1
RN HESI PHARMACOLOGY V2 ACTUAL EXAM 2026/2027 |
Actual Questions with Rationales | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Critical Care & Emergency Medications (Q1-10)
Q1. A patient in septic shock has a blood pressure of 78/52 mmHg after receiving 30
mL/kg of crystalloid resuscitation. The nurse prepares to administer a vasoactive
infusion. Which medication is the first-line vasopressor for this patient?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
B. Norepinephrine [CORRECT]
Rationale: Norepinephrine is the first-line vasopressor for septic shock per the
Surviving Sepsis Campaign due to its potent alpha-1 agonism with less
arrhythmogenicity and lower mortality compared to dopamine.
Correct Answer: B
Q2. A patient with acute decompensated heart failure has a cardiac index of 1.8
L/min/m² and a pulmonary capillary wedge pressure of 24 mmHg. Which inotropic
agent is most appropriate to increase myocardial contractility?
A. Norepinephrine
B. Dobutamine
C. Vasopressin
D. Phenylephrine
B. Dobutamine [CORRECT]
,2
Rationale: Dobutamine is a beta-1 adrenergic agonist that increases myocardial
contractility and cardiac output in cardiogenic shock or low-output heart failure
without significantly increasing afterload.
Correct Answer: B
Q3. A patient on a norepinephrine infusion at 30 mcg/min has a MAP of 62 mmHg.
The provider orders vasopressin as an adjunct. What is the primary mechanism by
which vasopressin supports blood pressure in septic shock?
A. Beta-1 receptor agonism increasing heart rate
B. V1 receptor agonism causing vasoconstriction without catecholamine receptor
activation
C. Alpha-1 receptor blockade reducing afterload
D. Phosphodiesterase inhibition increasing cAMP
B. V1 receptor agonism causing vasoconstriction without catecholamine receptor
activation [CORRECT]
Rationale: Vasopressin acts on V1 receptors to induce vasoconstriction via non-
catecholamine pathways, making it useful as an adjunct when high-dose
catecholamines are insufficient and reducing norepinephrine requirements.
Correct Answer: B
Q4. During a code blue, a patient in pulseless ventricular tachycardia receives
defibrillation and epinephrine 1 mg IV every 3–5 minutes. The rhythm persists. Which
antiarrhythmic is recommended next per ACLS?
A. Adenosine 6 mg rapid IV push
B. Amiodarone 300 mg IV push
C. Diltiazem 15 mg IV push
D. Atropine 1 mg IV push
B. Amiodarone 300 mg IV push [CORRECT]
, 3
Rationale: Amiodarone 300 mg IV push is indicated for shock-refractory ventricular
fibrillation or pulseless ventricular tachycardia after defibrillation and epinephrine per
the ACLS algorithm.
Correct Answer: B
Q5. A patient with new-onset atrial fibrillation with rapid ventricular response (HR
168) receives diltiazem 15 mg IV. Five minutes later, the patient becomes
hypotensive (BP 82/50) and the rhythm strip shows polymorphic ventricular
tachycardia. The patient has a history of Wolff-Parkinson-White syndrome. What is
the most likely cause?
A. Amiodarone toxicity
B. Diltiazem-induced acceleration of conduction through the accessory pathway
C. Adenosine-induced bronchospasm
D. Digoxin toxicity
B. Diltiazem-induced acceleration of conduction through the accessory pathway
[CORRECT]
Rationale: Calcium channel blockers and digoxin block the AV node but can
accelerate conduction through the accessory pathway in WPW, precipitating
ventricular fibrillation; procainamide or ibutilide is preferred in WPW with AFib.
Correct Answer: B
Q6. A patient receives adenosine 6 mg rapid IV push for supraventricular tachycardia.
The rhythm converts to sinus bradycardia for 15 seconds, then reverts to SVT. What is
the next appropriate action?
