NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION A
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
Total items: 55 (40 traditional MCQ + 5 SATA + 5 Matrix + 3 Cloze + 2 Drag-&-Drop/Ordered
Response)
1-40 Traditional Single-Answer MCQs
A 58-year-old receiving a thrombolytic for acute MI begins to cough up pink frothy sputum.
Which prescribed medication should the nurse question first?
A. Aspirin 325 mg
B. Heparin 5000 units IV push
C. Metoprolol 5 mg IV q5 min
D. Atorvastatin 80 mg PO
Correct Answer: B. Heparin
Rationale: Thrombolytics plus anticoagulants greatly ↑ bleeding risk; acute pulmonary edema
contraindicates additional anticoagulation.
A client on lithium 600 mg BID reports nausea, coarse hand tremors, and muscle weakness.
Serum lithium drawn this morning is 1.8 mEq/L (normal 0.6-1.2). Which nursing action is best?
A. Give the next scheduled dose
B. Hold lithium and notify provider
C. Increase fluid to 4000 mL/day and continue
D. Administer prn phenytoin for tremor
Correct Answer: B
Rationale: 1.8 = toxic; hold drug, hydrate, monitor levels.
When preparing to give an IV aminoglycoside, the nurse notes the trough level from 0600 is 3.5
mg/dL (high). Which action is required?
A. Give the 0800 dose on time
B. Hold the dose and call prescriber
C. Increase the interval to q48 h
D. Draw peak after dose
Correct Answer: B
Rationale: Elevated trough signals nephrotoxicity; dose must be adjusted.
A 10-year-old weighs 30 kg and is prescribed methylphenidate 0.3 mg/kg PO at 0800. Available:
5 mg tabs. How many tabs?
A. ½ tab
B. 1 tab
C. 1½ tabs
, D. 2 tabs
Correct Answer: D
Rationale: 0.3 × 30 = 9 mg; 5 mg tabs → 2 tabs = 10 mg (closest safe dose).
A client receiving digoxin 0.25 mg PO daily and furosemide 40 mg IV reports “seeing yellow
halos.” Potassium is 3.0 mEq/L. What is priority?
A. Give potassium supplement
B. Hold digoxin and obtain level
C. Increase furosemide
D. Reassure client
Correct Answer: B
Rationale: Classic digoxin toxicity; hypokalemia potentiates; hold drug first.
A patient on long-term prednisone 40 mg PO daily is scheduled for colonoscopy. Which
instruction is essential?
A. Take usual dose morning of procedure
B. Double dose night before
C. Hold dose 48 h prior
D. Switch to IV hydrocortisone day of
Correct Answer: D
Rationale: Stress-dose steroid coverage prevents adrenal crisis.
The nurse notes BP 88/50 mmHg 30 min after first dose of sublingual nitroglycerin for angina.
Heart rate 110. Which intervention first?
A. Give fluids 500 mL bolus
B. Place supine with legs elevated
C. Administer atropine
D. Repeat NTG
Correct Answer: B
Rationale: NTG-induced vasodilation; positioning restores cerebral perfusion.
A client receiving heparin drip (18 units/kg/h) has aPTT 110 sec (control 30). Next action?
A. Stop infusion for 1 h and reduce rate 20 %
B. Continue current rate
C. Protamine sulfate 10 mg IV
D. Add warfarin overlap
Correct Answer: A
Rationale: aPTT 3-4× control = bleeding risk; reduce per protocol.
Which teaching is correct for a patient starting phenytoin?
A. Take with antacid to reduce GI upset
B. Use good oral hygiene and see dentist yearly
C. Stop drug if rash appears and call next week
D. Expect pink-red discoloration of urine
Correct Answer: B
Rationale: Phenytoin causes gingival hyperplasia; dental care important.
A nurse prepares vancomycin 1 g IV. Which rate is safest?
