BSN HESI 315 Pharmacology Practice Exam V1
2026/2027 | Questions & Verified Answers | 100%
Correct | Grade A
Institution: Nightingale College School of Nursing
Academic Context: 2026/2027 BSN Program Preparation
Total Questions: 55 Estimated Time: 65 min
Format: Computer-Adaptive Simulation (Linear Version) – Multiple Choice (MC),
Select-All-That-Apply (SATA), Ordered Response (OR)
SECTION 1 Pharmacology Foundations & Safety (Q 1-15)
1. A client is ordered vancomycin 1 g IV every 12 h. The nurse notes the last trough
drawn 2 h after the dose was 24 µg/mL. Which action is most appropriate?
A. Give the next dose now and recheck trough after the following dose
B. Hold the dose and contact the prescriber immediately
C. Decrease the dose by 25 % and continue per protocol
D. Increase the infusion rate to complete the dose in 30 min
Correct Answer: B
Rationale: Therapeutic vancomycin trough 10–20 µg/mL (≤15 for MIC ≥1). 24 µg/mL
indicates nephrotoxic risk; holding and notifying provider prevents toxicity. Distractors:
A—trough drawn at wrong time invalidates result; C—nurse-initiated dose change
unsafe; D—rapid infusion increases “red-man” risk.
2. The nurse prepares to administer high-alert heparin 5000 units IV push. Which
right of medication administration is most critical to double-check with a second
nurse?
, A. Right time
B. Right dose
C. Right route
D. Right documentation
Correct Answer: B
Rationale: Heparin errors commonly involve 10-fold overdoses; independent
double-check of concentration and calculated dose prevents harm. Other rights are
important but dose is highest-risk.
3. A 20-kg child is prescribed oral cephalexin 50 mg/kg/day divided q8h. Pharmacy
stocks 250 mg/5 mL. How many mL per dose? (Record numeric answer only.)
Correct Answer: 6.7 mL
Rationale: 50 mg × 20 kg = 1000 mg/day ÷ 3 doses = 333 mg/dose. (333 mg ÷ 250 mg)
× 5 mL = 6.66 → 6.7 mL.
4. The nurse discovers that a client received enoxaparin 40 mg SC but the order
read “enoxaparin 40 mg IV.” Place the following nursing actions in order (1 = first,
4 = last).
A. Assess client for signs of bleeding
B. Complete incident report
C. Notify prescriber
D. Check coagulation studies per protocol
Correct Answer: C, A, D, B
Rationale: Immediate client safety (notify, assess), then monitoring, finally system-level
follow-up.
5. Which factor most increases free drug concentration in a client taking phenytoin
who has hypoalbuminemia?
A. Increased hepatic metabolism
B. Decreased renal excretion
, C. Reduced protein binding
D. Enhanced bioavailability
Correct Answer: C
Rationale: Phenytoin is 90 % albumin-bound; low albumin raises pharmacologically
active free drug, increasing risk of toxicity at lower total levels.
6. A client asks why nitroglycerin tablets tingle when effective. The nurse’s best
reply:
A. “The tingle means the drug is inert—spit it out.”
B. “Tingling indicates proper potency; if absent, replace the bottle.”
C. “Tingling is an expected vasodilatory side effect.”
D. “It shows rapid absorption through the stomach lining.”
Correct Answer: B
Rationale: NTG tablets lose potency when exposed to air/light; tingling is a quick
potency check.
7. SATA. The nurse recognizes which drugs as high-alert LASA pairs? (Select all.)
A. Metformin—Metronidazole
B. Humulin R—Humalog
C. Hydralazine—Hydroxyzine
D. Acetaminophen—Aspirin
E. Clonidine—Klonopin
Correct Answers: B, C, E
Rationale: Similar names and serious harm potential; A & D do not share sound-alike
risk.
8. The nurse administers digoxin 0.25 mg PO. Which finding warrants withholding
the dose and calling the provider?
