BSN HESI 315 Pharmacology Actual Exam
V2 (New 2026/2027 Update) Questions and
Verified Answers|100% Correct| Grade
A-Nightingale
1. A nurse is caring for a 68-year-old client with heart failure who is receiving digoxin 0.125 mg
PO daily. Before administering the morning dose, the nurse assesses the client and finds the
apical pulse is 58 beats per minute. Which action should the nurse take first?
A. Administer the dose as ordered and document the pulse rate
B. Withhold the dose and notify the healthcare provider
C. Give half the prescribed dose and recheck the pulse in one hour
D. Administer the dose with food to enhance absorption
Rationale:
Digoxin is a cardiac glycoside that slows the heart rate by increasing vagal tone and decreasing
conduction through the AV node. The nurse must withhold the medication if the apical pulse is
below 60 beats per minute in adults (or per facility protocol) and notify the healthcare provider,
as administration could cause severe bradycardia, heart block, or cardiac arrest. Option B is
correct because it prioritizes patient safety by preventing further cardiac depression. Option A is
incorrect because administering digoxin with a pulse below 60 bpm could cause life-threatening
dysrhythmias. Option C is incorrect because nurses cannot independently alter prescribed
dosages without a provider order. Option D is incorrect because while digoxin can be given with
food, this does not address the critical safety concern of bradycardia. Monitoring for signs of
digoxin toxicity (nausea, visual disturbances, confusion) and checking serum digoxin levels
(therapeutic range 0.5-2.0 ng/mL) are also essential nursing responsibilities.
2. A client with type 2 diabetes mellitus is prescribed metformin 500 mg PO twice daily. The
nurse should instruct the client to immediately report which symptom that may indicate a serious
adverse effect?
A. Mild nausea after taking the medication
B. Increased urinary frequency
C. Unusual muscle pain and extreme fatigue
D. Metallic taste in the mouth
,Rationale:
Metformin is a biguanide antidiabetic agent that can rarely cause lactic acidosis, a
life-threatening complication with a mortality rate of approximately 50%. Early symptoms include
unusual muscle pain, extreme fatigue, difficulty breathing, dizziness, and abdominal distress.
Option C is correct because these symptoms require immediate medical evaluation and
possible discontinuation of metformin. Option A is incorrect because mild gastrointestinal effects
(nausea, diarrhea) are common side effects that typically resolve with continued use or taking
the medication with food; they do not indicate lactic acidosis. Option B is incorrect because
increased urination would be more consistent with hyperglycemia or uncontrolled diabetes, not
a metformin adverse effect. Option D is incorrect because a metallic taste is a known, benign
side effect of metformin that does not require immediate reporting. Risk factors for lactic
acidosis include renal impairment, hepatic disease, alcohol abuse, and conditions causing
hypoxia. The nurse should emphasize withholding metformin before procedures using iodinated
contrast media.
3. A nurse is preparing to administer enoxaparin 40 mg subcutaneously to a postoperative client
for deep vein thrombosis prophylaxis. Which technique should the nurse use?
A. Massage the injection site after administration to promote absorption
B. Inject into the abdomen at least 2 inches from the umbilicus without aspirating
C. Use the deltoid muscle and apply firm pressure for 5 minutes
D. Administer into the vastus lateralis and apply a warm compress afterward
Rationale:
Enoxaparin is a low-molecular-weight heparin administered subcutaneously for anticoagulation.
Option B is correct because the preferred injection site is the abdomen (specifically the
anterolateral or posterolateral abdominal wall), at least 2 inches (5 cm) from the umbilicus, and
aspiration is contraindicated as it may cause tissue trauma and hematoma formation. The nurse
should inject at a 90-degree angle, not expel the air bubble (it helps ensure complete dose
delivery), and avoid rubbing the site. Option A is incorrect because massaging can cause
bruising, hematoma formation, and erratic absorption. Option C is incorrect because the deltoid
is not an appropriate site for enoxaparin; it is given subcutaneously, not intramuscularly, and firm
pressure could cause hematoma. Option D is incorrect because the vastus lateralis is an
intramuscular site, and heat application could increase bleeding risk. The nurse should monitor
for bleeding complications, check platelet counts (risk of heparin-induced thrombocytopenia),
and assess CBC regularly.
4. A client with atrial fibrillation is being discharged on warfarin 5 mg PO daily. Which statement
by the client indicates a need for further teaching?
, A. “I will wear a medical alert bracelet stating I take warfarin.”
B. “I need to have regular blood tests to monitor my INR levels.”
C. “I can use aspirin for my arthritis pain instead of acetaminophen.”
D. “I should avoid eating large amounts of green leafy vegetables suddenly.”
Rationale:
Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors. Option C is
correct as the answer requiring further teaching because aspirin is an antiplatelet agent that
increases bleeding risk when combined with warfarin, potentially causing hemorrhage.
