BSN 315 HESI PHARMACOLOGY EXAM VERSIONS 1, 2 & 3
LATEST 2026/2027 WITH REAL EXAM QUESTIONS AND
CORRECT ANSWERS AND RATIONALE NEW!!!!!!!!!!!!!
1. A nurse is administering digoxin to a client with heart failure. Which finding
requires withholding the medication?
A) Heart rate 58 bpm in an adult
B) Serum potassium 4.2 mEq/L
C) Skin rash
D) Headache
Answer: A
Rationale: Digoxin should be withheld if the adult heart rate is below 60 bpm, as
bradycardia is a sign of digoxin toxicity.
2. A client receiving warfarin (Coumadin) has an INR of 4.5. The client has no
signs of bleeding. Which action should the nurse take?
A) Administer vitamin K IM
B) Hold the next dose and notify the provider
C) Increase the next warfarin dose
D) Administer protamine sulfate
Answer: B
Rationale: Therapeutic INR for most indications is 2-3. An INR of 4.5 is elevated,
indicating increased bleeding risk. The nurse should hold the dose and notify the
provider. Vitamin K is typically given if INR exceeds 10 or if bleeding is present.
3. A nurse is teaching a client about metformin (Glucophage). Which instruction
should the nurse include?
A) "Take this medication on an empty stomach."
B) "Stop taking it for 48 hours before any contrast dye procedure."
C) "It may cause weight gain and increased appetite."
D) "Monitor for signs of lactic acidosis: muscle pain, drowsiness, malaise."
Answer: D
Rationale: Metformin carries a risk of lactic acidosis, a rare but serious adverse
effect. Signs include muscle pain, drowsiness, malaise, and hyperventilation.
Metformin should be held before contrast dye procedures to prevent kidney
damage and lactic acidosis.
,4. A client is prescribed enoxaparin (Lovenox) postoperatively. Which statement
indicates understanding?
A) "I should have my PT/INR checked daily."
B) "I will inject this medication into my abdomen subcutaneously."
C) "I can take aspirin for pain without any risk."
D) "This medication is safe to use with warfarin."
Answer: B
Rationale: Enoxaparin is a low molecular weight heparin administered
subcutaneously, typically in the abdomen. It does not require daily PT/INR
monitoring and should not be combined with aspirin without provider approval due
to bleeding risk.
5. A client receiving IV heparin has a partial thromboplastin time (PTT) of 120
seconds. The nurse should anticipate which order?
A) Increase heparin infusion rate
B) Administer protamine sulfate
C) Draw PTT again in 6 hours
D) Administer vitamin K
Answer: B
Rationale: Therapeutic PTT is 1.5-2.5 times the normal control (approximately 60-
80 seconds). A PTT of 120 seconds indicates excessive anticoagulation and
bleeding risk. Protamine sulfate is the antidote for heparin.
6. A nurse is teaching a client about levothyroxine (Synthroid). Which instruction
is correct?
A) "Take this medication at bedtime with a snack."
B) "Take on an empty stomach in the morning, at least 30-60 minutes before
breakfast."
C) "You can stop the medication once TSH is normal."
D) "Take with calcium supplements to enhance absorption."
Answer: B
Rationale: Levothyroxine is best absorbed on an empty stomach, at least 30-60
minutes before food or other medications. Therapy is typically lifelong, and
calcium supplements should be taken at a different time as they decrease
absorption.
7. A client with heart failure is prescribed digoxin. Which assessment finding
indicates a therapeutic response to the medication?
A) Increased heart rate and decreased urine output
B) Decreased shortness of breath and decreased peripheral edema
,C) Increased appetite and weight gain
D) Decreased blood pressure and increased heart rate
Answer: B
Rationale: Digoxin increases myocardial contractility (positive inotropic effect),
improving cardiac output. This leads to better tissue perfusion and decreased fluid
accumulation, reducing pulmonary congestion (shortness of breath) and peripheral
edema.
8. The nurse is administering digoxin to a client with an apical pulse of 52 beats
per minute. Which action should the nurse take?
A) Administer the dose and document the finding
B) Administer the dose with food to increase absorption
C) Hold the dose and notify the healthcare provider
D) Administer half the dose and recheck the pulse in one hour
Answer: C
Rationale: The apical pulse should be assessed for a full minute before
administering digoxin. If the pulse is below 60 bpm in an adult, the dose should be
withheld and the healthcare provider notified, as bradycardia may indicate digoxin
toxicity.
9. The nurse is educating a client with a new prescription for warfarin (Coumadin).
Which statement by the client indicates a need for further teaching?
A) "I will use a soft-bristled toothbrush to protect my gums."
B) "I will need to have my blood drawn regularly to check my levels."
C) "I can continue to eat large amounts of spinach and kale every day."
D) "I will report any unusual bruising or bleeding to my healthcare provider."
Answer: C
Rationale: Spinach and kale are high in vitamin K, which antagonizes the effects of
warfarin. Clients should maintain a consistent intake of vitamin K-containing foods
rather than consuming large or variable amounts. Fluctuations can cause wide
variations in INR, increasing bleeding or clotting risk.
