HESI PHARMACOLOGY EXAM QUESTIONS
2022/2023 ALL 55 QUESTIONS WITH
CORRECT ANSWERS
Section 1: Medication Administration & Safety
1. A nurse is preparing to administer digoxin to a client. Which assessment finding should the
nurse report to the provider before administering the medication?
A. Heart rate of 88 bpm
B. Blood pressure of 128/76 mm Hg
C. Heart rate of 52 bpm
D. Respiratory rate of 18 breaths/min
Rationale: Digoxin slows the heart rate and increases contractility. A heart rate below 60
bpm in adults is a contraindication to administering digoxin. The nurse should withhold the dose
and notify the provider. Options A, B, and D are within normal limits and do not require holding
the medication.
2. Which of the following are the "rights" of medication administration that the nurse should
verify before giving any medication? (Select All That Apply)
A. Right client
B. Right dose
C. Right route
D. Right time
E. Right documentation
F. Right insurance
Rationale: The traditional "Five Rights" include right client, right dose, right route, right
time, and right medication. Extended rights include right documentation, right reason, right to
refuse, and right assessment. Right insurance is not a medication administration right.
3. A nurse is administering an intramuscular injection to an adult client. Which site is
contraindicated for IM injections?
,A. Ventrogluteal
B. Deltoid
C. Dorsogluteal
D. Vastus lateralis
Rationale: The dorsogluteal site is contraindicated because of the risk of sciatic nerve injury
and inadvertent injection into blood vessels. The ventrogluteal site is the preferred site for
adults. The deltoid is used for small volumes, and the vastus lateralis is preferred for infants.
4. A nurse is preparing to administer a medication via a nasogastric (NG) tube. Which action
should the nurse take first?
A. Crush the medication and mix with water
B. Verify tube placement by aspirating gastric contents and checking pH
C. Flush the tube with 30 mL of air
D. Administer the medication quickly to prevent clogging
Rationale: The first action is to verify NG tube placement. The most reliable method is
aspirating gastric contents and testing the pH (gastric pH is typically 1–5). Auscultating air bolus
is no longer recommended as a sole method. After verification, the nurse should flush with
water, administer medications separately, and flush again.
5. A client is prescribed a medication that is classified as Pregnancy Category X. The nurse
understands that this means:
A. Studies show no risk to the fetus
B. Animal studies show risk, but human studies do not
C. The medication is contraindicated in pregnancy
D. There is no evidence of risk in the second or third trimester
Rationale: Pregnancy Category X medications are contraindicated in women who are or may
become pregnant. The risks clearly outweigh any possible benefit. Category A has no risk,
Category B has no evidence of risk, and Category C has risk that cannot be ruled out.
6. A nurse is teaching a client about taking sublingual nitroglycerin. Which statement by the
client indicates a need for further teaching?
,A. "I will place the tablet under my tongue and let it dissolve."
B. "I will swallow the tablet with a full glass of water."
C. "I will sit or lie down when I take this medication."
D. "I will call 911 if my chest pain doesn't improve after 3 doses."
Rationale: Sublingual nitroglycerin must be placed under the tongue and allowed to
dissolve—not swallowed—because the sublingual route allows for rapid absorption and avoids
first-pass metabolism. Swallowing the tablet would make it ineffective for acute angina relief.
7. A nurse is preparing to administer heparin subcutaneously. Which action is correct?
A. Massage the injection site after administration
B. Use a 25-gauge, 5/8-inch needle at a 45- to 90-degree angle
C. Aspirate before injecting to check for blood return
D. Use a 21-gauge, 1.5-inch needle at a 90-degree angle
Rationale: For subcutaneous heparin, use a 25- to 27-gauge, 3/8- to 5/8-inch needle at a 45-
to 90-degree angle. Do not aspirate (risk of hematoma) and do not massage the site. The
abdomen is the preferred site, avoiding the umbilicus by 2 inches.
8. Which of the following medications should the nurse withhold if the client's potassium
level is 3.0 mEq/L?
A. Furosemide
B. Spironolactone
C. Potassium chloride
D. Lisinopril
Rationale: Furosemide is a loop diuretic that causes potassium loss, which can worsen
hypokalemia. A normal potassium level is 3.5–5.0 mEq/L. The nurse should withhold furosemide
and notify the provider. Spironolactone is a potassium-sparing diuretic, and potassium chloride
would be given for hypokalemia.
9. A nurse is administering a medication that has a narrow therapeutic index. Which action is
most important?
, A. Administer the medication with food
B. Monitor serum drug levels closely
C. Administer the medication at bedtime
D. Use the largest effective dose
Rationale: Medications with a narrow therapeutic index (e.g., digoxin, warfarin, lithium,
phenytoin) require close monitoring of serum drug levels to ensure the drug is within the
therapeutic range and to prevent toxicity.
10. The nurse is preparing to administer a medication through a peripheral IV line. Which
finding requires immediate intervention?
A. The IV site is cool to the touch and swollen
B. The IV fluid is infusing at the prescribed rate
C. The client reports mild discomfort at the site
D. The IV site has a small bruise
Rationale: Coolness, swelling, and pain at the IV site indicate infiltration or extravasation.
The nurse should stop the infusion immediately, remove the IV, elevate the extremity, and notify
the provider. Applying warm or cold compresses depends on the medication infiltrated.
11. A nurse is reviewing a medication order that reads "MSO4 2 mg IV push q2h prn." What is
the nurse's priority action?
