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RN HESI PHARMACOLOGY V3 EXAM QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
2026 EDITION
RN HESI Pharmacology V3 Exam - Questions with Detailed Rationales
SECTION 1: CARDIOVASCULAR & ENDOCRINE PHARMACOLOGY (Questions 1-25)
1. A 54-year-old client with hypertension and type 2 diabetes mellitus is preparing
to take the first dose of captopril. His daily medications include spironolactone 25
mg/day, metformin 500 mg twice a day, and insulin glargine 25 units daily. Which
instructions should the nurse provide? Select all that apply.
A) Increase the insulin glargine dose by 3 units on the morning of the first dose
B) Limit fluids for several days before the first dose
C) Lie down if blood pressure drops quickly after the first dose
D) Monitor blood pressure for several hours after the first dose
E) Hold spironolactone for 3 days prior to the first dose
Answer: C, D
Rationale: For a client taking captopril (an ACE inhibitor), "first-dose hypotension" is a
significant risk. The nurse should instruct the client to lie down if blood pressure drops
and to monitor BP for several hours after the first dose. Increasing insulin without proven
need is contraindicated; limiting fluids before the first dose increases the risk of
dehydration and severe hypotension; and holding spironolactone is not routinely
required unless hyperkalemia is an active concern .
2. A client is prescribed spironolactone for heart failure and hyperaldosteronism.
Which instruction is most important for the nurse to provide?
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A) "Monitor for excessive bruising"
B) "Protect your skin from sunlight"
C) "Limit high-potassium foods"
D) "Replace salt with salt substitute"
Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic that increases the risk of
hyperkalemia. Patients must avoid excessive dietary potassium or potassium-
containing salt substitutes. Salt substitutes often contain potassium chloride and can
cause dangerous hyperkalemia when combined with spironolactone .
3. A client with benign prostatic hyperplasia (BPH) is prescribed tamsulosin. Which
adverse effect should the nurse prioritize monitoring?
A) Urine output
B) Daily weights
C) Bladder scan results
D) Blood pressure
Answer: D
Rationale: Tamsulosin is an alpha-1 blocker that can lower blood pressure, causing
orthostatic hypotension. Monitoring blood pressure is essential to prevent falls and
injury. The nurse should teach the client to rise slowly from sitting or lying positions .
4. A client receives a new prescription for montelukast (Singulair). Which teaching
should the nurse provide?
A) "The medication contracts bronchial smooth muscle"
B) "Montelukast helps increase mucus in the lungs"
C) "Montelukast helps repair base-lung tissue"
D) "It prophylactically limits the inflammatory response to allergens"
Answer: D
Rationale: Montelukast is a leukotriene receptor antagonist used in asthma and allergic
conditions to reduce inflammation. It is not a bronchodilator, does not increase mucus,
and does not rebuild damaged lung tissue. It is taken prophylactically, not for acute
symptom relief .
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5. A client with a renal transplant shows signs of graft rejection and admits to
taking St. John's Wort. Which finding is most significant?
A) Adding the herb decreases the need for corticosteroids
B) St. John's Wort can decrease plasma concentrations of cyclosporine
C) The herb can reduce the client's sodium intake
D) The client likely took it for depression
Answer: B
Rationale: St. John's Wort induces hepatic enzymes (CYP3A4), accelerating
cyclosporine metabolism and risking subtherapeutic levels, potentially leading to organ
rejection. This is a critical drug-herb interaction .
6. A client is prescribed atorvastatin and develops an elevated serum creatine
kinase (CK) level. The nurse should assess for which problem?
A) Muscle tenderness
B) Peripheral edema
C) Nausea, vomiting
D) Excessive bruising
Answer: A
Rationale: Elevated CK suggests possible myopathy or rhabdomyolysis from statin use,
often accompanied by muscle pain or tenderness. This requires immediate assessment
and potential discontinuation of the medication. The nurse should assess for muscle
aches, weakness, or dark-colored urine .
