PHARMACOLOGY HESI EXAM PREP SET 1 EXAM
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Before giving metoprolol, the nurse notes a heart rate of 48/min and blood pressure of 104/68 mm Hg.
Which action is most appropriate?
A. Administer the dose because beta blockers are expected to increase heart rate.
B. Hold the dose and follow the prescribed parameters or contact the prescriber for guidance.
C. Give the medication and ambulate the client immediately to raise the pulse.
D. Double the dose because the blood pressure is not dangerously low.
Correct Answer: B. Hold the dose and follow the prescribed parameters or contact the prescriber for guidance.
Rationale: Beta blockers reduce heart rate and blood pressure. Significant bradycardia is a reason to withhold the
dose according to ordered parameters and seek guidance.
2. Which instruction is most important for a client taking doxycycline?
A. Take each dose with a large glass of milk to prevent all gastrointestinal effects.
B. Stop the medication as soon as the fever resolves, even if doses remain.
C. Separate the medication from antacids, iron, calcium supplements, and similar products that can reduce
absorption.
D. Take the medication immediately before lying down to improve absorption.
Correct Answer: C. Separate the medication from antacids, iron, calcium supplements, and similar products that
can reduce absorption.
Rationale: Divalent and trivalent cations can chelate tetracyclines and reduce absorption. Doxycycline should
also be taken with sufficient water and not immediately before lying down because of esophageal irritation risk.
3. A client begins lisinopril and later reports a persistent dry cough with no fever or respiratory illness.
Which interpretation is most appropriate?
A. The cough is a known ACE-inhibitor adverse effect and should be reported for possible therapy change.
B. The cough proves the medication is reducing pulmonary edema and should not be reported.
C. The cough indicates acute bacterial pneumonia caused by lisinopril.
D. The cough means the dose is too low and should be doubled.
Correct Answer: A. The cough is a known ACE-inhibitor adverse effect and should be reported for possible
therapy change.
Rationale: A persistent dry cough can occur with ACE inhibitors because of bradykinin accumulation. It is not
dangerous by itself but can be bothersome enough to require a change in therapy.
4. Which symptom should a client taking a long-term antipsychotic report promptly?
A. Mild thirst after exercise
B. Occasional hiccups after meals
C. Temporary nasal congestion during a cold
D. New repetitive lip smacking and involuntary tongue movements.
Correct Answer: D. New repetitive lip smacking and involuntary tongue movements.
Rationale: Involuntary facial and tongue movements can indicate tardive dyskinesia, a potentially persistent
movement disorder associated with dopamine-blocking antipsychotics.
5. A client taking warfarin has black tarry stools and dizziness. What should the nurse instruct the client to
do?
A. Skip leafy green vegetables for one day and continue warfarin.
B. Take an extra dose of warfarin to prevent clot formation during the episode.
C. Begin an over-the-counter NSAID for abdominal discomfort.
D. Seek urgent medical evaluation because the findings may indicate gastrointestinal bleeding.
Correct Answer: D. Seek urgent medical evaluation because the findings may indicate gastrointestinal bleeding.
Rationale: Melena and dizziness can indicate significant bleeding, a serious complication of anticoagulation. The
client needs prompt assessment; NSAIDs can further increase bleeding risk.
6. A client taking an SSRI is given tramadol and later develops agitation, diaphoresis, clonus, and
hyperreflexia. Which adverse reaction is most likely?
A. Serotonin syndrome
B. Malignant hyperthermia
,C. Acute cholinergic crisis
D. Opioid withdrawal
Correct Answer: A. Serotonin syndrome
Rationale: Combining serotonergic drugs can precipitate serotonin syndrome. Neuromuscular hyperactivity such
as clonus and hyperreflexia helps distinguish it from other hyperthermic syndromes.
7. A client scheduled to receive a nitrate has a blood pressure of 82/50 mm Hg and reports lightheadedness.
Which interpretation is most appropriate?
A. The low blood pressure indicates the client needs a larger nitrate dose.
B. The nitrate may worsen hypotension, so the dose should be held and the prescriber notified according to
parameters.
C. Nitrates affect only coronary arteries and will not alter systemic blood pressure.
D. The finding is expected and requires no reassessment.
Correct Answer: B. The nitrate may worsen hypotension, so the dose should be held and the prescriber notified
according to parameters.
