1
BSN 315 HESI RN Specialty
Pharmacology Exam V1 Actual Exam
2026/2027 | Nightingale | Questions
with Verified Answers | 100% Correct |
Pass Guaranteed
Q001: A 6-year-old child with acute lymphoblastic leukemia is prescribed
intrathecal methotrexate 12 mg. The vial contains 25 mg/mL. After calculating the
exact volume needed, the nurse notes the residual volume in the dead space of the
25-gauge spinal needle is 0.1 mL. Which action best ensures the intended dose
reaches the cerebrospinal fluid?
Options:
A. Administer an additional 0.1 mL to compensate for dead space
B. Flush the needle with 0.2 mL of preservative-free normal saline after injection
C. Withdraw 0.48 mL, then inject the entire volume without flushing
D. Use a 30-gauge needle to reduce dead-space loss
ANSWER: B
Q002: A 72-kg patient in the MICU develops torsades de pointes after receiving IV
haloperidol 10 mg × 3 doses. Magnesium sulfate 2 g IV has already been given.
The physician orders IV ibutilide. Prior to administration, which lab value is most
critical to verify?
Options:
A. Serum calcium 8.9 mg/dL
, 2
B. Creatinine clearance 38 mL/min
C. Serum potassium 2.8 mEq/L
D. ALT 58 IU/L
ANSWER: C
Q003: A neonate born at 28 weeks’ gestation (Day 5 of life) is receiving caffeine
citrate 5 mg/kg IV q24h for apnea of prematurity. The trough serum level is 8
µg/mL (target 5–25 µg/mL), but episodes of apnea increase to 12 per shift. Which
pharmacokinetic factor best explains the suboptimal response?
Options:
A. Renal clearance is decreased due to proximal tubular immaturity
B. Hepatic CYP1A2 activity is virtually absent, prolonging half-life
C. Protein binding is increased, reducing free drug concentration
D. Volume of distribution is reduced, yielding lower tissue levels
ANSWER: B
Q004: A 58-year-old with metastatic colorectal cancer is starting FOLFIRI plus
bevacizumab. The nurse plans to infuse irinotecan 180 mg/m² over 90 minutes. The
patient’s BSA is 1.9 m² and the pharmacy supplies 20 mg/mL irinotecan in 50-mL
vials. What total volume should be withdrawn?
Options:
A. 8.6 mL
B. 17.1 mL
C. 34.2 mL
D. 51.3 mL
ANSWER: B
Q005: A 14-year-old with bipolar I disorder is prescribed lithium 300 mg PO BID.
Baseline labs show Na 142 mEq/L, Cr 0.7 mg/dL, TSH 2.1 µIU/mL. After 5 days,
the patient presents with coarse tremor, serum lithium 1.4 mEq/L, and urine
, 3
specific gravity 1.003. Which adjunct is most appropriate to enhance lithium
elimination?
Options:
A. IV 0.9 % saline at 150 mL/h
B. Oral sodium bicarbonate 1300 mg q6h
C. IV furosemide 20 mg push
D. Acetazolamide 250 mg PO BID
ANSWER: A
Q006: A 4-year-old with septic shock requires dopamine 10 µg/kg/min. The
pharmacy prepares 60 mg in 100 mL D5W. The child weighs 18 kg. At what rate
(mL/h) should the pump be set?
Options:
A. 1.8 mL/h
B. 3 mL/h
C. 18 mL/h
D. 30 mL/h
ANSWER: C
Q007: A 67-year-old with NYHA class III heart failure is started on
sacubitril/valsartan 49/51 mg BID. Which counseling point is most essential to
prevent serious adverse effects?
