BSN 315 Pharmacology HESI V7 — COMPREHENSIVE
FINAL EXAM QUESTIONS AND ANSWERS|NEW 2026-
2027 UPDATE
Question 1
A patient with HFrEF (EF 30%) remains symptomatic (NYHA III) on lisinopril,
metoprolol succinate, and spironolactone. Potassium is 4.0, creatinine 1.2. What is the
next evidence-based step?
A. Add digoxin 0.125 mg daily
B. Switch lisinopril to sacubitril/valsartan (Entresto)
C. Add hydralazine/isosorbide dinitrate
D. Increase spironolactone to 50 mg
Correct Answer: B
Rationale: PARADIGM-HF demonstrated that sacubitril/valsartan (ARNI) reduces CV
death and HF hospitalization vs. enalapril in symptomatic HFrEF on standard therapy.
It is guideline-recommended to replace ACEi/ARB in eligible patients. Digoxin is
adjunctive for symptoms. Hydralazine/isosorbide is for African Americans or ACEi-
intolerant patients. Increasing spironolactone risks hyperkalemia.
Question 2
A patient with type 2 diabetes, BMI 40, HbA1c 9.3% on metformin. No CVD or CKD.
Which add-on is MOST appropriate for glycemic control and weight loss?
A. Glipizide 10 mg daily
B. Pioglitazone 30 mg daily
C. Semaglutide 1.0 mg SC weekly
D. Insulin glargine 20 units at bedtime
Correct Answer: C
Rationale: Semaglutide (GLP-1 RA) lowers HbA1c by ~1.5-1.8%, promotes 10-15%
weight loss, and has low hypoglycemia risk. It is ideal for obese patients. Glipizide
, causes weight gain and hypoglycemia. Pioglitazone causes weight gain and fluid
retention. Basal insulin is effective but causes weight gain and hypoglycemia; not
first-line add-on when obesity is a concern.
Question 3
A patient on warfarin (mechanical mitral valve, target INR 2.5-3.5) has an INR of 4.2
without bleeding. What is the appropriate action?
A. Hold warfarin and give vitamin K 10 mg IV
B. Hold 1-2 doses, monitor INR, consider low-dose vitamin K if bleeding risk is high
C. Administer fresh frozen plasma
D. Continue warfarin at same dose
Correct Answer: B
Rationale: For mechanical valve patients, INR 4.2 is elevated but without bleeding:
hold 1-2 doses, monitor daily. Low-dose oral vitamin K (1-2.5 mg) may be considered
if bleeding risk is high. Mechanical valve patients need careful balance — high INR
increases bleeding but rapid reversal increases thrombosis risk. IV vitamin K and FFP
are reserved for serious bleeding or INR >10.
Question 4
A patient receives morphine 4 mg IV for post-op pain. RR drops to 8, pinpoint pupils,
decreased LOC. What is the FIRST priority?
A. Apply O₂ at 2L NC
B. Administer naloxone 0.4-2 mg IV immediately
C. Encourage deep breathing
D. Document and notify provider in 30 min
Correct Answer: B
Rationale: RR 8 with pinpoint pupils after opioid = opioid-induced respiratory
depression, a medical emergency. Naloxone (opioid antagonist) 0.4-2 mg IV/IM/IN
, reverses respiratory depression. Repeat q2-3 min as needed (max 10 mg). Oxygen
alone is insufficient. Deep breathing is ineffective. Delaying treatment risks
respiratory arrest.
Question 5
A patient with CAP and severe penicillin allergy (anaphylaxis) needs outpatient
antibiotic therapy. Which is MOST appropriate?
A. Amoxicillin-clavulanate
B. Azithromycin
C. Doxycycline or levofloxacin
D. Cefuroxime
Correct Answer: C
Rationale: For CAP with severe penicillin allergy, doxycycline or a respiratory
fluoroquinolone (levofloxacin, moxifloxacin) are recommended. Azithromycin
monotherapy is NOT recommended due to high pneumococcal resistance.
Amoxicillin-clavulanate and cefuroxime are contraindicated in anaphylactic penicillin
allergy (cephalosporin cross-reactivity ~10%).
Question 6
A patient with Graves' disease on methimazole develops fever, sore throat, and
severe malaise. WBC 2.1, ANC 800. What is the priority action?
A. Continue methimazole and start acetaminophen
B. Stop methimazole immediately, obtain CBC, notify provider
C. Switch to PTU immediately
D. Start propranolol and continue methimazole
Correct Answer: B
Rationale: Agranulocytosis (ANC <500) is a life-threatening adverse effect of
thionamides. Methimazole must be STOPPED immediately and NEVER rechallenged.
