BSN HESI 315 Pharmacology Practice Exam
(New 2026/ 2027 ) Questions & Answers
with Rationale |100% Correct| Grade A -
Nightingale
Q1. A client with heart failure is prescribed furosemide. Which laboratory value should
the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, leading to significant potassium wasting. Hypokalemia is
a common and dangerous adverse effect that can precipitate cardiac dysrhythmias,
especially in patients taking digoxin.
Q2. The nurse is administering IV vancomycin. Which adverse effect requires the nurse
to stop the infusion immediately?
A) Nausea
B) Headache
C) Flushing and pruritus of the neck and face
D) Dizziness
Answer: C) Flushing and pruritus of the neck and face
Rationale: Flushing, pruritus, and erythema of the neck, face, and upper torso are classic
signs of "Red Man Syndrome," caused by a rapid infusion of vancomycin that triggers
histamine release. The infusion should be stopped or slowed significantly, and the
provider notified.
,Q3. A client is prescribed metformin for type 2 diabetes. Which instruction is most
important for the nurse to include in discharge teaching?
A) Take the medication with food to reduce gastrointestinal upset.
B) Monitor for signs of hypoglycemia.
C) Hold the medication 48 hours before and after receiving IV contrast dye.
D) Expect weight gain as a side effect.
Answer: C) Hold the medication 48 hours before and after receiving IV contrast dye.
Rationale: Metformin carries a risk of lactic acidosis, especially in clients with renal
impairment. IV contrast dye can acutely worsen renal function; therefore, metformin
should be held for 48 hours before and after the procedure to prevent drug
accumulation and lactic acidosis.
Q4. The nurse is caring for a client receiving lithium carbonate for bipolar disorder.
Which serum lithium level indicates toxicity?
A) 0.6 mEq/L
B) 0.8 mEq/L
C) 1.2 mEq/L
D) 1.8 mEq/L
Answer: D) 1.8 mEq/L
Rationale: The therapeutic range for lithium is 0.6–1.2 mEq/L. Levels above 1.5 mEq/L
are considered toxic. Early signs of toxicity include coarse tremors, nausea, vomiting, and
diarrhea. Severe toxicity (>2.0 mEq/L) can lead to seizures, coma, and death.
Q5. A client on warfarin has an International Normalized Ratio (INR) of 5.0. Which
medication should the nurse prepare to administer?
A) Protamine sulfate
B) Vitamin K (phytonadione)
C) Naloxone
D) Flumazenil
Answer: B) Vitamin K (phytonadione)
Rationale: The therapeutic INR range for most indications is 2.0–3.0. An INR of 5.0
indicates significant over-anticoagulation with warfarin, a vitamin K antagonist. Vitamin
,K is the specific antidote that reverses warfarin's effects by promoting the synthesis of
clotting factors.
Q6. A client is prescribed amoxicillin for a respiratory infection. Which statement by the
client indicates a need for further teaching?
A) "I should finish all of this medication even if I feel better."
B) "I can take this medication with or without food."
C) "I will stop taking it if I develop a rash."
D) "I should report any watery diarrhea that does not stop."
Answer: C) "I will stop taking it if I develop a rash."
Rationale: A rash can indicate an allergic reaction to penicillin; however, the client
should be instructed to notify the provider before stopping the medication. More
importantly, stopping an antibiotic prematurely can lead to antibiotic resistance and
recurrence of infection. Clients should also report severe watery diarrhea as it may
indicate C. difficile infection.
Q7. Which medication is most commonly associated with ototoxicity and
nephrotoxicity?
A) Gentamicin
B) Azithromycin
C) Ciprofloxacin
D) Doxycycline
Answer: A) Gentamicin
Rationale: Gentamicin is an aminoglycoside antibiotic. It is well-known for its dose-
dependent nephrotoxicity (damage to renal tubules) and ototoxicity (damage to the
eighth cranial nerve causing hearing loss and vestibular dysfunction). Peak and trough
levels must be monitored closely.
Q8. A client with asthma is prescribed albuterol via metered-dose inhaler. The nurse
explains that the primary action of this medication is to:
A) Reduce airway inflammation
, B) Decrease mucus production
C) Dilate bronchioles by stimulating beta-2 receptors
D) Block histamine release
Answer: C) Dilate bronchioles by stimulating beta-2 receptors
Rationale: Albuterol is a short-acting beta-2 agonist (SABA). It works by stimulating
beta-2 adrenergic receptors in the bronchial smooth muscle, leading to bronchodilation.
It is a rescue medication for acute bronchospasm, not a controller medication for
inflammation.
Q9. A client is prescribed digoxin and furosemide. Which electrolyte imbalance increases
the risk of digoxin toxicity?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B) Hypokalemia
Rationale: Furosemide causes potassium loss. Hypokalemia increases the binding of
digoxin to cardiac sodium-potassium ATPase pumps, potentiating its effects and
significantly increasing the risk of digoxin toxicity, which can manifest as nausea,
vomiting, visual disturbances (yellow-green halos), and cardiac dysrhythmias.
Q10. The nurse is administering morphine sulfate to a client post-operatively. Which
adverse effect requires priority nursing intervention?
A) Constipation
B) Urinary retention
C) Respiratory depression
D) Nausea
Answer: C) Respiratory depression
Rationale: Morphine is an opioid agonist that depresses the respiratory center in the
brainstem. Respiratory depression is the most life-threatening adverse effect. The nurse
must monitor respiratory rate and depth; if the rate is <12 breaths/min, the nurse
should hold the medication and consider administering naloxone (the antidote).
