NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION D
100% Correct Answers with Rationales | NGN-Intensive |
2026/2027 | Advanced Clinical Judgment | Pass Guarantee
1. A 68-year-old man with septic shock is receiving norepinephrine 8 mcg/min. His
BP is 78/42 mmHg, HR 118, ScvO₂ 65%. The provider orders vasopressin 0.03
units/min to be added. What is the primary expected effect of this addition?
A. Increase contractility via V₁ receptors
B. Reduce norepinephrine dose by causing vasoconstriction through V₁ receptors
C. Increase heart rate via V₂ receptors
D. Dilate pulmonary vasculature via V₂ receptors
Correct Answer: B
Rationale: Vasopressin at low "stress" doses activates V₁ receptors on vascular smooth
muscle, augmenting SVR and often allowing reduction of catecholamine requirements
without increasing HR.
2. A patient on phenytoin 300 mg PO daily for status epilepticus has a trough level 6
mcg/mL (therapeutic 10-20). The patient has received continuous enteral feeds.
What is the most appropriate next action?
A. Switch to IM phenytoin
B. Hold feeds 1-2 h before & after dose and redraw level in 3 days
C. Increase dose to 400 mg daily without feed adjustment
D. Discontinue feeds permanently
Correct Answer: B
Rationale: Continuous enteral nutrition binds phenytoin, reducing absorption. Separating
administration and reassessing level prevents toxicity while achieving therapeutic
range.
, 3. A 55-year-old with acute respiratory failure is receiving cisatracurium 3
mcg/kg/min. The nurse notes HR 52, BP 90/50, and twitch monitor shows 0/4
twitches. Which medication should be immediately available?
A. Naloxone
B. Flumazenil
C. Atropine
D. Sugammadex
Correct Answer: C
Rationale: Profound paralysis with bradycardia suggests possible histamine release or
vagal response; atropine treats symptomatic bradycardia. Sugammadex is for
rocuronium/vecuronium, not cisatracurium.
4. A 72-year-old with heart failure (EF 25%) is prescribed digoxin 0.125 mg daily. K⁺
is 3.0 mEq/L. What is the priority nursing action?
A. Administer digoxin and recheck K⁺ in 1 week
B. Hold digoxin and notify provider of hypokalemia
C. Increase digoxin to 0.25 mg to compensate for low K⁺
D. Give potassium supplement without consulting provider
Correct Answer: B
Rationale: Hypokalemia increases digoxin toxicity risk by enhancing binding to
Na⁺/K⁺-ATPase; holding dose and correcting K⁺ is safer.
5. A patient receiving high-dose methylprednisolone for spinal cord injury develops
blood glucose 320 mg/dL. Which class of medication is most appropriate for
initial glycemic control?
A. Sulfonylurea
B. Rapid-acting insulin
C. Metformin
D. Alpha-glucosidase inhibitor
Correct Answer: B
, Rationale: Stress hyperglycemia from high-dose steroids requires rapid correction;
short-acting insulin (aspart/lispro) can be titrated hourly if needed.
6. A 90-kg patient is ordered amiodarone 150 mg IV over 10 min for VT with pulse.
The vial is 50 mg/mL. What volume should be administered?
A. 1 mL
B. 2 mL
C. 3 mL
D. 4 mL
Correct Answer: C
Rationale: 150 mg ÷ 50 mg/mL = 3 mL.
7. A patient on lithium 600 mg BID develops Na⁺ 128 mEq/L. Which diuretic is most
likely responsible?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Acetazolamide
Correct Answer: B
Rationale: Thiazides impair renal diluting capacity → sodium wasting and SIADH-like
effect, increasing lithium reabsorption and hyponatremia risk.
8. A patient with pulmonary hypertension on epoprostenol via continuous pump
reports sudden SOB and dizziness. The pump alarm shows "downstream
occlusion." What is the priority action?
A. Increase infusion rate to overcome occlusion
B. Check for catheter kink and gently flush with saline
C. Discontinue infusion and switch to PO treprostinil
D. Turn off alarm and reassess in 30 min
Correct Answer: B
Rationale: Epoprostenol has a 6-min half-life; abrupt interruption causes rebound
pulmonary hypertension. Rapidly identifying/fixing occlusion restores flow.
