1
HESI RN Pharmacology Exit Exam
(2025/2026) – Actual Exam Questions
with Verified Answers and
Pharmacological Rationales
Adverse Effects
1. A patient receiving warfarin reports bleeding gums. What is the nurse’s priority action?
A. Administer an additional dose of warfarin
B. Notify the provider immediately
C. Encourage the patient to brush teeth gently
D. Document the finding and continue monitoring
Rationale: Bleeding gums indicate a potential adverse effect of warfarin, an
anticoagulant that increases bleeding risk. Notifying the provider is critical to assess for
possible overdose or need for vitamin K, per anticoagulation therapy protocols.
2. A patient on digoxin reports nausea and visual halos. What should the nurse suspect?
A. Hypoglycemia
B. Digoxin toxicity
C. Allergic reaction
D. Dehydration
Rationale: Nausea and visual halos are hallmark signs of digoxin toxicity, often due to
elevated serum levels. Prompt assessment of digoxin levels and electrolyte imbalances
(e.g., hypokalemia) is needed, per cardiac glycoside pharmacology.
3. A patient receiving chemotherapy with doxorubicin complains of palpitations. What is
the nurse’s first action?
A. Administer an antiemetic
B. Assess the patient’s heart rate and rhythm
C. Increase the infusion rate
D. Document the complaint
Rationale: Doxorubicin is cardiotoxic and can cause arrhythmias. Assessing heart rate
and rhythm is critical to detect potential cardiac adverse effects, per chemotherapy safety
protocols.
4. A patient on lisinopril develops a dry cough. What should the nurse do?
A. Increase the lisinopril dose
B. Report the cough to the provider
C. Administer an antihistamine
D. Encourage fluid intake
Rationale: A dry cough is a common adverse effect of ACE inhibitors like lisinopril,
possibly requiring a switch to an ARB. The provider must be notified for further
evaluation, per antihypertensive pharmacology.
, 2
5. A patient receiving gentamicin reports hearing loss. What is the nurse’s priority?
A. Continue the medication as ordered
B. Hold the dose and notify the provider
C. Encourage ear hygiene
D. Document the finding only
Rationale: Gentamicin, an aminoglycoside, can cause ototoxicity. Holding the dose and
notifying the provider prevent further auditory damage, per antibiotic adverse effect
management.
6. A patient on metformin reports abdominal cramping and diarrhea. What should the nurse
do?
A. Administer an antidiarrheal
B. Educate the patient on taking metformin with meals
C. Increase the metformin dose
D. Discontinue the medication
Rationale: Gastrointestinal upset is a common adverse effect of metformin. Taking it
with meals reduces these symptoms, per oral hypoglycemic pharmacology.
7. A patient receiving heparin develops hematuria. What is the nurse’s first action?
A. Increase the heparin dose
B. Notify the provider immediately
C. Administer a diuretic
D. Monitor urine output
Rationale: Hematuria suggests bleeding, a serious adverse effect of heparin. Notifying
the provider is critical to assess for overdose or need for protamine sulfate, per
anticoagulant therapy protocols.
8. A patient on fluoxetine reports insomnia and agitation. What should the nurse suspect?
A. Hypoglycemia
B. Serotonin syndrome
C. Allergic reaction
D. Dehydration
Rationale: Insomnia and agitation are signs of serotonin syndrome, a potential adverse
effect of SSRIs like fluoxetine, requiring immediate medical evaluation, per
psychopharmacology.
9. A patient receiving vancomycin develops a rash and fever. What is the nurse’s priority?
A. Continue the infusion
B. Stop the infusion and notify the provider
C. Administer an antipyretic
D. Document the symptoms
Rationale: Rash and fever may indicate Red Man Syndrome or an allergic reaction to
vancomycin. Stopping the infusion prevents further harm, per antibiotic adverse effect
protocols.
10. A patient on levothyroxine reports palpitations and weight loss. What should the nurse
do?
