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+
1. A 58-year-old receiving IV heparin for PE has an aPTT of 96 sec (control 30 sec).
What is the priority nursing action?
A. Continue the current drip
B. Stop infusion & notify provider
C. Give protamine STAT
D. Increase rate 2 units/kg/hr
Correct: B
Rationale: aPTT > 3 × control = bleeding risk; stop infusion, call provider to reduce
dose. Protamine reserved for serious bleeding.
2. A patient on digoxin 0.25 mg daily has HR 52 bpm, K 2.9 mEq/L. Which ECG
finding requires immediate intervention?
A. U waves
B. Sinus bradycardia with frequent PVCs
C. Prolonged PR
D. Peaked T waves
Correct: B
Rationale: Hypokalemia ↑ digoxin toxicity → PVCs can deteriorate to VT; hold
digoxin, give K+, monitor.
3. A 32-week-pregnant client asks why she must stop ACE inhibitor. Best reply:
A. “It can injure fetal kidneys & cause oligohydramnios.”
B. “Your blood pressure will drop too low.”
C. “It decreases placental oxygen.”
D. “It causes maternal diabetes.”
Correct: A
Rationale: ACE inhibitors in 2nd/3rd trimester cause fetal renal tubular dysplasia,
oligohydramnios, lung hypoplasia.
4. A child weighs 22 kg. Order: ceftriaxone 100 mg/kg/day ÷ q12h IV. Each dose is:
A. 1.1 g
, B. 2.2 g
C. 0.55 g
D. 0.22 g
Correct: A
Rationale: 100 mg × 22 kg = 2.2 g/day ÷ 2 = 1.1 g every 12 h.
5. A patient takes phenytoin and warfarin. INR drops from 3 to 1.5. Cause:
A. Phenytoin induces CYP2C9 → ↓ warfarin level
B. Phenytoin displaces warfarin from protein
C. Phenytoin inhibits vitamin K absorption
D. Warfarin increases phenytoin metabolism
Correct: A
Rationale: Phenytoin is enzyme inducer; accelerates warfarin clearance →
sub-therapeutic INR.
6. The nurse is administering morning levothyroxine. Which finding requires holding
the dose?
A. HR 110 bpm, temp 38 °C
B. BP 150/90
C. TSH 0.1 mIU/L
D. BS 250 mg/dL
Correct: C
Rationale: TSH suppressed indicates over-replacement; hold & notify provider for
dose reduction.
7. A client receiving cisplatin has urine output 15 mL/h for 2 h. Priority:
A. Give furosemide
B. Increase IV fluids & notify provider
C. Hold next cisplatin dose
D. Check BUN/CR at discharge
Correct: B
Rationale: Cisplatin is nephrotoxic; minimum 50–100 mL/h expected; aggressive
hydration prevents damage.
8. A patient uses albuterol MDI 2 puffs q4h PRN. Teaching priority:
A. Rinse mouth after
B. Use spacer & wait 1 min between puffs
C. Shake inhaler only first time daily
D. Store in refrigerator
Correct: B
Rationale: Spacer improves lung deposition; waiting allows second puff to
penetrate.
, 9. A 72-year-old on metformin 1000 mg BID is scheduled for cardiac cath. Morning
of procedure nurse should:
A. Give metformin with sip water
B. Hold metformin & document
C. Cut dose in half
D. Switch to insulin
Correct: B
Rationale: Hold metformin day of & 48 h post cath to prevent lactic acidosis if
contrast-induced nephropathy occurs.
10. A patient starts lisinopril. Which instruction best prevents adverse effect?
A. “Change position slowly.”
B. “Take with high-protein snack.”
C. “Avoid citrus juices.”
D. “Double dose if chest pain.”
Correct: A
Rationale: First-dose hypotension & orthostasis common; slow position changes
reduce fall risk.
11. A patient on risperidone reports milky nipple discharge. Cause:
A. ↑ dopamine → ↑ prolactin
B. Dopamine blockade → ↑ prolactin
C. Serotonin excess
D. Anticholinergic effect
Correct: B
Rationale: Risperidone blocks D2 in tuberoinfundibular pathway → disinhibits
prolactin release.
12. A client receiving morphine PCA has respiratory rate 6/min. First action:
A. Give naloxone 0.4 mg IVP
B. Increase PCA basal rate
C. Apply O2 mask at 2 L
D. Arouse patient verbally
Correct: D
Rationale: Assess stimulus response; if unarousable & RR < 8, then naloxone.
13. A patient on lithium 600 mg BID has Na 128 mEq/L. Teaching priority:
A. Increase fluid to 3 L daily
B. Restrict fluid
C. Add salt tablets
D. Stop lithium 1 day then resume
Correct: A
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
100 % Correct Answers with Rationales | Graded A+
1. A 58-year-old receiving IV heparin for PE has an aPTT of 96 sec (control 30 sec).
What is the priority nursing action?
