1
BSN HESI 315 Pharmacology Exam V1
Actual Exam 2026/2027 | Complete
Exam-Style Questions | 100% Verified –
Detailed Rationales – Pass Guaranteed –
A+ Graded
TABLE OF CONTENTS
Section 1 | Pharmacokinetics and Pharmacodynamics | Q1 – Q12
Section 2 | Medication Administration and Dosage Calculations | Q13 – Q24
Section 3 | Autonomic and Cardiovascular Pharmacology | Q25 – Q36
Section 4 | Central Nervous System and Psychiatric Pharmacology | Q37 – Q48
Section 5 | Anti-infectives, Endocrine, and Respiratory Pharmacology | Q49 – Q60
SECTION 1: PHARMACOKINETICS AND PHARMACODYNAMICS
Question 1 of 60
A 68-year-old patient with chronic kidney disease stage 4 is prescribed gentamicin 1.5 mg/kg IV
every 8 hours for a gram-negative infection. The nurse reviews the patient's serum creatinine of
2.8 mg/dL and notes the last trough level was 3.2 mcg/mL. The therapeutic range for gentamicin
trough is less than 2 mcg/mL. The nurse should anticipate the prescriber will make what
adjustment?
A. Increase the dose to 2 mg/kg to achieve a higher peak concentration
B. Extend the dosing interval to every 24 hours and recheck trough levels
C. Discontinue the medication and switch to a nephrotoxicity-free alternative
D. Administer the next dose immediately to maintain therapeutic levels
B. Extend the dosing interval to every 24 hours and recheck trough levels ✓ CORRECT
Correct Answer: B
Rationale: In patients with renal impairment, aminoglycosides like gentamicin accumulate due to
reduced glomerular filtration, prolonging their half-life and increasing the risk of nephrotoxicity
,2
and ototoxicity. Extending the dosing interval allows for adequate drug elimination while
maintaining efficacy, and trough monitoring guides further adjustments. Option A is incorrect
because increasing the dose would further elevate trough levels and worsen nephrotoxicity,
contradicting pharmacokinetic principles of dose reduction or interval extension in renal
impairment. Regular monitoring of renal function and drug levels is essential when prescribing
nephrotoxic medications to patients with compromised kidney function.
Question 2 of 60
A 45-year-old patient with a history of hepatic cirrhosis is prescribed lorazepam 2 mg PO every 6
hours as needed for anxiety. The nurse recognizes that this benzodiazepine was selected over
diazepam primarily because of what pharmacokinetic advantage in liver disease?
A. Lorazepam undergoes extensive first-pass metabolism in the liver, reducing systemic
exposure
B. Lorazepam is metabolized through glucuronidation rather than oxidation, preserving clearance
in cirrhosis
C. Lorazepam has a larger volume of distribution, allowing rapid redistribution from the brain
D. Lorazepam is primarily excreted unchanged by the kidneys, bypassing hepatic metabolism
entirely
B. Lorazepam is metabolized through glucuronidation rather than oxidation, preserving clearance
in cirrhosis ✓ CORRECT
Correct Answer: B
Rationale: In hepatic cirrhosis, phase I oxidative metabolism via cytochrome P450 enzymes is
significantly impaired, whereas phase II glucuronidation remains relatively preserved.
Lorazepam, oxazepam, and temazepam undergo glucuronidation, making them safer choices in
liver disease compared to diazepam, which relies heavily on CYP450 oxidation and accumulates
in cirrhosis. Option A is incorrect because lorazepam actually has lower first-pass metabolism
than many benzodiazepines, and extensive first-pass metabolism would reduce bioavailability
rather than represent an advantage. Selecting benzodiazepines with glucuronidation pathways
minimizes the risk of excessive sedation and encephalopathy in patients with compromised
hepatic function.
Question 3 of 60
A 72-year-old patient with atrial fibrillation is prescribed digoxin 0.25 mg PO daily. The nurse
notes the patient's serum albumin is 2.8 g/dL (normal 3.5–5.0 g/dL) due to chronic malnutrition.
The nurse understands that the decreased albumin will most significantly affect which
pharmacokinetic parameter of digoxin?