Rationale: Nitrates dilate veins and arteries and can significantly lower blood pressure. Symptomatic
hypotension is a reason to withhold the medication and seek guidance.
8. Which supplement is commonly prescribed with isoniazid for a client at risk for peripheral neuropathy?
A. Vitamin K
B. Folic acid
C. Pyridoxine (vitamin B6)
D. Vitamin C
Correct Answer: C. Pyridoxine (vitamin B6)
Rationale: Isoniazid can interfere with pyridoxine metabolism and cause peripheral neuropathy. Vitamin B6
supplementation is used to reduce this risk in susceptible clients.
9. Which statement accurately compares apixaban with warfarin for many clients receiving chronic
anticoagulation?
A. Apixaban has a more predictable anticoagulant effect and does not require routine INR monitoring.
B. Apixaban requires a target INR of 2 to 3 before each dose.
C. Apixaban is reversed with vitamin K in the same way as warfarin.
D. Apixaban has no clinically important bleeding risk.
Correct Answer: A. Apixaban has a more predictable anticoagulant effect and does not require routine INR
monitoring.
Rationale: Direct factor Xa inhibitors such as apixaban have predictable dosing and do not use routine INR
monitoring. They still carry significant bleeding risk and have different reversal strategies than warfarin.
10. A client has severe vomiting and cannot retain oral medications. The provider changes an oral drug to
an IV form. Which pharmacokinetic difference should the nurse anticipate with IV administration?
A. The drug will be absorbed more slowly because it must diffuse through muscle tissue.
B. The drug will undergo greater first-pass hepatic metabolism before reaching circulation.
C. The drug enters systemic circulation directly and bypasses gastrointestinal absorption and first-pass
metabolism.
D. The drug will have lower bioavailability because IV solutions are more dilute than tablets.
Correct Answer: C. The drug enters systemic circulation directly and bypasses gastrointestinal absorption and
first-pass metabolism.
Rationale: IV medication is delivered directly into the bloodstream, producing complete systemic availability
and avoiding gastrointestinal absorption and first-pass metabolism.
11. Which statement by a client prescribed sublingual nitroglycerin indicates correct understanding?
A. I will store the tablets in a weekly pill organizer in the bathroom for convenience.
B. I will swallow the tablets with water because sublingual absorption is unreliable.
C. I can take nitroglycerin with sildenafil because the medicines work in different ways.
D. I will keep the tablets in their original tightly closed container and follow instructions for emergency
evaluation if chest pain is not relieved.
Correct Answer: D. I will keep the tablets in their original tightly closed container and follow instructions for
emergency evaluation if chest pain is not relieved.
, Rationale: Sublingual nitroglycerin should be stored as directed in its original container and used according to
emergency chest-pain instructions. Phosphodiesterase-5 inhibitors such as sildenafil can cause severe hypotension
when combined with nitrates.
12. A client who received insulin becomes shaky, diaphoretic, and confused. Bedside glucose is 48 mg/dL,
and the client can swallow safely. What should the nurse do first?
A. Administer the next scheduled insulin dose to prevent rebound hyperglycemia.
B. Give a rapid-acting oral carbohydrate according to the hypoglycemia protocol.
C. Offer a high-fat meal as the fastest way to raise blood glucose.
D. Restrict oral intake until the glucose rises spontaneously.
Correct Answer: B. Give a rapid-acting oral carbohydrate according to the hypoglycemia protocol.
Rationale: A conscious client with symptomatic hypoglycemia who can swallow should receive a rapid-acting
carbohydrate promptly, followed by reassessment and longer-acting food when appropriate.
13. A client taking atorvastatin reports severe new muscle pain and dark urine after a recent
medication change. Which action is most appropriate?
A. Reassure the client that muscle pain is required for the cholesterol-lowering effect.
B. Increase exercise intensity to strengthen the affected muscles.
C. Promptly report the symptoms and evaluate for muscle injury, including possible rhabdomyolysis.
D. Take the statin with a potassium supplement and continue therapy unchanged.
Correct Answer: C. Promptly report the symptoms and evaluate for muscle injury, including possible
rhabdomyolysis.
