PHARMACOLOGY HESI EXAM PREP SET 3 EXAM
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A client with acute decompensated heart failure is receiving IV milrinone and develops symptomatic
hypotension with a new ventricular dysrhythmia. Which action is most appropriate?
A. Increase the infusion rate because hypotension shows inadequate vasodilation.
B. Notify the provider and reassess the infusion because hypotension and dysrhythmias are important milrinone
adverse effects.
C. Administer a beta agonist automatically without reviewing the rhythm.
D. Continue unchanged because ventricular dysrhythmias are required for inotropic benefit.
Correct Answer: B. Notify the provider and reassess the infusion because hypotension and dysrhythmias are
important milrinone adverse effects.
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that increases contractility and causes vasodilation. It can
cause hypotension and ventricular dysrhythmias, requiring close hemodynamic and rhythm monitoring.
2. Which instruction is important for a client taking oral terbinafine for onychomycosis?
A. Take the drug only when nail pain is severe.
B. Expect progressive hearing loss as a normal treatment effect.
C. Double the dose if nail growth remains slow after one week.
D. Report persistent nausea, fatigue, dark urine, or jaundice because liver injury can occur.
Correct Answer: D. Report persistent nausea, fatigue, dark urine, or jaundice because liver injury can occur.
Rationale: Oral terbinafine can cause hepatotoxicity. Symptoms suggesting liver injury warrant prompt medical
evaluation.
3. A client takes ezetimibe together with a statin. Which monitoring may be appropriate when clinically
indicated?
A. Daily serum lithium levels
B. Liver enzymes, especially if symptoms of hepatic injury develop.
C. Weekly vancomycin troughs
D. Continuous blood glucose in every client
Correct Answer: B. Liver enzymes, especially if symptoms of hepatic injury develop.
Rationale: Ezetimibe combined with a statin can increase the risk of transaminase elevations. Liver-related
symptoms or laboratory abnormalities warrant assessment.
4. An older adult taking pregabalin is newly prescribed an opioid after surgery. Which safety concern
should guide nursing monitoring?
A. Pregabalin fully reverses opioid respiratory depression.
B. The combination prevents falls by improving coordination.
C. No additive CNS effects occur because the medications act on different receptors.
D. The combination can increase sedation and respiratory-depression risk, especially in an older adult.
Correct Answer: D. The combination can increase sedation and respiratory-depression risk, especially in an
older adult.
Rationale: Gabapentinoids can add to opioid-related CNS and respiratory depression, particularly in older adults
or clients with respiratory disease. Close monitoring and cautious dosing are appropriate.
5. A client prescribed a PCSK9 inhibitor for severe hypercholesterolemia asks how the
medication is given. Which response is accurate?
A. It is inhaled through a nebulizer during meals.
B. It is taken sublingually only during chest pain.
C. It is administered by subcutaneous injection on a product-specific schedule.
D. It must be infused continuously through a central line.
Correct Answer: C. It is administered by subcutaneous injection on a product-specific schedule.
Rationale: PCSK9 inhibitors are monoclonal antibodies administered subcutaneously, typically every few weeks
depending on the product.
6. A client receiving tobramycin has a rising creatinine and decreasing urine output. What is the nurse’s
priority action?
A. Hold the dose as appropriate and notify the prescriber or pharmacy team about possible nephrotoxicity.
,B. Increase the dose because kidney injury lowers aminoglycoside exposure.
C. Restrict all laboratory monitoring until therapy is complete.
D. Add an NSAID to improve renal perfusion.
Correct Answer: A. Hold the dose as appropriate and notify the prescriber or pharmacy team about possible
nephrotoxicity.
Rationale: Aminoglycosides can cause nephrotoxicity, and renal dysfunction can further increase drug
accumulation. Worsening kidney function requires prompt dosing reassessment.
7. A client with severe reactive airway disease is prescribed a nonselective beta blocker. Which nursing
concern is most appropriate?
