2025 RN Pharmacology & Fundamentals NCLEX NGN-
Style Exam: 200 Detailed Questions with Rationales and
Examiner Notes
Success guaranteed
1. Scenario:
A 72-year-old male with chronic heart failure and atrial fibrillation is admitted for worsening
shortness of breath and edema. His home medications include digoxin 0.125 mg daily,
furosemide 40 mg daily, lisinopril 10 mg daily, and spironolactone 25 mg daily. Labs: K+ 3.0
mEq/L, Na+ 138 mEq/L, creatinine 1.4 mg/dL. Vital signs: BP 100/68 mmHg, HR 48 bpm, RR 22,
SpO2 91% on 2 L O2. He reports nausea and blurred vision.
Question: What is the nurse’s priority action?
Answer: Hold digoxin and notify the provider.
Rationale: The patient’s symptoms (nausea, blurred vision, bradycardia) indicate digoxin
toxicity, which is potentiated by hypokalemia. Administering digoxin could precipitate severe
dysrhythmias. Furosemide worsens hypokalemia, increasing toxicity risk. Oxygen therapy is
appropriate but not the immediate priority.
Examiner Note: NGN items test prioritization and safety. Students often focus on edema or
hypoxia, overlooking digoxin toxicity signs. Always assess for life-threatening medication side
effects first.
2. Scenario:
A 65-year-old female with type 2 diabetes, hypertension, and COPD presents with shortness of
breath and wheezing. She uses albuterol inhaler PRN and tiotropium daily. Vitals: BP 130/78
mmHg, HR 92 bpm, RR 28, SpO2 88% on room air. Labs: Blood glucose 210 mg/dL. She says,
“I’ve been using my inhaler more than usual and still feel tight.”
Question: What should the nurse do first?
,Answer: Assess the patient’s inhaler technique and administer albuterol via nebulizer if
ordered.
Rationale: Poor inhaler technique is a common cause of inadequate bronchodilation.
Nebulized albuterol ensures effective delivery during acute exacerbation. Oxygen may be
indicated if SpO2 < 90%, but addressing bronchospasm is priority.
Examiner Note: NGN items integrate assessment, medication knowledge, and prioritization.
Students often jump to oxygen therapy without evaluating airway and medication
effectiveness.
3. Scenario:
A 58-year-old male with type 2 diabetes is admitted with hyperglycemia (blood glucose 480
mg/dL) and dehydration. He is NPO and requires IV fluids and insulin therapy. Orders include:
regular insulin IV infusion and 0.9% NaCl 1 L over 2 hours. Vitals: BP 90/60 mmHg, HR 110 bpm,
RR 26, Temp 37.2°C. Labs: Na+ 132 mEq/L, K+ 4.0 mEq/L, creatinine 1.8 mg/dL.
Question: Which action should the nurse take first before starting insulin?
Answer: Ensure serum potassium is ≥ 3.3 mEq/L before initiating IV insulin.
Rationale: IV insulin drives potassium into cells, risking severe hypokalemia. Although
correcting hyperglycemia is important, hypokalemia can cause cardiac arrest. Fluid
resuscitation is necessary, but potassium safety takes priority.
Examiner Note: NGN items test pharmacology knowledge, lab interpretation, and safety.
Students often administer insulin immediately without checking potassium, which is
dangerous.
4. Scenario:
A 70-year-old female with hypertension, atrial fibrillation, and chronic kidney disease is
prescribed warfarin for anticoagulation. She presents for routine labs. Vital signs: BP 128/72
mmHg, HR 78 bpm. Lab results: INR 1.8 (therapeutic range 2–3). She reports she started taking
vitamin K supplements daily.
Question: What is the nurse’s priority action?
Answer: Educate the patient to avoid vitamin K supplements and notify the provider.
Rationale: Vitamin K antagonizes warfarin, reducing anticoagulation effectiveness and
increasing risk of thrombosis. INR is subtherapeutic. Teaching and provider notification prevent
potential clot formation.
Examiner Note: NGN questions test patient education and lab interpretation. Students may
overlook dietary interactions, focusing only on medication adherence.
