1
2026 ADVANCED PHARMACOLOGY NGN BUNDLE | 150
PRACTICE QUESTIONS WITH DETAILED RATIONALES &
PARTIAL CREDIT SCORING | INSULIN, CARDIAC DRIPS,
ANTICOAGULANTS, PSYCHOTROPICS, ANTIBIOTICS,
DIURETICS, ACLS, RESPIRATORY & CHEMO | RN & PN
HIGH-YIELD REVIEW
QUESTION 1: RAPID-ACTING INSULIN PEAK
• Question: A client with type 1 diabetes receives insulin lispro at 0730 before breakfast.
The nurse should be most alert for signs of hypoglycemia during which time frame?
• Options:
A. 0800–0900
B. 1000–1200
C. 1400–1600
D. 2000–2200
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Lispro is rapid-acting with onset 15 min and peak
30–90 min; highest hypoglycemia risk occurs at peak.
o Distractor Pitfalls: Later windows correspond to short-, intermediate-, or long-
acting insulins.
QUESTION 2: LONG-ACTING INSULIN CHARACTERISTICS
• Question: Which statement about insulin glargine is correct?
• Options:
A. It has a pronounced peak at 4–6 hours
B. It should be mixed with regular insulin in the same syringe
C. It provides relatively peakless basal coverage lasting up to 24 hours
D. It is given only intravenously in emergencies
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: Glargine forms a precipitate that releases insulin
slowly, producing nearly peakless 20–24 hour coverage.
, 2
o Distractor Pitfalls: It must not be mixed; it is never given IV.
QUESTION 3: HYPOGLYCEMIA MANAGEMENT – CONSCIOUS CLIENT
• Question: A conscious client with diabetes develops diaphoresis, tremor, and a capillary
glucose of 52 mg/dL. What is the priority action?
• Options:
A. Administer 1 mg glucagon IM
B. Give 15 g of rapid-acting carbohydrate and recheck in 15 minutes
C. Start a continuous D10W infusion
D. Encourage the client to finish the current meal first
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Rule of 15: 15 g fast carbohydrate for conscious
hypoglycemic clients, followed by recheck.
o Distractor Pitfalls: Glucagon is for unconscious clients; IV dextrose is for severe
cases; delaying treatment risks deterioration.
QUESTION 4: INSULIN MIXING ORDER
• Question: When preparing a mixture of NPH and regular insulin, which action is
correct?
• Options:
A. Draw up NPH first, then regular
B. Draw up regular (clear) first, then NPH (cloudy)
C. Shake both vials vigorously before drawing
D. Administer the mixture within 5 minutes or discard
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Clear (regular) before cloudy (NPH) prevents
contamination of the short-acting vial.
o Distractor Pitfalls: Reverse order contaminates regular insulin; NPH is rolled,
not shaken.
QUESTION 5: NOREPINEPHRINE TITRATION PRIORITY
• Question: A client in septic shock is receiving norepinephrine at 0.15 mcg/kg/min. MAP
is 58 mm Hg and urine output is 15 mL/hr. What is the nurse’s priority action?
, 3
• Options:
A. Decrease the infusion rate
B. Notify the provider and prepare to titrate upward per protocol
C. Administer a fluid bolus without changing the drip
D. Switch to dopamine immediately
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Persistent hypotension and oliguria indicate need
for upward titration of the vasopressor while addressing volume status.
o Distractor Pitfalls: Decreasing the rate worsens perfusion; protocol-driven
titration is required.
QUESTION 6: EPINEPHRINE INDICATION IN ACLS
• Question: During cardiac arrest, epinephrine 1 mg IV is administered. How often may
this dose be repeated?
• Options:
A. Every 1 minute
B. Every 3–5 minutes
C. Every 10 minutes
D. Only once
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: ACLS guidelines recommend epinephrine 1 mg
every 3–5 minutes during cardiac arrest.
o Distractor Pitfalls: More frequent dosing increases toxicity risk; single dose is
insufficient.
QUESTION 7: AMIODARONE INFUSION MONITORING
• Question: A client receiving an amiodarone infusion develops new QT prolongation and
bradycardia. What is the priority nursing action?
• Options:
A. Continue the infusion and recheck in 1 hour
B. Stop the infusion and notify the provider
C. Increase the infusion rate
D. Administer additional potassium
, 4
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Amiodarone can cause significant bradycardia and
QT prolongation; the infusion must be stopped.
o Distractor Pitfalls: Continuing or increasing the rate risks deterioration into
torsades or asystole.
QUESTION 8: DOPAMINE DOSE-DEPENDENT EFFECTS
• Question: At which dose range does dopamine primarily stimulate dopaminergic
receptors causing renal vasodilation?
• Options:
A. 1–5 mcg/kg/min
B. 5–10 mcg/kg/min
C. 10–20 mcg/kg/min
D. >20 mcg/kg/min
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Low-dose (“renal-dose”) dopamine (1–5
mcg/kg/min) preferentially activates dopaminergic receptors.
o Distractor Pitfalls: Higher doses shift to beta- then alpha-adrenergic effects.
QUESTION 9: HEPARIN PROTOCOL – aPTT RESULT
• Question: A client on continuous heparin infusion has an aPTT of 110 seconds
(therapeutic range 60–80 seconds). What is the expected action?
• Options:
A. Increase the infusion rate by 2 units/kg/hr
B. Hold the infusion and notify the provider per protocol
C. Administer an additional bolus
D. Continue the current rate
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Supratherapeutic aPTT requires holding or reducing
the infusion to prevent bleeding.
o Distractor Pitfalls: Increasing or bolusing worsens the coagulopathy.
