1 | Page
2025-2026 NGN HESI RN PHARMACOLOGY EXAM TEST BANK (4
VERSIONS) WITH 100 VERIFIED ANSWERS AND RATIONALES (100%
CORRECT) | RN HESI PHARMACOLOGY WITH NGN LATEST
2025/2026 ALREADY A+ GRADED (NEWEST!).
1
Scenario — A 68-year-old client with chronic heart failure (EF 30%) is prescribed
digoxin 0.125 mg daily. Today the student nurse records an apical pulse of 54 bpm
and a serum potassium of 3.0 mEq/L on the chart. The client reports new mild
nausea and blurred vision. The charge nurse asks you for the immediate nursing
action and rationale.
Question: What should you do first?
Correct Answer: Withhold the digoxin and notify the provider immediately (do
not administer), obtain a stat serum digoxin level if ordered, and correct
hypokalemia per provider orders.
Rationale (super-detailed): Digoxin increases myocardial contractility by
inhibiting the Na⁺/K⁺-ATPase pump, but it has a narrow therapeutic index and
predisposition to toxicity when serum potassium is low. Hypokalemia potentiates
digoxin binding at the site of action and markedly increases the risk of life-
threatening arrhythmias; an apical rate <60 bpm is also a standard threshold to hold
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a dose and reassess. The client’s nausea and blurred vision are classic early signs of
digoxin toxicity. Immediate steps: hold the scheduled dose, place client on
continuous cardiac monitoring, notify the prescriber with current vitals and labs,
obtain a serum digoxin level and repeat electrolytes (K⁺, Mg²⁺, Ca²⁺, renal
function) as instructed, and prepare to treat arrhythmias per protocol (digoxin-
specific Fab fragments are used in severe toxicity). This is a high-risk safety
decision—do not give the dose. (FDA digoxin label: hypokalemia predisposes to
toxicity). FDA Access Data
2
Scenario — A hospitalized adult receiving an insulin sliding scale before lunch has
a bedside glucose of 56 mg/dL; the client is alert but shakey and diaphoretic. The
unit policy follows the “15-15” rule. The primary nurse asks what you will do right
now.
Question: What is the nurse’s immediate action?
Correct Answer: Give 15 grams of a fast-acting carbohydrate (e.g., 4 glucose
tablets, 4 oz fruit juice) immediately, wait 15 minutes, then recheck blood glucose
and repeat treatment if still <70 mg/dL; if client becomes unconscious, follow
emergency protocol (IV D50W or intramuscular glucagon).
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Rationale (super-detailed): Mild to moderate hypoglycemia (<70 mg/dL with
symptoms) should be treated promptly with 15 grams of fast-acting carbohydrate
(the “15-15 rule”) and reassessed in 15 minutes — this raises glucose safely and is
the standard emergency bedside action for conscious patients able to swallow. If
the patient does not respond or becomes unconscious, administer IV dextrose
(D50) or intramuscular glucagon per protocol to rapidly restore glucose. Document
interventions and notify the provider; review insulin dosing and recent missed
meals. (American Diabetes Association & Diabetes.org guideline: 15 g fast-acting
carb, recheck in 15 min). American Diabetes Association+1
3
Scenario — A client with a new diagnosis of pulmonary embolism is started on an
unfractionated heparin infusion. Six hours after initiation the lab reports an aPTT
of 110 seconds (the facility control aPTT is 30–40 s). The client is stable, no
bleeding. The heparin nomogram target is 1.5–2.5 × control. The resident asks
whether to stop or adjust the heparin infusion.
Question: What is the best next nursing action?
Correct Answer: Stop or reduce the heparin infusion per the institution’s
protocol/nomogram and notify the prescriber; obtain urgent repeat aPTT and assess
for bleeding.
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Rationale (super-detailed): Therapeutic unfractionated heparin is commonly
targeted to an aPTT approximately 1.5–2.5 times the control; an aPTT of 110 s
here likely exceeds the therapeutic window and increases bleeding risk. Follow the
facility heparin nomogram: typically hold the infusion or reduce rate and recheck
aPTT at the interval specified (often 4–6 hours), assess for bleeding, check platelet
count for HIT risk, and notify the prescriber. Document the action and prepare to
give protamine sulfate if clinically significant bleeding occurs. aPTT targets should
be matched to institutional reagent calibration. PMC+1
4
Scenario — A client on warfarin therapy for atrial fibrillation presents for routine
INR monitoring. The INR result is 1.1 (therapeutic goal 2.0–3.0). The client asks
whether they should skip warfarin that day.
Question: What is the appropriate nursing instruction and next step?
Correct Answer: Do not skip without provider direction; notify the
anticoagulation service or prescriber—warfarin dosing adjustments or bridging
may be needed to reach therapeutic INR 2.0–3.0; reinforce bleeding precautions
until INR is therapeutic.