Acetaminophen is the preferred analgesic for clients on warfarin. Option A is incorrect (shows
correct understanding) because wearing a medical alert bracelet ensures emergency personnel
are aware of anticoagulant therapy. Option B is incorrect (shows correct understanding)
because regular INR monitoring (target range typically 2.0-3.0 for atrial fibrillation) is essential to
maintain therapeutic anticoagulation and prevent bleeding or clotting complications. Option D is
incorrect (shows correct understanding) because sudden large increases in vitamin K intake
from green leafy vegetables (spinach, kale, broccoli) can decrease warfarin effectiveness,
though consistent intake is acceptable. Additional teaching should include avoiding NSAIDs,
reporting signs of bleeding (hematuria, black stools, excessive bruising), and notifying all
healthcare providers about warfarin use before procedures.
5. A nurse administers IV furosemide 40 mg to a client with acute pulmonary edema. Which
assessment finding would indicate the medication is achieving the desired therapeutic effect?
A. Blood pressure increases from 100/60 to 130/80 mmHg
B. Oxygen saturation improves from 88% to 95% on room air
C. Serum potassium level rises from 3.2 to 4.0 mEq/L
D. Apical heart rate decreases from 110 to 70 beats per minute
Rationale:
Furosemide is a potent loop diuretic that promotes rapid diuresis by inhibiting sodium and
chloride reabsorption in the loop of Henle. In acute pulmonary edema, the goal is to reduce fluid
overload in the lungs, improving oxygenation and reducing respiratory distress. Option B is
correct because improved oxygen saturation indicates decreased pulmonary congestion and
better gas exchange, which is the primary therapeutic goal. Option A is incorrect because
furosemide typically decreases blood pressure due to fluid loss and vasodilation; increasing
blood pressure is not the desired effect and could indicate worsening heart failure. Option C is
incorrect because furosemide causes potassium loss (hypokalemia), not an increase; while
correcting hypokalemia is important, it’s not the primary therapeutic goal for pulmonary edema.
Option D is incorrect because while heart rate may decrease with improved oxygenation, this is
a secondary effect, not the primary indicator of therapeutic effectiveness. The nurse should also
assess for decreased crackles on auscultation, reduced dyspnea, and weight loss. Monitor for
adverse effects including hypokalemia, hyponatremia, dehydration, and ototoxicity with rapid IV
administration.
V2 (New 2026/2027 Update) Questions and
Verified Answers|100% Correct| Grade
A-Nightingale
1. A nurse is caring for a 68-year-old client with heart failure who is receiving digoxin 0.125 mg
PO daily. Before administering the morning dose, the nurse assesses the client and finds the
apical pulse is 58 beats per minute. Which action should the nurse take first?
A. Administer the dose as ordered and document the pulse rate
B. Withhold the dose and notify the healthcare provider
C. Give half the prescribed dose and recheck the pulse in one hour
D. Administer the dose with food to enhance absorption
Rationale:
Digoxin is a cardiac glycoside that slows the heart rate by increasing vagal tone and decreasing
conduction through the AV node. The nurse must withhold the medication if the apical pulse is
below 60 beats per minute in adults (or per facility protocol) and notify the healthcare provider,
as administration could cause severe bradycardia, heart block, or cardiac arrest. Option B is
correct because it prioritizes patient safety by preventing further cardiac depression. Option A is
incorrect because administering digoxin with a pulse below 60 bpm could cause life-threatening
dysrhythmias. Option C is incorrect because nurses cannot independently alter prescribed
dosages without a provider order. Option D is incorrect because while digoxin can be given with
food, this does not address the critical safety concern of bradycardia. Monitoring for signs of
digoxin toxicity (nausea, visual disturbances, confusion) and checking serum digoxin levels
(therapeutic range 0.5-2.0 ng/mL) are also essential nursing responsibilities.
2. A client with type 2 diabetes mellitus is prescribed metformin 500 mg PO twice daily. The
nurse should instruct the client to immediately report which symptom that may indicate a serious
adverse effect?
A. Mild nausea after taking the medication
B. Increased urinary frequency
C. Unusual muscle pain and extreme fatigue
D. Metallic taste in the mouth
,Rationale:
Metformin is a biguanide antidiabetic agent that can rarely cause lactic acidosis, a
life-threatening complication with a mortality rate of approximately 50%. Early symptoms include
unusual muscle pain, extreme fatigue, difficulty breathing, dizziness, and abdominal distress.
