Nightingale BSN 315 Pharmacology II New HESI
Practice Exam (2026): Comprehensive Review with | 2
versions| HESI-Style Questions, Verified Answers &
Detailed Rationales
Section 1:
Pharmacokinetics, Pharmacodynamics, Medication Safety, and Autonomic Nervous
System Drugs
Question 1
A nurse is preparing to administer a medication that has a narrow therapeutic index to a
hospitalized adult patient. Which nursing action is the highest priority to minimize the risk of
toxicity while ensuring therapeutic effectiveness?
A. Administer the medication immediately after meals regardless of the prescription.
B. Encourage the patient to increase fluid intake without reviewing laboratory values.
C. Monitor prescribed serum drug levels and assess the patient for therapeutic and
adverse effects before administering subsequent doses.
D. Skip the medication if the patient reports mild nausea before administration.
Correct Answer: C
Rationale: Drugs with a narrow therapeutic index require close monitoring of serum
concentrations and patient assessment to maintain therapeutic levels while preventing
toxicity.
Question 2
,A patient receives an oral medication that undergoes significant first-pass metabolism in the
liver before reaching systemic circulation. Which statement best explains the effect of first-
pass metabolism?
A. It reduces the amount of active drug that reaches systemic circulation after oral
administration.
B. It increases renal elimination before absorption occurs.
C. It prevents gastrointestinal absorption of the medication.
D. It causes immediate therapeutic drug levels after ingestion.
Correct Answer: A
Rationale: First-pass metabolism occurs primarily in the liver and reduces the bioavailability
of many orally administered medications.
Question 3
A nurse is educating a patient about medications with a long half-life. Which statement by
the nurse is most accurate?
A. The medication will always require multiple doses each day.
B. The medication remains in the body longer and may require less frequent dosing.
C. The medication is eliminated before reaching therapeutic levels.
D. The medication has no risk of accumulation.
Correct Answer: B
Rationale: Drugs with long half-lives remain in circulation longer and often require less
frequent administration but may accumulate if dosing is excessive.
Question 4
A patient asks why a loading dose of an antibiotic was prescribed before maintenance
dosing. Which response by the nurse is most appropriate?
,A. Loading doses decrease drug elimination.
B. Loading doses reduce adverse reactions.
C. Loading doses rapidly achieve therapeutic drug concentrations.
D. Loading doses prevent allergic reactions.
Correct Answer: C
Rationale: A loading dose quickly establishes therapeutic plasma concentrations, especially
for medications with long half-lives.
Question 5
A nurse reviews a medication order before administration. Which action best demonstrates
adherence to the rights of medication administration?
A. Asking another nurse if the medication appears correct without reviewing the patient's
record.
B. Verifying the patient's identity using two approved identifiers before administering
the medication.
C. Administering the medication immediately after locating the medication label.
D. Giving medications based on room number when the patient confirms hospitalization.
Correct Answer: B
Rationale: Using two patient identifiers is a fundamental safety practice that helps prevent
medication administration errors.
Question 6
A nurse prepares to administer insulin to a patient with diabetes. Which laboratory value
should be reviewed first to promote safe medication administration?
A. Hemoglobin
B. Platelet count
, C. Current blood glucose level
D. White blood cell count
Correct Answer: C
Rationale: Blood glucose levels guide insulin administration and reduce the risk of
hypoglycemia or hyperglycemia.
Question 7
A nurse identifies a medication error before administering the medication to a patient. What
is the nurse's priority action?
A. Ignore the discrepancy if the patient appears stable.
B. Hold the medication and clarify the order with the prescribing provider.
C. Administer half of the prescribed dose.
D. Ask the patient to decide whether to take the medication.
Correct Answer: B
Rationale: Medication discrepancies should always be clarified before administration to
ensure patient safety.
Question 8
A patient experiences severe facial swelling and difficulty breathing shortly after receiving
intravenous penicillin. Which action should the nurse perform first?
