PHARMACOLOGY HESI EXIT EXAM– QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS PLUS
RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST| DOWNLOAD
INSTANT PDF
1. A nurse is preparing to administer digoxin to a client with heart failure. Which
assessment finding requires immediate withholding of the medication and notification of
the primary healthcare provider?
A. Blood pressure of 118/76 mm Hg
B. Apical pulse rate of 52 beats/minute
C. Serum potassium level of 4.2 mEq/L
D. Slight visual blurring reported by the client
ANSWER: B. Apical pulse rate of 52 beats/minute
An apical pulse rate below 60 beats/minute in an adult client indicates bradycardia, which is a
primary manifestation of digitalis toxicity. Digoxin must be withheld and the provider notified.
A blood pressure of 118/76 mm Hg is within normal limits. A serum potassium level of 4.2
mEq/L is normal (hypokalemia increases toxicity risk, but this level is safe). While visual
changes can indicate toxicity, the low heart rate is a direct, measurable contraindication
requiring immediate action.
2. A client is prescribed warfarin therapy for the prevention of deep vein thrombosis.
Which laboratory test result should the nurse monitor to evaluate the therapeutic
effectiveness of this medication?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Bleeding time
ANSWER: B. International Normalized Ratio (INR)
The International Normalized Ratio (INR) is the standard laboratory measurement used to
monitor the therapeutic effectiveness and dosage adjustments of warfarin therapy, with a
,typical therapeutic range between 2.0 and 3.0 for most conditions. Activated partial
thromboplastin time (aPTT) is used to monitor heparin therapy, not warfarin. Platelet count
monitors for thrombocytopenia, and bleeding time is a general assessment not routinely used
for warfarin management.
3. A client diagnosed with type 2 diabetes mellitus is prescribed metformin. Which
condition in the client's medical history should the nurse report as a primary
contraindication to this medication?
A. Hypertension managed with lisinopril
B. Chronic obstructive pulmonary disease
C. Severe renal impairment with elevated serum creatinine
D. History of mild seasonal allergies
ANSWER: C. Severe renal impairment with elevated serum creatinine
Metformin is excreted unchanged by the kidneys and is strictly contraindicated in clients with
severe renal impairment due to the high risk of developing life-threatening lactic acidosis.
Hypertension managed with lisinopril, chronic obstructive pulmonary disease, and mild
seasonal allergies do not contraindicate the use of metformin.
4. A client receives an intravenous infusion of regular insulin. Which electrolyte imbalance
must the nurse monitor for most closely during the peak action of this medication?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypomagnesemia
ANSWER: B. Hypokalemia
Insulin drives glucose into the cells along with potassium, which shifts potassium from the
extracellular fluid into the intracellular space, causing hypokalemia. Insulin does not directly
lower calcium, sodium, or magnesium levels in this manner.
5. A client is prescribed furosemide for acute pulmonary edema. Which clinical finding
indicates that the medication has achieved its primary therapeutic goal?
A. Increased pedal edema
,B. Decreased urinary output
C. Clear breath sounds and decreased dyspnea
D. Elevated blood pressure
ANSWER: C. Clear breath sounds and decreased dyspnea
Furosemide is a potent loop diuretic designed to rapidly remove excess fluid from the body,
resolving pulmonary congestion, clearing breath sounds, and relieving dyspnea in acute
pulmonary edema. Increased pedal edema, decreased urinary output, and elevated blood
pressure indicate worsening fluid overload or treatment failure.
6. A client with rheumatoid arthritis is prescribed methotrexate. Which instruction is
essential for the nurse to include in the client teaching plan?
A. "Discontinue the medication immediately if you experience mild nausea."
B. "Avoid crowds and individuals with known infections."
C. "Take the medication daily at bedtime with a full glass of milk."
D. "Increase your daily intake of vitamin C supplements."
ANSWER: B. "Avoid crowds and individuals with known infections."
Methotrexate is an immunosuppressant that suppresses bone marrow production, increasing
the risk of severe infection. Clients must avoid crowds and sources of infection. Methotrexate
is typically taken weekly, not daily, and mild side effects should be reported to the provider
rather than prompting abrupt discontinuation.
7. A client is prescribed levothyroxine for hypothyroidism. Which statement by the client
indicates an understanding of proper medication administration?
