HESI Advanced Pharmacology Exit Exam Study Guide 2026/2027: Comprehensive Review, Practice Questions, and Test Preparation

A client who has been taking atorvastatin reports generalized weakness. Laboratory testing shows a marked increase in creatine kinase. Which additional finding would most strongly support a diagnosis of statin-associated myopathy? A. Muscle tenderness and pain B. Bilateral ankle edema C. Frequent bruising D. Nausea after meals Correct Answer: A. Muscle tenderness and pain Rationale: Elevated creatine kinase accompanied by muscle pain or tenderness suggests statin-associated myopathy and possible rhabdomyolysis. The medication should be withheld and the healthcare provider notified. Bruising is more closely associated with impaired coagulation, while edema and nausea are not the characteristic manifestations of statin-induced skeletal muscle injury. Question 2 A client at high risk for coronary artery disease has taken atorvastatin for three months. Which laboratory finding best demonstrates that the medication is achieving its primary therapeutic effect? A. Increased low-density lipoprotein level B. Decreased low-density lipoprotein level C. Increased very-low-density lipoprotein level D. Increased serum triglyceride level Correct Answer: B. Decreased low-density lipoprotein level Rationale: Statins primarily reduce low-density lipoprotein cholesterol by inhibiting hepatic cholesterol synthesis and increasing LDL receptor activity. A decreased LDL level indicates the desired therapeutic response. Increases in LDL, VLDL, or triglycerides would indicate inadequate control and continued cardiovascular risk rather than medication effectiveness. Question 3 A client taking gabapentin for postherpetic neuralgia calls the clinic. Which reported finding should the nurse instruct the client to report promptly to the healthcare provider? A. Mild drowsiness after the morning dose B. Rapid weight gain with ankle swelling C. Occasional dry mouth D. Increased appetite at dinner Correct Answer: B. Rapid weight gain with ankle swelling Rationale: Gabapentin can cause peripheral edema and weight gain. Rapid weight gain accompanied by ankle swelling may indicate significant fluid retention and requires evaluation. Mild drowsiness and dry mouth are commonly manageable effects. An increased appetite without rapid weight change is less urgent than evidence of developing edema. Question 4 A client with chronic lower back pain has taken ibuprofen twice daily for several months. Which assessment is the nurse’s priority during a follow-up visit? A. Determine whether the client has epigastric or abdominal pain B. Measure the strength of pedal pulses C. Evaluate the client’s sleep routine D. Assess the client’s preferred exercise program Correct Answer: A. Determine whether the client has epigastric or abdominal pain Rationale: Long-term NSAID use can damage the gastric mucosa and cause gastritis, peptic ulcer disease, or gastrointestinal bleeding. Abdominal or epigastric pain may be an early warning sign. Pedal pulses, sleep patterns, and exercise habits may be relevant to overall health but do not directly identify a serious complication of chronic ibuprofen therapy. Question 5 The nurse administers risedronate to a client with osteoporosis. The client asks to take the medication with milk. Which response by the nurse is most appropriate? A. “You should take this medication only with plain water.” B. “Milk reduces stomach irritation caused by this medication.” C. “Take the medication immediately after breakfast.” D. “You may take it with milk if it is low in fat.” Correct Answer: A. “You should take this medication only with plain water.” Rationale: Risedronate should be taken with plain water on an empty stomach because food, milk, calcium, and other minerals significantly reduce its absorption. The client must remain upright for at least 30 minutes afterward to reduce esophageal irritation. Taking the medication with breakfast or any type of milk decreases its therapeutic effectiveness. Question 6 A client has received amlodipine for hypertension for four weeks. Which assessment provides the most direct evidence that the medication is effective? A. Serum calcium concentration B. Blood pressure measurement C. Urine specific gravity D. Serum sodium concentration Correct Answer: B. Blood pressure measurement Rationale: Amlodipine is a calcium channel blocker that promotes arterial vasodilation and lowers blood pressure. Therefore, serial blood pressure measurements provide the most direct evidence of effectiveness. It does not produce its therapeutic effect by changing serum calcium, sodium, or urine concentration, although edema should also be monitored as an adverse effect. Question 7 A client newly prescribed tamsulosin for benign prostatic hyperplasia is preparing for discharge. Which instruction is most important for the nurse to include? A. Restrict fluids after breakfast B. Rise slowly from sitting or lying positions C. Take the medication only when urinary retention occurs D. Double the dose when urinary hesitancy increases Correct Answer: B. Rise slowly from sitting or lying positions Rationale: Tamsulosin blocks alpha-1 receptors and can produce dizziness, orthostatic hypotension, and syncope, particularly when therapy begins. The client should change positions slowly and request assistance if unsteady. Fluid restriction may worsen urinary problems, and the medication should be taken consistently rather than only when symptoms occur or at an increased dose. Question 8 A client receiving metoclopramide for chemotherapy-induced nausea develops repetitive lip smacking and involuntary tongue movements. Which action should the nurse take? A. Reassure the client that the symptoms are temporary B. Hold the medication and notify the healthcare provider C. Administer the next dose with food D. Encourage the client to ambulate Correct Answer: B. Hold the medication and notify the healthcare provider Rationale: Repetitive facial, oral, or limb movements may indicate tardive dyskinesia, a potentially irreversible adverse effect of dopamine-blocking medications such as metoclopramide. The medication should be withheld and the provider notified. Food and ambulation will not reverse the reaction, and reassurance without intervention could delay necessary treatment. Question 9 A client begins taking orlistat as part of a weight-management program. Which ongoing assessment is most appropriate for determining the medication’s effectiveness? A. Body mass index B. Serum sodium level C. Daily urine output D. Neurological reflexes Correct Answer: A. Body mass index Rationale: Orlistat reduces intestinal absorption of dietary fat and is used to promote weight loss. Changes in body weight and body mass index provide the most useful measures of effectiveness. Serum sodium, urine output, and neurological reflexes do not directly evaluate weight reduction, although the client should also be monitored for nutritional deficiencies. Question 10 Before administering sumatriptan to a client with an acute migraine, which health history finding is most important for the nurse to report? A. Seasonal allergic rhinitis B. Irritable bowel syndrome C. Coronary artery disease D. Type 2 diabetes controlled by diet Correct Answer: C. Coronary artery disease Rationale: Sumatriptan causes cranial and systemic vasoconstriction and may precipitate coronary vasospasm, myocardial ischemia, or infarction. It is generally contraindicated in clients with coronary artery disease or uncontrolled hypertension. Allergic rhinitis and irritable bowel syndrome do not create the same immediate risk. Diabetes alone is not an absolute contraindication.