BSN 315 HESI Exam Pharmacology V1
ACTUAL EXAM 2026/2027 | Sets 1 2 & 3
150 Questions | Verified Q&A | Pass
Guaranteed - A+ Graded
SET 1 – Cardiovascular, Respiratory, Endocrine Medications (Questions 1–50)
Q1: A patient is prescribed furosemide (Lasix) 40 mg IV push for acute pulmonary edema. The nurse
administers the medication over 2 minutes. Fifteen minutes later, the patient reports a sudden "ringing
sound" in both ears. What is the nurse's priority action?
A. Administer naloxone as prescribed
B. Stop further furosemide administration and notify the provider [CORRECT]
C. Reassure the patient that tinnitus is a mild, expected side effect
D. Flush the IV line with normal saline immediately
Correct Answer: B
Rationale: Tinnitus is an early sign of furosemide-induced ototoxicity, which can be permanent if
infusion continues. Rapid IV push increases this risk. Option A (naloxone treats opioid overdose), C (false
reassurance), D (will not prevent ototoxicity).
Q2: A patient newly prescribed lisinopril reports a dry, hacking cough. The nurse recognizes this as:
A. An allergic reaction requiring immediate discontinuation
B. A common ACE inhibitor side effect due to bradykinin accumulation [CORRECT]
C. A sign of developing angioedema
D. An indication to switch to a thiazide diuretic
Correct Answer: B
Rationale: ACE inhibitors block bradykinin breakdown, causing a dry cough in 5–20% of patients. This is
not an allergy; switching to an ARB (losartan) resolves it. Angioedema presents with lip/tongue swelling.
,Q3: The nurse is teaching a patient about captopril. Which statement by the patient indicates
understanding?
A. "I should take this medication on an empty stomach." [CORRECT]
B. "I can use salt substitutes to reduce my sodium intake."
C. "If I miss a dose, I should double up the next dose."
D. "This medication will cure my high blood pressure permanently."
Correct Answer: A
Rationale: Captopril absorption is reduced by food. Salt substitutes contain potassium, risking
hyperkalemia with ACE inhibitors. Never double doses; hypertension requires lifelong management.
Q4: A patient on warfarin has an INR of 4.2 and reports nosebleeds that stop with pressure. What is the
nurse's priority action?
A. Administer vitamin K 10 mg IV immediately
B. Hold the next warfarin dose and notify the provider [CORRECT]
C. Continue warfarin and apply ice to the nose
D. Administer protamine sulfate
Correct Answer: B
Rationale: INR 4.2 with minor bleeding warrants holding the dose and notifying the provider. Vitamin K
is reserved for INR >10 or serious bleeding. Protamine reverses heparin, not warfarin.
Q5: A patient receiving heparin therapy has an aPTT of 90 seconds (control 30 seconds). The nurse
should:
A. Increase the heparin infusion rate
B. Administer protamine sulfate 1 mg per 100 units heparin [CORRECT]
C. Continue the current infusion rate
D. Obtain a STAT platelet count
Correct Answer: B
Rationale: aPTT >2.5× control (75 seconds) indicates supratherapeutic heparin with bleeding risk.
Protamine sulfate is the specific antidote. Option D (platelet count monitors for HIT, not acute
overdose).
Q6: A patient asks why enoxaparin (Lovenox) does not require routine lab monitoring. The best
response is:
,A. "It has a more predictable anticoagulant response." [CORRECT]
B. "It is less effective than heparin, so monitoring isn't needed."
C. "The aPTT test cannot measure its effects."
D. "It is eliminated by the kidneys, not the liver."
Correct Answer: A
Rationale: Low molecular weight heparins like enoxaparin have predictable pharmacokinetics,
eliminating routine aPTT/anti-Xa monitoring in most patients. Anti-Xa levels are reserved for renal
impairment, obesity, or pregnancy.
Q7: A patient on apixaban (Eliquis) is scheduled for elective surgery. The nurse anticipates the provider
will:
A. Bridge with heparin for 5 days preoperatively
B. Discontinue apixaban 48 hours before surgery [CORRECT]
C. Obtain a STAT INR preoperatively
D. Administer vitamin K 24 hours before surgery
Correct Answer: B
Rationale: Apixaban is discontinued 48 hours before low-bleeding-risk procedures (longer for CrCl <30
or high-risk surgery). No bridging is needed due to rapid onset/offset. INR does not monitor direct oral
anticoagulants.
Q8: A patient with atrial fibrillation is prescribed amiodarone. Which finding requires immediate nurse
intervention?
