HESI Pharmacology Exam 1 (Fall
2026)
100 NCLEX-Style Questions, Answers, and Detailed Rationales
MEDICATION SAFETY & NURSING PROCESS
1. A nurse is preparing to administer a medication that is known to have a
narrow therapeutic index. Which nursing action is most important?
A. Document the administration immediately after giving it.
B. Monitor the client for signs of toxicity and check blood levels.
C. Administer the drug with a full glass of water.
D. Check the drug’s expiration date.
Correct Answer: B
Rationale: Drugs with a narrow therapeutic index have a small margin of
safety between a therapeutic dose and a toxic dose. Monitoring peak/
trough levels and physical signs of toxicity is the priority safety intervention.
DOSAGE CALCULATIONS (HESI STYLE)
2. The nurse is caring for a client with end-stage renal disease. The client is
prescribed a medication that is primarily excreted by the kidneys. What is
the nurse's primary concern?
A. Increased risk of drug toxicity.
B. Decreased absorption of the drug.
C. Increased first-pass effect.
D. Rapid clearance of the medication.
Correct Answer: A
Rationale: If the kidneys cannot effectively excrete the drug, it will
accumulate in the bloodstream, significantly increasing the risk of toxicity.
HESI Pharmacology - Page 1
,ADRENERGIC & CHOLINERGIC AGENTS
3. An older adult client is prescribed a highly protein-bound medication.
The client’s serum albumin level is 2.8 g/dL (normal: 3.5-5.0). What effect
will this have on the medication's action?
A. The drug will be less effective.
B. There will be an increased amount of free, active drug.
C. The drug will be metabolized more quickly.
D. The drug will be unable to reach the target receptors.
Correct Answer: B
Rationale: Highly protein-bound drugs need albumin to stay 'inactive.' Low
albumin means fewer binding sites, resulting in more 'free' (active) drug in
the system, increasing the risk of over-dosage/toxicity.
ANTI-INFECTIVES (ANTIBIOTICS)
4. A client is receiving an intravenous infusion of Vancomycin. The nurse
notes the client’s face and neck have become flushed and red. What is the
nurse's first action?
A. Administer an antihistamine as ordered.
B. Notify the healthcare provider immediately.
C. Stop the infusion.
D. Slow the rate of the infusion.
Correct Answer: D
Rationale: Red Man Syndrome is a rate-dependent reaction to Vancomycin,
not a true allergy. The standard first response is to slow the infusion rate. If
it were anaphylaxis (wheezing, hives), the nurse would stop it entirely.
HESI Pharmacology - Page 2
,ANALGESICS (OPIOIDS/NSAIDS)
5. The healthcare provider orders 0.25 mg of Digoxin. The medication is
available as 125 mcg per tablet. How many tablets will the nurse
administer?
A. 0.5 tablet
B. 1 tablet
C. 2 tablets
D. 3 tablets
Correct Answer: C
Rationale: First, convert mg to mcg: 0.25 mg = 250 mcg. Then, Divide
Desired (250 mcg) by Have (125 mcg) = 2 tablets.
TOXICITY & THERAPEUTIC RANGES
6. HESI Pharmacology Question 6: A nurse is caring for a client receiving a
drug classified as a Toxicity & Therapeutic Ranges. Which assessment
finding requires immediate notification of the healthcare provider?
A. Minor nausea and dry mouth
B. A heart rate change from 80 to 110 bpm
C. The client's refusal to take the medication
D. A blood pressure of 122/78 mmHg
Correct Answer: B
Rationale: Sudden changes in vital signs (tachycardia) suggest an adverse
reaction or toxicity related to the drug's mechanism of action and take
priority over minor side effects.
HESI Pharmacology - Page 3
, LEGAL/ETHICAL ASPECTS OF ADMINISTRATION
7. HESI Pharmacology Question 7: A nurse is caring for a client receiving a
drug classified as a Legal/Ethical Aspects of Administration. Which
assessment finding requires immediate notification of the healthcare
provider?
A. Minor nausea and dry mouth
B. A heart rate change from 80 to 110 bpm
C. The client's refusal to take the medication
D. A blood pressure of 122/78 mmHg
Correct Answer: B
Rationale: Sudden changes in vital signs (tachycardia) suggest an adverse
reaction or toxicity related to the drug's mechanism of action and take
priority over minor side effects.
PHARMACOKINETICS (ADME)
8. HESI Pharmacology Question 8: A nurse is caring for a client receiving a
drug classified as a Pharmacokinetics (ADME). Which assessment finding
requires immediate notification of the healthcare provider?
A. Minor nausea and dry mouth
B. A heart rate change from 80 to 110 bpm
C. The client's refusal to take the medication
D. A blood pressure of 122/78 mmHg
Correct Answer: B
Rationale: Sudden changes in vital signs (tachycardia) suggest an adverse
reaction or toxicity related to the drug's mechanism of action and take
priority over minor side effects.