A. Nonselective beta blockade can provoke bronchospasm, so the indication and alternatives should be reviewed.
B. The medication is preferred because beta2 blockade causes bronchodilation.
C. Asthma eliminates all cardiovascular effects of beta blockers.
D. The medication should be doubled during wheezing episodes.
Correct Answer: A. Nonselective beta blockade can provoke bronchospasm, so the indication and alternatives
should be reviewed.
Rationale: Blocking pulmonary beta2 receptors can worsen bronchoconstriction. A nonselective beta blocker
requires careful risk-benefit assessment in clients with reactive airway disease.
8. An older adult recently started an SSRI and now has headache, confusion, weakness, and a sodium level
of 122 mEq/L. Which adverse effect should the nurse suspect?
A. Hypernatremia from diabetes insipidus
B. Lithium toxicity
C. Opioid withdrawal
D. SSRI-associated hyponatremia, often related to SIADH
Correct Answer: D. SSRI-associated hyponatremia, often related to SIADH
Rationale: SSRIs can contribute to SIADH and clinically significant hyponatremia, particularly in older adults
and those taking other sodium-lowering drugs.
9. In septic shock requiring a first-line vasopressor, which medication is generally preferred over dopamine
for most adults because it produces fewer tachyarrhythmias?
A. Digoxin
B. Adenosine
C. Norepinephrine
D. Verapamil
Correct Answer: C. Norepinephrine
Rationale: Current shock management commonly uses norepinephrine as the first-line vasopressor in septic
shock. Dopamine is associated with more tachyarrhythmias and is reserved for selected situations.
10. Which instruction is most appropriate for a client who self-injects insulin several times daily?
A. Use the exact same point for every injection to keep absorption constant.
B. Rotate injection sites within the same general anatomic region to reduce lipodystrophy while maintaining
predictable absorption.
C. Inject into scar tissue because it absorbs insulin faster.
D. Massage each site vigorously after injection.
Correct Answer: B. Rotate injection sites within the same general anatomic region to reduce lipodystrophy while
maintaining predictable absorption.
Rationale: Repeated injections into the same spot can cause lipohypertrophy or lipoatrophy and make absorption
erratic. Systematic site rotation reduces this problem.
11. A norepinephrine infusion through a peripheral IV is suspected to have infiltrated, and the
surrounding skin is pale and cool. What should the nurse do?
A. Increase the rate through the infiltrated catheter to restore circulation.
B. Massage the area vigorously and continue the infusion.
C. Stop the infusion at that site and initiate the organization’s vasopressor extravasation protocol promptly.
D. Ignore the site if the client’s blood pressure remains low.
Correct Answer: C. Stop the infusion at that site and initiate the organization’s vasopressor extravasation
protocol promptly.
, Rationale: Peripheral vasopressor extravasation can cause severe ischemic tissue injury. The infusion must be
stopped at that site and drug-specific measures such as aspiration and antidote management initiated promptly.
12. Which instruction is appropriate for a client taking oral levofloxacin?
A. Take every dose with an aluminum-magnesium antacid to improve absorption.
B. Separate the dose from antacids or supplements containing polyvalent cations according to product
instructions.
C. Crush the tablet into a calcium supplement before swallowing.
D. Stop the medication after the first normal temperature reading.
Correct Answer: B. Separate the dose from antacids or supplements containing polyvalent cations according to
product instructions.
Rationale: Calcium, magnesium, aluminum, iron, and other polyvalent cations can bind fluoroquinolones and
reduce absorption. Appropriate dose separation is important.
13. A client with heart failure is taking sacubitril/valsartan and asks why BNP may remain elevated even
while symptoms improve. Which explanation is most accurate?
A. Neprilysin inhibition can increase BNP concentrations, so clinical assessment and other markers such as
NT-proBNP may be more useful for trend interpretation.
B. Sacubitril permanently blocks all natriuretic peptide production.
C. BNP always falls to zero when heart failure treatment works.
D. BNP rises only when digoxin toxicity occurs.
Correct Answer: A. Neprilysin inhibition can increase BNP concentrations, so clinical assessment and other
markers such as NT-proBNP may be more useful for trend interpretation.
