BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
Questions and Verified Answers
with Rationales|100% Correct|
Grade A- Nightingale
Which client should the nurse identify as being at highest risk for complications during the use of
an opioid analgesic?
A young adult with inflammatory bowel disease.
Rationale:
The principal indication for opioid use is acute pain, and a client with inflammatory bowel
disease is at risk for toxic megacolon or paralytic ileus related to slowed peristalsis, a side effect
of morphine. Adverse effects of morphine do not pose as great a risk for clients with diabetes or a
fracture as for the client with bowel disease.
The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure.
Which intervention should the nurse implement prior to administering the digoxin?
Assess the serum potassium level.
Rationale:
Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving
digoxin. The nurse should monitor the client's serum potassium levels. Blood pressure and
respiratory rate will not inform the nurse about potential safety issues with digitalis.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching
is most important for the nurse to provide?
Expected duration of flushing.
Rationale:
Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin.
Inclusion of this effect in client teaching may promote compliance in taking the medication.
While nutrition tips and managing pruritis are worthwhile instructions to help clients minimize
or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes
the most concern for the client.
A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the
clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct
drug-specific teaching the nurse should provide to this client?
Make an appointment to see the healthcare provider, because muscle pain may be an indication
of a serious side effect.
Rationale:
Myopathy, suggested by the leg pain and weakness, is a serious, and potentially life-threatening,
complication of Lipitor, and should be evaluated immediately by the healthcare provider.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
An antacid (Maalox) is prescribed for a client with peptic ulcer disease. The nurse knows that the
purpose of this medication is to
maintain a gastric pH of 3.5 or above.
Rationale:
The objective of antacids is to neutralize gastric acids and keep pH of 3.5 or above which is
necessary for pepsinogen inactivity.
Which dosing schedule should the nurse teach the client to observe for a controlled-release
oxycodone prescription?
Every 12 hours.
Rationale:
A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe
pain, so a dosing schedule of every 12 hours provides the best around-the-clock pain
management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or
as needed schedule. Using a schedule of every 4 to 6 hours may jeopardize patient safety due to
cumulative effects.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for
symptom management. The nurse notes the client is allergic to sulfa. Which action is most
important for the nurse to implement prior to administering the first dose?
Notify the healthcare provider.
Rationale:
Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are
sensitive to sulfonamides, so the healthcare provider should be notified of the client's allergies.
The nurse is assessing a client who is experiencing anaphylaxis from an insect sting. Which
prescription should the nurse prepare to administer this client?
Epinephrine.
Rationale:
Epinephrine is an adrenergic agent that stimulates beta receptors to increase cardiac automaticity
in cardiac arrest and relax bronchospasms in anaphylaxis. On the ither hand, dopamine is a
vasopressor used to treat clients with shock. Ephedrine causes peripheral vasoconstriction and is
used in the treatment of nasal congestion. Diphenhydramine is an antihistamine decongestant
used in the treatment of mild allergic reactions and motion sickness. Epinephrine is the
medication of choice in treating anaphylaxis.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
Questions and Verified Answers
with Rationales|100% Correct|
Grade A- Nightingale
A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has
completed discharge teaching regarding medication administration. Which morning schedule
would indicate to the nurse that the client teaching has been effective?
Take medication, go for a 30 minute morning walk, then eat breakfast.
Rationale:
Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning.
The client should also be advised to remain in an upright position for at least thirty minutes after
taking the medication to reduce the risk of esophageal reflux and irritation.
After abdominal surgery, a male client is prescribed low molecular weight heparin (LMWH).
During administration of the medication, the client asks the nurse why he is receiving this
medication. Which is the best response for the nurse to provide?
This medication is a blood thinner given to prevent blood clot formation.
Rationale:
Unfractionated heparin or low molecular weight heparin (LMWH) is an anticoagulant that
inhibits thrombin-mediated conversion of fibrinogen to fibrin and is given prophylactically to
prevent postoperative venous thrombosis in order to prevent pulmonary embolism or deep vein
thrombosis following knee and abdominal surgeries.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
Which symptoms are serious adverse effects of beta-adrenergic blockers such as propranolol
(Inderal)?
Wheezing, hypotension, and AV block.
