HESI Pharmacology V2
Exam,2025/2026 Edition. Question and
answers
Question 1: Dosage Calculation - IV Morphine
Order: Morphine 2 mg IV q4h PRN pain. Available: 4 mg/mL. How many mL to administer?
A. 0.25 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Rationale: Use the formula: Desired dose (2 mg) ÷ Supply concentration (4 mg/mL) = 0.5 mL. Per 2025
ISMP guidelines, double-check high-alert opioids to prevent errors; administer slowly over 4-5 minutes to
avoid respiratory depression.
Question 2: Adverse Effects - Lisinopril
A client on lisinopril develops a dry, nonproductive cough. This is a common adverse effect due to:
A. Hyperkalemia.
B. Bradykinin accumulation from ACE inhibition.
C. Hypotension.
D. Angioedema.
Rationale: ACE inhibitors like lisinopril (2026 AHA HTN guidelines) cause cough in 10-20% of patients
via bradykinin; monitor and switch to ARB if persistent, as it resolves in 1-2 weeks post-discontinuation.
Question 3: Safe Medication Administration - Insulin
Before administering regular insulin, the nurse confirms:
,A. Only the dose.
B. Blood glucose level is >70 mg/dL.
C. Meal has been eaten.
D. Site rotation only.
Rationale: 2025 ADA standards require BG check to avoid hypoglycemia; use the "5 Rights" (right
patient, drug, dose, route, time) and teach subcutaneous injection at 90° angle for accuracy.
Question 4: Drug Interactions - Warfarin
A client on warfarin starts levofloxacin for UTI. The nurse anticipates:
A. Decreased INR.
B. Increased INR due to CYP inhibition, requiring dose adjustment.
C. No change.
D. Bleeding risk decrease.
Rationale: Fluoroquinolones like levofloxacin (2026 ASHP interaction checker) potentiate warfarin via
gut flora disruption; monitor INR q3d and hold if >3.5 to prevent hemorrhage.
Question 5: Dosage Calculation - Vancomycin
Order: Vancomycin 1 g IV q12h. Available: 1 g/250 mL D5W. Infuse over 90 minutes. What rate
(mL/hr)?
A. 100 mL/hr
B. 167 mL/hr
C. 250 mL/hr
D. 125 mL/hr
Rationale: Total volume 250 mL over 1.5 hours: 250 ÷ 1.5 = 166.67 ≈ 167 mL/hr. 2025 IDSA guidelines
emphasize trough levels (15-20 mcg/mL) for efficacy; slow infusion prevents Red Man syndrome.
Question 6: Adverse Effects - Digoxin
A client on digoxin complains of yellow vision and nausea. These symptoms indicate:
A. Therapeutic effect.
, B. Digoxin toxicity (level >2 ng/mL).
C. Hypokalemia.
D. Bradycardia only.
Rationale: Xanthopsia and GI upset (2026 AHA HF guidelines) signal toxicity; hold dose, check
level/K+, and give digibind if HR <60 or severe.
Question 7: Safe Medication Administration - Heparin
When administering IV heparin, the nurse uses:
A. Gravity drip.
B. Infusion pump for precise rate control.
C. Bolus only.
D. SubQ push.
Rationale: High-alert anticoagulant per 2025 ISMP; pump ensures aPTT-guided titration (1.5-2.5x
control) and reduces errors in weight-based dosing (80 U/kg bolus).
Question 8: Drug Interactions - Statins
A client on atorvastatin starts erythromycin. The nurse monitors for:
A. Rhabdomyolysis.
B. Myopathy from CYP3A4 inhibition increasing statin levels.
C. Hepatotoxicity decrease.
D. LDL reduction.
Rationale: Macrolides inhibit CYP3A4 (2026 ACC lipid guidelines); hold statin during therapy, monitor
CK if symptoms, and use pravastatin alternative.
Question 9: Dosage Calculation - Furosemide
Order: Furosemide 40 mg IV push. Available: 10 mg/mL. mL to administer?
