NCLEX Pharmacology Deep Dive questions
The PrepScore bank has 101 Pharmacology Deep Dive questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Take action and Generate solutions, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Insulin timing, anticonvulsant levels, antibiotic-specific issues, anticoagulant reversal, steroid taper, chemo safety, pediatric weight-based dosing.
Three worked questions
Q1. Which medication is the FIRST-LINE reversal for an opioid overdose?
- A. Flumazenil
- B. Naloxone
- C. Atropine
- D. Calcium gluconate
Show answer and rationale
Answer: Naloxone
Naloxone = opioid antagonist. Flumazenil = benzodiazepines. Atropine = brady. Ca gluc = mag/hyperK.
Q2. A pt is started on an SSRI. Teaching includes that the medication:
- A. Will work in 1-2 days
- B. May take 2-4 weeks for full effect
- C. Can be stopped abruptly
- D. Has no side effects
Show answer and rationale
Answer: May take 2-4 weeks for full effect
SSRIs: gradual onset. Stop abruptly = discontinuation syndrome. Side effects exist (GI, sexual, etc.).
Q3. Which are signs of digoxin toxicity? Select all that apply.
- A. Anorexia + N/V
- B. Bradycardia + heart block
- C. Visual changes (yellow halos)
- D. Confusion in older adults
- E. Hypertension + tachycardia
- F. Constipation only
Show answer and rationale
Answer: Anorexia + N/VBradycardia + heart blockVisual changes (yellow halos)Confusion in older adults
Digoxin toxicity signs (multi-system): GI (anorexia + N/V — often EARLIEST sign), cardiac (bradycardia + heart block — therapeutic effect amplified), visual (yellow halos / xanthopsia — pathognomonic), confusion in older adults (CNS toxicity). Hypertension + tachycardia + constipation alone aren't dig toxicity (opposite — dig slows HR).
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Lispro/aspart = WITH meal (food at bedside before giving). Regular insulin = 30 min BEFORE meal. NPH = peaks 4-12 h. Glargine/detemir = basal, no peak, DO NOT MIX with other insulins. Delayed tray = hold rapid-acting until tray arrives. Mismatch = hypoglycemia.
Phenytoin, valproate, warfarin, thyroid hormones are highly protein-bound. In low albumin, total level UNDERESTIMATES the active free fraction. If symptoms suggest toxicity but total level looks low, order the FREE level. Also: tube feeds reduce phenytoin absorption — hold 1-2 h before/after.
Draw trough 30-60 min BEFORE next dose (true trough). Therapeutic for serious MRSA = 15-20 mcg/mL (varies). Supratherapeutic + rising Cr = nephrotoxicity — HOLD + recheck. Infuse over at least 60 min per gram to avoid red man syndrome (histamine release: flushing, hypotension, rash).
Chronic glucocorticoids suppress the HPA axis. Abrupt stop → adrenal crisis. Surgery, severe illness, trauma require stress-dose steroids (typically hydrocortisone 50-100 mg IV at induction, then taper). Sick-day rules: double dose for fever/illness, triple for severe stress. MedicAlert + carry steroid card.
Warfarin → vitamin K + PCC (or FFP); heparin/LMWH → protamine sulfate; apixaban / rivaroxaban (Factor Xa) → andexanet alfa; dabigatran (direct thrombin) → idarucizumab. Vit K does NOT reverse DOACs. Protamine does NOT reverse warfarin. Specific drug = specific antidote.
STOP infusion immediately. Aspirate residual from catheter (do NOT flush). Apply drug-specific compress: COLD for anthracyclines (doxorubicin, daunorubicin); WARM for vinca alkaloids (vincristine, vinblastine). Anthracycline antidote = dexrazoxane within 6 h. Elevate, photograph, document, escalate. Future doses via central line.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Pharmacology Deep Dive questions does the bank have?
101 multiple-choice items, plus 10 unfolding cases in the Pharmacology Deep Dive pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Take action and Generate solutions, though every step appears.
Keep reading
By PrepScore · Last reviewed · Editorial standards