NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION A
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
Section 1: Traditional Multiple-Choice Questions
1. A 68-year-old patient with heart failure is prescribed digoxin 0.25 mg daily. Which
finding requires the nurse to withhold the medication and notify the provider
immediately?
A. Blood pressure 138/88 mmHg
B. Heart rate 58 bpm
C. Serum potassium 3.8 mEq/L
D. Serum digoxin level 1.2 ng/mL
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index and can cause severe bradycardia. A
heart rate <60 bpm is a critical hold parameter due to risk of advanced heart block or
asystole. The therapeutic digoxin level (0.5-2.0 ng/mL) and potassium (3.5-5.0 mEq/L)
are within range. Blood pressure is not a primary concern for digoxin toxicity.
2. A patient receiving vancomycin IV for MRSA bacteremia has a trough level drawn 30
minutes before the fourth dose. The result is 24 mcg/mL (target: 15-20 mcg/mL). What
is the nurse's priority action?
A. Administer the dose as scheduled
,B. Hold the dose and notify the provider
C. Increase the infusion rate
D. Document the finding and continue therapy
Correct Answer: B
Rationale: A vancomycin trough of 24 mcg/mL exceeds the therapeutic range,
increasing risk of nephrotoxicity and ototoxicity. The nurse must hold the dose and
contact the provider for dose adjustment. Never increase infusion rate (risk of Red Man
Syndrome). Continued administration could cause severe toxicity.
3. A 35-year-old pregnant patient at 28 weeks gestation develops a UTI. Which antibiotic
is contraindicated due to risk of teratogenic effects?
A. Amoxicillin
B. Nitrofurantoin
C. Trimethoprim-sulfamethoxazole
D. Cephalexin
Correct Answer: C
Rationale: Trimethoprim-sulfamethoxazole (Bactrim) is contraindicated in pregnancy,
especially third trimester, due to risk of kernicterus in the newborn and folate
antagonism causing neural tube defects. Amoxicillin and cephalexin are safe in
pregnancy. Nitrofurantoin is generally safe except near term.
4. A patient with type 1 diabetes is prescribed lispro (Humalog) insulin. Which patient
education statement is most accurate?
A. "Inject this insulin at bedtime for overnight glucose control"
B. "Take this insulin 15 minutes before eating"
C. "This insulin has a delayed onset of 2-4 hours"
D. "You can mix this insulin with glargine in the same syringe"
,Correct Answer: B
Rationale: Lispro is a rapid-acting insulin with onset in 15 minutes, peak at 1 hour, and
duration 3-5 hours. It must be taken 15 minutes before meals to match carbohydrate
absorption. Basal insulins (glargine) are for bedtime. Rapid-acting insulins cannot be
mixed with glargine.
5. A patient receiving morphine PCA post-operatively has a respiratory rate of
10/minute, SpO2 92%, and is difficult to arouse. Which medication should the nurse
prepare to administer?
A. Flumazenil
B. Naloxone
C. Naltrexone
D. Methadone
Correct Answer: B
Rationale: Naloxone is the opioid antagonist for reversing respiratory depression from
morphine toxicity. Flumazenil reverses benzodiazepines. Naltrexone is for
opioid/alcohol dependence (long-acting). Methadone is an opioid agonist and would
worsen the situation.
6. A patient with atrial fibrillation is started on warfarin (Coumadin). What is the target
INR range for therapeutic anticoagulation?
A. 1.0-1.5
B. 2.0-3.0
C. 3.0-4.0
D. 4.0-5.0
Correct Answer: B
, Rationale: The therapeutic INR for atrial fibrillation stroke prevention is 2.0-3.0. INR
1.0-1.5 is subtherapeutic. INR 3.0-4.0 is for mechanical heart valves. INR 4.0-5.0 is
supratherapeutic and increases bleeding risk.
7. A 78-year-old patient with hypertension is prescribed hydrochlorothiazide 25 mg daily.
Which electrolyte requires frequent monitoring?
A. Calcium
B. Potassium
C. Magnesium
D. Phosphate
Correct Answer: B
Rationale: Thiazide diuretics cause potassium wasting through renal excretion,
increasing risk of hypokalemia (<3.5 mEq/L). This can precipitate digoxin toxicity and
cardiac arrhythmias. While magnesium may also be affected, potassium is the primary
concern requiring routine monitoring.
8. A patient with Parkinson's disease is taking selegiline 5 mg twice daily. Which dietary
teaching is most important to prevent a hypertensive crisis?
A. Avoid grapefruit juice
B. Limit sodium intake to 2g daily
C. Avoid tyramine-rich foods
D. Increase vitamin K intake
Correct Answer: C
Rationale: Selegiline is a MAO-B inhibitor that can cause hypertensive crisis when
combined with tyramine-rich foods (aged cheese, cured meats, wine). This is the most
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
Section 1: Traditional Multiple-Choice Questions
1. A 68-year-old patient with heart failure is prescribed digoxin 0.25 mg daily. Which
finding requires the nurse to withhold the medication and notify the provider
immediately?
