PHARMACOLOGY HESI EXAM PREP SET 2 EXAM
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Before administering digoxin to an adult, the nurse notes an apical pulse of 52/min. Which action is most
appropriate?
A. Give the dose because digoxin is intended to increase heart rate.
B. Administer the medication and then obtain the apical pulse.
C. Hold the dose and follow the prescribed pulse parameters or contact the prescriber.
D. Give a double dose to improve contractility despite the bradycardia.
Correct Answer: C. Hold the dose and follow the prescribed pulse parameters or contact the prescriber.
Rationale: Digoxin can slow AV conduction and heart rate. Significant bradycardia is a reason to withhold the
dose according to parameters and seek guidance.
2. Which client history should make the nurse question a new prescription for bupropion?
A. A seizure disorder
B. Seasonal allergic rhinitis
C. Mild osteoarthritis
D. Corrected myopia
Correct Answer: A. A seizure disorder
Rationale: Bupropion lowers the seizure threshold and is contraindicated in clients with seizure disorders and
certain other conditions that increase seizure risk.
3. A client who abruptly stopped clonidine reports severe headache and a blood pressure of 214/118 mm
Hg. What should the nurse do?
A. Reassure the client that abrupt withdrawal lowers blood pressure gradually.
B. Take an over-the-counter decongestant to treat the headache.
C. Arrange urgent evaluation for possible rebound hypertension and notify the prescriber.
D. Wait several days because clonidine withdrawal cannot affect blood pressure.
Correct Answer: C. Arrange urgent evaluation for possible rebound hypertension and notify the prescriber.
Rationale: Abrupt clonidine discontinuation can produce marked rebound sympathetic activity and severe
hypertension. This requires prompt clinical assessment.
4. A client taking clindamycin develops frequent watery diarrhea, abdominal cramping, and fever. Which
complication should the nurse suspect?
A. Expected antibiotic-related stool softening that needs no evaluation
B. Acute pancreatitis caused by all lincosamides
C. Therapeutic eradication of intestinal flora
D. Clostridioides difficile-associated diarrhea
Correct Answer: D. Clostridioides difficile-associated diarrhea
Rationale: Clindamycin is strongly associated with C. difficile infection. Significant watery diarrhea, cramping,
or fever during or after therapy requires prompt evaluation.
5. A client with stable chronic heart failure is starting carvedilol. Which finding is most important for the
nurse to monitor during dose titration?
A. Only bowel sounds because beta blockers act primarily in the gastrointestinal tract.
B. Heart rate, blood pressure, weight, and signs of worsening fluid retention.
C. Visual acuity before each dose because carvedilol is directly retinotoxic.
D. Serum calcium only because carvedilol consistently causes hypercalcemia.
Correct Answer: B. Heart rate, blood pressure, weight, and signs of worsening fluid retention.
Rationale: Beta blockers used in heart failure are started low and titrated carefully. Bradycardia, hypotension,
and temporary worsening of fluid retention are important monitoring concerns.
6. Which instruction should the nurse give a client starting doxycycline for a skin infection?
A. Avoid all water for one hour after each dose to improve absorption.
B. Take the medication immediately before lying flat at bedtime.
C. Use sun protection because the medication can increase photosensitivity.
D. Stop therapy after the first day without redness even if doses remain.
Correct Answer: C. Use sun protection because the medication can increase photosensitivity.
,Rationale: Doxycycline can cause photosensitivity. Clients should use sun-protective measures and take the
medication exactly as prescribed.
7. A client taking high-dose aspirin reports tinnitus, dizziness, and rapid breathing. Which adverse effect
should the nurse suspect?
A. Salicylate toxicity
B. Therapeutic platelet inhibition only
C. Opioid intoxication
D. Acute dystonia
Correct Answer: A. Salicylate toxicity
Rationale: Tinnitus is a classic early sign of salicylate toxicity; more severe poisoning can cause acid-base
disturbances, tachypnea, fever, and neurologic changes.
