LPN HESI Pharmacology 2026 | Real Exam
Questions with Verified Answers & Detailed
Explanations – A+ Graded
1. A nurse is preparing to administer morphine sulfate to a patient in pain. Which
assessment finding should cause the nurse to withhold the medication?
A. Blood pressure of 130/85 mmHg B. Heart rate of 88 beats/min C. Pain rating of 7/10 D.
Temperature of 99.1°F E. Respiratory rate of 10 breaths/min
CORRECT ANSWER: E – Respiratory rate of 10 breaths/min RATIONALE:
Morphine is an opioid analgesic that causes CNS and respiratory depression. A respiratory rate
below 12 breaths/min is a contraindication to opioid administration. The nurse should withhold
the drug and notify the provider immediately.
2. A patient is prescribed metformin for type 2 diabetes. Which condition is a
contraindication for this medication?
A. Hypertension B. Obesity C. Renal impairment D. Hyperlipidemia E. Osteoporosis
CORRECT ANSWER: C – Renal impairment RATIONALE: Metformin is
contraindicated in renal impairment because it can accumulate and cause lactic acidosis, a rare
but life-threatening complication. Kidney function should be assessed before initiating therapy.
3. A nurse is teaching a patient about taking oral iron supplements. Which instruction is
most important?
A. Take the medication with milk to reduce GI upset B. Expect stools to be light-colored C.
Take the medication on an empty stomach or with vitamin C D. Avoid physical activity after
taking the medication E. Take the medication at bedtime only
CORRECT ANSWER: C – Take the medication on an empty stomach or with
vitamin C RATIONALE: Iron is best absorbed on an empty stomach. Vitamin C (ascorbic
acid) enhances iron absorption by converting ferric iron to ferrous iron. Milk and antacids inhibit
absorption.
4. Which medication requires the nurse to monitor potassium levels closely due to its risk of
hypokalemia?
,A. Lisinopril B. Spironolactone C. Furosemide D. Atenolol E. Metoprolol
CORRECT ANSWER: C – Furosemide RATIONALE: Furosemide is a loop
diuretic that causes potassium wasting through increased renal excretion. Hypokalemia is a
major adverse effect and can lead to cardiac arrhythmias. Potassium levels must be monitored
regularly.
5. A patient is taking warfarin. Which food should the nurse instruct the patient to
consume consistently and not suddenly increase?
A. Citrus fruits B. Dairy products C. Green leafy vegetables D. Red meats E. Refined
carbohydrates
CORRECT ANSWER: C – Green leafy vegetables RATIONALE: Green leafy
vegetables contain vitamin K, which antagonizes the effects of warfarin. Sudden large increases
in vitamin K intake can reduce warfarin's anticoagulant effect. Patients should maintain
consistent, moderate intake rather than eliminating these foods entirely.
6. A nurse administers naloxone to a patient. Which condition is this medication used to
treat?
A. Benzodiazepine overdose B. Alcohol withdrawal C. Opioid overdose D. Cocaine toxicity
E. Antihistamine overdose
CORRECT ANSWER: C – Opioid overdose RATIONALE: Naloxone (Narcan) is
a pure opioid antagonist that reverses opioid-induced respiratory depression, sedation, and
hypotension by competing for opioid receptor sites. It is the antidote for opioid overdose.
7. A nurse is preparing to administer digoxin. Which assessment is priority before
administration?
A. Blood pressure B. Respiratory rate C. Apical pulse for a full minute D. Temperature E.
Oxygen saturation
CORRECT ANSWER: C – Apical pulse for a full minute RATIONALE:
Digoxin is a cardiac glycoside that slows heart rate. The nurse must assess the apical pulse for a
full minute before administering. If the pulse is below 60 beats/min (adult), the medication
should be withheld and the provider notified.
,8. Which antidote should be readily available when a patient is receiving heparin therapy?
A. Vitamin K B. Naloxone C. Protamine sulfate D. Flumazenil E. Atropine
CORRECT ANSWER: C – Protamine sulfate RATIONALE: Protamine sulfate is
the antidote for heparin overdose. It is a positively charged protein that binds to the negatively
charged heparin, neutralizing its anticoagulant effect rapidly.
9. A patient is prescribed nitroglycerin sublingual tablets for angina. Which instruction
should the nurse include?
A. Swallow the tablet with water B. Take up to 10 tablets per episode C. If chest pain is not
relieved after 3 doses in 15 minutes, call 911 D. Store tablets in a clear plastic container E.
Avoid sitting down after taking the medication
CORRECT ANSWER: C – If chest pain is not relieved after 3 doses in 15 minutes,
call 911 RATIONALE: The standard protocol is one nitroglycerin tablet every 5 minutes for
a maximum of 3 doses. If pain persists, the patient may be experiencing a myocardial infarction
and must seek emergency care immediately.
10. A nurse is caring for a patient receiving IV vancomycin. Which adverse effect is
associated with too-rapid infusion?
