HESI RN Pharmacology Exit Exam
2025 – Practice Questions with
Answers and Rationales
1. A client with hypertension is prescribed lisinopril (Prinivil). Which assessment is most
important for the nurse to monitor?
A. Blood glucose levels
B. Blood pressure
C. Serum calcium levels
D. Respiratory rate
Correct Answer: B. Blood pressure
Rationale: Lisinopril is an ACE inhibitor used to manage hypertension by reducing
blood pressure through vasodilation and decreased angiotensin II production. Monitoring
blood pressure is critical to evaluate the drug’s effectiveness and detect hypotension.
Blood glucose, serum calcium, and respiratory rate are not directly affected by lisinopril.
2. A client is receiving heparin therapy for a pulmonary embolism. Which laboratory value
should the nurse monitor closely?
A. International Normalized Ratio (INR)
B. Activated Partial Thromboplastin Time (aPTT)
C. Platelet count
D. Prothrombin Time (PT)
Correct Answer: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin is an anticoagulant that prolongs clotting time, primarily monitored
by aPTT to ensure therapeutic levels (typically 1.5–2.5 times the baseline). INR and PT
are used for warfarin therapy, while platelet count monitoring is secondary to assess for
heparin-induced thrombocytopenia.
3. A client with type 2 diabetes is prescribed metformin (Glucophage). The nurse should
instruct the client to report which adverse effect?
A. Weight gain
B. Muscle pain and weakness
C. Hypoglycemia
D. Increased thirst
Correct Answer: B. Muscle pain and weakness
Rationale: Metformin can rarely cause lactic acidosis, a serious adverse effect
characterized by muscle pain, weakness, and fatigue. Hypoglycemia is uncommon with
metformin alone, and weight gain or increased thirst are not typical side effects.
4. The nurse administers digoxin (Lanoxin) 0.25 mg to a client with heart failure. Which
finding indicates a therapeutic response?
A. Heart rate decreases from 110 to 70 bpm
B. Blood pressure increases from 120/80 to 140/90 mmHg
, C. Respiratory rate increases from 16 to 24 breaths/min
D. Urine output decreases by 200 mL/day
Correct Answer: A. Heart rate decreases from 110 to 70 bpm
Rationale: Digoxin slows the heart rate and increases cardiac contractility in heart
failure, leading to a reduced heart rate as a therapeutic effect. Increased blood pressure,
increased respiratory rate, or decreased urine output are not expected outcomes.
5. A client is prescribed warfarin (Coumadin). Which food should the nurse advise the
client to limit?
A. Oranges
B. Spinach
C. Chicken
D. Rice
Correct Answer: B. Spinach
Rationale: Warfarin’s anticoagulant effect is antagonized by vitamin K, found in high
amounts in green leafy vegetables like spinach. Limiting these foods helps maintain
therapeutic INR levels. Oranges, chicken, and rice have minimal impact on warfarin’s
efficacy.
6. A client with a urinary tract infection is prescribed ciprofloxacin (Cipro). Which
instruction should the nurse provide?
A. Take with milk to enhance absorption
B. Avoid exposure to sunlight
C. Take with an antacid to reduce GI upset
D. Increase fluid intake to 1000 mL/day
Correct Answer: B. Avoid exposure to sunlight
Rationale: Ciprofloxacin can cause photosensitivity, increasing the risk of sunburn.
Clients should avoid sunlight exposure. Milk and antacids can reduce absorption, and
fluid intake should be higher than 1000 mL/day to promote diuresis.
7. A client receiving furosemide (Lasix) reports muscle cramps. Which laboratory value
should the nurse assess?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B. Serum potassium
Rationale: Furosemide, a loop diuretic, can cause hypokalemia, leading to muscle
cramps. Monitoring serum potassium is essential. Sodium, calcium, and magnesium
imbalances are less commonly associated with muscle cramps in this context.
8. The nurse is preparing to administer insulin lispro (Humalog) to a client. When is the
onset of action for this medication?
A. 15–30 minutes
B. 30–60 minutes
C. 1–2 hours
D. 4–6 hours
Correct Answer: A. 15–30 minutes
Rationale: Insulin lispro is a rapid-acting insulin with an onset of action within 15–30
, minutes, making it ideal for administration just before meals to control postprandial
glucose levels.