8. A client taking tizanidine becomes dizzy when standing and has a blood pressure of 86/54 mm Hg. Which
explanation is most likely?
A. The drug routinely produces severe hypertension.
B. Tizanidine can cause hypotension and sedation.
C. The client is experiencing insulin withdrawal.
D. The medication blocks all renal sodium excretion.
Correct Answer: B. Tizanidine can cause hypotension and sedation.
Rationale: Tizanidine is an alpha2-adrenergic agonist that can cause hypotension, dizziness, and sedation.
9. Which specific reversal agent is available for dabigatran when urgent reversal is needed?
A. Phytonadione
B. Protamine sulfate
C. Atropine
D. Idarucizumab
Correct Answer: D. Idarucizumab
Rationale: Idarucizumab is a monoclonal antibody fragment that binds dabigatran and rapidly reverses its
anticoagulant effect.
10. A nurse prepares a partial dose of a controlled substance and has medication remaining in the vial.
What should the nurse do with the unused portion?
A. Place the leftover medication in an unlabeled cup for the next client who needs the same drug.
B. Waste it using the organization’s controlled-substance procedure, including required witnessing and
documentation.
C. Take the remaining medication home so it is not discarded unnecessarily.
D. Pour it into the sink without documentation because the ordered portion was already charted.
Correct Answer: B. Waste it using the organization’s controlled-substance procedure, including required
witnessing and documentation.
Rationale: Controlled substances require secure handling, witnessed wasting when applicable, and accurate
documentation according to law and organizational policy.
11. Which adverse metabolic effect is more closely associated with hydrochlorothiazide than with a
potassium-sparing diuretic?
A. Severe bradycardia from AV-node blockade
B. Pulmonary fibrosis from iodine accumulation
C. Serotonin syndrome from monoamine oxidase inhibition
D. Hyperuricemia that may worsen gout.
Correct Answer: D. Hyperuricemia that may worsen gout.
Rationale: Thiazide diuretics can increase uric acid and precipitate gout in susceptible clients. They can also
affect sodium, potassium, glucose, and calcium balance.
12. Which organ toxicity is a major concern with systemic amphotericin B therapy?
A. Isolated retinal detachment
B. Permanent hypoglycemia
C. Nephrotoxicity
D. Obligatory bone-marrow aplasia in every client
Correct Answer: C. Nephrotoxicity
, Rationale: Amphotericin B can cause significant renal toxicity and electrolyte disturbances, so kidney function
and electrolytes require close monitoring.
13. A client on a QT-prolonging antiarrhythmic develops frequent premature ventricular contractions.
Laboratory results show potassium 2.9 mEq/L and magnesium 1.3 mg/dL. Which intervention should the
nurse anticipate first?
A. Prompt correction of the electrolyte abnormalities and review of the QT-prolonging medication.
B. Give a potassium-wasting diuretic to reduce ventricular irritability.
C. Administer another QT-prolonging drug to suppress the premature beats.
D. Delay action because low potassium and magnesium reduce dysrhythmia risk.
Correct Answer: A. Prompt correction of the electrolyte abnormalities and review of the QT-prolonging
medication.
Rationale: Hypokalemia and hypomagnesemia increase the risk of malignant ventricular dysrhythmias with
QT-prolonging drugs. Correcting these abnormalities is a key safety priority.
14. A client with epilepsy who takes sertraline is prescribed tramadol for pain. Which nursing concern is
most important?
A. Tramadol can increase seizure risk and serotonergic toxicity in this client.
B. Tramadol prevents all seizures and reduces SSRI effects.
C. Sertraline blocks tramadol absorption completely.
D. The combination is safe because tramadol has no central nervous system activity.
Correct Answer: A. Tramadol can increase seizure risk and serotonergic toxicity in this client.
Rationale: Tramadol lowers the seizure threshold and also has serotonergic activity. A client with epilepsy who
takes an SSRI has increased safety concerns.
