Fortis College NUR100 HESI Actual Exam Questions and Answers with
Rationales | Pharmacology Exam | Pass Guarantee
Question 1: A 68-year-old male with a history of chronic heart failure and atrial fibrillation is
admitted to the medical-surgical unit. He is currently prescribed digoxin 0.125 mg daily and
furosemide 40 mg daily. During the morning assessment, the nurse notes the patient is
complaining of nausea, visual disturbances described as "yellow halos" around lights, and a
heart rate of 52 beats per minute. The patient's latest serum potassium level is 3.1 mEq/L.
Based on this clinical presentation, what is the nurse's most appropriate initial action?
A. Administer the scheduled dose of digoxin and reassess the heart rate in one hour.
B. Hold the digoxin, notify the healthcare provider immediately, and anticipate an order for a
serum digoxin level and potassium replacement.
C. Administer the scheduled dose of furosemide to help eliminate the excess digoxin through
increased renal excretion.
D. Obtain a stat 12-lead ECG and prepare the patient for immediate synchronized cardioversion.
CORRECT ANSWER: B. Hold the digoxin, notify the healthcare provider immediately, and
anticipate an order for a serum digoxin level and potassium replacement.
Rationale: The patient is exhibiting classic signs of digoxin toxicity (nausea, visual changes,
bradycardia), which is exacerbated by hypokalemia (potassium of 3.1 mEq/L). The nurse must
hold the medication, notify the provider, and anticipate orders to check the digoxin level and
correct the potassium, as hypokalemia increases the heart's sensitivity to digoxin.
Question 2: A 55-year-old female with a history of type 2 diabetes mellitus and hypertension is
prescribed a new medication regimen that includes lisinopril. During the follow-up visit, she
reports developing a persistent, dry, non-productive cough that is disrupting her sleep. Her
blood pressure is well-controlled, and her renal function is normal. What is the most
appropriate pharmacological explanation for this adverse effect?
A. Lisinopril causes bronchoconstriction by blocking beta-2 adrenergic receptors in the lungs.
B. Lisinopril inhibits the breakdown of bradykinin, leading to its accumulation in the respiratory
tract and causing a dry cough.
C. Lisinopril induces severe gastroesophageal reflux disease (GERD), which manifests as a
chronic cough.
,D. Lisinopril causes fluid retention in the pulmonary interstitium, leading to a cough similar to
heart failure.
CORRECT ANSWER: B. Lisinopril inhibits the breakdown of bradykinin, leading to its
accumulation in the respiratory tract and causing a dry cough.
Rationale: ACE inhibitors, such as lisinopril, block the angiotensin-converting enzyme, which is
also responsible for breaking down bradykinin. The accumulation of bradykinin and substance P
in the respiratory tract is the well-documented mechanism behind the characteristic dry,
persistent cough associated with this drug class.
Question 3: A 42-year-old male is admitted to the emergency department with an acute
exacerbation of asthma. He is experiencing severe shortness of breath, wheezing, and an
oxygen saturation of 88% on room air. The healthcare provider orders albuterol via nebulizer
and intravenous methylprednisolone. What is the primary pharmacological rationale for
administering both of these medications concurrently?
A. Albuterol reduces airway inflammation, while methylprednisolone provides immediate
bronchodilation.
B. Albuterol provides rapid bronchodilation by stimulating beta-2 receptors, while
methylprednisolone reduces underlying airway inflammation and prevents late-phase asthmatic
responses.
C. Both medications act as mast cell stabilizers to prevent the release of histamine and
leukotrienes.
D. Methylprednisolone potentiates the beta-2 adrenergic effects of albuterol, allowing for a
lower dose of albuterol to be used.
CORRECT ANSWER: B. Albuterol provides rapid bronchodilation by stimulating beta-2
receptors, while methylprednisolone reduces underlying airway inflammation and prevents
late-phase asthmatic responses.
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that provides immediate relief of
bronchospasm. Methylprednisolone is a systemic corticosteroid that takes several hours to work
but is crucial for reducing airway edema, decreasing mucus production, and preventing the
biphasic (late-phase) inflammatory response in acute asthma exacerbations.