9. A client with asthma is prescribed albuterol (Proventil). Which side effect should the
nurse monitor for?
A. Bradycardia
B. Tremors
C. Constipation
D. Hypotension
Correct Answer: B. Tremors
Rationale: Albuterol, a beta-2 agonist, can cause tremors due to stimulation of beta-2
receptors in skeletal muscles. Bradycardia, constipation, and hypotension are not
common side effects.
10. A client is prescribed phenytoin (Dilantin) for seizures. Which laboratory value should
the nurse monitor?
A. Serum creatinine
B. Serum phenytoin levels
C. Blood urea nitrogen (BUN)
D. Serum glucose
Correct Answer: B. Serum phenytoin levels
Rationale: Phenytoin has a narrow therapeutic range (10–20 mcg/mL). Monitoring
serum levels is essential to ensure efficacy and avoid toxicity. Creatinine, BUN, and
glucose are not directly affected.
11. A client with rheumatoid arthritis is prescribed methotrexate. Which instruction should
the nurse include?
A. Avoid alcohol consumption
B. Take with food to enhance absorption
C. Expect increased bruising
D. Limit fluid intake
Correct Answer: A. Avoid alcohol consumption
Rationale: Methotrexate can cause hepatotoxicity, and alcohol increases this risk. It can
be taken with or without food, does not typically cause bruising, and fluid restriction is
not required.
12. A client with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium
(Atrovent). What is the primary action of this medication?
A. Reduces inflammation
B. Dilates bronchioles
C. Thins mucus secretions
D. Suppresses cough
Correct Answer: B. Dilates bronchioles
Rationale: Ipratropium is an anticholinergic bronchodilator that relaxes bronchial smooth
muscles, improving airflow in COPD. It does not reduce inflammation, thin mucus, or
suppress cough.
13. A client is receiving morphine sulfate for pain. Which assessment finding requires
immediate action?
A. Heart rate of 80 bpm
B. Respiratory rate of 10 breaths/min
2025 – Practice Questions with
Answers and Rationales
1. A client with hypertension is prescribed lisinopril (Prinivil). Which assessment is most
important for the nurse to monitor?
A. Blood glucose levels
B. Blood pressure
C. Serum calcium levels
D. Respiratory rate
Correct Answer: B. Blood pressure
Rationale: Lisinopril is an ACE inhibitor used to manage hypertension by reducing
blood pressure through vasodilation and decreased angiotensin II production. Monitoring
blood pressure is critical to evaluate the drug’s effectiveness and detect hypotension.
Blood glucose, serum calcium, and respiratory rate are not directly affected by lisinopril.
2. A client is receiving heparin therapy for a pulmonary embolism. Which laboratory value
should the nurse monitor closely?
A. International Normalized Ratio (INR)
B. Activated Partial Thromboplastin Time (aPTT)
C. Platelet count
D. Prothrombin Time (PT)
Correct Answer: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin is an anticoagulant that prolongs clotting time, primarily monitored
by aPTT to ensure therapeutic levels (typically 1.5–2.5 times the baseline). INR and PT
are used for warfarin therapy, while platelet count monitoring is secondary to assess for
heparin-induced thrombocytopenia.
3. A client with type 2 diabetes is prescribed metformin (Glucophage). The nurse should
instruct the client to report which adverse effect?
A. Weight gain
B. Muscle pain and weakness
C. Hypoglycemia
D. Increased thirst
Correct Answer: B. Muscle pain and weakness
Rationale: Metformin can rarely cause lactic acidosis, a serious adverse effect
characterized by muscle pain, weakness, and fatigue. Hypoglycemia is uncommon with
metformin alone, and weight gain or increased thirst are not typical side effects.
4. The nurse administers digoxin (Lanoxin) 0.25 mg to a client with heart failure. Which
finding indicates a therapeutic response?
