NGN HESI RN Pharmacology Real Exams: 400+
Questions with Verified Answers & Rationales – 6 Full
Versions Covering All Major Drug Categories | instant
pdf download
Cardiovascular Medications (Questions 1–10)
1. A nurse is administering digoxin 0.25 mg orally to a client with heart failure.
Which assessment finding requires immediate action before giving the
medication?
Answer: The nurse should hold the digoxin and notify the healthcare provider if
the client's apical pulse is below 60 beats per minute because digoxin decreases
heart rate and can worsen bradycardia, leading to decreased cardiac output and
potential heart block.
2. A client receiving warfarin for atrial fibrillation has an international
normalized ratio (INR) of 4.5. What priority action should the nurse take based
on this laboratory value?
Answer: The nurse should hold the next warfarin dose and notify the healthcare
provider immediately because an INR of 4.5 indicates a high risk for spontaneous
bleeding, and the provider may order vitamin K as the specific reversal agent.
3. A nurse is teaching a client about newly prescribed lisinopril for hypertension.
What adverse effect should the client be instructed to report immediately to the
healthcare provider?
Answer: The client should report any swelling of the face, lips, tongue, or throat
immediately because these symptoms indicate angioedema, a serious allergic
reaction to ACE inhibitors that can compromise the airway and become life-
threatening without prompt treatment.
4. A client on furosemide (Lasix) 40 mg twice daily reports muscle cramps and
weakness. Which electrolyte imbalance is the most likely cause of these
symptoms?
Answer: Hypokalemia (low serum potassium) is the most likely cause because
,furosemide is a loop diuretic that causes excessive potassium excretion in the
distal tubule, and muscle cramps and weakness are classic signs of potassium
deficiency.
5. A nurse is administering intravenous heparin to a client with a pulmonary
embolism. Which laboratory test should be monitored to evaluate therapeutic
effectiveness of this medication?
Answer: The activated partial thromboplastin time (aPTT) should be monitored
because heparin works by potentiating antithrombin III to inactivate thrombin
and factor Xa, and the therapeutic goal is an aPTT 1.5 to 2.5 times the normal
control value.
6. A client prescribed metoprolol for heart failure reports dizziness and a heart
rate of 52 beats per minute. What is the nurse's priority action regarding
medication administration?
Answer: The nurse should withhold the metoprolol dose and reassess the client's
blood pressure and heart rate because beta-blockers can cause symptomatic
bradycardia and hypotension, and administering the drug with a rate below 60
may further reduce cardiac output.
7. A nurse is providing discharge teaching to a client starting amiodarone for
ventricular arrhythmias. What important adverse effect should the client be
instructed to monitor and report?
Answer: The client should report any new onset of cough, shortness of breath, or
difficulty breathing because amiodarone can cause life-threatening pulmonary
toxicity including pulmonary fibrosis, which requires immediate discontinuation of
the medication.
8. A client taking atorvastatin (Lipitor) for hyperlipidemia reports severe muscle
pain and dark-colored urine. Which serious adverse reaction should the nurse
suspect based on these symptoms?
Answer: The nurse should suspect rhabdomyolysis, which is a serious breakdown
of muscle tissue that releases myoglobin into the bloodstream and can cause
acute kidney injury, requiring immediate discontinuation of the statin and
laboratory evaluation of creatine kinase levels.
9. A nurse is teaching a client about clopidogrel (Plavix) prescribed after a
coronary stent placement. What key information should the nurse emphasize
,regarding medication duration and discontinuation?
Answer: The nurse should emphasize that the client must never stop taking
clopidogrel without the healthcare provider's approval because premature
discontinuation significantly increases the risk of in-stent thrombosis, which can
cause a fatal myocardial infarction.
10. A client receiving a nitroglycerin infusion for acute chest pain develops a
blood pressure of 80/50 mm Hg. What is the nurse's priority action?
Answer: The nurse should immediately stop or decrease the nitroglycerin infusion
rate and notify the healthcare provider because nitroglycerin causes venous and
arterial vasodilation that can lead to severe hypotension, which reduces coronary
artery perfusion and worsens myocardial ischemia.
Endocrine Medications (Questions 11–20)
11. A nurse is teaching a client with type 1 diabetes how to mix regular insulin
and NPH insulin in the same syringe. Which sequence of steps should the nurse
instruct the client to follow?
Answer: The client should first draw up the clear regular insulin followed by the
cloudy NPH insulin because this prevents contamination of the regular insulin vial
with NPH insulin, which could alter the onset and peak action of the rapid-acting
insulin.
12. A client with type 2 diabetes taking metformin is scheduled for a cardiac
catheterization with contrast dye. What instruction should the nurse provide
regarding metformin administration before the procedure?
