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NGN HESI RN Pharmacology Real Exams (
Versions) with 300+ MCQs, Answers, and
Detailed Rationales – Updated for 202 6 |
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VERSION 1
1. A client with heart failure is prescribed digoxin. Which finding indicates a therapeutic response? A) Increased heart rate B) Decreased blood pressure C) Improved urinary output D) Relief of chest pain Answer: C Rationale: Digoxin increases cardiac contractility and cardiac output, which improves renal perfusion and urinary output in heart failure. A decreased heart rate is an effect but not the primary therapeutic goal in HF. Chest pain relief is not a direct effect. 2. A nurse administers enoxaparin subcutaneously. Which technique is correct? A) Aspirate before injection B) Massage the site after injection C) Administer in the abdomen while pinching a skin fold D) Expel the air bubble from the prefilled syringe
Answer: C Rationale: Enoxaparin (Lovenox) is given subcutaneously in the abdomen with a skin fold pinched. Aspiration is not recommended. Do not massage. Do not expel the air bubble—it ensures full dose delivery.
3. A client takes warfarin. Which lab value indicates therapy is therapeutic? A) INR of 1. B) INR of 2. C) aPTT of 60 seconds D) Platelets 150,000/mm³ Answer: B Rationale: For most indications (e.g., atrial fibrillation, DVT), a therapeutic INR range is 2.0–3.0. INR of 1.0 indicates no effect. aPTT monitors heparin, not warfarin. 4. A client reports muscle pain and weakness while taking atorvastatin. What is the nurse’s priority? A) Administer acetaminophen B) Encourage potassium-rich foods C) Assess for rhabdomyolysis D) Suggest switching to a different statin Answer: C Rationale: Statins can cause rhabdomyolysis (muscle breakdown), which may lead to
7. A client on IV morphine has a respiratory rate of 8 breaths/min. Which medication should the nurse prepare? A) Flumazenil B) Naloxone C) Acetylcysteine D) Protamine sulfate Answer: B Rationale: Naloxone (Narcan) is an opioid antagonist that reverses respiratory depression. Flumazenil reverses benzodiazepines. Acetylcysteine treats acetaminophen overdose. Protamine reverses heparin. 8. A nurse administers subcutaneous insulin aspart. When should the client eat? A) Immediately B) 30 minutes C) 1–2 hours D) 4–5 hours Answer: A Rationale: Insulin aspart is rapid-acting, onset ~15 minutes. Meal should be consumed immediately to prevent hypoglycemia. 9. Which finding indicates a client is experiencing a heparin overdose?
A) Thrombocytopenia B) Hematuria C) INR 5. D) Hyperkalemia Answer: B Rationale: Heparin overdose causes bleeding. Hematuria (blood in urine) is a sign. Thrombocytopenia is HIT, not overdose. INR monitors warfarin.
10. A client with GERD takes omeprazole. Which long-term risk should the nurse monitor? A) Hypernatremia B) Vitamin B12 deficiency C) Hypercalcemia D) Hypoglycemia Answer: B Rationale: Chronic PPI use reduces gastric acid, impairing vitamin B12 absorption from food, leading to deficiency over months to years. 11. A client is prescribed lithium. Which lab value requires immediate action? A) Sodium 135 mEq/L B) Lithium level 1.8 mEq/L C) Creatinine 0.9 mg/dL D) TSH 2.5 mIU/L
14. A client receives albuterol via nebulizer. Which finding indicates effectiveness? A) Heart rate 120/min B) Wheezing in all fields C) Decreased shortness of breath D) Dry cough Answer: C Rationale: Albuterol is a bronchodilator. Relief of dyspnea is desired. Tachycardia is an adverse effect. Wheezing indicates ongoing bronchospasm. 15. Which herbal supplement increases bleeding risk when taken with warfarin? A) St. John’s wort B) Ginseng C) Garlic D) Echinacea Answer: C Rationale: Garlic, ginkgo, and ginger increase bleeding risk. St. John’s wort reduces warfarin efficacy. Ginseng may decrease INR. 16. A client with TB is started on rifampin. What should the nurse teach? A) Urine may turn orange-red B) Avoid sunlight completely
C) Take with antacids D) Limit dairy products Answer: A Rationale: Rifampin causes harmless orange-red discoloration of urine, sweat, and tears. Always warn the client to prevent alarm.
17. A client on amiodarone develops cough and dyspnea. What is the priority? A) Give oxygen B) Assess for pulmonary toxicity C) Administer bronchodilator D) Reassure it’s normal Answer: B Rationale: Amiodarone causes pulmonary fibrosis. New cough + dyspnea requires immediate evaluation (CXR, DLCO). Do not dismiss. 18. A nurse gives IV phenytoin. Which action is correct? A) Mix with dextrose 5% B) Administer via rapid IV push C) Use an in-line filter D) Flush with saline before and after Answer: D Rationale: Phenytoin is incompatible with dextrose (precipitates). Flush with NS. Give slowly (≤50 mg/min). No filter needed.
A) Stop the infusion B) Slow the infusion rate C) Administer diphenhydramine D) Document as non-allergic reaction Answer: B Rationale: "Red man syndrome" is caused by too rapid infusion. Slow the rate over ≥ minutes. It is not an IgE allergy.
22. The nurse administers naloxone to a client with opioid overdose. What is the priority reassessment? A) Pain level B) Respiratory rate C) Level of consciousness D) Blood pressure Answer: B Rationale: The primary goal is reversal of respiratory depression. RR is the most critical parameter. 23. A client on sertraline reports sexual dysfunction. What is the best response? A) "Stop the medication immediately." B) "This is not related to your medication." C) "Discuss this with your provider; dose adjustment may help." D) "Take the medication every other day."
