.
These 10 free RNPHARM questions are organized by exam domain, so you can see how each part of the NLN RN Pharmacology in Clinical Nursing Assessment blueprint is tested. Reveal the answer and explanation under each question.
A 6-year-old weighs 52.8 lb and is prescribed cefuroxime 280 mg by mouth every 8 hours. The reference range is 25-40 mg/kg/day in three divided doses. What conclusion should the nurse reach?
Correct answer: A - Administer the dose; 280 mg is within the 200-320 mg safe range per dose
For renal dosing, a 68-year-old woman weighs 60 kg and has a serum creatinine of 1.5 mg/dL. For women, use CrCl = [(140 - age) × weight]/(72 × serum creatinine) × 0.85. A medication label directs full dosing at CrCl 50 mL/min or greater, reduced dosing at 30-49 mL/min, and avoidance below 30 mL/min. Which dosing plan matches the calculation?
Correct answer: C - Use the reduced dose; the estimated CrCl is about 34 mL/min
Norepinephrine is infusing in an 82-kg adult. The protocol directs an increase to 0.06 mcg/kg/min when mean arterial pressure remains below 65 mm Hg; the current mean arterial pressure is 61 mm Hg. The bag contains 8 mg in 250 mL, and the pump is set in mL/hr. Rounded to the nearest tenth, which new rate should be programmed?
Correct answer: D - 9.2 mL/hr
Chemotherapy is ordered for an adult who is 160 cm tall and weighs 50 kg. The order is 85 mg/m². Use BSA = √[(height in cm × weight in kg)/3,600]. The medication reference lists an absolute maximum single dose of 120 mg, and the order gives no authorization to adjust the dose. How should the nurse handle the order?
Correct answer: B - Hold and clarify; the calculated dose is about 126.7 mg, above the 120-mg cap
The barcode scanner confirms a scheduled metoprolol dose for the correct patient. The order says to hold for an apical pulse below 60/min. The patient's apical pulse is 54/min, blood pressure is 118/72 mm Hg, and the patient is asymptomatic. How should the nurse proceed?
Correct answer: B - Hold the dose, document the finding, and follow the order's notification instructions
Continuous enteral nutrition is running for a patient who receives phenytoin suspension through a feeding tube. Despite documented adherence, the phenytoin concentration is subtherapeutic. Which change most directly addresses a common administration cause?
Correct answer: D - Pause feeding 1-2 hours before and after per protocol, flush well, and monitor response
During inhaler teaching, a patient with asthma demonstrates how to use scheduled albuterol and fluticasone metered-dose inhalers. Which return demonstration shows correct sequencing?
Correct answer: A - Use albuterol first, then fluticasone; rinse and spit after fluticasone
Burning, swelling, and blanching develop at a peripheral IV site during a doxorubicin infusion. Which immediate response best protects the tissue?
Correct answer: C - Stop the infusion, do not flush, leave the catheter in place initially for aspiration or antidote, and notify the oncology team
Ten minutes after an unintended extra dose of IV hydromorphone, a patient responds only to repeated stimulation, has shallow respirations at 9/min, and an oxygen saturation of 86% on room air. What is the immediate priority?
Correct answer: D - Stop further opioid, support ventilation, give naloxone per protocol, and activate the emergency response
Regular insulin and NPH insulin are prescribed in one subcutaneous injection. After verifying the doses and vial concentrations, which preparation sequence is correct?
Correct answer: B - Inject air into NPH, inject air into regular, draw regular, then draw NPH
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