A. Administer amiodarone 150 mg IV
B. Administer adenosine 12 mg rapid IV push followed by a 20 mL saline flush
C. Administer diltiazem 25 mg IV bolus
D. Perform immediate synchronized cardioversion
RN HESI PHARMACOLOGY V2 ACTUAL EXAM 2026/2027 |
Actual Questions with Rationales | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Critical Care & Emergency Medications (Q1-10)
Q1. A patient in septic shock has a blood pressure of 78/52 mmHg after receiving 30
mL/kg of crystalloid resuscitation. The nurse prepares to administer a vasoactive
infusion. Which medication is the first-line vasopressor for this patient?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
B. Norepinephrine [CORRECT]
Rationale: Norepinephrine is the first-line vasopressor for septic shock per the
Surviving Sepsis Campaign due to its potent alpha-1 agonism with less
arrhythmogenicity and lower mortality compared to dopamine.
Correct Answer: B
Q2. A patient with acute decompensated heart failure has a cardiac index of 1.8
L/min/m² and a pulmonary capillary wedge pressure of 24 mmHg. Which inotropic
agent is most appropriate to increase myocardial contractility?
A. Norepinephrine
B. Dobutamine
C. Vasopressin
D. Phenylephrine
B. Dobutamine [CORRECT]
,2
Rationale: Dobutamine is a beta-1 adrenergic agonist that increases myocardial
contractility and cardiac output in cardiogenic shock or low-output heart failure
without significantly increasing afterload.
Correct Answer: B
Q3. A patient on a norepinephrine infusion at 30 mcg/min has a MAP of 62 mmHg.
The provider orders vasopressin as an adjunct. What is the primary mechanism by
which vasopressin supports blood pressure in septic shock?
A. Beta-1 receptor agonism increasing heart rate
B. V1 receptor agonism causing vasoconstriction without catecholamine receptor
activation
C. Alpha-1 receptor blockade reducing afterload
D. Phosphodiesterase inhibition increasing cAMP
B. V1 receptor agonism causing vasoconstriction without catecholamine receptor
activation [CORRECT]
Rationale: Vasopressin acts on V1 receptors to induce vasoconstriction via non-
catecholamine pathways, making it useful as an adjunct when high-dose
catecholamines are insufficient and reducing norepinephrine requirements.
Correct Answer: B
Q4. During a code blue, a patient in pulseless ventricular tachycardia receives
defibrillation and epinephrine 1 mg IV every 3–5 minutes. The rhythm persists. Which
antiarrhythmic is recommended next per ACLS?
A. Adenosine 6 mg rapid IV push
B. Amiodarone 300 mg IV push
C. Diltiazem 15 mg IV push
D. Atropine 1 mg IV push
B. Amiodarone 300 mg IV push [CORRECT]
, 3
Rationale: Amiodarone 300 mg IV push is indicated for shock-refractory ventricular
fibrillation or pulseless ventricular tachycardia after defibrillation and epinephrine per
the ACLS algorithm.
Correct Answer: B
Q5. A patient with new-onset atrial fibrillation with rapid ventricular response (HR
168) receives diltiazem 15 mg IV. Five minutes later, the patient becomes
hypotensive (BP 82/50) and the rhythm strip shows polymorphic ventricular
tachycardia. The patient has a history of Wolff-Parkinson-White syndrome. What is
the most likely cause?
A. Amiodarone toxicity
B. Diltiazem-induced acceleration of conduction through the accessory pathway
C. Adenosine-induced bronchospasm
D. Digoxin toxicity
B. Diltiazem-induced acceleration of conduction through the accessory pathway
[CORRECT]
Rationale: Calcium channel blockers and digoxin block the AV node but can
accelerate conduction through the accessory pathway in WPW, precipitating
ventricular fibrillation; procainamide or ibutilide is preferred in WPW with AFib.
Correct Answer: B
Q6. A patient receives adenosine 6 mg rapid IV push for supraventricular tachycardia.
The rhythm converts to sinus bradycardia for 15 seconds, then reverts to SVT. What is
the next appropriate action?
A. Administer amiodarone 150 mg IV
B. Administer adenosine 12 mg rapid IV push followed by a 20 mL saline flush
C. Administer diltiazem 25 mg IV bolus
D. Perform immediate synchronized cardioversion
