NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION D
100% Correct Answers with Rationales | NGN-Intensive |
2026/2027 | Advanced Clinical Judgment | Pass Guarantee
EXAM INSTRUCTIONS:
● This exam contains 55 questions reflecting Next Generation NCLEX (NGN) item
types
● Read each question carefully and follow the specific instructions provided
● Time allowed: 2 hours 15 minutes
● Passing standard: 75% (41/55 questions correct)
SECTION 1: TRADITIONAL SINGLE-ANSWER MCQs (Questions 1-30)
Question 1
A 68-year-old patient with acute decompensated heart failure is receiving a continuous
IV infusion of dobutamine at 5 mcg/kg/min. The patient's baseline blood pressure was
88/52 mmHg. After 30 minutes, the nurse assesses the patient and notes: BP 92/58
mmHg, HR 118 bpm (irregular), SpO2 91% on 2L NC, and the patient reports
palpitations. Which action should the nurse take first?
A. Increase the dobutamine infusion to 7.5 mcg/kg/min
B. Administer a prescribed bolus of IV furosemide 40 mg
C. Obtain a 12-lead ECG immediately
D. Reduce the dobutamine infusion by 50%
,Correct Answer: C
Rationale: The patient is exhibiting signs of potential cardiac dysrhythmia (irregular
heart rate, palpitations, tachycardia) secondary to dobutamine's beta-1 agonist effects.
Dobutamine increases myocardial oxygen demand and can precipitate ventricular
dysrhythmias. While the blood pressure has improved slightly, the development of
new-onset irregular tachycardia requires immediate ECG evaluation to identify
potentially life-threatening rhythms before any further pharmacologic adjustments.
Option A would exacerbate the dysrhythmia; Option B addresses fluid overload but not
the immediate dysrhythmia risk; Option D may be appropriate after ECG evaluation but
premature without knowing the rhythm.
Question 2
A patient with status epilepticus has received lorazepam 4 mg IV without cessation of
seizure activity. Per protocol, the next medication to administer is fosphenytoin 20 mg
PE/kg IV. The patient weighs 70 kg. How many milligrams of phenytoin equivalents (PE)
should the nurse administer?
A. 1,000 mg
B. 1,200 mg
C. 1,400 mg
D. 1,600 mg
Correct Answer: C
Rationale: Calculation: 20 mg PE/kg × 70 kg = 1,400 mg PE. Fosphenytoin is dosed in
phenytoin equivalents (PE) to allow for seamless conversion from parenteral to oral
phenytoin. The drug must be administered no faster than 150 mg PE/min to avoid
,hypotension and cardiac dysrhythmias. Status epilepticus requires rapid control to
prevent neuronal damage; however, speed of administration must be balanced against
cardiovascular risks, particularly in hemodynamically compromised patients.
Question 3
A patient receiving high-dose methylprednisolone for acute spinal cord injury develops
acute gastrointestinal bleeding. Which laboratory finding would the nurse expect to see?
A. Decreased PT/INR
B. Increased serum amylase
C. Decreased serum albumin
D. Increased BUN with normal creatinine
Correct Answer: D
Rationale: Corticosteroids increase gastric acid secretion, decrease mucus production,
and impair mucosal defense mechanisms, leading to stress ulceration and upper GI
bleeding. The digestion of blood proteins in the upper GI tract produces a protein load
that elevates BUN disproportionately to creatinine (BUN:creatinine ratio >20:1), a classic
finding in upper GI hemorrhage. Option A is incorrect because corticosteroids do not
directly affect coagulation cascade; Option B relates to pancreatitis; Option C reflects
chronic malnutrition or hepatic dysfunction, not acute bleeding.
Question 4
A patient with severe sepsis is receiving norepinephrine at 0.5 mcg/kg/min to maintain
MAP >65 mmHg. The nurse notes the patient's hands and feet are cool, mottled, and
capillary refill is >4 seconds. Urine output has decreased to 15 mL/hr. Which
intervention is most appropriate?
, A. Increase norepinephrine to achieve MAP >80 mmHg
B. Add vasopressin 0.03 units/min to reduce catecholamine requirements
C. Discontinue norepinephrine and initiate phenylephrine
D. Administer IV hydrocortisone 50 mg every 6 hours
Correct Answer: B
Rationale: The patient exhibits signs of excessive vasoconstriction from high-dose
norepinephrine (peripheral mottling, decreased perfusion, declining urine output).
Current sepsis guidelines recommend adding vasopressin (up to 0.03 units/min) when
norepinephrine doses exceed 0.5-0.6 mcg/kg/min to reduce catecholamine exposure
and improve perfusion. Option A would worsen peripheral ischemia; Option C
substitutes one vasopressor for another without addressing the underlying
catecholamine excess; Option D is appropriate for refractory shock but secondary to
optimizing vasopressor strategy.
Question 5
A patient with chronic kidney disease (GFR 25 mL/min) is prescribed gabapentin 300
mg PO TID for neuropathic pain. What adjustment should the nurse anticipate?
