NGN HESI RN PHARMACOLOGY All (4 Versions) covered
Version A
1. A client taking digoxin is at risk of toxicity when which electrolyte is low?
A. Calcium
B. Potassium
C. Sodium
D. Chloride
Rationale: Hypokalemia increases the risk of digoxin toxicity, which may cause arrhythmias.
Calcium imbalance affects muscle contraction, not digoxin levels. Sodium and chloride do not
have a significant effect on digoxin sensitivity.
2. Which adverse effect is most concerning with aminoglycoside antibiotics such as
gentamicin?
A. Nausea
B. Ototoxicity
C. Headache
D. Constipation
Rationale: Ototoxicity (hearing loss, tinnitus, balance issues) is a severe and irreversible
complication of aminoglycosides. Nausea and headache are mild side effects. Constipation is
unrelated.
3. A patient on warfarin has an INR of 5.2. What is the priority nursing action?
A. Encourage fluids
B. Hold the dose and notify the provider
C. Give an extra dose
D. Encourage ambulation
Rationale: An INR of 5.2 is above the therapeutic range (2–3), placing the patient at bleeding
risk. The medication should be held and the provider notified. Extra dose would worsen bleeding
risk. Ambulation and fluids do not address coagulation.
4. Which insulin has the fastest onset of action?
A. NPH
B. Lispro
,C. Regular insulin
D. Glargine
Rationale: Lispro is a rapid-acting insulin with onset of about 15 minutes. Regular insulin is
short-acting (30–60 minutes). NPH is intermediate (1–2 hours). Glargine is long-acting (1–2
hours, no peak).
5. A client taking lithium for bipolar disorder shows tremors, confusion, and vomiting.
What is the nurse’s priority action?
A. Administer PRN pain medication
B. Encourage deep breathing
C. Hold the medication and notify the provider
D. Give food with the medication
Rationale: These are signs of lithium toxicity. The medication should be held and provider
notified. Pain meds and food do not treat toxicity. Deep breathing is irrelevant.
6. Which adverse effect is most serious with clozapine?
A. Sedation
B. Weight gain
C. Agranulocytosis
D. Dry mouth
Rationale: Clozapine can cause agranulocytosis (dangerous drop in WBC count), which is life-
threatening. Sedation, weight gain, and dry mouth are common but not life-threatening.
7. A nurse is teaching a client about nitroglycerin sublingual tablets. Which instruction is
correct?
A. Swallow the tablet with water
B. Place under tongue until dissolved
C. Chew the tablet for faster effect
D. Take only at bedtime
Rationale: Sublingual nitroglycerin must dissolve under the tongue for rapid absorption.
Swallowing or chewing inactivates it. It should be taken during chest pain, not only at bedtime.
8. Which lab test should be monitored with heparin therapy?
A. INR
B. aPTT
,C. Platelets only
D. Hemoglobin
Rationale: aPTT measures heparin’s anticoagulation effect. INR is for warfarin. Platelets and
hemoglobin are monitored for bleeding, but not dosage adjustment.
9. Which client statement indicates understanding of levothyroxine therapy?
A. “I’ll stop taking it once I feel better.”
B. “I need to take this every morning before breakfast.”
C. “I should take it with an antacid.”
D. “I’ll double the dose if I miss one.”
Rationale: Levothyroxine is taken daily in the morning on an empty stomach. It is lifelong
therapy, not stopped when feeling better. Antacids interfere with absorption. Doses should not be
doubled.
10. Which adverse effect is associated with ACE inhibitors like lisinopril?
A. Constipation
B. Dry cough
C. Bradycardia
D. Hypoglycemia
Rationale: ACE inhibitors can cause a persistent dry cough. They may also cause hyperkalemia
and hypotension, but not constipation, bradycardia, or hypoglycemia.
11. What is the antidote for acetaminophen overdose?
A. Naloxone
B. Acetylcysteine
C. Protamine sulfate
D. Vitamin K
Rationale: Acetylcysteine prevents liver damage in acetaminophen overdose. Naloxone reverses
opioids. Protamine sulfate is for heparin. Vitamin K is for warfarin.
12. Which adverse effect requires immediate discontinuation of metformin?
A. Weight gain
B. Lactic acidosis symptoms
C. Headache
D. Nausea
, Rationale: Lactic acidosis is a rare but life-threatening complication of metformin. Nausea is
common but manageable. Weight gain is not typical. Headache is nonspecific.
13. A client receiving morphine reports pinpoint pupils and respiratory rate of 6. What
should the nurse do first?
A. Apply oxygen
B. Administer naloxone
C. Notify the provider
D. Reassess in 15 minutes
Rationale: Naloxone reverses opioid-induced respiratory depression. Oxygen helps but does not
reverse the cause. Waiting is unsafe. Provider can be notified after immediate action.
14. Which drug is contraindicated in pregnancy due to teratogenic effects?
A. Acetaminophen
B. Isotretinoin
C. Penicillin
D. Levothyroxine
Rationale: Isotretinoin is highly teratogenic and contraindicated in pregnancy. The others are
safe when prescribed correctly.
15. A client taking hydrochlorothiazide should increase intake of which nutrient?
A. Vitamin K
B. Potassium
C. Calcium
D. Iron
Rationale: Thiazide diuretics cause potassium loss. Potassium-rich foods should be increased.
Calcium is not depleted. Vitamin K and iron are unrelated.
16. Which adverse effect is most serious with statins like atorvastatin?
A. Constipation
B. Rhabdomyolysis
C. Cough
D. Rash
Rationale: Rhabdomyolysis (muscle breakdown leading to renal failure) is the most severe statin
complication. Constipation, cough, and rash are mild.