Options:
A. Avoid potassium supplements and salt substitutes
B. Take the dose 30 minutes before breakfast for optimal absorption
C. Discontinue if systolic BP drops below 100 mmHg for more than 3 days
D. Expect a 2-week delay before noticing symptom improvement
ANSWER: A
BSN 315 HESI RN Specialty
Pharmacology Exam V1 Actual Exam
2026/2027 | Nightingale | Questions
with Verified Answers | 100% Correct |
Pass Guaranteed
Q001: A 6-year-old child with acute lymphoblastic leukemia is prescribed
intrathecal methotrexate 12 mg. The vial contains 25 mg/mL. After calculating the
exact volume needed, the nurse notes the residual volume in the dead space of the
25-gauge spinal needle is 0.1 mL. Which action best ensures the intended dose
reaches the cerebrospinal fluid?
Options:
A. Administer an additional 0.1 mL to compensate for dead space
B. Flush the needle with 0.2 mL of preservative-free normal saline after injection
C. Withdraw 0.48 mL, then inject the entire volume without flushing
D. Use a 30-gauge needle to reduce dead-space loss
ANSWER: B
Q002: A 72-kg patient in the MICU develops torsades de pointes after receiving IV
haloperidol 10 mg × 3 doses. Magnesium sulfate 2 g IV has already been given.
The physician orders IV ibutilide. Prior to administration, which lab value is most
critical to verify?
Options:
A. Serum calcium 8.9 mg/dL
, 2
B. Creatinine clearance 38 mL/min
C. Serum potassium 2.8 mEq/L
D. ALT 58 IU/L
ANSWER: C
Q003: A neonate born at 28 weeks’ gestation (Day 5 of life) is receiving caffeine
citrate 5 mg/kg IV q24h for apnea of prematurity. The trough serum level is 8
µg/mL (target 5–25 µg/mL), but episodes of apnea increase to 12 per shift. Which
pharmacokinetic factor best explains the suboptimal response?
Options:
A. Renal clearance is decreased due to proximal tubular immaturity
B. Hepatic CYP1A2 activity is virtually absent, prolonging half-life
C. Protein binding is increased, reducing free drug concentration
D. Volume of distribution is reduced, yielding lower tissue levels
ANSWER: B
Q004: A 58-year-old with metastatic colorectal cancer is starting FOLFIRI plus
bevacizumab. The nurse plans to infuse irinotecan 180 mg/m² over 90 minutes. The
patient’s BSA is 1.9 m² and the pharmacy supplies 20 mg/mL irinotecan in 50-mL
vials. What total volume should be withdrawn?
Options:
A. 8.6 mL
B. 17.1 mL
C. 34.2 mL
D. 51.3 mL
ANSWER: B
Q005: A 14-year-old with bipolar I disorder is prescribed lithium 300 mg PO BID.
Baseline labs show Na 142 mEq/L, Cr 0.7 mg/dL, TSH 2.1 µIU/mL. After 5 days,
the patient presents with coarse tremor, serum lithium 1.4 mEq/L, and urine
, 3
specific gravity 1.003. Which adjunct is most appropriate to enhance lithium
elimination?
Options:
A. IV 0.9 % saline at 150 mL/h
B. Oral sodium bicarbonate 1300 mg q6h
C. IV furosemide 20 mg push
D. Acetazolamide 250 mg PO BID
ANSWER: A
Q006: A 4-year-old with septic shock requires dopamine 10 µg/kg/min. The
pharmacy prepares 60 mg in 100 mL D5W. The child weighs 18 kg. At what rate
(mL/h) should the pump be set?
Options:
A. 1.8 mL/h
B. 3 mL/h
C. 18 mL/h
D. 30 mL/h
ANSWER: C
Q007: A 67-year-old with NYHA class III heart failure is started on
sacubitril/valsartan 49/51 mg BID. Which counseling point is most essential to
prevent serious adverse effects?
Options:
A. Avoid potassium supplements and salt substitutes
B. Take the dose 30 minutes before breakfast for optimal absorption
C. Discontinue if systolic BP drops below 100 mmHg for more than 3 days
D. Expect a 2-week delay before noticing symptom improvement
ANSWER: A
