BSN HESI 315 Pharmacology Practice Exam V2
2026/2027 - 95 Evidence-Based Questions
SECTION A. PHARMACOLOGICAL PRINCIPLES (15 QUESTIONS)
A1. Pharmacokinetics & Pharmacodynamics (5 Q)
Q1.
A 68-year-old male with COPD and atrial fibrillation is started on digoxin 0.25 mg PO
daily. His latest serum creatinine is 1.8 mg/dL (eGFR 35 mL/min/1.73 m²). Which
pharmacokinetic parameter is most affected by his renal impairment?
A. Absorption rate
B. Volume of distribution
C. Hepatic first-pass effect
D. Elimination half-life
Answer: D – Elimination half-life
Rationale: Digoxin is 70–80% renally excreted; reduced GFR prolongs half-life → risk of
toxicity. Monitor levels and hold if HR <60 or visual changes occur.
Q2.
SATA. Which factors increase bioavailability of oral propranolol? (Select all that apply.)
A. Hepatic enzyme induction (e.g., rifampin)
,B. Hepatic enzyme inhibition (e.g., cimetidine)
C. Taking with high-protein meal
D. Concurrent hepatic impairment
E. Increased first-pass metabolism
Answers: B, D – Enzyme inhibition and hepatic impairment reduce first-pass
metabolism, increasing bioavailability; enzyme induction (A) and high first-pass (E)
decrease it; meals (C) have minimal effect on propranolol.
Q3.
A 45-year-old woman on phenytoin 300 mg PO BID has albumin 2.0 g/dL (normal
3.5–5.0). The nurse should interpret total serum phenytoin results by:
A. Doubling the reported value
B. Using the reported value as-is
C. Calculating corrected concentration (adjusted for hypoalbuminemia)
D. Monitoring free phenytoin level instead
Answer: C – Calculating corrected concentration
Rationale: Phenytoin is 90% protein-bound; hypoalbuminemia increases free drug while
total appears low. Use correction equation or free level for dosing decisions.
Q4.
,A 70-kg patient receives amiodarone 150 mg IV over 10 min followed by 1 mg/min for 6
h, then 0.5 mg/min. Which statement about amiodarone kinetics is correct?
A. Large Vd → prolonged half-life (up to 58 days)
B. Renal dosing required
C. Immediate antiarrhythmic effect within 5 min
D. Therapeutic levels achieved in 2 h
Answer: A – Large Vd → prolonged half-life (up to 58 days)
Rationale: Large volume of distribution (Vd ≈ 60 L/kg) and long half-life; loading
infusions needed; full effect may take days; not renally dosed.
Q5.
A child on high-dose methotrexate receives leucovorin rescue. The mechanism of
leucovorin is:
A. Inhibits dihydrofolate reductase
B. Provides reduced folate bypassing blocked enzyme
C. Enhances methotrexate excretion
D. Reverses renal toxicity
Answer: B – Provides reduced folate bypassing blocked enzyme
Rationale: Leucovorin (folinic acid) is active folate; rescues normal cells by bypassing
DHFR inhibition, limiting methotrexate toxicity.
, A2. Medication Safety & Rights (4 Q)
Q6.
A nurse discovers that insulin aspart was administered to the wrong patient. The first
action per 2026 Joint Commission sentinel-event protocol is:
A. Complete occurrence report within 24 h
B. Notify the provider immediately
C. Assess the patient for hypoglycemia
D. Document in medical record
Answer: C – Assess the patient for hypoglycemia
Rationale: Patient safety first—assess for adverse effect (hypoglycemia); notification
and reporting follow.
Q7.
SATA. Which are included in the expanded 15 Rights of Medication Administration
(2026)? (Select all that apply.)
A. Right documentation
B. Right reason
C. Right to refuse
D. Right response/evaluation
E. Right generic equivalent
2026/2027 - 95 Evidence-Based Questions
SECTION A. PHARMACOLOGICAL PRINCIPLES (15 QUESTIONS)
A1. Pharmacokinetics & Pharmacodynamics (5 Q)
Q1.
A 68-year-old male with COPD and atrial fibrillation is started on digoxin 0.25 mg PO
daily. His latest serum creatinine is 1.8 mg/dL (eGFR 35 mL/min/1.73 m²). Which
pharmacokinetic parameter is most affected by his renal impairment?
A. Absorption rate
B. Volume of distribution
C. Hepatic first-pass effect
D. Elimination half-life
Answer: D – Elimination half-life
Rationale: Digoxin is 70–80% renally excreted; reduced GFR prolongs half-life → risk of
toxicity. Monitor levels and hold if HR <60 or visual changes occur.
Q2.
SATA. Which factors increase bioavailability of oral propranolol? (Select all that apply.)
A. Hepatic enzyme induction (e.g., rifampin)
,B. Hepatic enzyme inhibition (e.g., cimetidine)
C. Taking with high-protein meal
D. Concurrent hepatic impairment
E. Increased first-pass metabolism
Answers: B, D – Enzyme inhibition and hepatic impairment reduce first-pass
metabolism, increasing bioavailability; enzyme induction (A) and high first-pass (E)
decrease it; meals (C) have minimal effect on propranolol.
Q3.
A 45-year-old woman on phenytoin 300 mg PO BID has albumin 2.0 g/dL (normal
3.5–5.0). The nurse should interpret total serum phenytoin results by:
A. Doubling the reported value
B. Using the reported value as-is
C. Calculating corrected concentration (adjusted for hypoalbuminemia)
D. Monitoring free phenytoin level instead
Answer: C – Calculating corrected concentration
Rationale: Phenytoin is 90% protein-bound; hypoalbuminemia increases free drug while
total appears low. Use correction equation or free level for dosing decisions.
Q4.
,A 70-kg patient receives amiodarone 150 mg IV over 10 min followed by 1 mg/min for 6
h, then 0.5 mg/min. Which statement about amiodarone kinetics is correct?
A. Large Vd → prolonged half-life (up to 58 days)
B. Renal dosing required
C. Immediate antiarrhythmic effect within 5 min
D. Therapeutic levels achieved in 2 h
Answer: A – Large Vd → prolonged half-life (up to 58 days)
Rationale: Large volume of distribution (Vd ≈ 60 L/kg) and long half-life; loading
infusions needed; full effect may take days; not renally dosed.
Q5.
A child on high-dose methotrexate receives leucovorin rescue. The mechanism of
leucovorin is:
A. Inhibits dihydrofolate reductase
B. Provides reduced folate bypassing blocked enzyme
C. Enhances methotrexate excretion
D. Reverses renal toxicity
Answer: B – Provides reduced folate bypassing blocked enzyme
Rationale: Leucovorin (folinic acid) is active folate; rescues normal cells by bypassing
DHFR inhibition, limiting methotrexate toxicity.
, A2. Medication Safety & Rights (4 Q)
Q6.
A nurse discovers that insulin aspart was administered to the wrong patient. The first
action per 2026 Joint Commission sentinel-event protocol is:
A. Complete occurrence report within 24 h
B. Notify the provider immediately
C. Assess the patient for hypoglycemia
D. Document in medical record
Answer: C – Assess the patient for hypoglycemia
Rationale: Patient safety first—assess for adverse effect (hypoglycemia); notification
and reporting follow.
Q7.
SATA. Which are included in the expanded 15 Rights of Medication Administration
(2026)? (Select all that apply.)
A. Right documentation
B. Right reason
C. Right to refuse
D. Right response/evaluation
E. Right generic equivalent