2026 ADVANCED PHARMACOLOGY NGN BUNDLE | 150
PRACTICE QUESTIONS WITH DETAILED RATIONALES &
PARTIAL CREDIT SCORING | INSULIN, CARDIAC DRIPS,
ANTICOAGULANTS, PSYCHOTROPICS, ANTIBIOTICS,
DIURETICS, ACLS, RESPIRATORY & CHEMO | RN & PN
HIGH-YIELD REVIEW
QUESTION 1: RAPID-ACTING INSULIN PEAK
• Question: A client with type 1 diabetes receives insulin lispro at 0730 before breakfast.
The nurse should be most alert for signs of hypoglycemia during which time frame?
• Options:
A. 0800–0900
B. 1000–1200
C. 1400–1600
D. 2000–2200
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Lispro is rapid-acting with onset 15 min and peak
30–90 min; highest hypoglycemia risk occurs at peak.
o Distractor Pitfalls: Later windows correspond to short-, intermediate-, or long-
acting insulins.
QUESTION 2: LONG-ACTING INSULIN CHARACTERISTICS
• Question: Which statement about insulin glargine is correct?
• Options:
A. It has a pronounced peak at 4–6 hours
B. It should be mixed with regular insulin in the same syringe
C. It provides relatively peakless basal coverage lasting up to 24 hours
D. It is given only intravenously in emergencies
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: Glargine forms a precipitate that releases insulin
slowly, producing nearly peakless 20–24 hour coverage.
, 2
o Distractor Pitfalls: It must not be mixed; it is never given IV.
QUESTION 3: HYPOGLYCEMIA MANAGEMENT – CONSCIOUS CLIENT
• Question: A conscious client with diabetes develops diaphoresis, tremor, and a capillary
glucose of 52 mg/dL. What is the priority action?
• Options:
A. Administer 1 mg glucagon IM
B. Give 15 g of rapid-acting carbohydrate and recheck in 15 minutes
C. Start a continuous D10W infusion
D. Encourage the client to finish the current meal first
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Rule of 15: 15 g fast carbohydrate for conscious
hypoglycemic clients, followed by recheck.
o Distractor Pitfalls: Glucagon is for unconscious clients; IV dextrose is for severe
cases; delaying treatment risks deterioration.
QUESTION 4: INSULIN MIXING ORDER
• Question: When preparing a mixture of NPH and regular insulin, which action is
correct?
• Options:
A. Draw up NPH first, then regular
B. Draw up regular (clear) first, then NPH (cloudy)
C. Shake both vials vigorously before drawing
D. Administer the mixture within 5 minutes or discard
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Clear (regular) before cloudy (NPH) prevents
contamination of the short-acting vial.
o Distractor Pitfalls: Reverse order contaminates regular insulin; NPH is rolled,
not shaken.
QUESTION 5: NOREPINEPHRINE TITRATION PRIORITY
• Question: A client in septic shock is receiving norepinephrine at 0.15 mcg/kg/min. MAP
is 58 mm Hg and urine output is 15 mL/hr. What is the nurse’s priority action?
, 3
• Options:
A. Decrease the infusion rate
B. Notify the provider and prepare to titrate upward per protocol
C. Administer a fluid bolus without changing the drip
D. Switch to dopamine immediately
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Persistent hypotension and oliguria indicate need
for upward titration of the vasopressor while addressing volume status.
o Distractor Pitfalls: Decreasing the rate worsens perfusion; protocol-driven
titration is required.
QUESTION 6: EPINEPHRINE INDICATION IN ACLS
• Question: During cardiac arrest, epinephrine 1 mg IV is administered. How often may
this dose be repeated?
• Options:
A. Every 1 minute
B. Every 3–5 minutes
C. Every 10 minutes
D. Only once
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: ACLS guidelines recommend epinephrine 1 mg
every 3–5 minutes during cardiac arrest.
o Distractor Pitfalls: More frequent dosing increases toxicity risk; single dose is
insufficient.
QUESTION 7: AMIODARONE INFUSION MONITORING
• Question: A client receiving an amiodarone infusion develops new QT prolongation and
bradycardia. What is the priority nursing action?
• Options:
A. Continue the infusion and recheck in 1 hour
B. Stop the infusion and notify the provider
C. Increase the infusion rate
D. Administer additional potassium
, 4
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Amiodarone can cause significant bradycardia and
QT prolongation; the infusion must be stopped.
o Distractor Pitfalls: Continuing or increasing the rate risks deterioration into
torsades or asystole.
QUESTION 8: DOPAMINE DOSE-DEPENDENT EFFECTS
• Question: At which dose range does dopamine primarily stimulate dopaminergic
receptors causing renal vasodilation?
• Options:
A. 1–5 mcg/kg/min
B. 5–10 mcg/kg/min
C. 10–20 mcg/kg/min
D. >20 mcg/kg/min
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Low-dose (“renal-dose”) dopamine (1–5
mcg/kg/min) preferentially activates dopaminergic receptors.
o Distractor Pitfalls: Higher doses shift to beta- then alpha-adrenergic effects.
QUESTION 9: HEPARIN PROTOCOL – aPTT RESULT
• Question: A client on continuous heparin infusion has an aPTT of 110 seconds
(therapeutic range 60–80 seconds). What is the expected action?
• Options:
A. Increase the infusion rate by 2 units/kg/hr
B. Hold the infusion and notify the provider per protocol
C. Administer an additional bolus
D. Continue the current rate
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Supratherapeutic aPTT requires holding or reducing
the infusion to prevent bleeding.
o Distractor Pitfalls: Increasing or bolusing worsens the coagulopathy.
