, HESI Exit Exam Pharmacology Questions and
Answers with Rationale 2026/2027
Question 1
A client with type 1 diabetes mellitus is prescribed regular insulin and
NPH insulin subcutaneously every morning. At what time should the
nurse anticipate that the client is most likely to experience hypoglycemia
from the NPH insulin peak?
A. 1 to 2 hours after administration
B. 4 to 12 hours after administration
C. 16 to 24 hours after administration
D. 30 to 60 minutes after administration
Correct Answer: B. 4 to 12 hours after administration
Rationale: NPH insulin is an intermediate-acting insulin with an onset
of 1 to 2 hours, a peak time of 4 to 12 hours, and a duration of 18 to 24
hours. The nurse must monitor the client closely for signs of
hypoglycemia during the peak window.
Question 2
A client is prescribed digoxin 0.25 mg orally daily for heart failure.
Before administering the medication, the nurse checks the client's apical
pulse and notes a rate of 52 beats/min. What is the most appropriate
action for the nurse to take?
A. Administer the medication as prescribed and document the pulse
B. Withhold the medication and notify the primary healthcare
provider
, C. Give a half dose (0.125 mg) and recheck the pulse in 1 hour
D. Crush the tablet and mix it with applesauce for faster absorption
Correct Answer: B. Withhold the medication and notify the primary
healthcare provider
Rationale: Digoxin slows heart rate by decreasing AV nodal
conduction. In adult clients, the apical pulse should be assessed for
a full minute; if the rate is below 60 beats/min, the nurse must
withhold the dose and notify the provider to prevent digitalis
toxicity.
Question 3
A client is receiving intravenous heparin infusion for the treatment of
deep vein thrombosis (DVT). Which laboratory test should the nurse
monitor to evaluate the therapeutic effectiveness of heparin?
A. Prothrombin Time (PT) and International Normalized Ratio (INR)
B. Activated Partial Thromboplastin Time (aPTT)
C. Bleeding time
D. Complete blood count (CBC) hemoglobin levels
Correct Answer: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin therapy is monitored using the Activated Partial
Thromboplastin Time (aPTT), whereas PT and INR are used to
monitor oral anticoagulant therapy such as warfarin.
Question 4
An adult client is prescribed warfarin sodium following a pulmonary
embolism. Which antidote should the nurse ensure is readily available
, on the clinical unit in the event of an overdose or dangerously elevated
INR?
A. Protamine sulfate
B. Vitamin K (Phytonadione)
C. Flumazenil
D. Naloxone hydrochloride
Correct Answer: B. Vitamin K (Phytonadione)
Rationale: Vitamin K is the specific reversal agent for warfarin.
Protamine sulfate is the antidote for heparin overdose, flumazenil
reverses benzodiazepines, and naloxone reverses opioids.
Question 5
A client with a history of asthma is prescribed propranolol for
hypertension. Which nursing action is most critical regarding this
prescription?
A. Administer the medication with a full glass of water
B. Contact the prescriber to question the order because non-selective
beta-blockers can cause bronchospasm
C. Instruct the client to take the medication only at bedtime
D. Monitor the client's urine output every 4 hours
Correct Answer: B. Contact the prescriber to question the order
because non-selective beta-blockers can cause bronchospasm
Rationale: Propranolol is a non-selective beta-blocker that blocks
both beta-1 (cardiac) and beta-2 (bronchial) receptors. Blocking
Answers with Rationale 2026/2027
Question 1
A client with type 1 diabetes mellitus is prescribed regular insulin and
NPH insulin subcutaneously every morning. At what time should the
nurse anticipate that the client is most likely to experience hypoglycemia
from the NPH insulin peak?
A. 1 to 2 hours after administration
B. 4 to 12 hours after administration
C. 16 to 24 hours after administration
D. 30 to 60 minutes after administration
Correct Answer: B. 4 to 12 hours after administration
Rationale: NPH insulin is an intermediate-acting insulin with an onset
of 1 to 2 hours, a peak time of 4 to 12 hours, and a duration of 18 to 24
hours. The nurse must monitor the client closely for signs of
hypoglycemia during the peak window.
Question 2
A client is prescribed digoxin 0.25 mg orally daily for heart failure.
Before administering the medication, the nurse checks the client's apical
pulse and notes a rate of 52 beats/min. What is the most appropriate
action for the nurse to take?
A. Administer the medication as prescribed and document the pulse
B. Withhold the medication and notify the primary healthcare
provider
, C. Give a half dose (0.125 mg) and recheck the pulse in 1 hour
D. Crush the tablet and mix it with applesauce for faster absorption
Correct Answer: B. Withhold the medication and notify the primary
healthcare provider
Rationale: Digoxin slows heart rate by decreasing AV nodal
conduction. In adult clients, the apical pulse should be assessed for
a full minute; if the rate is below 60 beats/min, the nurse must
withhold the dose and notify the provider to prevent digitalis
toxicity.
Question 3
A client is receiving intravenous heparin infusion for the treatment of
deep vein thrombosis (DVT). Which laboratory test should the nurse
monitor to evaluate the therapeutic effectiveness of heparin?
A. Prothrombin Time (PT) and International Normalized Ratio (INR)
B. Activated Partial Thromboplastin Time (aPTT)
C. Bleeding time
D. Complete blood count (CBC) hemoglobin levels
Correct Answer: B. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin therapy is monitored using the Activated Partial
Thromboplastin Time (aPTT), whereas PT and INR are used to
monitor oral anticoagulant therapy such as warfarin.
Question 4
An adult client is prescribed warfarin sodium following a pulmonary
embolism. Which antidote should the nurse ensure is readily available
, on the clinical unit in the event of an overdose or dangerously elevated
INR?
A. Protamine sulfate
B. Vitamin K (Phytonadione)
C. Flumazenil
D. Naloxone hydrochloride
Correct Answer: B. Vitamin K (Phytonadione)
Rationale: Vitamin K is the specific reversal agent for warfarin.
Protamine sulfate is the antidote for heparin overdose, flumazenil
reverses benzodiazepines, and naloxone reverses opioids.
Question 5
A client with a history of asthma is prescribed propranolol for
hypertension. Which nursing action is most critical regarding this
prescription?
A. Administer the medication with a full glass of water
B. Contact the prescriber to question the order because non-selective
beta-blockers can cause bronchospasm
C. Instruct the client to take the medication only at bedtime
D. Monitor the client's urine output every 4 hours
Correct Answer: B. Contact the prescriber to question the order
because non-selective beta-blockers can cause bronchospasm
Rationale: Propranolol is a non-selective beta-blocker that blocks
both beta-1 (cardiac) and beta-2 (bronchial) receptors. Blocking
