HESI RN Exit Pharmacology Practice
Questions 2026/2027 | ACTUAL-Style Practice
Questions & Answers, Medication
Administration, Drug Classifications, Dosage
Calculations, Side Effects, Nursing
Interventions, and Detailed Rationales
Question 1: A client with chronic kidney disease is prescribed epoetin
alfa. The nurse should monitor which laboratory value to evaluate the
therapeutic response?
A. Serum potassium
B. Hemoglobin and hematocrit
C. Serum creatinine
D. Platelet count
CORRECT ANSWER: B. Hemoglobin and hematocrit
Rationale: Epoetin alfa is a colony-stimulating factor that stimulates
erythropoiesis in the bone marrow. The primary therapeutic goal is
correction of anemia associated with chronic kidney disease. Monitoring
hemoglobin and hematocrit levels determines whether the medication is
achieving its intended effect. Potassium, creatinine, and platelets are not
the primary parameters for evaluating epoetin alfa efficacy, although
potassium may require monitoring due to potential hyperkalemia from
improved red blood cell production.
Question 2: A nurse is preparing to administer digoxin to an adult client.
The nurse should withhold the dose and notify the provider if which
assessment finding is noted?
A. Heart rate of 58 beats per minute
B. Apical pulse of 52 beats per minute
C. Blood pressure of 118/72 mm Hg
D. Respiratory rate of 18 breaths per minute
CORRECT ANSWER: B. Apical pulse of 52 beats per minute
Rationale: Digoxin increases cardiac contractility and decreases heart rate
through vagal stimulation. A therapeutic adult resting heart rate is typically
60 to 100 beats per minute. An apical pulse below 60 beats per minute may
indicate digoxin toxicity or excessive bradycardia. The nurse should hold
the dose and notify the provider when the adult apical pulse is less than 60
,beats per minute. A rate of 58 may be borderline but 52 is clearly
bradycardic and unsafe for administration.
Question 3: A client receiving warfarin has an INR of 5.2. The client is
not actively bleeding. Which action should the nurse anticipate taking?
A. Administer protamine sulfate
B. Administer vitamin K intravenously
C. Hold the next dose and notify the provider
D. Increase the next warfarin dose
CORRECT ANSWER: C. Hold the next dose and notify the provider
Rationale: The therapeutic INR range for warfarin is typically 2.0 to 3.0. An
INR of 5.2 is supratherapeutic and places the client at increased risk for
bleeding. In the absence of active bleeding, the next dose should be held,
and the provider should be notified. Oral vitamin K may be prescribed for
elevated INR without bleeding, but IV vitamin K is reserved for serious
bleeding. Protamine sulfate reverses heparin, not warfarin. Increasing the
dose would further elevate the INR and increase bleeding risk.
Question 4: A client is prescribed spironolactone for heart failure.
Which dietary instruction should the nurse include in teaching?
A. Increase intake of bananas and oranges
B. Avoid salt substitutes containing potassium
C. Take the medication with a potassium supplement
D. Increase fluid intake to 3 liters per day
CORRECT ANSWER: B. Avoid salt substitutes containing potassium
Rationale: Spironolactone is a potassium-sparing diuretic that inhibits
aldosterone receptors in the distal tubule, reducing sodium reabsorption
and potassium excretion. Clients are at risk for hyperkalemia. Salt
substitutes frequently contain potassium chloride, which can further
elevate serum potassium levels. Bananas and oranges are high-potassium
foods that should be consumed in moderation, not increased. Potassium
supplements should not be taken with spironolactone unless specifically
prescribed.
Question 5: A nurse is teaching a client about sublingual nitroglycerin
for angina. Which statement by the client indicates correct
understanding?
,A. "I should swallow the tablet with a full glass of water."
B. "I will take one tablet every 5 minutes for up to three doses and call 911 if
pain persists."
C. "I should take this medication only when my blood pressure is above
140/90."
D. "I will store the tablets in the bathroom for easy access."
CORRECT ANSWER: B. "I will take one tablet every 5 minutes for up to
three doses and call 911 if pain persists."
Rationale: Sublingual nitroglycerin is absorbed directly through the oral
mucosa and should not be swallowed. The standard protocol for angina is
one tablet every 5 minutes for a maximum of three doses. If chest pain
persists after the third dose, emergency medical services must be
activated. The medication should be stored in a dark glass container away
from heat and moisture, not in the bathroom. Nitroglycerin is taken at the
onset of angina, not based on blood pressure parameters.
