BSN 315 HESI RN SPECIALTY
PHARMACOLOGY EXAM V3 (LATEST
2026/2027 UPDATE) QUESTIONS &
ANSWERS | 100% CORRECT | GRADE A -
NIGHTINGALE
AT NIGHTINGALE COLLEGE
BSN 315 HESI RN Specialty Pharmacology Exam V3 (Latest Update)
Questions 1–200 (Multiple Choice)
Question 1
The nurse admits a client with a diagnosis of stage 4 cancer who has a prescription for a subcutaneous
morphine sulfate patch for pain control. The client is short of breath and difficult to arouse. During the head-
to-toe assessment, the nurse discovers four morphine patches on the client’s body. Which action should the
nurse take first?
A. Monitor blood pressure
B. Administer a narcotic reversal drug
C. Remove the morphine patches
D. Apply oxygen via face mask
Correct Answer: C. Remove the morphine patches
Rationale: Multiple opioid patches can cause opioid toxicity, leading to respiratory depression and
decreased level of consciousness. The priority intervention is to stop further opioid absorption by removing
the patches. Removing the source addresses the cause before administering reversal agents. Oxygen and
monitoring may be needed afterward but do not correct the underlying problem.
Question 2
The nurse is caring for a patient taking digoxin (Lanoxin). Which additional medication listed on the
medication administration record (MAR) should cause the nurse concern before administering digoxin?
A. Spironolactone (Aldactone)
B. Metolazone (Zaroxolyn)
C. Apical pulse of 68 beats/minute
D. Normal serum sodium level
Correct Answer: A. Spironolactone (Aldactone)
Rationale: Spironolactone is a potassium-sparing diuretic that can increase serum potassium levels. Altered
,potassium levels affect digoxin activity and increase the risk of digoxin toxicity. Drug interactions must be
assessed prior to administration. Vital signs and sodium levels alone do not contraindicate digoxin use.
Question 3
Which describes the mechanism of action of lisinopril (Prinivil) when prescribed for hypertension?
A. Dilates arterioles directly
B. Causes peripheral vasodilation
C. Increases myocardial afterload
D. Regulates heart rhythm
Correct Answer: B. Causes peripheral vasodilation
Rationale: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that blocks the conversion of
angiotensin I to angiotensin II. This results in vasodilation and reduced aldosterone secretion. The overall
effect is decreased blood pressure. It does not directly regulate heart rhythm.
Question 4
The nurse is caring for a patient taking lisinopril (Prinivil). Which adverse effect should the nurse closely
monitor?
A. Elevated serum potassium
B. Increased urine output
C. Bronchodilation
D. Increased blood pressure
Correct Answer: A. Elevated serum potassium
Rationale: ACE inhibitors decrease aldosterone secretion, leading to potassium retention. Hyperkalemia can
result, especially in patients with renal impairment. Monitoring serum potassium is essential. The other
options are not common adverse effects of ACE inhibitors.
Question 5
The nurse is caring for a diabetic patient with heart failure. Which medication should be used with caution in
this patient?
A. Losartan (Cozaar)
B. Propranolol (Inderal)
C. Spironolactone (Aldactone)
D. Dobutamine (Dobutrex)
Correct Answer: C. Spironolactone (Aldactone)
Rationale: Spironolactone can cause hyperkalemia, particularly in patients with diabetes and renal
impairment. Elevated potassium levels can lead to serious cardiac dysrhythmias. Careful monitoring is
required. The other medications may be used with closer monitoring.
Question 6
The nurse is caring for a patient with heart failure who is hypokalemic. Which medication on the MAR most
likely explains this laboratory finding?
A. Atenolol (Tenormin)
B. Hydralazine/isosorbide dinitrate (BiDil)
C. Furosemide (Lasix)
D. Digoxin (Lanoxin)
Correct Answer: C. Furosemide (Lasix)
Rationale: Furosemide is a loop diuretic that increases urinary excretion of potassium. Hypokalemia is a
,common adverse effect. Low potassium levels can increase the risk of digoxin toxicity. Electrolytes must be
closely monitored in patients receiving loop diuretics.
