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 PO BID by the ED physician. Which
action is MOST important for the nurse to take before administration?
A. Verify the last dialysis run ended >2 h ago
B. Reduce the dose to 75 mg PO BID
C. Obtain aPTT baseline
D. Administer on an empty stomach to enhance absorption
Correct Answer: B
Rationale: Dabigatran is 80 % renal eliminated; CrCl <30 mL/min mandates dose
reduction to 75 mg BID. Dialysis timing (A) is not relevant for this drug. aPTT (C)
is not used for monitoring. Food does NOT alter absorption (D).
2. Traditional MCQ
A 5-year-old (22 kg) with ALL is to receive morphine 50 mcg/kg IV q4h PRN. The
vial contains 2 mg/mL. How many mL should the nurse administer per dose?
A. 0.55 mL
B. 0.75 mL
C. 1.1 mL
D. 1.5 mL
Correct Answer: A
Rationale: 50 mcg × 22 kg = 1,100 mcg = 1.1 mg; 1.1 mg ÷ 2 mg/mL = 0.55 mL.
3. Multiple-Select
A client is receiving a high-dose cyclophosphamide regimen. Which THREE
nursing measures BEST reduce the risk of hemorrhagic cystitis? (Select all that
apply.)
A. Encourage 3 L oral fluid intake daily
B. Administer mesna 20 % of cyclophosphamide dose IV at 0, 4, 8 h
C. Monitor urine for blood every void
, D. Restrict potassium-rich foods
E. Give furosemide 20 mg IV push after each dose
Correct Answers: A, B, C
Rationale: Hydration and mesna detoxify acrolein metabolite; gross hematuria
monitoring allows early intervention. Dietary potassium (D) is unrelated, and
routine diuretics (E) may worsen dehydration.
4. Traditional MCQ
A client on a norepinephrine 8 mcg/min drip develops extravasation. The nurse
prepares to inject phentolamine. The vial contains 5 mg/2 mL. What volume
should be injected into the extravasation site?
A. 0.4 mL
B. 1 mL
C. 2 mL
D. 5 mL
Correct Answer: B
Rationale: Standard dose is 5–10 mg diluted to 10 mL; 5 mg = 1 mL of stock,
then dilute further. 1 mL is the amount of concentrate required.
5. Matrix/Grid
A pregnant client (32 weeks) with new-onset HTN is prescribed labetalol 200 mg
PO BID. For each teaching statement, identify whether it reflects Understanding,
Misunderstanding, or Requires Clarification.
TableCopy
Understa Misunderst Requires
Statement
nding anding Clarification
“I will stop the medicine if my pulse drops below
✔
60.”
“This medication could slow my baby’s heart
✔
rate.”
, “I should take the medication with food.” ✔
“I will check my weight weekly to watch for
✔
sudden swelling.”
Correct Grid: As shown.
Rationale: Holding β-blocker for maternal
bradycardia <60 is appropriate teaching
(Understanding), not a misunderstanding. All
others correctly reflect patient education.
6. Traditional MCQ
A client receiving a continuous propofol infusion for refractory status epilepticus
develops fever 39.2 °C, metabolic acidosis pH 7.25, and triglycerides 950 mg/dL.
Which action is MOST urgent?
A. Switch to midazolam and stop propofol immediately
B. Administer acetaminophen 650 mg PR
C. Increase propofol to 100 mcg/kg/min
D. Start insulin infusion for propofol-induced hyperglycemia
Correct Answer: A
Rationale: Triad of propofol infusion syndrome (PRIS) – metabolic acidosis,
hypertriglyceridemia, rhabdomyolysis; propofol must be discontinued.
Acetaminophen (B) treats symptom, not cause. Increasing dose (C) worsens
PRIS. Insulin (D) is not indicated for triglyceride elevation.
7. Traditional MCQ
A 4-year-old with asthma is prescribed montelukast 5 mg chewable QHS. The
parent asks why it must be given at night. The nurse’s BEST response is:
A. “Chewable tablets dissolve faster when saliva is thicker during sleep.”
B. “Leukotriene levels peak at night, so blocking them reduces nocturnal
symptoms.”