Rationale (super-detailed): Most indications for warfarin (non-valvular atrial
fibrillation, VTE) target an INR of ~2.0–3.0; an INR of 1.1 is subtherapeutic and
2025-2026 NGN HESI RN PHARMACOLOGY EXAM TEST BANK (4
VERSIONS) WITH 100 VERIFIED ANSWERS AND RATIONALES (100%
CORRECT) | RN HESI PHARMACOLOGY WITH NGN LATEST
2025/2026 ALREADY A+ GRADED (NEWEST!).
1
Scenario — A 68-year-old client with chronic heart failure (EF 30%) is prescribed
digoxin 0.125 mg daily. Today the student nurse records an apical pulse of 54 bpm
and a serum potassium of 3.0 mEq/L on the chart. The client reports new mild
nausea and blurred vision. The charge nurse asks you for the immediate nursing
action and rationale.
Question: What should you do first?
Correct Answer: Withhold the digoxin and notify the provider immediately (do
not administer), obtain a stat serum digoxin level if ordered, and correct
hypokalemia per provider orders.
Rationale (super-detailed): Digoxin increases myocardial contractility by
inhibiting the Na⁺/K⁺-ATPase pump, but it has a narrow therapeutic index and
predisposition to toxicity when serum potassium is low. Hypokalemia potentiates
digoxin binding at the site of action and markedly increases the risk of life-
threatening arrhythmias; an apical rate <60 bpm is also a standard threshold to hold
,2 | Page
a dose and reassess. The client’s nausea and blurred vision are classic early signs of
digoxin toxicity. Immediate steps: hold the scheduled dose, place client on
continuous cardiac monitoring, notify the prescriber with current vitals and labs,
obtain a serum digoxin level and repeat electrolytes (K⁺, Mg²⁺, Ca²⁺, renal
function) as instructed, and prepare to treat arrhythmias per protocol (digoxin-
specific Fab fragments are used in severe toxicity). This is a high-risk safety
decision—do not give the dose. (FDA digoxin label: hypokalemia predisposes to
toxicity). FDA Access Data
2
Scenario — A hospitalized adult receiving an insulin sliding scale before lunch has
a bedside glucose of 56 mg/dL; the client is alert but shakey and diaphoretic. The
unit policy follows the “15-15” rule. The primary nurse asks what you will do right
now.
Question: What is the nurse’s immediate action?
Correct Answer: Give 15 grams of a fast-acting carbohydrate (e.g., 4 glucose
tablets, 4 oz fruit juice) immediately, wait 15 minutes, then recheck blood glucose
and repeat treatment if still <70 mg/dL; if client becomes unconscious, follow
emergency protocol (IV D50W or intramuscular glucagon).
,3 | Page
Rationale (super-detailed): Mild to moderate hypoglycemia (<70 mg/dL with
symptoms) should be treated promptly with 15 grams of fast-acting carbohydrate
(the “15-15 rule”) and reassessed in 15 minutes — this raises glucose safely and is
the standard emergency bedside action for conscious patients able to swallow. If
the patient does not respond or becomes unconscious, administer IV dextrose
(D50) or intramuscular glucagon per protocol to rapidly restore glucose. Document
interventions and notify the provider; review insulin dosing and recent missed
meals. (American Diabetes Association & Diabetes.org guideline: 15 g fast-acting
carb, recheck in 15 min). American Diabetes Association+1
3
Scenario — A client with a new diagnosis of pulmonary embolism is started on an
unfractionated heparin infusion. Six hours after initiation the lab reports an aPTT
of 110 seconds (the facility control aPTT is 30–40 s). The client is stable, no
bleeding. The heparin nomogram target is 1.5–2.5 × control. The resident asks
whether to stop or adjust the heparin infusion.
Question: What is the best next nursing action?
Correct Answer: Stop or reduce the heparin infusion per the institution’s
protocol/nomogram and notify the prescriber; obtain urgent repeat aPTT and assess
for bleeding.
, 4 | Page
Rationale (super-detailed): Therapeutic unfractionated heparin is commonly
targeted to an aPTT approximately 1.5–2.5 times the control; an aPTT of 110 s
here likely exceeds the therapeutic window and increases bleeding risk. Follow the
facility heparin nomogram: typically hold the infusion or reduce rate and recheck
aPTT at the interval specified (often 4–6 hours), assess for bleeding, check platelet
count for HIT risk, and notify the prescriber. Document the action and prepare to
give protamine sulfate if clinically significant bleeding occurs. aPTT targets should
be matched to institutional reagent calibration. PMC+1
4
Scenario — A client on warfarin therapy for atrial fibrillation presents for routine
INR monitoring. The INR result is 1.1 (therapeutic goal 2.0–3.0). The client asks
whether they should skip warfarin that day.
Question: What is the appropriate nursing instruction and next step?
Correct Answer: Do not skip without provider direction; notify the
anticoagulation service or prescriber—warfarin dosing adjustments or bridging
may be needed to reach therapeutic INR 2.0–3.0; reinforce bleeding precautions
until INR is therapeutic.
Rationale (super-detailed): Most indications for warfarin (non-valvular atrial
fibrillation, VTE) target an INR of ~2.0–3.0; an INR of 1.1 is subtherapeutic and
