PN HESI PHARMACOLOGY EXAM 2027 REVIEW TEST BANK
Fresh Questions with Correct Answers & Detailed Rationales
Evolve HESI PN Pharmacology Review – Complete A+ Guide
SECTION 1: MEDICATION ADMINISTRATION & SAFETY
(Questions 1-20)
QUESTION 1
A patient is prescribed a medication with extensive first-pass metabolism. Which route
of administration is MOST appropriate to bypass this effect?
A) Oral
B) Sublingual
C) Intramuscular
D) Topical
Answer: B) Sublingual
Rationale: The first-pass effect refers to the metabolism of a drug in the liver after oral
absorption, reducing the amount of active drug reaching systemic circulation. Sublingual
administration bypasses the first-pass effect because the medication is absorbed directly
into the bloodstream through the sublingual mucosa, avoiding the hepatic portal system.
Oral administration is subject to first-pass metabolism. Intramuscular and topical routes
,also bypass first-pass effect to some degree, but sublingual is the most appropriate for
drugs with extensive first-pass metabolism .
QUESTION 2
The nurse is preparing to administer an IM injection to an adult patient. Which needle
length and gauge are most appropriate for the ventrogluteal site?
A) ½ inch, 25 gauge
B) ⅝ inch, 22 gauge
C) 1½ inch, 20-22 gauge
D) 2 inch, 18 gauge
Answer: C) 1½ inch, 20-22 gauge
Rationale: For the ventrogluteal site in an adult, a 1½ inch needle with a 20-22 gauge is
appropriate. This ensures the medication reaches the muscle tissue. The ventrogluteal site
is preferred because it is free of major nerves and blood vessels. Shorter needles may not
reach the muscle, especially in obese patients. Gauge selection depends on the medication
viscosity; 20-22 gauge accommodates most IM medications .
QUESTION 3
What are the "Five Rights" of medication administration?
A) Right Patient, Drug, Dose, Route, Time
B) Right Patient, Dose, Frequency, Route, Documentation
C) Right Drug, Dose, Route, Time, Refill
D) Right Patient, Drug, Dose, Route, Education
,Answer: A) Right Patient, Drug, Dose, Route, Time
Rationale: The "Five Rights" (right patient, drug, dose, route, time) are fundamental to
medication safety. Right documentation, indication, and patient education are often
considered additional rights, but the core five are standard on the HESI exam. Always ask
about allergies in addition to the five rights .
QUESTION 4
A client has an order for a medication supplied in a multidose vial. Which action by the
nurse is correct?
A) Date the vial and discard after 28 days
B) Use the vial for multiple patients
C) Store the vial in the patient's bedside drawer
D) Discard the vial immediately after the first dose
Answer: A) Date the vial and discard after 28 days
Rationale: Multidose vials should be dated when first opened and discarded after 28 days
unless otherwise specified by the manufacturer. They should not be used for multiple
patients due to infection control risks. Medications should be stored appropriately, not in
patient bedside drawers .
QUESTION 5
The nurse is preparing to administer ear drops to a 4-year-old child. How should the
nurse position the child's ear?
A) Pull the pinna up and back
B) Pull the pinna down and back
, C) Pull the pinna straight outward
D) Do not manipulate the pinna
Answer: B) Pull the pinna down and back
Rationale: For children under 3 years of age, the pinna is pulled down and back to
straighten the ear canal. For adults and children over 3 years, the pinna is pulled up and
back. This positioning ensures the medication reaches the tympanic membrane. The drops
should be at room temperature to prevent dizziness .
QUESTION 6
The nurse is preparing to administer a narcotic medication. Which action is most
important?
A) Count the narcotic with another nurse
B) Document the administration in the patient's chart only
C) Discard the unused portion in the trash
D) Administer the medication without a witness
Answer: A) Count the narcotic with another nurse
Rationale: Narcotics are controlled substances that require counting and witnessing to
prevent diversion. Two nurses must count and verify the dose. Documentation must
include the count. Unused portions must be wasted with a witness and documented.
Accurate accounting of controlled substances is a legal requirement .