,Question 4: A 70-year-old female with a history of deep vein thrombosis (DVT) is being
discharged home on warfarin (Coumadin). During discharge teaching, the nurse evaluates the
patient's understanding of dietary modifications. Which of the following statements by the
patient indicates a need for further teaching?
A. "I will get my blood drawn regularly to check my INR levels."
B. "I will maintain a consistent intake of green leafy vegetables like spinach and kale."
C. "I will avoid all green leafy vegetables completely to prevent my blood from clotting."
D. "I will inform my dentist and any new doctors that I am taking warfarin before any
procedures."
CORRECT ANSWER: C. "I will avoid all green leafy vegetables completely to prevent my blood
from clotting."
Rationale: Patients on warfarin should not completely avoid vitamin K-rich foods (like green
leafy vegetables), as this can cause dangerous fluctuations in INR. Instead, they should maintain
a consistent, steady intake of vitamin K so the warfarin dose can be accurately adjusted to
maintain a therapeutic INR.
Question 5: A 35-year-old female is diagnosed with major depressive disorder and is prescribed
phenelzine, a monoamine oxidase inhibitor (MAOI). During the nursing assessment, the patient
mentions she enjoys eating aged cheeses, cured meats, and drinking red wine. What is the
nurse's most critical intervention regarding this dietary habit?
A. Encourage the patient to continue this diet as it provides essential nutrients for brain health.
B. Instruct the patient to strictly avoid these foods because they contain high levels of tyramine,
which can precipitate a life-threatening hypertensive crisis.
C. Advise the patient to take the phenelzine with these foods to enhance the medication's
absorption.
D. Recommend that the patient switch to a selective serotonin reuptake inhibitor (SSRI) if she
wishes to continue this diet.
CORRECT ANSWER: B. Instruct the patient to strictly avoid these foods because they contain
high levels of tyramine, which can precipitate a life-threatening hypertensive crisis.
Rationale: MAOIs inhibit the enzyme responsible for breaking down tyramine in the
gastrointestinal tract. Consuming tyramine-rich foods (aged cheeses, cured meats, red wine)
, while on an MAOI can lead to a massive release of norepinephrine, resulting in a severe,
potentially fatal hypertensive crisis.
Question 6: A 60-year-old male with a history of benign prostatic hyperplasia (BPH) is prescribed
tamsulosin (Flomax). He reports feeling dizzy and lightheaded when standing up from a seated
position, especially in the morning. What is the most appropriate nursing intervention to
address this adverse effect?
A. Instruct the patient to increase his fluid intake to 4 liters per day to expand his blood volume.
B. Advise the patient to take the medication in the morning with breakfast to minimize
orthostatic changes.
C. Instruct the patient to change positions slowly, dangle his legs at the bedside before standing,
and take the medication at bedtime.
D. Discontinue the tamsulosin immediately and notify the healthcare provider to switch to a 5-
alpha-reductase inhibitor.
CORRECT ANSWER: C. Instruct the patient to change positions slowly, dangle his legs at the
bedside before standing, and take the medication at bedtime.
Rationale: Tamsulosin is an alpha-1 adrenergic antagonist that can cause orthostatic
hypotension by preventing normal vasoconstriction upon standing. Taking the medication at
bedtime and implementing slow position changes helps mitigate this "first-dose" orthostatic
effect and improves patient safety.
Question 7: A 28-year-old female is admitted to the hospital with a severe urinary tract infection
(UTI) and is prescribed intravenous ciprofloxacin. The patient's medication administration record
shows she is also scheduled to receive an oral dose of calcium carbonate and ferrous sulfate at
the same time. What is the nurse's best action?
A. Administer all three medications together to ensure compliance with the medication
schedule.
B. Separate the administration of ciprofloxacin and the mineral supplements by at least 2 hours
to prevent chelation and decreased antibiotic absorption.
C. Crush the calcium and iron supplements and mix them with the ciprofloxacin IV solution to
enhance absorption.