Question 6: A client receiving IV furosemide for pulmonary edema. To
prevent ototoxicity, the nurse should administer the medication at a
rate no faster than:
A. 5 mg/min
B. 10 mg/min
C. 20 mg/min
D. 40 mg/min
CORRECT ANSWER: C. 20 mg/min
Rationale: IV furosemide should be administered at a rate not exceeding 20
mg per minute to reduce the risk of ototoxicity, which can result in
irreversible hearing loss. Rapid administration can also cause significant
hypotension. The nurse should use an infusion pump when possible for
precise rate control, particularly for higher doses.
Question 7: A client with type 2 diabetes is prescribed metformin.
Which laboratory value should the nurse monitor most closely?
A. Serum potassium
B. Serum creatinine
C. Serum calcium
D. Serum sodium
, CORRECT ANSWER: B. Serum creatinine
Rationale: Metformin is primarily excreted unchanged by the kidneys. Renal
impairment increases the risk of metformin accumulation and lactic
acidosis, a rare but life-threatening complication. Serum creatinine and
estimated glomerular filtration rate should be assessed before initiation
and periodically during therapy. Metformin is contraindicated when eGFR is
below 30 mL/min/1.73 m². Potassium, calcium, and sodium are not the
primary parameters for metformin safety monitoring.
Question 8: A nurse is administering IV vancomycin. The client
develops flushing, pruritus, and a rash on the face and upper chest 30
minutes into the infusion. Which action should the nurse take first?
A. Continue the infusion and document the finding
B. Stop the infusion and notify the provider
C. Administer diphenhydramine orally
D. Increase the infusion rate to complete the dose faster
CORRECT ANSWER: B. Stop the infusion and notify the provider
Rationale: Vancomycin infusion reaction, historically called "red man
syndrome," is characterized by flushing, pruritus, and erythema of the face,
neck, and upper torso. It results from rapid infusion of vancomycin and
histamine release. The infusion should be stopped immediately, the
provider notified, and the infusion resumed at a slower rate with
diphenhydramine administration as prescribed. Continuing at the current
rate or increasing the rate would worsen the reaction.
Question 9: A client is prescribed enoxaparin for DVT prophylaxis.
Which instruction is most important for the nurse to include?
A. "Take the medication with food to prevent nausea."
B. "Do not rub the injection site after administering the medication."
C. "Take aspirin for pain if needed."
D. "Massage the injection site to improve absorption."
CORRECT ANSWER: B. "Do not rub the injection site after administering
the medication."
Rationale: Enoxaparin is a low molecular weight heparin administered
subcutaneously. Rubbing or massaging the injection site can cause
hematoma formation and bruising. The injection should be administered in
Questions 2026/2027 | ACTUAL-Style Practice
Questions & Answers, Medication
Administration, Drug Classifications, Dosage
Calculations, Side Effects, Nursing
Interventions, and Detailed Rationales
Question 1: A client with chronic kidney disease is prescribed epoetin
alfa. The nurse should monitor which laboratory value to evaluate the
therapeutic response?
A. Serum potassium
B. Hemoglobin and hematocrit
C. Serum creatinine
D. Platelet count
CORRECT ANSWER: B. Hemoglobin and hematocrit
Rationale: Epoetin alfa is a colony-stimulating factor that stimulates
erythropoiesis in the bone marrow. The primary therapeutic goal is
correction of anemia associated with chronic kidney disease. Monitoring
hemoglobin and hematocrit levels determines whether the medication is
achieving its intended effect. Potassium, creatinine, and platelets are not
the primary parameters for evaluating epoetin alfa efficacy, although
potassium may require monitoring due to potential hyperkalemia from
improved red blood cell production.
Question 2: A nurse is preparing to administer digoxin to an adult client.
The nurse should withhold the dose and notify the provider if which
assessment finding is noted?
A. Heart rate of 58 beats per minute
B. Apical pulse of 52 beats per minute
C. Blood pressure of 118/72 mm Hg
D. Respiratory rate of 18 breaths per minute
CORRECT ANSWER: B. Apical pulse of 52 beats per minute
Rationale: Digoxin increases cardiac contractility and decreases heart rate
through vagal stimulation. A therapeutic adult resting heart rate is typically
60 to 100 beats per minute. An apical pulse below 60 beats per minute may
indicate digoxin toxicity or excessive bradycardia. The nurse should hold
the dose and notify the provider when the adult apical pulse is less than 60
,beats per minute. A rate of 58 may be borderline but 52 is clearly
bradycardic and unsafe for administration.
Question 3: A client receiving warfarin has an INR of 5.2. The client is
not actively bleeding. Which action should the nurse anticipate taking?
A. Administer protamine sulfate
B. Administer vitamin K intravenously
C. Hold the next dose and notify the provider
D. Increase the next warfarin dose
CORRECT ANSWER: C. Hold the next dose and notify the provider
Rationale: The therapeutic INR range for warfarin is typically 2.0 to 3.0. An
INR of 5.2 is supratherapeutic and places the client at increased risk for
bleeding. In the absence of active bleeding, the next dose should be held,
and the provider should be notified. Oral vitamin K may be prescribed for
elevated INR without bleeding, but IV vitamin K is reserved for serious
bleeding. Protamine sulfate reverses heparin, not warfarin. Increasing the
dose would further elevate the INR and increase bleeding risk.
