HESI RN ADVANCED PHARMACOLOGY EXAM 2026/2027 | Newest
Version Actual Exam 160 Questions | Detailed Answers with Rationales |
Verified | A+ Graded | Pass Guaranteed
Section 1: Cardiovascular Pharmacology - HTN, HF, Antidysrhythmics, Anticoagulation
(Q1-30)
Q1. A 58-year-old client prescribed lisinopril for hypertension returns to the clinic
complaining of a persistent dry cough. The nurse recognizes this as an adverse effect
of ACE inhibitors and anticipates the provider will likely:
A. Discontinue the ACE inhibitor and switch to an ARB such as losartan
B. Prescribe an antitussive to suppress the cough and continue the ACE inhibitor
C. Switch to a beta-blocker such as metoprolol as first-line therapy
D. Reduce the dose of lisinopril by 50% to eliminate the cough
Correct Answer: A. Discontinue the ACE inhibitor and switch to an ARB such as losartan
[CORRECT]
Rationale: A dry, nonproductive cough is a well-known adverse effect of ACE inhibitors
due to bradykinin accumulation; switching to an ARB avoids this pathway while
maintaining RAAS blockade. Antitussives (Option B) do not address the mechanism;
beta-blockers (Option C) are not the direct replacement for ACE inhibitor intolerance.
Q2. A nurse is teaching a client with type 1 diabetes who takes metoprolol for
hypertension. Which statement by the client indicates understanding of a critical safety
concern?
A. "I will monitor my blood glucose more frequently because metoprolol can mask the
tremors and tachycardia of hypoglycemia."
B. "Metoprolol will increase my insulin absorption so I need less insulin."
C. "I should stop taking metoprolol if my blood pressure drops below 120/80 mmHg."
D. "Metoprolol will prevent diabetic ketoacidosis."
,Correct Answer: A. "I will monitor my blood glucose more frequently because metoprolol
can mask the tremors and tachycardia of hypoglycemia." [CORRECT]
Rationale: Nonselective and cardioselective beta-blockers can mask the adrenergic
symptoms (tremors, palpitations, sweating) of hypoglycemia, delaying recognition and
treatment; frequent glucose monitoring is essential. Option B is incorrect; Option C is
unsafe without provider direction.
Q3. A client taking amlodipine for hypertension reports bilateral ankle swelling. The
nurse explains that this peripheral edema is caused by:
A. Left-sided heart failure exacerbation
B. Arteriolar dilation without proportional venous dilation, leading to hydrostatic
pressure in capillaries
C. Hyperaldosteronism induced by calcium channel blockers
D. Nephrotic syndrome from renal toxicity
Correct Answer: B. Arteriolar dilation without proportional venous dilation, leading to
hydrostatic pressure in capillaries [CORRECT]
Rationale: Dihydropyridine calcium channel blockers (amlodipine) cause selective
arteriolar dilation, increasing capillary hydrostatic pressure and causing peripheral
edema unrelated to heart failure or renal dysfunction. Option A requires additional
cardiac symptoms; Option C is not a CCB mechanism.
Q4. A nurse is caring for a client receiving digoxin. The client reports nausea and seeing
yellow-green halos around objects. The nurse checks the digoxin level and finds it is 2.8
ng/mL. What is the priority nursing action?
A. Administer the next scheduled dose because the level is only slightly elevated
B. Hold the next dose and notify the provider immediately
C. Administer potassium supplements because hypokalemia is always present
D. Increase the client's fluid intake to excrete the drug more quickly
Correct Answer: B. Hold the next dose and notify the provider immediately [CORRECT]
,Rationale: The therapeutic range for digoxin is 0.8-2.0 ng/mL; levels above 2.0 ng/mL
indicate toxicity, manifested by GI symptoms and visual disturbances (yellow-green
halos). The priority is to hold the drug and notify the provider. Option A is dangerous;
Option C is incorrect because hyperkalemia, not hypokalemia, is associated with severe
digoxin toxicity.
Q5. A client with atrial fibrillation is prescribed warfarin. The nurse understands that the
target INR for this condition is typically:
A. 1.0-1.5
B. 2.0-3.0
C. 3.0-4.5
D. 4.5-6.0
Correct Answer: B. 2.0-3.0 [CORRECT]
Rationale: For most indications including atrial fibrillation, the therapeutic INR range for
warfarin is 2.0-3.0. Mechanical heart valves may require 2.5-3.5. Option A is
subtherapeutic; Options C and D increase bleeding risk excessively.