Rationales | Pharmacology Exam | Pass Guarantee
Question 1: A 68-year-old male with a history of chronic heart failure and atrial fibrillation is
admitted to the medical-surgical unit. He is currently prescribed digoxin 0.125 mg daily and
furosemide 40 mg daily. During the morning assessment, the nurse notes the patient is
complaining of nausea, visual disturbances described as "yellow halos" around lights, and a
heart rate of 52 beats per minute. The patient's latest serum potassium level is 3.1 mEq/L.
Based on this clinical presentation, what is the nurse's most appropriate initial action?
A. Administer the scheduled dose of digoxin and reassess the heart rate in one hour.
B. Hold the digoxin, notify the healthcare provider immediately, and anticipate an order for a
serum digoxin level and potassium replacement.
C. Administer the scheduled dose of furosemide to help eliminate the excess digoxin through
increased renal excretion.
D. Obtain a stat 12-lead ECG and prepare the patient for immediate synchronized cardioversion.
CORRECT ANSWER: B. Hold the digoxin, notify the healthcare provider immediately, and
anticipate an order for a serum digoxin level and potassium replacement.
Rationale: The patient is exhibiting classic signs of digoxin toxicity (nausea, visual changes,
bradycardia), which is exacerbated by hypokalemia (potassium of 3.1 mEq/L). The nurse must
hold the medication, notify the provider, and anticipate orders to check the digoxin level and
correct the potassium, as hypokalemia increases the heart's sensitivity to digoxin.
Question 2: A 55-year-old female with a history of type 2 diabetes mellitus and hypertension is
prescribed a new medication regimen that includes lisinopril. During the follow-up visit, she
reports developing a persistent, dry, non-productive cough that is disrupting her sleep. Her
blood pressure is well-controlled, and her renal function is normal. What is the most
appropriate pharmacological explanation for this adverse effect?
A. Lisinopril causes bronchoconstriction by blocking beta-2 adrenergic receptors in the lungs.
B. Lisinopril inhibits the breakdown of bradykinin, leading to its accumulation in the respiratory
tract and causing a dry cough.
C. Lisinopril induces severe gastroesophageal reflux disease (GERD), which manifests as a
chronic cough.
,D. Lisinopril causes fluid retention in the pulmonary interstitium, leading to a cough similar to
heart failure.
CORRECT ANSWER: B. Lisinopril inhibits the breakdown of bradykinin, leading to its
accumulation in the respiratory tract and causing a dry cough.
Rationale: ACE inhibitors, such as lisinopril, block the angiotensin-converting enzyme, which is
also responsible for breaking down bradykinin. The accumulation of bradykinin and substance P
in the respiratory tract is the well-documented mechanism behind the characteristic dry,
persistent cough associated with this drug class.
Question 3: A 42-year-old male is admitted to the emergency department with an acute
exacerbation of asthma. He is experiencing severe shortness of breath, wheezing, and an
oxygen saturation of 88% on room air. The healthcare provider orders albuterol via nebulizer
and intravenous methylprednisolone. What is the primary pharmacological rationale for
administering both of these medications concurrently?
A. Albuterol reduces airway inflammation, while methylprednisolone provides immediate
bronchodilation.
B. Albuterol provides rapid bronchodilation by stimulating beta-2 receptors, while
methylprednisolone reduces underlying airway inflammation and prevents late-phase asthmatic
responses.
C. Both medications act as mast cell stabilizers to prevent the release of histamine and
leukotrienes.
D. Methylprednisolone potentiates the beta-2 adrenergic effects of albuterol, allowing for a
lower dose of albuterol to be used.
CORRECT ANSWER: B. Albuterol provides rapid bronchodilation by stimulating beta-2
receptors, while methylprednisolone reduces underlying airway inflammation and prevents
late-phase asthmatic responses.
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that provides immediate relief of
bronchospasm. Methylprednisolone is a systemic corticosteroid that takes several hours to work
but is crucial for reducing airway edema, decreasing mucus production, and preventing the
biphasic (late-phase) inflammatory response in acute asthma exacerbations.
