BSN 315 HESI Pharmacology V1 Practice Exam +
Rationales | Nightingale (2026/2027)
Advanced Nursing Pharmacology | Key Domains: Cardiovascular & Renal Pharmacotherapeutics,
Neuro-Psychopharmacology, Endocrine & Respiratory Drugs, Antimicrobial & Chemotherapeutic
Agents, Pain Management & Analgesics, and Special Population Considerations | Expert-Aligned
Structure | Practice Exam Format
Introduction
This structured BSN 315 HESI Pharmacology V1 Practice Exam for Nightingale College for
2026/2027 provides a focused set of high-quality, exam-style questions with correct answers and
rationales. It emphasizes the application of pharmacological principles to complex clinical
scenarios, focusing on mechanism of action, therapeutic use, adverse effect management, and
patient-specific factors influencing drug therapy.
Exam Structure:
• Practice Exam V1: (65 QUESTIONS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining the pharmacologic rationale for the drug of choice, the key assessment or laboratory
parameter to monitor for efficacy/toxicity, the appropriate nursing intervention for a side effect or
interaction, and why alternative options are less effective, contraindicated, or pose a greater risk to
the patient.
1. A 68-year-old male with heart failure (HF) and an ejection fraction of 28% is prescribed a
new medication regimen. Which drug should the nurse anticipate will be included to
improve survival and reduce hospitalizations?
A. Verapamil
B. Digoxin
, C. Sacubitril/valsartan
D. Hydrochlorothiazide
Rationale: Sacubitril/valsartan (Entresto) is an angiotensin receptor-neprilysin inhibitor (ARNI) shown
in clinical trials (PARADIGM-HF) to significantly reduce mortality and hospitalization in patients with
HFrEF (heart failure with reduced ejection fraction) compared to enalapril. It is now a first-line agent
per current ACC/AHA guidelines. Verapamil (a non-dihydropyridine calcium channel blocker) can
worsen HF. Digoxin improves symptoms but not mortality. Hydrochlorothiazide is a diuretic used for
symptom relief but does not improve survival.
2. A patient with schizophrenia is started on risperidone. Which adverse effect should the
nurse prioritize monitoring for during the initial weeks of therapy?
A. Photosensitivity
B. Extrapyramidal symptoms (EPS)
C. Hypothyroidism
D. Hyperglycemia
Rationale: Risperidone, a second-generation antipsychotic, carries a risk of extrapyramidal symptoms
(e.g., dystonia, akathisia, parkinsonism), especially at higher doses or during initiation. While metabolic
effects like hyperglycemia are possible with atypical antipsychotics, EPS is more acute and requires early
monitoring. Photosensitivity is associated with first-generation agents like chlorpromazine, and
hypothyroidism is not a common side effect of antipsychotics.
3. A patient with type 2 diabetes is prescribed metformin. Which laboratory value is most
critical to assess before initiating therapy?
A. Hemoglobin A1c
B. Fasting blood glucose
C. Serum creatinine/eGFR
, D. Liver enzymes
Rationale: Metformin is contraindicated in patients with significant renal impairment (eGFR <30
mL/min) due to the risk of lactic acidosis. Serum creatinine and estimated glomerular filtration rate
(eGFR) must be assessed before starting and monitored periodically. While HbA1c and fasting glucose
guide glycemic control, they do not determine metformin safety. Liver enzymes are relevant for
medications like statins or certain antidiabetics (e.g., pioglitazone), but not primarily for metformin.
4. A 45-year-old woman with a urinary tract infection (UTI) is prescribed ciprofloxacin.
Which patient education point is most essential?
A. Take with dairy products to enhance absorption
B. Avoid direct sunlight and use sunscreen
C. Expect orange discoloration of urine
D. Discontinue if diarrhea develops
Rationale: Ciprofloxacin, a fluoroquinolone antibiotic, can cause photosensitivity reactions. Patients
should avoid excessive sun exposure and use protective measures. Dairy products (calcium) decrease
absorption of fluoroquinolones and should be avoided within 2 hours of dosing. Orange urine is seen
with rifampin, not ciprofloxacin. While antibiotic-associated diarrhea (including C. difficile) is a risk,
patients should not stop antibiotics without consulting a provider—instead, they should report severe or
persistent diarrhea.
5. Which analgesic is safest for a pregnant patient at 28 weeks gestation complaining of
moderate headache?
