ATI PN PHARMACOLOGY NGN-STYLE EXAM
Case Study 1: Cardiovascular Pharmacology
A 68-year-old client with a history of hypertension and heart failure is admitted
with shortness of breath and bilateral ankle edema. Current prescriptions include
furosemide, lisinopril, and digoxin.
Question 1 (NGN – Select All That Apply)
Which findings indicate the furosemide is having a therapeutic effect?
A. Decreased peripheral edema
B. Increased urine output
C. Serum potassium of 2.9 mEq/L
D. Decreased crackles in lung bases
E. Blood pressure 88/54 mm Hg
Correct Answers: A, B, D
Rationale:
Furosemide is a loop diuretic used to reduce fluid overload. Decreased edema,
increased urine output, and improved lung sounds indicate effectiveness.
Hypokalemia and hypotension are adverse effects, not therapeutic outcomes.
,Question 2 (NGN – Bow-Tie Item)
Condition: Worsening heart failure
Action: Administer digoxin
Parameters to Monitor:
Heart rate below 60 bpm
Serum potassium level
Apical pulse
Digoxin level
Correct Bow-Tie Mapping:
Condition: Worsening heart failure
Action: Administer digoxin
Monitor: Apical pulse, serum potassium, digoxin level
Rationale:
Digoxin improves cardiac contractility. Bradycardia, electrolyte imbalance, and
elevated digoxin levels increase toxicity risk and must be monitored.
Case Study 2: Endocrine – Insulin Therapy
A 45-year-old client with type 1 diabetes receives insulin lispro at 0730 before
breakfast.
Question 3 (NGN – Multiple Choice)
When should the nurse anticipate peak insulin action?
A. 0800–0830
B. 0900–1000
C. 1200–1400
D. 1600–1800
Correct Answer: B
,Rationale:
Insulin lispro is rapid-acting, with peak effects occurring 1–2 hours after
administration.
Question 4 (NGN – Cloze / Drop-Down)
The nurse should monitor the client most closely for signs of hypoglycemia during
the time period of peak insulin action.
Correct Drop-Downs:
Hypoglycemia
Peak insulin action
Rationale:
Hypoglycemia is the primary risk during peak insulin activity.
Case Study 3: Antibiotic Therapy
A client is prescribed vancomycin IV for MRSA.
Question 5 (NGN – Select All That Apply)
Which assessments are priority before administering vancomycin?
A. Renal function labs
B. Hearing assessment
C. Blood glucose level
D. Trough drug level
E. White blood cell count
Correct Answers: A, B, D
Rationale:
Vancomycin can cause nephrotoxicity and ototoxicity. Monitoring trough levels
prevents toxicity. WBC trends evaluate infection response but are not a pre-
administration priority.
, Question 6 (NGN – Multiple Response)
Which findings indicate vancomycin toxicity?
A. Tinnitus
B. Decreased urine output
C. Hypotension during infusion
D. Red, flushed upper body
E. Elevated creatinine
Correct Answers: A, B, E
Rationale:
Ototoxicity (tinnitus) and nephrotoxicity (oliguria, elevated creatinine) are major
toxic effects. Flushing and hypotension may indicate Red Man Syndrome, an
infusion reaction.
Case Study 4: CNS – Opioid Analgesics
A postoperative client receives morphine IV.
Question 7 (NGN – Multiple Choice)
Which assessment requires immediate intervention?
A. Respiratory rate 10/min
B. Pain score 3/10
C. Blood pressure 110/70
D. Pupils 2 mm
Correct Answer: A
Rationale:
Respiratory depression is a life-threatening adverse effect of opioids and requires
prompt intervention.
Case Study 1: Cardiovascular Pharmacology
A 68-year-old client with a history of hypertension and heart failure is admitted
with shortness of breath and bilateral ankle edema. Current prescriptions include
furosemide, lisinopril, and digoxin.
Question 1 (NGN – Select All That Apply)
Which findings indicate the furosemide is having a therapeutic effect?
A. Decreased peripheral edema
B. Increased urine output
C. Serum potassium of 2.9 mEq/L
D. Decreased crackles in lung bases
E. Blood pressure 88/54 mm Hg
Correct Answers: A, B, D
Rationale:
Furosemide is a loop diuretic used to reduce fluid overload. Decreased edema,
increased urine output, and improved lung sounds indicate effectiveness.
Hypokalemia and hypotension are adverse effects, not therapeutic outcomes.
,Question 2 (NGN – Bow-Tie Item)
Condition: Worsening heart failure
Action: Administer digoxin
Parameters to Monitor:
Heart rate below 60 bpm
Serum potassium level
Apical pulse
Digoxin level
Correct Bow-Tie Mapping:
Condition: Worsening heart failure
Action: Administer digoxin
Monitor: Apical pulse, serum potassium, digoxin level
Rationale:
Digoxin improves cardiac contractility. Bradycardia, electrolyte imbalance, and
elevated digoxin levels increase toxicity risk and must be monitored.
Case Study 2: Endocrine – Insulin Therapy
A 45-year-old client with type 1 diabetes receives insulin lispro at 0730 before
breakfast.
Question 3 (NGN – Multiple Choice)
When should the nurse anticipate peak insulin action?
A. 0800–0830
B. 0900–1000
C. 1200–1400
D. 1600–1800
Correct Answer: B
,Rationale:
Insulin lispro is rapid-acting, with peak effects occurring 1–2 hours after
administration.
Question 4 (NGN – Cloze / Drop-Down)
The nurse should monitor the client most closely for signs of hypoglycemia during
the time period of peak insulin action.
Correct Drop-Downs:
Hypoglycemia
Peak insulin action
Rationale:
Hypoglycemia is the primary risk during peak insulin activity.
Case Study 3: Antibiotic Therapy
A client is prescribed vancomycin IV for MRSA.
Question 5 (NGN – Select All That Apply)
Which assessments are priority before administering vancomycin?
A. Renal function labs
B. Hearing assessment
C. Blood glucose level
D. Trough drug level
E. White blood cell count
Correct Answers: A, B, D
Rationale:
Vancomycin can cause nephrotoxicity and ototoxicity. Monitoring trough levels
prevents toxicity. WBC trends evaluate infection response but are not a pre-
administration priority.
, Question 6 (NGN – Multiple Response)
Which findings indicate vancomycin toxicity?
A. Tinnitus
B. Decreased urine output
C. Hypotension during infusion
D. Red, flushed upper body
E. Elevated creatinine
Correct Answers: A, B, E
Rationale:
Ototoxicity (tinnitus) and nephrotoxicity (oliguria, elevated creatinine) are major
toxic effects. Flushing and hypotension may indicate Red Man Syndrome, an
infusion reaction.
Case Study 4: CNS – Opioid Analgesics
A postoperative client receives morphine IV.
Question 7 (NGN – Multiple Choice)
Which assessment requires immediate intervention?
A. Respiratory rate 10/min
B. Pain score 3/10
C. Blood pressure 110/70
D. Pupils 2 mm
Correct Answer: A
Rationale:
Respiratory depression is a life-threatening adverse effect of opioids and requires
prompt intervention.
