NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION C
(2026/2027) 100% Correct Answers with Rationales | Graded
A+ | Unique to Version C
1. (Traditional) A 68-year-old male with heparin-induced thrombocytopenia (HIT) is
prescribed argatroban. The nurse notes the baseline aPTT is 32 seconds. Which
laboratory monitoring parameter is most appropriate to evaluate therapeutic efficacy?
A. INR maintained between 2.0 and 3.0
B. aPTT maintained at 1.5 to 3 times the baseline (48-96 seconds)
C. Anti-Xa level maintained between 0.5 and 1.0 units/mL
D. Platelet count maintained above 150,000/mm³
Correct Answer: B
Rationale: Argatroban is a direct thrombin inhibitor used in HIT. Its therapeutic effect is
monitored using the aPTT, with a target range of 1.5-3 times the patient's baseline
(typically 48-96 seconds). INR (A) is used for warfarin therapy and is unreliable with
argatroban. Anti-Xa levels (C) are used for heparin and LMWH monitoring. While platelet
count (D) must be monitored for HIT resolution, it does not measure argatroban
efficacy.
2. (Traditional) A 72-year-old female presents with a life-threatening gastrointestinal
bleed while taking apixaban 5 mg twice daily. Which reversal agent is most appropriate?
A. Idarucizumab 5 g IV
B. Andexanet alfa low dose (400 mg IV bolus)
C. Protamine sulfate 50 mg IV
D. Vitamin K 10 mg IV
,Correct Answer: B
Rationale: Andexanet alfa is the specific reversal agent for Factor Xa inhibitors
(apixaban, rivaroxaban). The dose depends on the specific drug and timing of last dose.
Idarucizumab (A) reverses dabigatran only. Protamine (C) reverses heparin. Vitamin K
(D) reverses warfarin.
3. (Traditional) A 45-year-old female with diabetic foot infection is prescribed linezolid
600 mg IV every 12 hours. She also takes escitalopram 20 mg daily for depression.
Which potential adverse interaction requires immediate monitoring?
A. Serotonin syndrome from MAOI properties of linezolid
B. QT prolongation from combined cardiac effects
C. Severe hypoglycemia from enhanced insulin sensitivity
D. Nephrotoxicity from combined renal excretion
Correct Answer: A
Rationale: Linezolid is a weak, reversible monoamine oxidase inhibitor (MAOI). When
combined with SSRIs (escitalopram), it can precipitate serotonin syndrome (mental
status changes, autonomic instability, neuromuscular hyperactivity). The nurse must
monitor for agitation, tremor, hyperthermia, and clonus. Linezolid does not significantly
prolong QT (B), cause hypoglycemia (C), or exhibit nephrotoxicity (D).
4. (Traditional) A 4-year-old child with a body surface area (BSA) of 0.64 m² is
prescribed morphine 0.05 mg/kg/dose IV every 4 hours for post-operative pain. The
child weighs 18 kg. How many milligrams should the nurse administer per dose?
A. 0.3 mg
B. 0.5 mg
C. 0.9 mg
,D. 1.2 mg
Correct Answer: C
Rationale: The order specifies weight-based dosing: 0.05 mg/kg. For an 18 kg child: 0.05
mg × 18 kg = 0.9 mg per dose. BSA is not used for this particular calculation as the
order specifically states mg/kg. If the order were mg/m², the calculation would be
different (0.05 mg/m² × 0.64 m² = 0.032 mg, which is not an option). Therefore, the
weight-based calculation is correct.
5. (Traditional) A 28-year-old male with HIV is started on dolutegravir 50 mg daily. Which
patient statement indicates a need for further teaching?
A. "I should take this medication at the same time every day"
B. "I can take this with my antacid containing magnesium"
C. "I need to report any rash immediately as it could indicate a severe reaction"
D. "This medication can cause insomnia, so I should avoid taking it at bedtime"
Correct Answer: B
Rationale: Dolutegravir is an integrase strand transfer inhibitor (INSTI) that requires
cation separation. Polyvalent cations (magnesium, aluminum, calcium, iron) chelate
dolutegravir, reducing absorption by up to 75%. Antacids must be taken 2 hours before
or 6 hours after dolutegravir. While insomnia (D) is a side effect, taking at bedtime is not
contraindicated if tolerated. Rash (C) requires reporting due to hypersensitivity risk.