A. Increase the dose
B. Report symptoms to the provider
C. Encourage a low-calorie diet
D. Monitor blood pressure only
HESI RN Pharmacology Exit Exam
(2025/2026) – Actual Exam Questions
with Verified Answers and
Pharmacological Rationales
Adverse Effects
1. A patient receiving warfarin reports bleeding gums. What is the nurse’s priority action?
A. Administer an additional dose of warfarin
B. Notify the provider immediately
C. Encourage the patient to brush teeth gently
D. Document the finding and continue monitoring
Rationale: Bleeding gums indicate a potential adverse effect of warfarin, an
anticoagulant that increases bleeding risk. Notifying the provider is critical to assess for
possible overdose or need for vitamin K, per anticoagulation therapy protocols.
2. A patient on digoxin reports nausea and visual halos. What should the nurse suspect?
A. Hypoglycemia
B. Digoxin toxicity
C. Allergic reaction
D. Dehydration
Rationale: Nausea and visual halos are hallmark signs of digoxin toxicity, often due to
elevated serum levels. Prompt assessment of digoxin levels and electrolyte imbalances
(e.g., hypokalemia) is needed, per cardiac glycoside pharmacology.
3. A patient receiving chemotherapy with doxorubicin complains of palpitations. What is
the nurse’s first action?
A. Administer an antiemetic
B. Assess the patient’s heart rate and rhythm
C. Increase the infusion rate
D. Document the complaint
Rationale: Doxorubicin is cardiotoxic and can cause arrhythmias. Assessing heart rate
and rhythm is critical to detect potential cardiac adverse effects, per chemotherapy safety
protocols.
4. A patient on lisinopril develops a dry cough. What should the nurse do?
A. Increase the lisinopril dose
B. Report the cough to the provider
C. Administer an antihistamine
D. Encourage fluid intake
Rationale: A dry cough is a common adverse effect of ACE inhibitors like lisinopril,
possibly requiring a switch to an ARB. The provider must be notified for further
evaluation, per antihypertensive pharmacology.
, 2
5. A patient receiving gentamicin reports hearing loss. What is the nurse’s priority?
A. Continue the medication as ordered
B. Hold the dose and notify the provider
C. Encourage ear hygiene
D. Document the finding only
Rationale: Gentamicin, an aminoglycoside, can cause ototoxicity. Holding the dose and
notifying the provider prevent further auditory damage, per antibiotic adverse effect
management.
6. A patient on metformin reports abdominal cramping and diarrhea. What should the nurse
do?
A. Administer an antidiarrheal
B. Educate the patient on taking metformin with meals
C. Increase the metformin dose
D. Discontinue the medication
Rationale: Gastrointestinal upset is a common adverse effect of metformin. Taking it
with meals reduces these symptoms, per oral hypoglycemic pharmacology.
7. A patient receiving heparin develops hematuria. What is the nurse’s first action?
A. Increase the heparin dose
B. Notify the provider immediately
C. Administer a diuretic
D. Monitor urine output
Rationale: Hematuria suggests bleeding, a serious adverse effect of heparin. Notifying
the provider is critical to assess for overdose or need for protamine sulfate, per
anticoagulant therapy protocols.
8. A patient on fluoxetine reports insomnia and agitation. What should the nurse suspect?
A. Hypoglycemia
B. Serotonin syndrome
C. Allergic reaction
D. Dehydration
Rationale: Insomnia and agitation are signs of serotonin syndrome, a potential adverse
effect of SSRIs like fluoxetine, requiring immediate medical evaluation, per
psychopharmacology.
9. A patient receiving vancomycin develops a rash and fever. What is the nurse’s priority?
A. Continue the infusion
B. Stop the infusion and notify the provider
C. Administer an antipyretic
D. Document the symptoms
Rationale: Rash and fever may indicate Red Man Syndrome or an allergic reaction to
vancomycin. Stopping the infusion prevents further harm, per antibiotic adverse effect
protocols.
10. A patient on levothyroxine reports palpitations and weight loss. What should the nurse
do?
A. Increase the dose
B. Report symptoms to the provider
C. Encourage a low-calorie diet
D. Monitor blood pressure only