5. Scenario:
,A 60-year-old male with COPD is admitted for acute exacerbation. Current meds: inhaled
corticosteroid, albuterol, and prednisone. Vitals: BP 140/85 mmHg, HR 98 bpm, RR 30, SpO2
85% on 2L O2. He complains of oral thrush and has white patches on the tongue and oral
mucosa.
Question: Which is the nurse’s priority intervention?
Answer: Instruct the patient to rinse mouth after each use of inhaled corticosteroid.
Rationale: Rinsing reduces oral candidiasis risk. Continuing inhaler without proper oral hygiene
exacerbates infection. Oxygen therapy may be needed, but prevention of complications from
medication is the priority.
Examiner Note: NGN questions combine assessment, medication knowledge, and patient
teaching. Students often treat symptoms without linking them to medication side effects.
6. Scenario:
A 65-year-old female with heart failure, hypertension, and CKD is taking furosemide 40 mg
daily and spironolactone 25 mg daily. Labs: K+ 3.0 mEq/L, Na+ 136 mEq/L, creatinine 1.6
mg/dL. Vitals: BP 95/62 mmHg, HR 88 bpm. She reports muscle cramps and weakness.
Question: What should the nurse do first?
Answer: Hold furosemide and notify the provider.
Rationale: Hypokalemia (K+ 3.0) places the patient at risk for cardiac dysrhythmias. Furosemide
is potassium-wasting and may worsen symptoms. Spironolactone is potassium-sparing, but the
net effect is still hypokalemia. Administering furosemide could precipitate arrhythmias.
Examiner Note: NGN items test lab interpretation, pharmacology knowledge, and
prioritization. Students may focus on hypotension alone rather than potassium safety.
7. Scenario:
A 58-year-old male with type 2 diabetes is admitted for hyperglycemia. He takes metformin
1000 mg BID. He reports diarrhea and nausea. Blood glucose: 240 mg/dL. Vitals: BP 128/78
mmHg, HR 82 bpm.
Question: What instruction should the nurse provide?
Answer: Take metformin with meals.
Rationale: Taking with food reduces gastrointestinal upset and improves medication tolerance.
Severe GI distress may require provider evaluation for dose adjustment.
Examiner Note: NGN questions often integrate patient education with pharmacology side
effects.
8. Scenario:
, A 60-year-old male with postoperative pain is prescribed morphine 2 mg IV q2h PRN. Vitals: BP
100/60 mmHg, HR 78 bpm, RR 10, SpO2 92% on 2L O2.
Question: Should the nurse administer the dose?
Answer: No; hold and notify the provider.
Rationale: RR < 12 indicates respiratory depression risk. Administering morphine could
precipitate respiratory arrest. Monitoring and oxygen support are essential before giving
opioids.
Examiner Note: NGN items test safety prioritization. Students sometimes administer based
solely on pain score without checking vital signs.
9. Scenario:
A 70-year-old female on lisinopril reports a persistent dry cough for 3 weeks. Vitals: BP 130/70
mmHg, HR 78 bpm.
Question: What is the nurse’s best action?
Answer: Notify the provider for possible ACE inhibitor substitution.
Rationale: Dry cough is a common ACE inhibitor adverse effect. Persistent cough can lead to
nonadherence; the provider may switch to an ARB.
Examiner Note: NGN questions test recognition of adverse effects and patient-centered care.
10. Scenario:
A 55-year-old male with DKA is prescribed regular insulin IV. Labs: K+ 4.0 mEq/L, glucose 480
mg/dL, Na+ 132 mEq/L. Vitals: BP 90/60 mmHg, HR 112 bpm.
Question: Which action should the nurse take first?
Answer: Ensure potassium is ≥ 3.3 mEq/L before starting insulin.
Rationale: Insulin drives potassium into cells, risking hypokalemia and cardiac arrest. Fluid
resuscitation is important, but potassium safety takes priority.
Examiner Note: NGN items test pharmacology, lab interpretation, and safety. Students often
overlook potassium checks before insulin.
11. Scenario:
A 68-year-old male with angina is prescribed sublingual nitroglycerin. He reports chest
tightness 3/10.
