NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION A
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
100 % Correct Answers with Rationales | Graded A+
55 Questions | Mixed NGN item types | Print-friendly single column
1. A 56-year-old receiving digoxin 0.25 mg PO daily reports new-onset
“yellow-tinted” vision. Which single action is MOST important for the nurse?
A. Obtain a serum potassium level
B. Hold the next dose and call the provider
C. Check the apical pulse for 1 min
D. Administer an anti-emetic
Correct Answer: B
Rationale: “Yellow-green” halos are a classic early sign of digoxin toxicity; holding
the dose prevents further digitalis accumulation while awaiting a serum digoxin
level and further orders.
2. A patient with heart failure is started on lisinopril 5 mg PO daily. Which finding
BEST indicates a therapeutic effect? (Select one)
A. BP 96/60 mm Hg
B. Urine output 35 mL/h
C. Decreased crackles & weight loss 1 kg in 24 h
D. Serum creatinine rise from 1.0 → 1.3 mg/dL
Correct Answer: C
Rationale: After-load reduction and diuresis produce decreased pulmonary
congestion and fluid loss—direct therapeutic goals.
3. A 28-year-old with asthma is prescribed albuterol MDI 2 puffs q4h PRN. Patient
asks, “Can I use it every day?” The nurse should teach:
A. “Daily use is fine if you rinse your mouth.”
B. “Increase to q2h if peak flow < 200.”
, C. “Regular need indicates poor control; call your provider.”
D. “Switch to the nebulizer for daily use.”
Correct Answer: C
Rationale: PRN β2-agonist use > 2×/week signals inadequate control; step-up
controller therapy is needed.
4. A client receiving IV heparin has an aPTT of 96 sec (control 30 sec). The nurse
should FIRST:
A. Stop the infusion
B. Give protamine sulfate
C. Reduce rate by 2 mL/h
D. Obtain a platelet count
Correct Answer: A
Rationale: aPTT > 3 × control places patient at bleeding risk; stopping the
infusion is immediate harm reduction.
5. For each potential adverse effect of amiodarone, indicate whether it is Expected,
Adverse, or Unrelated:
Matrix item – mark (✔) one column per row
TableCopy
Finding Expected Adverse Unrelated
Bradycardia ✔
Pulmonary fibrosis ✔
Corneal micro-deposits ✔
Hypothyroidism ✔
Correct Grid: As shown.
Rationale: Bradycardia & corneal deposits are common/expected; pulmonary fibrosis &
hypo/hyperthyroidism are serious adverse effects requiring monitoring.
, 6. A 12-year-old (40 kg) with bacterial meningitis is ordered ceftriaxone 2 g IV q12h.
The safe range is 100 mg/kg/day divided q12h. The nurse’s INITIAL action is:
A. Give the drug now—within range
B. Hold and clarify; ordered dose equals 4 g/day = 200 mg/kg/day
C. Dilute in 40 mL D5W and infuse over 30 min
D. Give 1 g and document partial dose
Correct Answer: B
Rationale: 4 g/day provides 100 mg/kg/dose (200 mg/kg/day) – double the
recommended daily maximum; verification is required.
7. A post-operative patient has morphine 10 mg IV q4h PRN. Respirations 8/min,
SpO2 89 %. Which medication should the nurse prepare?
A. Naloxone 0.4 mg IVP
B. Flumazenil 0.5 mg
C. Naltrexone 50 mg PO
D. Albuterol nebulizer
Correct Answer: A
Rationale: Opioid-induced respiratory depression is reversed with naloxone; other
agents are ineffective.
8. A client with RA begins methotrexate 15 mg PO weekly. Which lab is MOST
important to monitor?
A. Hemoglobin
B. Serum creatinine
C. Alkaline phosphatase
D. Serum sodium
Correct Answer: B
Rationale: Methotrexate is renally eliminated; elevated creatinine increases
toxicity risk.
9. A nurse teaches a patient starting sertraline. Which statement by the patient
indicates understanding?
A. “I will stop the drug as soon as I feel better.”
B. “I may feel nauseated the first week.”
C. “I can have grapefruit with breakfast.”
D. “I will double the dose if my mood drops.”
Correct Answer: B
Rationale: SSRI GI effects are common early; drug must be tapered and taken
consistently.
