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NURS 440 Advanced Pharmacology for
Nursing Practice Exam Questions & Answers
2026–2027 | HESI Pharmacology
Comprehensive Practice Exam | Nursing
Pharmacology Exam Preparation
Description:
This comprehensive 150-question practice examination is designed to
assess the knowledge and clinical decision-making skills of nursing
students preparing for the HESI Pharmacology specialty exam. The
test covers all major content areas, including pharmacokinetics,
pharmacodynamics, medication administration, adverse effects, drug
interactions, and patient teaching. Questions range from foundational
recall to complex application-level scenarios that require critical
thinking and the application of professional standards. This exam
mirrors the structure, style, and rigor of actual licensing examinations,
providing a realistic and thorough preparation tool for academic or
licensure readiness.
HESI Pharmacology Nursing Practice Test Exam
Section 1: Questions 1-50
Question 1
A client with a history of heart failure is prescribed digoxin 0.25 mg
PO daily. The nurse should prioritize which assessment before
administering this medication?
A) Serum potassium level
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B) Apical pulse for one full minute
C) Blood pressure in the supine position
D) Daily weight and urine output
Rationale: Digoxin has a narrow therapeutic index and can cause
bradycardia and dysrhythmias. The apical pulse must be assessed for
one full minute before administration. The medication should be held
if the pulse is below 60 bpm in an adult. While potassium levels,
blood pressure, and daily weight are all important assessments for
patients on digoxin, the immediate priority before administration is
the apical pulse to prevent life-threatening cardiac toxicity.
Question 2
A nurse is preparing to administer 500 mL of normal saline over 4
hours. The drop factor is 15 gtt/mL. What is the flow rate in gtt/min?
A) 21 gtt/min
B) 25 gtt/min
C) 31 gtt/min
D) 42 gtt/min
Rationale: To calculate the flow rate, use the formula: (Volume in mL
divided by Time in minutes) multiplied by Drop factor. Here, 500 mL
divided by 240 minutes equals 2.083 mL/min. Then, 2.083 mL/min
multiplied by 15 gtt/mL equals 31.25, rounded down to 31 gtt/min.
The nurse must always verify the drop factor with the specific IV
tubing being used and double-check calculations to ensure patient
safety.
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Question 3
A client is prescribed metformin 1000 mg PO twice daily for type 2
diabetes mellitus. Which of the following side effects should the nurse
include in the patient teaching?
A) Weight gain
B) Hypoglycemia
C) Peripheral edema
D) Gastrointestinal upset
Rationale: Metformin is a biguanide that commonly causes
gastrointestinal side effects such as nausea, diarrhea, and abdominal
discomfort. These are often dose-dependent and may diminish over
time. Metformin is not associated with weight gain or peripheral
edema, and it rarely causes hypoglycemia unless combined with other
antidiabetic agents or excessive exercise without caloric intake.
Question 4
A client receiving IV heparin for a deep vein thrombosis has an aPTT
level of 120 seconds. The therapeutic range for this client is 60-80
seconds. Which action should the nurse take first?
A) Administer vitamin K
B) Stop the heparin infusion
C) Notify the healthcare provider
D) Decrease the heparin rate by 50%
Rationale: An aPTT of 120 seconds is critically above the therapeutic
range, indicating a high risk of bleeding. The nurse's priority action is
to stop the infusion immediately to prevent further anticoagulation.
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After stopping the infusion, the nurse should notify the provider and
prepare for the potential administration of protamine sulfate, which is
the specific antidote for heparin. Vitamin K is the antidote for
warfarin, not heparin.
Question 5
A client is prescribed amlodipine 5 mg PO daily for hypertension.
Which adverse effect is most commonly associated with this
medication?
A) Dry cough
B) Hyperkalemia
C) Peripheral edema
D) Reflex tachycardia
Rationale: Amlodipine is a dihydropyridine calcium channel blocker
that causes significant peripheral vasodilation, leading to peripheral
edema as a common adverse effect. Dry cough is associated with
ACE inhibitors, not calcium channel blockers. Hyperkalemia is more
commonly associated with potassium-sparing diuretics and ACE
inhibitors. Reflex tachycardia can occur but is less common with
amlodipine due to its slow onset of action.
Question 6
The nurse is administering morphine sulfate 2 mg IV push to a
postoperative client. Which assessment finding requires immediate
nursing intervention?
