HESI Pharmacology Exam Study Guide 2026
2027 Updated Edition 100 Questions with
Answers & Rationales
EXAM OVERVIEW
The HESI Pharmacology Exam tests your knowledge of drug
classifications, mechanisms of action, adverse effects, nursing
interventions, and patient education. This guide includes 100
practice questions with detailed rationales covering the core
content areas for the 2026-2027 exam cycle.
Key Content Areas:
• Pharmacokinetics & Pharmacodynamics
• Cardiovascular Medications
• Central Nervous System Agents
• Endocrine & Metabolic Drugs
• Antimicrobials & Antivirals
• Gastrointestinal & Respiratory Drugs
• Medication Administration & Safety
• Nursing Considerations & Patient Teaching
,SECTION 1: PHARMACOKINETICS & MEDICATION
SAFETY (Questions 1-10)
1. A client who has taken atenolol for 2 years is switched to
enalapril for blood pressure management. Which instruction
should the nurse provide regarding the new medication?
A) Take the medication at bedtime.
B) Report presence of increased bruising.
C) Check pulse before taking medication.
D) Rise slowly when getting out of bed.
Answer D:
Rationale: Enalapril is an ACE inhibitor that can cause orthostatic
hypotension, especially when starting therapy. The client should be
instructed to rise slowly from a sitting or lying position to prevent
dizziness and falls. Enalapril does not significantly affect heart rate
like beta-blockers (atenolol) and does not typically cause increased
bruising. ---
2. A client is prescribed ciprofloxacin 400 mg IV every 12 hours,
to be infused over 1 hour. The IV bag contains ciprofloxacin 400
mg in 200 mL of D5W. How many mL/hr should the nurse
program the pump to deliver?
A) 100 mL/hr
B) 200 mL/hr
C) 300 mL/hr
D) 400 mL/hr
Answer B:
,Rationale: The nurse should infuse 200 mL over 60 minutes, which is
200 mL/hr. This ensures appropriate therapeutic levels and minimizes
complications. Ciprofloxacin is a fluoroquinolone antibiotic used for
various infections. ---
3. A client with hyperparathyroidism has a serum calcium level of
13 mg/dL. Which medication should the nurse prepare to
administer as prescribed?
A) Calcium chloride
B) Calcium gluconate
C) Calcitonin (Miacalcin)
D) Large doses of vitamin D
Answer C:
Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This
client is experiencing hypercalcemia. Calcium gluconate and calcium
chloride are used for hypocalcemia. In hypercalcemia, large doses of
vitamin D should be avoided. Calcitonin, a thyroid hormone,
decreases plasma calcium by inhibiting bone resorption and lowering
serum calcium concentration. ---
4. A nurse is caring for a client treated with flumazenil for
benzodiazepine toxicity. What will the nurse carefully assess for?
A) Agitation, confusion, and seizures
B) Cerebral hemorrhage and dystonia
C) Hypertension and renal insufficiency
D) Hypotension, dysrhythmias, and cardiac arrest
Answer A:
, Rationale: Administration of flumazenil blocks the action of
benzodiazepines. If the patient has been taking these medications for
an extended period, the blockage could precipitate an acute
benzodiazepine withdrawal syndrome with symptoms including
agitation, confusion, and seizures. ---
5. The nurse administers promethazine (Phenergan) before
sending a patient to the preoperative holding area. What is the
rationale for this drug?
A) Sedation
B) Oral secretions
C) Hypotension and bradycardia
D) Confusion
Answer A:
Rationale: Antihistamines like promethazine and diphenhydramine
can be very sedating. They are used as preoperative medications and
postoperatively to decrease the need for narcotics. Promethazine is not
given for hypotension, bradycardia, confusion, or oral secretions. ---
6. Oral iron supplements are prescribed for a 6-year-old child
with iron deficiency anemia. The nurse instructs the mother to
administer the iron with which food item?