SECTION 2: NEUROLOGICAL & PSYCHIATRIC PHARMACOLOGY (Questions 7-15)
7. A client with major depression is receiving a new prescription for duloxetine.
Which information is most important for the nurse to obtain?
A) Family history of mental illness
B) Weight change in the last month
C) Liver function laboratory results
D) Recent use of other antidepressants
Answer: C
Rationale: Duloxetine (an SNRI) can be hepatotoxic, so checking liver enzymes (ALT,
AST) is crucial before therapy. While a history of mental illness, weight changes, and
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concurrent antidepressants are relevant, ensuring normal hepatic function is the
highest priority .
8. Which nursing action has the highest priority when administering a dose of
codeine with acetaminophen to a client?
A) Advise the client that the medication should start working in about 30 minutes
B) Instruct the client to request assistance when ambulating to the bathroom
C) Tell the client to notify the nurse if the pain is not relieved
D) Administer a stool softener or laxative at the same time
Answer: B
Rationale: Codeine can cause sedation and orthostatic hypotension. The priority is
preventing falls and injury by having the client call for help when getting up. The other
actions are appropriate but secondary to safety .
9. Which statement by a client prescribed duloxetine indicates a need for further
teaching?
A) "I will take this medication with food to prevent stomach upset"
B) "I can expect this medication to help with my nerve pain"
C) "I should not stop taking this medication abruptly"
D) "I can take St. John's Wort with this medication to help my mood"
Answer: D
Rationale: Combining duloxetine with St. John's Wort increases the risk of serotonin
syndrome due to excess serotonin activity. The client should be taught to avoid St.
John's Wort and other serotonergic agents while taking duloxetine. The other statements
demonstrate correct understanding .
10. A client with chemotherapy-induced nausea has been prescribed
metoclopramide. Which adverse effect is most important to report?
A) Nausea
B) Involuntary movements
C) Diarrhea
D) Unusual irritability
Answer: B
RN HESI PHARMACOLOGY V3 EXAM QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
2026 EDITION
RN HESI Pharmacology V3 Exam - Questions with Detailed Rationales
SECTION 1: CARDIOVASCULAR & ENDOCRINE PHARMACOLOGY (Questions 1-25)
1. A 54-year-old client with hypertension and type 2 diabetes mellitus is preparing
to take the first dose of captopril. His daily medications include spironolactone 25
mg/day, metformin 500 mg twice a day, and insulin glargine 25 units daily. Which
instructions should the nurse provide? Select all that apply.
A) Increase the insulin glargine dose by 3 units on the morning of the first dose
B) Limit fluids for several days before the first dose
C) Lie down if blood pressure drops quickly after the first dose
D) Monitor blood pressure for several hours after the first dose
E) Hold spironolactone for 3 days prior to the first dose
Answer: C, D
Rationale: For a client taking captopril (an ACE inhibitor), "first-dose hypotension" is a
significant risk. The nurse should instruct the client to lie down if blood pressure drops
and to monitor BP for several hours after the first dose. Increasing insulin without proven
need is contraindicated; limiting fluids before the first dose increases the risk of
dehydration and severe hypotension; and holding spironolactone is not routinely
required unless hyperkalemia is an active concern .
2. A client is prescribed spironolactone for heart failure and hyperaldosteronism.
Which instruction is most important for the nurse to provide?
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A) "Monitor for excessive bruising"
B) "Protect your skin from sunlight"
C) "Limit high-potassium foods"
D) "Replace salt with salt substitute"
Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic that increases the risk of
hyperkalemia. Patients must avoid excessive dietary potassium or potassium-
containing salt substitutes. Salt substitutes often contain potassium chloride and can
cause dangerous hyperkalemia when combined with spironolactone .
3. A client with benign prostatic hyperplasia (BPH) is prescribed tamsulosin. Which
adverse effect should the nurse prioritize monitoring?