Answer: The nurse should instruct the client to hold metformin on the day of the
procedure and for 48 hours afterward because contrast dye can impair renal
function, and metformin combined with renal impairment increases the risk of
life-threatening lactic acidosis.
13. A nurse is assessing a client receiving levothyroxine (Synthroid) for
hypothyroidism. Which finding indicates that the medication is achieving a
therapeutic effect?
Answer: A return to normal energy levels, stable weight, normal heart rate
between 60 and 100 beats per minute, and resolution of constipation indicate
, therapeutic effect because levothyroxine replaces deficient thyroid hormone and
reverses the symptoms of hypothyroidism.
14. A client with hyperthyroidism is prescribed propylthiouracil (PTU). What
serious adverse effect should the nurse teach the client to report immediately?
Answer: The client should report fever, sore throat, mouth ulcers, or unusual
bleeding because propylthiouracil can cause agranulocytosis, a dangerous drop in
white blood cells that increases infection risk, and hepatotoxicity, which may
cause jaundice and dark urine.
15. A nurse is administering intravenous glucocorticoids to a client with an acute
asthma exacerbation. Why is this route preferred over oral administration in
this situation?
Answer: Intravenous administration provides immediate systemic absorption and
rapid onset of anti-inflammatory effects, which is critical during an acute asthma
exacerbation because oral glucocorticoids take several hours to absorb and would
delay life-saving bronchodilation.
16. A client on long-term prednisone therapy for rheumatoid arthritis reports
abrupt discontinuation of the medication due to cost. Which life-threatening
complication should the nurse monitor for?
Answer: The nurse should monitor for acute adrenal insufficiency, including
hypotension, hyponatremia, hyperkalemia, and hypoglycemia, because long-term
exogenous steroid therapy suppresses the hypothalamic-pituitary-adrenal axis
and abrupt withdrawal prevents endogenous cortisol production.
17. A nurse is teaching a client starting liraglutide (Victoza) for type 2 diabetes.
What specific administration instruction should the nurse provide regarding
timing and injection site?
Answer: The nurse should instruct the client to inject liraglutide once daily at the
same time each day regardless of meals, rotating injection sites between the
abdomen, thigh, or upper arm, because consistent timing maintains steady drug
levels and rotation prevents lipodystrophy.
18. A client with diabetes insipidus is prescribed desmopressin (DDAVP) nasal
spray. What outcome indicates that the medication is effectively treating the
condition?
Answer: Reduced urine output, decreased thirst, normalized serum sodium levels,
Questions with Verified Answers & Rationales – 6 Full
Versions Covering All Major Drug Categories | instant
pdf download
Cardiovascular Medications (Questions 1–10)
1. A nurse is administering digoxin 0.25 mg orally to a client with heart failure.
Which assessment finding requires immediate action before giving the
medication?
Answer: The nurse should hold the digoxin and notify the healthcare provider if
the client's apical pulse is below 60 beats per minute because digoxin decreases
heart rate and can worsen bradycardia, leading to decreased cardiac output and
potential heart block.
2. A client receiving warfarin for atrial fibrillation has an international
normalized ratio (INR) of 4.5. What priority action should the nurse take based
on this laboratory value?
Answer: The nurse should hold the next warfarin dose and notify the healthcare
provider immediately because an INR of 4.5 indicates a high risk for spontaneous
bleeding, and the provider may order vitamin K as the specific reversal agent.
3. A nurse is teaching a client about newly prescribed lisinopril for hypertension.
What adverse effect should the client be instructed to report immediately to the
healthcare provider?
Answer: The client should report any swelling of the face, lips, tongue, or throat
immediately because these symptoms indicate angioedema, a serious allergic
reaction to ACE inhibitors that can compromise the airway and become life-
threatening without prompt treatment.
4. A client on furosemide (Lasix) 40 mg twice daily reports muscle cramps and
weakness. Which electrolyte imbalance is the most likely cause of these
symptoms?
Answer: Hypokalemia (low serum potassium) is the most likely cause because
,furosemide is a loop diuretic that causes excessive potassium excretion in the
distal tubule, and muscle cramps and weakness are classic signs of potassium
deficiency.
5. A nurse is administering intravenous heparin to a client with a pulmonary
embolism. Which laboratory test should be monitored to evaluate therapeutic
effectiveness of this medication?
Answer: The activated partial thromboplastin time (aPTT) should be monitored
because heparin works by potentiating antithrombin III to inactivate thrombin
and factor Xa, and the therapeutic goal is an aPTT 1.5 to 2.5 times the normal
control value.
6. A client prescribed metoprolol for heart failure reports dizziness and a heart
rate of 52 beats per minute. What is the nurse's priority action regarding
medication administration?
Answer: The nurse should withhold the metoprolol dose and reassess the client's
blood pressure and heart rate because beta-blockers can cause symptomatic
bradycardia and hypotension, and administering the drug with a rate below 60
may further reduce cardiac output.
