NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION D 100% Correct
Answers with Rationales | NGN-Intensive | 2026/2027 | Advanced Clinical
Judgment | Pass Guarantee
1. Single-Answer MCQ
A 68-year-old (72 kg) with septic shock is on norepinephrine 12 mcg/min. The
intensivist adds vasopressin 0.04 units/min. Which parameter best indicates the
vasopressin is effective?
A. MAP ↑ from 62 → 68 mmHg within 30 min
B. HR ↓ from 110 → 95 bpm
C. ScvO₂ ↑ from 65 → 70 %
D. Urine output ↑ from 15 → 25 mL/h
Correct: A
Rationale: Vasopressin targets V₁-receptor–mediated vasoplegia; the earliest
measurable effect is rise in MAP without ↑ inotropic chronotropic effect. Other options
lag or reflect global oxygenation/renal response.
2. Single-Answer MCQ
Phenytoin 1,000 mg IV loading is ordered for status epilepticus. The pharmacy sends a
50 mL vial labeled “phenytoin 50 mg/mL with 40 % propylene glycol.” The nurse should:
A. Give through 0.22 micron filter
B. Dilute in 100 mL NS and infuse over 30 min
,C. Inject undiluted via slow IV push over 2 min
D. Administer through a central line at 25 mg/min
Correct: D
Rationale: Phenytoin precipitates in dextrose and must be given ≤ 25 mg/min to avoid
hypotension/arrhythmias; propylene glycol formulation requires central access if
possible.
3. Single-Answer MCQ
A patient receiving cisatracurium for ARDS shows train-of-four 0/4. Which lab value best
predicts the need for dose reduction?
A. Serum creatinine 2.8 mg/dL
B. ALT 180 U/L
C. pH 7.18
D. Albumin 2.1 g/dL
Correct: C
Rationale: Cisatracurium undergoes Hoffman elimination, accelerated by acidosis and
hypothermia; pH 7.18 prolongs effect and mandates dose ↓.
4. Single-Answer MCQ
A 5-year-old (22 kg) with acute lymphoblastic leukemia is prescribed intrathecal
methotrexate 12 mg. Prior to administration the nurse should verify:
,A. Concurrent IV leucovorin 15 mg ordered
B. Use of 25-gauge spinal needle
C. Platelet count ≥ 50 k/µL
D. Co-trimoxazole held for 24 h
Correct: C
Rationale: Intrathecal methotrexate requires platelets ≥ 50 k to prevent CNS bleeding;
leucovorin rescue starts AFTER intrathecal dose.
5. Single-Answer MCQ
A patient on amiodarone 400 mg daily develops new-onset VT. Serum amiodarone level
is 3.8 mg/L (normal 1–2.5). The priority action is:
A. Reduce dose to 200 mg daily
B. Check serum TSH & FT₄
C. Obtain pulmonary function tests
D. Switch to dronedarone
Correct: B
Rationale: Amiodarone toxicity at supratherapeutic levels often manifests as thyroid
dysfunction, which can precipitate VT; labs guide immediate management.
6. Single-Answer MCQ
, A post-PCI patient receives bivalirudin. ACT is 220 s (goal 200–250). Next dose is due in
30 min. Which finding requires infusion rate reduction?
A. aPTT 90 s (baseline 30)
B. HR 88 bpm
C. Hgb drop 0.8 g/dL from morning
D. Platelets 95 k/µL
Correct: A
Rationale: aPTT > 3 × baseline signals excessive anticoagulation with bivalirudin; risk of
bleeding and mandates rate ↓.
7. Single-Answer MCQ
A 4 g magnesium sulfate loading dose is ordered for preeclampsia. The nurse should
first:
A. Ensure calcium gluconate is available
B. Place the patient on NPO status
C. Obtain DTRs q15 min
D. Start lidocaine drip as prophylaxis
Correct: A
Rationale: Antidote (calcium gluconate 1 g IV) must be at bedside before MgSO₄ to
counteract respiratory arrest from hypermagnesemia.
