NGN HESI RN PHARMACOLOGY REAL EXAM –
VERSION B (2026/2027) 100% Correct Answers with
Rationales | Graded A+ | Unique to Version B
1. Traditional MCQ
A 67-year-old with stage 4 CKD (eGFR 18 mL/min) and new-onset atrial
fibrillation is prescribed dabigatran 150 mg BID. The nurse’s priority action is:
A. Administer the drug with cranberry juice to enhance absorption
B. Hold the dose and consult the prescriber for renal dosing adjustment
C. Check the INR 12 h after the first dose
D. Give the drug with food to reduce GI upset
Correct Answer: B
Rationale: Dabigatran is 80 % renally eliminated; 150 mg BID is contraindicated if eGFR <
30 mL/min. INR is not used to monitor dabigatran. Cranberry may increase bleeding
risk.
2. Traditional MCQ
A 32-year-old pregnant client (28 weeks) with HIV receives a new prescription for
dolutegravir. The nurse teaches:
A. “Take the tablet on an empty stomach to improve levels.”
B. “This drug prevents vertical transmission by crossing the placenta.”
C. “You will need monthly fasting glucose checks.”
D. “Discontinue immediately if you develop a rash.”
Correct Answer: B
Rationale: Dolutegravir has high placental transfer and is recommended to reduce
perinatal transmission. No fasting required; rash is uncommon.
, 3. Multiple-Select (Select ALL That Apply)
A 5-year-old (22 kg) with status asthmaticus receives IV magnesium sulfate 50
mg/kg (1,100 mg) over 20 min. Which nursing actions are appropriate? (Select all
that apply.)
A. Place on continuous cardiac monitoring
B. Have calcium gluconate available as antidote
C. Assess deep-tendon reflexes q5 min during infusion
D. Monitor respiratory rate and breath sounds
E. Expect blood pressure to increase 20 mmHg
Correct Answers: A, B, D
Rationale: Magnesium can cause hypotension, bradycardia, and respiratory depression;
calcium reverses toxicity. Reflexes are not the best pediatric indicator. BP usually falls.
4. Traditional MCQ
A 79-year-old with heart failure (EF 30 %) and COPD is started on digoxin 0.125
mg daily. Which serum value best indicates early toxicity in this patient?
A. Digoxin level 0.9 ng/mL
B. Potassium 3.0 mEq/L
C. Creatinine 0.9 mg/dL
D. Magnesium 2.0 mEq/L
Correct Answer: B
Rationale: Hypokalemia increases risk of digoxin toxicity even at “therapeutic” levels.
Target K 4–5 mEq/L in digoxin patients.
5. Cloze (Drop-Down) Item
A 55-year-old with hepatic cirrhosis (Child-Pugh B) and recurrent VT receives
amiodarone 600 mg IV over 24 h. The nurse expects the prescriber to reduce the
maintenance dose by (A. 25 % / B. 50 % / C. 75 % / D. No change) because
amiodarone is (E. 100 % renally eliminated / F. metabolized by CYP450 and
accumulates in hepatic impairment / G. dialyzable).
Correct Answers: B, F
, Rationale: Amiodarone is hepatically metabolized; 50 % dose reduction recommended
in Child-Pugh B to avoid bradycardia and hepatotoxicity.
6. Traditional MCQ
A 40-year-old with active RA is prescribed tofacitinib 5 mg PO BID. Which lab test
should be monitored most frequently during the first 3 months?
A. Serum creatinine
B. Liver enzymes
C. Absolute lymphocyte count
D. Hemoglobin A1C
Correct Answer: C
Rationale: JAK inhibitors can cause lymphopenia and increase infection risk; monitor
CBC q4–8 weeks.
7. Matrix/Grid Item
A nurse teaches a client starting phenelzine (Nardil), an MAOI. For each client
statement, indicate whether it reflects Understanding, Misunderstanding, or
Requires Clarification.
TableCopy
Client Statement Response
“I will avoid aged cheeses and cured
Understanding
meats.”
“I can continue to drink my daily
Misunderstanding
Cabernet.”