Question 7
A patient presents to the emergency department with confirmed digitalis toxicity. Which medication does the
nurse anticipate administering?
A. Digitalis glycoside
B. Spironolactone (Aldactone)
C. Amiodarone (Cordarone)
D. Digoxin immune Fab
Correct Answer: D. Digoxin immune Fab
Rationale: Digoxin immune Fab binds to circulating digoxin, forming complexes that are excreted by the
kidneys. This rapidly reduces free digoxin levels. It is the treatment of choice for life-threatening digoxin
toxicity. Other medications do not reverse toxicity.
Question 8
The nurse is administering intravenous morphine sulfate to a postoperative patient. Which assessment
finding requires immediate nursing intervention?
A. Pain score of 3/10
B. Respiratory rate of 10 breaths/minute
C. Blood pressure of 110/70 mm Hg
D. Pupils equal and reactive
Correct Answer: B. Respiratory rate of 10 breaths/minute
Rationale: Morphine is an opioid analgesic that depresses the central nervous system. A respiratory rate
below 12 breaths per minute indicates respiratory depression and requires immediate intervention. Opioid-
induced hypoventilation can be life-threatening if not addressed promptly. Other findings are within
expected limits.
Question 9
The nurse is teaching a patient prescribed nitroglycerin sublingual tablets for angina. Which statement by the
patient indicates correct understanding?
A. “I will take the medication after meals.”
B. “I can take up to three tablets five minutes apart for chest pain.”
C. “I should swallow the tablet with water.”
D. “I will store the tablets in a pill organizer.”
Correct Answer: B. “I can take up to three tablets five minutes apart for chest pain.”
Rationale: Nitroglycerin is taken sublingually at the onset of chest pain. The patient may take one tablet
every five minutes for a total of three doses. Proper administration allows rapid absorption and vasodilation.
Tablets should be stored in their original container and not swallowed.
Question 10
A patient is prescribed metoprolol (Lopressor). Which vital sign should the nurse assess before administering
this medication?
A. Temperature
B. Respiratory rate
C. Apical heart rate
, D. Oxygen saturation
Correct Answer: C. Apical heart rate
Rationale: Metoprolol is a beta-1 selective beta-blocker that decreases heart rate and myocardial
contractility. Assessing the apical pulse ensures it is within a safe range prior to administration. Holding the
medication may be necessary if bradycardia is present. Other vital signs are less directly affected.
Question 11
The nurse is caring for a patient taking warfarin (Coumadin). Which laboratory value is most important to
monitor?
A. Platelet count
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Hemoglobin level
Correct Answer: C. International normalized ratio (INR)
Rationale: Warfarin therapy is monitored using the INR to evaluate clotting time. Therapeutic INR levels
reduce the risk of thromboembolic events while minimizing bleeding risk. aPTT is used for heparin therapy.
Regular INR monitoring is essential for safe dosing.
Question 12
Which medication would the nurse anticipate administering to reverse the effects of warfarin (Coumadin)?
A. Protamine sulfate
B. Vitamin K
C. Fresh frozen plasma
D. Alteplase (tPA)
Correct Answer: B. Vitamin K
Rationale: Vitamin K is the antidote for warfarin overdose or excessive anticoagulation. It promotes the
synthesis of clotting factors, reversing warfarin’s effects. Protamine sulfate reverses heparin, not warfarin.
Vitamin K is effective for non-emergent reversal.
Question 13
The nurse is caring for a patient receiving heparin therapy. Which laboratory test should be monitored?
A. INR
B. Platelet count
C. aPTT
D. Hematocrit
Correct Answer: C. aPTT
Rationale: Heparin prolongs clotting time by inhibiting thrombin and factor Xa. The aPTT measures the
intrinsic clotting pathway and is used to adjust heparin dosing. Therapeutic levels prevent clot formation
while minimizing bleeding risk. Monitoring is essential during continuous infusion.