A. Blue-gray skin discoloration on the face
B. New onset of dry cough
C. Dyspnea with bilateral crackles on auscultation [CORRECT]
D. Corneal deposits noted on eye exam
Correct Answer: C
Rationale: Pulmonary toxicity (pneumonitis/fibrosis) is a life-threatening amiodarone adverse effect
requiring immediate discontinuation. Skin discoloration and corneal deposits are expected, manageable
side effects.
Q9: A patient with angina takes sublingual nitroglycerin. Which instruction is most important?
A. "Store the tablets in a clear pillbox for easy access."
B. "If chest pain persists after 3 tablets, call 911." [CORRECT]
, C. "Chew the tablet for faster absorption."
D. "Take the medication with food to prevent stomach upset."
Correct Answer: B
Rationale: Sublingual nitroglycerin is absorbed under the tongue (not chewed). If pain persists after 3
tablets (5 min apart), this indicates possible MI requiring emergency care. Tablets must be stored in
original dark, airtight containers.
Q10: A patient on metoprolol reports feeling dizzy when standing. The nurse checks the blood pressure
and finds 98/62 mmHg. What is the priority nursing action?
A. Hold the metoprolol and notify the provider [CORRECT]
B. Encourage the patient to increase fluid intake
C. Administer atropine 0.5 mg IV
D. Instruct the patient to take the medication at bedtime
Correct Answer: A
Rationale: Hypotension (98/62) with orthostatic symptoms indicates excessive beta-blockade. Holding
the dose prevents further BP reduction. Atropine treats bradycardia, not hypotension.
Q11: A patient with asthma uses albuterol inhaler more than twice weekly. The nurse recognizes this
indicates:
A. Well-controlled asthma
B. The need for a long-acting beta-agonist
C. Poorly controlled asthma requiring controller therapy [CORRECT]
D. Albuterol tolerance requiring dose increase
Correct Answer: C
Rationale: SABA use >2×/week indicates poor asthma control per GINA guidelines. The patient needs
inhaled corticosteroid controller therapy, not increased SABA use, which increases mortality risk.
Q12: After using fluticasone (Flovent) inhaler, the patient should be instructed to:
A. Rinse the mouth with water and spit [CORRECT]
B. Take a drink of water and swallow
C. Use a bronchodilator inhaler immediately after
D. Hold their breath for 10 seconds only
ACTUAL EXAM 2026/2027 | Sets 1 2 & 3
150 Questions | Verified Q&A | Pass
Guaranteed - A+ Graded
SET 1 – Cardiovascular, Respiratory, Endocrine Medications (Questions 1–50)
Q1: A patient is prescribed furosemide (Lasix) 40 mg IV push for acute pulmonary edema. The nurse
administers the medication over 2 minutes. Fifteen minutes later, the patient reports a sudden "ringing
sound" in both ears. What is the nurse's priority action?
A. Administer naloxone as prescribed
B. Stop further furosemide administration and notify the provider [CORRECT]
C. Reassure the patient that tinnitus is a mild, expected side effect
D. Flush the IV line with normal saline immediately
Correct Answer: B
Rationale: Tinnitus is an early sign of furosemide-induced ototoxicity, which can be permanent if
infusion continues. Rapid IV push increases this risk. Option A (naloxone treats opioid overdose), C (false
reassurance), D (will not prevent ototoxicity).
Q2: A patient newly prescribed lisinopril reports a dry, hacking cough. The nurse recognizes this as:
A. An allergic reaction requiring immediate discontinuation
B. A common ACE inhibitor side effect due to bradykinin accumulation [CORRECT]
C. A sign of developing angioedema
D. An indication to switch to a thiazide diuretic
Correct Answer: B
Rationale: ACE inhibitors block bradykinin breakdown, causing a dry cough in 5–20% of patients. This is
not an allergy; switching to an ARB (losartan) resolves it. Angioedema presents with lip/tongue swelling.
,Q3: The nurse is teaching a patient about captopril. Which statement by the patient indicates
understanding?
A. "I should take this medication on an empty stomach." [CORRECT]
B. "I can use salt substitutes to reduce my sodium intake."
C. "If I miss a dose, I should double up the next dose."
D. "This medication will cure my high blood pressure permanently."
Correct Answer: A
Rationale: Captopril absorption is reduced by food. Salt substitutes contain potassium, risking
hyperkalemia with ACE inhibitors. Never double doses; hypertension requires lifelong management.
Q4: A patient on warfarin has an INR of 4.2 and reports nosebleeds that stop with pressure. What is the
nurse's priority action?
