HESI PHARMACOLOGY EXAM
2026 COMPREHENSIVE
REVIEW||||Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Student Name: _________________________
Date: _________________________
Total Questions: 85
Time Allowed: 2 hours
Instructions: Select the best answer. Correct answers are highlighted in
yellow with rationale.
Section 1: Cardiovascular Medications (Questions 1–15)
1. A client with heart failure is prescribed digoxin. Which finding indicates a
therapeutic response?
A. Increased heart rate >100 bpm
B. Decreased shortness of breath and clear lung sounds
C. Jugular vein distension
D. 3+ pitting edema in lower extremities
Rationale: Therapeutic digoxin increases myocardial contractility, leading to
improved cardiac output, reduced pulmonary congestion, and decreased dyspnea.
2. A nurse administers furosemide to a client with hypertension. Which lab
value requires immediate follow-up?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 100 mEq/L
D. Glucose 95 mg/dL
,Rationale: Furosemide is a loop diuretic that can cause hypokalemia (normal 3.5–
5.0 mEq/L), increasing risk for dysrhythmias.
3. A client on warfarin has an INR of 5.2. Which action is priority?
A. Administer vitamin K
B. Give protamine sulfate
C. Hold next dose and notify provider
D. Increase warfarin dose
Rationale: INR goal is 2–3 for most indications. INR >5 increases bleeding risk;
holding dose and notifying provider is first step.
4. Which medication is most appropriate for a client with acute angina
unrelieved by rest?
A. Metoprolol
B. Nitroglycerin sublingual
C. Amlodipine
D. Clopidogrel
Rationale: Sublingual nitroglycerin is first-line for acute angina, causing rapid
coronary vasodilation.
5. A client taking lisinopril develops a persistent dry cough. What is the
nurse’s best action?
A. Administer an antitussive
B. Reassure client it will resolve
C. Notify provider to consider ARB
D. Increase dose of lisinopril
Rationale: ACE inhibitor-induced dry cough is common; switching to an ARB
(e.g., losartan) eliminates cough while maintaining BP control.
6. Which statement by a client on atorvastatin indicates need for teaching?
A. “I will take this at bedtime.”
B. “I can drink grapefruit juice daily.”
C. “I need periodic liver function tests.”
D. “I should report muscle pain.”
Rationale: Grapefruit juice inhibits CYP3A4, increasing statin levels and risk of
myopathy/rhabdomyolysis.
, 7. A client on amiodarone reports cough and dyspnea. Priority action?
A. Check apical pulse
B. Obtain chest x-ray
C. Give oxygen
D. Administer bronchodilator
Rationale: Amiodarone can cause pulmonary toxicity (fibrosis). Chest x-ray is
priority to assess for infiltrates.
8. Which lab should be monitored for a client on spironolactone?
A. Potassium
B. Calcium
C. Magnesium
D. Phosphate
Rationale: Spironolactone is potassium-sparing; risk of hyperkalemia (especially
with renal impairment or ACE inhibitors).
9. A client on clopidogrel is scheduled for surgery. When should it be stopped
electively?
A. 1 day prior
B. 3 days prior
C. 5–7 days prior
D. 10–14 days prior
Rationale: Clopidogrel irreversibly inhibits platelets; stop 5–7 days pre-op to
reduce bleeding risk.
10. Which is a priority adverse effect of IV alteplase (tPA)?
A. Bradycardia
B. Intracranial hemorrhage
C. Nephrotoxicity
D. Hepatotoxicity
Rationale: tPA is a thrombolytic; most serious risk is intracranial bleeding. Neuro
checks and BP monitoring are critical.
11. A client with heart failure on carvedilol has HR 52 and BP 90/50. Next
action?
A. Administer atropine
B. Hold next dose and notify provider
2026 COMPREHENSIVE
REVIEW||||Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Student Name: _________________________
Date: _________________________
Total Questions: 85
Time Allowed: 2 hours
Instructions: Select the best answer. Correct answers are highlighted in
yellow with rationale.
Section 1: Cardiovascular Medications (Questions 1–15)
1. A client with heart failure is prescribed digoxin. Which finding indicates a
therapeutic response?
A. Increased heart rate >100 bpm
B. Decreased shortness of breath and clear lung sounds
C. Jugular vein distension
D. 3+ pitting edema in lower extremities
Rationale: Therapeutic digoxin increases myocardial contractility, leading to
improved cardiac output, reduced pulmonary congestion, and decreased dyspnea.
2. A nurse administers furosemide to a client with hypertension. Which lab
value requires immediate follow-up?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 100 mEq/L
D. Glucose 95 mg/dL
,Rationale: Furosemide is a loop diuretic that can cause hypokalemia (normal 3.5–
5.0 mEq/L), increasing risk for dysrhythmias.
3. A client on warfarin has an INR of 5.2. Which action is priority?
A. Administer vitamin K
B. Give protamine sulfate
C. Hold next dose and notify provider
D. Increase warfarin dose
Rationale: INR goal is 2–3 for most indications. INR >5 increases bleeding risk;
holding dose and notifying provider is first step.
4. Which medication is most appropriate for a client with acute angina
unrelieved by rest?
A. Metoprolol
B. Nitroglycerin sublingual
C. Amlodipine
D. Clopidogrel
Rationale: Sublingual nitroglycerin is first-line for acute angina, causing rapid
coronary vasodilation.
5. A client taking lisinopril develops a persistent dry cough. What is the
nurse’s best action?
A. Administer an antitussive
B. Reassure client it will resolve
C. Notify provider to consider ARB
D. Increase dose of lisinopril
Rationale: ACE inhibitor-induced dry cough is common; switching to an ARB
(e.g., losartan) eliminates cough while maintaining BP control.
6. Which statement by a client on atorvastatin indicates need for teaching?
A. “I will take this at bedtime.”
B. “I can drink grapefruit juice daily.”
C. “I need periodic liver function tests.”
D. “I should report muscle pain.”
Rationale: Grapefruit juice inhibits CYP3A4, increasing statin levels and risk of
myopathy/rhabdomyolysis.
, 7. A client on amiodarone reports cough and dyspnea. Priority action?
A. Check apical pulse
B. Obtain chest x-ray
C. Give oxygen
D. Administer bronchodilator
Rationale: Amiodarone can cause pulmonary toxicity (fibrosis). Chest x-ray is
priority to assess for infiltrates.
8. Which lab should be monitored for a client on spironolactone?
A. Potassium
B. Calcium
C. Magnesium
D. Phosphate
Rationale: Spironolactone is potassium-sparing; risk of hyperkalemia (especially
with renal impairment or ACE inhibitors).
9. A client on clopidogrel is scheduled for surgery. When should it be stopped
electively?
A. 1 day prior
B. 3 days prior
C. 5–7 days prior
D. 10–14 days prior
Rationale: Clopidogrel irreversibly inhibits platelets; stop 5–7 days pre-op to
reduce bleeding risk.
10. Which is a priority adverse effect of IV alteplase (tPA)?
A. Bradycardia
B. Intracranial hemorrhage
C. Nephrotoxicity
D. Hepatotoxicity
Rationale: tPA is a thrombolytic; most serious risk is intracranial bleeding. Neuro
checks and BP monitoring are critical.
11. A client with heart failure on carvedilol has HR 52 and BP 90/50. Next
action?
A. Administer atropine
B. Hold next dose and notify provider