A. Ibuprofen
B. Aspirin
C. Codeine
D. Acetaminophen
Rationales | Nightingale (2026/2027)
Advanced Nursing Pharmacology | Key Domains: Cardiovascular & Renal Pharmacotherapeutics,
Neuro-Psychopharmacology, Endocrine & Respiratory Drugs, Antimicrobial & Chemotherapeutic
Agents, Pain Management & Analgesics, and Special Population Considerations | Expert-Aligned
Structure | Practice Exam Format
Introduction
This structured BSN 315 HESI Pharmacology V1 Practice Exam for Nightingale College for
2026/2027 provides a focused set of high-quality, exam-style questions with correct answers and
rationales. It emphasizes the application of pharmacological principles to complex clinical
scenarios, focusing on mechanism of action, therapeutic use, adverse effect management, and
patient-specific factors influencing drug therapy.
Exam Structure:
• Practice Exam V1: (65 QUESTIONS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining the pharmacologic rationale for the drug of choice, the key assessment or laboratory
parameter to monitor for efficacy/toxicity, the appropriate nursing intervention for a side effect or
interaction, and why alternative options are less effective, contraindicated, or pose a greater risk to
the patient.
1. A 68-year-old male with heart failure (HF) and an ejection fraction of 28% is prescribed a
new medication regimen. Which drug should the nurse anticipate will be included to
improve survival and reduce hospitalizations?
A. Verapamil
B. Digoxin
, C. Sacubitril/valsartan
D. Hydrochlorothiazide
Rationale: Sacubitril/valsartan (Entresto) is an angiotensin receptor-neprilysin inhibitor (ARNI) shown
in clinical trials (PARADIGM-HF) to significantly reduce mortality and hospitalization in patients with
HFrEF (heart failure with reduced ejection fraction) compared to enalapril. It is now a first-line agent
per current ACC/AHA guidelines. Verapamil (a non-dihydropyridine calcium channel blocker) can
worsen HF. Digoxin improves symptoms but not mortality. Hydrochlorothiazide is a diuretic used for
symptom relief but does not improve survival.
2. A patient with schizophrenia is started on risperidone. Which adverse effect should the
nurse prioritize monitoring for during the initial weeks of therapy?
A. Photosensitivity
B. Extrapyramidal symptoms (EPS)
C. Hypothyroidism
D. Hyperglycemia
Rationale: Risperidone, a second-generation antipsychotic, carries a risk of extrapyramidal symptoms
(e.g., dystonia, akathisia, parkinsonism), especially at higher doses or during initiation. While metabolic
effects like hyperglycemia are possible with atypical antipsychotics, EPS is more acute and requires early
monitoring. Photosensitivity is associated with first-generation agents like chlorpromazine, and
hypothyroidism is not a common side effect of antipsychotics.
3. A patient with type 2 diabetes is prescribed metformin. Which laboratory value is most
critical to assess before initiating therapy?
A. Hemoglobin A1c
B. Fasting blood glucose
C. Serum creatinine/eGFR
, D. Liver enzymes
Rationale: Metformin is contraindicated in patients with significant renal impairment (eGFR <30
mL/min) due to the risk of lactic acidosis. Serum creatinine and estimated glomerular filtration rate
(eGFR) must be assessed before starting and monitored periodically. While HbA1c and fasting glucose
guide glycemic control, they do not determine metformin safety. Liver enzymes are relevant for
medications like statins or certain antidiabetics (e.g., pioglitazone), but not primarily for metformin.
4. A 45-year-old woman with a urinary tract infection (UTI) is prescribed ciprofloxacin.
Which patient education point is most essential?
A. Take with dairy products to enhance absorption
B. Avoid direct sunlight and use sunscreen
C. Expect orange discoloration of urine
D. Discontinue if diarrhea develops
Rationale: Ciprofloxacin, a fluoroquinolone antibiotic, can cause photosensitivity reactions. Patients
should avoid excessive sun exposure and use protective measures. Dairy products (calcium) decrease
absorption of fluoroquinolones and should be avoided within 2 hours of dosing. Orange urine is seen
with rifampin, not ciprofloxacin. While antibiotic-associated diarrhea (including C. difficile) is a risk,
patients should not stop antibiotics without consulting a provider—instead, they should report severe or
persistent diarrhea.
5. Which analgesic is safest for a pregnant patient at 28 weeks gestation complaining of
moderate headache?
A. Ibuprofen
B. Aspirin
C. Codeine
D. Acetaminophen
