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 (1-38)
1. A 72-year-old patient with atrial fibrillation and chronic kidney disease (CrCl 38
mL/min) is prescribed apixaban 5 mg orally twice daily. What is the nurse's priority
assessment before administering the first dose?
A. Verify the patient has taken aspirin 325 mg daily
B. Calculate the patient's IBW to determine dosage
C. Assess for concurrent strong CYP3A4 inhibitor use
D. Check the patient's last INR result
Correct Answer: C
Rationale: Apixaban is metabolized via CYP3A4 and is a P-glycoprotein substrate.
Concurrent use of strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) or inducers
(e.g., rifampin, carbamazepine) significantly alters apixaban levels, increasing bleeding
or clotting risk. This assessment is critical for safety. Apixaban does not require INR
monitoring (not affected by aspirin), and dosing is based on renal function and age, not
IBW.
2. A patient receiving vancomycin IV for MRSA bacteremia has a trough level drawn 30
minutes before the fourth dose that returns at 24 mcg/mL (target 15-20 mcg/mL). The
patient has stable renal function. What is the most appropriate nursing action?
,A. Document the level and administer the next dose as scheduled
B. Hold the dose and notify the provider immediately
C. Increase the infusion rate to complete the dose faster
D. Administer the dose and draw a peak level 30 minutes after completion
Correct Answer: B
Rationale: A vancomycin trough of 24 mcg/mL exceeds the therapeutic range, placing
the patient at high risk for nephrotoxicity and ototoxicity. The nurse must hold the dose
and notify the provider for dose adjustment. Increasing the infusion rate would increase
toxicity risk. Peak levels are not routinely monitored for vancomycin.
3. A pregnant patient at 28 weeks gestation is diagnosed with symptomatic bacterial
vaginosis. Which medication is contraindicated due to potential fetal toxicity?
A. Metronidazole 500 mg PO BID for 7 days
B. Clindamycin 300 mg PO BID for 7 days
C. Tinidazole 2 g PO single dose
D. Miconazole vaginal suppository
Correct Answer: C
Rationale: Tinidazole, like other nitroimidazoles, is contraindicated in the first trimester
and should be avoided in the third trimester due to potential carcinogenic and
mutagenic effects. Metronidazole and clindamycin are safe in pregnancy. Miconazole is
a topical antifungal and not indicated for bacterial vaginosis.
4. A patient with type 2 diabetes and an eGFR of 52 mL/min/1.73m² is prescribed
empagliflozin 25 mg daily. What is the nurse's priority intervention?
A. Educate about hypoglycemia symptoms
B. Monitor for signs of euglycemic diabetic ketoacidosis
C. Assess for weight gain
,D. Check fasting glucose daily
Correct Answer: B
Rationale: SGLT2 inhibitors like empagliflozin can cause euglycemic DKA (normal blood
glucose but positive ketones), especially in patients with reduced renal function, during
illness, or with low carbohydrate intake. The nurse must educate the patient to monitor
for DKA symptoms (nausea, vomiting, abdominal pain, shortness of breath) and to hold
the medication during acute illness. SGLT2 inhibitors have low hypoglycemia risk and
promote weight loss.
5. A patient with metastatic cancer is receiving morphine sulfate 10 mg IV q4h PRN for
breakthrough pain while on a fentanyl transdermal patch 75 mcg/hr. The patient reports
pain 9/10 one hour after receiving morphine. What is the most appropriate nursing
action?
A. Administer another dose of morphine immediately
B. Assess pain characteristics and notify the provider
C. Increase the fentanyl patch to 100 mcg/hr
D. Apply a heating pad over the fentanyl patch
Correct Answer: B
Rationale: The patient has uncontrolled breakthrough pain despite adequate PRN
dosing, suggesting the baseline opioid regimen is insufficient. The nurse must perform
a complete pain assessment (location, quality, precipitating factors) and notify the
provider for possible dose escalation or adjunct therapy. Re-dosing morphine within one
hour is unsafe. The fentanyl patch should not be titrated more frequently than every 3
days. Heat increases fentanyl absorption unpredictably.
, 6. A patient with deep vein thrombosis is receiving enoxaparin 1 mg/kg subcutaneously
q12h. The patient's platelet count drops from 280,000 to 98,000/mm³ on day 5 of
therapy. What is the priority nursing action?
A. Continue enoxaparin and monitor platelets daily
B. Hold the next dose and notify the provider immediately
C. Switch to unfractionated heparin infusion
D. Administer the next dose and draw anti-Xa level
Correct Answer: B
Rationale: A >50% decrease in platelets or absolute count <100,000 suggests
heparin-induced thrombocytopenia (HIT), a life-threatening prothrombotic condition. All
heparin products must be stopped immediately and provider notified for alternative
anticoagulation (e.g., argatroban, fondaparinux). Continuing heparin or switching to UFH
is contraindicated.
7. An 85-year-old patient with hypertension and benign prostatic hyperplasia is
prescribed terazosin 2 mg at bedtime. Which adverse effect is the nurse most
concerned about?
A. Orthostatic hypotension and fall risk
B. Worsening BPH symptoms
C. Bradycardia
D. Hyperglycemia
Correct Answer: A
Rationale: Terazosin is an alpha-1 blocker that causes significant first-dose orthostatic
hypotension, especially in elderly patients, increasing fall risk. It is actually used to
improve BPH symptoms. It does not cause bradycardia or affect glucose.
