HESI PHARMACOLOGY EXAM PRACTICE (VERSION
2022/2023) GRADED A+
CORE DOMAINS
Medication Safety, Administration & Pharmacokinetics
Cardiovascular & Renal Medications
Endocrine & Diabetes Management
Respiratory & Allergic Disorder Medications
Neurological & Psychiatric Medications
Antimicrobials & Anti-Infective Agents
Gastrointestinal & Musculoskeletal Medications
Dosage Calculations & High-Alert Medications
INTRODUCTION
This comprehensive examination assesses the pharmacology knowledge
and clinical decision-making skills required of the nursing student. It
evaluates understanding of medication safety, pharmacokinetics and
pharmacodynamics, and the therapeutic application of pharmacologic
agents across major body systems. The examination employs multiple-
choice and scenario-based questions that simulate realistic clinical
encounters. Emphasis is placed on critical thinking, drug mechanism
understanding, adverse effect monitoring, patient teaching, and the
application of evidence-based pharmacotherapeutics. This assessment
prepares candidates for the rigor of the HESI Pharmacology specialty
examination and real-world clinical practice.
SECTION ONE: MEDICATION SAFETY, ADMINISTRATION &
PHARMACOKINETICS (QUESTIONS 1–20)
1. A nurse is preparing to administer a medication to a client. Which
of the following actions demonstrates the use of two client identifiers
before medication administration?
A. Verifying the client's name and room number
B. Checking the client's armband and asking the client to state their name
and date of birth
,C. Confirming the client's diagnosis and medication order
D. Asking the client if they are allergic to any medications
B. Checking the client's armband and asking the client to state their
name and date of birth
RATIONALE: The Joint Commission requires the use of two client
identifiers before medication administration. Acceptable identifiers include
the client's name, date of birth, medical record number, or telephone
number. The client's armband and the client's verbal confirmation of their
name and date of birth are appropriate identifiers. Room numbers are not
acceptable identifiers.
2. A client with liver cirrhosis is prescribed propranolol 40 mg PO. The
nurse expects the drug's bioavailability to be significantly altered due
to which mechanism?
A. Increased renal excretion of the drug
B. Decreased first-pass metabolism due to hepatic impairment
C. Increased protein binding in the bloodstream
D. Enhanced absorption in the gastrointestinal tract
B. Decreased first-pass metabolism due to hepatic impairment
RATIONALE: First-pass metabolism occurs in the liver, where orally
administered drugs are metabolized before reaching systemic circulation.
In hepatic impairment (cirrhosis), the liver's ability to metabolize drugs is
reduced, leading to increased bioavailability of drugs with high first-pass
metabolism such as propranolol.
3. The nurse is preparing to administer a high-alert medication. Which
action is most important to ensure patient safety?
A. Administer the medication quickly to prevent pain
B. Verify the medication with a second nurse and use two client identifiers
C. Document the medication administration before giving it
D. Ask the client to confirm the medication name
B. Verify the medication with a second nurse and use two client
identifiers
, RATIONALE: High-alert medications carry a heightened risk of
significant patient harm when used in error. Independent double-check with
a second nurse and verification of two client identifiers are essential safety
strategies to prevent medication errors.
4. Which of the following best describes the "Five Rights" of
medication administration?
A. Right Patient, Right Drug, Right Dose, Right Route, Right Time
B. Right Room, Right Bed, Right Time, Right Route, Right Doctor
C. Right Patient, Right Pharmacy, Right Dose, Right Route, Right
Documentation
D. Right Patient, Right Drug, Right Dose, Right Diet, Right Time
A. Right Patient, Right Drug, Right Dose, Right Route, Right Time
RATIONALE: The Five Rights of medication administration are: Right
Patient, Right Drug, Right Dose, Right Route, and Right Time. Some
institutions add Right Documentation and Right to Refuse as additional
rights.