VERSION B (2026/2027) 100% Correct Answers with
Rationales | Graded A+ | Unique to Version B
1. Traditional MCQ
A 67-year-old with stage 4 CKD (eGFR 18 mL/min) and new-onset atrial
fibrillation is prescribed dabigatran 150 mg BID. The nurse’s priority action is:
A. Administer the drug with cranberry juice to enhance absorption
B. Hold the dose and consult the prescriber for renal dosing adjustment
C. Check the INR 12 h after the first dose
D. Give the drug with food to reduce GI upset
Correct Answer: B
Rationale: Dabigatran is 80 % renally eliminated; 150 mg BID is contraindicated if eGFR <
30 mL/min. INR is not used to monitor dabigatran. Cranberry may increase bleeding
risk.
2. Traditional MCQ
A 32-year-old pregnant client (28 weeks) with HIV receives a new prescription for
dolutegravir. The nurse teaches:
A. “Take the tablet on an empty stomach to improve levels.”
B. “This drug prevents vertical transmission by crossing the placenta.”
C. “You will need monthly fasting glucose checks.”
D. “Discontinue immediately if you develop a rash.”
Correct Answer: B
Rationale: Dolutegravir has high placental transfer and is recommended to reduce
perinatal transmission. No fasting required; rash is uncommon.
, 3. Multiple-Select (Select ALL That Apply)
A 5-year-old (22 kg) with status asthmaticus receives IV magnesium sulfate 50
mg/kg (1,100 mg) over 20 min. Which nursing actions are appropriate? (Select all
that apply.)
A. Place on continuous cardiac monitoring
B. Have calcium gluconate available as antidote
C. Assess deep-tendon reflexes q5 min during infusion
D. Monitor respiratory rate and breath sounds
E. Expect blood pressure to increase 20 mmHg
Correct Answers: A, B, D
Rationale: Magnesium can cause hypotension, bradycardia, and respiratory depression;
calcium reverses toxicity. Reflexes are not the best pediatric indicator. BP usually falls.
4. Traditional MCQ
A 79-year-old with heart failure (EF 30 %) and COPD is started on digoxin 0.125
mg daily. Which serum value best indicates early toxicity in this patient?
A. Digoxin level 0.9 ng/mL
B. Potassium 3.0 mEq/L
C. Creatinine 0.9 mg/dL
D. Magnesium 2.0 mEq/L
Correct Answer: B
Rationale: Hypokalemia increases risk of digoxin toxicity even at “therapeutic” levels.
Target K 4–5 mEq/L in digoxin patients.
5. Cloze (Drop-Down) Item
A 55-year-old with hepatic cirrhosis (Child-Pugh B) and recurrent VT receives
amiodarone 600 mg IV over 24 h. The nurse expects the prescriber to reduce the
maintenance dose by (A. 25 % / B. 50 % / C. 75 % / D. No change) because
amiodarone is (E. 100 % renally eliminated / F. metabolized by CYP450 and
accumulates in hepatic impairment / G. dialyzable).
Correct Answers: B, F
, Rationale: Amiodarone is hepatically metabolized; 50 % dose reduction recommended
in Child-Pugh B to avoid bradycardia and hepatotoxicity.
6. Traditional MCQ
A 40-year-old with active RA is prescribed tofacitinib 5 mg PO BID. Which lab test
should be monitored most frequently during the first 3 months?
A. Serum creatinine
B. Liver enzymes
C. Absolute lymphocyte count
D. Hemoglobin A1C
Correct Answer: C
Rationale: JAK inhibitors can cause lymphopenia and increase infection risk; monitor
CBC q4–8 weeks.
7. Matrix/Grid Item
A nurse teaches a client starting phenelzine (Nardil), an MAOI. For each client
statement, indicate whether it reflects Understanding, Misunderstanding, or
Requires Clarification.
TableCopy
Client Statement Response
“I will avoid aged cheeses and cured
Understanding
meats.”
“I can continue to drink my daily
Misunderstanding
Cabernet.”