15. A client taking acarbose with insulin develops symptomatic hypoglycemia. Which oral carbohydrate is
preferred for rapid treatment if the client can swallow?
A. Table sugar dissolved in water as the only acceptable option
B. A high-fat pastry
C. A fiber supplement
D. Glucose (dextrose) tablets or gel
Correct Answer: D. Glucose (dextrose) tablets or gel
Rationale: Acarbose delays breakdown of sucrose and complex carbohydrates. Pure glucose is absorbed directly
and is preferred for rapid treatment of hypoglycemia in clients using alpha-glucosidase inhibitors.
16. A client taking an oral cephalosporin says, "My symptoms are gone after two days, so I can stop now."
Which response is best?
A. Stop now because continuing after symptom relief always causes resistance.
B. Save the remaining capsules for the next respiratory illness.
C. Complete the prescribed course unless the prescriber instructs otherwise.
D. Share the remaining doses with a family member who develops similar symptoms.
Correct Answer: C. Complete the prescribed course unless the prescriber instructs otherwise.
Rationale: Antibiotics should be taken for the prescribed duration unless therapy is changed by the clinician.
Stopping early, saving leftovers, or sharing medication can lead to treatment failure and inappropriate antibiotic
use.
17. A client starting sotalol has a markedly prolonged QTc and low serum potassium. What is the priority
nursing concern?
A. The client will develop opioid withdrawal unless sotalol is increased.
B. The client is at increased risk for torsades de pointes and needs prompt correction and prescriber review.
C. Low potassium protects against ventricular dysrhythmias during sotalol therapy.
D. QT prolongation is the desired endpoint of all beta-blocker therapy.
Correct Answer: B. The client is at increased risk for torsades de pointes and needs prompt correction and
prescriber review.
Rationale: Sotalol can prolong repolarization and the QT interval. Hypokalemia further increases the risk of
torsades de pointes.
18. Why does a medication with a narrow therapeutic index require especially careful monitoring?
A. It can be administered only by the intravenous route.
B. It never interacts with food or other medications.
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Before administering digoxin to an adult, the nurse notes an apical pulse of 52/min. Which action is most
appropriate?
A. Give the dose because digoxin is intended to increase heart rate.
B. Administer the medication and then obtain the apical pulse.
C. Hold the dose and follow the prescribed pulse parameters or contact the prescriber.
D. Give a double dose to improve contractility despite the bradycardia.
Correct Answer: C. Hold the dose and follow the prescribed pulse parameters or contact the prescriber.
Rationale: Digoxin can slow AV conduction and heart rate. Significant bradycardia is a reason to withhold the
dose according to parameters and seek guidance.
2. Which client history should make the nurse question a new prescription for bupropion?
A. A seizure disorder
B. Seasonal allergic rhinitis
C. Mild osteoarthritis
D. Corrected myopia
Correct Answer: A. A seizure disorder
Rationale: Bupropion lowers the seizure threshold and is contraindicated in clients with seizure disorders and
certain other conditions that increase seizure risk.
3. A client who abruptly stopped clonidine reports severe headache and a blood pressure of 214/118 mm
Hg. What should the nurse do?
A. Reassure the client that abrupt withdrawal lowers blood pressure gradually.
B. Take an over-the-counter decongestant to treat the headache.
C. Arrange urgent evaluation for possible rebound hypertension and notify the prescriber.
D. Wait several days because clonidine withdrawal cannot affect blood pressure.
Correct Answer: C. Arrange urgent evaluation for possible rebound hypertension and notify the prescriber.
Rationale: Abrupt clonidine discontinuation can produce marked rebound sympathetic activity and severe
hypertension. This requires prompt clinical assessment.
4. A client taking clindamycin develops frequent watery diarrhea, abdominal cramping, and fever. Which
complication should the nurse suspect?