10. A client receiving a heparin infusion has an aPTT of 98 seconds. The
therapeutic range is 60-80 seconds. What is the nurse's priority action?
A) Increase the heparin infusion rate as per protocol
B) Assess the client for signs of bleeding and notify the healthcare provider
C) Administer the antidote, protamine sulfate, immediately
D) Continue the infusion as aPTT is within therapeutic range
Answer: B
, Rationale: An aPTT of 98 seconds is above the therapeutic range, indicating
increased bleeding risk. The nurse's priority is to assess for active bleeding
(hematuria, bruising, melena, gum bleeding) and notify the healthcare provider for
a possible dose reduction. Protamine sulfate is reserved for severe bleeding, not an
elevated lab value alone.
11. A client with angina is prescribed sublingual nitroglycerin for chest pain.
Which instruction is most important for the nurse to provide?
A) "Swallow the tablet whole with a full glass of water."
B) "Take one tablet every 30 minutes until the pain subsides."
C) "Place the tablet under your tongue and let it dissolve. Seek emergency care if
pain is not relieved after one dose."
D) "Store the tablets in a warm, bright place to maintain potency."
Answer: C
Rationale: Sublingual nitroglycerin is absorbed through the oral mucosa, bypassing
first-pass metabolism. The correct protocol is: if chest pain occurs, place one tablet
under the tongue; if no relief after 5 minutes, call 911 immediately. Tablets should
be stored in a dark, cool container as heat and light degrade the medication.
12. Which change in data indicates to the nurse that the desired effect of the
angiotensin II receptor antagonist valsartan has been achieved?
A) Dependent edema reduced from +3 to +1
B) Serum HDL increased from 35 to 55 mg/dl
C) Pulse rate reduced from 150 to 90 beats/minute
D) Blood pressure reduced from 160/90 to 130/80 mmHg
Answer: D
Rationale: Valsartan is an angiotensin II receptor blocker (ARB) prescribed
primarily for hypertension. Its mechanism involves blocking angiotensin II binding
in vascular smooth muscle, leading to vasodilation and reduced blood pressure.
The desired therapeutic effect is therefore a reduction in blood pressure.
13. A client taking atorvastatin (Lipitor) develops an increased serum creatine
phosphokinase (CK) level. The nurse should assess the client for the onset of
which problem?
A) Nausea and vomiting
B) Muscle tenderness and pain
C) Excessive bruising
D) Peripheral edema
Answer: B
LATEST 2026/2027 WITH REAL EXAM QUESTIONS AND
CORRECT ANSWERS AND RATIONALE NEW!!!!!!!!!!!!!
1. A nurse is administering digoxin to a client with heart failure. Which finding
requires withholding the medication?
A) Heart rate 58 bpm in an adult
B) Serum potassium 4.2 mEq/L
C) Skin rash
D) Headache
Answer: A
Rationale: Digoxin should be withheld if the adult heart rate is below 60 bpm, as
bradycardia is a sign of digoxin toxicity.
2. A client receiving warfarin (Coumadin) has an INR of 4.5. The client has no
signs of bleeding. Which action should the nurse take?
A) Administer vitamin K IM
B) Hold the next dose and notify the provider
C) Increase the next warfarin dose
D) Administer protamine sulfate
Answer: B
Rationale: Therapeutic INR for most indications is 2-3. An INR of 4.5 is elevated,
indicating increased bleeding risk. The nurse should hold the dose and notify the
provider. Vitamin K is typically given if INR exceeds 10 or if bleeding is present.
3. A nurse is teaching a client about metformin (Glucophage). Which instruction
should the nurse include?
A) "Take this medication on an empty stomach."
B) "Stop taking it for 48 hours before any contrast dye procedure."
C) "It may cause weight gain and increased appetite."
D) "Monitor for signs of lactic acidosis: muscle pain, drowsiness, malaise."
Answer: D
Rationale: Metformin carries a risk of lactic acidosis, a rare but serious adverse
effect. Signs include muscle pain, drowsiness, malaise, and hyperventilation.
Metformin should be held before contrast dye procedures to prevent kidney
damage and lactic acidosis.
,4. A client is prescribed enoxaparin (Lovenox) postoperatively. Which statement
indicates understanding?
A) "I should have my PT/INR checked daily."
B) "I will inject this medication into my abdomen subcutaneously."
C) "I can take aspirin for pain without any risk."
D) "This medication is safe to use with warfarin."
Answer: B
Rationale: Enoxaparin is a low molecular weight heparin administered
subcutaneously, typically in the abdomen. It does not require daily PT/INR
monitoring and should not be combined with aspirin without provider approval due
to bleeding risk.
5. A client receiving IV heparin has a partial thromboplastin time (PTT) of 120
seconds. The nurse should anticipate which order?