Rationale:
Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-
blocking agents. AV block is generally associated with bradycardia and results in potentially life-
threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and
hypotension represent life-threatening respiratory and cardiac disorders.
Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal
attack, which assessment finding indicates to the nurse that the desired effect has been achieved?
Client states chest pain is relieved.
Rationale:
Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces
chest pain.
A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which
laboratory finding should the nurse identify that places this client at risk?
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
Hypokalemia.
Rationale:
Hypokalemia affects myocardial contractility and places this client at greatest risk for
dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium
and calcium can effect cardiac rhythm, the greatest risk for the client receiving digoxin is low
potassium.
A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The
nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the
expected outcome for this client following administration of this pharmacologic agent?
Decreased muscle weakness.
Rationale:
Administration of edrophonium chloride (Tensilon), a cholinergic agent, will temporarily reduce
muscle weakness, the most common complaint of newly-diagnosed clients with myasthenia
gravis. This medication is used to diagnose myasthenia gravis due to its short duration of action.
This drug would temporarily reverse difficulty in swallowing and respiratory effort.
In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse
should encourage the client to report which adverse response to the healthcare provider?
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
Presence of hand tremors.
Rationale:
Neurological complications, such as hand tremors, occur in about 50% of clients taking
cyclosporine and should be reported. Although this drug can be nephrotoxic, changes in urine
color typically does not occur. Nausea is a common side effects, but is not usually severe.
A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50
ml/hour. The nurse notes that the client's urinary output has been 20 ml/hour for the last two
hours. Which intervention should the nurse initiate?
Notify the healthcare provider of the urinary output.
Rationale:
The main effect of dopamine is adrenergic stimulation used to increase cardiac output, which
should also result in increased urinary output. A urinary output of less than 20 ml/hour is oliguria
and should be reported to the healthcare provider, so the dose of dopamine can be adjusted.
Depending on the current rate of administration, the dose may need to be increased or decreased.
Which nursing diagnosis is important to include in the plan of care for a client receiving the
angiotensin-2 receptor antagonist irbesartan (Avapro)?
Risk for injury.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
Questions and Verified Answers
with Rationales|100% Correct|
Grade A- Nightingale
Rationale:
Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various
receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury
A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with
which condition?
Heart failure.
Rationale:
Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure and are
indicated in heart failure, shock, atrioventricular block dysrhythmias, and cardiac arrest. In
contrast, glaucoma is managed using adrenergic agents and beta-adrenergic blocking agents.
Beta-1 blocking agents are used in the management of hypertension. Medications that stimulate
beta-2 receptors in the bronchi are effective for bronchoconstriction in respiratory disorders, such
as asthma.
Which method of medication administration provides the client with the greatest first-pass
effect?
Oral.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
Rationale:
The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in
the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried
directly to the liver via the hepatic portal circulation where hepatic inactivation occurs and
reduces the bioavailability of the drug. Alternative method of administration, such as sublingual,
IV, and subcutaneous routes, avoid this first-pass effect.
A female client with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4 times a day. To
prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which
information is most important for the nurse to include in client teaching?
Use contraception during intercourse.
Rationale:
Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as
an abortifacient, so the client should be instructed to use contraception during intercourse to
prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation
prevention strategies are usually not needed. Cytotec and Motrin should be taken together to
provide protective properties against gastrointestinal bleeding.
The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in
the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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Grade A- Nightingale
with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment
has the highest priority before initiating the PCA pump?
The rate and depth of the client's respirations.
Rationale
A life-threatening side effect of intravenous administration of morphine sulfate, an opiate
narcotic, is respiratory depression. Prior to the initiation of the PCA pump, the nurse should
assess the client's respirations to obtain a baseline of their respiratory rate and depth. Once the
PCA pump is initiated and if the client's respiratory rate falls below 12 breaths per minute, the
PCA pump should be stopped and the healthcare provider notified immediately.
Which action is most important for the nurse to implement prior to the administration of the
antiarrhythmic drug adenosine (Adenocard)?
Apply continuous cardiac monitoring.
Rationale:
Adenosine (Adenocard) is an antiarrhythmic drug used to restore a normal sinus rhythm in
clients with rapid supraventricular tachycardia. The client's heart rate should be monitored
continuously for the onset of additional arrhythmias while receiving adenosine.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an
increase in which laboratory value as the result of this medication?