A. Expected antibiotic-related stool softening that needs no evaluation
B. Acute pancreatitis caused by all lincosamides
C. Therapeutic eradication of intestinal flora
D. Clostridioides difficile-associated diarrhea
Correct Answer: D. Clostridioides difficile-associated diarrhea
Rationale: Clindamycin is strongly associated with C. difficile infection. Significant watery diarrhea, cramping,
or fever during or after therapy requires prompt evaluation.
5. A client with stable chronic heart failure is starting carvedilol. Which finding is most important for the
nurse to monitor during dose titration?
A. Only bowel sounds because beta blockers act primarily in the gastrointestinal tract.
B. Heart rate, blood pressure, weight, and signs of worsening fluid retention.
C. Visual acuity before each dose because carvedilol is directly retinotoxic.
D. Serum calcium only because carvedilol consistently causes hypercalcemia.
Correct Answer: B. Heart rate, blood pressure, weight, and signs of worsening fluid retention.
Rationale: Beta blockers used in heart failure are started low and titrated carefully. Bradycardia, hypotension,
and temporary worsening of fluid retention are important monitoring concerns.
6. Which instruction should the nurse give a client starting doxycycline for a skin infection?
A. Avoid all water for one hour after each dose to improve absorption.
B. Take the medication immediately before lying flat at bedtime.
C. Use sun protection because the medication can increase photosensitivity.
D. Stop therapy after the first day without redness even if doses remain.
Correct Answer: C. Use sun protection because the medication can increase photosensitivity.
,Rationale: Doxycycline can cause photosensitivity. Clients should use sun-protective measures and take the
medication exactly as prescribed.
7. A client taking high-dose aspirin reports tinnitus, dizziness, and rapid breathing. Which adverse effect
should the nurse suspect?
A. Salicylate toxicity
B. Therapeutic platelet inhibition only
C. Opioid intoxication
D. Acute dystonia
Correct Answer: A. Salicylate toxicity
Rationale: Tinnitus is a classic early sign of salicylate toxicity; more severe poisoning can cause acid-base
disturbances, tachypnea, fever, and neurologic changes.
8. A client taking tizanidine becomes dizzy when standing and has a blood pressure of 86/54 mm Hg. Which
explanation is most likely?
A. The drug routinely produces severe hypertension.
B. Tizanidine can cause hypotension and sedation.
C. The client is experiencing insulin withdrawal.
D. The medication blocks all renal sodium excretion.
Correct Answer: B. Tizanidine can cause hypotension and sedation.
Rationale: Tizanidine is an alpha2-adrenergic agonist that can cause hypotension, dizziness, and sedation.
9. Which specific reversal agent is available for dabigatran when urgent reversal is needed?
A. Phytonadione
B. Protamine sulfate
C. Atropine
D. Idarucizumab
Correct Answer: D. Idarucizumab
Rationale: Idarucizumab is a monoclonal antibody fragment that binds dabigatran and rapidly reverses its
anticoagulant effect.
10. A nurse prepares a partial dose of a controlled substance and has medication remaining in the vial.
What should the nurse do with the unused portion?
A. Place the leftover medication in an unlabeled cup for the next client who needs the same drug.
B. Waste it using the organization’s controlled-substance procedure, including required witnessing and
documentation.
C. Take the remaining medication home so it is not discarded unnecessarily.
D. Pour it into the sink without documentation because the ordered portion was already charted.
Correct Answer: B. Waste it using the organization’s controlled-substance procedure, including required
witnessing and documentation.
Rationale: Controlled substances require secure handling, witnessed wasting when applicable, and accurate
documentation according to law and organizational policy.
11. Which adverse metabolic effect is more closely associated with hydrochlorothiazide than with a
potassium-sparing diuretic?
A. Severe bradycardia from AV-node blockade
B. Pulmonary fibrosis from iodine accumulation
C. Serotonin syndrome from monoamine oxidase inhibition
D. Hyperuricemia that may worsen gout.
Correct Answer: D. Hyperuricemia that may worsen gout.
Rationale: Thiazide diuretics can increase uric acid and precipitate gout in susceptible clients. They can also
affect sodium, potassium, glucose, and calcium balance.
