BSN 315 HESI PHARMACOLOGY II EXAM
WITH ACTUAL QUESTIONS AND
ANSWERS WITH RATIONALES
1. A client receiving WARFARIN is admitted with a major bleed. Which medication will the
nurse expect to be ordered immediately?
A. Vitamin B12
B. Protamine sulfate
C. Vitamin K (phytonadione)
D. Fresh frozen plasma (FFP) only
Answer: C. Vitamin K (phytonadione)
Rationale: Vitamin K reverses warfarin’s effects. In major bleeding, IV vitamin K plus
FFP or prothrombin complex concentrate may be used.
2. A patient on insulin glargine (Lantus) asks why they take it at night. The nurse
explains:
A. “It’s rapid-acting and controls after meals.”
B. “It’s long-acting and provides basal insulin for 24 hours.”
C. “It prevents hypoglycemia overnight only.”
D. “It only works if taken on an empty stomach.”
Answer: B. “It’s long-acting and provides basal insulin for 24 hours.”
Rationale: Insulin glargine is long-acting (basal) insulin, typically given once daily to
provide steady insulin levels.
3. Which medication is most appropriate for immediate reversal of heparin anticoagulation
in a patient with active bleeding?
A. Vitamin K
B. Protamine sulfate
C. Idarucizumab
D. Tranexamic acid
Answer: B. Protamine sulfate
Rationale: Protamine sulfate neutralizes heparin. Idarucizumab reverses dabigatran,
not heparin.
4. A client who takes digoxin develops nausea, visual changes (yellow halos), and
bradycardia. The nurse recognizes this as:
A. Signs of hypokalemia
B. Normal side effects
C. Signs of digoxin toxicity
D. An allergic reaction
, Answer: C. Signs of digoxin toxicity
Rationale: GI symptoms, visual disturbances, and bradycardia are classic for digoxin
toxicity; check serum levels and K+.
5. A client is prescribed metoprolol for hypertension. Which condition would require
caution or avoidance? A. Asthma exacerbation
B. Migraine headaches
C. Hyperthyroidism
D. Sinus bradycardia and heart block
Answer: D. Sinus bradycardia and heart block
Rationale: Beta-blockers lower HR and AV conduction; avoid in bradycardia/AV block.
Use caution with reactive airway disease but cardioselective drugs are preferred.
6. A nurse teaching about nitroglycerin transdermal patches should include which
instruction?
A. “Apply to oily skin for better absorption.”
B. “Remove patch at night to reduce tolerance.”
C. “If headache occurs, remove the patch immediately.”
D. “Keep patches on continuously for best effect.”
Answer: B. “Remove patch at night to reduce tolerance.”
Rationale: A nitrate-free interval (often at night) reduces tolerance. Headaches are
common but not an indication to remove unless severe.
7. Which lab will the nurse monitor for a patient on statin (atorvastatin) therapy?
A. Hemoglobin A1c
B. Serum creatinine
C. Liver function tests (ALT/AST)
D. Serum calcium
Answer: C. Liver function tests (ALT/AST)
Rationale: Statins can cause hepatotoxicity; baseline and periodic LFTs are
recommended.
8. A client is started on levothyroxine for hypothyroidism. Which symptom indicates
appropriate dosing after several weeks?
A. New chest pain and palpitations
B. Improved energy and decreased cold intolerance
C. Weight gain and constipation
D. Worsening depression
Answer: B. Improved energy and decreased cold intolerance
Rationale: Effective thyroid replacement improves hypothyroid symptoms; chest pain
may indicate overtreatment.
9. A patient receiving vancomycin should be monitored for which adverse effect?
A. Ototoxicity and nephrotoxicity
WITH ACTUAL QUESTIONS AND
ANSWERS WITH RATIONALES
1. A client receiving WARFARIN is admitted with a major bleed. Which medication will the
nurse expect to be ordered immediately?
A. Vitamin B12
B. Protamine sulfate
C. Vitamin K (phytonadione)
D. Fresh frozen plasma (FFP) only
Answer: C. Vitamin K (phytonadione)
Rationale: Vitamin K reverses warfarin’s effects. In major bleeding, IV vitamin K plus
FFP or prothrombin complex concentrate may be used.
2. A patient on insulin glargine (Lantus) asks why they take it at night. The nurse
explains:
A. “It’s rapid-acting and controls after meals.”
B. “It’s long-acting and provides basal insulin for 24 hours.”
C. “It prevents hypoglycemia overnight only.”
D. “It only works if taken on an empty stomach.”
Answer: B. “It’s long-acting and provides basal insulin for 24 hours.”
Rationale: Insulin glargine is long-acting (basal) insulin, typically given once daily to
provide steady insulin levels.
3. Which medication is most appropriate for immediate reversal of heparin anticoagulation
in a patient with active bleeding?
A. Vitamin K
B. Protamine sulfate
C. Idarucizumab
D. Tranexamic acid
Answer: B. Protamine sulfate
Rationale: Protamine sulfate neutralizes heparin. Idarucizumab reverses dabigatran,
not heparin.
4. A client who takes digoxin develops nausea, visual changes (yellow halos), and
bradycardia. The nurse recognizes this as:
A. Signs of hypokalemia
B. Normal side effects
C. Signs of digoxin toxicity
D. An allergic reaction
, Answer: C. Signs of digoxin toxicity
Rationale: GI symptoms, visual disturbances, and bradycardia are classic for digoxin
toxicity; check serum levels and K+.
5. A client is prescribed metoprolol for hypertension. Which condition would require
caution or avoidance? A. Asthma exacerbation
B. Migraine headaches
C. Hyperthyroidism
D. Sinus bradycardia and heart block
Answer: D. Sinus bradycardia and heart block
Rationale: Beta-blockers lower HR and AV conduction; avoid in bradycardia/AV block.
Use caution with reactive airway disease but cardioselective drugs are preferred.
6. A nurse teaching about nitroglycerin transdermal patches should include which
instruction?
A. “Apply to oily skin for better absorption.”
B. “Remove patch at night to reduce tolerance.”
C. “If headache occurs, remove the patch immediately.”
D. “Keep patches on continuously for best effect.”
Answer: B. “Remove patch at night to reduce tolerance.”
Rationale: A nitrate-free interval (often at night) reduces tolerance. Headaches are
common but not an indication to remove unless severe.
7. Which lab will the nurse monitor for a patient on statin (atorvastatin) therapy?
A. Hemoglobin A1c
B. Serum creatinine
C. Liver function tests (ALT/AST)
D. Serum calcium
Answer: C. Liver function tests (ALT/AST)
Rationale: Statins can cause hepatotoxicity; baseline and periodic LFTs are
recommended.
8. A client is started on levothyroxine for hypothyroidism. Which symptom indicates
appropriate dosing after several weeks?
A. New chest pain and palpitations
B. Improved energy and decreased cold intolerance
C. Weight gain and constipation
D. Worsening depression
Answer: B. Improved energy and decreased cold intolerance
Rationale: Effective thyroid replacement improves hypothyroid symptoms; chest pain
may indicate overtreatment.
9. A patient receiving vancomycin should be monitored for which adverse effect?
A. Ototoxicity and nephrotoxicity