Serum glucose.
Rationale:
Solu-Medrol is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects
can lead to hyperglycemia which is reflected as an increase in the serum glucose value. The
client taking Solu-Medrol is also at risk for hypocalcemia and hypokalemia which result in a
decrease in the serum calcium and serum potassium levels. These medications also alter the some
of the body's immune responses by suppressing the migration of white blood cells decreasing
inflammation response.
A client receiving Doxorubicin (Adriamycin) intravenously (IV) complains of pain at the
insertion site, and the nurse notes edema at the site. Which intervention is most important for the
nurse to implement?
Discontinue the IV fluids.
Rationale:
Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue
upon extravasation. First, all IV fluids should be discontinued at the site to prevent further tissue
damage by the vesicant.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
Questions and Verified Answers
with Rationales|100% Correct|
Grade A- Nightingale
A category X drug is prescribed for a young adult female client. Which instruction is most
important for the nurse to teach this client?
Use a reliable form of birth control.
Rationale
Drugs classified in the category X place a client who is in the first trimester of pregnancy at risk
for teratogenesis, so women in the childbearing years should be counseled to use a reliable form
of birth control during drug therapy. If the client is planning to become pregnant, she should be
encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative
prescription can be provided if pregnancy occurs.
The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker
(ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory
results and notes that the client's serum potassium level is 5.9 mEq/L. What action should the
nurse take first?
Withhold the scheduled dose.
Rationale
The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic
(normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
in heart failure, hyperkalemia is associated with several heart failure medications, including
ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the
apical pulse for rate and rhythm, and the blood pressure.
A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which observation by
the nurse would indicate that the desired outcome of the medication is being achieved?
Lessening of tremors.
Rationale
Sinemet increases the amount of levodopa to the CNS (dopamine to the brain). Increased
amounts of dopamine improve the symptoms of Parkinson's, such as involuntary movements,
resting tremors, shuffling gait, etc. Decreased drooling would be a desired effect, not increased
salivation.
Which medications should the nurse caution the client about taking while receiving an opioid
analgesic?
Benzodiazepines.
Rationale
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
Respiratory depression increases with the concurrent use of opioid analgesics and other central
nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines. Antacids
and antidiabetic agents do not interact with opiates to produce adverse effects. Antihypertensives
may cause morphine-induced hypotension, but should not be withheld without notifying the
healthcare provider.
An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent
motion sickness while on a cruise. Which information should the nurse provide to the client?
Apply the patch at least 4 hours prior to departure.
Rationale
Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in
6 hours, so the client should be instructed to apply the patch at least 4 hours before departure on
the cruise ship. The duration of the transdermal patch is 72 hours. Scolopamine blocks
muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the
patch is behind the ear. Anticholinergic medications are CNS depressants, so the client should be
instructed to avoid alcohol while using the patch.
A client who has been taking levodopa PO TID to control the symptoms of Parkinson's disease
has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The
client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan
for this client?
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
"You can begin taking the Sinemet this evening, but do not take any more levodopa."
Rationale
Carbidopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the
new prescription should not be started until eight hours after the previous dose of levodopa, but
can be started the same day.
A postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35
mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse
notes that the client has become increasingly restless, irritable and confused, stating that there are
bugs all over the walls. What action should the nurse take first?
Decrease the IV infusion rate of the meperidine (Demerol) per protocol.
Rationale
The client is exhibiting symptoms of Demerol toxicity which is consistent with the large doses of
Demerol received over four days. Decreasing the infusion rate of the Demerol as per protocol is
the most effective action to immediately decrease the amount of serum Demerol. The next
nursing action is for the nurse to notify the healthcare provider.
A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should
the nurse include in the client's instruction?
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
Take the medication with food.
Rationale
Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be
instructed to take the medication on a full stomach. Urine may be red-brown or dark from Flagyl,
but this side effect is an expectant finding and not necessary to report tot he healthcare provider.
Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin
for arthritis?
Bismuth subsalicylate (Pepto Bismol).
Rationale
Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for
salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate
preparation).
A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse
provide?
"No, it is not an oral insulin and can be used only when some beta cell function is present."
Rationale
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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Grade A- Nightingale
An effective oral form of insulin has not yet been developed because when insulin is taken orally,
it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that
enhances pancreatic production of insulin.
