2021 HESI PHARMACOLOGY VERSION 1-
100 QUESTIONS AND ANSWERS WITH
RATIONALE
Section 1: Medication Administration & Safety (Q1–20)
1. The nurse is preparing to administer digoxin to an adult client. Which assessment finding
requires the nurse to withhold the dose and notify the provider?
A. Heart rate 88 bpm
B. Apical heart rate 52 bpm
C. Blood pressure 118/76 mm Hg
D. Serum potassium 4.2 mEq/L
Digoxin slows conduction through the AV node; a resting apical rate below 60 bpm in an
adult is a classic reason to hold the dose. Hypokalemia (not normokalemia) potentiates digoxin
toxicity.
2. Which action by the nurse best demonstrates the "rights" of medication administration?
A. Checking the client's name band before giving a medication
B. Verifying the medication against the MAR using two client identifiers
C. Asking the client to state their name before administration
D. Documenting the dose before administering it
Using two identifiers and comparing the MAR to the medication label is the core safety
check. Documentation should occur after administration, not before.
3. A nurse is preparing to give a subcutaneous injection of heparin. Which site and technique
are appropriate? (SATA)
A. Abdomen, at least 2 inches from the umbilicus
B. 90-degree angle with a short needle
C. Deltoid muscle, 45-degree angle
D. Rotate sites and avoid aspirating before injection
E. Massage the site vigorously after injection
, Heparin is given subcutaneously in the abdomen; aspiration and massage are avoided to
reduce hematoma risk. The deltoid is an IM site, and massage increases bleeding.
4. The nurse is administering a medication that is highly protein-bound. Which client is at
greatest risk for drug toxicity?
A. A client with dehydration
B. A client with cirrhosis and low albumin
C. A client with a fractured femur
D. A client with a urinary tract infection
Low albumin means fewer binding sites, increasing free (active) drug and risk of toxicity.
Dehydration can also raise concentrations, but hypoalbuminemia is the most direct cause.
5. A client is prescribed a medication with a narrow therapeutic index. Which nursing action is
most important?
A. Administer with food to reduce GI upset
B. Monitor serum drug levels and assess for toxicity
C. Encourage increased fluid intake
D. Teach the client to double the dose if a dose is missed
Narrow therapeutic index drugs (e.g., digoxin, warfarin, phenytoin, lithium) require
therapeutic drug monitoring because small changes can cause toxicity or therapeutic failure.
6. The nurse is teaching a client about a new prescription. Which statement indicates the
client needs further teaching?
A. "I will use a pill organizer to remember my doses."
B. "I will check with my pharmacist before taking herbal supplements."
C. "I will stop taking the medication as soon as I feel better."
D. "I will keep a list of all my medications with me."
Many medications (antibiotics, antihypertensives, antidepressants) must be completed or
taken consistently; stopping early can cause relapse or rebound effects.
7. Which route of administration has the most rapid onset of action?
A. Oral
,B. Subcutaneous
C. Intravenous
D. Intramuscular
IV bypasses absorption barriers, producing the most rapid onset. IM and SC are slower; oral
is slowest and affected by first-pass metabolism.
8. A nurse is calculating a pediatric dose. The child weighs 22 lb. The ordered dose is 10
mg/kg/day divided every 12 hours. How many mg per dose should the nurse administer?
(Round to the nearest whole number.)
A. 25 mg
B. 50 mg
C. 100 mg
D. 220 mg
22 lb ÷ 2.2 = 10 kg. 10 mg/kg/day × 10 kg = 100 mg/day ÷ 2 doses = 50 mg/dose.
9. The nurse is preparing to administer an oral medication to a client with a nasogastric (NG)
tube. Which action is correct?
A. Mix the medication with enteral feeding formula
B. Flush with 15–30 mL of water before and after each medication
C. Administer all medications together in one syringe
D. Give extended-release tablets crushed with water
Flushing prevents clogging and ensures delivery. Medications should be given separately,
and extended-release forms should not be crushed unless specifically ordered.
10. Which client is at highest risk for adverse drug reactions?
A. A 25-year-old athlete
B. A 40-year-old with hypertension
C. An 82-year-old taking nine medications
D. A 55-year-old with seasonal allergies
Polypharmacy and age-related changes in renal/hepatic function, body composition, and
albumin increase adverse drug reaction risk in older adults.
, 11. A nurse is reviewing a medication order that reads "MSO4 2 mg IV q4h prn." Which action
is the priority?
A. Administer the medication as ordered
B. Clarify the order because "MSO4" can be misread as magnesium sulfate
C. Ask another nurse to administer it
D. Document the order as written and give the drug
"MSO4" is a dangerous abbreviation that can mean morphine sulfate or magnesium sulfate.
The nurse must clarify before administration.
12. The nurse is teaching a client about safe medication storage. Which statement is correct?
A. "Keep all medications in the bathroom cabinet."
B. "Store medications in a cool, dry place away from direct sunlight."
C. "Transfer medications to unlabeled containers to save space."
D. "Keep nitroglycerin in the refrigerator."
Heat, moisture, and light can degrade medications. Bathrooms are humid; unlabeled
containers are unsafe. Nitroglycerin should be kept in its original dark glass container, not
refrigerated.
13. A client refuses a scheduled medication. Which action should the nurse take first?
A. Administer the medication by a different route
B. Explore the client's reason for refusal and document it
C. Notify the provider immediately
D. Crush the medication and hide it in food
The client has the right to refuse. The nurse should assess the reason, educate, document,
and notify the provider if refusal continues. Hiding medication violates autonomy.
