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. A 56-year-old post-MI patient is started on atorvastatin 40 mg PO daily. Which lab
result BEST indicates the drug’s intended therapeutic effect?
A. HDL increase of 8 mg/dL
B. Triglyceride decrease of 20 mg/dL
C. LDL reduction of 38 % at 6 weeks
D. Total cholesterol drop of 5 %
Correct Answer: C
Rationale: Statin primary goal is LDL reduction ≥30-50 %; 38 % meets
evidence-based post-MI target.
2. The nurse is administering the first dose of piperacillin-tazobactam to a patient
with a penicillin allergy documented as “rash.” Which action is MOST important?
A. Give the dose over 30 min
B. Obtain peak & trough levels
C. Hold dose & clarify with provider
D. Monitor creatinine only
Correct Answer: C
Rationale: Any allergy history requires reassessment; cross-reactivity risk
outweighs benefit without desensitization plan.
3. A client takes lithium 600 mg BID and reports mild diarrhea. Today’s lithium level
is 1.4 mEq/L (normal 0.6-1.2). Which instruction is priority?
A. “Take the next dose with food.”
B. “Skip the next dose & call the lab for a redraw in 48 h.”
C. “Increase clear fluids; continue drug.”
D. “Split daily dose into TID.”
Correct Answer: B
Rationale: Level exceeds therapeutic range; hold dose, hydrate, and reevaluate
before resuming.
,4. A 32-week-pregnant patient receives betamethasone 12 mg IM × 2 doses 24 h
apart. What is the PRIMARY purpose?
A. Maternal glucose control
B. Accelerate fetal lung maturity
C. Prevent eclampsia
D. Delay preterm labor
Correct Answer: B
Rationale: Corticosteroids up-regulate fetal surfactant production, cutting
neonatal RDS risk.
5. The provider orders filgrastim 300 mcg subcut daily for a neutropenic patient.
Which finding indicates a therapeutic response?
A. Platelet count rises from 90 k → 150 k/µL
B. ANC increases from 800 → 3500/µL by day 5
C. Hgb improves 1 g/dL in 3 days
D. Temperature 37.2 °C
Correct Answer: B
Rationale: Filgrastim (G-CSF) stimulates neutrophil production; ANC rebound is
expected.
6. A child weighing 22 lb is prescribed amoxicillin 45 mg/kg/day divided q12 h × 10
days. What is the CORRECT daily dose? (Round to nearest whole number.)
A. 220 mg
B. 450 mg
C. 500 mg
D. 1000 mg
Correct Answer: B
Rationale: 22 lb = 10 kg; 45 mg × 10 = 450 mg/day.
7. The nurse is caring for a patient receiving IV regular insulin at 6 units/h for DKA.
Which serum value MOST directly guides titration?
A. Potassium 3.5 mEq/L
B. Blood glucose dropping 80 mg/dL/h
C. pH 7.28
D. Anion gap 16 mEq/L
Correct Answer: B
Rationale: Target glucose decline 50-90 mg/dL/h to prevent cerebral edema;
adjust drip accordingly.
8. A 72-year-old with heart failure is prescribed digoxin 0.25 mg PO daily. Which
finding warrants immediate hold & provider call?
A. HR 62 bpm
B. Serum digoxin 1.3 ng/mL
, C. Serum K 3.0 mEq/L
D. SCr 1.1 mg/dL
Correct Answer: C
Rationale: Hypokalemia increases digoxin toxicity risk even with “normal” dig
level; hold & replace K.
9. A patient on chronic prednisone 40 mg daily develops a temperature of 38.5 °C.
What is the priority nursing action?
A. Give next dose to prevent adrenal crisis
B. Hold dose & notify provider for infection work-up
C. Taper dose by 5 mg
D. Administer live vaccine prophylaxis
Correct Answer: B
Rationale: Immunosuppressed patient needs infection evaluation before
continuing high-dose steroid.
10. A client receiving morphine PCA after surgery reports nausea & mild pruritus.
Which adjunct prescription is MOST appropriate?
A. Naloxone 0.4 mg IV push now
B. Ondansetron 4 mg IV
C. Increase morphine dose
D. Give aspirin 325 mg
Correct Answer: B
Rationale: Ondansetron targets opioid-induced nausea without reversing
analgesia; naloxone is for overdose/respiratory depression.
11. A patient taking warfarin has INR 5.8 (target 2-3). No bleeding is noted. Which
evidence-based action is BEST?
A. Give vitamin K 2.5-5 mg PO
B. Hold 1 dose & reduce weekly dose 10-20 %
C. Switch to rivaroxaban immediately
D. Administer protamine sulfate
Correct Answer: B
Rationale: INR 5-9 without bleeding: hold 1-2 doses & reduce weekly dose; oral
vitamin K optional per protocol.
12. A patient is started on isoniazid for latent TB. Which teaching is ESSENTIAL?
A. Take with antacids to prevent GI upset
B. Avoid aged cheeses
C. Limit protein to 40 g/day
D. Report numbness/tingling
Correct Answer: D
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
1. A 56-year-old post-MI patient is started on atorvastatin 40 mg PO daily. Which lab
result BEST indicates the drug’s intended therapeutic effect?