A. No adjustment necessary
B. Reduce dose to 300 mg PO BID
C. Reduce dose to 300 mg PO daily
D. Increase dose to 600 mg PO TID
Correct Answer: B
100% Correct Answers with Rationales | NGN-Intensive |
2026/2027 | Advanced Clinical Judgment | Pass Guarantee
EXAM INSTRUCTIONS:
● This exam contains 55 questions reflecting Next Generation NCLEX (NGN) item
types
● Read each question carefully and follow the specific instructions provided
● Time allowed: 2 hours 15 minutes
● Passing standard: 75% (41/55 questions correct)
SECTION 1: TRADITIONAL SINGLE-ANSWER MCQs (Questions 1-30)
Question 1
A 68-year-old patient with acute decompensated heart failure is receiving a continuous
IV infusion of dobutamine at 5 mcg/kg/min. The patient's baseline blood pressure was
88/52 mmHg. After 30 minutes, the nurse assesses the patient and notes: BP 92/58
mmHg, HR 118 bpm (irregular), SpO2 91% on 2L NC, and the patient reports
palpitations. Which action should the nurse take first?
A. Increase the dobutamine infusion to 7.5 mcg/kg/min
B. Administer a prescribed bolus of IV furosemide 40 mg
C. Obtain a 12-lead ECG immediately
D. Reduce the dobutamine infusion by 50%
,Correct Answer: C
Rationale: The patient is exhibiting signs of potential cardiac dysrhythmia (irregular
heart rate, palpitations, tachycardia) secondary to dobutamine's beta-1 agonist effects.
Dobutamine increases myocardial oxygen demand and can precipitate ventricular
dysrhythmias. While the blood pressure has improved slightly, the development of
new-onset irregular tachycardia requires immediate ECG evaluation to identify
potentially life-threatening rhythms before any further pharmacologic adjustments.
Option A would exacerbate the dysrhythmia; Option B addresses fluid overload but not
the immediate dysrhythmia risk; Option D may be appropriate after ECG evaluation but
premature without knowing the rhythm.
Question 2
A patient with status epilepticus has received lorazepam 4 mg IV without cessation of
seizure activity. Per protocol, the next medication to administer is fosphenytoin 20 mg
PE/kg IV. The patient weighs 70 kg. How many milligrams of phenytoin equivalents (PE)
should the nurse administer?
A. 1,000 mg
B. 1,200 mg
C. 1,400 mg
D. 1,600 mg
Correct Answer: C
Rationale: Calculation: 20 mg PE/kg × 70 kg = 1,400 mg PE. Fosphenytoin is dosed in
phenytoin equivalents (PE) to allow for seamless conversion from parenteral to oral
phenytoin. The drug must be administered no faster than 150 mg PE/min to avoid
,hypotension and cardiac dysrhythmias. Status epilepticus requires rapid control to
prevent neuronal damage; however, speed of administration must be balanced against
cardiovascular risks, particularly in hemodynamically compromised patients.
Question 3
A patient receiving high-dose methylprednisolone for acute spinal cord injury develops
acute gastrointestinal bleeding. Which laboratory finding would the nurse expect to see?
A. Decreased PT/INR
B. Increased serum amylase
C. Decreased serum albumin
D. Increased BUN with normal creatinine
Correct Answer: D
Rationale: Corticosteroids increase gastric acid secretion, decrease mucus production,
and impair mucosal defense mechanisms, leading to stress ulceration and upper GI
bleeding. The digestion of blood proteins in the upper GI tract produces a protein load
that elevates BUN disproportionately to creatinine (BUN:creatinine ratio >20:1), a classic
finding in upper GI hemorrhage. Option A is incorrect because corticosteroids do not
directly affect coagulation cascade; Option B relates to pancreatitis; Option C reflects
chronic malnutrition or hepatic dysfunction, not acute bleeding.
Question 4
A patient with severe sepsis is receiving norepinephrine at 0.5 mcg/kg/min to maintain
MAP >65 mmHg. The nurse notes the patient's hands and feet are cool, mottled, and
capillary refill is >4 seconds. Urine output has decreased to 15 mL/hr. Which
intervention is most appropriate?
, A. Increase norepinephrine to achieve MAP >80 mmHg
B. Add vasopressin 0.03 units/min to reduce catecholamine requirements
C. Discontinue norepinephrine and initiate phenylephrine
D. Administer IV hydrocortisone 50 mg every 6 hours
Correct Answer: B
Rationale: The patient exhibits signs of excessive vasoconstriction from high-dose
norepinephrine (peripheral mottling, decreased perfusion, declining urine output).
Current sepsis guidelines recommend adding vasopressin (up to 0.03 units/min) when
norepinephrine doses exceed 0.5-0.6 mcg/kg/min to reduce catecholamine exposure
and improve perfusion. Option A would worsen peripheral ischemia; Option C
substitutes one vasopressor for another without addressing the underlying
catecholamine excess; Option D is appropriate for refractory shock but secondary to
optimizing vasopressor strategy.
Question 5
A patient with chronic kidney disease (GFR 25 mL/min) is prescribed gabapentin 300
mg PO TID for neuropathic pain. What adjustment should the nurse anticipate?
A. No adjustment necessary
B. Reduce dose to 300 mg PO BID
C. Reduce dose to 300 mg PO daily
D. Increase dose to 600 mg PO TID
Correct Answer: B
