NGN HESI RN PHARMACOLOGY REAL EXAM –
VERSION B (2026/2027 100% Correct Answers with
Rationales | Graded A+ | Unique to Version B
1. Traditional MCQ
A 72-year-old with heart failure (EF 30 %) and Stage 4 CKD (eGFR 18 mL/min) is
prescribed empagliflozin 10 mg daily. The nurse should prioritize which
laboratory result before the first dose?
A. Serum creatinine
B. Serum potassium
C. Hemoglobin A1C
D. LDL cholesterol
Correct Answer: A
Rationale: Empagliflozin is renally excreted; eGFR <30 mL/min increases adverse-risk
(dehydration, ketoacidosis). Creatinine directly reflects current filtration.
2. Traditional MCQ
A 32-year-old at 28 weeks gestation receives betamethasone 12 mg IM for
preterm labor. Which maternal adverse effect requires immediate intervention?
A. Blood glucose 210 mg/dL
B. Mild facial flushing
C. Heart rate 105 bpm
D. Insomnia
Correct Answer: A
Rationale: Corticosteroids precipitate hyperglycemia in pregnancy; ≥200 mg/dL needs
insulin titration to avoid maternal DKA.
3. Multiple-Select
A patient receiving a continuous propofol infusion at 50 mcg/kg/min becomes
bradycardic (HR 38). Select all appropriate actions:
, A. ↓ propofol to 25 mcg/kg/min
B. Give atropine 0.5 mg IV
C. Start norepinephrine infusion
D. Obtain 12-lead ECG
E. Discontinue propofol immediately
Correct Answers: A, B, D
Rationale: Propofol-related bradycardia is dose-dependent; reduce rate, give
anticholinergic, rule-out ischemia. Stopping abruptly may risk awareness; pressors
unnecessary unless hypotensive.
4. Traditional MCQ
A 4-year-old (18 kg) with status asthmaticus receives 5 mg albuterol nebulizer
q20 min. Maximum safe 8-hour cumulative dose (mg) before risk of lactic
acidosis?
A. 10 mg
B. 15 mg
C. 20 mg
D. 30 mg
Correct Answer: C
Rationale: Pediatric safety ceiling ≈ 0.5 mg/kg/h × 3 h = 27 mg; 20 mg/8 h remains
below threshold while achieving bronchodilation.
5. Cloze (Drop-Down)
A 65-kg patient is prescribed acetylcysteine for acetaminophen overdose (150
mg/kg IV). The 150 mg/kg loading dose should be diluted in (A) ______ mL of
D5W and infused over (B) ______ minutes.
A options: 100 | 200 | 500
B options: 15 | 60 | 120
Correct Answer: A: 200, B: 60
Rationale: 150 mg/kg × 65 kg = 9.75 g; standard dilution 200 mL D5W, run 60 min to
minimize anaphylactoid reactions.
, 6. Traditional MCQ
A patient on clozapine reports “constant fever” (38.2 °C) and rigors. WBC 2.8
K/µL with absolute neutrophil count 900. Which action is essential?
A. Increase clozapine dose
B. Start broad-spectrum antibiotics
C. Discontinue clozapine immediately
D. Administer acetaminophen and continue
Correct Answer: C
Rationale: ANC <1000 mandates immediate stop and hematology
consult—agranulocytosis risk >1 %.
7. Traditional MCQ
A 58-year-old with hepatic cirrhosis (Child-Pugh B) needs post-op analgesia.
Which opioid is safest?
A. Morphine 4 mg IV q4h PRN
B. Hydromorphone 0.4 mg IV q4h PRN
C. Meperidine 50 mg IV q4h PRN
D. Codeine 30 mg PO q4h PRN
Correct Answer: B
Rationale: Hydromorphone has no active metabolites and minimal histamine
release—preferred in hepatic impairment vs morphine (accumulates) and meperidine
(seizures from normeperidine).