7. A nurse is providing discharge teaching to a client starting amiodarone for
ventricular arrhythmias. What important adverse effect should the client be
instructed to monitor and report?
Answer: The client should report any new onset of cough, shortness of breath, or
difficulty breathing because amiodarone can cause life-threatening pulmonary
toxicity including pulmonary fibrosis, which requires immediate discontinuation of
the medication.
8. A client taking atorvastatin (Lipitor) for hyperlipidemia reports severe muscle
pain and dark-colored urine. Which serious adverse reaction should the nurse
suspect based on these symptoms?
Answer: The nurse should suspect rhabdomyolysis, which is a serious breakdown
of muscle tissue that releases myoglobin into the bloodstream and can cause
acute kidney injury, requiring immediate discontinuation of the statin and
laboratory evaluation of creatine kinase levels.
9. A nurse is teaching a client about clopidogrel (Plavix) prescribed after a
coronary stent placement. What key information should the nurse emphasize
,regarding medication duration and discontinuation?
Answer: The nurse should emphasize that the client must never stop taking
clopidogrel without the healthcare provider's approval because premature
discontinuation significantly increases the risk of in-stent thrombosis, which can
cause a fatal myocardial infarction.
10. A client receiving a nitroglycerin infusion for acute chest pain develops a
blood pressure of 80/50 mm Hg. What is the nurse's priority action?
Answer: The nurse should immediately stop or decrease the nitroglycerin infusion
rate and notify the healthcare provider because nitroglycerin causes venous and
arterial vasodilation that can lead to severe hypotension, which reduces coronary
artery perfusion and worsens myocardial ischemia.
Endocrine Medications (Questions 11–20)
11. A nurse is teaching a client with type 1 diabetes how to mix regular insulin
and NPH insulin in the same syringe. Which sequence of steps should the nurse
instruct the client to follow?
Answer: The client should first draw up the clear regular insulin followed by the
cloudy NPH insulin because this prevents contamination of the regular insulin vial
with NPH insulin, which could alter the onset and peak action of the rapid-acting
insulin.
12. A client with type 2 diabetes taking metformin is scheduled for a cardiac
catheterization with contrast dye. What instruction should the nurse provide
regarding metformin administration before the procedure?
Answer: The nurse should instruct the client to hold metformin on the day of the
procedure and for 48 hours afterward because contrast dye can impair renal
function, and metformin combined with renal impairment increases the risk of
life-threatening lactic acidosis.
13. A nurse is assessing a client receiving levothyroxine (Synthroid) for
hypothyroidism. Which finding indicates that the medication is achieving a
therapeutic effect?
Answer: A return to normal energy levels, stable weight, normal heart rate
between 60 and 100 beats per minute, and resolution of constipation indicate
, therapeutic effect because levothyroxine replaces deficient thyroid hormone and
reverses the symptoms of hypothyroidism.
14. A client with hyperthyroidism is prescribed propylthiouracil (PTU). What
serious adverse effect should the nurse teach the client to report immediately?
Answer: The client should report fever, sore throat, mouth ulcers, or unusual
bleeding because propylthiouracil can cause agranulocytosis, a dangerous drop in
white blood cells that increases infection risk, and hepatotoxicity, which may
cause jaundice and dark urine.
15. A nurse is administering intravenous glucocorticoids to a client with an acute
asthma exacerbation. Why is this route preferred over oral administration in
this situation?
Answer: Intravenous administration provides immediate systemic absorption and
rapid onset of anti-inflammatory effects, which is critical during an acute asthma
exacerbation because oral glucocorticoids take several hours to absorb and would
delay life-saving bronchodilation.
16. A client on long-term prednisone therapy for rheumatoid arthritis reports
abrupt discontinuation of the medication due to cost. Which life-threatening
complication should the nurse monitor for?
Answer: The nurse should monitor for acute adrenal insufficiency, including
hypotension, hyponatremia, hyperkalemia, and hypoglycemia, because long-term
exogenous steroid therapy suppresses the hypothalamic-pituitary-adrenal axis
and abrupt withdrawal prevents endogenous cortisol production.
17. A nurse is teaching a client starting liraglutide (Victoza) for type 2 diabetes.
What specific administration instruction should the nurse provide regarding
timing and injection site?
Answer: The nurse should instruct the client to inject liraglutide once daily at the
same time each day regardless of meals, rotating injection sites between the
abdomen, thigh, or upper arm, because consistent timing maintains steady drug
levels and rotation prevents lipodystrophy.
18. A client with diabetes insipidus is prescribed desmopressin (DDAVP) nasal
spray. What outcome indicates that the medication is effectively treating the
condition?
Answer: Reduced urine output, decreased thirst, normalized serum sodium levels,