A. Apical pulse 58 bpm
B. Serum potassium 3.2 mEq/L
C. Serum creatinine 1.3 mg/dL
D. Client reports yellow haze vision
2026/2027 | Questions & Verified Answers | 100%
Correct | Grade A
Institution: Nightingale College School of Nursing
Academic Context: 2026/2027 BSN Program Preparation
Total Questions: 55 Estimated Time: 65 min
Format: Computer-Adaptive Simulation (Linear Version) – Multiple Choice (MC),
Select-All-That-Apply (SATA), Ordered Response (OR)
SECTION 1 Pharmacology Foundations & Safety (Q 1-15)
1. A client is ordered vancomycin 1 g IV every 12 h. The nurse notes the last trough
drawn 2 h after the dose was 24 µg/mL. Which action is most appropriate?
A. Give the next dose now and recheck trough after the following dose
B. Hold the dose and contact the prescriber immediately
C. Decrease the dose by 25 % and continue per protocol
D. Increase the infusion rate to complete the dose in 30 min
Correct Answer: B
Rationale: Therapeutic vancomycin trough 10–20 µg/mL (≤15 for MIC ≥1). 24 µg/mL
indicates nephrotoxic risk; holding and notifying provider prevents toxicity. Distractors:
A—trough drawn at wrong time invalidates result; C—nurse-initiated dose change
unsafe; D—rapid infusion increases “red-man” risk.
2. The nurse prepares to administer high-alert heparin 5000 units IV push. Which
right of medication administration is most critical to double-check with a second
nurse?
, A. Right time
B. Right dose
C. Right route
D. Right documentation
Correct Answer: B
Rationale: Heparin errors commonly involve 10-fold overdoses; independent
double-check of concentration and calculated dose prevents harm. Other rights are
important but dose is highest-risk.
3. A 20-kg child is prescribed oral cephalexin 50 mg/kg/day divided q8h. Pharmacy
stocks 250 mg/5 mL. How many mL per dose? (Record numeric answer only.)
Correct Answer: 6.7 mL
Rationale: 50 mg × 20 kg = 1000 mg/day ÷ 3 doses = 333 mg/dose. (333 mg ÷ 250 mg)
× 5 mL = 6.66 → 6.7 mL.
4. The nurse discovers that a client received enoxaparin 40 mg SC but the order
read “enoxaparin 40 mg IV.” Place the following nursing actions in order (1 = first,
4 = last).
A. Assess client for signs of bleeding
B. Complete incident report
C. Notify prescriber
D. Check coagulation studies per protocol
Correct Answer: C, A, D, B
Rationale: Immediate client safety (notify, assess), then monitoring, finally system-level
follow-up.
5. Which factor most increases free drug concentration in a client taking phenytoin
who has hypoalbuminemia?
A. Increased hepatic metabolism
B. Decreased renal excretion
, C. Reduced protein binding
D. Enhanced bioavailability
Correct Answer: C
Rationale: Phenytoin is 90 % albumin-bound; low albumin raises pharmacologically
active free drug, increasing risk of toxicity at lower total levels.
6. A client asks why nitroglycerin tablets tingle when effective. The nurse’s best
reply:
A. “The tingle means the drug is inert—spit it out.”
B. “Tingling indicates proper potency; if absent, replace the bottle.”
C. “Tingling is an expected vasodilatory side effect.”
D. “It shows rapid absorption through the stomach lining.”
Correct Answer: B
Rationale: NTG tablets lose potency when exposed to air/light; tingling is a quick
potency check.
7. SATA. The nurse recognizes which drugs as high-alert LASA pairs? (Select all.)
A. Metformin—Metronidazole
B. Humulin R—Humalog
C. Hydralazine—Hydroxyzine
D. Acetaminophen—Aspirin
E. Clonidine—Klonopin
Correct Answers: B, C, E
Rationale: Similar names and serious harm potential; A & D do not share sound-alike
risk.
8. The nurse administers digoxin 0.25 mg PO. Which finding warrants withholding
the dose and calling the provider?
A. Apical pulse 58 bpm
B. Serum potassium 3.2 mEq/L
C. Serum creatinine 1.3 mg/dL
D. Client reports yellow haze vision
