1
BSN HESI 315 Pharmacology Actual
Exam V2 (New 2026/2027 Update)
Questions and Verified Answers|100%
Correct| Grade A-Nightingale
1. A 68-year-old client with chronic heart failure is prescribed digoxin 0.25 mg PO
daily. Before administering the morning dose, the nurse assesses the client and
finds an apical pulse of 56 beats per minute. Which action should the nurse take
first?
A. Administer the dose as prescribed and document the heart rate
B. Hold the medication and notify the healthcare provider
C. Reduce the dose to 0.125 mg and administer
D. Assess the client's potassium level before making a decision
Rationale: Digoxin has a narrow therapeutic index and can cause bradycardia and
heart blocks. The established protocol is to withhold digoxin if the apical pulse is
below 60 bpm in adults due to the risk of further cardiac depression and toxicity.
The nurse must hold the medication and notify the provider for further assessment
and orders. Administering the drug (Option A) could worsen bradycardia and
precipitate life-threatening arrhythmias. The nurse cannot independently alter the
prescribed dose (Option C) without a provider order. While hypokalemia
potentiates digoxin toxicity and should be monitored (Option D), the immediate
priority when the pulse is critically low is to withhold the medication and seek
medical guidance. This follows the safety principle of "do no harm" and
appropriate delegation to the prescriber for medical decision-making.
, 2
2. A nurse is teaching a client newly diagnosed with type 2 diabetes who has been
prescribed metformin 500 mg PO twice daily. Which statement by the client
indicates understanding of an important adverse effect to report?
A. "I should expect to gain some weight while taking this medication."
B. "I need to call my doctor if I have severe muscle pain or difficulty
breathing."
C. "This medication will cause my urine to turn orange."
D. "I should take this medication on an empty stomach for best absorption."
Rationale: Metformin carries a rare but serious risk of lactic acidosis, a potentially
fatal condition characterized by muscle pain, weakness, dyspnea, abdominal
discomfort, and altered mental status. Clients must be educated to immediately
report these symptoms. This risk increases in patients with renal impairment,
hepatic dysfunction, or conditions causing tissue hypoxia. Option A is incorrect
because metformin typically causes weight loss or is weight-neutral, not weight
gain. Option C is incorrect; metformin does not change urine color (this may occur
with medications like rifampin or phenazopyridine). Option D is incorrect because
metformin should be taken with meals to reduce gastrointestinal side effects such
as nausea, diarrhea, and abdominal cramping. Recognizing signs of lactic acidosis
is a critical patient safety teaching point for all clients receiving metformin therapy.
3. A client receiving warfarin therapy for atrial fibrillation has an INR of 5.2. The
client denies any bleeding but reports eating large amounts of spinach and kale
salads over the past week. What is the nurse's priority action?
A. Continue warfarin at the current dose and recheck INR in one week
B. Administer vitamin K as prescribed and hold the next warfarin dose
C. Notify the healthcare provider of the elevated INR and assess for signs of
bleeding
D. Instruct the client to avoid all green leafy vegetables permanently
, 3
Rationale: An INR of 5.2 is significantly elevated (therapeutic range for atrial
fibrillation is typically 2.0-3.0), placing the client at high risk for spontaneous
bleeding. The priority nursing action is to notify the healthcare provider
immediately and perform a thorough assessment for any signs of bleeding
(bruising, hematuria, melena, petechiae, bleeding gums). The provider will
determine whether vitamin K, fresh frozen plasma, or simply holding doses is
appropriate. Option A is dangerous as continuing warfarin could lead to life-
threatening hemorrhage. Option B assumes vitamin K is already prescribed; the
nurse must first notify the provider, as vitamin K can overcorrect and make the
patient resistant to warfarin therapy. Option D provides incorrect teaching—while
consistency in vitamin K intake is important, the paradoxical issue here is that high
vitamin K intake (from spinach and kale) would typically LOWER the INR, not
raise it. The elevated INR likely indicates overanticoagulation from the warfarin
dose itself, and the dietary history may be a red herring. The immediate priority is
provider notification and bleeding assessment per the NCSBN safety and risk
reduction framework.
4. A nurse is preparing to administer regular insulin 8 units subcutaneously to a
client with type 1 diabetes before breakfast. Which action demonstrates correct
insulin administration technique?
A. Massage the injection site after administering to enhance absorption
B. Rotate injection sites systematically within the same anatomical region
C. Inject the insulin at a 90-degree angle into the deltoid muscle
D. Shake the insulin vial vigorously before drawing up the dose
Rationale: Systematic rotation of injection sites within the same anatomical region
(e.g., rotating within the abdomen) prevents lipodystrophy (lipohypertrophy or
lipoatrophy) while maintaining consistent absorption rates. Different anatomical
regions have different absorption rates (abdomen fastest, then arms, thighs,
buttocks), so staying within one region promotes predictable glycemic control.
