PHARMACOLOGY HESI COMPREHENSIVE REVIEW FOR
THE NCLEX-PN EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST 2026A
This comprehensive Pharmacology HESI Review for the NCLEX-PN Exam
contains 300 unique practice questions with multiple-choice answers and
detailed rationales. Each question covers essential pharmacology topics
including medication administration, drug classifications, adverse effects,
therapeutic uses, drug interactions, nursing interventions, and patient
education. The questions progress from foundational concepts to complex
clinical applications, testing knowledge of cardiovascular, respiratory,
endocrine, psychiatric, neurological, gastrointestinal, and anti-infective
medications. Every answer includes a thorough explanation of why the correct
option is right and why the distractors are incorrect, reinforcing
understanding of pharmacological principles. This resource is ideal for self-
assessment and NCLEX-PN exam readiness.
1. A client with heart failure is prescribed digoxin. Which finding indicates digoxin
toxicity?
A. Heart rate of 72 beats per minute
B. Serum potassium of 4.0 mEq/L
C. Visual disturbances and nausea
D. Blood pressure of 120/80 mm Hg
Answer: C
Rationale: Digoxin toxicity presents with visual disturbances (yellow-green halos),
nausea, vomiting, and cardiac arrhythmias. Hypokalemia increases toxicity risk.
2. A client is prescribed furosemide for pulmonary edema. Which laboratory value
should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
,Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalemia. Monitor potassium levels closely to prevent cardiac arrhythmias.
3. A client with asthma is prescribed albuterol. Which side effect should the nurse
expect?
A. Bradycardia
B. Tachycardia
C. Hypotension
D. Drowsiness
Answer: B
Rationale: Albuterol is a beta-agonist bronchodilator that can cause tachycardia,
palpitations, and tremors due to beta-1 receptor stimulation.
4. A client is prescribed warfarin for atrial fibrillation. Which laboratory value
indicates therapeutic effect?
A. INR of 1.0
B. INR of 2.5
C. aPTT of 30 seconds
D. Platelet count of 150,000
Answer: B
Rationale: Therapeutic INR for warfarin is typically 2.0-3.0 for atrial fibrillation.
INR of 2.5 indicates therapeutic anticoagulation.
5. A client is prescribed metformin for type 2 diabetes. Which side effect should
the nurse include in teaching?
A. Weight gain
B. Hypoglycemia
C. Gastrointestinal upset
D. Hyperglycemia
Answer: C
Rationale: Metformin commonly causes gastrointestinal side effects including
nausea, diarrhea, and abdominal discomfort. Taking with meals reduces these
effects.
6. A client prescribed lithium for bipolar disorder should be taught to maintain a
consistent intake of which nutrient?
A. Calcium
,B. Sodium
C. Potassium
D. Magnesium
Answer: B
Rationale: Lithium levels are affected by sodium balance. Dehydration or low
sodium intake can increase lithium levels and risk of toxicity.
7. A nurse is administering enoxaparin subcutaneously. Which action is correct?
A. Aspirate before injection
B. Massage the site after injection
C. Administer in the abdomen
D. Use a 21-gauge needle
Answer: C
Rationale: Enoxaparin is administered subcutaneously in the abdomen. Do not
aspirate or massage the site to prevent bruising and hematoma formation.
8. A client is prescribed nitroglycerin sublingually for angina. Which instruction
should the nurse include?
A. Swallow the tablet with water
B. Take one tablet every 5 minutes up to three tablets
C. Take one tablet every hour
D. Store the tablets in the refrigerator
Answer: B
Rationale: Nitroglycerin is taken sublingually one tablet every 5 minutes up to
three tablets. If pain persists after three tablets, emergency care is needed.
9. A client prescribed prednisone for rheumatoid arthritis should be monitored for
which adverse effect?
A. Hypotension
B. Hypoglycemia
C. Weight loss
D. Hyperglycemia
Answer: D
Rationale: Prednisone is a corticosteroid that causes hyperglycemia, weight gain,
hypertension, and immunosuppression.
, 10. A nurse is administering IV vancomycin and observes the client developing
flushing and rash on the neck and chest. Which action should the nurse take first?
A. Stop the infusion
B. Notify the provider
C. Slow the infusion rate
D. Administer diphenhydramine
Answer: A
Rationale: This is Red Man Syndrome, caused by rapid vancomycin infusion. Stop
the infusion first, then slow the rate and administer antihistamines.
11. A client is prescribed sertraline for depression. Which side effect should the
nurse monitor?
A. Hypertensive crisis
B. Sexual dysfunction
C. Weight gain
D. Sedation
Answer: B
Rationale: SSRIs like sertraline commonly cause sexual dysfunction including
decreased libido and anorgasmia.
12. A client prescribed alendronate for osteoporosis should be instructed to:
A. Take with a full glass of water and remain upright for 30 minutes
B. Take with food to reduce stomach upset
C. Lie down immediately after taking
D. Take with milk for better absorption
Answer: A
Rationale: Alendronate must be taken on an empty stomach with a full glass of
water and the client must remain upright for 30-60 minutes to prevent esophageal
injury.
13. A client is prescribed morphine for severe pain. Which finding requires
immediate intervention?