QUESTION 7
Fresh Questions with Correct Answers & Detailed Rationales
Evolve HESI PN Pharmacology Review – Complete A+ Guide
SECTION 1: MEDICATION ADMINISTRATION & SAFETY
(Questions 1-20)
QUESTION 1
A patient is prescribed a medication with extensive first-pass metabolism. Which route
of administration is MOST appropriate to bypass this effect?
A) Oral
B) Sublingual
C) Intramuscular
D) Topical
Answer: B) Sublingual
Rationale: The first-pass effect refers to the metabolism of a drug in the liver after oral
absorption, reducing the amount of active drug reaching systemic circulation. Sublingual
administration bypasses the first-pass effect because the medication is absorbed directly
into the bloodstream through the sublingual mucosa, avoiding the hepatic portal system.
Oral administration is subject to first-pass metabolism. Intramuscular and topical routes
,also bypass first-pass effect to some degree, but sublingual is the most appropriate for
drugs with extensive first-pass metabolism .
QUESTION 2
The nurse is preparing to administer an IM injection to an adult patient. Which needle
length and gauge are most appropriate for the ventrogluteal site?
A) ½ inch, 25 gauge
B) ⅝ inch, 22 gauge
C) 1½ inch, 20-22 gauge
D) 2 inch, 18 gauge
Answer: C) 1½ inch, 20-22 gauge
Rationale: For the ventrogluteal site in an adult, a 1½ inch needle with a 20-22 gauge is
appropriate. This ensures the medication reaches the muscle tissue. The ventrogluteal site
is preferred because it is free of major nerves and blood vessels. Shorter needles may not
reach the muscle, especially in obese patients. Gauge selection depends on the medication
viscosity; 20-22 gauge accommodates most IM medications .
QUESTION 3
What are the "Five Rights" of medication administration?
A) Right Patient, Drug, Dose, Route, Time
B) Right Patient, Dose, Frequency, Route, Documentation
C) Right Drug, Dose, Route, Time, Refill
D) Right Patient, Drug, Dose, Route, Education
,Answer: A) Right Patient, Drug, Dose, Route, Time
Rationale: The "Five Rights" (right patient, drug, dose, route, time) are fundamental to
medication safety. Right documentation, indication, and patient education are often
considered additional rights, but the core five are standard on the HESI exam. Always ask
about allergies in addition to the five rights .
QUESTION 4
A client has an order for a medication supplied in a multidose vial. Which action by the
nurse is correct?
A) Date the vial and discard after 28 days
B) Use the vial for multiple patients
C) Store the vial in the patient's bedside drawer
D) Discard the vial immediately after the first dose
Answer: A) Date the vial and discard after 28 days
Rationale: Multidose vials should be dated when first opened and discarded after 28 days
unless otherwise specified by the manufacturer. They should not be used for multiple
patients due to infection control risks. Medications should be stored appropriately, not in
patient bedside drawers .
QUESTION 5
The nurse is preparing to administer ear drops to a 4-year-old child. How should the
nurse position the child's ear?
A) Pull the pinna up and back
B) Pull the pinna down and back
, C) Pull the pinna straight outward
D) Do not manipulate the pinna
Answer: B) Pull the pinna down and back
Rationale: For children under 3 years of age, the pinna is pulled down and back to
straighten the ear canal. For adults and children over 3 years, the pinna is pulled up and
back. This positioning ensures the medication reaches the tympanic membrane. The drops
should be at room temperature to prevent dizziness .
QUESTION 6
The nurse is preparing to administer a narcotic medication. Which action is most
important?
A) Count the narcotic with another nurse
B) Document the administration in the patient's chart only
C) Discard the unused portion in the trash
D) Administer the medication without a witness
Answer: A) Count the narcotic with another nurse
Rationale: Narcotics are controlled substances that require counting and witnessing to
prevent diversion. Two nurses must count and verify the dose. Documentation must
include the count. Unused portions must be wasted with a witness and documented.
Accurate accounting of controlled substances is a legal requirement .
QUESTION 7