Option A is incorrect; massaging the site accelerates absorption unpredictably and
can cause bruising. Option C is incorrect because regular insulin is administered
BSN HESI 315 Pharmacology Actual
Exam V2 (New 2026/2027 Update)
Questions and Verified Answers|100%
Correct| Grade A-Nightingale
1. A 68-year-old client with chronic heart failure is prescribed digoxin 0.25 mg PO
daily. Before administering the morning dose, the nurse assesses the client and
finds an apical pulse of 56 beats per minute. Which action should the nurse take
first?
A. Administer the dose as prescribed and document the heart rate
B. Hold the medication and notify the healthcare provider
C. Reduce the dose to 0.125 mg and administer
D. Assess the client's potassium level before making a decision
Rationale: Digoxin has a narrow therapeutic index and can cause bradycardia and
heart blocks. The established protocol is to withhold digoxin if the apical pulse is
below 60 bpm in adults due to the risk of further cardiac depression and toxicity.
The nurse must hold the medication and notify the provider for further assessment
and orders. Administering the drug (Option A) could worsen bradycardia and
precipitate life-threatening arrhythmias. The nurse cannot independently alter the
prescribed dose (Option C) without a provider order. While hypokalemia
potentiates digoxin toxicity and should be monitored (Option D), the immediate
priority when the pulse is critically low is to withhold the medication and seek
medical guidance. This follows the safety principle of "do no harm" and
appropriate delegation to the prescriber for medical decision-making.
, 2
2. A nurse is teaching a client newly diagnosed with type 2 diabetes who has been
prescribed metformin 500 mg PO twice daily. Which statement by the client
indicates understanding of an important adverse effect to report?
A. "I should expect to gain some weight while taking this medication."
B. "I need to call my doctor if I have severe muscle pain or difficulty
breathing."
C. "This medication will cause my urine to turn orange."
D. "I should take this medication on an empty stomach for best absorption."
Rationale: Metformin carries a rare but serious risk of lactic acidosis, a potentially
fatal condition characterized by muscle pain, weakness, dyspnea, abdominal
discomfort, and altered mental status. Clients must be educated to immediately
report these symptoms. This risk increases in patients with renal impairment,
hepatic dysfunction, or conditions causing tissue hypoxia. Option A is incorrect
because metformin typically causes weight loss or is weight-neutral, not weight
gain. Option C is incorrect; metformin does not change urine color (this may occur
with medications like rifampin or phenazopyridine). Option D is incorrect because
metformin should be taken with meals to reduce gastrointestinal side effects such
as nausea, diarrhea, and abdominal cramping. Recognizing signs of lactic acidosis
is a critical patient safety teaching point for all clients receiving metformin therapy.
3. A client receiving warfarin therapy for atrial fibrillation has an INR of 5.2. The
client denies any bleeding but reports eating large amounts of spinach and kale
salads over the past week. What is the nurse's priority action?
A. Continue warfarin at the current dose and recheck INR in one week
B. Administer vitamin K as prescribed and hold the next warfarin dose
C. Notify the healthcare provider of the elevated INR and assess for signs of
bleeding
D. Instruct the client to avoid all green leafy vegetables permanently
, 3
Rationale: An INR of 5.2 is significantly elevated (therapeutic range for atrial
fibrillation is typically 2.0-3.0), placing the client at high risk for spontaneous
bleeding. The priority nursing action is to notify the healthcare provider
immediately and perform a thorough assessment for any signs of bleeding
(bruising, hematuria, melena, petechiae, bleeding gums). The provider will
determine whether vitamin K, fresh frozen plasma, or simply holding doses is
appropriate. Option A is dangerous as continuing warfarin could lead to life-
threatening hemorrhage. Option B assumes vitamin K is already prescribed; the
nurse must first notify the provider, as vitamin K can overcorrect and make the
patient resistant to warfarin therapy. Option D provides incorrect teaching—while
consistency in vitamin K intake is important, the paradoxical issue here is that high
vitamin K intake (from spinach and kale) would typically LOWER the INR, not
raise it. The elevated INR likely indicates overanticoagulation from the warfarin
dose itself, and the dietary history may be a red herring. The immediate priority is
provider notification and bleeding assessment per the NCSBN safety and risk
reduction framework.
4. A nurse is preparing to administer regular insulin 8 units subcutaneously to a
client with type 1 diabetes before breakfast. Which action demonstrates correct
insulin administration technique?
A. Massage the injection site after administering to enhance absorption
B. Rotate injection sites systematically within the same anatomical region
C. Inject the insulin at a 90-degree angle into the deltoid muscle
D. Shake the insulin vial vigorously before drawing up the dose
Rationale: Systematic rotation of injection sites within the same anatomical region
(e.g., rotating within the abdomen) prevents lipodystrophy (lipohypertrophy or
lipoatrophy) while maintaining consistent absorption rates. Different anatomical
regions have different absorption rates (abdomen fastest, then arms, thighs,
buttocks), so staying within one region promotes predictable glycemic control.
Option A is incorrect; massaging the site accelerates absorption unpredictably and
can cause bruising. Option C is incorrect because regular insulin is administered