14. Which statement about the "right documentation" is accurate?
A. Documentation can be done at the end of the shift
B. Documentation should occur immediately after administration
C. Pre-charting is acceptable if the nurse is busy
D. Only the provider needs to document administered drugs
100 QUESTIONS AND ANSWERS WITH
RATIONALE
Section 1: Medication Administration & Safety (Q1–20)
1. The nurse is preparing to administer digoxin to an adult client. Which assessment finding
requires the nurse to withhold the dose and notify the provider?
A. Heart rate 88 bpm
B. Apical heart rate 52 bpm
C. Blood pressure 118/76 mm Hg
D. Serum potassium 4.2 mEq/L
Digoxin slows conduction through the AV node; a resting apical rate below 60 bpm in an
adult is a classic reason to hold the dose. Hypokalemia (not normokalemia) potentiates digoxin
toxicity.
2. Which action by the nurse best demonstrates the "rights" of medication administration?
A. Checking the client's name band before giving a medication
B. Verifying the medication against the MAR using two client identifiers
C. Asking the client to state their name before administration
D. Documenting the dose before administering it
Using two identifiers and comparing the MAR to the medication label is the core safety
check. Documentation should occur after administration, not before.
3. A nurse is preparing to give a subcutaneous injection of heparin. Which site and technique
are appropriate? (SATA)
A. Abdomen, at least 2 inches from the umbilicus
B. 90-degree angle with a short needle
C. Deltoid muscle, 45-degree angle
D. Rotate sites and avoid aspirating before injection
E. Massage the site vigorously after injection
, Heparin is given subcutaneously in the abdomen; aspiration and massage are avoided to
reduce hematoma risk. The deltoid is an IM site, and massage increases bleeding.
4. The nurse is administering a medication that is highly protein-bound. Which client is at
greatest risk for drug toxicity?
A. A client with dehydration
B. A client with cirrhosis and low albumin
C. A client with a fractured femur
D. A client with a urinary tract infection
Low albumin means fewer binding sites, increasing free (active) drug and risk of toxicity.
Dehydration can also raise concentrations, but hypoalbuminemia is the most direct cause.
5. A client is prescribed a medication with a narrow therapeutic index. Which nursing action is
most important?
A. Administer with food to reduce GI upset
B. Monitor serum drug levels and assess for toxicity
C. Encourage increased fluid intake
D. Teach the client to double the dose if a dose is missed
Narrow therapeutic index drugs (e.g., digoxin, warfarin, phenytoin, lithium) require
therapeutic drug monitoring because small changes can cause toxicity or therapeutic failure.
6. The nurse is teaching a client about a new prescription. Which statement indicates the
client needs further teaching?
A. "I will use a pill organizer to remember my doses."
B. "I will check with my pharmacist before taking herbal supplements."
C. "I will stop taking the medication as soon as I feel better."
D. "I will keep a list of all my medications with me."
Many medications (antibiotics, antihypertensives, antidepressants) must be completed or
taken consistently; stopping early can cause relapse or rebound effects.
7. Which route of administration has the most rapid onset of action?
A. Oral
,B. Subcutaneous
C. Intravenous
D. Intramuscular
IV bypasses absorption barriers, producing the most rapid onset. IM and SC are slower; oral
is slowest and affected by first-pass metabolism.
8. A nurse is calculating a pediatric dose. The child weighs 22 lb. The ordered dose is 10
mg/kg/day divided every 12 hours. How many mg per dose should the nurse administer?
(Round to the nearest whole number.)
A. 25 mg
B. 50 mg
C. 100 mg
D. 220 mg
22 lb ÷ 2.2 = 10 kg. 10 mg/kg/day × 10 kg = 100 mg/day ÷ 2 doses = 50 mg/dose.
9. The nurse is preparing to administer an oral medication to a client with a nasogastric (NG)
tube. Which action is correct?
A. Mix the medication with enteral feeding formula
B. Flush with 15–30 mL of water before and after each medication
C. Administer all medications together in one syringe
D. Give extended-release tablets crushed with water
Flushing prevents clogging and ensures delivery. Medications should be given separately,
and extended-release forms should not be crushed unless specifically ordered.
10. Which client is at highest risk for adverse drug reactions?
A. A 25-year-old athlete
B. A 40-year-old with hypertension
C. An 82-year-old taking nine medications
D. A 55-year-old with seasonal allergies
Polypharmacy and age-related changes in renal/hepatic function, body composition, and
albumin increase adverse drug reaction risk in older adults.
, 11. A nurse is reviewing a medication order that reads "MSO4 2 mg IV q4h prn." Which action
is the priority?
A. Administer the medication as ordered
B. Clarify the order because "MSO4" can be misread as magnesium sulfate
C. Ask another nurse to administer it
D. Document the order as written and give the drug
"MSO4" is a dangerous abbreviation that can mean morphine sulfate or magnesium sulfate.
The nurse must clarify before administration.
12. The nurse is teaching a client about safe medication storage. Which statement is correct?
A. "Keep all medications in the bathroom cabinet."
B. "Store medications in a cool, dry place away from direct sunlight."
C. "Transfer medications to unlabeled containers to save space."
D. "Keep nitroglycerin in the refrigerator."
Heat, moisture, and light can degrade medications. Bathrooms are humid; unlabeled
containers are unsafe. Nitroglycerin should be kept in its original dark glass container, not
refrigerated.
13. A client refuses a scheduled medication. Which action should the nurse take first?
A. Administer the medication by a different route
B. Explore the client's reason for refusal and document it
C. Notify the provider immediately
D. Crush the medication and hide it in food
The client has the right to refuse. The nurse should assess the reason, educate, document,
and notify the provider if refusal continues. Hiding medication violates autonomy.
14. Which statement about the "right documentation" is accurate?
A. Documentation can be done at the end of the shift
B. Documentation should occur immediately after administration
C. Pre-charting is acceptable if the nurse is busy
D. Only the provider needs to document administered drugs
