BSN315 Final Exam Actual Exam Style V2
| BSN 315 HESI RN Specialty
Pharmacology Exam | Nightingale
1. A client with heart failure is receiving digoxin. Which assessment finding should the nurse
identify as an early sign of digoxin toxicity?
A. Bradypnea
B. Anorexia
C. Hypertension
D. Tinnitus
Answer: B
Rationale: Early signs of digoxin toxicity typically manifest as gastrointestinal distress,
including anorexia, nausea, and vomiting. Neurological symptoms such as blurred vision or
yellow-green halos may also occur as toxicity progresses. It is essential for the nurse to
monitor the serum digoxin level to ensure it remains within the therapeutic range of 0.8 to
2.0 ng/mL.
2. A patient is prescribed enalapril for hypertension. Which adverse effect is most commonly
associated with ACE inhibitors?
A. Peripheral edema
B. Hypokalemia
,C. Tachycardia
D. Persistent dry cough
Answer: D
Rationale: A persistent dry, nonproductive cough is a common side effect of ACE inhibitors
due to the accumulation of bradykinin in the lungs. If the cough becomes intolerable for the
patient, the healthcare provider may switch the medication to an angiotensin II receptor
blocker (ARB). Patients should also be monitored for angioedema, which is a rare but life-
threatening reaction to this class of medication.
3. A nurse is preparing to administer NPH insulin to a client with type 1 diabetes. When
should the nurse expect this insulin to reach its peak effect?
A. 30 to 60 minutes after injection
B. 1 to 3 hours after injection
C. 4 to 12 hours after injection
D. 18 to 24 hours after injection
Answer: C
Rationale: NPH is an intermediate-acting insulin that typically peaks between 4 and 12
hours after administration. Because of this peak, the nurse must ensure the client has
adequate caloric intake during this window to prevent hypoglycemia. The duration of
action for NPH is generally 12 to 18 hours, necessitating twice-daily dosing for some
patients.
,4. Which laboratory value is used to monitor the therapeutic effectiveness of warfarin
therapy?
A. International Normalized Ratio (INR)
B. Platelet count
C. Bleeding time
D. Activated partial thromboplastin time (aPTT)
Answer: A
Rationale: The INR is the standard laboratory value used to monitor the effectiveness of
warfarin and determine if the dosage is within the therapeutic range. For most patients, a
therapeutic INR level is between 2.0 and 3.0, though it may be higher for those with
mechanical heart valves. In contrast, the aPTT is used to monitor the effectiveness of
unfractionated heparin therapy.
5. A client is receiving gentamicin for a severe infection. The nurse should monitor which
laboratory values due to the risk of nephrotoxicity?
A. Sodium and potassium levels
B. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
C. Serum amylase and lipase
D. Blood urea nitrogen (BUN) and creatinine
Answer: D
, Rationale: Gentamicin is an aminoglycoside antibiotic known for its potential to cause
both nephrotoxicity and ototoxicity. Elevated BUN and creatinine levels are indicators of
declining renal function and may necessitate a dosage adjustment or discontinuation. The
nurse should also monitor peak and trough levels to ensure the drug remains within a safe
and effective therapeutic range.
6. When administering intravenous phenytoin, which solution is the only compatible fluid for
flushing the IV line?
A. 5% Dextrose in water (D5W)
B. 0.9% Sodium chloride (NS)
C. Lactated Ringer’s solution
D. Sterile water for injection
Answer: B
Rationale: Phenytoin is highly incompatible with most fluids and will precipitate if mixed
with dextrose-containing solutions. Normal saline (0.9% Sodium chloride) must be used to
flush the line before and after administration to prevent crystallization. Additionally, the
nurse should administer the medication slowly to avoid hypotension and cardiac
arrhythmias.
7. A patient taking lithium carbonate for bipolar disorder should be instructed to maintain a
consistent intake of which substance?
A. Potassium
| BSN 315 HESI RN Specialty
Pharmacology Exam | Nightingale
1. A client with heart failure is receiving digoxin. Which assessment finding should the nurse
identify as an early sign of digoxin toxicity?
A. Bradypnea
B. Anorexia
C. Hypertension
D. Tinnitus
Answer: B
Rationale: Early signs of digoxin toxicity typically manifest as gastrointestinal distress,
including anorexia, nausea, and vomiting. Neurological symptoms such as blurred vision or
yellow-green halos may also occur as toxicity progresses. It is essential for the nurse to
monitor the serum digoxin level to ensure it remains within the therapeutic range of 0.8 to
2.0 ng/mL.
2. A patient is prescribed enalapril for hypertension. Which adverse effect is most commonly
associated with ACE inhibitors?
A. Peripheral edema
B. Hypokalemia
,C. Tachycardia
D. Persistent dry cough
Answer: D
Rationale: A persistent dry, nonproductive cough is a common side effect of ACE inhibitors
due to the accumulation of bradykinin in the lungs. If the cough becomes intolerable for the
patient, the healthcare provider may switch the medication to an angiotensin II receptor
blocker (ARB). Patients should also be monitored for angioedema, which is a rare but life-
threatening reaction to this class of medication.
3. A nurse is preparing to administer NPH insulin to a client with type 1 diabetes. When
should the nurse expect this insulin to reach its peak effect?
A. 30 to 60 minutes after injection
B. 1 to 3 hours after injection
C. 4 to 12 hours after injection
D. 18 to 24 hours after injection
Answer: C
Rationale: NPH is an intermediate-acting insulin that typically peaks between 4 and 12
hours after administration. Because of this peak, the nurse must ensure the client has
adequate caloric intake during this window to prevent hypoglycemia. The duration of
action for NPH is generally 12 to 18 hours, necessitating twice-daily dosing for some
patients.
,4. Which laboratory value is used to monitor the therapeutic effectiveness of warfarin
therapy?
A. International Normalized Ratio (INR)
B. Platelet count
C. Bleeding time
D. Activated partial thromboplastin time (aPTT)
Answer: A
Rationale: The INR is the standard laboratory value used to monitor the effectiveness of
warfarin and determine if the dosage is within the therapeutic range. For most patients, a
therapeutic INR level is between 2.0 and 3.0, though it may be higher for those with
mechanical heart valves. In contrast, the aPTT is used to monitor the effectiveness of
unfractionated heparin therapy.
5. A client is receiving gentamicin for a severe infection. The nurse should monitor which
laboratory values due to the risk of nephrotoxicity?
A. Sodium and potassium levels
B. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
C. Serum amylase and lipase
D. Blood urea nitrogen (BUN) and creatinine
Answer: D
, Rationale: Gentamicin is an aminoglycoside antibiotic known for its potential to cause
both nephrotoxicity and ototoxicity. Elevated BUN and creatinine levels are indicators of
declining renal function and may necessitate a dosage adjustment or discontinuation. The
nurse should also monitor peak and trough levels to ensure the drug remains within a safe
and effective therapeutic range.
6. When administering intravenous phenytoin, which solution is the only compatible fluid for
flushing the IV line?
A. 5% Dextrose in water (D5W)
B. 0.9% Sodium chloride (NS)
C. Lactated Ringer’s solution
D. Sterile water for injection
Answer: B
Rationale: Phenytoin is highly incompatible with most fluids and will precipitate if mixed
with dextrose-containing solutions. Normal saline (0.9% Sodium chloride) must be used to
flush the line before and after administration to prevent crystallization. Additionally, the
nurse should administer the medication slowly to avoid hypotension and cardiac
arrhythmias.
7. A patient taking lithium carbonate for bipolar disorder should be instructed to maintain a
consistent intake of which substance?
A. Potassium