,3
A. The volume of distribution, as digoxin distributes extensively into tissues rather than
remaining protein-bound
B. The free fraction of digoxin in plasma, potentially increasing pharmacologic effect
C. The hepatic metabolism rate, as protein binding alters CYP450 enzyme activity
D. The renal clearance of digoxin, since only bound drug is filtered by the glomerulus
A. The volume of distribution, as digoxin distributes extensively into tissues rather than
remaining protein-bound ✓ CORRECT
Correct Answer: A
Rationale: Digoxin exhibits a very large volume of distribution (approximately 500–600 L)
because it extensively distributes into muscle and tissue sites rather than remaining bound to
plasma proteins; approximately 20–30% is protein-bound, so changes in albumin minimally
affect free fraction. In hypoalbuminemia, the clinical concern with digoxin is not altered protein
binding but rather the potential for toxicity from other factors such as renal impairment or drug
interactions. Option B is incorrect because digoxin has low protein binding, so hypoalbuminemia
does not significantly increase the free fraction or pharmacologic effect in the way it would for
highly protein-bound drugs like warfarin or phenytoin. Nurses must recognize that highly tissue-
distributed drugs are less affected by protein-binding changes, and digoxin toxicity monitoring
should focus on renal function and electrolyte status instead.
Question 4 of 60
A 55-year-old patient with hypertension is prescribed propranolol 40 mg PO twice daily. After
two weeks, the nurse assesses the patient and finds the blood pressure unchanged at 158/96
mmHg. The nurse recalls that propranolol exhibits nonlinear pharmacokinetics at higher doses
due to what characteristic?
A. Propranolol undergoes dose-dependent renal tubular reabsorption, reducing excretion at
higher doses
B. Propranolol demonstrates saturable first-pass hepatic metabolism, leading to increased
bioavailability with dose escalation
C. Propranolol activates autoinduction of hepatic enzymes, accelerating its own clearance over
time
D. Propranolol forms irreversible bonds with beta-adrenergic receptors, requiring receptor
regeneration
D. Propranolol demonstrates saturable first-pass hepatic metabolism, leading to increased
bioavailability with dose escalation ✓ CORRECT
, 4
Correct Answer: D
Rationale: Propranolol undergoes extensive first-pass metabolism via hepatic CYP450 enzymes,
and this metabolic pathway becomes saturated at higher doses, resulting in disproportionately
increased bioavailability and plasma concentrations. This nonlinear pharmacokinetic profile
means dose increases produce greater-than-expected clinical effects, and the nurse should
monitor for excessive bradycardia or hypotension if the dose is escalated. Option C is incorrect
because propranolol does not induce its own metabolism; autoinduction is characteristic of drugs
like carbamazepine, not beta-blockers. Understanding saturable metabolism helps nurses
anticipate that titration of propranolol requires careful monitoring, as small dose increments may
produce unexpectedly large changes in blood pressure and heart rate.
Question 5 of 60
A 34-year-old patient receiving treatment for tuberculosis develops orange-colored urine and
contacts the clinic. The nurse reviews the medication regimen of isoniazid, rifampin, ethambutol,
and pyrazinamide. The nurse should explain that this discoloration is an expected
pharmacodynamic effect of which drug?
A. Isoniazid, which causes harmless pigment deposition in the renal tubules
B. Rifampin, which imparts a benign orange-red color to body fluids and secretions
C. Ethambutol, which produces urinary discoloration through retinal pigment excretion
D. Pyrazinamide, which alters urine pH and causes crystalluria with orange sediment
B. Rifampin, which imparts a benign orange-red color to body fluids and secretions ✓
CORRECT
Correct Answer: B
Rationale: Rifampin is a well-known inducer of cytochrome P450 enzymes and produces a
harmless orange-red discoloration of urine, sweat, tears, and other body fluids due to the drug's
natural pigmentation, which is an expected pharmacodynamic effect rather than an adverse
reaction. Patients should be counseled about this effect before starting therapy to prevent
unnecessary anxiety or premature discontinuation. Option A is incorrect because isoniazid does
not cause orange urine; its characteristic adverse effects include hepatotoxicity and peripheral
neuropathy, not pigment deposition in renal tubules. Educating patients about benign but
alarming drug effects improves adherence to lengthy tuberculosis regimens and reduces
unnecessary emergency department visits.
