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Advanced Nursing Licensure Excellence
Exam (ANLEE)
**1.** A patient is prescribed digoxin. Which laboratory value most
increases the risk of digoxin toxicity?
A. Sodium 138 mEq/L
B. Potassium 3.2 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 2.1 mg/dL
> **Answer: B** (Hypokalemia increases digoxin binding to sodium-
potassium ATPase, raising toxicity risk.)
**2.** Which antibiotic is associated with red man syndrome when
infused too rapidly?
A. Penicillin G
B. Vancomycin
C. Gentamicin
D. Ciprofloxacin
,> **Answer: B** (Vancomycin causes histamine release; slow infusion
over ≥60 min prevents this.)
**3.** A nurse administers naloxone to a patient with opioid overdose.
What is the expected onset of action?
A. 1–2 minutes
B. 10–15 minutes
C. 30–60 minutes
D. 2–4 hours
> **Answer: A** (Naloxone acts within 1–2 min IV; duration 30–90
min.)
**4.** Which medication requires a low-tyramine diet to prevent
hypertensive crisis?
A. Lisinopril
B. Phenelzine
C. Metoprolol
D. Losartan
> **Answer: B** (Phenelzine is an MAOI; tyramine-rich foods cause
severe hypertension.)
,**5.** A patient on warfarin has an INR of 4.5 without bleeding. The
nurse expects which intervention?
A. Hold warfarin and give vitamin K orally
B. Give fresh frozen plasma
C. Administer protamine sulfate
D. Increase warfarin dose
> **Answer: A** (INR 4.5 with no bleeding: hold warfarin + low-dose
oral vitamin K.)
**6.** Which drug is first-line for acute anaphylaxis?
A. Diphenhydramine
B. Albuterol
C. Epinephrine
D. Methylprednisolone
> **Answer: C** (Epinephrine IM is first-line; it reverses bronchospasm
and hypotension.)
**7.** A patient taking lithium reports nausea, tremor, and confusion.
Serum lithium level is 2.0 mEq/L. This indicates:
A. Subtherapeutic level
B. Therapeutic level
, C. Early toxicity
D. Severe toxicity
> **Answer: C** (Therapeutic: 0.6–1.2; 1.5–2.5 = early toxicity; >2.5 =
severe.)
**8.** Which medication is contraindicated in acute porphyria?
A. Acetaminophen
B. Phenobarbital
C. Insulin
D. Aspirin
> **Answer: B** (Barbiturates induce hepatic ALA synthase,
precipitating porphyria attacks.)
**9.** A patient on furosemide develops ototoxicity. Which risk factor
is most relevant?
A. Hypokalemia
B. Concurrent aminoglycoside use
C. Hypernatremia
D. Advanced age only
Advanced Nursing Licensure Excellence
Exam (ANLEE)
**1.** A patient is prescribed digoxin. Which laboratory value most
increases the risk of digoxin toxicity?
A. Sodium 138 mEq/L
B. Potassium 3.2 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 2.1 mg/dL
> **Answer: B** (Hypokalemia increases digoxin binding to sodium-
potassium ATPase, raising toxicity risk.)
**2.** Which antibiotic is associated with red man syndrome when
infused too rapidly?
A. Penicillin G
B. Vancomycin
C. Gentamicin
D. Ciprofloxacin
,> **Answer: B** (Vancomycin causes histamine release; slow infusion
over ≥60 min prevents this.)
**3.** A nurse administers naloxone to a patient with opioid overdose.
What is the expected onset of action?
A. 1–2 minutes
B. 10–15 minutes
C. 30–60 minutes
D. 2–4 hours
> **Answer: A** (Naloxone acts within 1–2 min IV; duration 30–90
min.)
**4.** Which medication requires a low-tyramine diet to prevent
hypertensive crisis?
A. Lisinopril
B. Phenelzine
C. Metoprolol
D. Losartan
> **Answer: B** (Phenelzine is an MAOI; tyramine-rich foods cause
severe hypertension.)
,**5.** A patient on warfarin has an INR of 4.5 without bleeding. The
nurse expects which intervention?
A. Hold warfarin and give vitamin K orally
B. Give fresh frozen plasma
C. Administer protamine sulfate
D. Increase warfarin dose
> **Answer: A** (INR 4.5 with no bleeding: hold warfarin + low-dose
oral vitamin K.)
**6.** Which drug is first-line for acute anaphylaxis?
A. Diphenhydramine
B. Albuterol
C. Epinephrine
D. Methylprednisolone
> **Answer: C** (Epinephrine IM is first-line; it reverses bronchospasm
and hypotension.)
**7.** A patient taking lithium reports nausea, tremor, and confusion.
Serum lithium level is 2.0 mEq/L. This indicates:
A. Subtherapeutic level
B. Therapeutic level
, C. Early toxicity
D. Severe toxicity
> **Answer: C** (Therapeutic: 0.6–1.2; 1.5–2.5 = early toxicity; >2.5 =
severe.)
**8.** Which medication is contraindicated in acute porphyria?
A. Acetaminophen
B. Phenobarbital
C. Insulin
D. Aspirin
> **Answer: B** (Barbiturates induce hepatic ALA synthase,
precipitating porphyria attacks.)
**9.** A patient on furosemide develops ototoxicity. Which risk factor
is most relevant?
A. Hypokalemia
B. Concurrent aminoglycoside use
C. Hypernatremia
D. Advanced age only