A. Respiratory rate of 10 breaths per minute
B. Pain score of 4 on a 0-10 scale
C. Blood pressure of 110/70 mm Hg
D. Pupils equal and reactive
THE NCLEX-PN EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST 2026A
This comprehensive Pharmacology HESI Review for the NCLEX-PN Exam
contains 300 unique practice questions with multiple-choice answers and
detailed rationales. Each question covers essential pharmacology topics
including medication administration, drug classifications, adverse effects,
therapeutic uses, drug interactions, nursing interventions, and patient
education. The questions progress from foundational concepts to complex
clinical applications, testing knowledge of cardiovascular, respiratory,
endocrine, psychiatric, neurological, gastrointestinal, and anti-infective
medications. Every answer includes a thorough explanation of why the correct
option is right and why the distractors are incorrect, reinforcing
understanding of pharmacological principles. This resource is ideal for self-
assessment and NCLEX-PN exam readiness.
1. A client with heart failure is prescribed digoxin. Which finding indicates digoxin
toxicity?
A. Heart rate of 72 beats per minute
B. Serum potassium of 4.0 mEq/L
C. Visual disturbances and nausea
D. Blood pressure of 120/80 mm Hg
Answer: C
Rationale: Digoxin toxicity presents with visual disturbances (yellow-green halos),
nausea, vomiting, and cardiac arrhythmias. Hypokalemia increases toxicity risk.
2. A client is prescribed furosemide for pulmonary edema. Which laboratory value
should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
,Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalemia. Monitor potassium levels closely to prevent cardiac arrhythmias.
3. A client with asthma is prescribed albuterol. Which side effect should the nurse
expect?
A. Bradycardia
B. Tachycardia
C. Hypotension
D. Drowsiness
Answer: B
Rationale: Albuterol is a beta-agonist bronchodilator that can cause tachycardia,
palpitations, and tremors due to beta-1 receptor stimulation.
4. A client is prescribed warfarin for atrial fibrillation. Which laboratory value
indicates therapeutic effect?
A. INR of 1.0
B. INR of 2.5
C. aPTT of 30 seconds
D. Platelet count of 150,000
Answer: B
Rationale: Therapeutic INR for warfarin is typically 2.0-3.0 for atrial fibrillation.
INR of 2.5 indicates therapeutic anticoagulation.
5. A client is prescribed metformin for type 2 diabetes. Which side effect should
the nurse include in teaching?
A. Weight gain
B. Hypoglycemia
C. Gastrointestinal upset
D. Hyperglycemia
Answer: C
Rationale: Metformin commonly causes gastrointestinal side effects including
nausea, diarrhea, and abdominal discomfort. Taking with meals reduces these
effects.
6. A client prescribed lithium for bipolar disorder should be taught to maintain a
consistent intake of which nutrient?
A. Calcium
,B. Sodium
C. Potassium
D. Magnesium
Answer: B
Rationale: Lithium levels are affected by sodium balance. Dehydration or low
sodium intake can increase lithium levels and risk of toxicity.
7. A nurse is administering enoxaparin subcutaneously. Which action is correct?
A. Aspirate before injection
B. Massage the site after injection
C. Administer in the abdomen
D. Use a 21-gauge needle
Answer: C
Rationale: Enoxaparin is administered subcutaneously in the abdomen. Do not
aspirate or massage the site to prevent bruising and hematoma formation.
8. A client is prescribed nitroglycerin sublingually for angina. Which instruction
should the nurse include?
A. Swallow the tablet with water
B. Take one tablet every 5 minutes up to three tablets
C. Take one tablet every hour
D. Store the tablets in the refrigerator
Answer: B
Rationale: Nitroglycerin is taken sublingually one tablet every 5 minutes up to
three tablets. If pain persists after three tablets, emergency care is needed.
9. A client prescribed prednisone for rheumatoid arthritis should be monitored for
which adverse effect?
A. Hypotension
B. Hypoglycemia
C. Weight loss
D. Hyperglycemia
Answer: D
Rationale: Prednisone is a corticosteroid that causes hyperglycemia, weight gain,
hypertension, and immunosuppression.
, 10. A nurse is administering IV vancomycin and observes the client developing
flushing and rash on the neck and chest. Which action should the nurse take first?
A. Stop the infusion
B. Notify the provider
C. Slow the infusion rate
D. Administer diphenhydramine
Answer: A
Rationale: This is Red Man Syndrome, caused by rapid vancomycin infusion. Stop
the infusion first, then slow the rate and administer antihistamines.
11. A client is prescribed sertraline for depression. Which side effect should the
nurse monitor?
A. Hypertensive crisis
B. Sexual dysfunction
C. Weight gain
D. Sedation
Answer: B
Rationale: SSRIs like sertraline commonly cause sexual dysfunction including
decreased libido and anorgasmia.
12. A client prescribed alendronate for osteoporosis should be instructed to:
A. Take with a full glass of water and remain upright for 30 minutes
B. Take with food to reduce stomach upset
C. Lie down immediately after taking
D. Take with milk for better absorption
Answer: A
Rationale: Alendronate must be taken on an empty stomach with a full glass of
water and the client must remain upright for 30-60 minutes to prevent esophageal
injury.
13. A client is prescribed morphine for severe pain. Which finding requires
immediate intervention?
A. Respiratory rate of 10 breaths per minute
B. Pain score of 4 on a 0-10 scale
C. Blood pressure of 110/70 mm Hg
D. Pupils equal and reactive
