Comprehensive HESI Pharmacology Examination Nursing
Pharmacology Practice Questions & Detailed Rationales
Complete Self-Test Assessment Covering All Core
Pharmacology Topics 2026–2027 Edition with Evidence-Based
Rationales
QUESTION 1
The nurse is preparing to administer digoxin to a patient with heart failure. Which assessment
finding would indicate the need to withhold the medication and notify the healthcare provider?
A) Heart rate of 68 beats per minute
B) Serum potassium level of 3.2 mEq/L
C) Blood pressure of 130/82 mmHg
D) Respiratory rate of 18 breaths per minute
Answer: B
Explanation: Hypokalemia (potassium < 3.5 mEq/L) increases the risk of digoxin toxicity. The
nurse should withhold digoxin and notify the provider. A heart rate of 68 (A) is within normal
range and appropriate for digoxin administration. Blood pressure of 130/82 (C) is acceptable.
Respiratory rate of 18 (D) is normal. Digoxin toxicity is more likely in patients with hypokalemia,
and the medication should be held until potassium levels are corrected.
QUESTION 2
A patient is prescribed warfarin for atrial fibrillation. Which laboratory value is most important
for the nurse to monitor?
A) Serum potassium
B) Complete blood count
C) International Normalized Ratio (INR)
D) Liver function tests
Answer: C
Explanation: INR is the primary monitoring parameter for warfarin therapy to ensure
therapeutic anticoagulation (typically INR 2-3 for atrial fibrillation) and to prevent bleeding
complications. Serum potassium (A) is not related to warfarin. Complete blood count (B) may be
1
,monitored but is not the primary parameter. Liver function tests (D) may be affected but are not
the primary monitoring value.
QUESTION 3
The nurse is teaching a patient about metformin. Which statement by the patient indicates
understanding of the medication?
A) "I should take this medication with my meals to prevent stomach upset"
B) "I need to check my blood sugar before each meal"
C) "This medication can cause weight gain"
D) "I should take this medication on an empty stomach"
Answer: A
Explanation: Metformin should be taken with meals to reduce gastrointestinal side effects
(nausea, diarrhea). Checking blood sugar before meals (B) is not specific to metformin.
Metformin is weight-neutral or may cause weight loss, not weight gain (C). Taking on an empty
stomach (D) increases GI side effects.
QUESTION 4
A patient is receiving IV furosemide. Which assessment finding indicates the medication is
having the desired effect?
A) Decreased urine output
B) Increased urine output
C) Decreased heart rate
D) Increased blood pressure
Answer: B
Explanation: Furosemide is a loop diuretic; the desired effect is increased urine output (diuresis)
to reduce fluid overload. Decreased urine output (A) indicates the medication is not effective or
the patient is developing renal impairment. Decreased heart rate (C) and increased blood
pressure (D) are not direct desired effects of furosemide.
QUESTION 5
The nurse is administering an aminoglycoside antibiotic. Which adverse effect is most
concerning with this class of medications?
A) Ototoxicity and nephrotoxicity
2
,B) Hepatotoxicity
C) Cardiotoxicity
D) Gastrointestinal bleeding
Answer: A
Explanation: Aminoglycosides (gentamicin, tobramycin, amikacin) are associated with
ototoxicity (hearing loss, tinnitus) and nephrotoxicity (acute kidney injury). These are dose-
dependent and require therapeutic drug monitoring. Hepatotoxicity (B) is not the primary
concern. Cardiotoxicity (C) and GI bleeding (D) are not typical adverse effects of
aminoglycosides.
QUESTION 6
A patient is prescribed enoxaparin (Lovenox) postoperatively. Which statement by the patient
indicates the need for further teaching?
A) "I will need to have my blood drawn regularly to check my levels"
B) "I should report any unusual bruising or bleeding"
C) "I will inject this medication into my abdomen"
D) "I should not take aspirin while on this medication"
Answer: A
Explanation: Enoxaparin is a low molecular weight heparin that does not require routine
monitoring of aPTT or INR. The patient should not expect regular blood draws for monitoring.
