PHARM HESI PRACTICE EXAM
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE. JUST RELEASED
1. A client with a history of heart failure is prescribed digoxin. Which assessment finding
should the nurse prioritize as an early sign of digoxin toxicity?
A. Anorexia and nausea
B. Hyperkalemia
C. Ventricular tachycardia
D. Yellow-green halos in vision
Answer: A
Conceptual Explanation: Anorexia, nausea, and vomiting are often the earliest signs of
digoxin toxicity. Visual disturbances like yellow-green halos and arrhythmias are later,
more severe signs.
,2. A patient is receiving an intravenous infusion of heparin for deep vein thrombosis. The
nurse notes the activated partial thromboplastin time (aPTT) is 110 seconds. What is the
priority nursing action?
A. Stop the infusion and notify the provider
B. Increase the infusion rate per protocol
C. Continue the infusion at the current rate
D. Administer Vitamin K intramuscularly
Answer: A
Conceptual Explanation: The therapeutic range for aPTT is generally 1.5 to 2.5 times the
control (roughly 45-70 seconds). 110 seconds is significantly supratherapeutic, posing a
high risk for bleeding; the infusion must be stopped.
3. A patient diagnosed with bipolar disorder is taking lithium carbonate. Which electrolyte
imbalance should the nurse most closely monitor to prevent lithium toxicity?
A. Hypercalcemia
B. Hypomagnesemia
C. Hyperkalemia
D. Hyponatremia
Answer: D
, Conceptual Explanation: Lithium is a salt. When sodium levels are low (hyponatremia),
the kidneys retain lithium in an attempt to maintain electrolyte balance, leading to toxic
lithium levels.
4. The nurse is preparing to administer spironolactone to a patient with cirrhosis. Which lab
value requires immediate follow-up before administration?
A. INR of 1.4
B. Serum Sodium of 134 mEq/L
C. Bilirubin of 2.0 mg/dL
D. Serum Potassium of 5.8 mEq/L
Answer: D
Conceptual Explanation: Spironolactone is a potassium-sparing diuretic. A potassium
level of 5.8 mEq/L indicates hyperkalemia, which can lead to life-threatening cardiac
arrhythmias if the drug is administered.
5. A client is prescribed vancomycin IV for a MRSA infection. During the infusion, the client
develops intense flushing of the face and neck. What is the nurse’s first action?
A. Administer diphenhydramine immediately
B. Stop the infusion and prepare for intubation
C. Slow the infusion rate
D. Apply cold compresses to the neck
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE. JUST RELEASED
1. A client with a history of heart failure is prescribed digoxin. Which assessment finding
should the nurse prioritize as an early sign of digoxin toxicity?
A. Anorexia and nausea
B. Hyperkalemia
C. Ventricular tachycardia
D. Yellow-green halos in vision
Answer: A
Conceptual Explanation: Anorexia, nausea, and vomiting are often the earliest signs of
digoxin toxicity. Visual disturbances like yellow-green halos and arrhythmias are later,
more severe signs.
,2. A patient is receiving an intravenous infusion of heparin for deep vein thrombosis. The
nurse notes the activated partial thromboplastin time (aPTT) is 110 seconds. What is the
priority nursing action?
A. Stop the infusion and notify the provider
B. Increase the infusion rate per protocol
C. Continue the infusion at the current rate
D. Administer Vitamin K intramuscularly
Answer: A
Conceptual Explanation: The therapeutic range for aPTT is generally 1.5 to 2.5 times the
control (roughly 45-70 seconds). 110 seconds is significantly supratherapeutic, posing a
high risk for bleeding; the infusion must be stopped.
3. A patient diagnosed with bipolar disorder is taking lithium carbonate. Which electrolyte
imbalance should the nurse most closely monitor to prevent lithium toxicity?
A. Hypercalcemia
B. Hypomagnesemia
C. Hyperkalemia
D. Hyponatremia
Answer: D
, Conceptual Explanation: Lithium is a salt. When sodium levels are low (hyponatremia),
the kidneys retain lithium in an attempt to maintain electrolyte balance, leading to toxic
lithium levels.
4. The nurse is preparing to administer spironolactone to a patient with cirrhosis. Which lab
value requires immediate follow-up before administration?
A. INR of 1.4
B. Serum Sodium of 134 mEq/L
C. Bilirubin of 2.0 mg/dL
D. Serum Potassium of 5.8 mEq/L
Answer: D
Conceptual Explanation: Spironolactone is a potassium-sparing diuretic. A potassium
level of 5.8 mEq/L indicates hyperkalemia, which can lead to life-threatening cardiac
arrhythmias if the drug is administered.
5. A client is prescribed vancomycin IV for a MRSA infection. During the infusion, the client
develops intense flushing of the face and neck. What is the nurse’s first action?
A. Administer diphenhydramine immediately
B. Stop the infusion and prepare for intubation
C. Slow the infusion rate
D. Apply cold compresses to the neck