Question 6 of 60
A 29-year-old patient with epilepsy has been seizure-free on phenytoin 300 mg PO daily for two
years. The patient recently started taking omeprazole 20 mg daily for GERD. At the next clinic
BSN HESI 315 Pharmacology Exam V1
Actual Exam 2026/2027 | Complete
Exam-Style Questions | 100% Verified –
Detailed Rationales – Pass Guaranteed –
A+ Graded
TABLE OF CONTENTS
Section 1 | Pharmacokinetics and Pharmacodynamics | Q1 – Q12
Section 2 | Medication Administration and Dosage Calculations | Q13 – Q24
Section 3 | Autonomic and Cardiovascular Pharmacology | Q25 – Q36
Section 4 | Central Nervous System and Psychiatric Pharmacology | Q37 – Q48
Section 5 | Anti-infectives, Endocrine, and Respiratory Pharmacology | Q49 – Q60
SECTION 1: PHARMACOKINETICS AND PHARMACODYNAMICS
Question 1 of 60
A 68-year-old patient with chronic kidney disease stage 4 is prescribed gentamicin 1.5 mg/kg IV
every 8 hours for a gram-negative infection. The nurse reviews the patient's serum creatinine of
2.8 mg/dL and notes the last trough level was 3.2 mcg/mL. The therapeutic range for gentamicin
trough is less than 2 mcg/mL. The nurse should anticipate the prescriber will make what
adjustment?
A. Increase the dose to 2 mg/kg to achieve a higher peak concentration
B. Extend the dosing interval to every 24 hours and recheck trough levels
C. Discontinue the medication and switch to a nephrotoxicity-free alternative
D. Administer the next dose immediately to maintain therapeutic levels
B. Extend the dosing interval to every 24 hours and recheck trough levels ✓ CORRECT
Correct Answer: B
Rationale: In patients with renal impairment, aminoglycosides like gentamicin accumulate due to
reduced glomerular filtration, prolonging their half-life and increasing the risk of nephrotoxicity
,2
and ototoxicity. Extending the dosing interval allows for adequate drug elimination while
maintaining efficacy, and trough monitoring guides further adjustments. Option A is incorrect
because increasing the dose would further elevate trough levels and worsen nephrotoxicity,
contradicting pharmacokinetic principles of dose reduction or interval extension in renal
impairment. Regular monitoring of renal function and drug levels is essential when prescribing
nephrotoxic medications to patients with compromised kidney function.
Question 2 of 60
A 45-year-old patient with a history of hepatic cirrhosis is prescribed lorazepam 2 mg PO every 6
hours as needed for anxiety. The nurse recognizes that this benzodiazepine was selected over
diazepam primarily because of what pharmacokinetic advantage in liver disease?
A. Lorazepam undergoes extensive first-pass metabolism in the liver, reducing systemic
exposure
B. Lorazepam is metabolized through glucuronidation rather than oxidation, preserving clearance
in cirrhosis
C. Lorazepam has a larger volume of distribution, allowing rapid redistribution from the brain
D. Lorazepam is primarily excreted unchanged by the kidneys, bypassing hepatic metabolism
entirely
B. Lorazepam is metabolized through glucuronidation rather than oxidation, preserving clearance
in cirrhosis ✓ CORRECT
Correct Answer: B
Rationale: In hepatic cirrhosis, phase I oxidative metabolism via cytochrome P450 enzymes is
significantly impaired, whereas phase II glucuronidation remains relatively preserved.
Lorazepam, oxazepam, and temazepam undergo glucuronidation, making them safer choices in
liver disease compared to diazepam, which relies heavily on CYP450 oxidation and accumulates
in cirrhosis. Option A is incorrect because lorazepam actually has lower first-pass metabolism
than many benzodiazepines, and extensive first-pass metabolism would reduce bioavailability
rather than represent an advantage. Selecting benzodiazepines with glucuronidation pathways
minimizes the risk of excessive sedation and encephalopathy in patients with compromised
hepatic function.
Question 3 of 60
A 72-year-old patient with atrial fibrillation is prescribed digoxin 0.25 mg PO daily. The nurse
notes the patient's serum albumin is 2.8 g/dL (normal 3.5–5.0 g/dL) due to chronic malnutrition.
The nurse understands that the decreased albumin will most significantly affect which
pharmacokinetic parameter of digoxin?
