HESI RN Pharmacology Version 5 – Practice Exam (70 Questions – Latest
Update 2024)
Cardiovascular Medications (1-15)
A client with heart failure is receiving digoxin. Which assessment finding should the
nurse identify as an early sign of digoxin toxicity?
A. Bradycardia
B. Visual disturbances such as yellow halos
C. Anorexia, nausea, and vomiting
D. Atrial fibrillation
C
1. Early signs of digoxin toxicity are typically gastrointestinal, including anorexia,
nausea, and vomiting. While visual disturbances (yellow/green halos),
bradycardia, and arrhythmias like atrial fibrillation are also signs of toxicity,
they generally occur later in the toxicity progression. Recognizing GI
symptoms allows for early intervention before severe cardiac toxicity
develops.
A nurse is reviewing the laboratory results for a client taking digoxin. Which result
indicates a risk for digoxin toxicity?
A. Potassium 5.4 mEq/L
B. Potassium 3.0 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.1 mg/dL
B
2. Hypokalemia (potassium 3.0 mEq/L) increases the risk of digoxin toxicity
because potassium competes with digoxin for binding sites at the
myocardium. When potassium levels are low, more digoxin binds to the
myocardium, increasing its effects and toxicity. Hyperkalemia, normal calcium,
and normal magnesium do not potentiate digoxin toxicity in this manner.
A client is receiving intravenous heparin therapy for a deep vein thrombosis. Which
laboratory value should the nurse monitor to evaluate the therapeutic effect of this
medication?
A. International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Prothrombin time (PT)
D. Platelet count
B
3. Heparin therapy is monitored using the activated partial thromboplastin time
(aPTT). The therapeutic range for aPTT is typically 1.5 to 2.5 times the control
, value. INR and PT are used to monitor warfarin therapy. While platelet counts
are monitored to assess for heparin-induced thrombocytopenia (HIT), they do
not evaluate the therapeutic anticoagulant effect of the drug.
A client on heparin therapy develops a significantly low platelet count and a new
deep vein thrombosis. The nurse anticipates the administration of which medication
as the antidote?
A. Protamine sulfate
B. Vitamin K
C. Argatroban
D. Naloxone
C
4. The client is displaying signs of heparin-induced thrombocytopenia (HIT), a
paradoxical reaction where heparin causes a drop in platelets and new
thromboses. Heparin must be stopped immediately, and a direct thrombin
inhibitor like argatroban is initiated. Protamine sulfate is the antidote for
heparin bleeding, not HIT. Vitamin K is the antidote for warfarin. Naloxone is
for opioid reversal.
A nurse is providing discharge teaching to a client who is starting warfarin therapy.
Which statement by the client indicates a need for further teaching?
A. "I will eat a consistent amount of green leafy vegetables."
B. "I will wear a medical alert bracelet."
C. "I will take a daily aspirin to prevent a heart attack."
D. "I will have my blood drawn regularly to check my INR."
C
5. Taking aspirin concurrently with warfarin significantly increases the risk of
bleeding without a specific prescription to do so, as both drugs impair clotting.
The client should be taught to avoid over-the-counter NSAIDs and aspirin
unless directed by a provider. Eating consistent amounts of vitamin K foods
prevents fluctuations in INR, a medical bracelet is necessary for safety, and
regular INR monitoring is required.
A client has an INR of 8.2 and is experiencing active bleeding. Which medication
should the nurse prepare to administer?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Fresh frozen plasma only
D. Iron dextran
B
6. Vitamin K (phytonadione) is the specific antidote for warfarin overdose. Given
the severely elevated INR (normal is 2-3 for most indications) and active
, bleeding, Vitamin K should be administered to restore the synthesis of vitamin
K-dependent clotting factors (II, VII, IX, X). Protamine sulfate reverses
heparin. Fresh frozen plasma may also be given for immediate hemostasis,
but Vitamin K is the direct pharmacological antidote.
A nurse is administering subcutaneous enoxaparin to a client. Which technique is
correct for this administration?
A. Massage the site after injection to enhance absorption.
B. Aspirate before injecting the medication to ensure it is not in a blood vessel.
C. Inject the medication into the lateral abdominal wall, 2 inches from the umbilicus.
D. Administer the injection into the deltoid muscle.
C
7. Enoxaparin is administered subcutaneously into the lateral abdominal wall, at
least 2 inches away from the umbilicus, to prevent bruising and tissue
irritation. Aspiration is not recommended for low molecular weight heparins,
as it can cause hematoma formation. Massaging the site should be avoided
as it can lead to bruising. It is never administered intramuscularly.
A client is taking lisinopril. Which adverse effect should the nurse instruct the client to
report immediately?
A. Dry, persistent cough
B. Mild dizziness upon standing
C. Swelling of the lips and tongue
D. Decreased appetite
C
8. Swelling of the lips and tongue is a sign of angioedema, a life-threatening
adverse effect of ACE inhibitors like lisinopril that requires immediate
emergency intervention due to potential airway compromise. A dry cough is a
common, non-life-threatening side effect. Mild dizziness may indicate
orthostatic hypotension but is not an immediate emergency like angioedema.
Decreased appetite is not directly associated with ACE inhibitors.
A nurse is assessing a client who is taking furosemide. Which laboratory value
requires immediate intervention by the nurse?
A. Potassium 3.0 mEq/L
B. Sodium 138 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 1.8 mg/dL
A
9. Furosemide is a loop diuretic that causes potassium wasting (hypokalemia). A
potassium level of 3.0 mEq/L is critically low and places the client at high risk
for lethal cardiac dysrhythmias. The nurse must notify the provider
HESI RN Pharmacology Version 5 – Practice Exam (70 Questions – Latest
Update 2024)
Cardiovascular Medications (1-15)
A client with heart failure is receiving digoxin. Which assessment finding should the
nurse identify as an early sign of digoxin toxicity?
