BSN HESI 315 Pharmacology Practice Exam V1
2026/2027 | Questions & Verified Answers | 100%
Correct | Grade A - Nightingale College
Q1. A 68-year-old receiving a 1 g vancomycin IVPB every 12 hours reports flushing and
pruritus 10 minutes into the infusion. Which action is most important for the nurse to
take?
A) Slow the infusion to run over 3 hours
B) Stop the infusion immediately and assess the patient*
C) Administer diphenhydramine 25 mg PO
D) Document as expected side effect and continue
Rationale: Red-man syndrome results from rapid vancomycin infusion; stopping
immediately prevents severe hypotension. Slowing to 3 h is inappropriate without
physician order and does not address acute reaction.
Q2. A patient with heart failure is prescribed digoxin 0.25 mg daily. Which serum level
indicates toxicity?
A) 0.8 ng/mL
B) 1.2 ng/mL
C) 2.4 ng/mL*
D) 1.8 ng/mL
,Rationale: Therapeutic range 0.5–2 ng/mL; levels ≥2.4 ng/mL correlate with toxicity
(nausea, visual halos, arrhythmias). 1.8 ng/mL is high but not definitive.
Q3. A 55-year-old on lithium 600 mg BID presents with nausea, coarse tremors, and Na+
128 mEq/L. Which laboratory finding confirms lithium toxicity?
A) Lithium level 0.6 mEq/L
B) Lithium level 1.2 mEq/L
C) Lithium level 2.0 mEq/L*
D) Lithium level 0.8 mEq/L
Rationale: Toxicity usually occurs >1.5 mEq/L; 2.0 mEq/L requires prompt intervention.
0.6–0.8 mEq/L is therapeutic; 1.2 mEq/L is upper-therapeutic.
Q4. A patient receiving a first dose of penicillin G develops wheezing and hypotension.
Which medication is first-line?
A) Methylprednisolone 125 mg IV
B) Diphenhydramine 50 mg IV
C) Epinephrine 0.3 mg IM*
D) Albuterol nebulizer
Rationale: Epinephrine rapidly reverses anaphylactic bronchospasm and vasodilation.
Steroids and antihistamines are adjunctive, not first-line.
Q5. A nurse prepares heparin 5,000 units subcutaneous for DVT prophylaxis. Which
laboratory test monitors low-dose heparin effectiveness?
, A) aPTT*
B) PT/INR
C) Platelet count
D) D-dimer
Rationale: aPTT reflects heparin’s action on intrinsic pathway; target 1.5–2.5 × baseline.
PT/INR measures warfarin effect.
Q6. A patient on warfarin with INR 5.8 and no bleeding is scheduled for minor dental
extraction. Which action is appropriate?
A) Administer vitamin K 10 mg IV
B) Hold warfarin 2 doses and recheck INR*
C) Continue warfarin and proceed
D) Switch to aspirin
Rationale: Holding 1–2 doses usually lowers INR to ≤3.0, safe for minor procedures
without reversing anticoagulation. Vitamin K causes rapid over-correction.
Q7. A 32-year-old with asthma receives her first biologic—dupilumab 300 mg SC. Which
instruction is most important?
A) Rotate injection sites*
B) Expect immediate symptom relief
C) Discontinue albuterol
D) Avoid live vaccines for 1 week
2026/2027 | Questions & Verified Answers | 100%
Correct | Grade A - Nightingale College
Q1. A 68-year-old receiving a 1 g vancomycin IVPB every 12 hours reports flushing and
pruritus 10 minutes into the infusion. Which action is most important for the nurse to
take?
A) Slow the infusion to run over 3 hours
B) Stop the infusion immediately and assess the patient*
C) Administer diphenhydramine 25 mg PO
D) Document as expected side effect and continue
Rationale: Red-man syndrome results from rapid vancomycin infusion; stopping
immediately prevents severe hypotension. Slowing to 3 h is inappropriate without
physician order and does not address acute reaction.
Q2. A patient with heart failure is prescribed digoxin 0.25 mg daily. Which serum level
indicates toxicity?
A) 0.8 ng/mL
B) 1.2 ng/mL
C) 2.4 ng/mL*
D) 1.8 ng/mL
,Rationale: Therapeutic range 0.5–2 ng/mL; levels ≥2.4 ng/mL correlate with toxicity
(nausea, visual halos, arrhythmias). 1.8 ng/mL is high but not definitive.
Q3. A 55-year-old on lithium 600 mg BID presents with nausea, coarse tremors, and Na+
128 mEq/L. Which laboratory finding confirms lithium toxicity?
A) Lithium level 0.6 mEq/L
B) Lithium level 1.2 mEq/L
C) Lithium level 2.0 mEq/L*
D) Lithium level 0.8 mEq/L
Rationale: Toxicity usually occurs >1.5 mEq/L; 2.0 mEq/L requires prompt intervention.
0.6–0.8 mEq/L is therapeutic; 1.2 mEq/L is upper-therapeutic.
Q4. A patient receiving a first dose of penicillin G develops wheezing and hypotension.
Which medication is first-line?
A) Methylprednisolone 125 mg IV
B) Diphenhydramine 50 mg IV
C) Epinephrine 0.3 mg IM*
D) Albuterol nebulizer
Rationale: Epinephrine rapidly reverses anaphylactic bronchospasm and vasodilation.
Steroids and antihistamines are adjunctive, not first-line.
Q5. A nurse prepares heparin 5,000 units subcutaneous for DVT prophylaxis. Which
laboratory test monitors low-dose heparin effectiveness?
, A) aPTT*
B) PT/INR
C) Platelet count
D) D-dimer
Rationale: aPTT reflects heparin’s action on intrinsic pathway; target 1.5–2.5 × baseline.
PT/INR measures warfarin effect.
Q6. A patient on warfarin with INR 5.8 and no bleeding is scheduled for minor dental
extraction. Which action is appropriate?
A) Administer vitamin K 10 mg IV
B) Hold warfarin 2 doses and recheck INR*
C) Continue warfarin and proceed
D) Switch to aspirin
Rationale: Holding 1–2 doses usually lowers INR to ≤3.0, safe for minor procedures
without reversing anticoagulation. Vitamin K causes rapid over-correction.
Q7. A 32-year-old with asthma receives her first biologic—dupilumab 300 mg SC. Which
instruction is most important?
A) Rotate injection sites*
B) Expect immediate symptom relief
C) Discontinue albuterol
D) Avoid live vaccines for 1 week