A. 4 mL
B. 4 mL
Exam,2025/2026 Edition. Question and
answers
Question 1: Dosage Calculation - IV Morphine
Order: Morphine 2 mg IV q4h PRN pain. Available: 4 mg/mL. How many mL to administer?
A. 0.25 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Rationale: Use the formula: Desired dose (2 mg) ÷ Supply concentration (4 mg/mL) = 0.5 mL. Per 2025
ISMP guidelines, double-check high-alert opioids to prevent errors; administer slowly over 4-5 minutes to
avoid respiratory depression.
Question 2: Adverse Effects - Lisinopril
A client on lisinopril develops a dry, nonproductive cough. This is a common adverse effect due to:
A. Hyperkalemia.
B. Bradykinin accumulation from ACE inhibition.
C. Hypotension.
D. Angioedema.
Rationale: ACE inhibitors like lisinopril (2026 AHA HTN guidelines) cause cough in 10-20% of patients
via bradykinin; monitor and switch to ARB if persistent, as it resolves in 1-2 weeks post-discontinuation.
Question 3: Safe Medication Administration - Insulin
Before administering regular insulin, the nurse confirms:
,A. Only the dose.
B. Blood glucose level is >70 mg/dL.
C. Meal has been eaten.
D. Site rotation only.
Rationale: 2025 ADA standards require BG check to avoid hypoglycemia; use the "5 Rights" (right
patient, drug, dose, route, time) and teach subcutaneous injection at 90° angle for accuracy.
Question 4: Drug Interactions - Warfarin
A client on warfarin starts levofloxacin for UTI. The nurse anticipates:
A. Decreased INR.
B. Increased INR due to CYP inhibition, requiring dose adjustment.
C. No change.
D. Bleeding risk decrease.
Rationale: Fluoroquinolones like levofloxacin (2026 ASHP interaction checker) potentiate warfarin via
gut flora disruption; monitor INR q3d and hold if >3.5 to prevent hemorrhage.
Question 5: Dosage Calculation - Vancomycin
Order: Vancomycin 1 g IV q12h. Available: 1 g/250 mL D5W. Infuse over 90 minutes. What rate
(mL/hr)?
A. 100 mL/hr
B. 167 mL/hr
C. 250 mL/hr
D. 125 mL/hr
Rationale: Total volume 250 mL over 1.5 hours: 250 ÷ 1.5 = 166.67 ≈ 167 mL/hr. 2025 IDSA guidelines
emphasize trough levels (15-20 mcg/mL) for efficacy; slow infusion prevents Red Man syndrome.
Question 6: Adverse Effects - Digoxin
A client on digoxin complains of yellow vision and nausea. These symptoms indicate:
A. Therapeutic effect.
, B. Digoxin toxicity (level >2 ng/mL).
C. Hypokalemia.
D. Bradycardia only.
Rationale: Xanthopsia and GI upset (2026 AHA HF guidelines) signal toxicity; hold dose, check
level/K+, and give digibind if HR <60 or severe.
Question 7: Safe Medication Administration - Heparin
When administering IV heparin, the nurse uses:
A. Gravity drip.
B. Infusion pump for precise rate control.
C. Bolus only.
D. SubQ push.
Rationale: High-alert anticoagulant per 2025 ISMP; pump ensures aPTT-guided titration (1.5-2.5x
control) and reduces errors in weight-based dosing (80 U/kg bolus).
Question 8: Drug Interactions - Statins
A client on atorvastatin starts erythromycin. The nurse monitors for:
A. Rhabdomyolysis.
B. Myopathy from CYP3A4 inhibition increasing statin levels.
C. Hepatotoxicity decrease.
D. LDL reduction.
Rationale: Macrolides inhibit CYP3A4 (2026 ACC lipid guidelines); hold statin during therapy, monitor
CK if symptoms, and use pravastatin alternative.
Question 9: Dosage Calculation - Furosemide
Order: Furosemide 40 mg IV push. Available: 10 mg/mL. mL to administer?
A. 4 mL
B. 4 mL
