NGN HESI RN PHARMACOLOGY REAL EXAM – VERSION C
(2026/2027) 100% Correct Answers with Rationales | Graded
A+ | Unique to Version C
1. Traditional MCQ
A 66-year-old intubated patient on propofol 40 mcg/kg/min develops
hypotension (MAP 52 mmHg) and triglycerides 620 mg/dL. Which action is most
appropriate?
A. Continue propofol and start vasopressin
B. Reduce propofol by 50 % and add dexmedetomidine
C. Switch to midazolam and stop propofol immediately
D. Increase propofol for deeper sedation to blunt catecholamines
Correct Answer: C
Rationale: Propofol infusion syndrome risk ↑ with high doses & lipids >500 mg/dL; stop
propofol, switch sedative.
2. Traditional MCQ
A 4-year-old (18 kg) in status asthmaticus receives 5 mg albuterol nebulizer q20
min. Maximum safe 8-hour cumulative dose (mg) before lactic acidosis risk?
A. 10 mg
B. 15 mg
C. 20 mg
D. 30 mg
Correct Answer: C
Rationale: Pediatric ceiling ≈ 0.5 mg/kg/h × 3 h = 27 mg; 20 mg/8 h remains below
threshold.
, 3. Multiple-Select
A patient receiving norepinephrine 12 mcg/min for septic shock suddenly
extravasates. Select all appropriate actions:
A. Stop infusion immediately
B. Give phentolamine 5 mg diluted into 10 mL NS locally
C. Apply warm compress for 15–20 min
D. Elevate limb above heart level
E. Continue infusion through same line slowly
Correct Answers: A, B, C
Rationale: Stop drug, infiltrate α-blocker, warm compress to vasodilate; elevation is not
recommended (↓ perfusion).
4. Traditional MCQ
A 70-kg patient on a heparin protocol has aPTT 95 s (target 60–80). Current drip
18 units/kg/h. Next adjustment?
A. Decrease by 2 units/kg/h
B. Decrease by 4 units/kg/h
C. Hold infusion 30 min then restart at −4 units/kg/h
D. No change—within acceptable range
Correct Answer: B
Rationale: >80 s → decrease by 2–4 units/kg/h; 95 s warrants 4-unit reduction to reach
target faster.
5. Cloze (Drop-Down)
A 60-kg patient with STEMI is prescribed tenecteplase. The weight-based bolus is
(A) ______ mg, given IV push over (B) ______ seconds.
A options: 30 | 40 | 50
B options: 5 | 30 | 120
Correct Answer: A: 50, B: 5
Rationale: 0.5 mg/kg × 60 kg = 30 mg (rounded to nearest vial); give as single bolus over
5 s.
, 6. Traditional MCQ
A patient on mechanical ventilation receives cisatracurium 3 mcg/kg/min.
Train-of-four monitoring shows 0/4 twitches. Appropriate action?
A. Continue current rate
B. Reduce by 50 %
C. Increase rate to achieve 1/4
D. Stop infusion and give sugammadex
Correct Answer: B
Rationale: Aim 1–2 twitches; 0/4 = over-paralyzed → reduce rate to avoid prolonged
weakness.
7. Traditional MCQ
A 58-year-old with COPD is started on roflumilast. Which adverse effect requires
monitoring?
A. Weight gain
B. Tremor
C. Diarrhea and weight loss
D. Hypoglycemia
Correct Answer: C
Rationale: PDE-4 inhibitor causes GI upset and anorexia; monitor BMI.
8. Matrix/Grid
A patient on amiodarone infusion for VT is being monitored. Classify each lab
value:
TableCopy
Lab Value Classification
TSH 6.2 µIU/mL (high) Requires monitoring
(2026/2027) 100% Correct Answers with Rationales | Graded
A+ | Unique to Version C
1. Traditional MCQ
A 66-year-old intubated patient on propofol 40 mcg/kg/min develops
hypotension (MAP 52 mmHg) and triglycerides 620 mg/dL. Which action is most
appropriate?
A. Continue propofol and start vasopressin
B. Reduce propofol by 50 % and add dexmedetomidine
C. Switch to midazolam and stop propofol immediately
D. Increase propofol for deeper sedation to blunt catecholamines
Correct Answer: C
Rationale: Propofol infusion syndrome risk ↑ with high doses & lipids >500 mg/dL; stop
propofol, switch sedative.
2. Traditional MCQ
A 4-year-old (18 kg) in status asthmaticus receives 5 mg albuterol nebulizer q20
min. Maximum safe 8-hour cumulative dose (mg) before lactic acidosis risk?
A. 10 mg
B. 15 mg
C. 20 mg
D. 30 mg
Correct Answer: C
Rationale: Pediatric ceiling ≈ 0.5 mg/kg/h × 3 h = 27 mg; 20 mg/8 h remains below
threshold.
, 3. Multiple-Select
A patient receiving norepinephrine 12 mcg/min for septic shock suddenly
extravasates. Select all appropriate actions:
A. Stop infusion immediately
B. Give phentolamine 5 mg diluted into 10 mL NS locally
C. Apply warm compress for 15–20 min
D. Elevate limb above heart level
E. Continue infusion through same line slowly
Correct Answers: A, B, C
Rationale: Stop drug, infiltrate α-blocker, warm compress to vasodilate; elevation is not
recommended (↓ perfusion).
4. Traditional MCQ
A 70-kg patient on a heparin protocol has aPTT 95 s (target 60–80). Current drip
18 units/kg/h. Next adjustment?
A. Decrease by 2 units/kg/h
B. Decrease by 4 units/kg/h
C. Hold infusion 30 min then restart at −4 units/kg/h
D. No change—within acceptable range
Correct Answer: B
Rationale: >80 s → decrease by 2–4 units/kg/h; 95 s warrants 4-unit reduction to reach
target faster.
5. Cloze (Drop-Down)
A 60-kg patient with STEMI is prescribed tenecteplase. The weight-based bolus is
(A) ______ mg, given IV push over (B) ______ seconds.
A options: 30 | 40 | 50
B options: 5 | 30 | 120
Correct Answer: A: 50, B: 5
Rationale: 0.5 mg/kg × 60 kg = 30 mg (rounded to nearest vial); give as single bolus over
5 s.
, 6. Traditional MCQ
A patient on mechanical ventilation receives cisatracurium 3 mcg/kg/min.
Train-of-four monitoring shows 0/4 twitches. Appropriate action?
A. Continue current rate
B. Reduce by 50 %
C. Increase rate to achieve 1/4
D. Stop infusion and give sugammadex
Correct Answer: B
Rationale: Aim 1–2 twitches; 0/4 = over-paralyzed → reduce rate to avoid prolonged
weakness.
7. Traditional MCQ
A 58-year-old with COPD is started on roflumilast. Which adverse effect requires
monitoring?
A. Weight gain
B. Tremor
C. Diarrhea and weight loss
D. Hypoglycemia
Correct Answer: C
Rationale: PDE-4 inhibitor causes GI upset and anorexia; monitor BMI.
8. Matrix/Grid
A patient on amiodarone infusion for VT is being monitored. Classify each lab
value:
TableCopy
Lab Value Classification
TSH 6.2 µIU/mL (high) Requires monitoring