Answers with Rationales | NGN-Intensive | 2026/2027 | Advanced Clinical
Judgment | Pass Guarantee
1. Single-Answer MCQ
A 68-year-old (72 kg) with septic shock is on norepinephrine 12 mcg/min. The
intensivist adds vasopressin 0.04 units/min. Which parameter best indicates the
vasopressin is effective?
A. MAP ↑ from 62 → 68 mmHg within 30 min
B. HR ↓ from 110 → 95 bpm
C. ScvO₂ ↑ from 65 → 70 %
D. Urine output ↑ from 15 → 25 mL/h
Correct: A
Rationale: Vasopressin targets V₁-receptor–mediated vasoplegia; the earliest
measurable effect is rise in MAP without ↑ inotropic chronotropic effect. Other options
lag or reflect global oxygenation/renal response.
2. Single-Answer MCQ
Phenytoin 1,000 mg IV loading is ordered for status epilepticus. The pharmacy sends a
50 mL vial labeled “phenytoin 50 mg/mL with 40 % propylene glycol.” The nurse should:
A. Give through 0.22 micron filter
B. Dilute in 100 mL NS and infuse over 30 min
,C. Inject undiluted via slow IV push over 2 min
D. Administer through a central line at 25 mg/min
Correct: D
Rationale: Phenytoin precipitates in dextrose and must be given ≤ 25 mg/min to avoid
hypotension/arrhythmias; propylene glycol formulation requires central access if
possible.
3. Single-Answer MCQ
A patient receiving cisatracurium for ARDS shows train-of-four 0/4. Which lab value best
predicts the need for dose reduction?
A. Serum creatinine 2.8 mg/dL
B. ALT 180 U/L
C. pH 7.18
D. Albumin 2.1 g/dL
Correct: C
Rationale: Cisatracurium undergoes Hoffman elimination, accelerated by acidosis and
hypothermia; pH 7.18 prolongs effect and mandates dose ↓.
4. Single-Answer MCQ
A 5-year-old (22 kg) with acute lymphoblastic leukemia is prescribed intrathecal
methotrexate 12 mg. Prior to administration the nurse should verify:
,A. Concurrent IV leucovorin 15 mg ordered
B. Use of 25-gauge spinal needle
C. Platelet count ≥ 50 k/µL
D. Co-trimoxazole held for 24 h
Correct: C
Rationale: Intrathecal methotrexate requires platelets ≥ 50 k to prevent CNS bleeding;
leucovorin rescue starts AFTER intrathecal dose.
5. Single-Answer MCQ
A patient on amiodarone 400 mg daily develops new-onset VT. Serum amiodarone level
is 3.8 mg/L (normal 1–2.5). The priority action is:
A. Reduce dose to 200 mg daily
B. Check serum TSH & FT₄
C. Obtain pulmonary function tests
D. Switch to dronedarone
Correct: B
Rationale: Amiodarone toxicity at supratherapeutic levels often manifests as thyroid
dysfunction, which can precipitate VT; labs guide immediate management.
6. Single-Answer MCQ
, A post-PCI patient receives bivalirudin. ACT is 220 s (goal 200–250). Next dose is due in
30 min. Which finding requires infusion rate reduction?
A. aPTT 90 s (baseline 30)
B. HR 88 bpm
C. Hgb drop 0.8 g/dL from morning
D. Platelets 95 k/µL
Correct: A
Rationale: aPTT > 3 × baseline signals excessive anticoagulation with bivalirudin; risk of
bleeding and mandates rate ↓.
7. Single-Answer MCQ
A 4 g magnesium sulfate loading dose is ordered for preeclampsia. The nurse should
first:
A. Ensure calcium gluconate is available
B. Place the patient on NPO status
C. Obtain DTRs q15 min
D. Start lidocaine drip as prophylaxis
Correct: A
Rationale: Antidote (calcium gluconate 1 g IV) must be at bedside before MgSO₄ to
counteract respiratory arrest from hypermagnesemia.
