NSG124 Final Exam Pharmacology Comprehensive
Review | Herzing University | 2026/2027 Updated |
Complete Q&A | 100% Correct | Graded A+
Instructions for the Candidate
Time Allowed: 3 hours
This examination assesses your mastery of entry-to-practice pharmacotherapeutics for
the 2026/2027 licensing cohort. Select the single best answer for each item.
Calculators and drug-reference apps are permitted; collaboration is not. Record all
answers on the optical score sheet.
Questions 1 – 80
1. A 68-year-old with stage-3 CKD and newly diagnosed heart failure with preserved
ejection fraction is started on dapagliflozin 10 mg PO daily. Which baseline
laboratory result requires correction before the first dose?
A. HbA1c 6.2 %
*B. eGFR 28 mL/min/1.73 m²
C. Serum Na⁺ 134 mmol/L
D. BNP 220 pg/mL
Rationale: The 2026 ADA/KDIGO joint statement maintains dapagliflozin
contraindication when eGFR < 30 mL/min/1.73 m² because of limited glycemic
benefit and increased genital-mycosis risk. Sodium and BNP do not preclude use;
HbA1c 6.2 % is acceptable.
2. A postpartum nurse prepares Rh₀(D) immune globulin for an Rh-negative parent
whose newborn is Rh-positive. The birth was 36 hours ago. Which dose interval
is evidence-based?
A. Within 1 hour
B. Within 12 hours
*C. Within 72 hours
, D. Within 7 days
Rationale: ACOG 2025 reaffirms 72-hour window for maximal alloimmunization
suppression. Beyond 72 hours, efficacy declines but partial benefit still warrants
administration.
3. A patient on the 2026 Veterans Affairs hybrid precision-dosing protocol receives
genotype results: CYP2C19 *2/*17. The provider plans clopidogrel 75 mg daily
after PCI. The nurse should anticipate which prescription change?
*A. Switch to prasugrel 10 mg daily
B. Increase clopidogrel to 150 mg daily
C. Add cimetidine to boost bioavailability
D. Continue clopidogrel; no change needed
Rationale: *2 loss-of-function allele yields intermediate metabolizer status;
guidelines recommend prasugrel or ticagrelor to avert stent thrombosis. *17
gain-of-function does not compensate *2.
4. A 14-year-old with severe vaccine-derived poliovirus type-2 is prescribed
pocapavir (experimental enteroviral capsid inhibitor) under EUA 2026. Which
adverse event is the nurse required to report within 24 hours to the CDC safety
registry?
A. Grade-1 nausea
B. Self-limiting rash
*C. Acute flaccid limb weakness
D. Serum amylase 1.5 × ULN
Rationale: Any new neurological deficit may indicate on-therapy viral resistance
or paradoxical neurovirulence, triggering immediate registry notification per EUA
pharmacovigilance.
5. A medical-floor patient receiving 1 L 0.9 % saline with 40 mmol KCl at 125 mL/h
develops burning along the IV site. Which intervention is best?
A. Stop infusion; restart distal to site
B. Dilute KCl further to 20 mmol/L
*C. Decrease rate to 75 mL/h and reassess
D. Apply warm compress and maintain rate
Rationale: 2026 INS standards list pain as early sign of vein irritation; slowing
rate is first-line before considering concentration or catheter relocation.
6. A 2027 graduate nurse reviews a MAR: methylphenidate transdermal 15 mg/9 h
patch applied at 0600 and removed at 1500. Which instruction to the patient is
accurate?
A. “Apply to same site each day for consistency.”
B. “You may leave it on overnight if studying late.”
*C. “Rotate sites between flank, hip, and upper arm.”
, D. “Showering will deactivate the medication.”
Rationale: Rotating sites minimizes skin irritation and ensures predictable
absorption. Patch wear-time must not exceed 9 h to prevent insomnia.
7. A patient with treatment-resistant schizophrenia begins ulotaront (TAAR-1
agonist) 50 mg BID. The nurse should counsel about which newly flagged
interaction in the 2026 package insert?
A. Grapefruit juice decreases levels
B. Concurrent QT-prolonging agents
*C. Strong CYP3A4 inducers reduce efficacy
D. Warfarin potentiation
Rationale: Ulotaront is a CYP3A4 substrate; carbamazepine, rifampin, and St.
John’s wort lower exposure ≥ 70 %, risking relapse.
8. A 5-year-old with Lennox-Gastaut receives cenobamate 100 mg PO daily. Which
developmental milestone assessment finding warrants immediate prescriber
contact?
A. Riding a tricycle
*B. Loss of previously acquired speech
C. Improved sleep latency
D. Weight gain 0.5 kg in 4 weeks
Rationale: Cenobamate carries 2026 FDA boxed warning for DRESS-related
neurocognitive regression; loss of speech may indicate non-convulsive status or
severe hypersensitivity.
9. A nurse crushes dabigatran pellets for a PEG tube and flushes with 30 mL water.
Which post-administration action is essential?
A. Clamp tube 60 minutes
B. Check gastric residual every 2 h
*C. Resume enteral feeds after 30 minutes
D. Give next dose 8 hours early
Rationale: Dabigatran pellets require acidic environment; 30-minute feeding
hiatus ensures dissolution. Earlier feeding raises gastric pH and reduces AUC 25
%.
10. A labor nurse administers carbetocin 100 µg IV for postpartum hemorrhage
prophylaxis in a Jehovah’s Witness. Within 3 minutes BP rises to 160/100 mmHg.
Which medication reverses vasoconstriction?
