NURS 318HESI PHARMACOLOGYMEDICATION THERAPYNURS 318HESI
PHARMACOLOGYMEDICATION THERAPY QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Section One: Questions 1–100
Question 1
A client with chronic heart failure is prescribed digoxin 0.125 mg orally daily. Which clinical manifestation
should the nurse recognize as an early indicator of digoxin toxicity?
A. Tachycardia
B. Hypertension
C. Anorexia
D. Peripheral edema
🟢 Correct answer C. Option
🔴 RATIONALE: Anorexia, nausea, vomiting, and abdominal pain are early gastrointestinal signs of
digoxin toxicity. Neurological symptoms such as fatigue and visual changes may also manifest early,
whereas cardiac arrhythmias occur later.
Question 2
A nurse is preparing to administer an intravenous bolus of a medication. According to regulatory safety
standards and professional compliance, what is the minimum number of client identifiers the nurse must
check prior to administration?
A. One
B. Two
C. Three
D. Four
🟢 Correct answer B. Option
🔴 RATIONALE: Joint Commission safety goals require at least two unique client identifiers (such as
,name and date of birth) before administering any medication or blood product to ensure patient safety
and prevent medical errors.
Question 3
A client diagnosed with open-angle glaucoma is prescribed timolol ophthalmic drops. The nurse instructs
the client to apply pressure to the nasolacrimal duct after instilling the drops. What is the primary ethical
and clinical rationale for this intervention?
A. To prevent local irritation of the sclera
B. To minimize systemic absorption and adverse cardiovascular effects
C. To promote rapid drainage into the nasal cavity
D. To maximize the concentration of the medication in the systemic circulation
🟢 Correct answer B. Option
🔴 RATIONALE: Timolol is a non-selective beta-blocker. Applying pressure to the nasolacrimal duct
(punctal occlusion) for 1 to 2 minutes prevents the medication from draining into the systemic circulation,
thereby reducing the risk of systemic adverse effects like bradycardia and hypotension.
Question 4
A nurse is reviewing laboratory results for a client receiving therapeutic heparin infusions for a deep vein
thrombosis. Which laboratory parameter should the nurse monitor to adjust the heparin dosage?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
🟢 Correct answer C. Option
🔴 RATIONALE: Continuous intravenous heparin therapy is monitored and adjusted based on the
activated partial thromboplastin time (aPTT). PT and INR are used primarily to monitor oral warfarin
therapy, while platelet counts are monitored to screen for heparin-induced thrombocytopenia.
Question 5
A client with type 1 diabetes mellitus is prescribed 10 units of regular insulin and 20 units of NPH insulin
,to be administered subcutaneously before breakfast. How should the nurse prepare this injection in a
single syringe?
A. Draw up the NPH insulin first, followed by the regular insulin.
B. Draw up the regular insulin first, followed by the NPH insulin.
C. Draw each insulin into separate syringes and mix them in a third syringe.
D. Inject air into the regular vial first, draw regular insulin, then inject air into NPH and draw NPH.
🟢 Correct answer B. Option
🔴 RATIONALE: When mixing regular (clear) and NPH (cloudy) insulin in one syringe, the clear insulin
must be drawn first to prevent contamination of the short-acting insulin vial with the longer-acting NPH
insulin. The sequence for air injection is NPH then regular, followed by drawing regular then NPH.
Question 6
A nurse is caring for a client who is receiving a continuous intravenous infusion of nitroprusside sodium
for a hypertensive crisis. The nurse should closely monitor the client for signs of which toxic metabolic
byproduct?
A. Methemoglobin
B. Cyanide
C. Sulfate
D. Ammonium
🟢 Correct answer B. Option
🔴 RATIONALE: Nitroprusside sodium is metabolized into thiocyanate and cyanide. Prolonged infusions,
high doses, or renal/hepatic impairment can result in fatal cyanide toxicity. Symptoms include metabolic
acidosis, confusion, and hyperreflexia.
Question 7
A provider prescribes an oral medication for a client who is post-operative and has a functional
nasogastric tube attached to low intermittent suction. What action should the nurse take to ensure proper
medication administration and absorption?
A. Mix the medication with a large volume of enteral feeding solution and flush immediately.
, B. Crush the medication if appropriate, dissolve in water, administer via tube, and clamp the tube for 30
to 60 minutes.
C. Administer the medication into the tube while suction remains fully functional.
D. Request an immediate change to the intravenous route for all ordered oral medications regardless of
formulation.
🟢 Correct answer B. Option
🔴 RATIONALE: To allow proper absorption of oral medications administered through a nasogastric tube
attached to suction, the suction must be turned off and the tube clamped for at least 30 to 60 minutes
post-administration.
Question 8
An older adult client is prescribed a medication that is highly protein-bound. The nurse notes that the
client’s serum albumin level is 2.2 g/dL (normal: 3.5–5.0 g/dL). What is the primary pharmacokinetic
consequence of this lab value?
A. The therapeutic effect of the drug will decrease rapidly.
B. There will be an increased concentration of free, active drug in the bloodstream.
C. Clearance of the drug by the kidneys will double.
D. The drug will become completely inactive due to lack of transport proteins.
🟢 Correct answer B. Option
🔴 RATIONALE: Decreased serum albumin levels mean there are fewer binding sites for highly protein-
bound medications. This results in an increased concentration of unbound, free, active drug, significantly
elevating the risk of toxicity and adverse effects.
Question 9
A client is taking a monoamine oxidase inhibitor (MAOI) for treatment-resistant depression. During a
dietary assessment, the nurse should instruct the client to completely avoid which of the following foods?