Rationale: Sacubitril inhibits neprilysin, an enzyme that degrades BNP, so BNP can be influenced by the drug.
NT-proBNP is not a neprilysin substrate and is often easier to interpret during ARNI therapy.
14. A client taking clozapine develops fever and sore throat. What should the nurse do?
A. Give the next dose early because infection lowers clozapine levels.
B. Reassure the client that fever is an expected antipsychotic effect.
C. Recommend a live vaccine without contacting the prescriber.
D. Arrange prompt evaluation including the required neutrophil count monitoring because severe neutropenia is
possible.
Correct Answer: D. Arrange prompt evaluation including the required neutrophil count monitoring because
severe neutropenia is possible.
Rationale: Clozapine can cause severe neutropenia. Fever or sore throat requires prompt assessment and ANC
evaluation under the monitoring program.
15. Which term refers to the time from medication administration until the first measurable therapeutic
effect occurs?
A. Peak effect
B. Duration of action
C. Steady-state concentration
D. Onset of action
Correct Answer: D. Onset of action
Rationale: Onset is the time required for a medication to begin producing its intended effect. Peak is the time of
maximum effect, and duration is how long the effect persists.
16. Which statement by a client taking paroxetine daily requires correction?
A. Dose reduction is often gradual when the medication is discontinued.
B. Abrupt stopping can cause dizziness, flu-like symptoms, anxiety, or sensory disturbances.
C. I can stop it abruptly as soon as I feel better because antidepressants do not cause discontinuation symptoms.
D. I should discuss a taper with the prescriber rather than stopping on my own.
Correct Answer: C. I can stop it abruptly as soon as I feel better because antidepressants do not cause
discontinuation symptoms.
Rationale: Short-half-life SSRIs can cause a discontinuation syndrome if stopped suddenly. Gradual tapering is
often used.
17. An older adult takes 14 medications from several prescribers and recently started another drug to treat
dizziness that began after a blood-pressure medication was added. Which nursing concern is most
appropriate?
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A client with acute decompensated heart failure is receiving IV milrinone and develops symptomatic
hypotension with a new ventricular dysrhythmia. Which action is most appropriate?
A. Increase the infusion rate because hypotension shows inadequate vasodilation.
B. Notify the provider and reassess the infusion because hypotension and dysrhythmias are important milrinone
adverse effects.
C. Administer a beta agonist automatically without reviewing the rhythm.
D. Continue unchanged because ventricular dysrhythmias are required for inotropic benefit.
Correct Answer: B. Notify the provider and reassess the infusion because hypotension and dysrhythmias are
important milrinone adverse effects.
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that increases contractility and causes vasodilation. It can
cause hypotension and ventricular dysrhythmias, requiring close hemodynamic and rhythm monitoring.
2. Which instruction is important for a client taking oral terbinafine for onychomycosis?
A. Take the drug only when nail pain is severe.
B. Expect progressive hearing loss as a normal treatment effect.
C. Double the dose if nail growth remains slow after one week.
D. Report persistent nausea, fatigue, dark urine, or jaundice because liver injury can occur.
Correct Answer: D. Report persistent nausea, fatigue, dark urine, or jaundice because liver injury can occur.
Rationale: Oral terbinafine can cause hepatotoxicity. Symptoms suggesting liver injury warrant prompt medical
evaluation.
3. A client takes ezetimibe together with a statin. Which monitoring may be appropriate when clinically
indicated?
A. Daily serum lithium levels
B. Liver enzymes, especially if symptoms of hepatic injury develop.
C. Weekly vancomycin troughs
D. Continuous blood glucose in every client
Correct Answer: B. Liver enzymes, especially if symptoms of hepatic injury develop.
Rationale: Ezetimibe combined with a statin can increase the risk of transaminase elevations. Liver-related
symptoms or laboratory abnormalities warrant assessment.
4. An older adult taking pregabalin is newly prescribed an opioid after surgery. Which safety concern
should guide nursing monitoring?
