NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION A
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
1. Traditional MCQ
A 68-year-old receiving digoxin 0.25 mg PO daily for atrial fibrillation reports nausea and
“yellow-green” vision. Digoxin level is 2.8 ng/mL (therapeutic 0.5–0.9 ng/mL). Which
antidote should the nurse prepare?
A. Naloxone 0.4 mg IV
B. Digoxin immune Fab 38 mg IV
C. Protamine sulfate 25 mg IV
D. Glucagon 5 mg IV
Correct Answer: B
Rationale: Digoxin toxicity (GI, visual, level >2 ng/mL) is reversed with digoxin-specific
antibody fragments. Each 38 mg vial binds ≈0.5 mg digoxin; dose calculated from
ingested amount or level. Naloxone is for opioids, protamine for heparin, glucagon for
β-blocker/CCB overdose.
2. Traditional MCQ
,A patient is prescribed empagliflozin 10 mg PO daily. Which counseling point is most
important?
A. “Take with food to reduce GI upset.”
B. “Report groin pain or swelling immediately.”
C. “Hold if fasting >12 h.”
D. “Expect weight gain.”
Correct Answer: B
Rationale: SGLT2 inhibitors ↑ risk of Fournier gangrene (necrotizing fasciitis of
perineum). Early symptom is genital pain/swelling. They cause mild weight loss, can be
taken without food, and do not require holding for routine fasting.
3. Matrix/Grid
A patient is started on lithium carbonate 300 mg PO BID for bipolar disorder. For each
assessment finding, indicate if it is Expected, Unexpected, or Requires Immediate
Intervention.
TableCopy
Expect Unexpecte Requires Immediate
Assessment Finding
ed d Intervention
Fine hand tremor ✅
Na 128 mEq/L ✅
, Polyuria & polydipsia ✅
Lithium level 1.4 mEq/L (12 h
post-dose)
✅
Correct Grid
Fine tremor and polyuria are common; Na <135 ↑ lithium retention and risk of toxicity;
1.4 mEq/L is above therapeutic (0.8–1.2) and requires dose reduction.
4. Traditional MCQ
A 55 kg patient is ordered heparin per protocol: 80 units/kg IV bolus then 18 units/kg/h.
Pharmacy supplies 25 000 units/250 mL. What is the correct bolus dose?
A. 4 400 units
B. 5 500 units
C. 6 000 units
D. 7 200 units
Correct Answer: A
Rationale: 55 kg × 80 units/kg = 4 400 units. Always round to nearest 100 units for
practical drawing.
5. Cloze (Drop-Down)
, A patient with acute gout is prescribed colchicine 1.2 mg PO, then 0.6 mg 1 h later. The
nurse notes the patient takes clarithromycin 500 mg BID. The nurse should ______
(Action).
Available actions: [Give as ordered, Hold and notify prescriber, Reduce second dose to
0.3 mg, Monitor for myalgia]
Correct Drop-Down: Hold and notify prescriber
Rationale: Clarithromycin is a strong CYP3A4 & P-gp inhibitor → ↑ colchicine toxicity
(rhabdomyolysis, neuropathy). Contraindicated combo; alternative therapy needed.
6. Traditional MCQ
A patient receiving IV morphine 4 mg q4h PRN reports constipation. Which adjunct is
most appropriate?
A. Docusate sodium 100 mg PO BID
B. Methylnaltrexone 12 mg SC q48h
C. Psyllium 3.4 g PO daily
D. Bisacodyl 10 mg supp PR daily
Correct Answer: B
Rationale: Methylnaltrexone is a peripherally-acting μ-opioid receptor antagonist (does
not cross BBB) that reverses opioid-induced constipation without analgesia loss.
Docusate is weak, psyllium can worsen, suppository is local.
7. Matrix/Grid
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
1. Traditional MCQ
A 68-year-old receiving digoxin 0.25 mg PO daily for atrial fibrillation reports nausea and
“yellow-green” vision. Digoxin level is 2.8 ng/mL (therapeutic 0.5–0.9 ng/mL). Which
antidote should the nurse prepare?
A. Naloxone 0.4 mg IV
B. Digoxin immune Fab 38 mg IV
C. Protamine sulfate 25 mg IV
D. Glucagon 5 mg IV
Correct Answer: B
Rationale: Digoxin toxicity (GI, visual, level >2 ng/mL) is reversed with digoxin-specific
antibody fragments. Each 38 mg vial binds ≈0.5 mg digoxin; dose calculated from
ingested amount or level. Naloxone is for opioids, protamine for heparin, glucagon for
β-blocker/CCB overdose.
2. Traditional MCQ
,A patient is prescribed empagliflozin 10 mg PO daily. Which counseling point is most
important?
A. “Take with food to reduce GI upset.”
B. “Report groin pain or swelling immediately.”
C. “Hold if fasting >12 h.”
D. “Expect weight gain.”
Correct Answer: B
Rationale: SGLT2 inhibitors ↑ risk of Fournier gangrene (necrotizing fasciitis of
perineum). Early symptom is genital pain/swelling. They cause mild weight loss, can be
taken without food, and do not require holding for routine fasting.
3. Matrix/Grid
A patient is started on lithium carbonate 300 mg PO BID for bipolar disorder. For each
assessment finding, indicate if it is Expected, Unexpected, or Requires Immediate
Intervention.
TableCopy
Expect Unexpecte Requires Immediate
Assessment Finding
ed d Intervention
Fine hand tremor ✅
Na 128 mEq/L ✅
, Polyuria & polydipsia ✅
Lithium level 1.4 mEq/L (12 h
post-dose)
✅
Correct Grid
Fine tremor and polyuria are common; Na <135 ↑ lithium retention and risk of toxicity;
1.4 mEq/L is above therapeutic (0.8–1.2) and requires dose reduction.
4. Traditional MCQ
A 55 kg patient is ordered heparin per protocol: 80 units/kg IV bolus then 18 units/kg/h.
Pharmacy supplies 25 000 units/250 mL. What is the correct bolus dose?
A. 4 400 units
B. 5 500 units
C. 6 000 units
D. 7 200 units
Correct Answer: A
Rationale: 55 kg × 80 units/kg = 4 400 units. Always round to nearest 100 units for
practical drawing.
5. Cloze (Drop-Down)
, A patient with acute gout is prescribed colchicine 1.2 mg PO, then 0.6 mg 1 h later. The
nurse notes the patient takes clarithromycin 500 mg BID. The nurse should ______
(Action).
Available actions: [Give as ordered, Hold and notify prescriber, Reduce second dose to
0.3 mg, Monitor for myalgia]
Correct Drop-Down: Hold and notify prescriber
Rationale: Clarithromycin is a strong CYP3A4 & P-gp inhibitor → ↑ colchicine toxicity
(rhabdomyolysis, neuropathy). Contraindicated combo; alternative therapy needed.
6. Traditional MCQ
A patient receiving IV morphine 4 mg q4h PRN reports constipation. Which adjunct is
most appropriate?
A. Docusate sodium 100 mg PO BID
B. Methylnaltrexone 12 mg SC q48h
C. Psyllium 3.4 g PO daily
D. Bisacodyl 10 mg supp PR daily
Correct Answer: B
Rationale: Methylnaltrexone is a peripherally-acting μ-opioid receptor antagonist (does
not cross BBB) that reverses opioid-induced constipation without analgesia loss.
Docusate is weak, psyllium can worsen, suppository is local.
7. Matrix/Grid