A. Heart rate decreases from 110 to 70 bpm
B. Blood pressure increases from 120/80 to 140/90 mmHg
, C. Respiratory rate increases from 16 to 24 breaths/min
D. Urine output decreases by 200 mL/day
Correct Answer: A. Heart rate decreases from 110 to 70 bpm
Rationale: Digoxin slows the heart rate and increases cardiac contractility in heart
failure, leading to a reduced heart rate as a therapeutic effect. Increased blood pressure,
increased respiratory rate, or decreased urine output are not expected outcomes.
5. A client is prescribed warfarin (Coumadin). Which food should the nurse advise the
client to limit?
A. Oranges
B. Spinach
C. Chicken
D. Rice
Correct Answer: B. Spinach
Rationale: Warfarin’s anticoagulant effect is antagonized by vitamin K, found in high
amounts in green leafy vegetables like spinach. Limiting these foods helps maintain
therapeutic INR levels. Oranges, chicken, and rice have minimal impact on warfarin’s
efficacy.
6. A client with a urinary tract infection is prescribed ciprofloxacin (Cipro). Which
instruction should the nurse provide?
A. Take with milk to enhance absorption
B. Avoid exposure to sunlight
C. Take with an antacid to reduce GI upset
D. Increase fluid intake to 1000 mL/day
Correct Answer: B. Avoid exposure to sunlight
Rationale: Ciprofloxacin can cause photosensitivity, increasing the risk of sunburn.
Clients should avoid sunlight exposure. Milk and antacids can reduce absorption, and
fluid intake should be higher than 1000 mL/day to promote diuresis.
7. A client receiving furosemide (Lasix) reports muscle cramps. Which laboratory value
should the nurse assess?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B. Serum potassium
Rationale: Furosemide, a loop diuretic, can cause hypokalemia, leading to muscle
cramps. Monitoring serum potassium is essential. Sodium, calcium, and magnesium
imbalances are less commonly associated with muscle cramps in this context.
8. The nurse is preparing to administer insulin lispro (Humalog) to a client. When is the
onset of action for this medication?
A. 15–30 minutes
B. 30–60 minutes
C. 1–2 hours
D. 4–6 hours
Correct Answer: A. 15–30 minutes
Rationale: Insulin lispro is a rapid-acting insulin with an onset of action within 15–30
, minutes, making it ideal for administration just before meals to control postprandial
glucose levels.
9. A client with asthma is prescribed albuterol (Proventil). Which side effect should the
nurse monitor for?
A. Bradycardia
B. Tremors
C. Constipation
D. Hypotension
Correct Answer: B. Tremors
Rationale: Albuterol, a beta-2 agonist, can cause tremors due to stimulation of beta-2
receptors in skeletal muscles. Bradycardia, constipation, and hypotension are not
common side effects.
10. A client is prescribed phenytoin (Dilantin) for seizures. Which laboratory value should
the nurse monitor?
A. Serum creatinine
B. Serum phenytoin levels
C. Blood urea nitrogen (BUN)
D. Serum glucose
Correct Answer: B. Serum phenytoin levels
Rationale: Phenytoin has a narrow therapeutic range (10–20 mcg/mL). Monitoring
serum levels is essential to ensure efficacy and avoid toxicity. Creatinine, BUN, and
glucose are not directly affected.
11. A client with rheumatoid arthritis is prescribed methotrexate. Which instruction should
the nurse include?
A. Avoid alcohol consumption
B. Take with food to enhance absorption
C. Expect increased bruising
D. Limit fluid intake
Correct Answer: A. Avoid alcohol consumption
Rationale: Methotrexate can cause hepatotoxicity, and alcohol increases this risk. It can
be taken with or without food, does not typically cause bruising, and fluid restriction is
not required.
12. A client with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium
(Atrovent). What is the primary action of this medication?
A. Reduces inflammation
B. Dilates bronchioles
C. Thins mucus secretions
D. Suppresses cough
Correct Answer: B. Dilates bronchioles
Rationale: Ipratropium is an anticholinergic bronchodilator that relaxes bronchial smooth
muscles, improving airflow in COPD. It does not reduce inflammation, thin mucus, or
suppress cough.
13. A client is receiving morphine sulfate for pain. Which assessment finding requires
immediate action?
A. Heart rate of 80 bpm
B. Respiratory rate of 10 breaths/min