HESI Pharmacology - Page 4
2026)
100 NCLEX-Style Questions, Answers, and Detailed Rationales
MEDICATION SAFETY & NURSING PROCESS
1. A nurse is preparing to administer a medication that is known to have a
narrow therapeutic index. Which nursing action is most important?
A. Document the administration immediately after giving it.
B. Monitor the client for signs of toxicity and check blood levels.
C. Administer the drug with a full glass of water.
D. Check the drug’s expiration date.
Correct Answer: B
Rationale: Drugs with a narrow therapeutic index have a small margin of
safety between a therapeutic dose and a toxic dose. Monitoring peak/
trough levels and physical signs of toxicity is the priority safety intervention.
DOSAGE CALCULATIONS (HESI STYLE)
2. The nurse is caring for a client with end-stage renal disease. The client is
prescribed a medication that is primarily excreted by the kidneys. What is
the nurse's primary concern?
A. Increased risk of drug toxicity.
B. Decreased absorption of the drug.
C. Increased first-pass effect.
D. Rapid clearance of the medication.
Correct Answer: A
Rationale: If the kidneys cannot effectively excrete the drug, it will
accumulate in the bloodstream, significantly increasing the risk of toxicity.
HESI Pharmacology - Page 1
,ADRENERGIC & CHOLINERGIC AGENTS
3. An older adult client is prescribed a highly protein-bound medication.
The client’s serum albumin level is 2.8 g/dL (normal: 3.5-5.0). What effect
will this have on the medication's action?
A. The drug will be less effective.
B. There will be an increased amount of free, active drug.
C. The drug will be metabolized more quickly.
D. The drug will be unable to reach the target receptors.
Correct Answer: B
Rationale: Highly protein-bound drugs need albumin to stay 'inactive.' Low
albumin means fewer binding sites, resulting in more 'free' (active) drug in
the system, increasing the risk of over-dosage/toxicity.
ANTI-INFECTIVES (ANTIBIOTICS)
4. A client is receiving an intravenous infusion of Vancomycin. The nurse
notes the client’s face and neck have become flushed and red. What is the
nurse's first action?
A. Administer an antihistamine as ordered.
B. Notify the healthcare provider immediately.
C. Stop the infusion.
D. Slow the rate of the infusion.
Correct Answer: D
Rationale: Red Man Syndrome is a rate-dependent reaction to Vancomycin,
not a true allergy. The standard first response is to slow the infusion rate. If
it were anaphylaxis (wheezing, hives), the nurse would stop it entirely.
HESI Pharmacology - Page 2
,ANALGESICS (OPIOIDS/NSAIDS)
5. The healthcare provider orders 0.25 mg of Digoxin. The medication is
available as 125 mcg per tablet. How many tablets will the nurse
administer?
A. 0.5 tablet
B. 1 tablet
C. 2 tablets
D. 3 tablets
Correct Answer: C
Rationale: First, convert mg to mcg: 0.25 mg = 250 mcg. Then, Divide
Desired (250 mcg) by Have (125 mcg) = 2 tablets.
TOXICITY & THERAPEUTIC RANGES
6. HESI Pharmacology Question 6: A nurse is caring for a client receiving a
drug classified as a Toxicity & Therapeutic Ranges. Which assessment
finding requires immediate notification of the healthcare provider?
A. Minor nausea and dry mouth
B. A heart rate change from 80 to 110 bpm
C. The client's refusal to take the medication
D. A blood pressure of 122/78 mmHg
Correct Answer: B
Rationale: Sudden changes in vital signs (tachycardia) suggest an adverse
reaction or toxicity related to the drug's mechanism of action and take
priority over minor side effects.
HESI Pharmacology - Page 3
, LEGAL/ETHICAL ASPECTS OF ADMINISTRATION
7. HESI Pharmacology Question 7: A nurse is caring for a client receiving a
drug classified as a Legal/Ethical Aspects of Administration. Which
assessment finding requires immediate notification of the healthcare
provider?
A. Minor nausea and dry mouth
B. A heart rate change from 80 to 110 bpm
C. The client's refusal to take the medication
D. A blood pressure of 122/78 mmHg
Correct Answer: B
Rationale: Sudden changes in vital signs (tachycardia) suggest an adverse
reaction or toxicity related to the drug's mechanism of action and take
priority over minor side effects.
PHARMACOKINETICS (ADME)
8. HESI Pharmacology Question 8: A nurse is caring for a client receiving a
drug classified as a Pharmacokinetics (ADME). Which assessment finding
requires immediate notification of the healthcare provider?
A. Minor nausea and dry mouth
B. A heart rate change from 80 to 110 bpm
C. The client's refusal to take the medication
D. A blood pressure of 122/78 mmHg
Correct Answer: B
Rationale: Sudden changes in vital signs (tachycardia) suggest an adverse
reaction or toxicity related to the drug's mechanism of action and take
priority over minor side effects.
HESI Pharmacology - Page 4