Question 4: A client is prescribed spironolactone for heart failure.
Which dietary instruction should the nurse include in teaching?
A. Increase intake of bananas and oranges
B. Avoid salt substitutes containing potassium
C. Take the medication with a potassium supplement
D. Increase fluid intake to 3 liters per day
CORRECT ANSWER: B. Avoid salt substitutes containing potassium
Rationale: Spironolactone is a potassium-sparing diuretic that inhibits
aldosterone receptors in the distal tubule, reducing sodium reabsorption
and potassium excretion. Clients are at risk for hyperkalemia. Salt
substitutes frequently contain potassium chloride, which can further
elevate serum potassium levels. Bananas and oranges are high-potassium
foods that should be consumed in moderation, not increased. Potassium
supplements should not be taken with spironolactone unless specifically
prescribed.
Question 5: A nurse is teaching a client about sublingual nitroglycerin
for angina. Which statement by the client indicates correct
understanding?
,A. "I should swallow the tablet with a full glass of water."
B. "I will take one tablet every 5 minutes for up to three doses and call 911 if
pain persists."
C. "I should take this medication only when my blood pressure is above
140/90."
D. "I will store the tablets in the bathroom for easy access."
CORRECT ANSWER: B. "I will take one tablet every 5 minutes for up to
three doses and call 911 if pain persists."
Rationale: Sublingual nitroglycerin is absorbed directly through the oral
mucosa and should not be swallowed. The standard protocol for angina is
one tablet every 5 minutes for a maximum of three doses. If chest pain
persists after the third dose, emergency medical services must be
activated. The medication should be stored in a dark glass container away
from heat and moisture, not in the bathroom. Nitroglycerin is taken at the
onset of angina, not based on blood pressure parameters.
Question 6: A client receiving IV furosemide for pulmonary edema. To
prevent ototoxicity, the nurse should administer the medication at a
rate no faster than:
A. 5 mg/min
B. 10 mg/min
C. 20 mg/min
D. 40 mg/min
CORRECT ANSWER: C. 20 mg/min
Rationale: IV furosemide should be administered at a rate not exceeding 20
mg per minute to reduce the risk of ototoxicity, which can result in
irreversible hearing loss. Rapid administration can also cause significant
hypotension. The nurse should use an infusion pump when possible for
precise rate control, particularly for higher doses.
Question 7: A client with type 2 diabetes is prescribed metformin.
Which laboratory value should the nurse monitor most closely?
A. Serum potassium
B. Serum creatinine
C. Serum calcium
D. Serum sodium
, CORRECT ANSWER: B. Serum creatinine
Rationale: Metformin is primarily excreted unchanged by the kidneys. Renal
impairment increases the risk of metformin accumulation and lactic
acidosis, a rare but life-threatening complication. Serum creatinine and
estimated glomerular filtration rate should be assessed before initiation
and periodically during therapy. Metformin is contraindicated when eGFR is
below 30 mL/min/1.73 m². Potassium, calcium, and sodium are not the
primary parameters for metformin safety monitoring.
Question 8: A nurse is administering IV vancomycin. The client
develops flushing, pruritus, and a rash on the face and upper chest 30
minutes into the infusion. Which action should the nurse take first?
A. Continue the infusion and document the finding
B. Stop the infusion and notify the provider
C. Administer diphenhydramine orally
D. Increase the infusion rate to complete the dose faster
CORRECT ANSWER: B. Stop the infusion and notify the provider
Rationale: Vancomycin infusion reaction, historically called "red man
syndrome," is characterized by flushing, pruritus, and erythema of the face,
neck, and upper torso. It results from rapid infusion of vancomycin and
histamine release. The infusion should be stopped immediately, the
provider notified, and the infusion resumed at a slower rate with
diphenhydramine administration as prescribed. Continuing at the current
rate or increasing the rate would worsen the reaction.
Question 9: A client is prescribed enoxaparin for DVT prophylaxis.
Which instruction is most important for the nurse to include?
A. "Take the medication with food to prevent nausea."
B. "Do not rub the injection site after administering the medication."
C. "Take aspirin for pain if needed."
D. "Massage the injection site to improve absorption."
CORRECT ANSWER: B. "Do not rub the injection site after administering
the medication."
Rationale: Enoxaparin is a low molecular weight heparin administered
subcutaneously. Rubbing or massaging the injection site can cause
hematoma formation and bruising. The injection should be administered in