10. A patient with type 1 diabetes is NPO for surgery at 6 a.m. Blood glucose 210
mg/dL at 4 a.m. The nurse should:
A. Give 4 units regular insulin IV per sliding scale
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
100 % Correct Answers with Rationales | Graded A+
55 Questions | Mixed NGN item types | Print-friendly single column
1. A 56-year-old receiving digoxin 0.25 mg PO daily reports new-onset
“yellow-tinted” vision. Which single action is MOST important for the nurse?
A. Obtain a serum potassium level
B. Hold the next dose and call the provider
C. Check the apical pulse for 1 min
D. Administer an anti-emetic
Correct Answer: B
Rationale: “Yellow-green” halos are a classic early sign of digoxin toxicity; holding
the dose prevents further digitalis accumulation while awaiting a serum digoxin
level and further orders.
2. A patient with heart failure is started on lisinopril 5 mg PO daily. Which finding
BEST indicates a therapeutic effect? (Select one)
A. BP 96/60 mm Hg
B. Urine output 35 mL/h
C. Decreased crackles & weight loss 1 kg in 24 h
D. Serum creatinine rise from 1.0 → 1.3 mg/dL
Correct Answer: C
Rationale: After-load reduction and diuresis produce decreased pulmonary
congestion and fluid loss—direct therapeutic goals.
3. A 28-year-old with asthma is prescribed albuterol MDI 2 puffs q4h PRN. Patient
asks, “Can I use it every day?” The nurse should teach:
A. “Daily use is fine if you rinse your mouth.”
B. “Increase to q2h if peak flow < 200.”
, C. “Regular need indicates poor control; call your provider.”
D. “Switch to the nebulizer for daily use.”
Correct Answer: C
Rationale: PRN β2-agonist use > 2×/week signals inadequate control; step-up
controller therapy is needed.
4. A client receiving IV heparin has an aPTT of 96 sec (control 30 sec). The nurse
should FIRST:
A. Stop the infusion
B. Give protamine sulfate
C. Reduce rate by 2 mL/h
D. Obtain a platelet count
Correct Answer: A
Rationale: aPTT > 3 × control places patient at bleeding risk; stopping the
infusion is immediate harm reduction.
5. For each potential adverse effect of amiodarone, indicate whether it is Expected,
Adverse, or Unrelated:
Matrix item – mark (✔) one column per row
TableCopy
Finding Expected Adverse Unrelated
Bradycardia ✔
Pulmonary fibrosis ✔
Corneal micro-deposits ✔
Hypothyroidism ✔
Correct Grid: As shown.
Rationale: Bradycardia & corneal deposits are common/expected; pulmonary fibrosis &
hypo/hyperthyroidism are serious adverse effects requiring monitoring.
, 6. A 12-year-old (40 kg) with bacterial meningitis is ordered ceftriaxone 2 g IV q12h.
The safe range is 100 mg/kg/day divided q12h. The nurse’s INITIAL action is:
A. Give the drug now—within range
B. Hold and clarify; ordered dose equals 4 g/day = 200 mg/kg/day
C. Dilute in 40 mL D5W and infuse over 30 min
D. Give 1 g and document partial dose
Correct Answer: B
Rationale: 4 g/day provides 100 mg/kg/dose (200 mg/kg/day) – double the
recommended daily maximum; verification is required.
7. A post-operative patient has morphine 10 mg IV q4h PRN. Respirations 8/min,
SpO2 89 %. Which medication should the nurse prepare?
A. Naloxone 0.4 mg IVP
B. Flumazenil 0.5 mg
C. Naltrexone 50 mg PO
D. Albuterol nebulizer
Correct Answer: A
Rationale: Opioid-induced respiratory depression is reversed with naloxone; other
agents are ineffective.
8. A client with RA begins methotrexate 15 mg PO weekly. Which lab is MOST
important to monitor?
A. Hemoglobin
B. Serum creatinine
C. Alkaline phosphatase
D. Serum sodium
Correct Answer: B
Rationale: Methotrexate is renally eliminated; elevated creatinine increases
toxicity risk.
9. A nurse teaches a patient starting sertraline. Which statement by the patient
indicates understanding?
A. “I will stop the drug as soon as I feel better.”
B. “I may feel nauseated the first week.”
C. “I can have grapefruit with breakfast.”
D. “I will double the dose if my mood drops.”
Correct Answer: B
Rationale: SSRI GI effects are common early; drug must be tapered and taken
consistently.
10. A patient with type 1 diabetes is NPO for surgery at 6 a.m. Blood glucose 210
mg/dL at 4 a.m. The nurse should:
A. Give 4 units regular insulin IV per sliding scale
