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 68-year-old with heart failure (EF 30%) is started on sacubitril/valsartan. Which
finding indicates the drug is exerting its intended physiologic effect?
A. HR 88 → 82 bpm in 24 h
B. BNP 820 → 340 pg/mL in 2 weeks
C. SBP 96 mmHg
D. K⁺ 5.1 mEq/L
Correct Answer: B
Rationale: Sacubitril/valsartan reduces ventricular wall stress → ↓ BNP is a direct
biomarker of reduced neuro-hormonal activation. Hypotension & slight
bradycardia can occur but are not the best indicators of therapeutic effect.
2. A child weighing 18 kg is prescribed amoxicillin 45 mg/kg/day PO divided q8h for
otitis media. How many milligrams are needed per dose?
A. 270 mg
B. 810 mg
C. 405 mg
D. 135 mg
Correct Answer: A
Rationale: 45 mg × 18 kg = 810 mg/day ÷ 3 = 270 mg per dose.
3. A patient on phenytoin has a trough level of 6 mcg/mL (therapeutic 10–20). The
provider increases the dose. When should the nurse schedule the next trough
level?
A. Immediately after the next dose
B. 2–3 h after the IV load
C. Just before the fourth new dose (≈ 5 half-lives)
D. One week after discharge
Correct Answer: C
Rationale: Phenytoin follows first-order kinetics; steady state is reached in ~5
, half-lives (≈ 36–48 h). Trough must be drawn just before the next dose to reflect
true trough.
4. A 32-week-pregnant client is receiving magnesium sulfate 2 g/h IV for preterm
labor. Her DTRs are absent and respiratory rate 10/min. Which antidote should
the nurse prepare?
A. Naloxone 0.4 mg
B. Calcium gluconate 1 g IV
C. Protamine sulfate
D. Flumazenil 0.2 mg
Correct Answer: B
Rationale: Mg toxicity (loss DTRs, resp depression) is antagonized by IV calcium.
5. A patient taking warfarin is prescribed TMP-SMX for UTI. What lab should be
monitored more frequently?
A. Serum creatinine
B. aPTT
C. INR
D. ALT
Correct Answer: C
Rationale: TMP-SMX inhibits CYP2C9 and displaces warfarin from albumin → ↑
INR & bleeding risk.
6. A nurse is administering the first dose of IV infliximab. Which action is most
important during the first 15 min?
A. Stop infusion if HR ↑ 10 bpm
B. Keep rate at ordered 5 mL/h regardless of reaction
C. Remain at bedside and monitor for infusion reaction
D. Pre-medicate with acetaminophen after the dose
Correct Answer: C
Rationale: Anaphylactoid reactions occur early; nurse must stay, monitor VS, and
be prepared to pause/slow infusion.
7. A patient with type 2 DM is started on empagliflozin. Which patient statement
indicates need for further teaching?
A. “I will watch for yeast infections.”
B. “I can stop my metformin now.”
C. “I’ll drink plenty of water.”
D. “I’ll notify my doctor if I can’t eat for any reason.”
Correct Answer: B
Rationale: SGLT-2 inhibitors are add-on therapy; stopping metformin without
provider order can cause hyperglycemia.
, 8. A patient on risperidone reports milky breast discharge. The nurse recognizes
this is due to:
A. Dopamine blockade → ↑ prolactin
B. Serotonin excess
C. Ach blockade
D. α₁ blockade
Correct Answer: A
Rationale: D2 antagonism in tuberoinfundibular pathway removes prolactin
inhibition.
9. A patient receiving morphine PCA has RR 8/min and is difficult to arouse. After
stopping infusion, which is the priority nursing action?
A. Give naloxone 0.4 mg IV push
B. Apply oxygen 2 L NC
C. Stimulate patient and call rapid response
D. Document and restart at 50 % dose
Correct Answer: C
Rationale: First assess stimulus response, ensure airway, then escalate to
naloxone if unarousable & RR < 8 per protocol.
10. A nurse is preparing heparin 5000 units subcut. The vial reads 10,000 units/mL.
How many mL should be withdrawn?
A. 0.2 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Correct Answer: B
Rationale: 5000 ÷ 10,000 = 0.5 mL.
11. A patient on lithium has Na 128 mEq/L. Which instruction is most appropriate?
A. “Stop lithium and drink 3 L fluid today.”
B. “Increase dietary sodium and avoid NSAIDs.”
C. “Take lithium with food to reduce GI upset.”
D. “Switch to sustained-release lithium.”
Correct Answer: B
Rationale: Hyponatremia ↑ lithium retention; encourage Na intake, avoid NSAIDs
that worsen Na wasting & Li retention.
12. A patient receiving cisplatin has urine output 20 mL/h for 2 h. Which intervention
is priority?
