NGN HESI RN PHARMACOLOGY PROCTORED EXIT
EXAM
200 Practice Questions with Correct Answers & Detailed
Rationales
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
Questions 1–35
1. A patient with heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
• A. Heart rate of 72 bpm
• B. Serum digoxin level of 2.5 ng/mL
• C. Blood pressure of 130/80 mmHg
• D. Potassium level of 4.0 mEq/L
Answer: B. Serum digoxin level of 2.5 ng/mL
Rationale: The therapeutic range for digoxin is 0.5-2.0 ng/mL. A level of 2.5 ng/mL
indicates toxicity. Signs of digoxin toxicity include nausea, vomiting, visual disturbances
(yellow-green halos), and cardiac dysrhythmias. Hypokalemia increases the risk of
digoxin toxicity.
,2. A patient on warfarin has an INR of 5.2. The nurse should anticipate which
intervention?
• A. Administer vitamin K
• B. Increase the warfarin dose
• C. Administer protamine sulfate
• D. No intervention is needed
Answer: A. Administer vitamin K
Rationale: The therapeutic INR range for warfarin is typically 2.0-3.0 (or 2.5-3.5 for
mechanical heart valves). An INR of 5.2 indicates excessive anticoagulation and
increased bleeding risk. Vitamin K is the antidote for warfarin. Protamine sulfate is the
antidote for heparin.
3. A patient is prescribed amiodarone. Which baseline assessment is most
important before starting this medication?
• A. Liver function tests
• B. Thyroid function tests
• C. Pulmonary function tests
• D. All of the above
Answer: D. All of the above
Rationale: Amiodarone has significant toxicity risks including pulmonary fibrosis
(baseline CXR/PFTs), thyroid dysfunction (baseline TSH), liver toxicity (baseline LFTs), and
corneal deposits (baseline eye exam). Baseline and periodic monitoring of all these
parameters is essential.
,4. A patient on lisinopril develops a dry, persistent cough. The nurse recognizes
this as:
• A. An expected side effect that will resolve
• B. A sign of an allergic reaction
• C. A common side effect of ACE inhibitors
• D. A sign of heart failure exacerbation
Answer: C. A common side effect of ACE inhibitors
Rationale: A dry, persistent cough is a common side effect of ACE inhibitors (lisinopril,
enalapril, etc.) due to accumulation of bradykinin. If the cough is intolerable, the
medication may be switched to an ARB (e.g., losartan), which does not cause this side
effect.
5. A patient is prescribed atorvastatin. The nurse should monitor which laboratory
value?
• A. Serum creatinine
• B. Liver function tests
• C. Complete blood count
• D. Serum sodium
Answer: B. Liver function tests
Rationale: Statins (atorvastatin, simvastatin, rosuvastatin) can cause hepatotoxicity. Liver
function tests should be monitored at baseline and periodically during treatment.
Patients should also be monitored for muscle pain (myopathy/rhabdomyolysis) and
instructed to report any unexplained muscle pain
6. A patient on clopidogrel is scheduled for surgery. The nurse should notify the
provider because clopidogrel should be stopped:
, • A. 24 hours before surgery
• B. 5-7 days before surgery
• C. 12 hours before surgery
• D. It does not need to be stopped
Answer: B. 5-7 days before surgery
Rationale: Clopidogrel is an antiplatelet agent that irreversibly inhibits platelet function
for the life of the platelet (7-10 days). It should be stopped 5-7 days before surgery to
reduce the risk of bleeding. The provider should be consulted for specific timing.
7. A patient is prescribed metoprolol for hypertension. Which assessment finding
indicates the medication is effective?
• A. Heart rate of 55 bpm
• B. Blood pressure of 128/78 mmHg
• C. Respiratory rate of 20 breaths/min
• D. Oxygen saturation of 98%
Answer: B. Blood pressure of 128/78 mmHg
Rationale: Metoprolol is a beta-blocker used to treat hypertension and angina.
Effectiveness is demonstrated by achieving target blood pressure. A heart rate of 55
bpm may indicate bradycardia (a side effect). The target heart rate is typically 60-100
bpm.
