BSN 315 Hesi Pharmacology II Exam | Actual Exam 2026/2027 | Verified Questions
Advanced Pharmacology for Nursing Practice | HESI Blueprint | BSN Candidates
Comprehensive 200-Question Original Review Set | 2 Versions (100 Questions per
Version)
Introduction
This comprehensive testing suite contains 200 original high-yield questions split into 2
unique versions of 100 questions each, specifically mapped to advanced nursing
pharmacology concepts (BSN 315 / HESI Pharmacology II).
The content addresses complex pharmacodynamics, drug-to-drug interactions, high-alert
medication protocols, and clinical prioritization across critical drug classes including cardiac,
neurological, endocrine, antimicrobial, and psychiatric therapeutics. Each item features a
Verified Question paired with a concise rationale formatted with bold key terms, bold
italic answers, and italicized text designed for rapid visual mapping and exam day mastery.
VERSION 1: System-Focused Advanced Therapeutics (Questions 1–100)
Cardiovascular and Renal Pharmacology
1. A nurse is preparing to administer the initial dose of an ACE inhibitor, lisinopril, to
a client with heart failure. Which clinical indicator should the nurse assess most
closely within the first 4 hours following administration?
A. Apical pulse rate
, B. Blood pressure
C. Serum potassium level
D. Total urine output
Explanation: ACE inhibitors cause marked vasodilation. The priority is tracking blood
pressure to detect first-dose hypotension, a common adverse effect, particularly in volume-
depleted or diuretic-treated clients.
2. A client taking digoxin for chronic atrial fibrillation reports blurred vision and
seeing green-yellow halos around light fixtures. Which laboratory parameter must the
nurse verify immediately?
A. Serum digoxin and potassium levels
B. Serum sodium and chloride levels
C. Blood urea nitrogen and creatinine
D. Activated partial thromboplastin time (aPTT)
Explanation: Visual disturbances like green-yellow halos are classic clinical signs of
digoxin toxicity. Hypokalemia exacerbates this toxicity, requiring immediate validation of
both digoxin and potassium levels.
3. A nurse is evaluating a client receiving an intravenous infusion of amiodarone for
refractory ventricular tachycardia. Which toxic side effect represents a critical long-
term limitation of this antiarrhythmic medication?
, A. Permanent hearing loss
B. Acute renal failure
C. Severe bone marrow suppression
D. Pulmonary toxicity (fibrosis)
Explanation: Amiodarone carries a black box warning for pulmonary toxicity, which
can present as progressive dyspnea and cough caused by interstitial pneumonitis or
fibrosis.
4. Prior to administering a scheduled morning dose of the beta-blocker metoprolol
succinate, the nurse notes the client's apical pulse is 48 beats per minute. Which
action should the nurse take first?
A. Administer half the prescribed dose immediately.
B. Hold the dose and notify the healthcare provider.
C. Inject a rescue dose of subcutaneous epinephrine.
D. Document the heart rate and re-evaluate in two hours.
Explanation: Beta-blockers exhibit negative chronotropic effects. A heart rate below
50–60 bpm requires the nurse to hold the dose and notify the provider to prevent
profound bradycardia and low cardiac output.
, 5. A nurse is reviewing medications for a client with a history of severe calcium-
channel blocker overdose. Which antidote should the nurse anticipate administering
to reverse toxic calcium-channel blockade?
A. Protamine sulfate
B. Intravenous calcium gluconate or calcium chloride
C. Flumazenil injection
D. Deferoxamine chelation
Explanation: Calcium gluconate or calcium chloride effectively increases
extracellular calcium concentrations to overcome the competitive receptor blockade caused
by toxic doses of calcium channel blockers.
6. A client with acute pulmonary edema is prescribed an intravenous bolus of
furosemide. The nurse should administer this loop diuretic slowly over 1 to 2 minutes
to prevent which adverse effect?