A. Notify the pharmacist.
B. Document the reaction.
C. Stop the medication and initiate emergency management for anaphylaxis.
D. Reassure the patient that symptoms will improve.
Correct Answer: C
Practice Exam (2026): Comprehensive Review with | 2
versions| HESI-Style Questions, Verified Answers &
Detailed Rationales
Section 1:
Pharmacokinetics, Pharmacodynamics, Medication Safety, and Autonomic Nervous
System Drugs
Question 1
A nurse is preparing to administer a medication that has a narrow therapeutic index to a
hospitalized adult patient. Which nursing action is the highest priority to minimize the risk of
toxicity while ensuring therapeutic effectiveness?
A. Administer the medication immediately after meals regardless of the prescription.
B. Encourage the patient to increase fluid intake without reviewing laboratory values.
C. Monitor prescribed serum drug levels and assess the patient for therapeutic and
adverse effects before administering subsequent doses.
D. Skip the medication if the patient reports mild nausea before administration.
Correct Answer: C
Rationale: Drugs with a narrow therapeutic index require close monitoring of serum
concentrations and patient assessment to maintain therapeutic levels while preventing
toxicity.
Question 2
,A patient receives an oral medication that undergoes significant first-pass metabolism in the
liver before reaching systemic circulation. Which statement best explains the effect of first-
pass metabolism?
A. It reduces the amount of active drug that reaches systemic circulation after oral
administration.
B. It increases renal elimination before absorption occurs.
C. It prevents gastrointestinal absorption of the medication.
D. It causes immediate therapeutic drug levels after ingestion.
Correct Answer: A
Rationale: First-pass metabolism occurs primarily in the liver and reduces the bioavailability
of many orally administered medications.
Question 3
A nurse is educating a patient about medications with a long half-life. Which statement by
the nurse is most accurate?
A. The medication will always require multiple doses each day.
B. The medication remains in the body longer and may require less frequent dosing.
C. The medication is eliminated before reaching therapeutic levels.
D. The medication has no risk of accumulation.
Correct Answer: B
Rationale: Drugs with long half-lives remain in circulation longer and often require less
frequent administration but may accumulate if dosing is excessive.
Question 4
A patient asks why a loading dose of an antibiotic was prescribed before maintenance
dosing. Which response by the nurse is most appropriate?
,A. Loading doses decrease drug elimination.
B. Loading doses reduce adverse reactions.
C. Loading doses rapidly achieve therapeutic drug concentrations.
D. Loading doses prevent allergic reactions.
Correct Answer: C
Rationale: A loading dose quickly establishes therapeutic plasma concentrations, especially
for medications with long half-lives.
Question 5
A nurse reviews a medication order before administration. Which action best demonstrates
adherence to the rights of medication administration?
A. Asking another nurse if the medication appears correct without reviewing the patient's
record.
B. Verifying the patient's identity using two approved identifiers before administering
the medication.
C. Administering the medication immediately after locating the medication label.
D. Giving medications based on room number when the patient confirms hospitalization.
Correct Answer: B
Rationale: Using two patient identifiers is a fundamental safety practice that helps prevent
medication administration errors.
Question 6
A nurse prepares to administer insulin to a patient with diabetes. Which laboratory value
should be reviewed first to promote safe medication administration?
A. Hemoglobin
B. Platelet count
, C. Current blood glucose level
D. White blood cell count
Correct Answer: C
Rationale: Blood glucose levels guide insulin administration and reduce the risk of
hypoglycemia or hyperglycemia.
Question 7
A nurse identifies a medication error before administering the medication to a patient. What
is the nurse's priority action?
A. Ignore the discrepancy if the patient appears stable.
B. Hold the medication and clarify the order with the prescribing provider.
C. Administer half of the prescribed dose.
D. Ask the patient to decide whether to take the medication.
Correct Answer: B
Rationale: Medication discrepancies should always be clarified before administration to
ensure patient safety.
Question 8
A patient experiences severe facial swelling and difficulty breathing shortly after receiving
intravenous penicillin. Which action should the nurse perform first?
A. Notify the pharmacist.
B. Document the reaction.
C. Stop the medication and initiate emergency management for anaphylaxis.
D. Reassure the patient that symptoms will improve.
Correct Answer: C