A. "I will take this pill right after eating a heavy breakfast."
B. "I should take this medication on an empty stomach every morning with a full glass of
water."
C. "I can stop taking the medication as soon as my energy levels return to normal."
D. "I will take the medication at bedtime to help me sleep better."
ANSWER: B. "I should take this medication on an empty stomach every morning with a
full glass of water."
, Levothyroxine absorption is significantly reduced by food in the stomach; therefore, it must be
taken on an empty stomach in the morning with water. It is a lifelong replacement therapy and
should never be stopped abruptly, nor should it be taken at night.
8. A client is prescribed lithium carbonate for bipolar disorder. Which laboratory value
should the nurse review prior to administering the morning dose?
A. Serum lithium level
B. Serum amylase level
C. Fasting blood glucose level
D. Erythrocyte sedimentation rate
ANSWER: A. Serum lithium level
Lithium has a very narrow therapeutic index (typically 0.6 to 1.2 mEq/L), making regular
monitoring of serum lithium levels essential to prevent toxicity. Amylase, blood glucose, and
sedimentation rate are unrelated to lithium monitoring.
9. A client is prescribed enoxaparin following a total knee replacement surgery. Which
action should the nurse take when administering this subcutaneous injection?
A. Aspirate before injecting the medication to verify vein placement.
B. Massage the injection site vigorously after administration to enhance absorption.
C. Administer the injection into the anterolateral or posterolateral abdominal wall.
D. Expel the air bubble from the prefilled syringe prior to injection.
ANSWER: C. Administer the injection into the anterolateral or posterolateral abdominal
wall.
Enoxaparin should be administered subcutaneously in the lateral abdominal folds. Aspiration
is not recommended, the air bubble should not be expelled because it ensures delivery of the
full dose, and the site should not be massaged to prevent bruising and hematoma formation.
10. A client with asthma is prescribed albuterol and fluticasone inhalers. Which instruction
should the nurse provide regarding the correct sequence of administration?
A. Use the fluticasone inhaler first, wait 5 minutes, then use the albuterol inhaler.
B. Use the albuterol inhaler first, wait 5 minutes, then use the fluticasone inhaler.
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS PLUS
RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST| DOWNLOAD
INSTANT PDF
1. A nurse is preparing to administer digoxin to a client with heart failure. Which
assessment finding requires immediate withholding of the medication and notification of
the primary healthcare provider?
A. Blood pressure of 118/76 mm Hg
B. Apical pulse rate of 52 beats/minute
C. Serum potassium level of 4.2 mEq/L
D. Slight visual blurring reported by the client
ANSWER: B. Apical pulse rate of 52 beats/minute
An apical pulse rate below 60 beats/minute in an adult client indicates bradycardia, which is a
primary manifestation of digitalis toxicity. Digoxin must be withheld and the provider notified.
A blood pressure of 118/76 mm Hg is within normal limits. A serum potassium level of 4.2
mEq/L is normal (hypokalemia increases toxicity risk, but this level is safe). While visual
changes can indicate toxicity, the low heart rate is a direct, measurable contraindication
requiring immediate action.
2. A client is prescribed warfarin therapy for the prevention of deep vein thrombosis.
Which laboratory test result should the nurse monitor to evaluate the therapeutic
effectiveness of this medication?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Bleeding time
ANSWER: B. International Normalized Ratio (INR)
The International Normalized Ratio (INR) is the standard laboratory measurement used to
monitor the therapeutic effectiveness and dosage adjustments of warfarin therapy, with a
,typical therapeutic range between 2.0 and 3.0 for most conditions. Activated partial
thromboplastin time (aPTT) is used to monitor heparin therapy, not warfarin. Platelet count
monitors for thrombocytopenia, and bleeding time is a general assessment not routinely used
for warfarin management.
3. A client diagnosed with type 2 diabetes mellitus is prescribed metformin. Which
condition in the client's medical history should the nurse report as a primary
contraindication to this medication?
A. Hypertension managed with lisinopril
B. Chronic obstructive pulmonary disease
C. Severe renal impairment with elevated serum creatinine
D. History of mild seasonal allergies
ANSWER: C. Severe renal impairment with elevated serum creatinine
Metformin is excreted unchanged by the kidneys and is strictly contraindicated in clients with
severe renal impairment due to the high risk of developing life-threatening lactic acidosis.
