HESI PHARM ACTUAL EXAM LATEST UPDATES 2026 -
2027 70 QUESTION AND CORRECT ANSWERS WITH
RATIONALES RATED A GRADE.
QUESTION
A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information
should the nurse include in the client's instruction?
a. Notify the clinic of any changes in the color of urine.
b. Avoid overexposure to the sun.
c. Stop the medication after the diarrhea resolves.
d. Take the medication with food.
CORRECT ANS: d. Take the medication with food.
EXPERT RATIONALE
Metronidazole can cause significant gastrointestinal upset, including nausea, vomiting,
and a metallic taste. Taking the medication with food or milk can help to minimize these
adverse effects. The client should complete the full course of therapy to ensure
eradication of the parasite, and not stop when symptoms resolve. While metronidazole
can cause a darkening of the urine, this is a harmless side effect and does not require
notification. Sun sensitivity is not a primary concern with metronidazole.
QUESTION
A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a
day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is
prescribed. Which information is most important for the nurse to include in client
teaching?
a. Use contraception during intercourse.
b. Ensure the Cytotec is taken on an empty stomach.
c. Encourage oral fluid intake to prevent constipation.
d. Take Cytotec 30 minutes prior to Motrin.
CORRECT ANS: a. Use contraception during intercourse.
,EXPERT RATIONALE
Misoprostol is a prostaglandin analog that is used to prevent NSAID-induced gastric
ulcers. However, it is also a potent abortifacient and is Pregnancy Category X. It is
absolutely contraindicated during pregnancy and can cause uterine contractions,
miscarriage, and birth defects. Therefore, the most critical teaching point for a female
client of childbearing age is to use reliable contraception during intercourse. It should
be taken with food, not on an empty stomach, and it can cause diarrhea, not
constipation. It is typically taken with meals, not at a specific interval before the NSAID.
QUESTION
A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for
symptom management. The nurse notes the client is allergic to sulfa. Which action is
most important for the nurse to implement prior to administering the first dose?
a. Review the client's hemoglobin results.
b. Notify the healthcare provider.
c. Inquire about the reaction to sulfa.
d. Record the client's vital signs.
CORRECT ANS: b. Notify the healthcare provider.
EXPERT RATIONALE
Celecoxib is a COX-2 inhibitor that contains a sulfonamide moiety. There is a known
cross-sensitivity and increased risk of allergic reactions in clients with a sulfa allergy.
While inquiring about the reaction (c) is important, the most critical action is to notify
the healthcare provider (b) so that an alternative medication can be prescribed.
Administering the drug without provider knowledge could precipitate a severe
hypersensitivity reaction.
QUESTION
A client is admitted to the hospital for a new onset of supraventricular tachycardia (SVT)
and is prescribed digoxin. For which laboratory finding should the nurse notify the
healthcare provider immediately?
,a. Potassium level of 3.1 mEq/L.
b. Sodium level of 132 mEq/L.
c. Calcium level of 8.6 mg/dL.
d. Magnesium level of 1.2 mEq/L.
CORRECT ANS: a. Potassium level of 3.1 mEq/L.
EXPERT RATIONALE
Hypokalemia (low potassium) increases the risk of digoxin toxicity, which can lead to
life-threatening cardiac dysrhythmias. A potassium level of 3.1 mEq/L is significantly
below the normal range (3.5-5.0 mEq/L) and requires immediate intervention. The
healthcare provider should be notified to assess the client's potassium status and
potentially adjust the digoxin dose or replace potassium.
QUESTION
The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client
who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should
the nurse implement?
a. Verify both prescriptions with the healthcare provider.
b. Report the medication interactions to the nurse manager.
c. Hold the ACE inhibitor and give the new prescription.
d. Transcribe and send the prescription to the pharmacy.
CORRECT ANS: a. Verify both prescriptions with the healthcare provider.
EXPERT RATIONALE
Spironolactone is a potassium-sparing diuretic. ACE inhibitors also have a tendency to
increase serum potassium levels by reducing aldosterone secretion. Concurrent use of
these two medications significantly increases the risk of hyperkalemia, which can be life-
threatening. The nurse should verify the combination with the healthcare provider to
ensure that the client's potassium levels are being monitored and that the prescription is
appropriate.
, QUESTION
The nurse admits a client with tumor-induced spinal cord compression. Which
medication should the nurse anticipate to be prescribed to offer the best palliative
treatment for this client?
a. Morphine sulfate.
b. Ibuprofen.
c. Amitriptyline.
d. Dexamethasone.
CORRECT ANS: d. Dexamethasone.
EXPERT RATIONALE
Tumor-induced spinal cord compression is a medical emergency. Dexamethasone is a
potent corticosteroid that is the mainstay of palliative treatment for this condition. It
reduces inflammation and edema around the spinal cord, thereby relieving pressure,
decreasing pain, and preserving neurological function. While morphine (a) is used for
pain, it does not address the underlying inflammation. Ibuprofen (b) is a mild analgesic
and anti-inflammatory but is not sufficient for this severe condition. Amitriptyline (c) is
used for neuropathic pain, but corticosteroids are the primary treatment for cord
compression.
QUESTION
The nurse is preparing an education session for a client prescribed opioids for
intractable cancer pain. The nurse should include strategies to help prevent which
common side effect associated with long-term use of opioids?
a. Sedation.
b. Constipation.
c. Urinary retention.
d. Respiratory depression.
CORRECT ANS: b. Constipation.
EXPERT RATIONALE
Constipation is the most common and persistent side effect of long-term opioid
therapy. Opioids decrease gastrointestinal motility and increase fluid absorption, leading
to hard, dry stools. Unlike other side effects such as sedation, nausea, and respiratory
2027 70 QUESTION AND CORRECT ANSWERS WITH
RATIONALES RATED A GRADE.