,Question 4: A 70-year-old female with a history of deep vein thrombosis (DVT) is being
discharged home on warfarin (Coumadin). During discharge teaching, the nurse evaluates the
patient's understanding of dietary modifications. Which of the following statements by the
patient indicates a need for further teaching?
A. "I will get my blood drawn regularly to check my INR levels."
B. "I will maintain a consistent intake of green leafy vegetables like spinach and kale."
C. "I will avoid all green leafy vegetables completely to prevent my blood from clotting."
D. "I will inform my dentist and any new doctors that I am taking warfarin before any
procedures."
CORRECT ANSWER: C. "I will avoid all green leafy vegetables completely to prevent my blood
from clotting."
Rationale: Patients on warfarin should not completely avoid vitamin K-rich foods (like green
leafy vegetables), as this can cause dangerous fluctuations in INR. Instead, they should maintain
a consistent, steady intake of vitamin K so the warfarin dose can be accurately adjusted to
maintain a therapeutic INR.
Question 5: A 35-year-old female is diagnosed with major depressive disorder and is prescribed
phenelzine, a monoamine oxidase inhibitor (MAOI). During the nursing assessment, the patient
mentions she enjoys eating aged cheeses, cured meats, and drinking red wine. What is the
nurse's most critical intervention regarding this dietary habit?
A. Encourage the patient to continue this diet as it provides essential nutrients for brain health.
B. Instruct the patient to strictly avoid these foods because they contain high levels of tyramine,
which can precipitate a life-threatening hypertensive crisis.
C. Advise the patient to take the phenelzine with these foods to enhance the medication's
absorption.
D. Recommend that the patient switch to a selective serotonin reuptake inhibitor (SSRI) if she
wishes to continue this diet.
CORRECT ANSWER: B. Instruct the patient to strictly avoid these foods because they contain
high levels of tyramine, which can precipitate a life-threatening hypertensive crisis.
Rationale: MAOIs inhibit the enzyme responsible for breaking down tyramine in the
gastrointestinal tract. Consuming tyramine-rich foods (aged cheeses, cured meats, red wine)
, while on an MAOI can lead to a massive release of norepinephrine, resulting in a severe,
potentially fatal hypertensive crisis.
Question 6: A 60-year-old male with a history of benign prostatic hyperplasia (BPH) is prescribed
tamsulosin (Flomax). He reports feeling dizzy and lightheaded when standing up from a seated
position, especially in the morning. What is the most appropriate nursing intervention to
address this adverse effect?
A. Instruct the patient to increase his fluid intake to 4 liters per day to expand his blood volume.
B. Advise the patient to take the medication in the morning with breakfast to minimize
orthostatic changes.
C. Instruct the patient to change positions slowly, dangle his legs at the bedside before standing,
and take the medication at bedtime.
D. Discontinue the tamsulosin immediately and notify the healthcare provider to switch to a 5-
alpha-reductase inhibitor.
CORRECT ANSWER: C. Instruct the patient to change positions slowly, dangle his legs at the
bedside before standing, and take the medication at bedtime.
Rationale: Tamsulosin is an alpha-1 adrenergic antagonist that can cause orthostatic
hypotension by preventing normal vasoconstriction upon standing. Taking the medication at
bedtime and implementing slow position changes helps mitigate this "first-dose" orthostatic
effect and improves patient safety.
Question 7: A 28-year-old female is admitted to the hospital with a severe urinary tract infection
(UTI) and is prescribed intravenous ciprofloxacin. The patient's medication administration record
shows she is also scheduled to receive an oral dose of calcium carbonate and ferrous sulfate at
the same time. What is the nurse's best action?
A. Administer all three medications together to ensure compliance with the medication
schedule.
B. Separate the administration of ciprofloxacin and the mineral supplements by at least 2 hours
to prevent chelation and decreased antibiotic absorption.
C. Crush the calcium and iron supplements and mix them with the ciprofloxacin IV solution to
enhance absorption.