A. Hypertension B. Bradycardia C. Red man syndrome D. Hypoglycemia E. Respiratory
alkalosis
CORRECT ANSWER: C – Red man syndrome RATIONALE: Red man
syndrome is a non-allergic infusion reaction characterized by flushing, erythema, and pruritus of
the face, neck, and upper torso caused by histamine release when vancomycin is infused too
rapidly. Infusion should occur over at least 60 minutes.
11. A patient taking lithium reports tremors, nausea, and blurred vision. The nurse
recognizes these as signs of:
A. Therapeutic drug levels B. Lithium toxicity C. Allergic reaction D. Hypothyroidism E.
Serotonin syndrome
, CORRECT ANSWER: B – Lithium toxicity RATIONALE: Early signs of lithium
toxicity include fine tremors, nausea, vomiting, diarrhea, and blurred vision. Lithium has a
narrow therapeutic index (0.6–1.2 mEq/L), and toxicity can progress to seizures and cardiac
arrhythmias if not treated.
12. Which class of medications is used as the first-line treatment for hypertension in
patients with heart failure?
A. Calcium channel blockers B. Beta blockers C. ACE inhibitors D. Thiazide diuretics E.
Alpha blockers
CORRECT ANSWER: C – ACE inhibitors RATIONALE: ACE inhibitors (e.g.,
lisinopril, enalapril) are first-line for hypertension with heart failure because they reduce
afterload, preload, and cardiac remodeling. They block angiotensin-converting enzyme, reducing
aldosterone secretion and fluid retention.
13. A patient is prescribed albuterol inhaler. The nurse understands this medication is
classified as a:
A. Anticholinergic B. Corticosteroid C. Short-acting beta-2 agonist D. Leukotriene
receptor antagonist E. Long-acting bronchodilator
CORRECT ANSWER: C – Short-acting beta-2 agonist RATIONALE: Albuterol
is a short-acting beta-2 agonist (SABA) used as a rescue inhaler for acute bronchospasm in
asthma and COPD. It stimulates beta-2 receptors in the bronchi, causing bronchodilation within
minutes.
14. A nurse is educating a patient about taking alendronate (Fosamax) for osteoporosis.
Which instruction is essential?
A. Take at bedtime with a glass of milk B. Lie down for 30 minutes after taking C. Take on
an empty stomach with 8 oz of water and remain upright for 30 minutes D. Take with food
to reduce GI upset E. Crush and mix with juice if unable to swallow
CORRECT ANSWER: C – Take on an empty stomach with 8 oz of water and
remain upright for 30 minutes RATIONALE: Alendronate must be taken on an empty
stomach with a full glass of water to enhance absorption. The patient must remain upright for at
least 30 minutes to prevent esophageal irritation and ulceration, a serious adverse effect.
Questions with Verified Answers & Detailed
Explanations – A+ Graded
1. A nurse is preparing to administer morphine sulfate to a patient in pain. Which
assessment finding should cause the nurse to withhold the medication?
A. Blood pressure of 130/85 mmHg B. Heart rate of 88 beats/min C. Pain rating of 7/10 D.
Temperature of 99.1°F E. Respiratory rate of 10 breaths/min
CORRECT ANSWER: E – Respiratory rate of 10 breaths/min RATIONALE:
Morphine is an opioid analgesic that causes CNS and respiratory depression. A respiratory rate
below 12 breaths/min is a contraindication to opioid administration. The nurse should withhold
the drug and notify the provider immediately.
2. A patient is prescribed metformin for type 2 diabetes. Which condition is a
contraindication for this medication?
A. Hypertension B. Obesity C. Renal impairment D. Hyperlipidemia E. Osteoporosis
CORRECT ANSWER: C – Renal impairment RATIONALE: Metformin is
contraindicated in renal impairment because it can accumulate and cause lactic acidosis, a rare
but life-threatening complication. Kidney function should be assessed before initiating therapy.
3. A nurse is teaching a patient about taking oral iron supplements. Which instruction is
most important?
A. Take the medication with milk to reduce GI upset B. Expect stools to be light-colored C.
Take the medication on an empty stomach or with vitamin C D. Avoid physical activity after
taking the medication E. Take the medication at bedtime only
CORRECT ANSWER: C – Take the medication on an empty stomach or with
vitamin C RATIONALE: Iron is best absorbed on an empty stomach. Vitamin C (ascorbic
acid) enhances iron absorption by converting ferric iron to ferrous iron. Milk and antacids inhibit
absorption.
4. Which medication requires the nurse to monitor potassium levels closely due to its risk of
hypokalemia?
,A. Lisinopril B. Spironolactone C. Furosemide D. Atenolol E. Metoprolol
CORRECT ANSWER: C – Furosemide RATIONALE: Furosemide is a loop
diuretic that causes potassium wasting through increased renal excretion. Hypokalemia is a
major adverse effect and can lead to cardiac arrhythmias. Potassium levels must be monitored
regularly.
5. A patient is taking warfarin. Which food should the nurse instruct the patient to
consume consistently and not suddenly increase?
A. Citrus fruits B. Dairy products C. Green leafy vegetables D. Red meats E. Refined
carbohydrates
CORRECT ANSWER: C – Green leafy vegetables RATIONALE: Green leafy
vegetables contain vitamin K, which antagonizes the effects of warfarin. Sudden large increases
in vitamin K intake can reduce warfarin's anticoagulant effect. Patients should maintain
consistent, moderate intake rather than eliminating these foods entirely.