Hypertension managed with lisinopril, chronic obstructive pulmonary disease, and mild
seasonal allergies do not contraindicate the use of metformin.
4. A client receives an intravenous infusion of regular insulin. Which electrolyte imbalance
must the nurse monitor for most closely during the peak action of this medication?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypomagnesemia
ANSWER: B. Hypokalemia
Insulin drives glucose into the cells along with potassium, which shifts potassium from the
extracellular fluid into the intracellular space, causing hypokalemia. Insulin does not directly
lower calcium, sodium, or magnesium levels in this manner.
5. A client is prescribed furosemide for acute pulmonary edema. Which clinical finding
indicates that the medication has achieved its primary therapeutic goal?
A. Increased pedal edema
,B. Decreased urinary output
C. Clear breath sounds and decreased dyspnea
D. Elevated blood pressure
ANSWER: C. Clear breath sounds and decreased dyspnea
Furosemide is a potent loop diuretic designed to rapidly remove excess fluid from the body,
resolving pulmonary congestion, clearing breath sounds, and relieving dyspnea in acute
pulmonary edema. Increased pedal edema, decreased urinary output, and elevated blood
pressure indicate worsening fluid overload or treatment failure.
6. A client with rheumatoid arthritis is prescribed methotrexate. Which instruction is
essential for the nurse to include in the client teaching plan?
A. "Discontinue the medication immediately if you experience mild nausea."
B. "Avoid crowds and individuals with known infections."
C. "Take the medication daily at bedtime with a full glass of milk."
D. "Increase your daily intake of vitamin C supplements."
ANSWER: B. "Avoid crowds and individuals with known infections."
Methotrexate is an immunosuppressant that suppresses bone marrow production, increasing
the risk of severe infection. Clients must avoid crowds and sources of infection. Methotrexate
is typically taken weekly, not daily, and mild side effects should be reported to the provider
rather than prompting abrupt discontinuation.
7. A client is prescribed levothyroxine for hypothyroidism. Which statement by the client
indicates an understanding of proper medication administration?
A. "I will take this pill right after eating a heavy breakfast."
B. "I should take this medication on an empty stomach every morning with a full glass of
water."
C. "I can stop taking the medication as soon as my energy levels return to normal."
D. "I will take the medication at bedtime to help me sleep better."
ANSWER: B. "I should take this medication on an empty stomach every morning with a
full glass of water."
, Levothyroxine absorption is significantly reduced by food in the stomach; therefore, it must be
taken on an empty stomach in the morning with water. It is a lifelong replacement therapy and
should never be stopped abruptly, nor should it be taken at night.
8. A client is prescribed lithium carbonate for bipolar disorder. Which laboratory value
should the nurse review prior to administering the morning dose?
A. Serum lithium level
B. Serum amylase level
C. Fasting blood glucose level
D. Erythrocyte sedimentation rate
ANSWER: A. Serum lithium level
Lithium has a very narrow therapeutic index (typically 0.6 to 1.2 mEq/L), making regular
monitoring of serum lithium levels essential to prevent toxicity. Amylase, blood glucose, and
sedimentation rate are unrelated to lithium monitoring.
9. A client is prescribed enoxaparin following a total knee replacement surgery. Which
action should the nurse take when administering this subcutaneous injection?
A. Aspirate before injecting the medication to verify vein placement.
B. Massage the injection site vigorously after administration to enhance absorption.
C. Administer the injection into the anterolateral or posterolateral abdominal wall.
D. Expel the air bubble from the prefilled syringe prior to injection.
ANSWER: C. Administer the injection into the anterolateral or posterolateral abdominal
wall.
Enoxaparin should be administered subcutaneously in the lateral abdominal folds. Aspiration
is not recommended, the air bubble should not be expelled because it ensures delivery of the
full dose, and the site should not be massaged to prevent bruising and hematoma formation.
10. A client with asthma is prescribed albuterol and fluticasone inhalers. Which instruction
should the nurse provide regarding the correct sequence of administration?
A. Use the fluticasone inhaler first, wait 5 minutes, then use the albuterol inhaler.
B. Use the albuterol inhaler first, wait 5 minutes, then use the fluticasone inhaler.