Rationale: Severe myalgia with dark urine can indicate significant muscle injury or rhabdomyolysis. The
medication should be reviewed promptly and appropriate laboratory evaluation obtained.
14. A client with a baseline prolonged QT interval is prescribed azithromycin. Which finding makes the
prescription most concerning?
A. The client is also taking another medication known to prolong the QT interval.
B. The client takes acetaminophen occasionally for headaches.
C. The client drinks one glass of water with morning medications.
D. The client uses a topical emollient for dry skin.
Correct Answer: A. The client is also taking another medication known to prolong the QT interval.
Rationale: Macrolides can prolong the QT interval in susceptible clients. Concomitant QT-prolonging drugs and
existing QT prolongation increase the risk for serious ventricular dysrhythmias.
15. Which teaching best distinguishes the expected onset of an SSRI antidepressant from the immediate
effects of a sedative?
A. Antidepressant benefit should be complete after the first dose.
B. Mood improvement may take several weeks even though some adverse effects can appear earlier.
C. If mood does not improve in 24 hours, the client should double the dose.
D. SSRIs work only when taken as needed during episodes of sadness.
Correct Answer: B. Mood improvement may take several weeks even though some adverse effects can appear
earlier.
Rationale: SSRIs are taken regularly and therapeutic mood effects typically develop over weeks. Early adverse
effects may occur before full benefit, so adherence and monitoring are important.
16. Which medication-administration action requires correction?
A. Verifying the client’s identity using two approved identifiers.
B. Comparing the medication label with the medication administration record before giving the dose.
C. Assessing relevant laboratory data before a medication with known organ-toxicity risk.
D. Crushing an extended-release tablet to make it easier for the client to swallow.
Correct Answer: D. Crushing an extended-release tablet to make it easier for the client to swallow.
Rationale: Extended-release formulations generally should not be crushed because doing so can alter release
characteristics and cause dose dumping. The other actions support medication safety.
17. A client taking levothyroxine develops palpitations, tremor, heat intolerance, and insomnia. Which
explanation is most likely?
A. The client has developed insulin deficiency.
B. The thyroid hormone dose may be excessive.
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Before giving metoprolol, the nurse notes a heart rate of 48/min and blood pressure of 104/68 mm Hg.
Which action is most appropriate?
A. Administer the dose because beta blockers are expected to increase heart rate.
B. Hold the dose and follow the prescribed parameters or contact the prescriber for guidance.
C. Give the medication and ambulate the client immediately to raise the pulse.
D. Double the dose because the blood pressure is not dangerously low.
Correct Answer: B. Hold the dose and follow the prescribed parameters or contact the prescriber for guidance.
Rationale: Beta blockers reduce heart rate and blood pressure. Significant bradycardia is a reason to withhold the
dose according to ordered parameters and seek guidance.
2. Which instruction is most important for a client taking doxycycline?
A. Take each dose with a large glass of milk to prevent all gastrointestinal effects.
B. Stop the medication as soon as the fever resolves, even if doses remain.
C. Separate the medication from antacids, iron, calcium supplements, and similar products that can reduce
absorption.
D. Take the medication immediately before lying down to improve absorption.
Correct Answer: C. Separate the medication from antacids, iron, calcium supplements, and similar products that
can reduce absorption.
Rationale: Divalent and trivalent cations can chelate tetracyclines and reduce absorption. Doxycycline should
also be taken with sufficient water and not immediately before lying down because of esophageal irritation risk.
3. A client begins lisinopril and later reports a persistent dry cough with no fever or respiratory illness.
Which interpretation is most appropriate?
A. The cough is a known ACE-inhibitor adverse effect and should be reported for possible therapy change.
B. The cough proves the medication is reducing pulmonary edema and should not be reported.
C. The cough indicates acute bacterial pneumonia caused by lisinopril.
D. The cough means the dose is too low and should be doubled.
Correct Answer: A. The cough is a known ACE-inhibitor adverse effect and should be reported for possible
therapy change.
Rationale: A persistent dry cough can occur with ACE inhibitors because of bradykinin accumulation. It is not
dangerous by itself but can be bothersome enough to require a change in therapy.