,3
A. The volume of distribution, as digoxin distributes extensively into tissues rather than
remaining protein-bound
B. The free fraction of digoxin in plasma, potentially increasing pharmacologic effect
C. The hepatic metabolism rate, as protein binding alters CYP450 enzyme activity
D. The renal clearance of digoxin, since only bound drug is filtered by the glomerulus
A. The volume of distribution, as digoxin distributes extensively into tissues rather than
remaining protein-bound ✓ CORRECT
Correct Answer: A
Rationale: Digoxin exhibits a very large volume of distribution (approximately 500–600 L)
because it extensively distributes into muscle and tissue sites rather than remaining bound to
plasma proteins; approximately 20–30% is protein-bound, so changes in albumin minimally
affect free fraction. In hypoalbuminemia, the clinical concern with digoxin is not altered protein
binding but rather the potential for toxicity from other factors such as renal impairment or drug
interactions. Option B is incorrect because digoxin has low protein binding, so hypoalbuminemia
does not significantly increase the free fraction or pharmacologic effect in the way it would for
highly protein-bound drugs like warfarin or phenytoin. Nurses must recognize that highly tissue-
distributed drugs are less affected by protein-binding changes, and digoxin toxicity monitoring
should focus on renal function and electrolyte status instead.
Question 4 of 60
A 55-year-old patient with hypertension is prescribed propranolol 40 mg PO twice daily. After
two weeks, the nurse assesses the patient and finds the blood pressure unchanged at 158/96
mmHg. The nurse recalls that propranolol exhibits nonlinear pharmacokinetics at higher doses
due to what characteristic?
A. Propranolol undergoes dose-dependent renal tubular reabsorption, reducing excretion at
higher doses
B. Propranolol demonstrates saturable first-pass hepatic metabolism, leading to increased
bioavailability with dose escalation
C. Propranolol activates autoinduction of hepatic enzymes, accelerating its own clearance over
time
D. Propranolol forms irreversible bonds with beta-adrenergic receptors, requiring receptor
regeneration
D. Propranolol demonstrates saturable first-pass hepatic metabolism, leading to increased
bioavailability with dose escalation ✓ CORRECT
, 4
Correct Answer: D
Rationale: Propranolol undergoes extensive first-pass metabolism via hepatic CYP450 enzymes,
and this metabolic pathway becomes saturated at higher doses, resulting in disproportionately
increased bioavailability and plasma concentrations. This nonlinear pharmacokinetic profile
means dose increases produce greater-than-expected clinical effects, and the nurse should
monitor for excessive bradycardia or hypotension if the dose is escalated. Option C is incorrect
because propranolol does not induce its own metabolism; autoinduction is characteristic of drugs
like carbamazepine, not beta-blockers. Understanding saturable metabolism helps nurses
anticipate that titration of propranolol requires careful monitoring, as small dose increments may
produce unexpectedly large changes in blood pressure and heart rate.
Question 5 of 60
A 34-year-old patient receiving treatment for tuberculosis develops orange-colored urine and
contacts the clinic. The nurse reviews the medication regimen of isoniazid, rifampin, ethambutol,
and pyrazinamide. The nurse should explain that this discoloration is an expected
pharmacodynamic effect of which drug?
A. Isoniazid, which causes harmless pigment deposition in the renal tubules
B. Rifampin, which imparts a benign orange-red color to body fluids and secretions
C. Ethambutol, which produces urinary discoloration through retinal pigment excretion
D. Pyrazinamide, which alters urine pH and causes crystalluria with orange sediment
B. Rifampin, which imparts a benign orange-red color to body fluids and secretions ✓
CORRECT
Correct Answer: B
Rationale: Rifampin is a well-known inducer of cytochrome P450 enzymes and produces a
harmless orange-red discoloration of urine, sweat, tears, and other body fluids due to the drug's
natural pigmentation, which is an expected pharmacodynamic effect rather than an adverse
reaction. Patients should be counseled about this effect before starting therapy to prevent
unnecessary anxiety or premature discontinuation. Option A is incorrect because isoniazid does
not cause orange urine; its characteristic adverse effects include hepatotoxicity and peripheral
neuropathy, not pigment deposition in renal tubules. Educating patients about benign but
alarming drug effects improves adherence to lengthy tuberculosis regimens and reduces
unnecessary emergency department visits.
Question 6 of 60
A 29-year-old patient with epilepsy has been seizure-free on phenytoin 300 mg PO daily for two
years. The patient recently started taking omeprazole 20 mg daily for GERD. At the next clinic