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
Section 1: Traditional Multiple-Choice Questions (1-38)
1. A 72-year-old patient with atrial fibrillation and chronic kidney disease (CrCl 38
mL/min) is prescribed apixaban 5 mg orally twice daily. What is the nurse's priority
assessment before administering the first dose?
A. Verify the patient has taken aspirin 325 mg daily
B. Calculate the patient's IBW to determine dosage
C. Assess for concurrent strong CYP3A4 inhibitor use
D. Check the patient's last INR result
Correct Answer: C
Rationale: Apixaban is metabolized via CYP3A4 and is a P-glycoprotein substrate.
Concurrent use of strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) or inducers
(e.g., rifampin, carbamazepine) significantly alters apixaban levels, increasing bleeding
or clotting risk. This assessment is critical for safety. Apixaban does not require INR
monitoring (not affected by aspirin), and dosing is based on renal function and age, not
IBW.
2. A patient receiving vancomycin IV for MRSA bacteremia has a trough level drawn 30
minutes before the fourth dose that returns at 24 mcg/mL (target 15-20 mcg/mL). The
patient has stable renal function. What is the most appropriate nursing action?
,A. Document the level and administer the next dose as scheduled
B. Hold the dose and notify the provider immediately
C. Increase the infusion rate to complete the dose faster
D. Administer the dose and draw a peak level 30 minutes after completion
Correct Answer: B
Rationale: A vancomycin trough of 24 mcg/mL exceeds the therapeutic range, placing
the patient at high risk for nephrotoxicity and ototoxicity. The nurse must hold the dose
and notify the provider for dose adjustment. Increasing the infusion rate would increase
toxicity risk. Peak levels are not routinely monitored for vancomycin.
3. A pregnant patient at 28 weeks gestation is diagnosed with symptomatic bacterial
vaginosis. Which medication is contraindicated due to potential fetal toxicity?
A. Metronidazole 500 mg PO BID for 7 days
B. Clindamycin 300 mg PO BID for 7 days
C. Tinidazole 2 g PO single dose
D. Miconazole vaginal suppository
Correct Answer: C
Rationale: Tinidazole, like other nitroimidazoles, is contraindicated in the first trimester
and should be avoided in the third trimester due to potential carcinogenic and
mutagenic effects. Metronidazole and clindamycin are safe in pregnancy. Miconazole is
a topical antifungal and not indicated for bacterial vaginosis.
4. A patient with type 2 diabetes and an eGFR of 52 mL/min/1.73m² is prescribed
empagliflozin 25 mg daily. What is the nurse's priority intervention?
A. Educate about hypoglycemia symptoms
B. Monitor for signs of euglycemic diabetic ketoacidosis
C. Assess for weight gain
,D. Check fasting glucose daily
Correct Answer: B
Rationale: SGLT2 inhibitors like empagliflozin can cause euglycemic DKA (normal blood
glucose but positive ketones), especially in patients with reduced renal function, during
illness, or with low carbohydrate intake. The nurse must educate the patient to monitor
for DKA symptoms (nausea, vomiting, abdominal pain, shortness of breath) and to hold
the medication during acute illness. SGLT2 inhibitors have low hypoglycemia risk and
promote weight loss.
5. A patient with metastatic cancer is receiving morphine sulfate 10 mg IV q4h PRN for
breakthrough pain while on a fentanyl transdermal patch 75 mcg/hr. The patient reports
pain 9/10 one hour after receiving morphine. What is the most appropriate nursing
action?
A. Administer another dose of morphine immediately
B. Assess pain characteristics and notify the provider
C. Increase the fentanyl patch to 100 mcg/hr
D. Apply a heating pad over the fentanyl patch
Correct Answer: B
Rationale: The patient has uncontrolled breakthrough pain despite adequate PRN
dosing, suggesting the baseline opioid regimen is insufficient. The nurse must perform
a complete pain assessment (location, quality, precipitating factors) and notify the
provider for possible dose escalation or adjunct therapy. Re-dosing morphine within one
hour is unsafe. The fentanyl patch should not be titrated more frequently than every 3
days. Heat increases fentanyl absorption unpredictably.
, 6. A patient with deep vein thrombosis is receiving enoxaparin 1 mg/kg subcutaneously
q12h. The patient's platelet count drops from 280,000 to 98,000/mm³ on day 5 of
therapy. What is the priority nursing action?
A. Continue enoxaparin and monitor platelets daily
B. Hold the next dose and notify the provider immediately
C. Switch to unfractionated heparin infusion
D. Administer the next dose and draw anti-Xa level
Correct Answer: B
Rationale: A >50% decrease in platelets or absolute count <100,000 suggests
heparin-induced thrombocytopenia (HIT), a life-threatening prothrombotic condition. All
heparin products must be stopped immediately and provider notified for alternative
anticoagulation (e.g., argatroban, fondaparinux). Continuing heparin or switching to UFH
is contraindicated.
7. An 85-year-old patient with hypertension and benign prostatic hyperplasia is
prescribed terazosin 2 mg at bedtime. Which adverse effect is the nurse most
concerned about?
A. Orthostatic hypotension and fall risk
B. Worsening BPH symptoms
C. Bradycardia
D. Hyperglycemia
Correct Answer: A
Rationale: Terazosin is an alpha-1 blocker that causes significant first-dose orthostatic
hypotension, especially in elderly patients, increasing fall risk. It is actually used to
improve BPH symptoms. It does not cause bradycardia or affect glucose.