A. Fresh apples
B. Whole-wheat bread
C. Aged cheddar cheese
PHARMACOLOGYMEDICATION THERAPY QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Section One: Questions 1–100
Question 1
A client with chronic heart failure is prescribed digoxin 0.125 mg orally daily. Which clinical manifestation
should the nurse recognize as an early indicator of digoxin toxicity?
A. Tachycardia
B. Hypertension
C. Anorexia
D. Peripheral edema
🟢 Correct answer C. Option
🔴 RATIONALE: Anorexia, nausea, vomiting, and abdominal pain are early gastrointestinal signs of
digoxin toxicity. Neurological symptoms such as fatigue and visual changes may also manifest early,
whereas cardiac arrhythmias occur later.
Question 2
A nurse is preparing to administer an intravenous bolus of a medication. According to regulatory safety
standards and professional compliance, what is the minimum number of client identifiers the nurse must
check prior to administration?
A. One
B. Two
C. Three
D. Four
🟢 Correct answer B. Option
🔴 RATIONALE: Joint Commission safety goals require at least two unique client identifiers (such as
,name and date of birth) before administering any medication or blood product to ensure patient safety
and prevent medical errors.
Question 3
A client diagnosed with open-angle glaucoma is prescribed timolol ophthalmic drops. The nurse instructs
the client to apply pressure to the nasolacrimal duct after instilling the drops. What is the primary ethical
and clinical rationale for this intervention?
A. To prevent local irritation of the sclera
B. To minimize systemic absorption and adverse cardiovascular effects
C. To promote rapid drainage into the nasal cavity
D. To maximize the concentration of the medication in the systemic circulation
🟢 Correct answer B. Option
🔴 RATIONALE: Timolol is a non-selective beta-blocker. Applying pressure to the nasolacrimal duct
(punctal occlusion) for 1 to 2 minutes prevents the medication from draining into the systemic circulation,
thereby reducing the risk of systemic adverse effects like bradycardia and hypotension.
Question 4
A nurse is reviewing laboratory results for a client receiving therapeutic heparin infusions for a deep vein
thrombosis. Which laboratory parameter should the nurse monitor to adjust the heparin dosage?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
🟢 Correct answer C. Option
🔴 RATIONALE: Continuous intravenous heparin therapy is monitored and adjusted based on the
activated partial thromboplastin time (aPTT). PT and INR are used primarily to monitor oral warfarin
therapy, while platelet counts are monitored to screen for heparin-induced thrombocytopenia.
Question 5
A client with type 1 diabetes mellitus is prescribed 10 units of regular insulin and 20 units of NPH insulin
,to be administered subcutaneously before breakfast. How should the nurse prepare this injection in a
single syringe?
A. Draw up the NPH insulin first, followed by the regular insulin.
B. Draw up the regular insulin first, followed by the NPH insulin.
C. Draw each insulin into separate syringes and mix them in a third syringe.
D. Inject air into the regular vial first, draw regular insulin, then inject air into NPH and draw NPH.
🟢 Correct answer B. Option
🔴 RATIONALE: When mixing regular (clear) and NPH (cloudy) insulin in one syringe, the clear insulin
must be drawn first to prevent contamination of the short-acting insulin vial with the longer-acting NPH
insulin. The sequence for air injection is NPH then regular, followed by drawing regular then NPH.
Question 6
A nurse is caring for a client who is receiving a continuous intravenous infusion of nitroprusside sodium
for a hypertensive crisis. The nurse should closely monitor the client for signs of which toxic metabolic
byproduct?
A. Methemoglobin
B. Cyanide
C. Sulfate
D. Ammonium
🟢 Correct answer B. Option
🔴 RATIONALE: Nitroprusside sodium is metabolized into thiocyanate and cyanide. Prolonged infusions,
high doses, or renal/hepatic impairment can result in fatal cyanide toxicity. Symptoms include metabolic
acidosis, confusion, and hyperreflexia.
Question 7
A provider prescribes an oral medication for a client who is post-operative and has a functional
nasogastric tube attached to low intermittent suction. What action should the nurse take to ensure proper
medication administration and absorption?
A. Mix the medication with a large volume of enteral feeding solution and flush immediately.
, B. Crush the medication if appropriate, dissolve in water, administer via tube, and clamp the tube for 30
to 60 minutes.
C. Administer the medication into the tube while suction remains fully functional.
D. Request an immediate change to the intravenous route for all ordered oral medications regardless of
formulation.
🟢 Correct answer B. Option
🔴 RATIONALE: To allow proper absorption of oral medications administered through a nasogastric tube
attached to suction, the suction must be turned off and the tube clamped for at least 30 to 60 minutes
post-administration.
Question 8
An older adult client is prescribed a medication that is highly protein-bound. The nurse notes that the
client’s serum albumin level is 2.2 g/dL (normal: 3.5–5.0 g/dL). What is the primary pharmacokinetic
consequence of this lab value?
A. The therapeutic effect of the drug will decrease rapidly.
B. There will be an increased concentration of free, active drug in the bloodstream.
C. Clearance of the drug by the kidneys will double.
D. The drug will become completely inactive due to lack of transport proteins.
🟢 Correct answer B. Option
🔴 RATIONALE: Decreased serum albumin levels mean there are fewer binding sites for highly protein-
bound medications. This results in an increased concentration of unbound, free, active drug, significantly
elevating the risk of toxicity and adverse effects.
Question 9
A client is taking a monoamine oxidase inhibitor (MAOI) for treatment-resistant depression. During a
dietary assessment, the nurse should instruct the client to completely avoid which of the following foods?
A. Fresh apples
B. Whole-wheat bread
C. Aged cheddar cheese