A. 30-min infusion
B. 60-min infusion
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
Total items: 55 (40 traditional MCQ + 5 SATA + 5 Matrix + 3 Cloze + 2 Drag-&-Drop/Ordered
Response)
1-40 Traditional Single-Answer MCQs
A 58-year-old receiving a thrombolytic for acute MI begins to cough up pink frothy sputum.
Which prescribed medication should the nurse question first?
A. Aspirin 325 mg
B. Heparin 5000 units IV push
C. Metoprolol 5 mg IV q5 min
D. Atorvastatin 80 mg PO
Correct Answer: B. Heparin
Rationale: Thrombolytics plus anticoagulants greatly ↑ bleeding risk; acute pulmonary edema
contraindicates additional anticoagulation.
A client on lithium 600 mg BID reports nausea, coarse hand tremors, and muscle weakness.
Serum lithium drawn this morning is 1.8 mEq/L (normal 0.6-1.2). Which nursing action is best?
A. Give the next scheduled dose
B. Hold lithium and notify provider
C. Increase fluid to 4000 mL/day and continue
D. Administer prn phenytoin for tremor
Correct Answer: B
Rationale: 1.8 = toxic; hold drug, hydrate, monitor levels.
When preparing to give an IV aminoglycoside, the nurse notes the trough level from 0600 is 3.5
mg/dL (high). Which action is required?
A. Give the 0800 dose on time
B. Hold the dose and call prescriber
C. Increase the interval to q48 h
D. Draw peak after dose
Correct Answer: B
Rationale: Elevated trough signals nephrotoxicity; dose must be adjusted.
A 10-year-old weighs 30 kg and is prescribed methylphenidate 0.3 mg/kg PO at 0800. Available:
5 mg tabs. How many tabs?
A. ½ tab
B. 1 tab
C. 1½ tabs
, D. 2 tabs
Correct Answer: D
Rationale: 0.3 × 30 = 9 mg; 5 mg tabs → 2 tabs = 10 mg (closest safe dose).
A client receiving digoxin 0.25 mg PO daily and furosemide 40 mg IV reports “seeing yellow
halos.” Potassium is 3.0 mEq/L. What is priority?
A. Give potassium supplement
B. Hold digoxin and obtain level
C. Increase furosemide
D. Reassure client
Correct Answer: B
Rationale: Classic digoxin toxicity; hypokalemia potentiates; hold drug first.
A patient on long-term prednisone 40 mg PO daily is scheduled for colonoscopy. Which
instruction is essential?
A. Take usual dose morning of procedure
B. Double dose night before
C. Hold dose 48 h prior
D. Switch to IV hydrocortisone day of
Correct Answer: D
Rationale: Stress-dose steroid coverage prevents adrenal crisis.
The nurse notes BP 88/50 mmHg 30 min after first dose of sublingual nitroglycerin for angina.
Heart rate 110. Which intervention first?
A. Give fluids 500 mL bolus
B. Place supine with legs elevated
C. Administer atropine
D. Repeat NTG
Correct Answer: B
Rationale: NTG-induced vasodilation; positioning restores cerebral perfusion.
A client receiving heparin drip (18 units/kg/h) has aPTT 110 sec (control 30). Next action?
A. Stop infusion for 1 h and reduce rate 20 %
B. Continue current rate
C. Protamine sulfate 10 mg IV
D. Add warfarin overlap
Correct Answer: A
Rationale: aPTT 3-4× control = bleeding risk; reduce per protocol.
Which teaching is correct for a patient starting phenytoin?
A. Take with antacid to reduce GI upset
B. Use good oral hygiene and see dentist yearly
C. Stop drug if rash appears and call next week
D. Expect pink-red discoloration of urine
Correct Answer: B
Rationale: Phenytoin causes gingival hyperplasia; dental care important.
A nurse prepares vancomycin 1 g IV. Which rate is safest?
A. 30-min infusion
B. 60-min infusion