Question: What is the correct instruction?
Style Exam: 200 Detailed Questions with Rationales and
Examiner Notes
Success guaranteed
1. Scenario:
A 72-year-old male with chronic heart failure and atrial fibrillation is admitted for worsening
shortness of breath and edema. His home medications include digoxin 0.125 mg daily,
furosemide 40 mg daily, lisinopril 10 mg daily, and spironolactone 25 mg daily. Labs: K+ 3.0
mEq/L, Na+ 138 mEq/L, creatinine 1.4 mg/dL. Vital signs: BP 100/68 mmHg, HR 48 bpm, RR 22,
SpO2 91% on 2 L O2. He reports nausea and blurred vision.
Question: What is the nurse’s priority action?
Answer: Hold digoxin and notify the provider.
Rationale: The patient’s symptoms (nausea, blurred vision, bradycardia) indicate digoxin
toxicity, which is potentiated by hypokalemia. Administering digoxin could precipitate severe
dysrhythmias. Furosemide worsens hypokalemia, increasing toxicity risk. Oxygen therapy is
appropriate but not the immediate priority.
Examiner Note: NGN items test prioritization and safety. Students often focus on edema or
hypoxia, overlooking digoxin toxicity signs. Always assess for life-threatening medication side
effects first.
2. Scenario:
A 65-year-old female with type 2 diabetes, hypertension, and COPD presents with shortness of
breath and wheezing. She uses albuterol inhaler PRN and tiotropium daily. Vitals: BP 130/78
mmHg, HR 92 bpm, RR 28, SpO2 88% on room air. Labs: Blood glucose 210 mg/dL. She says,
“I’ve been using my inhaler more than usual and still feel tight.”
Question: What should the nurse do first?
,Answer: Assess the patient’s inhaler technique and administer albuterol via nebulizer if
ordered.
Rationale: Poor inhaler technique is a common cause of inadequate bronchodilation.
Nebulized albuterol ensures effective delivery during acute exacerbation. Oxygen may be
indicated if SpO2 < 90%, but addressing bronchospasm is priority.
Examiner Note: NGN items integrate assessment, medication knowledge, and prioritization.
Students often jump to oxygen therapy without evaluating airway and medication
effectiveness.
3. Scenario:
A 58-year-old male with type 2 diabetes is admitted with hyperglycemia (blood glucose 480
mg/dL) and dehydration. He is NPO and requires IV fluids and insulin therapy. Orders include:
regular insulin IV infusion and 0.9% NaCl 1 L over 2 hours. Vitals: BP 90/60 mmHg, HR 110 bpm,
RR 26, Temp 37.2°C. Labs: Na+ 132 mEq/L, K+ 4.0 mEq/L, creatinine 1.8 mg/dL.
Question: Which action should the nurse take first before starting insulin?
Answer: Ensure serum potassium is ≥ 3.3 mEq/L before initiating IV insulin.
Rationale: IV insulin drives potassium into cells, risking severe hypokalemia. Although
correcting hyperglycemia is important, hypokalemia can cause cardiac arrest. Fluid
resuscitation is necessary, but potassium safety takes priority.
Examiner Note: NGN items test pharmacology knowledge, lab interpretation, and safety.
Students often administer insulin immediately without checking potassium, which is
dangerous.
4. Scenario:
A 70-year-old female with hypertension, atrial fibrillation, and chronic kidney disease is
prescribed warfarin for anticoagulation. She presents for routine labs. Vital signs: BP 128/72
mmHg, HR 78 bpm. Lab results: INR 1.8 (therapeutic range 2–3). She reports she started taking
vitamin K supplements daily.
Question: What is the nurse’s priority action?
Answer: Educate the patient to avoid vitamin K supplements and notify the provider.
Rationale: Vitamin K antagonizes warfarin, reducing anticoagulation effectiveness and
increasing risk of thrombosis. INR is subtherapeutic. Teaching and provider notification prevent
potential clot formation.
Examiner Note: NGN questions test patient education and lab interpretation. Students may
overlook dietary interactions, focusing only on medication adherence.