A. Pregabalin fully reverses opioid respiratory depression.
B. The combination prevents falls by improving coordination.
C. No additive CNS effects occur because the medications act on different receptors.
D. The combination can increase sedation and respiratory-depression risk, especially in an older adult.
Correct Answer: D. The combination can increase sedation and respiratory-depression risk, especially in an
older adult.
Rationale: Gabapentinoids can add to opioid-related CNS and respiratory depression, particularly in older adults
or clients with respiratory disease. Close monitoring and cautious dosing are appropriate.
5. A client prescribed a PCSK9 inhibitor for severe hypercholesterolemia asks how the
medication is given. Which response is accurate?
A. It is inhaled through a nebulizer during meals.
B. It is taken sublingually only during chest pain.
C. It is administered by subcutaneous injection on a product-specific schedule.
D. It must be infused continuously through a central line.
Correct Answer: C. It is administered by subcutaneous injection on a product-specific schedule.
Rationale: PCSK9 inhibitors are monoclonal antibodies administered subcutaneously, typically every few weeks
depending on the product.
6. A client receiving tobramycin has a rising creatinine and decreasing urine output. What is the nurse’s
priority action?
A. Hold the dose as appropriate and notify the prescriber or pharmacy team about possible nephrotoxicity.
,B. Increase the dose because kidney injury lowers aminoglycoside exposure.
C. Restrict all laboratory monitoring until therapy is complete.
D. Add an NSAID to improve renal perfusion.
Correct Answer: A. Hold the dose as appropriate and notify the prescriber or pharmacy team about possible
nephrotoxicity.
Rationale: Aminoglycosides can cause nephrotoxicity, and renal dysfunction can further increase drug
accumulation. Worsening kidney function requires prompt dosing reassessment.
7. A client with severe reactive airway disease is prescribed a nonselective beta blocker. Which nursing
concern is most appropriate?
A. Nonselective beta blockade can provoke bronchospasm, so the indication and alternatives should be reviewed.
B. The medication is preferred because beta2 blockade causes bronchodilation.
C. Asthma eliminates all cardiovascular effects of beta blockers.
D. The medication should be doubled during wheezing episodes.
Correct Answer: A. Nonselective beta blockade can provoke bronchospasm, so the indication and alternatives
should be reviewed.
Rationale: Blocking pulmonary beta2 receptors can worsen bronchoconstriction. A nonselective beta blocker
requires careful risk-benefit assessment in clients with reactive airway disease.
8. An older adult recently started an SSRI and now has headache, confusion, weakness, and a sodium level
of 122 mEq/L. Which adverse effect should the nurse suspect?
A. Hypernatremia from diabetes insipidus
B. Lithium toxicity
C. Opioid withdrawal
D. SSRI-associated hyponatremia, often related to SIADH
Correct Answer: D. SSRI-associated hyponatremia, often related to SIADH
Rationale: SSRIs can contribute to SIADH and clinically significant hyponatremia, particularly in older adults
and those taking other sodium-lowering drugs.
9. In septic shock requiring a first-line vasopressor, which medication is generally preferred over dopamine
for most adults because it produces fewer tachyarrhythmias?
A. Digoxin
B. Adenosine
C. Norepinephrine
D. Verapamil
Correct Answer: C. Norepinephrine
Rationale: Current shock management commonly uses norepinephrine as the first-line vasopressor in septic
shock. Dopamine is associated with more tachyarrhythmias and is reserved for selected situations.
10. Which instruction is most appropriate for a client who self-injects insulin several times daily?
A. Use the exact same point for every injection to keep absorption constant.
B. Rotate injection sites within the same general anatomic region to reduce lipodystrophy while maintaining
predictable absorption.
C. Inject into scar tissue because it absorbs insulin faster.
D. Massage each site vigorously after injection.
Correct Answer: B. Rotate injection sites within the same general anatomic region to reduce lipodystrophy while
maintaining predictable absorption.
Rationale: Repeated injections into the same spot can cause lipohypertrophy or lipoatrophy and make absorption
erratic. Systematic site rotation reduces this problem.