C. “Sedation is a common side effect, so bedtime dosing promotes sleep.”
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 PO BID by the ED physician. Which
action is MOST important for the nurse to take before administration?
A. Verify the last dialysis run ended >2 h ago
B. Reduce the dose to 75 mg PO BID
C. Obtain aPTT baseline
D. Administer on an empty stomach to enhance absorption
Correct Answer: B
Rationale: Dabigatran is 80 % renal eliminated; CrCl <30 mL/min mandates dose
reduction to 75 mg BID. Dialysis timing (A) is not relevant for this drug. aPTT (C)
is not used for monitoring. Food does NOT alter absorption (D).
2. Traditional MCQ
A 5-year-old (22 kg) with ALL is to receive morphine 50 mcg/kg IV q4h PRN. The
vial contains 2 mg/mL. How many mL should the nurse administer per dose?
A. 0.55 mL
B. 0.75 mL
C. 1.1 mL
D. 1.5 mL
Correct Answer: A
Rationale: 50 mcg × 22 kg = 1,100 mcg = 1.1 mg; 1.1 mg ÷ 2 mg/mL = 0.55 mL.
3. Multiple-Select
A client is receiving a high-dose cyclophosphamide regimen. Which THREE
nursing measures BEST reduce the risk of hemorrhagic cystitis? (Select all that
apply.)
A. Encourage 3 L oral fluid intake daily
B. Administer mesna 20 % of cyclophosphamide dose IV at 0, 4, 8 h
C. Monitor urine for blood every void
, D. Restrict potassium-rich foods
E. Give furosemide 20 mg IV push after each dose
Correct Answers: A, B, C
Rationale: Hydration and mesna detoxify acrolein metabolite; gross hematuria
monitoring allows early intervention. Dietary potassium (D) is unrelated, and
routine diuretics (E) may worsen dehydration.
4. Traditional MCQ
A client on a norepinephrine 8 mcg/min drip develops extravasation. The nurse
prepares to inject phentolamine. The vial contains 5 mg/2 mL. What volume
should be injected into the extravasation site?
A. 0.4 mL
B. 1 mL
C. 2 mL
D. 5 mL
Correct Answer: B
Rationale: Standard dose is 5–10 mg diluted to 10 mL; 5 mg = 1 mL of stock,
then dilute further. 1 mL is the amount of concentrate required.
5. Matrix/Grid
A pregnant client (32 weeks) with new-onset HTN is prescribed labetalol 200 mg
PO BID. For each teaching statement, identify whether it reflects Understanding,
Misunderstanding, or Requires Clarification.
TableCopy
Understa Misunderst Requires
Statement
nding anding Clarification
“I will stop the medicine if my pulse drops below
✔
60.”
“This medication could slow my baby’s heart
✔
rate.”
, “I should take the medication with food.” ✔
“I will check my weight weekly to watch for
✔
sudden swelling.”
Correct Grid: As shown.
Rationale: Holding β-blocker for maternal
bradycardia <60 is appropriate teaching
(Understanding), not a misunderstanding. All
others correctly reflect patient education.
6. Traditional MCQ
A client receiving a continuous propofol infusion for refractory status epilepticus
develops fever 39.2 °C, metabolic acidosis pH 7.25, and triglycerides 950 mg/dL.
Which action is MOST urgent?
A. Switch to midazolam and stop propofol immediately
B. Administer acetaminophen 650 mg PR
C. Increase propofol to 100 mcg/kg/min
D. Start insulin infusion for propofol-induced hyperglycemia
Correct Answer: A
Rationale: Triad of propofol infusion syndrome (PRIS) – metabolic acidosis,
hypertriglyceridemia, rhabdomyolysis; propofol must be discontinued.
Acetaminophen (B) treats symptom, not cause. Increasing dose (C) worsens
PRIS. Insulin (D) is not indicated for triglyceride elevation.
7. Traditional MCQ
A 4-year-old with asthma is prescribed montelukast 5 mg chewable QHS. The
parent asks why it must be given at night. The nurse’s BEST response is:
A. “Chewable tablets dissolve faster when saliva is thicker during sleep.”
B. “Leukotriene levels peak at night, so blocking them reduces nocturnal
symptoms.”
C. “Sedation is a common side effect, so bedtime dosing promotes sleep.”
