HESI Pharmacology Practice Test
2026/2027
100 Questions, Answers & Rationales for Nursing Students
1. A nurse is preparing to administer digoxin to a client with heart failure. Which vital
sign is most important to assess before administration?
A. Blood pressure
B. Apical pulse
C. Respiratory rate
D. Temperature
Correct Answer: B
Rationale: Digoxin is a cardiac glycoside that slows the heart rate. The apical pulse must be checked for
one full minute; the medication is typically withheld if the pulse is less than 60 bpm in adults.
2. A client is prescribed spironolactone. Which lab value should the nurse monitor
closely?
A. Serum sodium
B. Serum potassium
C. Serum glucose
D. Serum calcium
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. It can lead to hyperkalemia, so monitoring
potassium levels is critical.
,3. Which medication is considered the antidote for heparin toxicity?
A. Vitamin K
B. Protamine sulfate
C. Glucagon
D. Acetylcysteine
Correct Answer: B
Rationale: Protamine sulfate is the specific antidote used to reverse the effects of heparin. Vitamin K is
for warfarin.
4. A nurse is teaching a client about sublingual nitroglycerin for angina. Which
statement by the client indicates a need for further teaching?
A. 'I should sit down before taking the tablet.'
B. 'I can take up to three doses, 5 minutes apart.'
C. 'I should swallow the tablet with a full glass of water.'
D. 'I should keep the tablets in their original dark glass bottle.'
Correct Answer: C
Rationale: Sublingual nitroglycerin must be dissolved under the tongue to be absorbed directly into the
bloodstream. Swallowing it will result in first-pass metabolism in the liver, making it ineffective.
5. A client is taking warfarin for atrial fibrillation. Which food choice should the nurse
advise the client to maintain in a consistent daily intake?
A. Bananas
B. Spinach
C. Whole grain bread
D. Red meat
Correct Answer: B
Rationale: Spinach is high in Vitamin K, which is the antagonist to warfarin. Consistent intake is
necessary to maintain a stable International Normalized Ratio (INR).
,6. A client is diagnosed with a dry, hacking cough after starting an ACE inhibitor. Which
medication class might the provider switch the client to?
A. Beta-blockers
B. Calcium channel blockers
C. Angiotensin II receptor blockers (ARBs)
D. Loop diuretics
Correct Answer: C
Rationale: ARBs (like losartan) are often prescribed for patients who cannot tolerate the 'ACE cough'
caused by the accumulation of bradykinin.
7. What is the primary mechanism of action of metformin?
A. Stimulating insulin production from the pancreas
B. Increasing glucose uptake in the kidneys
C. Decreasing hepatic glucose production and increasing insulin sensitivity
D. Inhibiting carbohydrate absorption in the small intestine
Correct Answer: C
Rationale: Metformin is a biguanide that reduces glucose production by the liver and improves insulin
sensitivity in peripheral tissues.
8. A nurse is administering lispro insulin. When should the nurse expect the onset of
action?
A. 15 to 30 minutes
B. 1 to 3 hours
C. 4 to 6 hours
D. 12 to 24 hours
Correct Answer: A
Rationale: Lispro is a rapid-acting insulin with an onset of 15-30 minutes. It should be administered right
before a meal.
, 9. Which of the following is a common side effect of rifampin used in tuberculosis
treatment?
A. Peripheral neuropathy
B. Orange-colored bodily fluids
C. Auditory nerve damage
D. Photosensitivity
Correct Answer: B
Rationale: Rifampin commonly causes a harmless reddish-orange discoloration of urine, sweat, tears,
and saliva.
10. A client receiving IV vancomycin reports neck pain and has a flushed face and
chest. What is the nurse's priority action?
A. Administer epinephrine
B. Increase the infusion rate
C. Slow the infusion rate
D. Stop the infusion and notify the provider
Correct Answer: C
Rationale: These are signs of 'Red Man Syndrome,' a rate-related reaction. The priority is to slow the
infusion. If it were a true anaphylactic reaction (hives, wheezing), the infusion would be stopped.
11. The nurse is monitoring a client on lithium carbonate. Which electrolyte imbalance
increases the risk of lithium toxicity?
A. Hyponatremia
B. Hypernatremia
C. Hypokalemia
D. Hypercalcemia
Correct Answer: A
Rationale: Low sodium levels (hyponatremia) cause the kidneys to retain lithium, leading to toxic levels.
