NGN HESI RN PHARMACOLOGY REAL
EXAMS
4 Versions with 300+ MCQs, Answers, and
Detailed Rationales – Updated for 2026/2027
VERSION 1
Questions 1-50
QUESTION 1
A client with heart failure is prescribed digoxin. Which finding indicates a
therapeutic response?
A. Increased heart rate
B. Decreased blood pressure
C. Improved urinary output
D. Relief of chest pain
Correct Answer: C. Improved urinary output
Rationale: Digoxin increases cardiac contractility and cardiac output, which
improves renal perfusion and urinary output in heart failure. Decreased heart rate is
an effect but not the primary therapeutic goal in HF. Chest pain relief is not a direct
effect of digoxin.
QUESTION 2
A nurse administers enoxaparin subcutaneously. Which technique is correct?
A. Aspirate before injection
B. Massage the site after injection
,C. Administer in the abdomen while pinching a skin fold
D. Expel the air bubble from the prefilled syringe
Correct Answer: C. Administer in the abdomen while pinching a skin fold
Rationale: Enoxaparin (Lovenox) is given subcutaneously in the abdomen with a
skin fold pinched. Aspiration is not recommended. Do not massage the site. Do not
expel the air bubble—it ensures full dose delivery.
QUESTION 3
A client takes warfarin. Which lab value indicates therapy is therapeutic?
A. INR of 1.0
B. INR of 2.5
C. aPTT of 60 seconds
D. Platelets 150,000/mm³
Correct Answer: B. INR of 2.5
Rationale: For most indications (e.g., atrial fibrillation, DVT), a therapeutic INR
range is 2.0–3.0. INR of 1.0 indicates no effect. aPTT monitors heparin, not
warfarin.
QUESTION 4
A client reports muscle pain and weakness while taking atorvastatin. What is the
nurse's priority?
A. Administer acetaminophen
B. Encourage potassium-rich foods
C. Assess for rhabdomyolysis
D. Suggest switching to a different statin
Correct Answer: C. Assess for rhabdomyolysis
Rationale: Statins can cause rhabdomyolysis (muscle breakdown), which may
lead to acute kidney injury. CK levels should be checked. Acetaminophen may
mask symptoms; the priority is assessment.
,QUESTION 5
The nurse administers furosemide IV push. What is the maximum recommended
rate?
A. 5 mg/min
B. 10 mg/min
C. 20 mg/min
D. 40 mg/min
Correct Answer: C. 20 mg/min
Rationale: Furosemide should be administered IV push at a maximum rate of 20
mg/min to prevent ototoxicity, especially when given in high doses.
QUESTION 6
Which lab value requires immediate action in a client on lithium therapy?
A. Sodium 135 mEq/L
B. Lithium level 1.8 mEq/L
C. Creatinine 0.9 mg/dL
D. TSH 2.5 mIU/L
Correct Answer: B. Lithium level 1.8 mEq/L
Rationale: Therapeutic lithium level is 0.6–1.2 mEq/L. A level of 1.8 mEq/L is
toxic, risking seizures, coma, and kidney damage.
QUESTION 7
A client on IV morphine has a respiratory rate of 8 breaths/min. Which medication
should the nurse prepare?
A. Flumazenil
B. Naloxone
, C. Acetylcysteine
D. Protamine sulfate k
CorrectAnswer: B. Naloxone
k k k
Rationale: Naloxone (Narcan) is an opioid antagonist that reverses respiratory
k k k k k k k k k
depression. Flumazenil reverses benzodiazepines. Acetylcysteine treats
k k k k k k
acetaminophen overdose. Protamine reverses heparin.
k k k k
QUESTION 8 k
A nurse administers subcutaneous insulin aspart. When should the client eat?
k k k k k k k k k k
A. Immediately
B. 30 minutes
k
C. 1–2 hoursk
D. 4–5 hoursk
CorrectAnswer: A. Immediately
k k k
Rationale: Insulin aspart is rapid-acting, with onset in approximately 15 minutes.
k k k k k k k k k k
Meal should be consumed immediately to prevent hypoglycemia.
k k k k k k k k
QUESTION 9 k
Which finding indicates a client is experiencing a heparin overdose?
k k k k k k k k k
A. Thrombocytopenia
B. Hematuria
C. INR 5.0 k
D. Hyperkalemia
CorrectAnswer: B. Hematuria
k k k
Rationale: Heparin overdose causes bleeding. Hematuria (blood in urine) is a sign of
k k k k k k k k k k k k
bleeding. Thrombocytopenia suggests HIT, not overdose. INR monitors warfarin.
k k k k k k k k k
EXAMS
4 Versions with 300+ MCQs, Answers, and
Detailed Rationales – Updated for 2026/2027
VERSION 1
Questions 1-50
QUESTION 1
A client with heart failure is prescribed digoxin. Which finding indicates a
therapeutic response?
