NR 567 Advanced Pharmacology AGACNP
ACTUAL EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1:
A 68 kg intubated ARDS patient on propofol 40 mL/h (10 mg/mL) and fentanyl 150 µg/h is starting
a cis-atracurium infusion for persistent P:F 90 mmHg on VC 6 mL/kg and PEEP 14 cmH₂O. Which
initial cis-atracurium dose is evidence-based for 24-h “light” NMB?
A. 0.6 mg/kg IV push, then 1 mg/kg/h
B. 2 µg/kg/min (≈ 0.12 mg/kg/h) after 0.1 mg/kg bolus
C. 0.3 mg/kg bolus, then 3 mg/kg/h
D. 0.05 mg/kg/h with no bolus
Correct Answer: B
Rationale: ROSE trial regimen: 0.1 mg/kg bolus → 2 µg/kg/min (0.12 mg/kg/h) provides adequate
NMB while permitting TOF recovery assessment every 24 h.
,Question 2:
A 55 kg patient in septic shock on norepinephrine 0.4 µg/kg/min (MAP 62 mmHg) needs empiric
antibiotics. CrCl 25 mL/min. Which piperacillin-tazobactam regimen optimizes PK/PD while
minimizing nephrotoxicity?
A. 3.375 g q8h 30-min infusion
B. 4.5 g q6h 4-h extended infusion
C. 2.25 g q8h IV push
D. 4.5 g q8h 30-min infusion
Correct Answer: B
Rationale: Extended 4-h infusion of 4.5 g q6h achieves > 50% fT>MIC for resistant Gram-negates
even in renal impairment and is endorsed by Surviving Sepsis 2021.
Question 3:
A post-ROSC STEMI patient (BMI 38 kg/m²) on continuous heparin 18 units/kg/h has aPTT 34 s
(goal 50–70). Anti-Xa 0.15 IU/mL. Which adjustment is correct?
A. Increase to 20 units/kg/h and re-check in 6 h
B. Increase by 4 units/kg/h and re-check anti-Xa in 6 h
C. Add argatroban 2 µg/kg/min because likely heparin resistance
,D. Switch to bivalirudin 0.15 mg/kg/h
Correct Answer: B
Rationale: Per CHEST 2023, titrate heparin upward by 2–4 units/kg/h when anti-Xa < 0.2 IU/mL;
monitor anti-Xa (not aPTT in obesity) to reach 0.3–0.7 IU/mL.
Question 4:
A 70 kg patient with AF on dabigatran 150 mg bid develops acute GI bleed (BP 84/46 mmHg, Hb
6.8 g/dL). INR is 1.9. Which reversal agent/dose is indicated?
A. PCC 25 units/kg IV
B. Idarucizumab 2 × 2.5 g IV bolus
C. Andexanet alfa low-dose bolus + infusion
D. Tranexamic acid 1 g IV
Correct Answer: B
Rationale: Idarucizumab 5 g (2 successive 2.5 g boluses) provides immediate, complete dabigatran
reversal and is FDA-approved for life-threatening bleeding.
Question 5:
, A 90 kg trauma patient on cis-atracurium 3 µg/kg/min has 2/4 twitches at 30 min. TOF 4/4 with fade
at 45 min. The most appropriate action is:
A. Administer sugammadex 16 mg/kg
B. Increase cis-atracurium to 5 µg/kg/min
C. Continue current rate and re-assess in 30 min
D. Add vecuronium 0.1 mg/kg bolus
Correct Answer: C
Rationale: Hofmann elimination of cis-atracurium is organ-independent; 2–4 twitches are
acceptable for continued NMB—no escalation needed unless TOF reaches 4/4 without fade.
Question 6:
A 60 kg patient with severe ARDS (Pplat 32 cmH₂O) on VC A/C 420 mL, PEEP 16, RR 32, receives
inhaled epoprostenol 6 ng/kg/min but remains P:F 80 mmHg. Which pharmacologic adjunct is
evidence-based?
