1
RN HESI PHARMACOLOGY V3 ACTUAL EXAM 2026/2027 |
Actual Questions with Rationales | PDF Ready | Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular Medications (Q1-18)
Q1. A patient newly prescribed lisinopril for hypertension reports a persistent dry
cough. The nurse recognizes this as:
A. An indication of impending angioedema requiring immediate discontinuation
B. A common adverse effect of ACE inhibitors caused by bradykinin accumulation
C. A sign of medication allergy necessitating switch to an ARB only after anaphylaxis
D. Evidence of therapeutic failure indicating the dose should be doubled
B. A common adverse effect of ACE inhibitors caused by bradykinin accumulation
[CORRECT]
Rationale: ACE inhibitors block bradykinin breakdown, commonly causing a dry,
nonproductive cough that is not an allergy but may warrant switching to an ARB.
Angioedema involves airway swelling, not cough.
Correct Answer: B
Q2. A patient with heart failure is prescribed sacubitril/valsartan. Which instruction is
essential?
A. Continue the concurrent ACE inhibitor at half dose
B. Ensure a washout period of at least 36 hours between last ACE inhibitor dose and
starting this medication
C. Take with a high-potassium salt substitute to enhance efficacy
D. Monitor for hypokalemia as the primary adverse effect
B. Ensure a washout period of at least 36 hours between last ACE inhibitor dose and
starting this medication [CORRECT]
,2
Rationale: Concurrent use of sacubitril/valsartan with ACE inhibitors increases
angioedema risk; a 36-hour washout is required. Hyperkalemia, not hypokalemia, is a
risk.
Correct Answer: B
Q3. The nurse is administering metoprolol to a patient with atrial fibrillation. Which
vital sign finding requires the nurse to hold the dose and notify the provider?
A. Blood pressure 138/84 mmHg and heart rate 72 bpm
B. Blood pressure 118/76 mmHg and heart rate 88 bpm
C. Blood pressure 96/58 mmHg and heart rate 52 bpm
D. Blood pressure 152/90 mmHg and heart rate 104 bpm
C. Blood pressure 96/58 mmHg and heart rate 52 bpm [CORRECT]
Rationale: Beta-blockers are held for systolic BP <100 mmHg or heart rate <60 bpm
due to risk of excessive bradycardia and hypotension.
Correct Answer: C
Q4. A patient taking amlodipine for hypertension develops bilateral ankle edema.
The nurse understands this is:
A. A sign of worsening heart failure requiring diuretic addition
B. A common vasodilatory adverse effect of dihydropyridine calcium channel
blockers
C. An indication of medication nonadherence and electrolyte imbalance
D. Evidence of renal failure caused by calcium channel blockade
B. A common vasodilatory adverse effect of dihydropyridine calcium channel
blockers [CORRECT]
Rationale: Amlodipine causes peripheral vasodilation and capillary pressure changes
leading to dependent edema; it is not heart failure or renal failure.
,3
Correct Answer: B
Q5. A patient receiving digoxin reports nausea, vomiting, and seeing "yellow halos"
around lights. Which laboratory value is most likely contributing to this presentation?
A. Serum sodium 142 mEq/L
B. Serum potassium 2.8 mEq/L
C. Serum calcium 9.5 mg/dL
D. Blood glucose 110 mg/dL
B. Serum potassium 2.8 mEq/L [CORRECT]
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and predisposes
to toxicity manifesting as GI symptoms and visual disturbances; potassium must be
monitored closely.
Correct Answer: B
Q6. A patient taking furosemide 40 mg daily is newly prescribed digoxin. To reduce
the risk of digoxin toxicity, the nurse should:
A. Administer both medications together to enhance diuresis
B. Monitor serum potassium and maintain normal levels because hypokalemia
potentiates digoxin toxicity
C. Encourage the patient to restrict all potassium intake to prevent hyperkalemia
D. Advise the patient to take digoxin at bedtime and furosemide in the morning
B. Monitor serum potassium and maintain normal levels because hypokalemia
potentiates digoxin toxicity [CORRECT]
Rationale: Loop diuretics cause potassium wasting, and hypokalemia increases
digoxin toxicity risk; potassium levels must be monitored and maintained.
Correct Answer: B
, 4
Q7. A patient receiving IV gentamicin for sepsis is also prescribed furosemide for
fluid overload. The nurse monitors for:
A. Hyperkalemia and digitalis toxicity
B. Additive ototoxicity and nephrotoxicity
C. Excessive diuresis leading to hypernatremia
D. Synergistic antibacterial effects requiring dose reduction
B. Additive ototoxicity and nephrotoxicity [CORRECT]
Rationale: Both aminoglycosides and loop diuretics are ototoxic and nephrotoxic;
concurrent use increases the risk of irreversible hearing loss and acute kidney injury.
Correct Answer: B
Q8. A patient with heart failure is prescribed spironolactone. Which dietary
instruction is most important?
A. Increase dietary potassium by eating bananas and oranges daily
B. Avoid salt substitutes containing potassium and monitor serum potassium levels
C. Restrict fluid intake to 500 mL per day
D. Take the medication on an empty stomach to enhance absorption
B. Avoid salt substitutes containing potassium and monitor serum potassium levels
[CORRECT]
Rationale: Spironolactone is a potassium-sparing diuretic; potassium supplements
and salt substitutes can cause life-threatening hyperkalemia.
Correct Answer: B
Q9. A nurse is reviewing morning medications. Which medication requires an
independent double-check by two nurses before administration?