Option C is correct because these symptoms require immediate medical evaluation and
possible discontinuation of metformin. Option A is incorrect because mild gastrointestinal effects
(nausea, diarrhea) are common side effects that typically resolve with continued use or taking
the medication with food; they do not indicate lactic acidosis. Option B is incorrect because
increased urination would be more consistent with hyperglycemia or uncontrolled diabetes, not
a metformin adverse effect. Option D is incorrect because a metallic taste is a known, benign
side effect of metformin that does not require immediate reporting. Risk factors for lactic
acidosis include renal impairment, hepatic disease, alcohol abuse, and conditions causing
hypoxia. The nurse should emphasize withholding metformin before procedures using iodinated
contrast media.
3. A nurse is preparing to administer enoxaparin 40 mg subcutaneously to a postoperative client
for deep vein thrombosis prophylaxis. Which technique should the nurse use?
A. Massage the injection site after administration to promote absorption
B. Inject into the abdomen at least 2 inches from the umbilicus without aspirating
C. Use the deltoid muscle and apply firm pressure for 5 minutes
D. Administer into the vastus lateralis and apply a warm compress afterward
Rationale:
Enoxaparin is a low-molecular-weight heparin administered subcutaneously for anticoagulation.
Option B is correct because the preferred injection site is the abdomen (specifically the
anterolateral or posterolateral abdominal wall), at least 2 inches (5 cm) from the umbilicus, and
aspiration is contraindicated as it may cause tissue trauma and hematoma formation. The nurse
should inject at a 90-degree angle, not expel the air bubble (it helps ensure complete dose
delivery), and avoid rubbing the site. Option A is incorrect because massaging can cause
bruising, hematoma formation, and erratic absorption. Option C is incorrect because the deltoid
is not an appropriate site for enoxaparin; it is given subcutaneously, not intramuscularly, and firm
pressure could cause hematoma. Option D is incorrect because the vastus lateralis is an
intramuscular site, and heat application could increase bleeding risk. The nurse should monitor
for bleeding complications, check platelet counts (risk of heparin-induced thrombocytopenia),
and assess CBC regularly.
4. A client with atrial fibrillation is being discharged on warfarin 5 mg PO daily. Which statement
by the client indicates a need for further teaching?
, A. “I will wear a medical alert bracelet stating I take warfarin.”
B. “I need to have regular blood tests to monitor my INR levels.”
C. “I can use aspirin for my arthritis pain instead of acetaminophen.”
D. “I should avoid eating large amounts of green leafy vegetables suddenly.”
Rationale:
Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors. Option C is
correct as the answer requiring further teaching because aspirin is an antiplatelet agent that
increases bleeding risk when combined with warfarin, potentially causing hemorrhage.
Acetaminophen is the preferred analgesic for clients on warfarin. Option A is incorrect (shows
correct understanding) because wearing a medical alert bracelet ensures emergency personnel
are aware of anticoagulant therapy. Option B is incorrect (shows correct understanding)
because regular INR monitoring (target range typically 2.0-3.0 for atrial fibrillation) is essential to
maintain therapeutic anticoagulation and prevent bleeding or clotting complications. Option D is
incorrect (shows correct understanding) because sudden large increases in vitamin K intake
from green leafy vegetables (spinach, kale, broccoli) can decrease warfarin effectiveness,
though consistent intake is acceptable. Additional teaching should include avoiding NSAIDs,
reporting signs of bleeding (hematuria, black stools, excessive bruising), and notifying all
healthcare providers about warfarin use before procedures.
5. A nurse administers IV furosemide 40 mg to a client with acute pulmonary edema. Which
assessment finding would indicate the medication is achieving the desired therapeutic effect?
A. Blood pressure increases from 100/60 to 130/80 mmHg
B. Oxygen saturation improves from 88% to 95% on room air
C. Serum potassium level rises from 3.2 to 4.0 mEq/L
D. Apical heart rate decreases from 110 to 70 beats per minute
Rationale:
Furosemide is a potent loop diuretic that promotes rapid diuresis by inhibiting sodium and
chloride reabsorption in the loop of Henle. In acute pulmonary edema, the goal is to reduce fluid
overload in the lungs, improving oxygenation and reducing respiratory distress. Option B is
correct because improved oxygen saturation indicates decreased pulmonary congestion and
better gas exchange, which is the primary therapeutic goal. Option A is incorrect because
furosemide typically decreases blood pressure due to fluid loss and vasodilation; increasing
blood pressure is not the desired effect and could indicate worsening heart failure. Option C is
incorrect because furosemide causes potassium loss (hypokalemia), not an increase; while
correcting hypokalemia is important, it’s not the primary therapeutic goal for pulmonary edema.
Option D is incorrect because while heart rate may decrease with improved oxygenation, this is
a secondary effect, not the primary indicator of therapeutic effectiveness. The nurse should also
assess for decreased crackles on auscultation, reduced dyspnea, and weight loss. Monitor for
adverse effects including hypokalemia, hyponatremia, dehydration, and ototoxicity with rapid IV
administration.