Q6. A client on heparin infusion develops active bleeding. The nurse prepares which
reversal agent?
A. Vitamin K
B. Protamine sulfate
C. Andexanet alfa
D. Idarucizumab
Correct Answer: B. Protamine sulfate [CORRECT]
Rationale: Protamine sulfate is the specific antidote for unfractionated heparin
overdose/bleeding; it binds heparin to form a stable salt. Vitamin K (Option A) reverses
warfarin; andexanet alfa (Option C) reverses factor Xa inhibitors; idarucizumab (Option
D) reverses dabigatran.
, Q7. A client prescribed apixaban asks why routine blood monitoring is not needed as it
was with warfarin. The nurse explains that direct oral anticoagulants (DOACs):
A. Have predictable pharmacokinetics and fixed dosing that do not require INR
monitoring
B. Are less effective than warfarin so monitoring is unnecessary
C. Do not affect coagulation pathways
D. Require only monthly CBC monitoring
Correct Answer: A. Have predictable pharmacokinetics and fixed dosing that do not
require INR monitoring [CORRECT]
Rationale: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) have predictable
dose-response relationships and do not require routine coagulation monitoring unlike
warfarin. Option B is false; Option C is incorrect as they directly inhibit specific clotting
factors.
Q8. A nurse is administering IV furosemide to a client with heart failure. Which adverse
effect requires the most immediate assessment?
A. Hypokalemia
B. Hypernatremia
C. Hyperglycemia
D. Hypercalcemia
Correct Answer: A. Hypokalemia [CORRECT]
Rationale: Loop diuretics cause significant potassium wasting, leading to hypokalemia
which can trigger life-threatening cardiac dysrhythmias; this is the priority assessment.
Options B, C, and D are not primary concerns with furosemide.
Q9. A client on sotalol for ventricular dysrhythmias is found to have a QTc interval of
560 msec on ECG. The nurse should:
A. Continue the medication and recheck the ECG in one week
B. Hold the medication and notify the provider immediately due to risk of torsades de
pointes
C. Administer a bolus of potassium to shorten the QT interval
Version Actual Exam 160 Questions | Detailed Answers with Rationales |
Verified | A+ Graded | Pass Guaranteed
Section 1: Cardiovascular Pharmacology - HTN, HF, Antidysrhythmics, Anticoagulation
(Q1-30)
Q1. A 58-year-old client prescribed lisinopril for hypertension returns to the clinic
complaining of a persistent dry cough. The nurse recognizes this as an adverse effect
of ACE inhibitors and anticipates the provider will likely:
A. Discontinue the ACE inhibitor and switch to an ARB such as losartan
B. Prescribe an antitussive to suppress the cough and continue the ACE inhibitor
C. Switch to a beta-blocker such as metoprolol as first-line therapy
D. Reduce the dose of lisinopril by 50% to eliminate the cough
Correct Answer: A. Discontinue the ACE inhibitor and switch to an ARB such as losartan
[CORRECT]
Rationale: A dry, nonproductive cough is a well-known adverse effect of ACE inhibitors
due to bradykinin accumulation; switching to an ARB avoids this pathway while
maintaining RAAS blockade. Antitussives (Option B) do not address the mechanism;
beta-blockers (Option C) are not the direct replacement for ACE inhibitor intolerance.
Q2. A nurse is teaching a client with type 1 diabetes who takes metoprolol for
hypertension. Which statement by the client indicates understanding of a critical safety
concern?
A. "I will monitor my blood glucose more frequently because metoprolol can mask the
tremors and tachycardia of hypoglycemia."
B. "Metoprolol will increase my insulin absorption so I need less insulin."
C. "I should stop taking metoprolol if my blood pressure drops below 120/80 mmHg."
D. "Metoprolol will prevent diabetic ketoacidosis."
,Correct Answer: A. "I will monitor my blood glucose more frequently because metoprolol
can mask the tremors and tachycardia of hypoglycemia." [CORRECT]
Rationale: Nonselective and cardioselective beta-blockers can mask the adrenergic
symptoms (tremors, palpitations, sweating) of hypoglycemia, delaying recognition and
treatment; frequent glucose monitoring is essential. Option B is incorrect; Option C is
unsafe without provider direction.