5. A nurse is reviewing a medication order for a client who is
prescribed digoxin. Which assessment finding should the nurse
report before administering the medication?
A. Apical pulse of 58 beats per minute
B. Blood pressure of 128/76 mmHg
C. Respiratory rate of 18 breaths per minute
D. Temperature of 98.6°F (37°C)
A. Apical pulse of 58 beats per minute
RATIONALE: Digoxin is a cardiac glycoside that slows the heart rate.
The nurse should assess the apical pulse for a full minute before
administration and hold the dose if the heart rate is below 60 beats per
minute in adults. A pulse of 58 bpm should be reported to the provider
before administering the medication.
6. Which of the following is the primary site of drug metabolism in the
body?
, A. Kidneys
B. Liver
C. Lungs
D. Small intestine
B. Liver
RATIONALE: The liver is the primary site of drug metabolism, where
drugs are chemically altered (biotransformed) into metabolites. The kidneys
are the primary site of drug excretion.
7. A nurse is educating a client about a new prescription for
sublingual nitroglycerin. Which statement by the client indicates a
need for further teaching?
A. "I will place the tablet under my tongue and let it dissolve."
B. "I will swallow the tablet with a glass of water."
C. "I will sit or lie down when taking this medication."
D. "I will call 911 if my chest pain does not improve after 3 tablets."
B. "I will swallow the tablet with a glass of water."
RATIONALE: Sublingual nitroglycerin must be placed under the tongue
and allowed to dissolve completely; it is not swallowed. Swallowing the
tablet would subject the medication to first-pass hepatic metabolism,
significantly reducing its effectiveness. The client should sit or lie down to
prevent hypotension and call 911 if chest pain persists after 3 tablets taken
5 minutes apart.
8. A client is prescribed warfarin. Which laboratory value should the
nurse monitor to evaluate the effectiveness of the medication?
A. aPTT
B. INR
C. Platelet count
D. Hemoglobin
B. INR
RATIONALE: Warfarin is an anticoagulant that inhibits vitamin K-
2022/2023) GRADED A+
CORE DOMAINS
Medication Safety, Administration & Pharmacokinetics
Cardiovascular & Renal Medications
Endocrine & Diabetes Management
Respiratory & Allergic Disorder Medications
Neurological & Psychiatric Medications
Antimicrobials & Anti-Infective Agents
Gastrointestinal & Musculoskeletal Medications
Dosage Calculations & High-Alert Medications
INTRODUCTION
This comprehensive examination assesses the pharmacology knowledge
and clinical decision-making skills required of the nursing student. It
evaluates understanding of medication safety, pharmacokinetics and
pharmacodynamics, and the therapeutic application of pharmacologic
agents across major body systems. The examination employs multiple-
choice and scenario-based questions that simulate realistic clinical
encounters. Emphasis is placed on critical thinking, drug mechanism
understanding, adverse effect monitoring, patient teaching, and the
application of evidence-based pharmacotherapeutics. This assessment
prepares candidates for the rigor of the HESI Pharmacology specialty
examination and real-world clinical practice.
SECTION ONE: MEDICATION SAFETY, ADMINISTRATION &
PHARMACOKINETICS (QUESTIONS 1–20)
1. A nurse is preparing to administer a medication to a client. Which
of the following actions demonstrates the use of two client identifiers
before medication administration?
A. Verifying the client's name and room number
B. Checking the client's armband and asking the client to state their name
and date of birth
,C. Confirming the client's diagnosis and medication order
D. Asking the client if they are allergic to any medications
B. Checking the client's armband and asking the client to state their
name and date of birth
RATIONALE: The Joint Commission requires the use of two client
identifiers before medication administration. Acceptable identifiers include
the client's name, date of birth, medical record number, or telephone
number. The client's armband and the client's verbal confirmation of their
name and date of birth are appropriate identifiers. Room numbers are not
acceptable identifiers.