FINAL EXAM QUESTIONS AND ANSWERS|NEW 2026-
2027 UPDATE
Question 1
A patient with HFrEF (EF 30%) remains symptomatic (NYHA III) on lisinopril,
metoprolol succinate, and spironolactone. Potassium is 4.0, creatinine 1.2. What is the
next evidence-based step?
A. Add digoxin 0.125 mg daily
B. Switch lisinopril to sacubitril/valsartan (Entresto)
C. Add hydralazine/isosorbide dinitrate
D. Increase spironolactone to 50 mg
Correct Answer: B
Rationale: PARADIGM-HF demonstrated that sacubitril/valsartan (ARNI) reduces CV
death and HF hospitalization vs. enalapril in symptomatic HFrEF on standard therapy.
It is guideline-recommended to replace ACEi/ARB in eligible patients. Digoxin is
adjunctive for symptoms. Hydralazine/isosorbide is for African Americans or ACEi-
intolerant patients. Increasing spironolactone risks hyperkalemia.
Question 2
A patient with type 2 diabetes, BMI 40, HbA1c 9.3% on metformin. No CVD or CKD.
Which add-on is MOST appropriate for glycemic control and weight loss?
A. Glipizide 10 mg daily
B. Pioglitazone 30 mg daily
C. Semaglutide 1.0 mg SC weekly
D. Insulin glargine 20 units at bedtime
Correct Answer: C
Rationale: Semaglutide (GLP-1 RA) lowers HbA1c by ~1.5-1.8%, promotes 10-15%
weight loss, and has low hypoglycemia risk. It is ideal for obese patients. Glipizide
, causes weight gain and hypoglycemia. Pioglitazone causes weight gain and fluid
retention. Basal insulin is effective but causes weight gain and hypoglycemia; not
first-line add-on when obesity is a concern.
Question 3
A patient on warfarin (mechanical mitral valve, target INR 2.5-3.5) has an INR of 4.2
without bleeding. What is the appropriate action?
A. Hold warfarin and give vitamin K 10 mg IV
B. Hold 1-2 doses, monitor INR, consider low-dose vitamin K if bleeding risk is high
C. Administer fresh frozen plasma
D. Continue warfarin at same dose
Correct Answer: B
Rationale: For mechanical valve patients, INR 4.2 is elevated but without bleeding:
hold 1-2 doses, monitor daily. Low-dose oral vitamin K (1-2.5 mg) may be considered
if bleeding risk is high. Mechanical valve patients need careful balance — high INR
increases bleeding but rapid reversal increases thrombosis risk. IV vitamin K and FFP
are reserved for serious bleeding or INR >10.
Question 4
A patient receives morphine 4 mg IV for post-op pain. RR drops to 8, pinpoint pupils,
decreased LOC. What is the FIRST priority?
A. Apply O₂ at 2L NC
B. Administer naloxone 0.4-2 mg IV immediately
C. Encourage deep breathing
D. Document and notify provider in 30 min
Correct Answer: B
Rationale: RR 8 with pinpoint pupils after opioid = opioid-induced respiratory
depression, a medical emergency. Naloxone (opioid antagonist) 0.4-2 mg IV/IM/IN
, reverses respiratory depression. Repeat q2-3 min as needed (max 10 mg). Oxygen
alone is insufficient. Deep breathing is ineffective. Delaying treatment risks
respiratory arrest.
Question 5
A patient with CAP and severe penicillin allergy (anaphylaxis) needs outpatient
antibiotic therapy. Which is MOST appropriate?
A. Amoxicillin-clavulanate
B. Azithromycin
C. Doxycycline or levofloxacin
D. Cefuroxime
Correct Answer: C
Rationale: For CAP with severe penicillin allergy, doxycycline or a respiratory
fluoroquinolone (levofloxacin, moxifloxacin) are recommended. Azithromycin
monotherapy is NOT recommended due to high pneumococcal resistance.
Amoxicillin-clavulanate and cefuroxime are contraindicated in anaphylactic penicillin
allergy (cephalosporin cross-reactivity ~10%).
Question 6
A patient with Graves' disease on methimazole develops fever, sore throat, and
severe malaise. WBC 2.1, ANC 800. What is the priority action?
A. Continue methimazole and start acetaminophen
B. Stop methimazole immediately, obtain CBC, notify provider
C. Switch to PTU immediately
D. Start propranolol and continue methimazole
Correct Answer: B
Rationale: Agranulocytosis (ANC <500) is a life-threatening adverse effect of
thionamides. Methimazole must be STOPPED immediately and NEVER rechallenged.