100% Correct Answers with Rationales | NGN-Intensive |
2026/2027 | Advanced Clinical Judgment | Pass Guarantee
1. A 68-year-old man with septic shock is receiving norepinephrine 8 mcg/min. His
BP is 78/42 mmHg, HR 118, ScvO₂ 65%. The provider orders vasopressin 0.03
units/min to be added. What is the primary expected effect of this addition?
A. Increase contractility via V₁ receptors
B. Reduce norepinephrine dose by causing vasoconstriction through V₁ receptors
C. Increase heart rate via V₂ receptors
D. Dilate pulmonary vasculature via V₂ receptors
Correct Answer: B
Rationale: Vasopressin at low "stress" doses activates V₁ receptors on vascular smooth
muscle, augmenting SVR and often allowing reduction of catecholamine requirements
without increasing HR.
2. A patient on phenytoin 300 mg PO daily for status epilepticus has a trough level 6
mcg/mL (therapeutic 10-20). The patient has received continuous enteral feeds.
What is the most appropriate next action?
A. Switch to IM phenytoin
B. Hold feeds 1-2 h before & after dose and redraw level in 3 days
C. Increase dose to 400 mg daily without feed adjustment
D. Discontinue feeds permanently
Correct Answer: B
Rationale: Continuous enteral nutrition binds phenytoin, reducing absorption. Separating
administration and reassessing level prevents toxicity while achieving therapeutic
range.
, 3. A 55-year-old with acute respiratory failure is receiving cisatracurium 3
mcg/kg/min. The nurse notes HR 52, BP 90/50, and twitch monitor shows 0/4
twitches. Which medication should be immediately available?
A. Naloxone
B. Flumazenil
C. Atropine
D. Sugammadex
Correct Answer: C
Rationale: Profound paralysis with bradycardia suggests possible histamine release or
vagal response; atropine treats symptomatic bradycardia. Sugammadex is for
rocuronium/vecuronium, not cisatracurium.
4. A 72-year-old with heart failure (EF 25%) is prescribed digoxin 0.125 mg daily. K⁺
is 3.0 mEq/L. What is the priority nursing action?
A. Administer digoxin and recheck K⁺ in 1 week
B. Hold digoxin and notify provider of hypokalemia
C. Increase digoxin to 0.25 mg to compensate for low K⁺
D. Give potassium supplement without consulting provider
Correct Answer: B
Rationale: Hypokalemia increases digoxin toxicity risk by enhancing binding to
Na⁺/K⁺-ATPase; holding dose and correcting K⁺ is safer.
5. A patient receiving high-dose methylprednisolone for spinal cord injury develops
blood glucose 320 mg/dL. Which class of medication is most appropriate for
initial glycemic control?
A. Sulfonylurea
B. Rapid-acting insulin
C. Metformin
D. Alpha-glucosidase inhibitor
Correct Answer: B
, Rationale: Stress hyperglycemia from high-dose steroids requires rapid correction;
short-acting insulin (aspart/lispro) can be titrated hourly if needed.
6. A 90-kg patient is ordered amiodarone 150 mg IV over 10 min for VT with pulse.
The vial is 50 mg/mL. What volume should be administered?
A. 1 mL
B. 2 mL
C. 3 mL
D. 4 mL
Correct Answer: C
Rationale: 150 mg ÷ 50 mg/mL = 3 mL.
7. A patient on lithium 600 mg BID develops Na⁺ 128 mEq/L. Which diuretic is most
likely responsible?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Acetazolamide
Correct Answer: B
Rationale: Thiazides impair renal diluting capacity → sodium wasting and SIADH-like
effect, increasing lithium reabsorption and hyponatremia risk.
8. A patient with pulmonary hypertension on epoprostenol via continuous pump
reports sudden SOB and dizziness. The pump alarm shows "downstream
occlusion." What is the priority action?
A. Increase infusion rate to overcome occlusion
B. Check for catheter kink and gently flush with saline
C. Discontinue infusion and switch to PO treprostinil
D. Turn off alarm and reassess in 30 min
Correct Answer: B
Rationale: Epoprostenol has a 6-min half-life; abrupt interruption causes rebound
pulmonary hypertension. Rapidly identifying/fixing occlusion restores flow.