2. A client with liver cirrhosis is prescribed propranolol 40 mg PO. The
nurse expects the drug's bioavailability to be significantly altered due
to which mechanism?
A. Increased renal excretion of the drug
B. Decreased first-pass metabolism due to hepatic impairment
C. Increased protein binding in the bloodstream
D. Enhanced absorption in the gastrointestinal tract
B. Decreased first-pass metabolism due to hepatic impairment
RATIONALE: First-pass metabolism occurs in the liver, where orally
administered drugs are metabolized before reaching systemic circulation.
In hepatic impairment (cirrhosis), the liver's ability to metabolize drugs is
reduced, leading to increased bioavailability of drugs with high first-pass
metabolism such as propranolol.
3. The nurse is preparing to administer a high-alert medication. Which
action is most important to ensure patient safety?
A. Administer the medication quickly to prevent pain
B. Verify the medication with a second nurse and use two client identifiers
C. Document the medication administration before giving it
D. Ask the client to confirm the medication name
B. Verify the medication with a second nurse and use two client
identifiers
, RATIONALE: High-alert medications carry a heightened risk of
significant patient harm when used in error. Independent double-check with
a second nurse and verification of two client identifiers are essential safety
strategies to prevent medication errors.
4. Which of the following best describes the "Five Rights" of
medication administration?
A. Right Patient, Right Drug, Right Dose, Right Route, Right Time
B. Right Room, Right Bed, Right Time, Right Route, Right Doctor
C. Right Patient, Right Pharmacy, Right Dose, Right Route, Right
Documentation
D. Right Patient, Right Drug, Right Dose, Right Diet, Right Time
A. Right Patient, Right Drug, Right Dose, Right Route, Right Time
RATIONALE: The Five Rights of medication administration are: Right
Patient, Right Drug, Right Dose, Right Route, and Right Time. Some
institutions add Right Documentation and Right to Refuse as additional
rights.
5. A nurse is reviewing a medication order for a client who is
prescribed digoxin. Which assessment finding should the nurse
report before administering the medication?
A. Apical pulse of 58 beats per minute
B. Blood pressure of 128/76 mmHg
C. Respiratory rate of 18 breaths per minute
D. Temperature of 98.6°F (37°C)
A. Apical pulse of 58 beats per minute
RATIONALE: Digoxin is a cardiac glycoside that slows the heart rate.
The nurse should assess the apical pulse for a full minute before
administration and hold the dose if the heart rate is below 60 beats per
minute in adults. A pulse of 58 bpm should be reported to the provider
before administering the medication.
6. Which of the following is the primary site of drug metabolism in the
body?
, A. Kidneys
B. Liver
C. Lungs
D. Small intestine
B. Liver
RATIONALE: The liver is the primary site of drug metabolism, where
drugs are chemically altered (biotransformed) into metabolites. The kidneys
are the primary site of drug excretion.
7. A nurse is educating a client about a new prescription for
sublingual nitroglycerin. Which statement by the client indicates a
need for further teaching?
A. "I will place the tablet under my tongue and let it dissolve."
B. "I will swallow the tablet with a glass of water."
C. "I will sit or lie down when taking this medication."
D. "I will call 911 if my chest pain does not improve after 3 tablets."
B. "I will swallow the tablet with a glass of water."
RATIONALE: Sublingual nitroglycerin must be placed under the tongue
and allowed to dissolve completely; it is not swallowed. Swallowing the
tablet would subject the medication to first-pass hepatic metabolism,
significantly reducing its effectiveness. The client should sit or lie down to
prevent hypotension and call 911 if chest pain persists after 3 tablets taken
5 minutes apart.
8. A client is prescribed warfarin. Which laboratory value should the
nurse monitor to evaluate the effectiveness of the medication?
A. aPTT
B. INR
C. Platelet count
D. Hemoglobin
B. INR
RATIONALE: Warfarin is an anticoagulant that inhibits vitamin K-
