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 68-year-old with HF is started on digoxin 0.125 mg PO daily. Which finding best
indicates a therapeutic effect?
A. Heart rate 140 bpm
B. Decreased edema and clear lungs
C. Serum potassium 3.0 mEq/L
D. Blood pressure 86/50 mm Hg
Correct Answer: B
Rationale: Positive inotropy and slowed ventricular response improve congestion;
peripheral edema and crackles diminish.
2. A patient receiving IV heparin has an aPTT of 96 sec (control 30 sec). The nurse
should FIRST:
A. Stop the infusion
B. Give protamine sulfate
C. Reduce rate by 2 mL/h
D. Obtain a platelet count
Correct Answer: A
Rationale: aPTT > 3 × control places patient at bleeding risk; stopping the
infusion is immediate harm reduction.
3. A 28-year-old with asthma is prescribed albuterol MDI 2 puffs q4h PRN. Patient
asks, “Can I use it every day?” The nurse should teach:
A. “Daily use is fine if you rinse your mouth.”
B. “Increase to q2h if peak flow < 200.”
C. “Regular need indicates poor control; call your provider.”
D. “Switch to the nebulizer for daily use.”
Correct Answer: C
Rationale: PRN β2-agonist use > 2×/week signals inadequate control; step-up
controller therapy is needed.
, 4. A post-operative patient has morphine 10 mg IV q4h PRN. Respirations 8/min,
SpO2 89 %. Which medication should the nurse prepare?
A. Naloxone 0.4 mg IVP
B. Flumazenil 0.5 mg
C. Naltrexone 50 mg PO
D. Albuterol nebulizer
Correct Answer: A
Rationale: Opioid-induced respiratory depression is reversed with naloxone; other
agents are ineffective.
5. A 12-year-old (40 kg) with bacterial meningitis is ordered ceftriaxone 2 g IV q12h.
The safe range is 100 mg/kg/day divided q12h. The nurse’s INITIAL action is:
A. Give the drug now—within range
B. Hold and clarify; ordered dose equals 4 g/day = 200 mg/kg/day
C. Dilute in 40 mL D5W and infuse over 30 min
D. Give 1 g and document partial dose
Correct Answer: B
Rationale: 4 g/day provides 100 mg/kg/dose (200 mg/kg/day) – double the
recommended daily maximum; verification is required.
6. A patient takes warfarin 5 mg daily. INR 5.8, no bleeding. The nurse anticipates
the provider will prescribe:
A. Hold warfarin and give 2.5 mg PO vitamin K
B. Infuse fresh frozen plasma now
C. Increase warfarin to 7.5 mg
D. Begin low-dose heparin bridge
Correct Answer: A
Rationale: Vitamin K 1–2.5 mg lowers INR safely when no active bleeding; FFP is
reserved for bleeding or very high INR.
7. A 34-week-pregnant patient needs corticosteroids for fetal lung maturity. Which
regimen is standard?
A. Betamethasone 6 mg IM × 1 dose
B. Dexamethasone 4 mg IV q6h × 4 doses
C. Betamethasone 12 mg IM × 2 doses 24 h apart
D. Prednisone 40 mg PO daily × 3 days
Correct Answer: C
Rationale: Two-dose betamethasone is evidence-based for preterm labor;
crosses placenta slowly.
8. A patient is started on phenytoin 300 mg PO BID after craniotomy. Which
instruction is PRIORITY?
A. “Take with an antacid to prevent nausea.”
(2026/2027) Complete Next Generation NCLEX® Exam |
Actual Questions & Verified Answers | Clinical Judgment
Measurement | Pass Guarantee
1. A 68-year-old with HF is started on digoxin 0.125 mg PO daily. Which finding best
indicates a therapeutic effect?
A. Heart rate 140 bpm
B. Decreased edema and clear lungs
C. Serum potassium 3.0 mEq/L
D. Blood pressure 86/50 mm Hg
Correct Answer: B
Rationale: Positive inotropy and slowed ventricular response improve congestion;
peripheral edema and crackles diminish.
2. A patient receiving IV heparin has an aPTT of 96 sec (control 30 sec). The nurse
should FIRST:
A. Stop the infusion
B. Give protamine sulfate
C. Reduce rate by 2 mL/h
D. Obtain a platelet count
Correct Answer: A
Rationale: aPTT > 3 × control places patient at bleeding risk; stopping the
infusion is immediate harm reduction.
3. A 28-year-old with asthma is prescribed albuterol MDI 2 puffs q4h PRN. Patient
asks, “Can I use it every day?” The nurse should teach:
A. “Daily use is fine if you rinse your mouth.”
B. “Increase to q2h if peak flow < 200.”
C. “Regular need indicates poor control; call your provider.”
D. “Switch to the nebulizer for daily use.”
Correct Answer: C
Rationale: PRN β2-agonist use > 2×/week signals inadequate control; step-up
controller therapy is needed.
, 4. A post-operative patient has morphine 10 mg IV q4h PRN. Respirations 8/min,
SpO2 89 %. Which medication should the nurse prepare?
A. Naloxone 0.4 mg IVP
B. Flumazenil 0.5 mg
C. Naltrexone 50 mg PO
D. Albuterol nebulizer
Correct Answer: A
Rationale: Opioid-induced respiratory depression is reversed with naloxone; other
agents are ineffective.
5. A 12-year-old (40 kg) with bacterial meningitis is ordered ceftriaxone 2 g IV q12h.
The safe range is 100 mg/kg/day divided q12h. The nurse’s INITIAL action is:
A. Give the drug now—within range
B. Hold and clarify; ordered dose equals 4 g/day = 200 mg/kg/day
C. Dilute in 40 mL D5W and infuse over 30 min
D. Give 1 g and document partial dose
Correct Answer: B
Rationale: 4 g/day provides 100 mg/kg/dose (200 mg/kg/day) – double the
recommended daily maximum; verification is required.
6. A patient takes warfarin 5 mg daily. INR 5.8, no bleeding. The nurse anticipates
the provider will prescribe:
A. Hold warfarin and give 2.5 mg PO vitamin K
B. Infuse fresh frozen plasma now
C. Increase warfarin to 7.5 mg
D. Begin low-dose heparin bridge
Correct Answer: A
Rationale: Vitamin K 1–2.5 mg lowers INR safely when no active bleeding; FFP is
reserved for bleeding or very high INR.
7. A 34-week-pregnant patient needs corticosteroids for fetal lung maturity. Which
regimen is standard?
A. Betamethasone 6 mg IM × 1 dose
B. Dexamethasone 4 mg IV q6h × 4 doses
C. Betamethasone 12 mg IM × 2 doses 24 h apart
D. Prednisone 40 mg PO daily × 3 days
Correct Answer: C
Rationale: Two-dose betamethasone is evidence-based for preterm labor;
crosses placenta slowly.
8. A patient is started on phenytoin 300 mg PO BID after craniotomy. Which
instruction is PRIORITY?
A. “Take with an antacid to prevent nausea.”
