HESI RN Pharmacology V1 Exam |
2025/2026 Verified Drug Questions +
Full Rationales
Major Drug Classes (Questions 1-20)
Question 1
A client with hypertension is prescribed lisinopril 10 mg PO daily. What is the primary
mechanism of action for this drug class?
A. Beta-adrenergic blockade
B. Angiotensin-converting enzyme (ACE) inhibition
C. Calcium channel blockade
D. Direct vasodilation
B. Angiotensin-converting enzyme (ACE) inhibition
Rationale: Lisinopril, an ACE inhibitor, prevents conversion of angiotensin I to II, reducing
vasoconstriction and aldosterone release, lowering blood pressure. Nursing considerations:
Monitor for dry cough (bradykinin accumulation) and hyperkalemia; contraindicated in
pregnancy (fetal renal damage). Per AHA 2025 guidelines, first-line for HTN with CKD.
Question 2
A nurse administers metoprolol 25 mg PO to a client post-MI. What class of medication is this,
and what is a key monitoring parameter?
A. ACE inhibitor; renal function
B. Beta-blocker; heart rate
C. Diuretic; electrolytes
D. Statin; liver enzymes
B. Beta-blocker; heart rate
,Rationale: Metoprolol, a selective beta-1 blocker, reduces myocardial oxygen demand and
arrhythmias post-MI. Monitor HR >60 bpm to avoid bradycardia; contraindicated in asthma (if
non-selective). AHA 2026: Reduces mortality 23% in MI patients.
Question 3
A client with type 2 diabetes starts metformin 500 mg PO BID. What is the therapeutic class and
primary side effect?
A. Sulfonylurea; hypoglycemia
B. Biguanide; gastrointestinal upset
C. Thiazolidinedione; weight gain
D. DPP-4 inhibitor; pancreatitis
B. Biguanide; gastrointestinal upset
Rationale: Metformin decreases hepatic gluconeogenesis and improves insulin sensitivity.
Common side effects: Nausea/diarrhea (take with food); contraindicated in eGFR <30 (lactic
acidosis risk). ADA 2025: First-line, reduces A1c 1-2%.
Question 4
A nurse prepares furosemide 40 mg IV for edema. What class is this, and what lab should be
monitored?
A. Loop diuretic; potassium
B. Thiazide; sodium
C. Osmotic; BUN
D. Potassium-sparing; calcium
A. Loop diuretic; potassium
Rationale: Furosemide inhibits Na/K/2Cl cotransporter in loop of Henle, promoting diuresis.
Hypokalemia risk; supplement K+ if <3.5 mEq/L. JNC 2026: For acute HF, monitor I&O.
Question 5
A client with anxiety receives lorazepam 0.5 mg PO. What benzodiazepine effect and
contraindication?
A. Sedation; glaucoma
B. Anticonvulsant; pregnancy
C. Muscle relaxant; renal failure
D. All of the above
, D. All of the above
Rationale: Lorazepam enhances GABA, causing sedation/anticonvulsant effects;
contraindicated in acute narrow-angle glaucoma (mydriasis), pregnancy (fetal harm). Short-term
use; monitor for dependence per APA 2025.
Question 6
A post-op client gets morphine 2 mg IV. What opioid class and antagonist?
A. Mu-agonist; naloxone
B. Kappa; flumazenil
C. Delta; atropine
D. NMDA; ketamine
A. Mu-agonist; naloxone
Rationale: Morphine binds mu-receptors for analgesia; respiratory depression reversed by
naloxone. Titrate slowly, monitor RR >12. ASRA 2026: PCA preferred for control.
Question 7
A client with hyperlipidemia takes atorvastatin 40 mg PO HS. What statin mechanism?
A. HMG-CoA reductase inhibition
B. Bile acid sequestration
C. Cholesterol absorption block
D. PPAR activation
A. HMG-CoA reductase inhibition
Rationale: Atorvastatin lowers LDL 50% by reducing hepatic synthesis. Monitor LFTs, myalgias
(rhabdo risk). ACC 2025: High-intensity for ASCVD.
Question 8
A nurse administers albuterol 2 puffs via MDI for asthma. What beta-2 agonist effect?