8. Matrix/Grid
A nurse teaches a patient starting apixaban. For each statement, indicate if it
reflects Understanding, Misunderstanding, or Requires Clarification:
TableCopy
Statement Response
VERSION B (2026/2027 100% Correct Answers with
Rationales | Graded A+ | Unique to Version B
1. Traditional MCQ
A 72-year-old with heart failure (EF 30 %) and Stage 4 CKD (eGFR 18 mL/min) is
prescribed empagliflozin 10 mg daily. The nurse should prioritize which
laboratory result before the first dose?
A. Serum creatinine
B. Serum potassium
C. Hemoglobin A1C
D. LDL cholesterol
Correct Answer: A
Rationale: Empagliflozin is renally excreted; eGFR <30 mL/min increases adverse-risk
(dehydration, ketoacidosis). Creatinine directly reflects current filtration.
2. Traditional MCQ
A 32-year-old at 28 weeks gestation receives betamethasone 12 mg IM for
preterm labor. Which maternal adverse effect requires immediate intervention?
A. Blood glucose 210 mg/dL
B. Mild facial flushing
C. Heart rate 105 bpm
D. Insomnia
Correct Answer: A
Rationale: Corticosteroids precipitate hyperglycemia in pregnancy; ≥200 mg/dL needs
insulin titration to avoid maternal DKA.
3. Multiple-Select
A patient receiving a continuous propofol infusion at 50 mcg/kg/min becomes
bradycardic (HR 38). Select all appropriate actions:
, A. ↓ propofol to 25 mcg/kg/min
B. Give atropine 0.5 mg IV
C. Start norepinephrine infusion
D. Obtain 12-lead ECG
E. Discontinue propofol immediately
Correct Answers: A, B, D
Rationale: Propofol-related bradycardia is dose-dependent; reduce rate, give
anticholinergic, rule-out ischemia. Stopping abruptly may risk awareness; pressors
unnecessary unless hypotensive.
4. Traditional MCQ
A 4-year-old (18 kg) with status asthmaticus receives 5 mg albuterol nebulizer
q20 min. Maximum safe 8-hour cumulative dose (mg) before risk of lactic
acidosis?
A. 10 mg
B. 15 mg
C. 20 mg
D. 30 mg
Correct Answer: C
Rationale: Pediatric safety ceiling ≈ 0.5 mg/kg/h × 3 h = 27 mg; 20 mg/8 h remains
below threshold while achieving bronchodilation.
5. Cloze (Drop-Down)
A 65-kg patient is prescribed acetylcysteine for acetaminophen overdose (150
mg/kg IV). The 150 mg/kg loading dose should be diluted in (A) ______ mL of
D5W and infused over (B) ______ minutes.
A options: 100 | 200 | 500
B options: 15 | 60 | 120
Correct Answer: A: 200, B: 60
Rationale: 150 mg/kg × 65 kg = 9.75 g; standard dilution 200 mL D5W, run 60 min to
minimize anaphylactoid reactions.
, 6. Traditional MCQ
A patient on clozapine reports “constant fever” (38.2 °C) and rigors. WBC 2.8
K/µL with absolute neutrophil count 900. Which action is essential?
A. Increase clozapine dose
B. Start broad-spectrum antibiotics
C. Discontinue clozapine immediately
D. Administer acetaminophen and continue
Correct Answer: C
Rationale: ANC <1000 mandates immediate stop and hematology
consult—agranulocytosis risk >1 %.
7. Traditional MCQ
A 58-year-old with hepatic cirrhosis (Child-Pugh B) needs post-op analgesia.
Which opioid is safest?
A. Morphine 4 mg IV q4h PRN
B. Hydromorphone 0.4 mg IV q4h PRN
C. Meperidine 50 mg IV q4h PRN
D. Codeine 30 mg PO q4h PRN
Correct Answer: B
Rationale: Hydromorphone has no active metabolites and minimal histamine
release—preferred in hepatic impairment vs morphine (accumulates) and meperidine
(seizures from normeperidine).
8. Matrix/Grid
A nurse teaches a patient starting apixaban. For each statement, indicate if it
reflects Understanding, Misunderstanding, or Requires Clarification:
TableCopy
Statement Response