12. Which organ toxicity is a major concern with systemic amphotericin B therapy?
A. Isolated retinal detachment
B. Permanent hypoglycemia
C. Nephrotoxicity
D. Obligatory bone-marrow aplasia in every client
Correct Answer: C. Nephrotoxicity
, Rationale: Amphotericin B can cause significant renal toxicity and electrolyte disturbances, so kidney function
and electrolytes require close monitoring.
13. A client on a QT-prolonging antiarrhythmic develops frequent premature ventricular contractions.
Laboratory results show potassium 2.9 mEq/L and magnesium 1.3 mg/dL. Which intervention should the
nurse anticipate first?
A. Prompt correction of the electrolyte abnormalities and review of the QT-prolonging medication.
B. Give a potassium-wasting diuretic to reduce ventricular irritability.
C. Administer another QT-prolonging drug to suppress the premature beats.
D. Delay action because low potassium and magnesium reduce dysrhythmia risk.
Correct Answer: A. Prompt correction of the electrolyte abnormalities and review of the QT-prolonging
medication.
Rationale: Hypokalemia and hypomagnesemia increase the risk of malignant ventricular dysrhythmias with
QT-prolonging drugs. Correcting these abnormalities is a key safety priority.
14. A client with epilepsy who takes sertraline is prescribed tramadol for pain. Which nursing concern is
most important?
A. Tramadol can increase seizure risk and serotonergic toxicity in this client.
B. Tramadol prevents all seizures and reduces SSRI effects.
C. Sertraline blocks tramadol absorption completely.
D. The combination is safe because tramadol has no central nervous system activity.
Correct Answer: A. Tramadol can increase seizure risk and serotonergic toxicity in this client.
Rationale: Tramadol lowers the seizure threshold and also has serotonergic activity. A client with epilepsy who
takes an SSRI has increased safety concerns.
15. A client taking acarbose with insulin develops symptomatic hypoglycemia. Which oral carbohydrate is
preferred for rapid treatment if the client can swallow?
A. Table sugar dissolved in water as the only acceptable option
B. A high-fat pastry
C. A fiber supplement
D. Glucose (dextrose) tablets or gel
Correct Answer: D. Glucose (dextrose) tablets or gel
Rationale: Acarbose delays breakdown of sucrose and complex carbohydrates. Pure glucose is absorbed directly
and is preferred for rapid treatment of hypoglycemia in clients using alpha-glucosidase inhibitors.
16. A client taking an oral cephalosporin says, "My symptoms are gone after two days, so I can stop now."
Which response is best?
A. Stop now because continuing after symptom relief always causes resistance.
B. Save the remaining capsules for the next respiratory illness.
C. Complete the prescribed course unless the prescriber instructs otherwise.
D. Share the remaining doses with a family member who develops similar symptoms.
Correct Answer: C. Complete the prescribed course unless the prescriber instructs otherwise.
Rationale: Antibiotics should be taken for the prescribed duration unless therapy is changed by the clinician.
Stopping early, saving leftovers, or sharing medication can lead to treatment failure and inappropriate antibiotic
use.
17. A client starting sotalol has a markedly prolonged QTc and low serum potassium. What is the priority
nursing concern?
A. The client will develop opioid withdrawal unless sotalol is increased.
B. The client is at increased risk for torsades de pointes and needs prompt correction and prescriber review.
C. Low potassium protects against ventricular dysrhythmias during sotalol therapy.
D. QT prolongation is the desired endpoint of all beta-blocker therapy.
Correct Answer: B. The client is at increased risk for torsades de pointes and needs prompt correction and
prescriber review.
Rationale: Sotalol can prolong repolarization and the QT interval. Hypokalemia further increases the risk of
torsades de pointes.
18. Why does a medication with a narrow therapeutic index require especially careful monitoring?
A. It can be administered only by the intravenous route.
B. It never interacts with food or other medications.