Which nursing intervention is most important when caring for a client receiving the
antimetabolite cytosine arabinoside (Arc-C) for chemotherapy?
Inspect the client's oral mucosa for ulcerations.
Rationale
Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis
and mucosal ulcerations are key signs of antimetabolite toxicity.
Which drug is used as a palliative treatment for a client with tumor-induced spinal cord
compression?
Dexamethasone (Decadron).
Rationale
Dexamethasone is a palliative treatment modality to manage symptoms related to compression
due to tumor growth ( the focus of this question). Morphine sulphate is an opioid analgesic used
in oncology to manage severe or intractable pain. Ibuprofen, a nonsteroidal antiinflammatory
drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and
BSN HESI 315 Pharmacology
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Grade A- Nightingale
reduction of fever. Amitriptyline, a tricyclic antidepressant, is often prescribed for pain related to
neuropathic origin and provides a reduction in opioid dosage.
A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When
the client reports the onset of a headache prior to the next scheduled dose, which action should
the nurse implement?
Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol).
Rationale
Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which
can generally be controlled with acetaminophen until the client develops a tolerance to this
adverse effect.
The nitrate isosorbide dinitrate (Isordil) is prescribed for a client with angina. Which instruction
should the nurse include in this client's discharge teaching plan?
Do not get up quickly. Always rise slowly.
Rationale
An expected side effect of nitrates is orthostatic hypotension and the nurse should address how to
prevent it--by rising slowly.
BSN HESI 315 Pharmacology
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Grade A- Nightingale
A client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment
finding indicates that the desired effect of the medication has been achieved?
Blood pressure has changed from 180/120 to 140/70 mmHg.
Rationale
Catapres acts as a centrally-acting analgesic and antihypertensive agent. A reduction of the blood
pressure to 140/70 mmHg indicates a reduction in hypertension.
Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with which
condition?
Heart failure.
Rationale
Dobutamine is a beta-1 adrenergic agonist that is indicated for short term use in cardiac
decompensation or heart failure related to reduced cardiac contractility due to organic heart
disease or cardiac surgical procedures. On the other hand, alpha and beta adrenergic agonists,
such as epinephrine and dopamine, are sympathomimetics used in the treatment of shock. Other
selective beta-2 adrenergic agonists, such as terbutaline and isoproterenol, are indicated in the
treatment of asthma. Although dobutamine improves cardiac output, it is not used to treat
hypotension.
BSN HESI 315 Pharmacology
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with Rationales|100% Correct|
Grade A- Nightingale
A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that
the action of this drug is to
inhibit synthesis of T3 and T4 by the thyroid gland
Rationale
PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid
hormones. It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy.
When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most
important for the nurse to assess for pain in which area of the body?
Abdomen.
Rationale
Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the
nurse to assess for pain in the right upper quadrant of the abdomen, which might indicate liver
damage, along with nausea and vomiting.
BSN HESI 315 Pharmacology
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Grade A- Nightingale
A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults.
The nurse knows that which medication would be contraindicated for this client?
Pentobarbital sodium (Nembutal Sodium) for sleep.
Rationale
Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates and
anesthetics.
The nurse is teaching a client with cancer about opioid management for intractable pain and
tolerance related side effects. The nurse should prepare the client for which side effect that is
most likely to persist during long-term use of opioids?
Constipation.
Rationale
The client should be prepared to implement measures for constipation which is the most likely
persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the
client may experience less sedation and respiratory depression as analgesic use continues.
Opioids increase the tone in the urinary bladder sphincter, which causes retention but may
subside. The most likely persistent side effect is constipation.
BSN HESI 315 Pharmacology
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Grade A- Nightingale
An older client with a decreased percentage of lean body mass is likely to receive a prescription
that is adjusted based on which pharmacokinetic process?
Distribution.
Rationale
A decreased lean body mass in an older adult affects the distribution of drugs which affects the
pharmacokinetics of drugs. In contrast, decreased gastric pH, delayed gastric emptying,
decreased splanchnic blood flow, decreased gastrointestinal absorption surface areas and motility
affect absorption in the older adult population. Decreased hepatic blood flow, decreased hepatic
mass, and decreased activity of hepatic enzymes affect metabolism in older adults. Decreased
renal blood flow, decreased glomerular filtration rate, decreased tubular secretion, and decreased
number of nephrons affects elimination in an older adult.
A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should
instruct the client to notify the healthcare provider immediately if which symptom occurs?
Rash.
Rationale
Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication
which could result in anaphylactic shock, a medical emergency.
BSN HESI 315 Pharmacology
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Grade A- Nightingale
The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who
receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse
implement?
Verify both prescriptions with the healthcare provider.
Rationale
The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-
sparing diuretic such as spironolactone, should be given with caution because the two drugs may
interact to cause an elevation in serum potassium levels. Although the client is currently
receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the
client's medication regimen and provides the safest action before administering the medication.
Upon admission to the emergency center, an adult client with acute status asthmaticus is
prescribed this series of medications. In which order should the nurse administer the prescribed
medications? (Arrange from first to last.)
1. Albuterol (Proventil) puffs.
2. Salmeterol (Serevent Diskus).
3. Prednisone (Deltasone) orally.
4. Gentamicin (Garamycin) IM.
Rationale
BSN HESI 315 Pharmacology
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Grade A- Nightingale
Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a beta2
adrenergic agonist and short acting bronchodilator, should be administered by inhalation first to
provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and
increase oxygenation. In stepwise management of persistent asthma, a long-action
bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of action should be
given next. Prednisone, an oral corticosteroid, provides prolonged anti-inflammatory effects and
should be given after the client's respiratory distress begins to resolves. Gentamicin, an
antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so
should be last in the sequence.
A client with heart failure (HF) is being discharged with a new prescription for the angiotensin-
converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should
include reporting which problem to the healthcare provider?
Dizziness.
Rationale
Angiotensin-converting enzyme (ACE) inhibitors are used in HF to reduce afterload by reversing
vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant
dizziness. Weight loss is desired if fluid overload is present, and may occur as the result of
effective combination drug therapy such as diuretics with ACE inhibitors. It does not reuiqre
reporting to the healthcare provider. Unlike ACE inhibitors, diuretics may result in hypokalemia
and excessive diuretic administration may result in fluid volume deficit manifested by symptoms
of dehydration.
BSN HESI 315 Pharmacology
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with Rationales|100% Correct|
Grade A- Nightingale
A client is taking hydromorphone (Dilaudid) PO q4h at home. Following surgery, Dilaudid IV
q4h PRN and butorphanol tartrate (Stadol) IV q4h PRN are prescribed for pain. The client
received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. What
intervention should the nurse implement?
Administer only the Dilaudid q4h PRN for pain.
Rationale
Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-
antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal
symptoms, and should be avoided.
A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9:00
p.m. dose. What action can the nurse take to alleviate this side effect?
Administer the dose with a snack.
Rationale
Administering oral doses of albuterol with food helps minimize GI discomfort.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new
prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the
nurse assesses the client. Which finding requires the most immediate intervention?
Vomiting.
Rationale
Vomiting, anorexia and abdominal pain are early indications of digitalis toxicity. Since Lipitor
increases the risk for digitalis toxicity, this finding requires the most immediate intervention by
the nurse.
A client with heart failure is prescribed spironolactone (Aldactone). Which information is most
important for the nurse to provide to the client about diet modifications?
Refrain for eating foods high in potassium.
Rationale
Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet
high in potassium should be avoided, along with table salt substitutes which are generally
contain potassium chloride which can lead to hyperkalemia.
A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the
optimum time for the nurse to obtain the trough level?
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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Grade A- Nightingale
Immediately before the next antibiotic dose is given.
Rationale
Trough levels are drawn when the blood level is at its lowest, which is typically just before the
next dose is given.
Which instruction(s) should the nurse give to a female client who just received a prescription for
oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.)
Increase fluid intake, especially cranberry juice., Avoid drinking alcohol while taking this
medication.,
Use condoms until treatment is completed.,
Ensure that all sexual partners are treated at the same time
Rationale
Increased fluid intake and cranberry juice are recommended for prevention and treatment of
urinary tract infections, which frequently accompany vaginal infections. It is not necessary to
taper use of this drug or to check the blood pressure daily, as this condition is not related to
hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of
alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated
at the same time and condoms should be used until after treatment is completed to avoid
reinfection.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is
performing as intended?