A. HDL increase of 8 mg/dL
B. Triglyceride decrease of 20 mg/dL
C. LDL reduction of 38 % at 6 weeks
D. Total cholesterol drop of 5 %
Correct Answer: C
Rationale: Statin primary goal is LDL reduction ≥30-50 %; 38 % meets
evidence-based post-MI target.
2. The nurse is administering the first dose of piperacillin-tazobactam to a patient
with a penicillin allergy documented as “rash.” Which action is MOST important?
A. Give the dose over 30 min
B. Obtain peak & trough levels
C. Hold dose & clarify with provider
D. Monitor creatinine only
Correct Answer: C
Rationale: Any allergy history requires reassessment; cross-reactivity risk
outweighs benefit without desensitization plan.
3. A client takes lithium 600 mg BID and reports mild diarrhea. Today’s lithium level
is 1.4 mEq/L (normal 0.6-1.2). Which instruction is priority?
A. “Take the next dose with food.”
B. “Skip the next dose & call the lab for a redraw in 48 h.”
C. “Increase clear fluids; continue drug.”
D. “Split daily dose into TID.”
Correct Answer: B
Rationale: Level exceeds therapeutic range; hold dose, hydrate, and reevaluate
before resuming.
,4. A 32-week-pregnant patient receives betamethasone 12 mg IM × 2 doses 24 h
apart. What is the PRIMARY purpose?
A. Maternal glucose control
B. Accelerate fetal lung maturity
C. Prevent eclampsia
D. Delay preterm labor
Correct Answer: B
Rationale: Corticosteroids up-regulate fetal surfactant production, cutting
neonatal RDS risk.
5. The provider orders filgrastim 300 mcg subcut daily for a neutropenic patient.
Which finding indicates a therapeutic response?
A. Platelet count rises from 90 k → 150 k/µL
B. ANC increases from 800 → 3500/µL by day 5
C. Hgb improves 1 g/dL in 3 days
D. Temperature 37.2 °C
Correct Answer: B
Rationale: Filgrastim (G-CSF) stimulates neutrophil production; ANC rebound is
expected.
6. A child weighing 22 lb is prescribed amoxicillin 45 mg/kg/day divided q12 h × 10
days. What is the CORRECT daily dose? (Round to nearest whole number.)
A. 220 mg
B. 450 mg
C. 500 mg
D. 1000 mg
Correct Answer: B
Rationale: 22 lb = 10 kg; 45 mg × 10 = 450 mg/day.
7. The nurse is caring for a patient receiving IV regular insulin at 6 units/h for DKA.
Which serum value MOST directly guides titration?
A. Potassium 3.5 mEq/L
B. Blood glucose dropping 80 mg/dL/h
C. pH 7.28
D. Anion gap 16 mEq/L
Correct Answer: B
Rationale: Target glucose decline 50-90 mg/dL/h to prevent cerebral edema;
adjust drip accordingly.
8. A 72-year-old with heart failure is prescribed digoxin 0.25 mg PO daily. Which
finding warrants immediate hold & provider call?
A. HR 62 bpm
B. Serum digoxin 1.3 ng/mL
, C. Serum K 3.0 mEq/L
D. SCr 1.1 mg/dL
Correct Answer: C
Rationale: Hypokalemia increases digoxin toxicity risk even with “normal” dig
level; hold & replace K.
9. A patient on chronic prednisone 40 mg daily develops a temperature of 38.5 °C.
What is the priority nursing action?
A. Give next dose to prevent adrenal crisis
B. Hold dose & notify provider for infection work-up
C. Taper dose by 5 mg
D. Administer live vaccine prophylaxis
Correct Answer: B
Rationale: Immunosuppressed patient needs infection evaluation before
continuing high-dose steroid.
10. A client receiving morphine PCA after surgery reports nausea & mild pruritus.
Which adjunct prescription is MOST appropriate?
A. Naloxone 0.4 mg IV push now
B. Ondansetron 4 mg IV
C. Increase morphine dose
D. Give aspirin 325 mg
Correct Answer: B
Rationale: Ondansetron targets opioid-induced nausea without reversing
analgesia; naloxone is for overdose/respiratory depression.
11. A patient taking warfarin has INR 5.8 (target 2-3). No bleeding is noted. Which
evidence-based action is BEST?
A. Give vitamin K 2.5-5 mg PO
B. Hold 1 dose & reduce weekly dose 10-20 %
C. Switch to rivaroxaban immediately
D. Administer protamine sulfate
Correct Answer: B
Rationale: INR 5-9 without bleeding: hold 1-2 doses & reduce weekly dose; oral
vitamin K optional per protocol.
12. A patient is started on isoniazid for latent TB. Which teaching is ESSENTIAL?
A. Take with antacids to prevent GI upset
B. Avoid aged cheeses
C. Limit protein to 40 g/day
D. Report numbness/tingling
Correct Answer: D