A) Increase heparin infusion rate
B) Administer protamine sulfate
C) Draw PTT again in 6 hours
D) Administer vitamin K
Answer: B
Rationale: Therapeutic PTT is 1.5-2.5 times the normal control (approximately 60-
80 seconds). A PTT of 120 seconds indicates excessive anticoagulation and
bleeding risk. Protamine sulfate is the antidote for heparin.
6. A nurse is teaching a client about levothyroxine (Synthroid). Which instruction
is correct?
A) "Take this medication at bedtime with a snack."
B) "Take on an empty stomach in the morning, at least 30-60 minutes before
breakfast."
C) "You can stop the medication once TSH is normal."
D) "Take with calcium supplements to enhance absorption."
Answer: B
Rationale: Levothyroxine is best absorbed on an empty stomach, at least 30-60
minutes before food or other medications. Therapy is typically lifelong, and
calcium supplements should be taken at a different time as they decrease
absorption.
7. A client with heart failure is prescribed digoxin. Which assessment finding
indicates a therapeutic response to the medication?
A) Increased heart rate and decreased urine output
B) Decreased shortness of breath and decreased peripheral edema
,C) Increased appetite and weight gain
D) Decreased blood pressure and increased heart rate
Answer: B
Rationale: Digoxin increases myocardial contractility (positive inotropic effect),
improving cardiac output. This leads to better tissue perfusion and decreased fluid
accumulation, reducing pulmonary congestion (shortness of breath) and peripheral
edema.
8. The nurse is administering digoxin to a client with an apical pulse of 52 beats
per minute. Which action should the nurse take?
A) Administer the dose and document the finding
B) Administer the dose with food to increase absorption
C) Hold the dose and notify the healthcare provider
D) Administer half the dose and recheck the pulse in one hour
Answer: C
Rationale: The apical pulse should be assessed for a full minute before
administering digoxin. If the pulse is below 60 bpm in an adult, the dose should be
withheld and the healthcare provider notified, as bradycardia may indicate digoxin
toxicity.
9. The nurse is educating a client with a new prescription for warfarin (Coumadin).
Which statement by the client indicates a need for further teaching?
A) "I will use a soft-bristled toothbrush to protect my gums."
B) "I will need to have my blood drawn regularly to check my levels."
C) "I can continue to eat large amounts of spinach and kale every day."
D) "I will report any unusual bruising or bleeding to my healthcare provider."
Answer: C
Rationale: Spinach and kale are high in vitamin K, which antagonizes the effects of
warfarin. Clients should maintain a consistent intake of vitamin K-containing foods
rather than consuming large or variable amounts. Fluctuations can cause wide
variations in INR, increasing bleeding or clotting risk.
10. A client receiving a heparin infusion has an aPTT of 98 seconds. The
therapeutic range is 60-80 seconds. What is the nurse's priority action?
A) Increase the heparin infusion rate as per protocol
B) Assess the client for signs of bleeding and notify the healthcare provider
C) Administer the antidote, protamine sulfate, immediately
D) Continue the infusion as aPTT is within therapeutic range
Answer: B
, Rationale: An aPTT of 98 seconds is above the therapeutic range, indicating
increased bleeding risk. The nurse's priority is to assess for active bleeding
(hematuria, bruising, melena, gum bleeding) and notify the healthcare provider for
a possible dose reduction. Protamine sulfate is reserved for severe bleeding, not an
elevated lab value alone.
11. A client with angina is prescribed sublingual nitroglycerin for chest pain.
Which instruction is most important for the nurse to provide?
A) "Swallow the tablet whole with a full glass of water."
B) "Take one tablet every 30 minutes until the pain subsides."
C) "Place the tablet under your tongue and let it dissolve. Seek emergency care if
pain is not relieved after one dose."
D) "Store the tablets in a warm, bright place to maintain potency."
Answer: C
Rationale: Sublingual nitroglycerin is absorbed through the oral mucosa, bypassing
first-pass metabolism. The correct protocol is: if chest pain occurs, place one tablet
under the tongue; if no relief after 5 minutes, call 911 immediately. Tablets should
be stored in a dark, cool container as heat and light degrade the medication.
12. Which change in data indicates to the nurse that the desired effect of the
angiotensin II receptor antagonist valsartan has been achieved?
A) Dependent edema reduced from +3 to +1
B) Serum HDL increased from 35 to 55 mg/dl
C) Pulse rate reduced from 150 to 90 beats/minute
D) Blood pressure reduced from 160/90 to 130/80 mmHg
Answer: D
Rationale: Valsartan is an angiotensin II receptor blocker (ARB) prescribed
primarily for hypertension. Its mechanism involves blocking angiotensin II binding
in vascular smooth muscle, leading to vasodilation and reduced blood pressure.
The desired therapeutic effect is therefore a reduction in blood pressure.
13. A client taking atorvastatin (Lipitor) develops an increased serum creatine
phosphokinase (CK) level. The nurse should assess the client for the onset of
which problem?
A) Nausea and vomiting
B) Muscle tenderness and pain
C) Excessive bruising
D) Peripheral edema
Answer: B