A) Respiratory rate of 22 breaths per minute
B) Blood pressure of 110/70 mmHg
NURS 440 Advanced Pharmacology for
Nursing Practice Exam Questions & Answers
2026–2027 | HESI Pharmacology
Comprehensive Practice Exam | Nursing
Pharmacology Exam Preparation
Description:
This comprehensive 150-question practice examination is designed to
assess the knowledge and clinical decision-making skills of nursing
students preparing for the HESI Pharmacology specialty exam. The
test covers all major content areas, including pharmacokinetics,
pharmacodynamics, medication administration, adverse effects, drug
interactions, and patient teaching. Questions range from foundational
recall to complex application-level scenarios that require critical
thinking and the application of professional standards. This exam
mirrors the structure, style, and rigor of actual licensing examinations,
providing a realistic and thorough preparation tool for academic or
licensure readiness.
HESI Pharmacology Nursing Practice Test Exam
Section 1: Questions 1-50
Question 1
A client with a history of heart failure is prescribed digoxin 0.25 mg
PO daily. The nurse should prioritize which assessment before
administering this medication?
A) Serum potassium level
,2|Page
B) Apical pulse for one full minute
C) Blood pressure in the supine position
D) Daily weight and urine output
Rationale: Digoxin has a narrow therapeutic index and can cause
bradycardia and dysrhythmias. The apical pulse must be assessed for
one full minute before administration. The medication should be held
if the pulse is below 60 bpm in an adult. While potassium levels,
blood pressure, and daily weight are all important assessments for
patients on digoxin, the immediate priority before administration is
the apical pulse to prevent life-threatening cardiac toxicity.
Question 2
A nurse is preparing to administer 500 mL of normal saline over 4
hours. The drop factor is 15 gtt/mL. What is the flow rate in gtt/min?
A) 21 gtt/min
B) 25 gtt/min
C) 31 gtt/min
D) 42 gtt/min
Rationale: To calculate the flow rate, use the formula: (Volume in mL
divided by Time in minutes) multiplied by Drop factor. Here, 500 mL
divided by 240 minutes equals 2.083 mL/min. Then, 2.083 mL/min
multiplied by 15 gtt/mL equals 31.25, rounded down to 31 gtt/min.
The nurse must always verify the drop factor with the specific IV
tubing being used and double-check calculations to ensure patient
safety.
,3|Page
Question 3
A client is prescribed metformin 1000 mg PO twice daily for type 2
diabetes mellitus. Which of the following side effects should the nurse
include in the patient teaching?
A) Weight gain
B) Hypoglycemia
C) Peripheral edema
D) Gastrointestinal upset
Rationale: Metformin is a biguanide that commonly causes
gastrointestinal side effects such as nausea, diarrhea, and abdominal
discomfort. These are often dose-dependent and may diminish over
time. Metformin is not associated with weight gain or peripheral
edema, and it rarely causes hypoglycemia unless combined with other
antidiabetic agents or excessive exercise without caloric intake.
Question 4
A client receiving IV heparin for a deep vein thrombosis has an aPTT
level of 120 seconds. The therapeutic range for this client is 60-80
seconds. Which action should the nurse take first?
A) Administer vitamin K
B) Stop the heparin infusion
C) Notify the healthcare provider
D) Decrease the heparin rate by 50%
Rationale: An aPTT of 120 seconds is critically above the therapeutic
range, indicating a high risk of bleeding. The nurse's priority action is
to stop the infusion immediately to prevent further anticoagulation.
, 4|Page
After stopping the infusion, the nurse should notify the provider and
prepare for the potential administration of protamine sulfate, which is
the specific antidote for heparin. Vitamin K is the antidote for
warfarin, not heparin.
Question 5
A client is prescribed amlodipine 5 mg PO daily for hypertension.
Which adverse effect is most commonly associated with this
medication?
A) Dry cough
B) Hyperkalemia
C) Peripheral edema
D) Reflex tachycardia
Rationale: Amlodipine is a dihydropyridine calcium channel blocker
that causes significant peripheral vasodilation, leading to peripheral
edema as a common adverse effect. Dry cough is associated with
ACE inhibitors, not calcium channel blockers. Hyperkalemia is more
commonly associated with potassium-sparing diuretics and ACE
inhibitors. Reflex tachycardia can occur but is less common with
amlodipine due to its slow onset of action.
Question 6
The nurse is administering morphine sulfate 2 mg IV push to a
postoperative client. Which assessment finding requires immediate
nursing intervention?
A) Respiratory rate of 22 breaths per minute
B) Blood pressure of 110/70 mmHg