6. A nurse administers naloxone to a patient. Which condition is this medication used to
treat?
A. Benzodiazepine overdose B. Alcohol withdrawal C. Opioid overdose D. Cocaine toxicity
E. Antihistamine overdose
CORRECT ANSWER: C – Opioid overdose RATIONALE: Naloxone (Narcan) is
a pure opioid antagonist that reverses opioid-induced respiratory depression, sedation, and
hypotension by competing for opioid receptor sites. It is the antidote for opioid overdose.
7. A nurse is preparing to administer digoxin. Which assessment is priority before
administration?
A. Blood pressure B. Respiratory rate C. Apical pulse for a full minute D. Temperature E.
Oxygen saturation
CORRECT ANSWER: C – Apical pulse for a full minute RATIONALE:
Digoxin is a cardiac glycoside that slows heart rate. The nurse must assess the apical pulse for a
full minute before administering. If the pulse is below 60 beats/min (adult), the medication
should be withheld and the provider notified.
,8. Which antidote should be readily available when a patient is receiving heparin therapy?
A. Vitamin K B. Naloxone C. Protamine sulfate D. Flumazenil E. Atropine
CORRECT ANSWER: C – Protamine sulfate RATIONALE: Protamine sulfate is
the antidote for heparin overdose. It is a positively charged protein that binds to the negatively
charged heparin, neutralizing its anticoagulant effect rapidly.
9. A patient is prescribed nitroglycerin sublingual tablets for angina. Which instruction
should the nurse include?
A. Swallow the tablet with water B. Take up to 10 tablets per episode C. If chest pain is not
relieved after 3 doses in 15 minutes, call 911 D. Store tablets in a clear plastic container E.
Avoid sitting down after taking the medication
CORRECT ANSWER: C – If chest pain is not relieved after 3 doses in 15 minutes,
call 911 RATIONALE: The standard protocol is one nitroglycerin tablet every 5 minutes for
a maximum of 3 doses. If pain persists, the patient may be experiencing a myocardial infarction
and must seek emergency care immediately.
10. A nurse is caring for a patient receiving IV vancomycin. Which adverse effect is
associated with too-rapid infusion?
A. Hypertension B. Bradycardia C. Red man syndrome D. Hypoglycemia E. Respiratory
alkalosis
CORRECT ANSWER: C – Red man syndrome RATIONALE: Red man
syndrome is a non-allergic infusion reaction characterized by flushing, erythema, and pruritus of
the face, neck, and upper torso caused by histamine release when vancomycin is infused too
rapidly. Infusion should occur over at least 60 minutes.
11. A patient taking lithium reports tremors, nausea, and blurred vision. The nurse
recognizes these as signs of:
A. Therapeutic drug levels B. Lithium toxicity C. Allergic reaction D. Hypothyroidism E.
Serotonin syndrome
, CORRECT ANSWER: B – Lithium toxicity RATIONALE: Early signs of lithium
toxicity include fine tremors, nausea, vomiting, diarrhea, and blurred vision. Lithium has a
narrow therapeutic index (0.6–1.2 mEq/L), and toxicity can progress to seizures and cardiac
arrhythmias if not treated.
12. Which class of medications is used as the first-line treatment for hypertension in
patients with heart failure?
A. Calcium channel blockers B. Beta blockers C. ACE inhibitors D. Thiazide diuretics E.
Alpha blockers
CORRECT ANSWER: C – ACE inhibitors RATIONALE: ACE inhibitors (e.g.,
lisinopril, enalapril) are first-line for hypertension with heart failure because they reduce
afterload, preload, and cardiac remodeling. They block angiotensin-converting enzyme, reducing
aldosterone secretion and fluid retention.
13. A patient is prescribed albuterol inhaler. The nurse understands this medication is
classified as a:
A. Anticholinergic B. Corticosteroid C. Short-acting beta-2 agonist D. Leukotriene
receptor antagonist E. Long-acting bronchodilator
CORRECT ANSWER: C – Short-acting beta-2 agonist RATIONALE: Albuterol
is a short-acting beta-2 agonist (SABA) used as a rescue inhaler for acute bronchospasm in
asthma and COPD. It stimulates beta-2 receptors in the bronchi, causing bronchodilation within
minutes.
14. A nurse is educating a patient about taking alendronate (Fosamax) for osteoporosis.
Which instruction is essential?
A. Take at bedtime with a glass of milk B. Lie down for 30 minutes after taking C. Take on
an empty stomach with 8 oz of water and remain upright for 30 minutes D. Take with food
to reduce GI upset E. Crush and mix with juice if unable to swallow
CORRECT ANSWER: C – Take on an empty stomach with 8 oz of water and
remain upright for 30 minutes RATIONALE: Alendronate must be taken on an empty
stomach with a full glass of water to enhance absorption. The patient must remain upright for at
least 30 minutes to prevent esophageal irritation and ulceration, a serious adverse effect.