5. Scenario:
,A 60-year-old male with COPD is admitted for acute exacerbation. Current meds: inhaled
corticosteroid, albuterol, and prednisone. Vitals: BP 140/85 mmHg, HR 98 bpm, RR 30, SpO2
85% on 2L O2. He complains of oral thrush and has white patches on the tongue and oral
mucosa.
Question: Which is the nurse’s priority intervention?
Answer: Instruct the patient to rinse mouth after each use of inhaled corticosteroid.
Rationale: Rinsing reduces oral candidiasis risk. Continuing inhaler without proper oral hygiene
exacerbates infection. Oxygen therapy may be needed, but prevention of complications from
medication is the priority.
Examiner Note: NGN questions combine assessment, medication knowledge, and patient
teaching. Students often treat symptoms without linking them to medication side effects.
6. Scenario:
A 65-year-old female with heart failure, hypertension, and CKD is taking furosemide 40 mg
daily and spironolactone 25 mg daily. Labs: K+ 3.0 mEq/L, Na+ 136 mEq/L, creatinine 1.6
mg/dL. Vitals: BP 95/62 mmHg, HR 88 bpm. She reports muscle cramps and weakness.
Question: What should the nurse do first?
Answer: Hold furosemide and notify the provider.
Rationale: Hypokalemia (K+ 3.0) places the patient at risk for cardiac dysrhythmias. Furosemide
is potassium-wasting and may worsen symptoms. Spironolactone is potassium-sparing, but the
net effect is still hypokalemia. Administering furosemide could precipitate arrhythmias.
Examiner Note: NGN items test lab interpretation, pharmacology knowledge, and
prioritization. Students may focus on hypotension alone rather than potassium safety.
7. Scenario:
A 58-year-old male with type 2 diabetes is admitted for hyperglycemia. He takes metformin
1000 mg BID. He reports diarrhea and nausea. Blood glucose: 240 mg/dL. Vitals: BP 128/78
mmHg, HR 82 bpm.
Question: What instruction should the nurse provide?
Answer: Take metformin with meals.
Rationale: Taking with food reduces gastrointestinal upset and improves medication tolerance.
Severe GI distress may require provider evaluation for dose adjustment.
Examiner Note: NGN questions often integrate patient education with pharmacology side
effects.
8. Scenario:
, A 60-year-old male with postoperative pain is prescribed morphine 2 mg IV q2h PRN. Vitals: BP
100/60 mmHg, HR 78 bpm, RR 10, SpO2 92% on 2L O2.
Question: Should the nurse administer the dose?
Answer: No; hold and notify the provider.
Rationale: RR < 12 indicates respiratory depression risk. Administering morphine could
precipitate respiratory arrest. Monitoring and oxygen support are essential before giving
opioids.
Examiner Note: NGN items test safety prioritization. Students sometimes administer based
solely on pain score without checking vital signs.
9. Scenario:
A 70-year-old female on lisinopril reports a persistent dry cough for 3 weeks. Vitals: BP 130/70
mmHg, HR 78 bpm.
Question: What is the nurse’s best action?
Answer: Notify the provider for possible ACE inhibitor substitution.
Rationale: Dry cough is a common ACE inhibitor adverse effect. Persistent cough can lead to
nonadherence; the provider may switch to an ARB.
Examiner Note: NGN questions test recognition of adverse effects and patient-centered care.
10. Scenario:
A 55-year-old male with DKA is prescribed regular insulin IV. Labs: K+ 4.0 mEq/L, glucose 480
mg/dL, Na+ 132 mEq/L. Vitals: BP 90/60 mmHg, HR 112 bpm.
Question: Which action should the nurse take first?
Answer: Ensure potassium is ≥ 3.3 mEq/L before starting insulin.
Rationale: Insulin drives potassium into cells, risking hypokalemia and cardiac arrest. Fluid
resuscitation is important, but potassium safety takes priority.
Examiner Note: NGN items test pharmacology, lab interpretation, and safety. Students often
overlook potassium checks before insulin.
11. Scenario:
A 68-year-old male with angina is prescribed sublingual nitroglycerin. He reports chest
tightness 3/10.
Question: What is the correct instruction?
