NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION C
(2026/2027) 100% Correct Answers with Rationales | Graded
A+ | Unique to Version C
1. Traditional MCQ
A 68-year-old with acute decompensated HF is started on a nesiritide infusion.
Which vital-sign change best indicates the desired effect after 1 h?
A. ↑ SBP 8 mmHg
B. ↓ PCWP 6 mmHg
C. ↑ HR 12 bpm
D. ↓ RR 4/min
Correct: B
Rationale: Nesiritide is a recombinant BNP that vasodilates veins & arteries;
primary outcome is ↓ filling pressures (PCWP) without ↑ HR or hypotension.
2. Traditional MCQ
A mechanically ventilated patient receiving propofol 40 mL/h develops
triglyceride 485 mg/dL. Which action is most appropriate?
A. Switch to dexmedetomidine
B. Add midazolam
C. Decrease propofol 20 mL/h
D. Start ω-3 lipid emulsion
Correct: A
Rationale: Hypertriglyceridemia >400 mg/dL signals propofol infusion syndrome
risk; dexmedetomidine provides sedation without lipid load.
3. Traditional MCQ
The ED nurse mixes tenecteplase for a 72-kg STEMI patient. Dose is 0.5 mg/kg.
How many mg should be given?
A. 36 mg
B. 40 mg
C. 45 mg
, D. 50 mg
Correct: A
Rationale: 0.5 mg/kg × 72 kg = 36 mg (maximum single bolus 50 mg).
4. Traditional MCQ
A postpartum client on heparin 5,000 units q8h wants to breastfeed. The nurse
teaches:
A. “Switch to enoxaparin; heparin is unsafe in milk.”
B. “Heparin is not excreted into breast milk; you may breastfeed.”
C. “Pump & discard for 24 h after each dose.”
D. “Add warfarin now to shorten heparin course.”
Correct: B
Rationale: Heparin has a large molecular weight & is not orally bioavailable;
negligible secretion into milk.
5. Traditional MCQ
Which laboratory result requires withholding rivaroxaban 20 mg in a 78-year-old
with NVAF?
A. Creatinine 2.3 mg/dL
B. INR 1.2
C. ALT 48 U/L
D. Hgb 10.8 g/dL
Correct: A
Rationale: Rivaroxaban is contraindicated when CrCl <30 mL/min (corresponds
roughly to serum Cr ≥2 mg/dL in elderly).
6. Traditional MCQ
A child (BSA 0.8 m²) is prescribed IV acyclovir 500 mg/m² q8h. Available vial =
500 mg/20 mL. How many mL per dose?
A. 8 mL
B. 16 mL
C. 20 mL
D. 24 mL
Correct: B
Rationale: 500 mg/m² × 0.8 m² = 400 mg; 400 mg ÷ 25 mg/mL = 16 mL.
, 7. Traditional MCQ
A patient on lithium 600 mg bid has Na 126 mEq/L. Priority nursing action:
A. Restrict fluids to 1 L/day
B. Administer 3% saline
C. Hold lithium & notify provider
D. Start furosemide
Correct: C
Rationale: Hyponatremia ↑ lithium levels → toxicity; hold drug & correct sodium
gradually.
8. Traditional MCQ
Which antidote is correctly matched with its toxicity?
A. Methylene blue – Iron
B. Glucagon – Calcium-channel blocker
C. Flumazenil – Tricyclic antidepressant
D. Pralidoxime – Acetaminophen
Correct: B
Rationale: Glucagon bypasses β-receptors to ↑ cAMP & cardiac contractility in
CCB overdose.
9. Traditional MCQ
A COPD patient on prednisone 40 mg/day × 5 days reports “feeling hyper.” Which
additional finding warrants provider call?
A. Fasting glucose 198 mg/dL
B. BP 138/88 mmHg
C. K 3.8 mEq/L
D. Weight ↑ 0.5 kg
Correct: A
Rationale: Steroid-induced hyperglycemia >180 mg/dL may need insulin
adjustment.
10. Traditional MCQ
A client receiving cisplatin 60 mg/m² is prescribed amifostine 740 mg/m² IV
prior. Primary purpose:
A. Prevent ototoxicity
B. Reduce nephrotoxicity
C. Minimize peripheral neuropathy
(2026/2027) 100% Correct Answers with Rationales | Graded
A+ | Unique to Version C
1. Traditional MCQ
A 68-year-old with acute decompensated HF is started on a nesiritide infusion.