2026/2027
100 Questions, Answers & Rationales for Nursing Students
1. A nurse is preparing to administer digoxin to a client with heart failure. Which vital
sign is most important to assess before administration?
A. Blood pressure
B. Apical pulse
C. Respiratory rate
D. Temperature
Correct Answer: B
Rationale: Digoxin is a cardiac glycoside that slows the heart rate. The apical pulse must be checked for
one full minute; the medication is typically withheld if the pulse is less than 60 bpm in adults.
2. A client is prescribed spironolactone. Which lab value should the nurse monitor
closely?
A. Serum sodium
B. Serum potassium
C. Serum glucose
D. Serum calcium
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. It can lead to hyperkalemia, so monitoring
potassium levels is critical.
,3. Which medication is considered the antidote for heparin toxicity?
A. Vitamin K
B. Protamine sulfate
C. Glucagon
D. Acetylcysteine
Correct Answer: B
Rationale: Protamine sulfate is the specific antidote used to reverse the effects of heparin. Vitamin K is
for warfarin.
4. A nurse is teaching a client about sublingual nitroglycerin for angina. Which
statement by the client indicates a need for further teaching?
A. 'I should sit down before taking the tablet.'
B. 'I can take up to three doses, 5 minutes apart.'
C. 'I should swallow the tablet with a full glass of water.'
D. 'I should keep the tablets in their original dark glass bottle.'
Correct Answer: C
Rationale: Sublingual nitroglycerin must be dissolved under the tongue to be absorbed directly into the
bloodstream. Swallowing it will result in first-pass metabolism in the liver, making it ineffective.
5. A client is taking warfarin for atrial fibrillation. Which food choice should the nurse
advise the client to maintain in a consistent daily intake?
A. Bananas
B. Spinach
C. Whole grain bread
D. Red meat
Correct Answer: B
Rationale: Spinach is high in Vitamin K, which is the antagonist to warfarin. Consistent intake is
necessary to maintain a stable International Normalized Ratio (INR).
,6. A client is diagnosed with a dry, hacking cough after starting an ACE inhibitor. Which
medication class might the provider switch the client to?
A. Beta-blockers
B. Calcium channel blockers
C. Angiotensin II receptor blockers (ARBs)
D. Loop diuretics
Correct Answer: C
Rationale: ARBs (like losartan) are often prescribed for patients who cannot tolerate the 'ACE cough'
caused by the accumulation of bradykinin.
7. What is the primary mechanism of action of metformin?
A. Stimulating insulin production from the pancreas
B. Increasing glucose uptake in the kidneys
C. Decreasing hepatic glucose production and increasing insulin sensitivity
D. Inhibiting carbohydrate absorption in the small intestine
Correct Answer: C
Rationale: Metformin is a biguanide that reduces glucose production by the liver and improves insulin
sensitivity in peripheral tissues.
8. A nurse is administering lispro insulin. When should the nurse expect the onset of
action?
A. 15 to 30 minutes
B. 1 to 3 hours
C. 4 to 6 hours
D. 12 to 24 hours
Correct Answer: A
Rationale: Lispro is a rapid-acting insulin with an onset of 15-30 minutes. It should be administered right
before a meal.
, 9. Which of the following is a common side effect of rifampin used in tuberculosis
treatment?
A. Peripheral neuropathy
B. Orange-colored bodily fluids
C. Auditory nerve damage
D. Photosensitivity
Correct Answer: B
Rationale: Rifampin commonly causes a harmless reddish-orange discoloration of urine, sweat, tears,
and saliva.
10. A client receiving IV vancomycin reports neck pain and has a flushed face and
chest. What is the nurse's priority action?
A. Administer epinephrine
B. Increase the infusion rate
C. Slow the infusion rate
D. Stop the infusion and notify the provider
Correct Answer: C
Rationale: These are signs of 'Red Man Syndrome,' a rate-related reaction. The priority is to slow the
infusion. If it were a true anaphylactic reaction (hives, wheezing), the infusion would be stopped.
11. The nurse is monitoring a client on lithium carbonate. Which electrolyte imbalance
increases the risk of lithium toxicity?
A. Hyponatremia
B. Hypernatremia
C. Hypokalemia
D. Hypercalcemia
Correct Answer: A
Rationale: Low sodium levels (hyponatremia) cause the kidneys to retain lithium, leading to toxic levels.