4. Which symptom should a client taking a long-term antipsychotic report promptly?
A. Mild thirst after exercise
B. Occasional hiccups after meals
C. Temporary nasal congestion during a cold
D. New repetitive lip smacking and involuntary tongue movements.
Correct Answer: D. New repetitive lip smacking and involuntary tongue movements.
Rationale: Involuntary facial and tongue movements can indicate tardive dyskinesia, a potentially persistent
movement disorder associated with dopamine-blocking antipsychotics.
5. A client taking warfarin has black tarry stools and dizziness. What should the nurse instruct the client to
do?
A. Skip leafy green vegetables for one day and continue warfarin.
B. Take an extra dose of warfarin to prevent clot formation during the episode.
C. Begin an over-the-counter NSAID for abdominal discomfort.
D. Seek urgent medical evaluation because the findings may indicate gastrointestinal bleeding.
Correct Answer: D. Seek urgent medical evaluation because the findings may indicate gastrointestinal bleeding.
Rationale: Melena and dizziness can indicate significant bleeding, a serious complication of anticoagulation. The
client needs prompt assessment; NSAIDs can further increase bleeding risk.
6. A client taking an SSRI is given tramadol and later develops agitation, diaphoresis, clonus, and
hyperreflexia. Which adverse reaction is most likely?
A. Serotonin syndrome
B. Malignant hyperthermia
,C. Acute cholinergic crisis
D. Opioid withdrawal
Correct Answer: A. Serotonin syndrome
Rationale: Combining serotonergic drugs can precipitate serotonin syndrome. Neuromuscular hyperactivity such
as clonus and hyperreflexia helps distinguish it from other hyperthermic syndromes.
7. A client scheduled to receive a nitrate has a blood pressure of 82/50 mm Hg and reports lightheadedness.
Which interpretation is most appropriate?
A. The low blood pressure indicates the client needs a larger nitrate dose.
B. The nitrate may worsen hypotension, so the dose should be held and the prescriber notified according to
parameters.
C. Nitrates affect only coronary arteries and will not alter systemic blood pressure.
D. The finding is expected and requires no reassessment.
Correct Answer: B. The nitrate may worsen hypotension, so the dose should be held and the prescriber notified
according to parameters.
Rationale: Nitrates dilate veins and arteries and can significantly lower blood pressure. Symptomatic
hypotension is a reason to withhold the medication and seek guidance.
8. Which supplement is commonly prescribed with isoniazid for a client at risk for peripheral neuropathy?
A. Vitamin K
B. Folic acid
C. Pyridoxine (vitamin B6)
D. Vitamin C
Correct Answer: C. Pyridoxine (vitamin B6)
Rationale: Isoniazid can interfere with pyridoxine metabolism and cause peripheral neuropathy. Vitamin B6
supplementation is used to reduce this risk in susceptible clients.
9. Which statement accurately compares apixaban with warfarin for many clients receiving chronic
anticoagulation?
A. Apixaban has a more predictable anticoagulant effect and does not require routine INR monitoring.
B. Apixaban requires a target INR of 2 to 3 before each dose.
C. Apixaban is reversed with vitamin K in the same way as warfarin.
D. Apixaban has no clinically important bleeding risk.
Correct Answer: A. Apixaban has a more predictable anticoagulant effect and does not require routine INR
monitoring.
Rationale: Direct factor Xa inhibitors such as apixaban have predictable dosing and do not use routine INR
monitoring. They still carry significant bleeding risk and have different reversal strategies than warfarin.
10. A client has severe vomiting and cannot retain oral medications. The provider changes an oral drug to
an IV form. Which pharmacokinetic difference should the nurse anticipate with IV administration?
A. The drug will be absorbed more slowly because it must diffuse through muscle tissue.
B. The drug will undergo greater first-pass hepatic metabolism before reaching circulation.
C. The drug enters systemic circulation directly and bypasses gastrointestinal absorption and first-pass
metabolism.
D. The drug will have lower bioavailability because IV solutions are more dilute than tablets.
Correct Answer: C. The drug enters systemic circulation directly and bypasses gastrointestinal absorption and
first-pass metabolism.
Rationale: IV medication is delivered directly into the bloodstream, producing complete systemic availability
and avoiding gastrointestinal absorption and first-pass metabolism.