A. Severe hyperuricemia
B. Ototoxicity (transient or permanent hearing loss)
C. Acute angle-closure glaucoma
D. Profound hyperkalemia
Advanced Pharmacology for Nursing Practice | HESI Blueprint | BSN Candidates
Comprehensive 200-Question Original Review Set | 2 Versions (100 Questions per
Version)
Introduction
This comprehensive testing suite contains 200 original high-yield questions split into 2
unique versions of 100 questions each, specifically mapped to advanced nursing
pharmacology concepts (BSN 315 / HESI Pharmacology II).
The content addresses complex pharmacodynamics, drug-to-drug interactions, high-alert
medication protocols, and clinical prioritization across critical drug classes including cardiac,
neurological, endocrine, antimicrobial, and psychiatric therapeutics. Each item features a
Verified Question paired with a concise rationale formatted with bold key terms, bold
italic answers, and italicized text designed for rapid visual mapping and exam day mastery.
VERSION 1: System-Focused Advanced Therapeutics (Questions 1–100)
Cardiovascular and Renal Pharmacology
1. A nurse is preparing to administer the initial dose of an ACE inhibitor, lisinopril, to
a client with heart failure. Which clinical indicator should the nurse assess most
closely within the first 4 hours following administration?
A. Apical pulse rate
, B. Blood pressure
C. Serum potassium level
D. Total urine output
Explanation: ACE inhibitors cause marked vasodilation. The priority is tracking blood
pressure to detect first-dose hypotension, a common adverse effect, particularly in volume-
depleted or diuretic-treated clients.
2. A client taking digoxin for chronic atrial fibrillation reports blurred vision and
seeing green-yellow halos around light fixtures. Which laboratory parameter must the
nurse verify immediately?
A. Serum digoxin and potassium levels
B. Serum sodium and chloride levels
C. Blood urea nitrogen and creatinine
D. Activated partial thromboplastin time (aPTT)
Explanation: Visual disturbances like green-yellow halos are classic clinical signs of
digoxin toxicity. Hypokalemia exacerbates this toxicity, requiring immediate validation of
both digoxin and potassium levels.
3. A nurse is evaluating a client receiving an intravenous infusion of amiodarone for
refractory ventricular tachycardia. Which toxic side effect represents a critical long-
term limitation of this antiarrhythmic medication?
, A. Permanent hearing loss
B. Acute renal failure
C. Severe bone marrow suppression
D. Pulmonary toxicity (fibrosis)
Explanation: Amiodarone carries a black box warning for pulmonary toxicity, which
can present as progressive dyspnea and cough caused by interstitial pneumonitis or
fibrosis.
4. Prior to administering a scheduled morning dose of the beta-blocker metoprolol
succinate, the nurse notes the client's apical pulse is 48 beats per minute. Which
action should the nurse take first?
A. Administer half the prescribed dose immediately.
B. Hold the dose and notify the healthcare provider.
C. Inject a rescue dose of subcutaneous epinephrine.
D. Document the heart rate and re-evaluate in two hours.
Explanation: Beta-blockers exhibit negative chronotropic effects. A heart rate below
50–60 bpm requires the nurse to hold the dose and notify the provider to prevent
profound bradycardia and low cardiac output.
, 5. A nurse is reviewing medications for a client with a history of severe calcium-
channel blocker overdose. Which antidote should the nurse anticipate administering
to reverse toxic calcium-channel blockade?
A. Protamine sulfate
B. Intravenous calcium gluconate or calcium chloride
C. Flumazenil injection
D. Deferoxamine chelation
Explanation: Calcium gluconate or calcium chloride effectively increases
extracellular calcium concentrations to overcome the competitive receptor blockade caused
by toxic doses of calcium channel blockers.
6. A client with acute pulmonary edema is prescribed an intravenous bolus of
furosemide. The nurse should administer this loop diuretic slowly over 1 to 2 minutes
to prevent which adverse effect?
A. Severe hyperuricemia
B. Ototoxicity (transient or permanent hearing loss)
C. Acute angle-closure glaucoma
D. Profound hyperkalemia