A. Bradycardia
B. Visual disturbances such as yellow halos
C. Anorexia, nausea, and vomiting
D. Atrial fibrillation
C
1. Early signs of digoxin toxicity are typically gastrointestinal, including anorexia,
nausea, and vomiting. While visual disturbances (yellow/green halos),
bradycardia, and arrhythmias like atrial fibrillation are also signs of toxicity,
they generally occur later in the toxicity progression. Recognizing GI
symptoms allows for early intervention before severe cardiac toxicity
develops.
A nurse is reviewing the laboratory results for a client taking digoxin. Which result
indicates a risk for digoxin toxicity?
A. Potassium 5.4 mEq/L
B. Potassium 3.0 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.1 mg/dL
B
2. Hypokalemia (potassium 3.0 mEq/L) increases the risk of digoxin toxicity
because potassium competes with digoxin for binding sites at the
myocardium. When potassium levels are low, more digoxin binds to the
myocardium, increasing its effects and toxicity. Hyperkalemia, normal calcium,
and normal magnesium do not potentiate digoxin toxicity in this manner.
A client is receiving intravenous heparin therapy for a deep vein thrombosis. Which
laboratory value should the nurse monitor to evaluate the therapeutic effect of this
medication?
A. International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Prothrombin time (PT)
D. Platelet count
B
3. Heparin therapy is monitored using the activated partial thromboplastin time
(aPTT). The therapeutic range for aPTT is typically 1.5 to 2.5 times the control
, value. INR and PT are used to monitor warfarin therapy. While platelet counts
are monitored to assess for heparin-induced thrombocytopenia (HIT), they do
not evaluate the therapeutic anticoagulant effect of the drug.
A client on heparin therapy develops a significantly low platelet count and a new
deep vein thrombosis. The nurse anticipates the administration of which medication
as the antidote?
A. Protamine sulfate
B. Vitamin K
C. Argatroban
D. Naloxone
C
4. The client is displaying signs of heparin-induced thrombocytopenia (HIT), a
paradoxical reaction where heparin causes a drop in platelets and new
thromboses. Heparin must be stopped immediately, and a direct thrombin
inhibitor like argatroban is initiated. Protamine sulfate is the antidote for
heparin bleeding, not HIT. Vitamin K is the antidote for warfarin. Naloxone is
for opioid reversal.
A nurse is providing discharge teaching to a client who is starting warfarin therapy.
Which statement by the client indicates a need for further teaching?
A. "I will eat a consistent amount of green leafy vegetables."
B. "I will wear a medical alert bracelet."
C. "I will take a daily aspirin to prevent a heart attack."
D. "I will have my blood drawn regularly to check my INR."
C
5. Taking aspirin concurrently with warfarin significantly increases the risk of
bleeding without a specific prescription to do so, as both drugs impair clotting.
The client should be taught to avoid over-the-counter NSAIDs and aspirin
unless directed by a provider. Eating consistent amounts of vitamin K foods
prevents fluctuations in INR, a medical bracelet is necessary for safety, and
regular INR monitoring is required.
A client has an INR of 8.2 and is experiencing active bleeding. Which medication
should the nurse prepare to administer?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Fresh frozen plasma only
D. Iron dextran
B
6. Vitamin K (phytonadione) is the specific antidote for warfarin overdose. Given
the severely elevated INR (normal is 2-3 for most indications) and active
, bleeding, Vitamin K should be administered to restore the synthesis of vitamin
K-dependent clotting factors (II, VII, IX, X). Protamine sulfate reverses
heparin. Fresh frozen plasma may also be given for immediate hemostasis,
but Vitamin K is the direct pharmacological antidote.
A nurse is administering subcutaneous enoxaparin to a client. Which technique is
correct for this administration?
A. Massage the site after injection to enhance absorption.
B. Aspirate before injecting the medication to ensure it is not in a blood vessel.
C. Inject the medication into the lateral abdominal wall, 2 inches from the umbilicus.
D. Administer the injection into the deltoid muscle.
C
7. Enoxaparin is administered subcutaneously into the lateral abdominal wall, at
least 2 inches away from the umbilicus, to prevent bruising and tissue
irritation. Aspiration is not recommended for low molecular weight heparins,
as it can cause hematoma formation. Massaging the site should be avoided
as it can lead to bruising. It is never administered intramuscularly.
A client is taking lisinopril. Which adverse effect should the nurse instruct the client to
report immediately?
A. Dry, persistent cough
B. Mild dizziness upon standing
C. Swelling of the lips and tongue
D. Decreased appetite
C
8. Swelling of the lips and tongue is a sign of angioedema, a life-threatening
adverse effect of ACE inhibitors like lisinopril that requires immediate
emergency intervention due to potential airway compromise. A dry cough is a
common, non-life-threatening side effect. Mild dizziness may indicate
orthostatic hypotension but is not an immediate emergency like angioedema.
Decreased appetite is not directly associated with ACE inhibitors.
A nurse is assessing a client who is taking furosemide. Which laboratory value
requires immediate intervention by the nurse?
A. Potassium 3.0 mEq/L
B. Sodium 138 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 1.8 mg/dL
A
9. Furosemide is a loop diuretic that causes potassium wasting (hypokalemia). A
potassium level of 3.0 mEq/L is critically low and places the client at high risk
for lethal cardiac dysrhythmias. The nurse must notify the provider