Question 14
A patient receiving heparin develops a sudden drop in platelet count. Which condition does the nurse
suspect?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Iron-deficiency anemia
D. Vitamin K deficiency
Correct Answer: B. Heparin-induced thrombocytopenia
PHARMACOLOGY EXAM V3 (LATEST
2026/2027 UPDATE) QUESTIONS &
ANSWERS | 100% CORRECT | GRADE A -
NIGHTINGALE
AT NIGHTINGALE COLLEGE
BSN 315 HESI RN Specialty Pharmacology Exam V3 (Latest Update)
Questions 1–200 (Multiple Choice)
Question 1
The nurse admits a client with a diagnosis of stage 4 cancer who has a prescription for a subcutaneous
morphine sulfate patch for pain control. The client is short of breath and difficult to arouse. During the head-
to-toe assessment, the nurse discovers four morphine patches on the client’s body. Which action should the
nurse take first?
A. Monitor blood pressure
B. Administer a narcotic reversal drug
C. Remove the morphine patches
D. Apply oxygen via face mask
Correct Answer: C. Remove the morphine patches
Rationale: Multiple opioid patches can cause opioid toxicity, leading to respiratory depression and
decreased level of consciousness. The priority intervention is to stop further opioid absorption by removing
the patches. Removing the source addresses the cause before administering reversal agents. Oxygen and
monitoring may be needed afterward but do not correct the underlying problem.
Question 2
The nurse is caring for a patient taking digoxin (Lanoxin). Which additional medication listed on the
medication administration record (MAR) should cause the nurse concern before administering digoxin?
A. Spironolactone (Aldactone)
B. Metolazone (Zaroxolyn)
C. Apical pulse of 68 beats/minute
D. Normal serum sodium level
Correct Answer: A. Spironolactone (Aldactone)
Rationale: Spironolactone is a potassium-sparing diuretic that can increase serum potassium levels. Altered
,potassium levels affect digoxin activity and increase the risk of digoxin toxicity. Drug interactions must be
assessed prior to administration. Vital signs and sodium levels alone do not contraindicate digoxin use.
Question 3
Which describes the mechanism of action of lisinopril (Prinivil) when prescribed for hypertension?
A. Dilates arterioles directly
B. Causes peripheral vasodilation
C. Increases myocardial afterload
D. Regulates heart rhythm
Correct Answer: B. Causes peripheral vasodilation
Rationale: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that blocks the conversion of
angiotensin I to angiotensin II. This results in vasodilation and reduced aldosterone secretion. The overall
effect is decreased blood pressure. It does not directly regulate heart rhythm.
Question 4
The nurse is caring for a patient taking lisinopril (Prinivil). Which adverse effect should the nurse closely
monitor?
A. Elevated serum potassium
B. Increased urine output
C. Bronchodilation
D. Increased blood pressure
Correct Answer: A. Elevated serum potassium
Rationale: ACE inhibitors decrease aldosterone secretion, leading to potassium retention. Hyperkalemia can
result, especially in patients with renal impairment. Monitoring serum potassium is essential. The other
options are not common adverse effects of ACE inhibitors.
Question 5
The nurse is caring for a diabetic patient with heart failure. Which medication should be used with caution in
this patient?
A. Losartan (Cozaar)
B. Propranolol (Inderal)
C. Spironolactone (Aldactone)
D. Dobutamine (Dobutrex)
Correct Answer: C. Spironolactone (Aldactone)
Rationale: Spironolactone can cause hyperkalemia, particularly in patients with diabetes and renal
impairment. Elevated potassium levels can lead to serious cardiac dysrhythmias. Careful monitoring is
required. The other medications may be used with closer monitoring.
Question 6
The nurse is caring for a patient with heart failure who is hypokalemic. Which medication on the MAR most
likely explains this laboratory finding?
A. Atenolol (Tenormin)
B. Hydralazine/isosorbide dinitrate (BiDil)
C. Furosemide (Lasix)
D. Digoxin (Lanoxin)
Correct Answer: C. Furosemide (Lasix)
Rationale: Furosemide is a loop diuretic that increases urinary excretion of potassium. Hypokalemia is a
,common adverse effect. Low potassium levels can increase the risk of digoxin toxicity. Electrolytes must be
closely monitored in patients receiving loop diuretics.