A. Continue the current drip
B. Stop infusion & notify provider
C. Give protamine STAT
D. Increase rate 2 units/kg/hr
Correct: B
Rationale: aPTT > 3 × control = bleeding risk; stop infusion, call provider to reduce
dose. Protamine reserved for serious bleeding.
2. A patient on digoxin 0.25 mg daily has HR 52 bpm, K 2.9 mEq/L. Which ECG
finding requires immediate intervention?
A. U waves
B. Sinus bradycardia with frequent PVCs
C. Prolonged PR
D. Peaked T waves
Correct: B
Rationale: Hypokalemia ↑ digoxin toxicity → PVCs can deteriorate to VT; hold
digoxin, give K+, monitor.
3. A 32-week-pregnant client asks why she must stop ACE inhibitor. Best reply:
A. “It can injure fetal kidneys & cause oligohydramnios.”
B. “Your blood pressure will drop too low.”
C. “It decreases placental oxygen.”
D. “It causes maternal diabetes.”
Correct: A
Rationale: ACE inhibitors in 2nd/3rd trimester cause fetal renal tubular dysplasia,
oligohydramnios, lung hypoplasia.
4. A child weighs 22 kg. Order: ceftriaxone 100 mg/kg/day ÷ q12h IV. Each dose is:
A. 1.1 g
, B. 2.2 g
C. 0.55 g
D. 0.22 g
Correct: A
Rationale: 100 mg × 22 kg = 2.2 g/day ÷ 2 = 1.1 g every 12 h.
5. A patient takes phenytoin and warfarin. INR drops from 3 to 1.5. Cause:
A. Phenytoin induces CYP2C9 → ↓ warfarin level
B. Phenytoin displaces warfarin from protein
C. Phenytoin inhibits vitamin K absorption
D. Warfarin increases phenytoin metabolism
Correct: A
Rationale: Phenytoin is enzyme inducer; accelerates warfarin clearance →
sub-therapeutic INR.
6. The nurse is administering morning levothyroxine. Which finding requires holding
the dose?
A. HR 110 bpm, temp 38 °C
B. BP 150/90
C. TSH 0.1 mIU/L
D. BS 250 mg/dL
Correct: C
Rationale: TSH suppressed indicates over-replacement; hold & notify provider for
dose reduction.
7. A client receiving cisplatin has urine output 15 mL/h for 2 h. Priority:
A. Give furosemide
B. Increase IV fluids & notify provider
C. Hold next cisplatin dose
D. Check BUN/CR at discharge
Correct: B
Rationale: Cisplatin is nephrotoxic; minimum 50–100 mL/h expected; aggressive
hydration prevents damage.
8. A patient uses albuterol MDI 2 puffs q4h PRN. Teaching priority:
A. Rinse mouth after
B. Use spacer & wait 1 min between puffs
C. Shake inhaler only first time daily
D. Store in refrigerator
Correct: B
Rationale: Spacer improves lung deposition; waiting allows second puff to
penetrate.
, 9. A 72-year-old on metformin 1000 mg BID is scheduled for cardiac cath. Morning
of procedure nurse should:
A. Give metformin with sip water
B. Hold metformin & document
C. Cut dose in half
D. Switch to insulin
Correct: B
Rationale: Hold metformin day of & 48 h post cath to prevent lactic acidosis if
contrast-induced nephropathy occurs.
10. A patient starts lisinopril. Which instruction best prevents adverse effect?
A. “Change position slowly.”
B. “Take with high-protein snack.”
C. “Avoid citrus juices.”
D. “Double dose if chest pain.”
Correct: A
Rationale: First-dose hypotension & orthostasis common; slow position changes
reduce fall risk.
11. A patient on risperidone reports milky nipple discharge. Cause:
A. ↑ dopamine → ↑ prolactin
B. Dopamine blockade → ↑ prolactin
C. Serotonin excess
D. Anticholinergic effect
Correct: B
Rationale: Risperidone blocks D2 in tuberoinfundibular pathway → disinhibits
prolactin release.
12. A client receiving morphine PCA has respiratory rate 6/min. First action:
A. Give naloxone 0.4 mg IVP
B. Increase PCA basal rate
C. Apply O2 mask at 2 L
D. Arouse patient verbally
Correct: D
Rationale: Assess stimulus response; if unarousable & RR < 8, then naloxone.
13. A patient on lithium 600 mg BID has Na 128 mEq/L. Teaching priority:
A. Increase fluid to 3 L daily
B. Restrict fluid
C. Add salt tablets
D. Stop lithium 1 day then resume
Correct: A