Reporting bruising/bleeding (B) is correct. Abdominal injection (C) is the correct administration
route. Avoiding aspirin (D) is correct due to increased bleeding risk.
QUESTION 7
The nurse is administering morphine sulfate for severe pain. Which finding requires immediate
nursing action?
A) Respiratory rate of 10 breaths per minute
B) Pain rating decreased from 8 to 4
C) Blood pressure of 110/70 mmHg
D) Heart rate of 88 beats per minute
Answer: A
Explanation: Respiratory depression (respiratory rate < 12) is a life-threatening adverse effect of
morphine. The nurse should prepare to administer naloxone if respiratory depression is severe.
3
, Pain reduction (B) is the desired effect. Blood pressure of 110/70 (C) and heart rate of 88 (D) are
acceptable.
QUESTION 8
A patient with type 1 diabetes is receiving insulin lispro (Humalog). When should the nurse
expect the onset of action for this insulin?
A) 30-60 minutes after administration
B) 1-2 hours after administration
C) 15-30 minutes after administration
D) 2-4 hours after administration
Answer: C
Explanation: Insulin lispro is a rapid-acting insulin with onset of action in 15-30 minutes. It
should be given immediately before meals (within 15 minutes of eating). Regular insulin has
onset of 30-60 minutes (A). NPH has onset of 1-2 hours (B). Intermediate-acting insulins peak at
2-4 hours (D).
QUESTION 9
A patient is prescribed lisinopril for hypertension. What adverse effect should the nurse include
in patient teaching?
A) Dry cough
B) Weight gain
C) Constipation
D) Urinary retention
Answer: A
Explanation: Lisinopril (ACE inhibitor) commonly causes a persistent dry cough due to bradykinin
accumulation. Weight gain (B) is associated with other antihypertensives (e.g., beta-blockers,
calcium channel blockers). Constipation (C) and urinary retention (D) are not common ACE
inhibitor side effects.
QUESTION 10
The nurse is administering ondansetron to a patient receiving chemotherapy. What is the
primary purpose of this medication?
A) Prevent chemotherapy-induced nausea and vomiting
4
Pharmacology Practice Questions & Detailed Rationales
Complete Self-Test Assessment Covering All Core
Pharmacology Topics 2026–2027 Edition with Evidence-Based
Rationales
QUESTION 1
The nurse is preparing to administer digoxin to a patient with heart failure. Which assessment
finding would indicate the need to withhold the medication and notify the healthcare provider?
A) Heart rate of 68 beats per minute
B) Serum potassium level of 3.2 mEq/L
C) Blood pressure of 130/82 mmHg
D) Respiratory rate of 18 breaths per minute
Answer: B
Explanation: Hypokalemia (potassium < 3.5 mEq/L) increases the risk of digoxin toxicity. The
nurse should withhold digoxin and notify the provider. A heart rate of 68 (A) is within normal
range and appropriate for digoxin administration. Blood pressure of 130/82 (C) is acceptable.
Respiratory rate of 18 (D) is normal. Digoxin toxicity is more likely in patients with hypokalemia,
and the medication should be held until potassium levels are corrected.
QUESTION 2
A patient is prescribed warfarin for atrial fibrillation. Which laboratory value is most important
for the nurse to monitor?
A) Serum potassium
B) Complete blood count
C) International Normalized Ratio (INR)
D) Liver function tests
Answer: C
Explanation: INR is the primary monitoring parameter for warfarin therapy to ensure
therapeutic anticoagulation (typically INR 2-3 for atrial fibrillation) and to prevent bleeding
complications. Serum potassium (A) is not related to warfarin. Complete blood count (B) may be
1
,monitored but is not the primary parameter. Liver function tests (D) may be affected but are not
the primary monitoring value.
QUESTION 3
The nurse is teaching a patient about metformin. Which statement by the patient indicates
understanding of the medication?
A) "I should take this medication with my meals to prevent stomach upset"
B) "I need to check my blood sugar before each meal"
C) "This medication can cause weight gain"
D) "I should take this medication on an empty stomach"
Answer: A
Explanation: Metformin should be taken with meals to reduce gastrointestinal side effects
(nausea, diarrhea). Checking blood sugar before meals (B) is not specific to metformin.