QUESTION
A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information
should the nurse include in the client's instruction?
a. Notify the clinic of any changes in the color of urine.
b. Avoid overexposure to the sun.
c. Stop the medication after the diarrhea resolves.
d. Take the medication with food.
CORRECT ANS: d. Take the medication with food.
EXPERT RATIONALE
Metronidazole can cause significant gastrointestinal upset, including nausea, vomiting,
and a metallic taste. Taking the medication with food or milk can help to minimize these
adverse effects. The client should complete the full course of therapy to ensure
eradication of the parasite, and not stop when symptoms resolve. While metronidazole
can cause a darkening of the urine, this is a harmless side effect and does not require
notification. Sun sensitivity is not a primary concern with metronidazole.
QUESTION
A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a
day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is
prescribed. Which information is most important for the nurse to include in client
teaching?
a. Use contraception during intercourse.
b. Ensure the Cytotec is taken on an empty stomach.
c. Encourage oral fluid intake to prevent constipation.
d. Take Cytotec 30 minutes prior to Motrin.
CORRECT ANS: a. Use contraception during intercourse.
,EXPERT RATIONALE
Misoprostol is a prostaglandin analog that is used to prevent NSAID-induced gastric
ulcers. However, it is also a potent abortifacient and is Pregnancy Category X. It is
absolutely contraindicated during pregnancy and can cause uterine contractions,
miscarriage, and birth defects. Therefore, the most critical teaching point for a female
client of childbearing age is to use reliable contraception during intercourse. It should
be taken with food, not on an empty stomach, and it can cause diarrhea, not
constipation. It is typically taken with meals, not at a specific interval before the NSAID.
QUESTION
A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for
symptom management. The nurse notes the client is allergic to sulfa. Which action is
most important for the nurse to implement prior to administering the first dose?
a. Review the client's hemoglobin results.
b. Notify the healthcare provider.
c. Inquire about the reaction to sulfa.
d. Record the client's vital signs.
CORRECT ANS: b. Notify the healthcare provider.
EXPERT RATIONALE
Celecoxib is a COX-2 inhibitor that contains a sulfonamide moiety. There is a known
cross-sensitivity and increased risk of allergic reactions in clients with a sulfa allergy.
While inquiring about the reaction (c) is important, the most critical action is to notify
the healthcare provider (b) so that an alternative medication can be prescribed.
Administering the drug without provider knowledge could precipitate a severe
hypersensitivity reaction.
QUESTION
A client is admitted to the hospital for a new onset of supraventricular tachycardia (SVT)
and is prescribed digoxin. For which laboratory finding should the nurse notify the
healthcare provider immediately?
,a. Potassium level of 3.1 mEq/L.
b. Sodium level of 132 mEq/L.
c. Calcium level of 8.6 mg/dL.
d. Magnesium level of 1.2 mEq/L.
CORRECT ANS: a. Potassium level of 3.1 mEq/L.
EXPERT RATIONALE
Hypokalemia (low potassium) increases the risk of digoxin toxicity, which can lead to
life-threatening cardiac dysrhythmias. A potassium level of 3.1 mEq/L is significantly
below the normal range (3.5-5.0 mEq/L) and requires immediate intervention. The
healthcare provider should be notified to assess the client's potassium status and
potentially adjust the digoxin dose or replace potassium.
QUESTION
The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client
who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should
the nurse implement?
a. Verify both prescriptions with the healthcare provider.
b. Report the medication interactions to the nurse manager.
c. Hold the ACE inhibitor and give the new prescription.
d. Transcribe and send the prescription to the pharmacy.
CORRECT ANS: a. Verify both prescriptions with the healthcare provider.
EXPERT RATIONALE
Spironolactone is a potassium-sparing diuretic. ACE inhibitors also have a tendency to
increase serum potassium levels by reducing aldosterone secretion. Concurrent use of
these two medications significantly increases the risk of hyperkalemia, which can be life-
threatening. The nurse should verify the combination with the healthcare provider to
ensure that the client's potassium levels are being monitored and that the prescription is
appropriate.
, QUESTION
The nurse admits a client with tumor-induced spinal cord compression. Which
medication should the nurse anticipate to be prescribed to offer the best palliative
treatment for this client?
a. Morphine sulfate.
b. Ibuprofen.
c. Amitriptyline.
d. Dexamethasone.
CORRECT ANS: d. Dexamethasone.
EXPERT RATIONALE
Tumor-induced spinal cord compression is a medical emergency. Dexamethasone is a
potent corticosteroid that is the mainstay of palliative treatment for this condition. It
reduces inflammation and edema around the spinal cord, thereby relieving pressure,
decreasing pain, and preserving neurological function. While morphine (a) is used for
pain, it does not address the underlying inflammation. Ibuprofen (b) is a mild analgesic
and anti-inflammatory but is not sufficient for this severe condition. Amitriptyline (c) is
used for neuropathic pain, but corticosteroids are the primary treatment for cord
compression.
QUESTION
The nurse is preparing an education session for a client prescribed opioids for
intractable cancer pain. The nurse should include strategies to help prevent which
common side effect associated with long-term use of opioids?
a. Sedation.
b. Constipation.
c. Urinary retention.
d. Respiratory depression.
CORRECT ANS: b. Constipation.
EXPERT RATIONALE
Constipation is the most common and persistent side effect of long-term opioid
therapy. Opioids decrease gastrointestinal motility and increase fluid absorption, leading
to hard, dry stools. Unlike other side effects such as sedation, nausea, and respiratory