Answer: C Rationale: SSRI-induced sexual side effects are common. Do not stop abruptly (discontinuation syndrome). Provider may lower dose, switch drugs, or add bupropion.
24. Which finding indicates a client is developing gentamicin nephrotoxicity? A) Tinnitus B) Elevated BUN and creatinine C) Hypokalemia D) Proteinuria 1+ Answer: B Rationale: Gentamicin causes acute kidney injury, reflected by rising BUN and Cr. Tinnitus = ototoxicity. Proteinuria may occur but is less specific. 25. A client takes clopidogrel. Which drug should the nurse question if newly ordered? A) Omeprazole B) Acetaminophen C) Metoprolol D) Levothyroxine Answer: A Rationale: Omeprazole (a PPI) inhibits CYP2C19, reducing conversion of clopidogrel to its active form, increasing thrombotic risk.
A) Give the medication as ordered B) Hold the medication and notify provider C) Administer IV fluids D) Recheck in 1 hour Answer: B Rationale: Beta-blockers are held for HR <60 or SBP <100 unless specified otherwise. Hypotension and bradycardia may worsen.
29. The nurse teaches about phenelzine (MAOI). Which food should the client avoid? A) Apple juice B) Aged cheddar cheese C) White rice D) Broccoli Answer: B Rationale: Aged cheese contains tyramine, which with MAOIs causes hypertensive crisis. Avoid aged/fermented foods. 30. A client takes prednisone 40 mg daily for 3 weeks. How should it be discontinued? A) Stop immediately B) Taper over several days to weeks C) Switch to every other day then stop D) No taper needed
Answer: B Rationale: After more than 2 weeks of systemic corticosteroids, taper to prevent adrenal insufficiency.
31. A client on IV dopamine extravasates. Which medication should be ready? A) Phentolamine B) Sodium bicarbonate C) Hyaluronidase D) Nitroglycerin paste Answer: A Rationale: Phentolamine is an alpha-blocker injected into the extravasation site to prevent necrosis from vasopressors. 32. A client receives chemotherapy and has a platelet count of 20,000/mm³. Which medication should be questioned? A) Acetaminophen B) Ondansetron C) Ibuprofen D) Dexamethasone Answer: C Rationale: NSAIDs like ibuprofen inhibit platelet aggregation and increase bleeding risk in severe thrombocytopenia.
A) Give vitamin K orally B) Hold warfarin for 1–2 days C) Give fresh frozen plasma D) Administer protamine Answer: B Rationale: For INR 4.5 without bleeding, hold warfarin. Oral vitamin K is for INR >5–10 with no bleeding.
36. A client receiving IV heparin has a drop in platelets from 250,000 to 80,000. What is the priority? A) Continue heparin and recheck B) Stop heparin immediately C) Administer platelets D) Start warfarin Answer: B Rationale: Suspect heparin-induced thrombocytopenia (HIT). Stop all heparin. Start non- heparin anticoagulant (argatroban). 37. Which finding in a client on lithium requires immediate intervention? A) Fine hand tremor B) Polydipsia C) Vomiting and diarrhea D) Weight gain
Answer: C Rationale: Vomiting + diarrhea can cause dehydration, raising lithium levels to toxicity. Tremor and polydipsia are common side effects, not emergencies.
38. A client with myasthenia gravis is given neostigmine. Which finding indicates cholinergic crisis? A) Muscle weakness improves B) Heart rate 110/min C) Abdominal cramping and diarrhea D) Dry mouth Answer: C Rationale: Cholinergic crisis = excessive acetylcholine (SLUDGE: salivation, lacrimation, urination, diarrhea, GI upset, emesis). 39. A client starts sulfamethoxazole-trimethoprim. Which finding requires immediate attention? A) Nausea B) Headache C) Rash and fever D) Photosensitivity Answer: C Rationale: Rash + fever may indicate Stevens-Johnson syndrome (SJS) or DRESS syndrome. Nausea and headache are common.
A) Discontinue nitroglycerin B) Administer morphine C) Reassure as expected and treat with acetaminophen D) Decrease infusion rate by half Answer: C Rationale: Headache is a common vasodilatory side effect. Do not stop. Usually resolves with mild analgesia.
43. A client with BPH takes tamsulosin. Which adverse effect requires a fall precaution? A) Urinary retention B) Dizziness and orthostatic hypotension C) Decreased libido D) Nasal congestion Answer: B Rationale: Tamsulosin (alpha-blocker) causes vasodilation → dizziness, hypotension → fall risk, especially in older adults. 44. A client starts oral contraceptives. Which medication reduces their effectiveness? A) Amoxicillin B) Rifampin C) Ibuprofen D) Cetirizine
Answer: B Rationale: Rifampin induces liver enzymes, accelerating estrogen metabolism → breakthrough bleeding and possible pregnancy.
45. A client on allopurinol for gout develops a rash. What is the priority? A) Administer antihistamine B) Continue allopurinol and monitor C) Stop allopurinol immediately D) Apply topical steroid Answer: C Rationale: Rash from allopurinol may precede Stevens-Johnson syndrome. Stop immediately and notify provider. 46. A nurse monitors a client receiving IV potassium. Which finding requires stopping the infusion? A) Phlebitis at the site B) Serum potassium 3.8 mEq/L C) Client reports burning D) ECG shows peaked T waves Answer: D Rationale: Peaked T waves indicate hyperkalemia. Stop potassium immediately and notify provider. Burning is common; slowing rate helps.