(New 2026/ 2027 ) Questions & Answers
with Rationale |100% Correct| Grade A -
Nightingale
Q1. A client with heart failure is prescribed furosemide. Which laboratory value should
the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, leading to significant potassium wasting. Hypokalemia is
a common and dangerous adverse effect that can precipitate cardiac dysrhythmias,
especially in patients taking digoxin.
Q2. The nurse is administering IV vancomycin. Which adverse effect requires the nurse
to stop the infusion immediately?
A) Nausea
B) Headache
C) Flushing and pruritus of the neck and face
D) Dizziness
Answer: C) Flushing and pruritus of the neck and face
Rationale: Flushing, pruritus, and erythema of the neck, face, and upper torso are classic
signs of "Red Man Syndrome," caused by a rapid infusion of vancomycin that triggers
histamine release. The infusion should be stopped or slowed significantly, and the
provider notified.
,Q3. A client is prescribed metformin for type 2 diabetes. Which instruction is most
important for the nurse to include in discharge teaching?
A) Take the medication with food to reduce gastrointestinal upset.
B) Monitor for signs of hypoglycemia.
C) Hold the medication 48 hours before and after receiving IV contrast dye.
D) Expect weight gain as a side effect.
Answer: C) Hold the medication 48 hours before and after receiving IV contrast dye.
Rationale: Metformin carries a risk of lactic acidosis, especially in clients with renal
impairment. IV contrast dye can acutely worsen renal function; therefore, metformin
should be held for 48 hours before and after the procedure to prevent drug
accumulation and lactic acidosis.
Q4. The nurse is caring for a client receiving lithium carbonate for bipolar disorder.
Which serum lithium level indicates toxicity?
A) 0.6 mEq/L
B) 0.8 mEq/L
C) 1.2 mEq/L
D) 1.8 mEq/L
Answer: D) 1.8 mEq/L
Rationale: The therapeutic range for lithium is 0.6–1.2 mEq/L. Levels above 1.5 mEq/L
are considered toxic. Early signs of toxicity include coarse tremors, nausea, vomiting, and
diarrhea. Severe toxicity (>2.0 mEq/L) can lead to seizures, coma, and death.
Q5. A client on warfarin has an International Normalized Ratio (INR) of 5.0. Which
medication should the nurse prepare to administer?
A) Protamine sulfate
B) Vitamin K (phytonadione)
C) Naloxone
D) Flumazenil
Answer: B) Vitamin K (phytonadione)
Rationale: The therapeutic INR range for most indications is 2.0–3.0. An INR of 5.0
indicates significant over-anticoagulation with warfarin, a vitamin K antagonist. Vitamin
,K is the specific antidote that reverses warfarin's effects by promoting the synthesis of
clotting factors.
Q6. A client is prescribed amoxicillin for a respiratory infection. Which statement by the
client indicates a need for further teaching?
A) "I should finish all of this medication even if I feel better."
B) "I can take this medication with or without food."
C) "I will stop taking it if I develop a rash."
D) "I should report any watery diarrhea that does not stop."
Answer: C) "I will stop taking it if I develop a rash."
Rationale: A rash can indicate an allergic reaction to penicillin; however, the client
should be instructed to notify the provider before stopping the medication. More
importantly, stopping an antibiotic prematurely can lead to antibiotic resistance and
recurrence of infection. Clients should also report severe watery diarrhea as it may
indicate C. difficile infection.
Q7. Which medication is most commonly associated with ototoxicity and
nephrotoxicity?
A) Gentamicin
B) Azithromycin
C) Ciprofloxacin
D) Doxycycline
Answer: A) Gentamicin
Rationale: Gentamicin is an aminoglycoside antibiotic. It is well-known for its dose-
dependent nephrotoxicity (damage to renal tubules) and ototoxicity (damage to the
eighth cranial nerve causing hearing loss and vestibular dysfunction). Peak and trough
levels must be monitored closely.
Q8. A client with asthma is prescribed albuterol via metered-dose inhaler. The nurse
explains that the primary action of this medication is to:
A) Reduce airway inflammation
, B) Decrease mucus production
C) Dilate bronchioles by stimulating beta-2 receptors
D) Block histamine release
Answer: C) Dilate bronchioles by stimulating beta-2 receptors
Rationale: Albuterol is a short-acting beta-2 agonist (SABA). It works by stimulating
beta-2 adrenergic receptors in the bronchial smooth muscle, leading to bronchodilation.
It is a rescue medication for acute bronchospasm, not a controller medication for
inflammation.
Q9. A client is prescribed digoxin and furosemide. Which electrolyte imbalance increases
the risk of digoxin toxicity?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B) Hypokalemia
Rationale: Furosemide causes potassium loss. Hypokalemia increases the binding of
digoxin to cardiac sodium-potassium ATPase pumps, potentiating its effects and
significantly increasing the risk of digoxin toxicity, which can manifest as nausea,
vomiting, visual disturbances (yellow-green halos), and cardiac dysrhythmias.
Q10. The nurse is administering morphine sulfate to a client post-operatively. Which
adverse effect requires priority nursing intervention?
A) Constipation
B) Urinary retention
C) Respiratory depression
D) Nausea
Answer: C) Respiratory depression
Rationale: Morphine is an opioid agonist that depresses the respiratory center in the
brainstem. Respiratory depression is the most life-threatening adverse effect. The nurse
must monitor respiratory rate and depth; if the rate is <12 breaths/min, the nurse
should hold the medication and consider administering naloxone (the antidote).