A. Increased heart rate
B. Decreased blood pressure
C. Improved urinary output
D. Relief of chest pain
Correct Answer: C. Improved urinary output
Rationale: Digoxin increases cardiac contractility and cardiac output, which
improves renal perfusion and urinary output in heart failure. Decreased heart rate is
an effect but not the primary therapeutic goal in HF. Chest pain relief is not a direct
effect of digoxin.
QUESTION 2
A nurse administers enoxaparin subcutaneously. Which technique is correct?
A. Aspirate before injection
B. Massage the site after injection
,C. Administer in the abdomen while pinching a skin fold
D. Expel the air bubble from the prefilled syringe
Correct Answer: C. Administer in the abdomen while pinching a skin fold
Rationale: Enoxaparin (Lovenox) is given subcutaneously in the abdomen with a
skin fold pinched. Aspiration is not recommended. Do not massage the site. Do not
expel the air bubble—it ensures full dose delivery.
QUESTION 3
A client takes warfarin. Which lab value indicates therapy is therapeutic?
A. INR of 1.0
B. INR of 2.5
C. aPTT of 60 seconds
D. Platelets 150,000/mm³
Correct Answer: B. INR of 2.5
Rationale: For most indications (e.g., atrial fibrillation, DVT), a therapeutic INR
range is 2.0–3.0. INR of 1.0 indicates no effect. aPTT monitors heparin, not
warfarin.
QUESTION 4
A client reports muscle pain and weakness while taking atorvastatin. What is the
nurse's priority?
A. Administer acetaminophen
B. Encourage potassium-rich foods
C. Assess for rhabdomyolysis
D. Suggest switching to a different statin
Correct Answer: C. Assess for rhabdomyolysis
Rationale: Statins can cause rhabdomyolysis (muscle breakdown), which may
lead to acute kidney injury. CK levels should be checked. Acetaminophen may
mask symptoms; the priority is assessment.
,QUESTION 5
The nurse administers furosemide IV push. What is the maximum recommended
rate?
A. 5 mg/min
B. 10 mg/min
C. 20 mg/min
D. 40 mg/min
Correct Answer: C. 20 mg/min
Rationale: Furosemide should be administered IV push at a maximum rate of 20
mg/min to prevent ototoxicity, especially when given in high doses.
QUESTION 6
Which lab value requires immediate action in a client on lithium therapy?
A. Sodium 135 mEq/L
B. Lithium level 1.8 mEq/L
C. Creatinine 0.9 mg/dL
D. TSH 2.5 mIU/L
Correct Answer: B. Lithium level 1.8 mEq/L
Rationale: Therapeutic lithium level is 0.6–1.2 mEq/L. A level of 1.8 mEq/L is
toxic, risking seizures, coma, and kidney damage.
QUESTION 7
A client on IV morphine has a respiratory rate of 8 breaths/min. Which medication
should the nurse prepare?
A. Flumazenil
B. Naloxone
, C. Acetylcysteine
D. Protamine sulfate k
CorrectAnswer: B. Naloxone
k k k
Rationale: Naloxone (Narcan) is an opioid antagonist that reverses respiratory
k k k k k k k k k
depression. Flumazenil reverses benzodiazepines. Acetylcysteine treats
k k k k k k
acetaminophen overdose. Protamine reverses heparin.
k k k k
QUESTION 8 k
A nurse administers subcutaneous insulin aspart. When should the client eat?
k k k k k k k k k k
A. Immediately
B. 30 minutes
k
C. 1–2 hoursk
D. 4–5 hoursk
CorrectAnswer: A. Immediately
k k k
Rationale: Insulin aspart is rapid-acting, with onset in approximately 15 minutes.
k k k k k k k k k k
Meal should be consumed immediately to prevent hypoglycemia.
k k k k k k k k
QUESTION 9 k
Which finding indicates a client is experiencing a heparin overdose?
k k k k k k k k k
A. Thrombocytopenia
B. Hematuria
C. INR 5.0 k
D. Hyperkalemia
CorrectAnswer: B. Hematuria
k k k
Rationale: Heparin overdose causes bleeding. Hematuria (blood in urine) is a sign of
k k k k k k k k k k k k
bleeding. Thrombocytopenia suggests HIT, not overdose. INR monitors warfarin.
k k k k k k k k k