A. Bronchodilation
B. Vasoconstriction
C. Increased mucus
D. Sedation
A. Bronchodilation
2025/2026 Verified Drug Questions +
Full Rationales
Major Drug Classes (Questions 1-20)
Question 1
A client with hypertension is prescribed lisinopril 10 mg PO daily. What is the primary
mechanism of action for this drug class?
A. Beta-adrenergic blockade
B. Angiotensin-converting enzyme (ACE) inhibition
C. Calcium channel blockade
D. Direct vasodilation
B. Angiotensin-converting enzyme (ACE) inhibition
Rationale: Lisinopril, an ACE inhibitor, prevents conversion of angiotensin I to II, reducing
vasoconstriction and aldosterone release, lowering blood pressure. Nursing considerations:
Monitor for dry cough (bradykinin accumulation) and hyperkalemia; contraindicated in
pregnancy (fetal renal damage). Per AHA 2025 guidelines, first-line for HTN with CKD.
Question 2
A nurse administers metoprolol 25 mg PO to a client post-MI. What class of medication is this,
and what is a key monitoring parameter?
A. ACE inhibitor; renal function
B. Beta-blocker; heart rate
C. Diuretic; electrolytes
D. Statin; liver enzymes
B. Beta-blocker; heart rate
,Rationale: Metoprolol, a selective beta-1 blocker, reduces myocardial oxygen demand and
arrhythmias post-MI. Monitor HR >60 bpm to avoid bradycardia; contraindicated in asthma (if
non-selective). AHA 2026: Reduces mortality 23% in MI patients.
Question 3
A client with type 2 diabetes starts metformin 500 mg PO BID. What is the therapeutic class and
primary side effect?
A. Sulfonylurea; hypoglycemia
B. Biguanide; gastrointestinal upset
C. Thiazolidinedione; weight gain
D. DPP-4 inhibitor; pancreatitis
B. Biguanide; gastrointestinal upset
Rationale: Metformin decreases hepatic gluconeogenesis and improves insulin sensitivity.
Common side effects: Nausea/diarrhea (take with food); contraindicated in eGFR <30 (lactic
acidosis risk). ADA 2025: First-line, reduces A1c 1-2%.
Question 4
A nurse prepares furosemide 40 mg IV for edema. What class is this, and what lab should be
monitored?
A. Loop diuretic; potassium
B. Thiazide; sodium
C. Osmotic; BUN
D. Potassium-sparing; calcium
A. Loop diuretic; potassium
Rationale: Furosemide inhibits Na/K/2Cl cotransporter in loop of Henle, promoting diuresis.
Hypokalemia risk; supplement K+ if <3.5 mEq/L. JNC 2026: For acute HF, monitor I&O.
Question 5
A client with anxiety receives lorazepam 0.5 mg PO. What benzodiazepine effect and
contraindication?
A. Sedation; glaucoma
B. Anticonvulsant; pregnancy
C. Muscle relaxant; renal failure
D. All of the above
, D. All of the above
Rationale: Lorazepam enhances GABA, causing sedation/anticonvulsant effects;
contraindicated in acute narrow-angle glaucoma (mydriasis), pregnancy (fetal harm). Short-term
use; monitor for dependence per APA 2025.
Question 6
A post-op client gets morphine 2 mg IV. What opioid class and antagonist?
A. Mu-agonist; naloxone
B. Kappa; flumazenil
C. Delta; atropine
D. NMDA; ketamine
A. Mu-agonist; naloxone
Rationale: Morphine binds mu-receptors for analgesia; respiratory depression reversed by
naloxone. Titrate slowly, monitor RR >12. ASRA 2026: PCA preferred for control.
Question 7
A client with hyperlipidemia takes atorvastatin 40 mg PO HS. What statin mechanism?
A. HMG-CoA reductase inhibition
B. Bile acid sequestration
C. Cholesterol absorption block
D. PPAR activation
A. HMG-CoA reductase inhibition
Rationale: Atorvastatin lowers LDL 50% by reducing hepatic synthesis. Monitor LFTs, myalgias
(rhabdo risk). ACC 2025: High-intensity for ASCVD.
Question 8
A nurse administers albuterol 2 puffs via MDI for asthma. What beta-2 agonist effect?
A. Bronchodilation
B. Vasoconstriction
C. Increased mucus
D. Sedation
A. Bronchodilation