Version A
1. A client taking digoxin is at risk of toxicity when which electrolyte is low?
A. Calcium
B. Potassium
C. Sodium
D. Chloride
Rationale: Hypokalemia increases the risk of digoxin toxicity, which may cause arrhythmias.
Calcium imbalance affects muscle contraction, not digoxin levels. Sodium and chloride do not
have a significant effect on digoxin sensitivity.
2. Which adverse effect is most concerning with aminoglycoside antibiotics such as
gentamicin?
A. Nausea
B. Ototoxicity
C. Headache
D. Constipation
Rationale: Ototoxicity (hearing loss, tinnitus, balance issues) is a severe and irreversible
complication of aminoglycosides. Nausea and headache are mild side effects. Constipation is
unrelated.
3. A patient on warfarin has an INR of 5.2. What is the priority nursing action?
A. Encourage fluids
B. Hold the dose and notify the provider
C. Give an extra dose
D. Encourage ambulation
Rationale: An INR of 5.2 is above the therapeutic range (2–3), placing the patient at bleeding
risk. The medication should be held and the provider notified. Extra dose would worsen bleeding
risk. Ambulation and fluids do not address coagulation.
4. Which insulin has the fastest onset of action?
A. NPH
B. Lispro
,C. Regular insulin
D. Glargine
Rationale: Lispro is a rapid-acting insulin with onset of about 15 minutes. Regular insulin is
short-acting (30–60 minutes). NPH is intermediate (1–2 hours). Glargine is long-acting (1–2
hours, no peak).
5. A client taking lithium for bipolar disorder shows tremors, confusion, and vomiting.
What is the nurse’s priority action?
A. Administer PRN pain medication
B. Encourage deep breathing
C. Hold the medication and notify the provider
D. Give food with the medication
Rationale: These are signs of lithium toxicity. The medication should be held and provider
notified. Pain meds and food do not treat toxicity. Deep breathing is irrelevant.
6. Which adverse effect is most serious with clozapine?
A. Sedation
B. Weight gain
C. Agranulocytosis
D. Dry mouth
Rationale: Clozapine can cause agranulocytosis (dangerous drop in WBC count), which is life-
threatening. Sedation, weight gain, and dry mouth are common but not life-threatening.
7. A nurse is teaching a client about nitroglycerin sublingual tablets. Which instruction is
correct?
A. Swallow the tablet with water
B. Place under tongue until dissolved
C. Chew the tablet for faster effect
D. Take only at bedtime
Rationale: Sublingual nitroglycerin must dissolve under the tongue for rapid absorption.
Swallowing or chewing inactivates it. It should be taken during chest pain, not only at bedtime.
8. Which lab test should be monitored with heparin therapy?
A. INR
B. aPTT
,C. Platelets only
D. Hemoglobin
Rationale: aPTT measures heparin’s anticoagulation effect. INR is for warfarin. Platelets and
hemoglobin are monitored for bleeding, but not dosage adjustment.
9. Which client statement indicates understanding of levothyroxine therapy?
A. “I’ll stop taking it once I feel better.”
B. “I need to take this every morning before breakfast.”
C. “I should take it with an antacid.”
D. “I’ll double the dose if I miss one.”
Rationale: Levothyroxine is taken daily in the morning on an empty stomach. It is lifelong
therapy, not stopped when feeling better. Antacids interfere with absorption. Doses should not be
doubled.
10. Which adverse effect is associated with ACE inhibitors like lisinopril?
A. Constipation
B. Dry cough
C. Bradycardia
D. Hypoglycemia
Rationale: ACE inhibitors can cause a persistent dry cough. They may also cause hyperkalemia
and hypotension, but not constipation, bradycardia, or hypoglycemia.
11. What is the antidote for acetaminophen overdose?
A. Naloxone
B. Acetylcysteine
C. Protamine sulfate
D. Vitamin K
Rationale: Acetylcysteine prevents liver damage in acetaminophen overdose. Naloxone reverses
opioids. Protamine sulfate is for heparin. Vitamin K is for warfarin.
12. Which adverse effect requires immediate discontinuation of metformin?
A. Weight gain
B. Lactic acidosis symptoms
C. Headache
D. Nausea
, Rationale: Lactic acidosis is a rare but life-threatening complication of metformin. Nausea is
common but manageable. Weight gain is not typical. Headache is nonspecific.
13. A client receiving morphine reports pinpoint pupils and respiratory rate of 6. What
should the nurse do first?
A. Apply oxygen
B. Administer naloxone
C. Notify the provider
D. Reassess in 15 minutes
Rationale: Naloxone reverses opioid-induced respiratory depression. Oxygen helps but does not
reverse the cause. Waiting is unsafe. Provider can be notified after immediate action.
14. Which drug is contraindicated in pregnancy due to teratogenic effects?
A. Acetaminophen
B. Isotretinoin
C. Penicillin
D. Levothyroxine
Rationale: Isotretinoin is highly teratogenic and contraindicated in pregnancy. The others are
safe when prescribed correctly.
15. A client taking hydrochlorothiazide should increase intake of which nutrient?
A. Vitamin K
B. Potassium
C. Calcium
D. Iron
Rationale: Thiazide diuretics cause potassium loss. Potassium-rich foods should be increased.
Calcium is not depleted. Vitamin K and iron are unrelated.
16. Which adverse effect is most serious with statins like atorvastatin?
A. Constipation
B. Rhabdomyolysis
C. Cough
D. Rash
Rationale: Rhabdomyolysis (muscle breakdown leading to renal failure) is the most severe statin
complication. Constipation, cough, and rash are mild.