A. Give furosemide 20 mg IV
B. Increase IV hydration and notify provider
C. Hold next cisplatin dose now
(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 68-year-old with heart failure (EF 30%) is started on sacubitril/valsartan. Which
finding indicates the drug is exerting its intended physiologic effect?
A. HR 88 → 82 bpm in 24 h
B. BNP 820 → 340 pg/mL in 2 weeks
C. SBP 96 mmHg
D. K⁺ 5.1 mEq/L
Correct Answer: B
Rationale: Sacubitril/valsartan reduces ventricular wall stress → ↓ BNP is a direct
biomarker of reduced neuro-hormonal activation. Hypotension & slight
bradycardia can occur but are not the best indicators of therapeutic effect.
2. A child weighing 18 kg is prescribed amoxicillin 45 mg/kg/day PO divided q8h for
otitis media. How many milligrams are needed per dose?
A. 270 mg
B. 810 mg
C. 405 mg
D. 135 mg
Correct Answer: A
Rationale: 45 mg × 18 kg = 810 mg/day ÷ 3 = 270 mg per dose.
3. A patient on phenytoin has a trough level of 6 mcg/mL (therapeutic 10–20). The
provider increases the dose. When should the nurse schedule the next trough
level?
A. Immediately after the next dose
B. 2–3 h after the IV load
C. Just before the fourth new dose (≈ 5 half-lives)
D. One week after discharge
Correct Answer: C
Rationale: Phenytoin follows first-order kinetics; steady state is reached in ~5
, half-lives (≈ 36–48 h). Trough must be drawn just before the next dose to reflect
true trough.
4. A 32-week-pregnant client is receiving magnesium sulfate 2 g/h IV for preterm
labor. Her DTRs are absent and respiratory rate 10/min. Which antidote should
the nurse prepare?
A. Naloxone 0.4 mg
B. Calcium gluconate 1 g IV
C. Protamine sulfate
D. Flumazenil 0.2 mg
Correct Answer: B
Rationale: Mg toxicity (loss DTRs, resp depression) is antagonized by IV calcium.
5. A patient taking warfarin is prescribed TMP-SMX for UTI. What lab should be
monitored more frequently?
A. Serum creatinine
B. aPTT
C. INR
D. ALT
Correct Answer: C
Rationale: TMP-SMX inhibits CYP2C9 and displaces warfarin from albumin → ↑
INR & bleeding risk.
6. A nurse is administering the first dose of IV infliximab. Which action is most
important during the first 15 min?
A. Stop infusion if HR ↑ 10 bpm
B. Keep rate at ordered 5 mL/h regardless of reaction
C. Remain at bedside and monitor for infusion reaction
D. Pre-medicate with acetaminophen after the dose
Correct Answer: C
Rationale: Anaphylactoid reactions occur early; nurse must stay, monitor VS, and
be prepared to pause/slow infusion.
7. A patient with type 2 DM is started on empagliflozin. Which patient statement
indicates need for further teaching?
A. “I will watch for yeast infections.”
B. “I can stop my metformin now.”
C. “I’ll drink plenty of water.”
D. “I’ll notify my doctor if I can’t eat for any reason.”
Correct Answer: B
Rationale: SGLT-2 inhibitors are add-on therapy; stopping metformin without
provider order can cause hyperglycemia.
, 8. A patient on risperidone reports milky breast discharge. The nurse recognizes
this is due to:
A. Dopamine blockade → ↑ prolactin
B. Serotonin excess
C. Ach blockade
D. α₁ blockade
Correct Answer: A
Rationale: D2 antagonism in tuberoinfundibular pathway removes prolactin
inhibition.
9. A patient receiving morphine PCA has RR 8/min and is difficult to arouse. After
stopping infusion, which is the priority nursing action?
A. Give naloxone 0.4 mg IV push
B. Apply oxygen 2 L NC
C. Stimulate patient and call rapid response
D. Document and restart at 50 % dose
Correct Answer: C
Rationale: First assess stimulus response, ensure airway, then escalate to
naloxone if unarousable & RR < 8 per protocol.
10. A nurse is preparing heparin 5000 units subcut. The vial reads 10,000 units/mL.
How many mL should be withdrawn?
A. 0.2 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Correct Answer: B
Rationale: 5000 ÷ 10,000 = 0.5 mL.
11. A patient on lithium has Na 128 mEq/L. Which instruction is most appropriate?
A. “Stop lithium and drink 3 L fluid today.”
B. “Increase dietary sodium and avoid NSAIDs.”
C. “Take lithium with food to reduce GI upset.”
D. “Switch to sustained-release lithium.”
Correct Answer: B
Rationale: Hyponatremia ↑ lithium retention; encourage Na intake, avoid NSAIDs
that worsen Na wasting & Li retention.
12. A patient receiving cisplatin has urine output 20 mL/h for 2 h. Which intervention
is priority?
A. Give furosemide 20 mg IV
B. Increase IV hydration and notify provider
C. Hold next cisplatin dose now