A. Inhaled nitric oxide 20 ppm
B. IV sildenafil 50 mg tid
C. Albuterol 2.5 mg q4h
D. IV dopamine 10 µg/kg/min
ACTUAL EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1:
A 68 kg intubated ARDS patient on propofol 40 mL/h (10 mg/mL) and fentanyl 150 µg/h is starting
a cis-atracurium infusion for persistent P:F 90 mmHg on VC 6 mL/kg and PEEP 14 cmH₂O. Which
initial cis-atracurium dose is evidence-based for 24-h “light” NMB?
A. 0.6 mg/kg IV push, then 1 mg/kg/h
B. 2 µg/kg/min (≈ 0.12 mg/kg/h) after 0.1 mg/kg bolus
C. 0.3 mg/kg bolus, then 3 mg/kg/h
D. 0.05 mg/kg/h with no bolus
Correct Answer: B
Rationale: ROSE trial regimen: 0.1 mg/kg bolus → 2 µg/kg/min (0.12 mg/kg/h) provides adequate
NMB while permitting TOF recovery assessment every 24 h.
,Question 2:
A 55 kg patient in septic shock on norepinephrine 0.4 µg/kg/min (MAP 62 mmHg) needs empiric
antibiotics. CrCl 25 mL/min. Which piperacillin-tazobactam regimen optimizes PK/PD while
minimizing nephrotoxicity?
A. 3.375 g q8h 30-min infusion
B. 4.5 g q6h 4-h extended infusion
C. 2.25 g q8h IV push
D. 4.5 g q8h 30-min infusion
Correct Answer: B
Rationale: Extended 4-h infusion of 4.5 g q6h achieves > 50% fT>MIC for resistant Gram-negates
even in renal impairment and is endorsed by Surviving Sepsis 2021.
Question 3:
A post-ROSC STEMI patient (BMI 38 kg/m²) on continuous heparin 18 units/kg/h has aPTT 34 s
(goal 50–70). Anti-Xa 0.15 IU/mL. Which adjustment is correct?
A. Increase to 20 units/kg/h and re-check in 6 h
B. Increase by 4 units/kg/h and re-check anti-Xa in 6 h
C. Add argatroban 2 µg/kg/min because likely heparin resistance
,D. Switch to bivalirudin 0.15 mg/kg/h
Correct Answer: B
Rationale: Per CHEST 2023, titrate heparin upward by 2–4 units/kg/h when anti-Xa < 0.2 IU/mL;
monitor anti-Xa (not aPTT in obesity) to reach 0.3–0.7 IU/mL.
Question 4:
A 70 kg patient with AF on dabigatran 150 mg bid develops acute GI bleed (BP 84/46 mmHg, Hb
6.8 g/dL). INR is 1.9. Which reversal agent/dose is indicated?
A. PCC 25 units/kg IV
B. Idarucizumab 2 × 2.5 g IV bolus
C. Andexanet alfa low-dose bolus + infusion
D. Tranexamic acid 1 g IV
Correct Answer: B
Rationale: Idarucizumab 5 g (2 successive 2.5 g boluses) provides immediate, complete dabigatran
reversal and is FDA-approved for life-threatening bleeding.
Question 5:
, A 90 kg trauma patient on cis-atracurium 3 µg/kg/min has 2/4 twitches at 30 min. TOF 4/4 with fade
at 45 min. The most appropriate action is:
A. Administer sugammadex 16 mg/kg
B. Increase cis-atracurium to 5 µg/kg/min
C. Continue current rate and re-assess in 30 min
D. Add vecuronium 0.1 mg/kg bolus
Correct Answer: C
Rationale: Hofmann elimination of cis-atracurium is organ-independent; 2–4 twitches are
acceptable for continued NMB—no escalation needed unless TOF reaches 4/4 without fade.
Question 6:
A 60 kg patient with severe ARDS (Pplat 32 cmH₂O) on VC A/C 420 mL, PEEP 16, RR 32, receives
inhaled epoprostenol 6 ng/kg/min but remains P:F 80 mmHg. Which pharmacologic adjunct is
evidence-based?
A. Inhaled nitric oxide 20 ppm
B. IV sildenafil 50 mg tid
C. Albuterol 2.5 mg q4h
D. IV dopamine 10 µg/kg/min