A) Urine output
B) Daily weights
C) Bladder scan results
D) Blood pressure
Answer: D
Rationale: Tamsulosin is an alpha-1 blocker that can lower blood pressure, causing
orthostatic hypotension. Monitoring blood pressure is essential to prevent falls and
injury. The nurse should teach the client to rise slowly from sitting or lying positions .
4. A client receives a new prescription for montelukast (Singulair). Which teaching
should the nurse provide?
A) "The medication contracts bronchial smooth muscle"
B) "Montelukast helps increase mucus in the lungs"
C) "Montelukast helps repair base-lung tissue"
D) "It prophylactically limits the inflammatory response to allergens"
Answer: D
Rationale: Montelukast is a leukotriene receptor antagonist used in asthma and allergic
conditions to reduce inflammation. It is not a bronchodilator, does not increase mucus,
and does not rebuild damaged lung tissue. It is taken prophylactically, not for acute
symptom relief .
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5. A client with a renal transplant shows signs of graft rejection and admits to
taking St. John's Wort. Which finding is most significant?
A) Adding the herb decreases the need for corticosteroids
B) St. John's Wort can decrease plasma concentrations of cyclosporine
C) The herb can reduce the client's sodium intake
D) The client likely took it for depression
Answer: B
Rationale: St. John's Wort induces hepatic enzymes (CYP3A4), accelerating
cyclosporine metabolism and risking subtherapeutic levels, potentially leading to organ
rejection. This is a critical drug-herb interaction .
6. A client is prescribed atorvastatin and develops an elevated serum creatine
kinase (CK) level. The nurse should assess for which problem?
A) Muscle tenderness
B) Peripheral edema
C) Nausea, vomiting
D) Excessive bruising
Answer: A
Rationale: Elevated CK suggests possible myopathy or rhabdomyolysis from statin use,
often accompanied by muscle pain or tenderness. This requires immediate assessment
and potential discontinuation of the medication. The nurse should assess for muscle
aches, weakness, or dark-colored urine .
SECTION 2: NEUROLOGICAL & PSYCHIATRIC PHARMACOLOGY (Questions 7-15)
7. A client with major depression is receiving a new prescription for duloxetine.
Which information is most important for the nurse to obtain?
A) Family history of mental illness
B) Weight change in the last month
C) Liver function laboratory results
D) Recent use of other antidepressants
Answer: C
Rationale: Duloxetine (an SNRI) can be hepatotoxic, so checking liver enzymes (ALT,
AST) is crucial before therapy. While a history of mental illness, weight changes, and
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concurrent antidepressants are relevant, ensuring normal hepatic function is the
highest priority .
8. Which nursing action has the highest priority when administering a dose of
codeine with acetaminophen to a client?
A) Advise the client that the medication should start working in about 30 minutes
B) Instruct the client to request assistance when ambulating to the bathroom
C) Tell the client to notify the nurse if the pain is not relieved
D) Administer a stool softener or laxative at the same time
Answer: B
Rationale: Codeine can cause sedation and orthostatic hypotension. The priority is
preventing falls and injury by having the client call for help when getting up. The other
actions are appropriate but secondary to safety .
9. Which statement by a client prescribed duloxetine indicates a need for further
teaching?
A) "I will take this medication with food to prevent stomach upset"
B) "I can expect this medication to help with my nerve pain"
C) "I should not stop taking this medication abruptly"
D) "I can take St. John's Wort with this medication to help my mood"
Answer: D
Rationale: Combining duloxetine with St. John's Wort increases the risk of serotonin
syndrome due to excess serotonin activity. The client should be taught to avoid St.
John's Wort and other serotonergic agents while taking duloxetine. The other statements
demonstrate correct understanding .
10. A client with chemotherapy-induced nausea has been prescribed
metoclopramide. Which adverse effect is most important to report?
A) Nausea
B) Involuntary movements
C) Diarrhea
D) Unusual irritability
Answer: B