A. Blood pressure 138/88 mmHg
B. Heart rate 58 bpm
C. Serum potassium 3.8 mEq/L
D. Serum digoxin level 1.2 ng/mL
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index and can cause severe bradycardia. A
heart rate <60 bpm is a critical hold parameter due to risk of advanced heart block or
asystole. The therapeutic digoxin level (0.5-2.0 ng/mL) and potassium (3.5-5.0 mEq/L)
are within range. Blood pressure is not a primary concern for digoxin toxicity.
2. A patient receiving vancomycin IV for MRSA bacteremia has a trough level drawn 30
minutes before the fourth dose. The result is 24 mcg/mL (target: 15-20 mcg/mL). What
is the nurse's priority action?
A. Administer the dose as scheduled
,B. Hold the dose and notify the provider
C. Increase the infusion rate
D. Document the finding and continue therapy
Correct Answer: B
Rationale: A vancomycin trough of 24 mcg/mL exceeds the therapeutic range,
increasing risk of nephrotoxicity and ototoxicity. The nurse must hold the dose and
contact the provider for dose adjustment. Never increase infusion rate (risk of Red Man
Syndrome). Continued administration could cause severe toxicity.
3. A 35-year-old pregnant patient at 28 weeks gestation develops a UTI. Which antibiotic
is contraindicated due to risk of teratogenic effects?
A. Amoxicillin
B. Nitrofurantoin
C. Trimethoprim-sulfamethoxazole
D. Cephalexin
Correct Answer: C
Rationale: Trimethoprim-sulfamethoxazole (Bactrim) is contraindicated in pregnancy,
especially third trimester, due to risk of kernicterus in the newborn and folate
antagonism causing neural tube defects. Amoxicillin and cephalexin are safe in
pregnancy. Nitrofurantoin is generally safe except near term.
4. A patient with type 1 diabetes is prescribed lispro (Humalog) insulin. Which patient
education statement is most accurate?
A. "Inject this insulin at bedtime for overnight glucose control"
B. "Take this insulin 15 minutes before eating"
C. "This insulin has a delayed onset of 2-4 hours"
D. "You can mix this insulin with glargine in the same syringe"
,Correct Answer: B
Rationale: Lispro is a rapid-acting insulin with onset in 15 minutes, peak at 1 hour, and
duration 3-5 hours. It must be taken 15 minutes before meals to match carbohydrate
absorption. Basal insulins (glargine) are for bedtime. Rapid-acting insulins cannot be
mixed with glargine.
5. A patient receiving morphine PCA post-operatively has a respiratory rate of
10/minute, SpO2 92%, and is difficult to arouse. Which medication should the nurse
prepare to administer?
A. Flumazenil
B. Naloxone
C. Naltrexone
D. Methadone
Correct Answer: B
Rationale: Naloxone is the opioid antagonist for reversing respiratory depression from
morphine toxicity. Flumazenil reverses benzodiazepines. Naltrexone is for
opioid/alcohol dependence (long-acting). Methadone is an opioid agonist and would
worsen the situation.
6. A patient with atrial fibrillation is started on warfarin (Coumadin). What is the target
INR range for therapeutic anticoagulation?
A. 1.0-1.5
B. 2.0-3.0
C. 3.0-4.0
D. 4.0-5.0
Correct Answer: B
, Rationale: The therapeutic INR for atrial fibrillation stroke prevention is 2.0-3.0. INR
1.0-1.5 is subtherapeutic. INR 3.0-4.0 is for mechanical heart valves. INR 4.0-5.0 is
supratherapeutic and increases bleeding risk.
7. A 78-year-old patient with hypertension is prescribed hydrochlorothiazide 25 mg daily.
Which electrolyte requires frequent monitoring?
A. Calcium
B. Potassium
C. Magnesium
D. Phosphate
Correct Answer: B
Rationale: Thiazide diuretics cause potassium wasting through renal excretion,
increasing risk of hypokalemia (<3.5 mEq/L). This can precipitate digoxin toxicity and
cardiac arrhythmias. While magnesium may also be affected, potassium is the primary
concern requiring routine monitoring.
8. A patient with Parkinson's disease is taking selegiline 5 mg twice daily. Which dietary
teaching is most important to prevent a hypertensive crisis?
A. Avoid grapefruit juice
B. Limit sodium intake to 2g daily
C. Avoid tyramine-rich foods
D. Increase vitamin K intake
Correct Answer: C
Rationale: Selegiline is a MAO-B inhibitor that can cause hypertensive crisis when
combined with tyramine-rich foods (aged cheese, cured meats, wine). This is the most