Which vital-sign change best indicates the desired effect after 1 h?
A. ↑ SBP 8 mmHg
B. ↓ PCWP 6 mmHg
C. ↑ HR 12 bpm
D. ↓ RR 4/min
Correct: B
Rationale: Nesiritide is a recombinant BNP that vasodilates veins & arteries;
primary outcome is ↓ filling pressures (PCWP) without ↑ HR or hypotension.
2. Traditional MCQ
A mechanically ventilated patient receiving propofol 40 mL/h develops
triglyceride 485 mg/dL. Which action is most appropriate?
A. Switch to dexmedetomidine
B. Add midazolam
C. Decrease propofol 20 mL/h
D. Start ω-3 lipid emulsion
Correct: A
Rationale: Hypertriglyceridemia >400 mg/dL signals propofol infusion syndrome
risk; dexmedetomidine provides sedation without lipid load.
3. Traditional MCQ
The ED nurse mixes tenecteplase for a 72-kg STEMI patient. Dose is 0.5 mg/kg.
How many mg should be given?
A. 36 mg
B. 40 mg
C. 45 mg
, D. 50 mg
Correct: A
Rationale: 0.5 mg/kg × 72 kg = 36 mg (maximum single bolus 50 mg).
4. Traditional MCQ
A postpartum client on heparin 5,000 units q8h wants to breastfeed. The nurse
teaches:
A. “Switch to enoxaparin; heparin is unsafe in milk.”
B. “Heparin is not excreted into breast milk; you may breastfeed.”
C. “Pump & discard for 24 h after each dose.”
D. “Add warfarin now to shorten heparin course.”
Correct: B
Rationale: Heparin has a large molecular weight & is not orally bioavailable;
negligible secretion into milk.
5. Traditional MCQ
Which laboratory result requires withholding rivaroxaban 20 mg in a 78-year-old
with NVAF?
A. Creatinine 2.3 mg/dL
B. INR 1.2
C. ALT 48 U/L
D. Hgb 10.8 g/dL
Correct: A
Rationale: Rivaroxaban is contraindicated when CrCl <30 mL/min (corresponds
roughly to serum Cr ≥2 mg/dL in elderly).
6. Traditional MCQ
A child (BSA 0.8 m²) is prescribed IV acyclovir 500 mg/m² q8h. Available vial =
500 mg/20 mL. How many mL per dose?
A. 8 mL
B. 16 mL
C. 20 mL
D. 24 mL
Correct: B
Rationale: 500 mg/m² × 0.8 m² = 400 mg; 400 mg ÷ 25 mg/mL = 16 mL.
, 7. Traditional MCQ
A patient on lithium 600 mg bid has Na 126 mEq/L. Priority nursing action:
A. Restrict fluids to 1 L/day
B. Administer 3% saline
C. Hold lithium & notify provider
D. Start furosemide
Correct: C
Rationale: Hyponatremia ↑ lithium levels → toxicity; hold drug & correct sodium
gradually.
8. Traditional MCQ
Which antidote is correctly matched with its toxicity?
A. Methylene blue – Iron
B. Glucagon – Calcium-channel blocker
C. Flumazenil – Tricyclic antidepressant
D. Pralidoxime – Acetaminophen
Correct: B
Rationale: Glucagon bypasses β-receptors to ↑ cAMP & cardiac contractility in
CCB overdose.
9. Traditional MCQ
A COPD patient on prednisone 40 mg/day × 5 days reports “feeling hyper.” Which
additional finding warrants provider call?
A. Fasting glucose 198 mg/dL
B. BP 138/88 mmHg
C. K 3.8 mEq/L
D. Weight ↑ 0.5 kg
Correct: A
Rationale: Steroid-induced hyperglycemia >180 mg/dL may need insulin
adjustment.
10. Traditional MCQ
A client receiving cisplatin 60 mg/m² is prescribed amifostine 740 mg/m² IV
prior. Primary purpose:
A. Prevent ototoxicity
B. Reduce nephrotoxicity
C. Minimize peripheral neuropathy