A) Milk
B) Water
C) Apple juice
D) Orange juice
Answer D:
2027 Updated Edition 100 Questions with
Answers & Rationales
EXAM OVERVIEW
The HESI Pharmacology Exam tests your knowledge of drug
classifications, mechanisms of action, adverse effects, nursing
interventions, and patient education. This guide includes 100
practice questions with detailed rationales covering the core
content areas for the 2026-2027 exam cycle.
Key Content Areas:
• Pharmacokinetics & Pharmacodynamics
• Cardiovascular Medications
• Central Nervous System Agents
• Endocrine & Metabolic Drugs
• Antimicrobials & Antivirals
• Gastrointestinal & Respiratory Drugs
• Medication Administration & Safety
• Nursing Considerations & Patient Teaching
,SECTION 1: PHARMACOKINETICS & MEDICATION
SAFETY (Questions 1-10)
1. A client who has taken atenolol for 2 years is switched to
enalapril for blood pressure management. Which instruction
should the nurse provide regarding the new medication?
A) Take the medication at bedtime.
B) Report presence of increased bruising.
C) Check pulse before taking medication.
D) Rise slowly when getting out of bed.
Answer D:
Rationale: Enalapril is an ACE inhibitor that can cause orthostatic
hypotension, especially when starting therapy. The client should be
instructed to rise slowly from a sitting or lying position to prevent
dizziness and falls. Enalapril does not significantly affect heart rate
like beta-blockers (atenolol) and does not typically cause increased
bruising. ---
2. A client is prescribed ciprofloxacin 400 mg IV every 12 hours,
to be infused over 1 hour. The IV bag contains ciprofloxacin 400
mg in 200 mL of D5W. How many mL/hr should the nurse
program the pump to deliver?
A) 100 mL/hr
B) 200 mL/hr
C) 300 mL/hr
D) 400 mL/hr
Answer B:
,Rationale: The nurse should infuse 200 mL over 60 minutes, which is
200 mL/hr. This ensures appropriate therapeutic levels and minimizes
complications. Ciprofloxacin is a fluoroquinolone antibiotic used for
various infections. ---
3. A client with hyperparathyroidism has a serum calcium level of
13 mg/dL. Which medication should the nurse prepare to
administer as prescribed?
A) Calcium chloride
B) Calcium gluconate
C) Calcitonin (Miacalcin)
D) Large doses of vitamin D
Answer C:
Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This
client is experiencing hypercalcemia. Calcium gluconate and calcium
chloride are used for hypocalcemia. In hypercalcemia, large doses of
vitamin D should be avoided. Calcitonin, a thyroid hormone,
decreases plasma calcium by inhibiting bone resorption and lowering
serum calcium concentration. ---
4. A nurse is caring for a client treated with flumazenil for
benzodiazepine toxicity. What will the nurse carefully assess for?
A) Agitation, confusion, and seizures
B) Cerebral hemorrhage and dystonia
C) Hypertension and renal insufficiency
D) Hypotension, dysrhythmias, and cardiac arrest
Answer A:
, Rationale: Administration of flumazenil blocks the action of
benzodiazepines. If the patient has been taking these medications for
an extended period, the blockage could precipitate an acute
benzodiazepine withdrawal syndrome with symptoms including
agitation, confusion, and seizures. ---
5. The nurse administers promethazine (Phenergan) before
sending a patient to the preoperative holding area. What is the
rationale for this drug?
A) Sedation
B) Oral secretions
C) Hypotension and bradycardia
D) Confusion
Answer A:
Rationale: Antihistamines like promethazine and diphenhydramine
can be very sedating. They are used as preoperative medications and
postoperatively to decrease the need for narcotics. Promethazine is not
given for hypotension, bradycardia, confusion, or oral secretions. ---
6. Oral iron supplements are prescribed for a 6-year-old child
with iron deficiency anemia. The nurse instructs the mother to
administer the iron with which food item?
A) Milk
B) Water
C) Apple juice
D) Orange juice
Answer D:
