BSN 315 HESI Pharmacology II Exam | 3 Versions,
2026| Nightingale College
Actual Questions & Verified Answers | Complete with
Rationales
1. A client is prescribed verapamil for the treatment of hypertension. Which
assessment finding should the nurse report to the healthcare provider?
A) Heart rate 72 beats/min
B) Constipation for 4 days
C) Blood pressure 138/88 mmHg
D) Mild headache
Rationale: Verapamil is a calcium channel blocker that commonly causes constipation due
to decreased gastrointestinal motility. This side effect should be managed with increased
fluids, fiber, and stool softeners. If severe, the provider should be notified.
2. A client receiving IV heparin for a pulmonary embolism has a platelet count
drop from 240,000 to 90,000. Which action should the nurse take?
A) Continue heparin as prescribed
B) Notify the healthcare provider immediately
C) Increase the heparin infusion rate
D) Administer vitamin K
Rationale: A significant drop in platelet count (often >50%) in a patient receiving heparin
suggests heparin-induced thrombocytopenia (HIT). Heparin should be discontinued and an
alternative anticoagulant initiated. This is a medical emergency.
,3. The nurse is teaching a client about the use of sublingual nitroglycerin for
angina. Which statement by the client indicates a need for further teaching?
A) "I will sit down before taking the medication."
B) "I will call 911 if I have no relief after one tablet."
C) "I will swallow the tablet with water for faster absorption."
D) "I will take a second tablet after 5 minutes if pain persists."
Rationale: Sublingual nitroglycerin should be placed under the tongue and allowed to
dissolve completely; it should not be swallowed. Swallowing the tablet prevents proper
absorption. The client should sit or lie down to prevent hypotension and call 911 if no
relief after one tablet.
4. A client is prescribed furosemide (Lasix) for heart failure. Which laboratory
finding should the nurse monitor most closely?
A) Serum sodium 135 mEq/L
B) Serum potassium 3.0 mEq/L
C) Serum calcium 9.5 mg/dL
D) Serum magnesium 2.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes significant potassium loss. A serum
potassium of 3.0 mEq/L is low (normal 3.5-5.0 mEq/L) and increases the risk of cardiac
arrhythmias, especially if the client is also taking digoxin.
5. A patient with type 1 diabetes is receiving a continuous insulin infusion. Which
finding indicates the patient is experiencing hypoglycemia?
A) Polyuria and polydipsia
B) Shakiness, diaphoresis, and confusion
C) Kussmaul respirations
D) Fruity-smelling breath
Rationale: Shakiness, diaphoresis, and confusion are classic signs of hypoglycemia.
Polyuria/polydipsia, Kussmaul respirations, and fruity breath indicate hyperglycemia/DKA.
,6. The nurse is preparing to administer IV vancomycin. Which action is most
important to prevent red man syndrome?
A) Administer with a cold compress
B) Infuse the medication over at least 60 minutes
C) Administer a bolus dose
D) Pre-medicate with aspirin
Rationale: Red man syndrome is a histamine-mediated reaction caused by rapid
vancomycin infusion. Infusing over at least 60 minutes (and up to 2 hours for higher
doses) prevents this reaction. Antihistamines may be given for mild cases.
7. A client is prescribed losartan for hypertension. Which statement by the client
indicates understanding of the medication?
A) "I can stop this medication when my blood pressure is normal."
B) "I should avoid taking potassium supplements while on this medication."
C) "This medication will work immediately."
D) "I can take this medication with grapefruit juice."
Rationale: Losartan is an ARB that can cause hyperkalemia. Clients should avoid
potassium supplements and potassium-sparing diuretics. Blood pressure medications
should not be stopped without provider guidance; effects take several weeks.
8. A patient is receiving a blood transfusion and develops chills, fever, and back
pain. Which action should the nurse take first?
A) Slow the transfusion rate
B) Stop the transfusion immediately
C) Administer diphenhydramine
D) Notify the provider
, Rationale: Chills, fever, and back pain indicate a transfusion reaction. The transfusion
should be stopped immediately, the IV line kept open with normal saline, and the provider
notified. The blood bag and tubing should be returned to the blood bank.
9. A client is prescribed isoniazid (INH) for tuberculosis. Which supplement should
the nurse teach the client to take to prevent peripheral neuropathy?
A) Pyridoxine (vitamin B6)
B) Vitamin C
C) Folic acid
D) Vitamin D
Rationale: Isoniazid can cause peripheral neuropathy due to pyridoxine (vitamin B6)
depletion. Pyridoxine supplementation (10-25 mg daily) is recommended to prevent this
side effect.
10. A patient receiving clozapine therapy should have which laboratory value
monitored weekly to prevent a life-threatening adverse effect?
A) Serum creatinine
B) Absolute neutrophil count (ANC)
C) Liver function tests
D) Serum electrolytes
Rationale: Clozapine can cause severe neutropenia (agranulocytosis). ANC must be
monitored weekly for the first 6 months, then biweekly, to prevent life-threatening
infection. If ANC drops below 1500/mm³, the medication may need to be discontinued.
11. A client with asthma is prescribed montelukast (Singulair). The nurse should
teach the client that this medication works by:
A) Relaxing bronchial smooth muscle
B) Blocking leukotriene receptors to reduce inflammation
2026| Nightingale College
Actual Questions & Verified Answers | Complete with
Rationales
1. A client is prescribed verapamil for the treatment of hypertension. Which
assessment finding should the nurse report to the healthcare provider?
A) Heart rate 72 beats/min
B) Constipation for 4 days
C) Blood pressure 138/88 mmHg
D) Mild headache
Rationale: Verapamil is a calcium channel blocker that commonly causes constipation due
to decreased gastrointestinal motility. This side effect should be managed with increased
fluids, fiber, and stool softeners. If severe, the provider should be notified.
2. A client receiving IV heparin for a pulmonary embolism has a platelet count
drop from 240,000 to 90,000. Which action should the nurse take?
A) Continue heparin as prescribed
B) Notify the healthcare provider immediately
C) Increase the heparin infusion rate
D) Administer vitamin K
Rationale: A significant drop in platelet count (often >50%) in a patient receiving heparin
suggests heparin-induced thrombocytopenia (HIT). Heparin should be discontinued and an
alternative anticoagulant initiated. This is a medical emergency.
,3. The nurse is teaching a client about the use of sublingual nitroglycerin for
angina. Which statement by the client indicates a need for further teaching?
A) "I will sit down before taking the medication."
B) "I will call 911 if I have no relief after one tablet."
C) "I will swallow the tablet with water for faster absorption."
D) "I will take a second tablet after 5 minutes if pain persists."
Rationale: Sublingual nitroglycerin should be placed under the tongue and allowed to
dissolve completely; it should not be swallowed. Swallowing the tablet prevents proper
absorption. The client should sit or lie down to prevent hypotension and call 911 if no
relief after one tablet.
4. A client is prescribed furosemide (Lasix) for heart failure. Which laboratory
finding should the nurse monitor most closely?
A) Serum sodium 135 mEq/L
B) Serum potassium 3.0 mEq/L
C) Serum calcium 9.5 mg/dL
D) Serum magnesium 2.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes significant potassium loss. A serum
potassium of 3.0 mEq/L is low (normal 3.5-5.0 mEq/L) and increases the risk of cardiac
arrhythmias, especially if the client is also taking digoxin.
5. A patient with type 1 diabetes is receiving a continuous insulin infusion. Which
finding indicates the patient is experiencing hypoglycemia?
A) Polyuria and polydipsia
B) Shakiness, diaphoresis, and confusion
C) Kussmaul respirations
D) Fruity-smelling breath
Rationale: Shakiness, diaphoresis, and confusion are classic signs of hypoglycemia.
Polyuria/polydipsia, Kussmaul respirations, and fruity breath indicate hyperglycemia/DKA.
,6. The nurse is preparing to administer IV vancomycin. Which action is most
important to prevent red man syndrome?
A) Administer with a cold compress
B) Infuse the medication over at least 60 minutes
C) Administer a bolus dose
D) Pre-medicate with aspirin
Rationale: Red man syndrome is a histamine-mediated reaction caused by rapid
vancomycin infusion. Infusing over at least 60 minutes (and up to 2 hours for higher
doses) prevents this reaction. Antihistamines may be given for mild cases.
7. A client is prescribed losartan for hypertension. Which statement by the client
indicates understanding of the medication?
A) "I can stop this medication when my blood pressure is normal."
B) "I should avoid taking potassium supplements while on this medication."
C) "This medication will work immediately."
D) "I can take this medication with grapefruit juice."
Rationale: Losartan is an ARB that can cause hyperkalemia. Clients should avoid
potassium supplements and potassium-sparing diuretics. Blood pressure medications
should not be stopped without provider guidance; effects take several weeks.
8. A patient is receiving a blood transfusion and develops chills, fever, and back
pain. Which action should the nurse take first?
A) Slow the transfusion rate
B) Stop the transfusion immediately
C) Administer diphenhydramine
D) Notify the provider
, Rationale: Chills, fever, and back pain indicate a transfusion reaction. The transfusion
should be stopped immediately, the IV line kept open with normal saline, and the provider
notified. The blood bag and tubing should be returned to the blood bank.
9. A client is prescribed isoniazid (INH) for tuberculosis. Which supplement should
the nurse teach the client to take to prevent peripheral neuropathy?
A) Pyridoxine (vitamin B6)
B) Vitamin C
C) Folic acid
D) Vitamin D
Rationale: Isoniazid can cause peripheral neuropathy due to pyridoxine (vitamin B6)
depletion. Pyridoxine supplementation (10-25 mg daily) is recommended to prevent this
side effect.
10. A patient receiving clozapine therapy should have which laboratory value
monitored weekly to prevent a life-threatening adverse effect?
A) Serum creatinine
B) Absolute neutrophil count (ANC)
C) Liver function tests
D) Serum electrolytes
Rationale: Clozapine can cause severe neutropenia (agranulocytosis). ANC must be
monitored weekly for the first 6 months, then biweekly, to prevent life-threatening
infection. If ANC drops below 1500/mm³, the medication may need to be discontinued.
11. A client with asthma is prescribed montelukast (Singulair). The nurse should
teach the client that this medication works by:
A) Relaxing bronchial smooth muscle
B) Blocking leukotriene receptors to reduce inflammation