A. Labetalol
B. Hydralazine
*C. Nitroglycerin 50 µg IV bolus
D. Magnesium sulfate
Rationale: Carbetocin-induced coronary artery spasm is best countered by
Review | Herzing University | 2026/2027 Updated |
Complete Q&A | 100% Correct | Graded A+
Instructions for the Candidate
Time Allowed: 3 hours
This examination assesses your mastery of entry-to-practice pharmacotherapeutics for
the 2026/2027 licensing cohort. Select the single best answer for each item.
Calculators and drug-reference apps are permitted; collaboration is not. Record all
answers on the optical score sheet.
Questions 1 – 80
1. A 68-year-old with stage-3 CKD and newly diagnosed heart failure with preserved
ejection fraction is started on dapagliflozin 10 mg PO daily. Which baseline
laboratory result requires correction before the first dose?
A. HbA1c 6.2 %
*B. eGFR 28 mL/min/1.73 m²
C. Serum Na⁺ 134 mmol/L
D. BNP 220 pg/mL
Rationale: The 2026 ADA/KDIGO joint statement maintains dapagliflozin
contraindication when eGFR < 30 mL/min/1.73 m² because of limited glycemic
benefit and increased genital-mycosis risk. Sodium and BNP do not preclude use;
HbA1c 6.2 % is acceptable.
2. A postpartum nurse prepares Rh₀(D) immune globulin for an Rh-negative parent
whose newborn is Rh-positive. The birth was 36 hours ago. Which dose interval
is evidence-based?
A. Within 1 hour
B. Within 12 hours
*C. Within 72 hours
, D. Within 7 days
Rationale: ACOG 2025 reaffirms 72-hour window for maximal alloimmunization
suppression. Beyond 72 hours, efficacy declines but partial benefit still warrants
administration.
3. A patient on the 2026 Veterans Affairs hybrid precision-dosing protocol receives
genotype results: CYP2C19 *2/*17. The provider plans clopidogrel 75 mg daily
after PCI. The nurse should anticipate which prescription change?
*A. Switch to prasugrel 10 mg daily
B. Increase clopidogrel to 150 mg daily
C. Add cimetidine to boost bioavailability
D. Continue clopidogrel; no change needed
Rationale: *2 loss-of-function allele yields intermediate metabolizer status;
guidelines recommend prasugrel or ticagrelor to avert stent thrombosis. *17
gain-of-function does not compensate *2.
4. A 14-year-old with severe vaccine-derived poliovirus type-2 is prescribed
pocapavir (experimental enteroviral capsid inhibitor) under EUA 2026. Which
adverse event is the nurse required to report within 24 hours to the CDC safety
registry?
A. Grade-1 nausea
B. Self-limiting rash
*C. Acute flaccid limb weakness
D. Serum amylase 1.5 × ULN
Rationale: Any new neurological deficit may indicate on-therapy viral resistance
or paradoxical neurovirulence, triggering immediate registry notification per EUA
pharmacovigilance.
5. A medical-floor patient receiving 1 L 0.9 % saline with 40 mmol KCl at 125 mL/h
develops burning along the IV site. Which intervention is best?
A. Stop infusion; restart distal to site
B. Dilute KCl further to 20 mmol/L
*C. Decrease rate to 75 mL/h and reassess
D. Apply warm compress and maintain rate
Rationale: 2026 INS standards list pain as early sign of vein irritation; slowing
rate is first-line before considering concentration or catheter relocation.
6. A 2027 graduate nurse reviews a MAR: methylphenidate transdermal 15 mg/9 h
patch applied at 0600 and removed at 1500. Which instruction to the patient is
accurate?
A. “Apply to same site each day for consistency.”
B. “You may leave it on overnight if studying late.”
*C. “Rotate sites between flank, hip, and upper arm.”
, D. “Showering will deactivate the medication.”
Rationale: Rotating sites minimizes skin irritation and ensures predictable
absorption. Patch wear-time must not exceed 9 h to prevent insomnia.
7. A patient with treatment-resistant schizophrenia begins ulotaront (TAAR-1
agonist) 50 mg BID. The nurse should counsel about which newly flagged
interaction in the 2026 package insert?
A. Grapefruit juice decreases levels
B. Concurrent QT-prolonging agents
*C. Strong CYP3A4 inducers reduce efficacy
D. Warfarin potentiation
Rationale: Ulotaront is a CYP3A4 substrate; carbamazepine, rifampin, and St.
John’s wort lower exposure ≥ 70 %, risking relapse.
8. A 5-year-old with Lennox-Gastaut receives cenobamate 100 mg PO daily. Which
developmental milestone assessment finding warrants immediate prescriber
contact?
A. Riding a tricycle
*B. Loss of previously acquired speech
C. Improved sleep latency
D. Weight gain 0.5 kg in 4 weeks
Rationale: Cenobamate carries 2026 FDA boxed warning for DRESS-related
neurocognitive regression; loss of speech may indicate non-convulsive status or
severe hypersensitivity.
9. A nurse crushes dabigatran pellets for a PEG tube and flushes with 30 mL water.
Which post-administration action is essential?
A. Clamp tube 60 minutes
B. Check gastric residual every 2 h
*C. Resume enteral feeds after 30 minutes
D. Give next dose 8 hours early
Rationale: Dabigatran pellets require acidic environment; 30-minute feeding
hiatus ensures dissolution. Earlier feeding raises gastric pH and reduces AUC 25
%.
10. A labor nurse administers carbetocin 100 µg IV for postpartum hemorrhage
prophylaxis in a Jehovah’s Witness. Within 3 minutes BP rises to 160/100 mmHg.
Which medication reverses vasoconstriction?
A. Labetalol
B. Hydralazine
*C. Nitroglycerin 50 µg IV bolus
D. Magnesium sulfate
Rationale: Carbetocin-induced coronary artery spasm is best countered by