6. (Traditional) A 56-year-old female with cryptococcal meningitis is prescribed
amphotericin B deoxycholate. Which intervention is most critical to prevent
nephrotoxicity?
A. Pre-hydration with 1 liter normal saline and potassium supplementation
, B. Prophylactic furosemide to maintain high urine output
C. Administration via rapid IV push over 5 minutes
D. Limiting infusion to once weekly dosing
Correct Answer: A
Rationale: Amphotericin B causes renal vasoconstriction and direct tubular toxicity.
Pre-hydration with saline (1 liter before and after) and maintaining potassium levels
(amphotericin causes renal potassium wasting) are essential preventive measures.
Furosemide (B) can worsen hypovolemia and kidney injury. Rapid push (C) causes
severe infusion reactions. Daily dosing (D) is standard; weekly dosing is insufficient for
fungal treatment.
7. (Traditional) A 65-year-old male with chronic insomnia is prescribed suvorexant 10
mg at bedtime. Which safety teaching is specific to this medication?
A. "You may experience complex sleep behaviors like sleep-driving"
B. "Avoid taking this medication if you have a history of narcolepsy"
C. "This medication can cause significant respiratory depression"
D. "You must take this on an empty stomach for best absorption"
Correct Answer: B
Rationale: Suvorexant is an orexin receptor antagonist that is contraindicated in patients
with narcolepsy (as orexin deficiency causes narcolepsy) and should be avoided in
other conditions causing excessive daytime sleepiness. Complex sleep behaviors (A)
are more characteristic of zolpidem and other Z-drugs. Significant respiratory
depression (C) is not a major concern with suvorexant. Food (D) does not significantly
affect absorption but high-fat meals may delay onset.
(2026/2027) 100% Correct Answers with Rationales | Graded
A+ | Unique to Version C
1. (Traditional) A 68-year-old male with heparin-induced thrombocytopenia (HIT) is
prescribed argatroban. The nurse notes the baseline aPTT is 32 seconds. Which
laboratory monitoring parameter is most appropriate to evaluate therapeutic efficacy?
A. INR maintained between 2.0 and 3.0
B. aPTT maintained at 1.5 to 3 times the baseline (48-96 seconds)
C. Anti-Xa level maintained between 0.5 and 1.0 units/mL
D. Platelet count maintained above 150,000/mm³
Correct Answer: B
Rationale: Argatroban is a direct thrombin inhibitor used in HIT. Its therapeutic effect is
monitored using the aPTT, with a target range of 1.5-3 times the patient's baseline
(typically 48-96 seconds). INR (A) is used for warfarin therapy and is unreliable with
argatroban. Anti-Xa levels (C) are used for heparin and LMWH monitoring. While platelet
count (D) must be monitored for HIT resolution, it does not measure argatroban
efficacy.
2. (Traditional) A 72-year-old female presents with a life-threatening gastrointestinal
bleed while taking apixaban 5 mg twice daily. Which reversal agent is most appropriate?
A. Idarucizumab 5 g IV
B. Andexanet alfa low dose (400 mg IV bolus)
C. Protamine sulfate 50 mg IV
D. Vitamin K 10 mg IV
,Correct Answer: B
Rationale: Andexanet alfa is the specific reversal agent for Factor Xa inhibitors
(apixaban, rivaroxaban). The dose depends on the specific drug and timing of last dose.
Idarucizumab (A) reverses dabigatran only. Protamine (C) reverses heparin. Vitamin K
(D) reverses warfarin.
3. (Traditional) A 45-year-old female with diabetic foot infection is prescribed linezolid
600 mg IV every 12 hours. She also takes escitalopram 20 mg daily for depression.
Which potential adverse interaction requires immediate monitoring?