A. Lisinopril 10 mg PO
B. Digoxin 0.25 mg PO
RN HESI PHARMACOLOGY V3 ACTUAL EXAM 2026/2027 |
Actual Questions with Rationales | PDF Ready | Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular Medications (Q1-18)
Q1. A patient newly prescribed lisinopril for hypertension reports a persistent dry
cough. The nurse recognizes this as:
A. An indication of impending angioedema requiring immediate discontinuation
B. A common adverse effect of ACE inhibitors caused by bradykinin accumulation
C. A sign of medication allergy necessitating switch to an ARB only after anaphylaxis
D. Evidence of therapeutic failure indicating the dose should be doubled
B. A common adverse effect of ACE inhibitors caused by bradykinin accumulation
[CORRECT]
Rationale: ACE inhibitors block bradykinin breakdown, commonly causing a dry,
nonproductive cough that is not an allergy but may warrant switching to an ARB.
Angioedema involves airway swelling, not cough.
Correct Answer: B
Q2. A patient with heart failure is prescribed sacubitril/valsartan. Which instruction is
essential?
A. Continue the concurrent ACE inhibitor at half dose
B. Ensure a washout period of at least 36 hours between last ACE inhibitor dose and
starting this medication
C. Take with a high-potassium salt substitute to enhance efficacy
D. Monitor for hypokalemia as the primary adverse effect
B. Ensure a washout period of at least 36 hours between last ACE inhibitor dose and
starting this medication [CORRECT]
,2
Rationale: Concurrent use of sacubitril/valsartan with ACE inhibitors increases
angioedema risk; a 36-hour washout is required. Hyperkalemia, not hypokalemia, is a
risk.
Correct Answer: B
Q3. The nurse is administering metoprolol to a patient with atrial fibrillation. Which
vital sign finding requires the nurse to hold the dose and notify the provider?
A. Blood pressure 138/84 mmHg and heart rate 72 bpm
B. Blood pressure 118/76 mmHg and heart rate 88 bpm
C. Blood pressure 96/58 mmHg and heart rate 52 bpm
D. Blood pressure 152/90 mmHg and heart rate 104 bpm
C. Blood pressure 96/58 mmHg and heart rate 52 bpm [CORRECT]
Rationale: Beta-blockers are held for systolic BP <100 mmHg or heart rate <60 bpm
due to risk of excessive bradycardia and hypotension.
Correct Answer: C
Q4. A patient taking amlodipine for hypertension develops bilateral ankle edema.
The nurse understands this is:
A. A sign of worsening heart failure requiring diuretic addition
B. A common vasodilatory adverse effect of dihydropyridine calcium channel
blockers
C. An indication of medication nonadherence and electrolyte imbalance
D. Evidence of renal failure caused by calcium channel blockade
B. A common vasodilatory adverse effect of dihydropyridine calcium channel
blockers [CORRECT]
Rationale: Amlodipine causes peripheral vasodilation and capillary pressure changes
leading to dependent edema; it is not heart failure or renal failure.
,3
Correct Answer: B
Q5. A patient receiving digoxin reports nausea, vomiting, and seeing "yellow halos"
around lights. Which laboratory value is most likely contributing to this presentation?
A. Serum sodium 142 mEq/L
B. Serum potassium 2.8 mEq/L
C. Serum calcium 9.5 mg/dL
D. Blood glucose 110 mg/dL
B. Serum potassium 2.8 mEq/L [CORRECT]
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and predisposes
to toxicity manifesting as GI symptoms and visual disturbances; potassium must be
monitored closely.
Correct Answer: B
Q6. A patient taking furosemide 40 mg daily is newly prescribed digoxin. To reduce
the risk of digoxin toxicity, the nurse should:
A. Administer both medications together to enhance diuresis
B. Monitor serum potassium and maintain normal levels because hypokalemia
potentiates digoxin toxicity
C. Encourage the patient to restrict all potassium intake to prevent hyperkalemia
D. Advise the patient to take digoxin at bedtime and furosemide in the morning
B. Monitor serum potassium and maintain normal levels because hypokalemia
potentiates digoxin toxicity [CORRECT]
Rationale: Loop diuretics cause potassium wasting, and hypokalemia increases
digoxin toxicity risk; potassium levels must be monitored and maintained.
Correct Answer: B
, 4
Q7. A patient receiving IV gentamicin for sepsis is also prescribed furosemide for
fluid overload. The nurse monitors for:
A. Hyperkalemia and digitalis toxicity
B. Additive ototoxicity and nephrotoxicity
C. Excessive diuresis leading to hypernatremia
D. Synergistic antibacterial effects requiring dose reduction
B. Additive ototoxicity and nephrotoxicity [CORRECT]
Rationale: Both aminoglycosides and loop diuretics are ototoxic and nephrotoxic;
concurrent use increases the risk of irreversible hearing loss and acute kidney injury.
Correct Answer: B
Q8. A patient with heart failure is prescribed spironolactone. Which dietary
instruction is most important?
A. Increase dietary potassium by eating bananas and oranges daily
B. Avoid salt substitutes containing potassium and monitor serum potassium levels
C. Restrict fluid intake to 500 mL per day
D. Take the medication on an empty stomach to enhance absorption
B. Avoid salt substitutes containing potassium and monitor serum potassium levels
[CORRECT]
Rationale: Spironolactone is a potassium-sparing diuretic; potassium supplements
and salt substitutes can cause life-threatening hyperkalemia.
Correct Answer: B
Q9. A nurse is reviewing morning medications. Which medication requires an
independent double-check by two nurses before administration?
A. Lisinopril 10 mg PO
B. Digoxin 0.25 mg PO