Two or three soft stools per day
Rationale
The medication lactulose can be administered for either chronic constipation or for portal-
systemic encephalopathy in clients with hepatic disease. Two to three stools a day indicate that
lactulose is performing as intended for chronic constipation. This would also indicate it should
be effective for the clients with encephalopathy because the lactulose's action prevents
absorption of ammonia in the colon as it increases water absorption and softens the stool. The
efficacy of the use for ammonia absorption would have to be verified by a serum ammonia level
and observation of clearing of the client's mental status.
An adult client has prescriptions for morphine sulfate 2.5 mg IV q6h and ketorolac (Toradol) 30
mg IV q6h. Which action should the nurse implement?
Administer both medications according to the prescription.
Rationale
Morphine and ketorolac (Toradol) can be administered concurrently, and may produce an
additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this
prescription. Toradol is an antiinflammatory analgesic, and does not have an antagonistic effect
with morphine.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
A 43-year-old female client is receiving thyroid replacement hormone following a
thyroidectomy. What adverse effects associated with thyroid hormone toxicity should the nurse
instruct the client to report promptly to the healthcare provider?
Tachycardia and chest pain.
Rationale
Thyroid replacement hormone increases the metabolic rate of all tissues, so common signs and
symptoms of toxicity include tachycardia and chest pain.
Following heparin treatment for a pulmonary embolism, a client is being discharged with a
prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the
client to have which diagnostic test monitored regularly after discharge?
Prothrombin Time (PT/INR).
Rationale
When used for a client with pulmonary embolus, the therapeutic goal for warfarin therapy is a PT
1 to 2 times greater than the control, or an INR of 2 to 3.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
A client is admitted to the coronary care unit with a medical diagnosis of acute myocardial
infarction. Which medication prescription decreases both preload and afterload?
Nitroglycerin.
Rationale
Nitroglycerin is a nitrate that causes peripheral vasodilation and decreases contractility, thereby
decreasing both preload and afterload.
The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client
with arthritis. The client reports that she can't hear the nurse's questions because her ears are
ringing. What action should the nurse implement?
Notify the healthcare provider of this finding immediately.
Rationale
Tinnitus is an early sign of salicylate toxicity. The healthcare provider should be notified
immediately, and the medication discontinued.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
While taking a nursing history, the client states, "I am allergic to penicillin." What related allergy
to another type of antiinfective agent should the nurse ask the client about when taking the
nursing history?
Cephalosporins.
Rationale
If a client has a history of being allergic to penicillin (PCN); there is appears to be a cross
sensitivity between penicillins and 1st generation cephalosporins. According to research, there
appears to be no cross sensitivity between PCN and 3rd or 4th generation cephalosporins.
The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with
osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective
after three weeks. Which is the best response for the nurse to provide?
Another type of nonsteroidal antiinflammatory drug may be indicated.
Rationale
Individual responses to nonsteroidal antiinflammatory drugs are vary from person to person, so
another nonsteroidal antiinflammatory drug (NSAID) may be indicated for this particular client.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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with Rationales|100% Correct|
Grade A- Nightingale
A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the
next 24 hours. What dosing schedule is best for the nurse to implement?
q6h.
Rationale
Pronestyl is a class 1A antidysrhythmic. It should be taken around-the-clock, so that a stable
blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an
adverse effect) occurring because of too much of the drug circulating systemically at any
particular time of day. Pronestyl may be given with food if GI distress is a problem.
Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor
antagonist valsartan (Diovan) has been achieved?
Blood pressure reduced from 160/90 to 130/80.
Rationale
Diovan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The
desired effect is a decrease in blood pressure.
A client is receiving metoprolol (Lopressor SR, Nu-Metop). What assessment is most important
for the nurse to obtain?
Blood pressure.
BSN HESI 315 Pharmacology
Exam v1 (New 2026/ 2027 Update)
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Grade A- Nightingale
Rationale
It is most important to monitor the blood pressure of clients taking this medication because
metoprolol is an antianginal, antiarrhythmic, antihypertensive agent.
The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which
assessment data would indicate that the naloxone has been effective? The client's
respiratory rate is 16 breaths/minute.
Rationale
Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of
opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory
depression has been reversed.