11. A norepinephrine infusion through a peripheral IV is suspected to have infiltrated, and the
surrounding skin is pale and cool. What should the nurse do?
A. Increase the rate through the infiltrated catheter to restore circulation.
B. Massage the area vigorously and continue the infusion.
C. Stop the infusion at that site and initiate the organization’s vasopressor extravasation protocol promptly.
D. Ignore the site if the client’s blood pressure remains low.
Correct Answer: C. Stop the infusion at that site and initiate the organization’s vasopressor extravasation
protocol promptly.
, Rationale: Peripheral vasopressor extravasation can cause severe ischemic tissue injury. The infusion must be
stopped at that site and drug-specific measures such as aspiration and antidote management initiated promptly.
12. Which instruction is appropriate for a client taking oral levofloxacin?
A. Take every dose with an aluminum-magnesium antacid to improve absorption.
B. Separate the dose from antacids or supplements containing polyvalent cations according to product
instructions.
C. Crush the tablet into a calcium supplement before swallowing.
D. Stop the medication after the first normal temperature reading.
Correct Answer: B. Separate the dose from antacids or supplements containing polyvalent cations according to
product instructions.
Rationale: Calcium, magnesium, aluminum, iron, and other polyvalent cations can bind fluoroquinolones and
reduce absorption. Appropriate dose separation is important.
13. A client with heart failure is taking sacubitril/valsartan and asks why BNP may remain elevated even
while symptoms improve. Which explanation is most accurate?
A. Neprilysin inhibition can increase BNP concentrations, so clinical assessment and other markers such as
NT-proBNP may be more useful for trend interpretation.
B. Sacubitril permanently blocks all natriuretic peptide production.
C. BNP always falls to zero when heart failure treatment works.
D. BNP rises only when digoxin toxicity occurs.
Correct Answer: A. Neprilysin inhibition can increase BNP concentrations, so clinical assessment and other
markers such as NT-proBNP may be more useful for trend interpretation.
Rationale: Sacubitril inhibits neprilysin, an enzyme that degrades BNP, so BNP can be influenced by the drug.
NT-proBNP is not a neprilysin substrate and is often easier to interpret during ARNI therapy.
14. A client taking clozapine develops fever and sore throat. What should the nurse do?
A. Give the next dose early because infection lowers clozapine levels.
B. Reassure the client that fever is an expected antipsychotic effect.
C. Recommend a live vaccine without contacting the prescriber.
D. Arrange prompt evaluation including the required neutrophil count monitoring because severe neutropenia is
possible.
Correct Answer: D. Arrange prompt evaluation including the required neutrophil count monitoring because
severe neutropenia is possible.
Rationale: Clozapine can cause severe neutropenia. Fever or sore throat requires prompt assessment and ANC
evaluation under the monitoring program.
15. Which term refers to the time from medication administration until the first measurable therapeutic
effect occurs?
A. Peak effect
B. Duration of action
C. Steady-state concentration
D. Onset of action
Correct Answer: D. Onset of action
Rationale: Onset is the time required for a medication to begin producing its intended effect. Peak is the time of
maximum effect, and duration is how long the effect persists.
16. Which statement by a client taking paroxetine daily requires correction?
A. Dose reduction is often gradual when the medication is discontinued.
B. Abrupt stopping can cause dizziness, flu-like symptoms, anxiety, or sensory disturbances.
C. I can stop it abruptly as soon as I feel better because antidepressants do not cause discontinuation symptoms.
D. I should discuss a taper with the prescriber rather than stopping on my own.
Correct Answer: C. I can stop it abruptly as soon as I feel better because antidepressants do not cause
discontinuation symptoms.
Rationale: Short-half-life SSRIs can cause a discontinuation syndrome if stopped suddenly. Gradual tapering is
often used.
17. An older adult takes 14 medications from several prescribers and recently started another drug to treat
dizziness that began after a blood-pressure medication was added. Which nursing concern is most
appropriate?