Metformin is weight-neutral or may cause weight loss, not weight gain (C). Taking on an empty
stomach (D) increases GI side effects.
QUESTION 4
A patient is receiving IV furosemide. Which assessment finding indicates the medication is
having the desired effect?
A) Decreased urine output
B) Increased urine output
C) Decreased heart rate
D) Increased blood pressure
Answer: B
Explanation: Furosemide is a loop diuretic; the desired effect is increased urine output (diuresis)
to reduce fluid overload. Decreased urine output (A) indicates the medication is not effective or
the patient is developing renal impairment. Decreased heart rate (C) and increased blood
pressure (D) are not direct desired effects of furosemide.
QUESTION 5
The nurse is administering an aminoglycoside antibiotic. Which adverse effect is most
concerning with this class of medications?
A) Ototoxicity and nephrotoxicity
2
,B) Hepatotoxicity
C) Cardiotoxicity
D) Gastrointestinal bleeding
Answer: A
Explanation: Aminoglycosides (gentamicin, tobramycin, amikacin) are associated with
ototoxicity (hearing loss, tinnitus) and nephrotoxicity (acute kidney injury). These are dose-
dependent and require therapeutic drug monitoring. Hepatotoxicity (B) is not the primary
concern. Cardiotoxicity (C) and GI bleeding (D) are not typical adverse effects of
aminoglycosides.
QUESTION 6
A patient is prescribed enoxaparin (Lovenox) postoperatively. Which statement by the patient
indicates the need for further teaching?
A) "I will need to have my blood drawn regularly to check my levels"
B) "I should report any unusual bruising or bleeding"
C) "I will inject this medication into my abdomen"
D) "I should not take aspirin while on this medication"
Answer: A
Explanation: Enoxaparin is a low molecular weight heparin that does not require routine
monitoring of aPTT or INR. The patient should not expect regular blood draws for monitoring.
Reporting bruising/bleeding (B) is correct. Abdominal injection (C) is the correct administration
route. Avoiding aspirin (D) is correct due to increased bleeding risk.
QUESTION 7
The nurse is administering morphine sulfate for severe pain. Which finding requires immediate
nursing action?
A) Respiratory rate of 10 breaths per minute
B) Pain rating decreased from 8 to 4
C) Blood pressure of 110/70 mmHg
D) Heart rate of 88 beats per minute
Answer: A
Explanation: Respiratory depression (respiratory rate < 12) is a life-threatening adverse effect of
morphine. The nurse should prepare to administer naloxone if respiratory depression is severe.
3
, Pain reduction (B) is the desired effect. Blood pressure of 110/70 (C) and heart rate of 88 (D) are
acceptable.
QUESTION 8
A patient with type 1 diabetes is receiving insulin lispro (Humalog). When should the nurse
expect the onset of action for this insulin?
A) 30-60 minutes after administration
B) 1-2 hours after administration
C) 15-30 minutes after administration
D) 2-4 hours after administration
Answer: C
Explanation: Insulin lispro is a rapid-acting insulin with onset of action in 15-30 minutes. It
should be given immediately before meals (within 15 minutes of eating). Regular insulin has
onset of 30-60 minutes (A). NPH has onset of 1-2 hours (B). Intermediate-acting insulins peak at
2-4 hours (D).
QUESTION 9
A patient is prescribed lisinopril for hypertension. What adverse effect should the nurse include
in patient teaching?
A) Dry cough
B) Weight gain
C) Constipation
D) Urinary retention
Answer: A
Explanation: Lisinopril (ACE inhibitor) commonly causes a persistent dry cough due to bradykinin
accumulation. Weight gain (B) is associated with other antihypertensives (e.g., beta-blockers,
calcium channel blockers). Constipation (C) and urinary retention (D) are not common ACE
inhibitor side effects.
QUESTION 10
The nurse is administering ondansetron to a patient receiving chemotherapy. What is the
primary purpose of this medication?
A) Prevent chemotherapy-induced nausea and vomiting
4