A. Serotonin syndrome from MAOI properties of linezolid
B. QT prolongation from combined cardiac effects
C. Severe hypoglycemia from enhanced insulin sensitivity
D. Nephrotoxicity from combined renal excretion
Correct Answer: A
Rationale: Linezolid is a weak, reversible monoamine oxidase inhibitor (MAOI). When
combined with SSRIs (escitalopram), it can precipitate serotonin syndrome (mental
status changes, autonomic instability, neuromuscular hyperactivity). The nurse must
monitor for agitation, tremor, hyperthermia, and clonus. Linezolid does not significantly
prolong QT (B), cause hypoglycemia (C), or exhibit nephrotoxicity (D).
4. (Traditional) A 4-year-old child with a body surface area (BSA) of 0.64 m² is
prescribed morphine 0.05 mg/kg/dose IV every 4 hours for post-operative pain. The
child weighs 18 kg. How many milligrams should the nurse administer per dose?
A. 0.3 mg
B. 0.5 mg
C. 0.9 mg
,D. 1.2 mg
Correct Answer: C
Rationale: The order specifies weight-based dosing: 0.05 mg/kg. For an 18 kg child: 0.05
mg × 18 kg = 0.9 mg per dose. BSA is not used for this particular calculation as the
order specifically states mg/kg. If the order were mg/m², the calculation would be
different (0.05 mg/m² × 0.64 m² = 0.032 mg, which is not an option). Therefore, the
weight-based calculation is correct.
5. (Traditional) A 28-year-old male with HIV is started on dolutegravir 50 mg daily. Which
patient statement indicates a need for further teaching?
A. "I should take this medication at the same time every day"
B. "I can take this with my antacid containing magnesium"
C. "I need to report any rash immediately as it could indicate a severe reaction"
D. "This medication can cause insomnia, so I should avoid taking it at bedtime"
Correct Answer: B
Rationale: Dolutegravir is an integrase strand transfer inhibitor (INSTI) that requires
cation separation. Polyvalent cations (magnesium, aluminum, calcium, iron) chelate
dolutegravir, reducing absorption by up to 75%. Antacids must be taken 2 hours before
or 6 hours after dolutegravir. While insomnia (D) is a side effect, taking at bedtime is not
contraindicated if tolerated. Rash (C) requires reporting due to hypersensitivity risk.
6. (Traditional) A 56-year-old female with cryptococcal meningitis is prescribed
amphotericin B deoxycholate. Which intervention is most critical to prevent
nephrotoxicity?
A. Pre-hydration with 1 liter normal saline and potassium supplementation
, B. Prophylactic furosemide to maintain high urine output
C. Administration via rapid IV push over 5 minutes
D. Limiting infusion to once weekly dosing
Correct Answer: A
Rationale: Amphotericin B causes renal vasoconstriction and direct tubular toxicity.
Pre-hydration with saline (1 liter before and after) and maintaining potassium levels
(amphotericin causes renal potassium wasting) are essential preventive measures.
Furosemide (B) can worsen hypovolemia and kidney injury. Rapid push (C) causes
severe infusion reactions. Daily dosing (D) is standard; weekly dosing is insufficient for
fungal treatment.
7. (Traditional) A 65-year-old male with chronic insomnia is prescribed suvorexant 10
mg at bedtime. Which safety teaching is specific to this medication?
A. "You may experience complex sleep behaviors like sleep-driving"
B. "Avoid taking this medication if you have a history of narcolepsy"
C. "This medication can cause significant respiratory depression"
D. "You must take this on an empty stomach for best absorption"
Correct Answer: B
Rationale: Suvorexant is an orexin receptor antagonist that is contraindicated in patients
with narcolepsy (as orexin deficiency causes narcolepsy) and should be avoided in
other conditions causing excessive daytime sleepiness. Complex sleep behaviors (A)
are more characteristic of zolpidem and other Z-drugs. Significant respiratory
depression (C) is not a major concern with suvorexant. Food (D) does not significantly
affect absorption but high-fat meals may delay onset.