11. Which statement by a client prescribed sublingual nitroglycerin indicates correct understanding?
A. I will store the tablets in a weekly pill organizer in the bathroom for convenience.
B. I will swallow the tablets with water because sublingual absorption is unreliable.
C. I can take nitroglycerin with sildenafil because the medicines work in different ways.
D. I will keep the tablets in their original tightly closed container and follow instructions for emergency
evaluation if chest pain is not relieved.
Correct Answer: D. I will keep the tablets in their original tightly closed container and follow instructions for
emergency evaluation if chest pain is not relieved.
, Rationale: Sublingual nitroglycerin should be stored as directed in its original container and used according to
emergency chest-pain instructions. Phosphodiesterase-5 inhibitors such as sildenafil can cause severe hypotension
when combined with nitrates.
12. A client who received insulin becomes shaky, diaphoretic, and confused. Bedside glucose is 48 mg/dL,
and the client can swallow safely. What should the nurse do first?
A. Administer the next scheduled insulin dose to prevent rebound hyperglycemia.
B. Give a rapid-acting oral carbohydrate according to the hypoglycemia protocol.
C. Offer a high-fat meal as the fastest way to raise blood glucose.
D. Restrict oral intake until the glucose rises spontaneously.
Correct Answer: B. Give a rapid-acting oral carbohydrate according to the hypoglycemia protocol.
Rationale: A conscious client with symptomatic hypoglycemia who can swallow should receive a rapid-acting
carbohydrate promptly, followed by reassessment and longer-acting food when appropriate.
13. A client taking atorvastatin reports severe new muscle pain and dark urine after a recent
medication change. Which action is most appropriate?
A. Reassure the client that muscle pain is required for the cholesterol-lowering effect.
B. Increase exercise intensity to strengthen the affected muscles.
C. Promptly report the symptoms and evaluate for muscle injury, including possible rhabdomyolysis.
D. Take the statin with a potassium supplement and continue therapy unchanged.
Correct Answer: C. Promptly report the symptoms and evaluate for muscle injury, including possible
rhabdomyolysis.
Rationale: Severe myalgia with dark urine can indicate significant muscle injury or rhabdomyolysis. The
medication should be reviewed promptly and appropriate laboratory evaluation obtained.
14. A client with a baseline prolonged QT interval is prescribed azithromycin. Which finding makes the
prescription most concerning?
A. The client is also taking another medication known to prolong the QT interval.
B. The client takes acetaminophen occasionally for headaches.
C. The client drinks one glass of water with morning medications.
D. The client uses a topical emollient for dry skin.
Correct Answer: A. The client is also taking another medication known to prolong the QT interval.
Rationale: Macrolides can prolong the QT interval in susceptible clients. Concomitant QT-prolonging drugs and
existing QT prolongation increase the risk for serious ventricular dysrhythmias.
15. Which teaching best distinguishes the expected onset of an SSRI antidepressant from the immediate
effects of a sedative?
A. Antidepressant benefit should be complete after the first dose.
B. Mood improvement may take several weeks even though some adverse effects can appear earlier.
C. If mood does not improve in 24 hours, the client should double the dose.
D. SSRIs work only when taken as needed during episodes of sadness.
Correct Answer: B. Mood improvement may take several weeks even though some adverse effects can appear
earlier.
Rationale: SSRIs are taken regularly and therapeutic mood effects typically develop over weeks. Early adverse
effects may occur before full benefit, so adherence and monitoring are important.
16. Which medication-administration action requires correction?
A. Verifying the client’s identity using two approved identifiers.
B. Comparing the medication label with the medication administration record before giving the dose.
C. Assessing relevant laboratory data before a medication with known organ-toxicity risk.
D. Crushing an extended-release tablet to make it easier for the client to swallow.
Correct Answer: D. Crushing an extended-release tablet to make it easier for the client to swallow.
Rationale: Extended-release formulations generally should not be crushed because doing so can alter release
characteristics and cause dose dumping. The other actions support medication safety.
17. A client taking levothyroxine develops palpitations, tremor, heat intolerance, and insomnia. Which
explanation is most likely?
A. The client has developed insulin deficiency.
B. The thyroid hormone dose may be excessive.