Q3. A client taking amlodipine for hypertension reports bilateral ankle swelling. The
nurse explains that this peripheral edema is caused by:
A. Left-sided heart failure exacerbation
B. Arteriolar dilation without proportional venous dilation, leading to hydrostatic
pressure in capillaries
C. Hyperaldosteronism induced by calcium channel blockers
D. Nephrotic syndrome from renal toxicity
Correct Answer: B. Arteriolar dilation without proportional venous dilation, leading to
hydrostatic pressure in capillaries [CORRECT]
Rationale: Dihydropyridine calcium channel blockers (amlodipine) cause selective
arteriolar dilation, increasing capillary hydrostatic pressure and causing peripheral
edema unrelated to heart failure or renal dysfunction. Option A requires additional
cardiac symptoms; Option C is not a CCB mechanism.
Q4. A nurse is caring for a client receiving digoxin. The client reports nausea and seeing
yellow-green halos around objects. The nurse checks the digoxin level and finds it is 2.8
ng/mL. What is the priority nursing action?
A. Administer the next scheduled dose because the level is only slightly elevated
B. Hold the next dose and notify the provider immediately
C. Administer potassium supplements because hypokalemia is always present
D. Increase the client's fluid intake to excrete the drug more quickly
Correct Answer: B. Hold the next dose and notify the provider immediately [CORRECT]
,Rationale: The therapeutic range for digoxin is 0.8-2.0 ng/mL; levels above 2.0 ng/mL
indicate toxicity, manifested by GI symptoms and visual disturbances (yellow-green
halos). The priority is to hold the drug and notify the provider. Option A is dangerous;
Option C is incorrect because hyperkalemia, not hypokalemia, is associated with severe
digoxin toxicity.
Q5. A client with atrial fibrillation is prescribed warfarin. The nurse understands that the
target INR for this condition is typically:
A. 1.0-1.5
B. 2.0-3.0
C. 3.0-4.5
D. 4.5-6.0
Correct Answer: B. 2.0-3.0 [CORRECT]
Rationale: For most indications including atrial fibrillation, the therapeutic INR range for
warfarin is 2.0-3.0. Mechanical heart valves may require 2.5-3.5. Option A is
subtherapeutic; Options C and D increase bleeding risk excessively.
Q6. A client on heparin infusion develops active bleeding. The nurse prepares which
reversal agent?
A. Vitamin K
B. Protamine sulfate
C. Andexanet alfa
D. Idarucizumab
Correct Answer: B. Protamine sulfate [CORRECT]
Rationale: Protamine sulfate is the specific antidote for unfractionated heparin
overdose/bleeding; it binds heparin to form a stable salt. Vitamin K (Option A) reverses
warfarin; andexanet alfa (Option C) reverses factor Xa inhibitors; idarucizumab (Option
D) reverses dabigatran.
, Q7. A client prescribed apixaban asks why routine blood monitoring is not needed as it
was with warfarin. The nurse explains that direct oral anticoagulants (DOACs):
A. Have predictable pharmacokinetics and fixed dosing that do not require INR
monitoring
B. Are less effective than warfarin so monitoring is unnecessary
C. Do not affect coagulation pathways
D. Require only monthly CBC monitoring
Correct Answer: A. Have predictable pharmacokinetics and fixed dosing that do not
require INR monitoring [CORRECT]
Rationale: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) have predictable
dose-response relationships and do not require routine coagulation monitoring unlike
warfarin. Option B is false; Option C is incorrect as they directly inhibit specific clotting
factors.
Q8. A nurse is administering IV furosemide to a client with heart failure. Which adverse
effect requires the most immediate assessment?
A. Hypokalemia
B. Hypernatremia
C. Hyperglycemia
D. Hypercalcemia
Correct Answer: A. Hypokalemia [CORRECT]
Rationale: Loop diuretics cause significant potassium wasting, leading to hypokalemia
which can trigger life-threatening cardiac dysrhythmias; this is the priority assessment.
Options B, C, and D are not primary concerns with furosemide.
Q9. A client on sotalol for ventricular dysrhythmias is found to have a QTc interval of
560 msec on ECG. The nurse should:
A. Continue the medication and recheck the ECG in one week
B. Hold the medication and notify the provider immediately due to risk of torsades de
pointes
C. Administer a bolus of potassium to shorten the QT interval