A. Administer vitamin K 10 mg IV immediately
B. Hold the next warfarin dose and notify the provider [CORRECT]
C. Continue warfarin and apply ice to the nose
D. Administer protamine sulfate
Correct Answer: B
Rationale: INR 4.2 with minor bleeding warrants holding the dose and notifying the provider. Vitamin K
is reserved for INR >10 or serious bleeding. Protamine reverses heparin, not warfarin.
Q5: A patient receiving heparin therapy has an aPTT of 90 seconds (control 30 seconds). The nurse
should:
A. Increase the heparin infusion rate
B. Administer protamine sulfate 1 mg per 100 units heparin [CORRECT]
C. Continue the current infusion rate
D. Obtain a STAT platelet count
Correct Answer: B
Rationale: aPTT >2.5× control (75 seconds) indicates supratherapeutic heparin with bleeding risk.
Protamine sulfate is the specific antidote. Option D (platelet count monitors for HIT, not acute
overdose).
Q6: A patient asks why enoxaparin (Lovenox) does not require routine lab monitoring. The best
response is:
,A. "It has a more predictable anticoagulant response." [CORRECT]
B. "It is less effective than heparin, so monitoring isn't needed."
C. "The aPTT test cannot measure its effects."
D. "It is eliminated by the kidneys, not the liver."
Correct Answer: A
Rationale: Low molecular weight heparins like enoxaparin have predictable pharmacokinetics,
eliminating routine aPTT/anti-Xa monitoring in most patients. Anti-Xa levels are reserved for renal
impairment, obesity, or pregnancy.
Q7: A patient on apixaban (Eliquis) is scheduled for elective surgery. The nurse anticipates the provider
will:
A. Bridge with heparin for 5 days preoperatively
B. Discontinue apixaban 48 hours before surgery [CORRECT]
C. Obtain a STAT INR preoperatively
D. Administer vitamin K 24 hours before surgery
Correct Answer: B
Rationale: Apixaban is discontinued 48 hours before low-bleeding-risk procedures (longer for CrCl <30
or high-risk surgery). No bridging is needed due to rapid onset/offset. INR does not monitor direct oral
anticoagulants.
Q8: A patient with atrial fibrillation is prescribed amiodarone. Which finding requires immediate nurse
intervention?
A. Blue-gray skin discoloration on the face
B. New onset of dry cough
C. Dyspnea with bilateral crackles on auscultation [CORRECT]
D. Corneal deposits noted on eye exam
Correct Answer: C
Rationale: Pulmonary toxicity (pneumonitis/fibrosis) is a life-threatening amiodarone adverse effect
requiring immediate discontinuation. Skin discoloration and corneal deposits are expected, manageable
side effects.
Q9: A patient with angina takes sublingual nitroglycerin. Which instruction is most important?
A. "Store the tablets in a clear pillbox for easy access."
B. "If chest pain persists after 3 tablets, call 911." [CORRECT]
, C. "Chew the tablet for faster absorption."
D. "Take the medication with food to prevent stomach upset."
Correct Answer: B
Rationale: Sublingual nitroglycerin is absorbed under the tongue (not chewed). If pain persists after 3
tablets (5 min apart), this indicates possible MI requiring emergency care. Tablets must be stored in
original dark, airtight containers.
Q10: A patient on metoprolol reports feeling dizzy when standing. The nurse checks the blood pressure
and finds 98/62 mmHg. What is the priority nursing action?
A. Hold the metoprolol and notify the provider [CORRECT]
B. Encourage the patient to increase fluid intake
C. Administer atropine 0.5 mg IV
D. Instruct the patient to take the medication at bedtime
Correct Answer: A
Rationale: Hypotension (98/62) with orthostatic symptoms indicates excessive beta-blockade. Holding
the dose prevents further BP reduction. Atropine treats bradycardia, not hypotension.
Q11: A patient with asthma uses albuterol inhaler more than twice weekly. The nurse recognizes this
indicates:
A. Well-controlled asthma
B. The need for a long-acting beta-agonist
C. Poorly controlled asthma requiring controller therapy [CORRECT]
D. Albuterol tolerance requiring dose increase
Correct Answer: C
Rationale: SABA use >2×/week indicates poor asthma control per GINA guidelines. The patient needs
inhaled corticosteroid controller therapy, not increased SABA use, which increases mortality risk.
Q12: After using fluticasone (Flovent) inhaler, the patient should be instructed to:
A. Rinse the mouth with water and spit [CORRECT]
B. Take a drink of water and swallow
C. Use a bronchodilator inhaler immediately after
D. Hold their breath for 10 seconds only
