PN HESI Exit Exam 2026/2027: The
Ultimate -Question Practice Review
with Rationales
PHARMACOLOGY & MEDICATION ADMINISTRATION (Questions 1-20)
Question 1
A practical nurse is preparing to administer digoxin to an older adult client
with heart failure. Before administration, the nurse obtains an apical pulse
of 54 beats/minute. What action should the nurse take?
A) Administer the medication and document the pulse
B) Hold the medication and notify the healthcare provider
C) Administer half the prescribed dose
D) Reassess the pulse after ambulation
Correct Answer: B
Rationale: Digoxin can cause bradycardia. The standard practice is to
withhold digoxin when the apical pulse is below 60 beats/minute in adults.
Administering the medication could worsen bradycardia and compromise
cardiac output. Options A and C are unsafe, while D delays necessary
intervention .
Question 2
,A client prescribed warfarin (Coumadin) states, "I will take ibuprofen for my
headaches." What is the nurse's best response?
A) "That is fine as long as you take it with food."
B) "Ibuprofen increases your risk of bleeding with warfarin."
C) "Take acetaminophen instead of ibuprofen."
D) "You should avoid all pain medications."
Correct Answer: B
Rationale: NSAIDs like ibuprofen increase the risk of bleeding when taken
with warfarin due to platelet inhibition and potential interactions. The nurse
should educate the client about this serious risk. Acetaminophen may be
acceptable but should be discussed with the healthcare provider .
Question 3
A client receiving morphine intravenously becomes difficult to arouse and
has a respiratory rate of 8 breaths/minute. Which medication should the
nurse anticipate administering?
A) Protamine sulfate
B) Flumazenil
C) Naloxone
D) Acetylcysteine
Correct Answer: C
Rationale: Naloxone is an opioid antagonist used to reverse respiratory
depression caused by opioid overdose. Protamine sulfate reverses heparin,
,flumazenil reverses benzodiazepines, and acetylcysteine treats
acetaminophen toxicity .
Question 4
A client is prescribed metformin (Glucophage) 850 mg twice daily. Lab
results show creatinine 2.1 mg/dL and eGFR 35 mL/min. What is the nurse's
priority action?
A) Administer the medication as prescribed
B) Hold the medication and notify the healthcare provider
C) Reduce the dose to 500 mg twice daily
D) Administer the medication with meals to reduce GI upset
Correct Answer: B
Rationale: Metformin is contraindicated with eGFR <30 mL/min/1.73m²
and should not be initiated with eGFR 30-45 mL/min/1.73m². The client's
eGFR of 35 is in the range where metformin should be held due to risk of
lactic acidosis. The nurse should hold and notify the provider .
Question 5
A client with type 2 diabetes is prescribed insulin glargine 10 units
subcutaneously once daily at bedtime and a sliding scale of insulin aspart
every 6 hours. What actions should the nurse include in the client's plan of
care? (Select all that apply)
, A) Do not contaminate the insulin aspart so that it is available for IV use
B) Review proper foot care and prevention of injury
C) Teach subcutaneous injection technique, site rotation, and insulin
management
D) Coordinate carbohydrate-controlled meals at consistent times and
intervals
E) Mix bedtime dose of insulin glargine with insulin aspart sliding scale
dose
F) Fingerstick glucose assessments every 6 hours with meals
Correct Answer: B, C, D, F
Rationale: Glargine is a long-acting insulin and should NEVER be mixed
with other insulins. Proper foot care is essential for diabetic clients.
Consistent meal timing with insulin administration prevents hypoglycemia.
Fingerstick glucose monitoring guides insulin dosing. Insulin aspart is for
subcutaneous use only, not IV .
Question 6
A client prescribed tetracycline asks how to take the medication. Which
instruction is most appropriate?
A) Take with milk
B) Take with antacids
C) Take with water on an empty stomach
D) Crush and mix with yogurt
Correct Answer: C
Ultimate -Question Practice Review
with Rationales
PHARMACOLOGY & MEDICATION ADMINISTRATION (Questions 1-20)
Question 1
A practical nurse is preparing to administer digoxin to an older adult client
with heart failure. Before administration, the nurse obtains an apical pulse
of 54 beats/minute. What action should the nurse take?
A) Administer the medication and document the pulse
B) Hold the medication and notify the healthcare provider
C) Administer half the prescribed dose
D) Reassess the pulse after ambulation
Correct Answer: B
Rationale: Digoxin can cause bradycardia. The standard practice is to
withhold digoxin when the apical pulse is below 60 beats/minute in adults.
Administering the medication could worsen bradycardia and compromise
cardiac output. Options A and C are unsafe, while D delays necessary
intervention .
Question 2
,A client prescribed warfarin (Coumadin) states, "I will take ibuprofen for my
headaches." What is the nurse's best response?
A) "That is fine as long as you take it with food."
B) "Ibuprofen increases your risk of bleeding with warfarin."
C) "Take acetaminophen instead of ibuprofen."
D) "You should avoid all pain medications."
Correct Answer: B
Rationale: NSAIDs like ibuprofen increase the risk of bleeding when taken
with warfarin due to platelet inhibition and potential interactions. The nurse
should educate the client about this serious risk. Acetaminophen may be
acceptable but should be discussed with the healthcare provider .
Question 3
A client receiving morphine intravenously becomes difficult to arouse and
has a respiratory rate of 8 breaths/minute. Which medication should the
nurse anticipate administering?
A) Protamine sulfate
B) Flumazenil
C) Naloxone
D) Acetylcysteine
Correct Answer: C
Rationale: Naloxone is an opioid antagonist used to reverse respiratory
depression caused by opioid overdose. Protamine sulfate reverses heparin,
,flumazenil reverses benzodiazepines, and acetylcysteine treats
acetaminophen toxicity .
Question 4
A client is prescribed metformin (Glucophage) 850 mg twice daily. Lab
results show creatinine 2.1 mg/dL and eGFR 35 mL/min. What is the nurse's
priority action?
A) Administer the medication as prescribed
B) Hold the medication and notify the healthcare provider
C) Reduce the dose to 500 mg twice daily
D) Administer the medication with meals to reduce GI upset
Correct Answer: B
Rationale: Metformin is contraindicated with eGFR <30 mL/min/1.73m²
and should not be initiated with eGFR 30-45 mL/min/1.73m². The client's
eGFR of 35 is in the range where metformin should be held due to risk of
lactic acidosis. The nurse should hold and notify the provider .
Question 5
A client with type 2 diabetes is prescribed insulin glargine 10 units
subcutaneously once daily at bedtime and a sliding scale of insulin aspart
every 6 hours. What actions should the nurse include in the client's plan of
care? (Select all that apply)
, A) Do not contaminate the insulin aspart so that it is available for IV use
B) Review proper foot care and prevention of injury
C) Teach subcutaneous injection technique, site rotation, and insulin
management
D) Coordinate carbohydrate-controlled meals at consistent times and
intervals
E) Mix bedtime dose of insulin glargine with insulin aspart sliding scale
dose
F) Fingerstick glucose assessments every 6 hours with meals
Correct Answer: B, C, D, F
Rationale: Glargine is a long-acting insulin and should NEVER be mixed
with other insulins. Proper foot care is essential for diabetic clients.
Consistent meal timing with insulin administration prevents hypoglycemia.
Fingerstick glucose monitoring guides insulin dosing. Insulin aspart is for
subcutaneous use only, not IV .
Question 6
A client prescribed tetracycline asks how to take the medication. Which
instruction is most appropriate?
A) Take with milk
B) Take with antacids
C) Take with water on an empty stomach
D) Crush and mix with yogurt
Correct Answer: C