Question 7
A patient presents to the emergency department with confirmed digitalis toxicity. Which medication does the
nurse anticipate administering?
A. Digitalis glycoside
B. Spironolactone (Aldactone)
C. Amiodarone (Cordarone)
D. Digoxin immune Fab
Correct Answer: D. Digoxin immune Fab
Rationale: Digoxin immune Fab binds to circulating digoxin, forming complexes that are excreted by the
kidneys. This rapidly reduces free digoxin levels. It is the treatment of choice for life-threatening digoxin
toxicity. Other medications do not reverse toxicity.
Question 8
The nurse is administering intravenous morphine sulfate to a postoperative patient. Which assessment
finding requires immediate nursing intervention?
A. Pain score of 3/10
B. Respiratory rate of 10 breaths/minute
C. Blood pressure of 110/70 mm Hg
D. Pupils equal and reactive
Correct Answer: B. Respiratory rate of 10 breaths/minute
Rationale: Morphine is an opioid analgesic that depresses the central nervous system. A respiratory rate
below 12 breaths per minute indicates respiratory depression and requires immediate intervention. Opioid-
induced hypoventilation can be life-threatening if not addressed promptly. Other findings are within
expected limits.
Question 9
The nurse is teaching a patient prescribed nitroglycerin sublingual tablets for angina. Which statement by the
patient indicates correct understanding?
A. “I will take the medication after meals.”
B. “I can take up to three tablets five minutes apart for chest pain.”
C. “I should swallow the tablet with water.”
D. “I will store the tablets in a pill organizer.”
Correct Answer: B. “I can take up to three tablets five minutes apart for chest pain.”
Rationale: Nitroglycerin is taken sublingually at the onset of chest pain. The patient may take one tablet
every five minutes for a total of three doses. Proper administration allows rapid absorption and vasodilation.
Tablets should be stored in their original container and not swallowed.
Question 10
A patient is prescribed metoprolol (Lopressor). Which vital sign should the nurse assess before administering
this medication?
A. Temperature
B. Respiratory rate
C. Apical heart rate
, D. Oxygen saturation
Correct Answer: C. Apical heart rate
Rationale: Metoprolol is a beta-1 selective beta-blocker that decreases heart rate and myocardial
contractility. Assessing the apical pulse ensures it is within a safe range prior to administration. Holding the
medication may be necessary if bradycardia is present. Other vital signs are less directly affected.
Question 11
The nurse is caring for a patient taking warfarin (Coumadin). Which laboratory value is most important to
monitor?
A. Platelet count
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Hemoglobin level
Correct Answer: C. International normalized ratio (INR)
Rationale: Warfarin therapy is monitored using the INR to evaluate clotting time. Therapeutic INR levels
reduce the risk of thromboembolic events while minimizing bleeding risk. aPTT is used for heparin therapy.
Regular INR monitoring is essential for safe dosing.
Question 12
Which medication would the nurse anticipate administering to reverse the effects of warfarin (Coumadin)?
A. Protamine sulfate
B. Vitamin K
C. Fresh frozen plasma
D. Alteplase (tPA)
Correct Answer: B. Vitamin K
Rationale: Vitamin K is the antidote for warfarin overdose or excessive anticoagulation. It promotes the
synthesis of clotting factors, reversing warfarin’s effects. Protamine sulfate reverses heparin, not warfarin.
Vitamin K is effective for non-emergent reversal.
Question 13
The nurse is caring for a patient receiving heparin therapy. Which laboratory test should be monitored?
A. INR
B. Platelet count
C. aPTT
D. Hematocrit
Correct Answer: C. aPTT
Rationale: Heparin prolongs clotting time by inhibiting thrombin and factor Xa. The aPTT measures the
intrinsic clotting pathway and is used to adjust heparin dosing. Therapeutic levels prevent clot formation
while minimizing bleeding risk. Monitoring is essential during continuous infusion.
Question 14
A patient receiving heparin develops a sudden drop in platelet count. Which condition does the nurse
suspect?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Iron-deficiency anemia
D. Vitamin K deficiency
Correct Answer: B. Heparin-induced thrombocytopenia
