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 67-year-old with heart failure (EF 30 %) is started on sacubitril/valsartan 49/51
mg BID. Which prior medication must be discontinued for 36 h before the first
dose?
A. Lisinopril
B. Carvedilol
C. Furosemide
D. Digoxin
Correct Answer: A
Rationale: Combined ARNI use with ACEI ↑ angioedema risk; 36-h washout
required.
2. A patient receiving cisplatin 75 mg/m² develops urine output 20 mL/h × 3 h.
Current SCr 1.8 mg/dL (baseline 1.0). Which action is priority?
A. Slow infusion to 6 h
B. Administer ondansetron
C. Increase NS hydration & notify provider
D. Give mannitol 25 g
Correct Answer: C
Rationale: Oliguria signals nephrotoxicity; aggressive saline diuresis & dose
adjustment are urgent.
3. A 4-year-old weighing 18 kg is prescribed oral prednisolone 2 mg/kg/day for
asthma exacerbation. Daily dose is:
A. 18 mg
B. 36 mg
C. 54 mg
D. 72 mg
Correct Answer: B
Rationale: 2 mg × 18 kg = 36 mg; give as single morning dose or divided BID.
, 4. A patient takes warfarin 5 mg daily. INR today is 6.2 (target 2-3) and no bleeding.
Evidence-based action:
A. Give vitamin K 10 mg IV
B. Hold 1-2 doses & reduce weekly dose 10-20 %
C. Switch to rivaroxaban today
D. Order protamine sulfate
Correct Answer: B
Rationale: INR 5-9 without bleeding: hold doses, adjust weekly total, optional
low-dose oral vitamin K.
5. A patient with new-onset type 1 DM receives insulin aspart 4 units at 07:30.
Which blood glucose value best indicates meal bolus effectiveness at 10:00?
A. 180 mg/dL
B. 140 mg/dL
C. 110 mg/dL
D. 70 mg/dL
Correct Answer: C
Rationale: Post-prandial goal <140-180; 110 mg/dL shows appropriate bolus
match.
6. A patient is started on phenytoin 300 mg PO HS. Which teaching is ESSENTIAL?
A. Take with antacid to prevent GI upset
B. Use soft-bristle toothbrush & report gum swelling
C. Expect orange sweat
D. Avoid dairy products
Correct Answer: B
Rationale: Gingival hyperplasia common; dental hygiene limits severity.
7. A patient receiving IV morphine 2 mg q2h PRN has respiratory rate 8/min & SpO₂
88 %. Which agent is appropriate?
A. Naloxone 0.4 mg IV push
B. Flumazenil 0.2 mg IV
C. Oxygen only
D. Increase morphine interval
Correct Answer: A
Rationale: Opioid-induced respiratory depression reversed with naloxone; titrate
to RR >10.
8. A 28-week-pregnant patient receives betamethasone 12 mg IM. Primary purpose:
A. Prevent neonatal hypoglycemia
B. Accelerate fetal lung maturity
C. Suppress preterm labor
D. Maternal anti-emetic
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
1. A 67-year-old with heart failure (EF 30 %) is started on sacubitril/valsartan 49/51
mg BID. Which prior medication must be discontinued for 36 h before the first
dose?
A. Lisinopril
B. Carvedilol
C. Furosemide
D. Digoxin
Correct Answer: A
Rationale: Combined ARNI use with ACEI ↑ angioedema risk; 36-h washout
required.
2. A patient receiving cisplatin 75 mg/m² develops urine output 20 mL/h × 3 h.
Current SCr 1.8 mg/dL (baseline 1.0). Which action is priority?
A. Slow infusion to 6 h
B. Administer ondansetron
C. Increase NS hydration & notify provider
D. Give mannitol 25 g
Correct Answer: C
Rationale: Oliguria signals nephrotoxicity; aggressive saline diuresis & dose
adjustment are urgent.
3. A 4-year-old weighing 18 kg is prescribed oral prednisolone 2 mg/kg/day for
asthma exacerbation. Daily dose is:
A. 18 mg
B. 36 mg
C. 54 mg
D. 72 mg
Correct Answer: B
Rationale: 2 mg × 18 kg = 36 mg; give as single morning dose or divided BID.
, 4. A patient takes warfarin 5 mg daily. INR today is 6.2 (target 2-3) and no bleeding.
Evidence-based action:
A. Give vitamin K 10 mg IV
B. Hold 1-2 doses & reduce weekly dose 10-20 %
C. Switch to rivaroxaban today
D. Order protamine sulfate
Correct Answer: B
Rationale: INR 5-9 without bleeding: hold doses, adjust weekly total, optional
low-dose oral vitamin K.
5. A patient with new-onset type 1 DM receives insulin aspart 4 units at 07:30.
Which blood glucose value best indicates meal bolus effectiveness at 10:00?
A. 180 mg/dL
B. 140 mg/dL
C. 110 mg/dL
D. 70 mg/dL
Correct Answer: C
Rationale: Post-prandial goal <140-180; 110 mg/dL shows appropriate bolus
match.
6. A patient is started on phenytoin 300 mg PO HS. Which teaching is ESSENTIAL?
A. Take with antacid to prevent GI upset
B. Use soft-bristle toothbrush & report gum swelling
C. Expect orange sweat
D. Avoid dairy products
Correct Answer: B
Rationale: Gingival hyperplasia common; dental hygiene limits severity.
7. A patient receiving IV morphine 2 mg q2h PRN has respiratory rate 8/min & SpO₂
88 %. Which agent is appropriate?
A. Naloxone 0.4 mg IV push
B. Flumazenil 0.2 mg IV
C. Oxygen only
D. Increase morphine interval
Correct Answer: A
Rationale: Opioid-induced respiratory depression reversed with naloxone; titrate
to RR >10.
8. A 28-week-pregnant patient receives betamethasone 12 mg IM. Primary purpose:
A. Prevent neonatal hypoglycemia
B. Accelerate fetal lung maturity
C. Suppress preterm labor
D. Maternal anti-emetic
