RN Pharmacology NGN Practice Exam: 70 Items
with Rationales — Bowtie, Matrix, SATA, Cloze,
and Drag-and-Drop
1. Bowtie – Digoxin toxicity
Client on digoxin has HR 52, nausea, visual halos.
Condition: Digoxin toxicity. Action: Hold digoxin and notify provider. Monitor:
Apical pulse and potassium.
Rationale: Bradycardia, GI upset, and visual changes suggest toxicity;
hypokalemia increases risk.
2. Bowtie – Heparin excess
IV heparin, aPTT 110 sec.
Condition: Heparin excess/bleeding risk. Action: Stop infusion and notify
provider. Monitor: aPTT and bleeding signs.
Rationale: Therapeutic aPTT is 1.5–2.5× control; antidote is protamine sulfate.
3. Matrix – Warfarin teaching
Indicated: Keep INR 2–3; Avoid large amounts of green leafy vegetables; Use
electric razor.
Contraindicated: Take aspirin for headaches.
Rationale: Aspirin increases bleeding risk.
4. Matrix – Insulin lispro
Indicated: Give 15 min before meals; Give with long-acting insulin if prescribed.
Contraindicated: Give at bedtime; Give if BG is 70 mg/dL without treating.
Rationale: Lispro is rapid-acting; hypoglycemia must be treated first.
5. SATA – Metformin and contrast dye
A. Hold metformin before procedure.
, B. Restart 48 hr after if renal function is okay.
C. Continue as normal.
D. Monitor for lactic acidosis.
E. Double the dose afterward.
Answer: A, B, D.
Rationale: Contrast can precipitate lactic acidosis; hold and restart only when
renal function is safe.
6. SATA – Hypoglycemia signs
A. Sweating
B. Tremors
C. Confusion
D. Bradycardia
E. Polyuria
Answer: A, B, C.
Rationale: Hypoglycemia causes sweating, tremors, confusion, and tachycardia—
not bradycardia or polyuria.
7. Drag-and-drop – Levothyroxine administration
Order: Morning → empty stomach → take with water → wait 30–60 min → avoid
calcium/iron within 4 hr.
Rationale: Food, calcium, and iron reduce absorption.
8. Matrix – Prednisone long-term
Indicated: Taper dose; Monitor glucose.
Contraindicated: Stop abruptly; Increase sodium intake.
Rationale: Abrupt stop can cause adrenal crisis; corticosteroids can raise glucose
and cause fluid retention.
9. Bowtie – Albuterol palpitations
Condition: Expected beta-2 agonist effect. Action: Reassure and continue as
with Rationales — Bowtie, Matrix, SATA, Cloze,
and Drag-and-Drop
1. Bowtie – Digoxin toxicity
Client on digoxin has HR 52, nausea, visual halos.
Condition: Digoxin toxicity. Action: Hold digoxin and notify provider. Monitor:
Apical pulse and potassium.
Rationale: Bradycardia, GI upset, and visual changes suggest toxicity;
hypokalemia increases risk.
2. Bowtie – Heparin excess
IV heparin, aPTT 110 sec.
Condition: Heparin excess/bleeding risk. Action: Stop infusion and notify
provider. Monitor: aPTT and bleeding signs.
Rationale: Therapeutic aPTT is 1.5–2.5× control; antidote is protamine sulfate.
3. Matrix – Warfarin teaching
Indicated: Keep INR 2–3; Avoid large amounts of green leafy vegetables; Use
electric razor.
Contraindicated: Take aspirin for headaches.
Rationale: Aspirin increases bleeding risk.
4. Matrix – Insulin lispro
Indicated: Give 15 min before meals; Give with long-acting insulin if prescribed.
Contraindicated: Give at bedtime; Give if BG is 70 mg/dL without treating.
Rationale: Lispro is rapid-acting; hypoglycemia must be treated first.
5. SATA – Metformin and contrast dye
A. Hold metformin before procedure.
, B. Restart 48 hr after if renal function is okay.
C. Continue as normal.
D. Monitor for lactic acidosis.
E. Double the dose afterward.
Answer: A, B, D.
Rationale: Contrast can precipitate lactic acidosis; hold and restart only when
renal function is safe.
6. SATA – Hypoglycemia signs
A. Sweating
B. Tremors
C. Confusion
D. Bradycardia
E. Polyuria
Answer: A, B, C.
Rationale: Hypoglycemia causes sweating, tremors, confusion, and tachycardia—
not bradycardia or polyuria.
7. Drag-and-drop – Levothyroxine administration
Order: Morning → empty stomach → take with water → wait 30–60 min → avoid
calcium/iron within 4 hr.
Rationale: Food, calcium, and iron reduce absorption.
8. Matrix – Prednisone long-term
Indicated: Taper dose; Monitor glucose.
Contraindicated: Stop abruptly; Increase sodium intake.
Rationale: Abrupt stop can cause adrenal crisis; corticosteroids can raise glucose
and cause fluid retention.
9. Bowtie – Albuterol palpitations
Condition: Expected beta-2 agonist effect. Action: Reassure and continue as