8. A patient on verapamil should be monitored for which side effect?
• A. Tachycardia
EXAM
200 Practice Questions with Correct Answers & Detailed
Rationales
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
Questions 1–35
1. A patient with heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
• A. Heart rate of 72 bpm
• B. Serum digoxin level of 2.5 ng/mL
• C. Blood pressure of 130/80 mmHg
• D. Potassium level of 4.0 mEq/L
Answer: B. Serum digoxin level of 2.5 ng/mL
Rationale: The therapeutic range for digoxin is 0.5-2.0 ng/mL. A level of 2.5 ng/mL
indicates toxicity. Signs of digoxin toxicity include nausea, vomiting, visual disturbances
(yellow-green halos), and cardiac dysrhythmias. Hypokalemia increases the risk of
digoxin toxicity.
,2. A patient on warfarin has an INR of 5.2. The nurse should anticipate which
intervention?
• A. Administer vitamin K
• B. Increase the warfarin dose
• C. Administer protamine sulfate
• D. No intervention is needed
Answer: A. Administer vitamin K
Rationale: The therapeutic INR range for warfarin is typically 2.0-3.0 (or 2.5-3.5 for
mechanical heart valves). An INR of 5.2 indicates excessive anticoagulation and
increased bleeding risk. Vitamin K is the antidote for warfarin. Protamine sulfate is the
antidote for heparin.
3. A patient is prescribed amiodarone. Which baseline assessment is most
important before starting this medication?
• A. Liver function tests
• B. Thyroid function tests
• C. Pulmonary function tests
• D. All of the above
Answer: D. All of the above
Rationale: Amiodarone has significant toxicity risks including pulmonary fibrosis
(baseline CXR/PFTs), thyroid dysfunction (baseline TSH), liver toxicity (baseline LFTs), and
corneal deposits (baseline eye exam). Baseline and periodic monitoring of all these
parameters is essential.
,4. A patient on lisinopril develops a dry, persistent cough. The nurse recognizes
this as:
• A. An expected side effect that will resolve
• B. A sign of an allergic reaction
• C. A common side effect of ACE inhibitors
• D. A sign of heart failure exacerbation
Answer: C. A common side effect of ACE inhibitors
Rationale: A dry, persistent cough is a common side effect of ACE inhibitors (lisinopril,
enalapril, etc.) due to accumulation of bradykinin. If the cough is intolerable, the
medication may be switched to an ARB (e.g., losartan), which does not cause this side
effect.
5. A patient is prescribed atorvastatin. The nurse should monitor which laboratory
value?
• A. Serum creatinine
• B. Liver function tests
• C. Complete blood count
• D. Serum sodium
Answer: B. Liver function tests
Rationale: Statins (atorvastatin, simvastatin, rosuvastatin) can cause hepatotoxicity. Liver
function tests should be monitored at baseline and periodically during treatment.
Patients should also be monitored for muscle pain (myopathy/rhabdomyolysis) and
instructed to report any unexplained muscle pain
6. A patient on clopidogrel is scheduled for surgery. The nurse should notify the
provider because clopidogrel should be stopped:
, • A. 24 hours before surgery
• B. 5-7 days before surgery
• C. 12 hours before surgery
• D. It does not need to be stopped
Answer: B. 5-7 days before surgery
Rationale: Clopidogrel is an antiplatelet agent that irreversibly inhibits platelet function
for the life of the platelet (7-10 days). It should be stopped 5-7 days before surgery to
reduce the risk of bleeding. The provider should be consulted for specific timing.
7. A patient is prescribed metoprolol for hypertension. Which assessment finding
indicates the medication is effective?
• A. Heart rate of 55 bpm
• B. Blood pressure of 128/78 mmHg
• C. Respiratory rate of 20 breaths/min
• D. Oxygen saturation of 98%
Answer: B. Blood pressure of 128/78 mmHg
Rationale: Metoprolol is a beta-blocker used to treat hypertension and angina.
Effectiveness is demonstrated by achieving target blood pressure. A heart rate of 55
bpm may indicate bradycardia (a side effect). The target heart rate is typically 60-100
bpm.
8. A patient on verapamil should be monitored for which side effect?
• A. Tachycardia
