HESI Pharmacology Actual Exam 2026 questions and well
detailed answers
, HESI Pharmacology Actual Exam 2026 questions and well
detailed answers
Question 1
A client with heart failure is prescribed digoxin. Which electrolyte
imbalance increases the client's risk for digoxin toxicity, even if serum
digoxin levels are within the therapeutic range?
• A) Hypernatremia.
• B) Hypokalemia.
• C) Hypercalcemia.
• D) Hypomagnesemia alone.
Correct Answer: B) Hypokalemia.
• Rationale: Potassium and digoxin compete for the same binding
site on the Na+/K+-ATPase pump. When potassium levels are low
(hypokalemia), more digoxin can bind, enhancing drug activity and
precipitating life-threatening digoxin toxicity.
Question 2
A client is receiving an intravenous heparin infusion for a deep vein
thrombosis. Which laboratory test is essential for monitoring the
therapeutic effectiveness of heparin?
• A) Prothrombin Time (PT) and International Normalized Ratio
(INR).
• B) Activated Partial Thromboplastin Time (aPTT).
• C) Platelet count exclusively.
• D) Bleeding time.
Correct Answer: B) Activated Partial Thromboplastin Time (aPTT).
, HESI Pharmacology Actual Exam 2026 questions and well
detailed answers
• Rationale: Heparin affects the intrinsic coagulation pathway,
which is monitored using the aPTT. Warfarin (Coumadin) therapy
is monitored using PT/INR.
Question 3
A client with type 1 diabetes is prescribed regular insulin and insulin
NPH. What is a key principle when mixing regular insulin and NPH in the
same syringe?
• A) Draw up NPH insulin into the syringe first, then regular insulin.
• B) Draw up regular (clear) insulin into the syringe first, followed by
NPH (cloudy) insulin to avoid contaminating the short-acting
insulin with intermediate-acting insulin.
• C) Shake the regular insulin vial vigorously before drawing.
• D) Never mix insulin types under any circumstance.
Correct Answer: B) Draw up regular (clear) insulin into the syringe
first, followed by NPH (cloudy) insulin to avoid contaminating the
short-acting insulin with intermediate-acting insulin.
• Rationale: Using the mnemonic "clear to cloudy" (regular is clear,
NPH is cloudy) prevents contaminating the regular insulin vial with
NPH.
Question 4
A client is prescribed lisinopril, an ACE inhibitor, for hypertension.
Which common side effect should the nurse monitor for and educate
the client about?
• A) Severe drowsiness and dry mouth.
, HESI Pharmacology Actual Exam 2026 questions and well
detailed answers
• B) Persistent, dry, hacking cough.
• C) Elevated white blood cell count.
• D) Visual disturbances and halos.
Correct Answer: B) Persistent, dry, hacking cough.
• Rationale: ACE inhibitors prevent the breakdown of bradykinin,
leading to its accumulation in the respiratory tract, which triggers
a non-productive, irritating cough in many clients.
Question 5
A client with asthma and hypertension is prescribed propranolol, a non-
selective beta-blocker. Why should the nurse question this prescription
and notify the prescribing provider?
• A) Propranolol causes severe hyperglycemia.
• B) Non-selective beta-blockers block beta-2 receptors in the lungs,
triggering bronchospasm and severe respiratory distress in clients
with asthma.
• C) Propranolol lowers blood pressure too quickly.
• D) Beta-blockers are contraindicated in all hypertensive clients.
Correct Answer: B) Non-selective beta-blockers block beta-2 receptors
in the lungs, triggering bronchospasm and severe respiratory distress
in clients with asthma.
• Rationale: Non-selective beta-blockers (like propranolol) inhibit
both beta-1 (heart) and beta-2 (bronchi) receptors, causing
bronchoconstriction that can precipitate a severe asthma attack.
detailed answers
, HESI Pharmacology Actual Exam 2026 questions and well
detailed answers
Question 1
A client with heart failure is prescribed digoxin. Which electrolyte
imbalance increases the client's risk for digoxin toxicity, even if serum
digoxin levels are within the therapeutic range?
• A) Hypernatremia.
• B) Hypokalemia.
• C) Hypercalcemia.
• D) Hypomagnesemia alone.
Correct Answer: B) Hypokalemia.
• Rationale: Potassium and digoxin compete for the same binding
site on the Na+/K+-ATPase pump. When potassium levels are low
(hypokalemia), more digoxin can bind, enhancing drug activity and
precipitating life-threatening digoxin toxicity.
Question 2
A client is receiving an intravenous heparin infusion for a deep vein
thrombosis. Which laboratory test is essential for monitoring the
therapeutic effectiveness of heparin?
• A) Prothrombin Time (PT) and International Normalized Ratio
(INR).
• B) Activated Partial Thromboplastin Time (aPTT).
• C) Platelet count exclusively.
• D) Bleeding time.
Correct Answer: B) Activated Partial Thromboplastin Time (aPTT).
, HESI Pharmacology Actual Exam 2026 questions and well
detailed answers
• Rationale: Heparin affects the intrinsic coagulation pathway,
which is monitored using the aPTT. Warfarin (Coumadin) therapy
is monitored using PT/INR.
Question 3
A client with type 1 diabetes is prescribed regular insulin and insulin
NPH. What is a key principle when mixing regular insulin and NPH in the
same syringe?
• A) Draw up NPH insulin into the syringe first, then regular insulin.
• B) Draw up regular (clear) insulin into the syringe first, followed by
NPH (cloudy) insulin to avoid contaminating the short-acting
insulin with intermediate-acting insulin.
• C) Shake the regular insulin vial vigorously before drawing.
• D) Never mix insulin types under any circumstance.
Correct Answer: B) Draw up regular (clear) insulin into the syringe
first, followed by NPH (cloudy) insulin to avoid contaminating the
short-acting insulin with intermediate-acting insulin.
• Rationale: Using the mnemonic "clear to cloudy" (regular is clear,
NPH is cloudy) prevents contaminating the regular insulin vial with
NPH.
Question 4
A client is prescribed lisinopril, an ACE inhibitor, for hypertension.
Which common side effect should the nurse monitor for and educate
the client about?
• A) Severe drowsiness and dry mouth.
, HESI Pharmacology Actual Exam 2026 questions and well
detailed answers
• B) Persistent, dry, hacking cough.
• C) Elevated white blood cell count.
• D) Visual disturbances and halos.
Correct Answer: B) Persistent, dry, hacking cough.
• Rationale: ACE inhibitors prevent the breakdown of bradykinin,
leading to its accumulation in the respiratory tract, which triggers
a non-productive, irritating cough in many clients.
Question 5
A client with asthma and hypertension is prescribed propranolol, a non-
selective beta-blocker. Why should the nurse question this prescription
and notify the prescribing provider?
• A) Propranolol causes severe hyperglycemia.
• B) Non-selective beta-blockers block beta-2 receptors in the lungs,
triggering bronchospasm and severe respiratory distress in clients
with asthma.
• C) Propranolol lowers blood pressure too quickly.
• D) Beta-blockers are contraindicated in all hypertensive clients.
Correct Answer: B) Non-selective beta-blockers block beta-2 receptors
in the lungs, triggering bronchospasm and severe respiratory distress
in clients with asthma.
• Rationale: Non-selective beta-blockers (like propranolol) inhibit
both beta-1 (heart) and beta-2 (bronchi) receptors, causing
bronchoconstriction that can precipitate a severe asthma attack.