A. Administer the medication as ordered
B. Clarify the order with the provider
C. Administer the medication IM instead
D. Hold the medication and document the refusal
Rationale: "MSO4" is an error-prone abbreviation for morphine sulfate. The Joint
Commission prohibits this abbreviation. The nurse should clarify the order with the provider
before administering. Other error-prone abbreviations include U for units, qd for daily, and MS
for morphine sulfate or magnesium sulfate.
12. Which of the following are appropriate nursing actions when administering a blood
transfusion? (Select All That Apply)
2022/2023 ALL 55 QUESTIONS WITH
CORRECT ANSWERS
Section 1: Medication Administration & Safety
1. A nurse is preparing to administer digoxin to a client. Which assessment finding should the
nurse report to the provider before administering the medication?
A. Heart rate of 88 bpm
B. Blood pressure of 128/76 mm Hg
C. Heart rate of 52 bpm
D. Respiratory rate of 18 breaths/min
Rationale: Digoxin slows the heart rate and increases contractility. A heart rate below 60
bpm in adults is a contraindication to administering digoxin. The nurse should withhold the dose
and notify the provider. Options A, B, and D are within normal limits and do not require holding
the medication.
2. Which of the following are the "rights" of medication administration that the nurse should
verify before giving any medication? (Select All That Apply)
A. Right client
B. Right dose
C. Right route
D. Right time
E. Right documentation
F. Right insurance
Rationale: The traditional "Five Rights" include right client, right dose, right route, right
time, and right medication. Extended rights include right documentation, right reason, right to
refuse, and right assessment. Right insurance is not a medication administration right.
3. A nurse is administering an intramuscular injection to an adult client. Which site is
contraindicated for IM injections?
,A. Ventrogluteal
B. Deltoid
C. Dorsogluteal
D. Vastus lateralis
Rationale: The dorsogluteal site is contraindicated because of the risk of sciatic nerve injury
and inadvertent injection into blood vessels. The ventrogluteal site is the preferred site for
adults. The deltoid is used for small volumes, and the vastus lateralis is preferred for infants.
4. A nurse is preparing to administer a medication via a nasogastric (NG) tube. Which action
should the nurse take first?
A. Crush the medication and mix with water
B. Verify tube placement by aspirating gastric contents and checking pH
C. Flush the tube with 30 mL of air
D. Administer the medication quickly to prevent clogging
Rationale: The first action is to verify NG tube placement. The most reliable method is
aspirating gastric contents and testing the pH (gastric pH is typically 1–5). Auscultating air bolus
is no longer recommended as a sole method. After verification, the nurse should flush with
water, administer medications separately, and flush again.
5. A client is prescribed a medication that is classified as Pregnancy Category X. The nurse
understands that this means:
A. Studies show no risk to the fetus
B. Animal studies show risk, but human studies do not
C. The medication is contraindicated in pregnancy
D. There is no evidence of risk in the second or third trimester
Rationale: Pregnancy Category X medications are contraindicated in women who are or may
become pregnant. The risks clearly outweigh any possible benefit. Category A has no risk,
Category B has no evidence of risk, and Category C has risk that cannot be ruled out.
6. A nurse is teaching a client about taking sublingual nitroglycerin. Which statement by the
client indicates a need for further teaching?
,A. "I will place the tablet under my tongue and let it dissolve."
B. "I will swallow the tablet with a full glass of water."
C. "I will sit or lie down when I take this medication."
D. "I will call 911 if my chest pain doesn't improve after 3 doses."
Rationale: Sublingual nitroglycerin must be placed under the tongue and allowed to
dissolve—not swallowed—because the sublingual route allows for rapid absorption and avoids
first-pass metabolism. Swallowing the tablet would make it ineffective for acute angina relief.
7. A nurse is preparing to administer heparin subcutaneously. Which action is correct?
A. Massage the injection site after administration
B. Use a 25-gauge, 5/8-inch needle at a 45- to 90-degree angle
C. Aspirate before injecting to check for blood return
D. Use a 21-gauge, 1.5-inch needle at a 90-degree angle
Rationale: For subcutaneous heparin, use a 25- to 27-gauge, 3/8- to 5/8-inch needle at a 45-
to 90-degree angle. Do not aspirate (risk of hematoma) and do not massage the site. The
abdomen is the preferred site, avoiding the umbilicus by 2 inches.
8. Which of the following medications should the nurse withhold if the client's potassium
level is 3.0 mEq/L?
A. Furosemide
B. Spironolactone
C. Potassium chloride
D. Lisinopril
Rationale: Furosemide is a loop diuretic that causes potassium loss, which can worsen
hypokalemia. A normal potassium level is 3.5–5.0 mEq/L. The nurse should withhold furosemide
and notify the provider. Spironolactone is a potassium-sparing diuretic, and potassium chloride
would be given for hypokalemia.
9. A nurse is administering a medication that has a narrow therapeutic index. Which action is
most important?
, A. Administer the medication with food
B. Monitor serum drug levels closely
C. Administer the medication at bedtime
D. Use the largest effective dose
Rationale: Medications with a narrow therapeutic index (e.g., digoxin, warfarin, lithium,
phenytoin) require close monitoring of serum drug levels to ensure the drug is within the
therapeutic range and to prevent toxicity.
10. The nurse is preparing to administer a medication through a peripheral IV line. Which
finding requires immediate intervention?
A. The IV site is cool to the touch and swollen
B. The IV fluid is infusing at the prescribed rate
C. The client reports mild discomfort at the site
D. The IV site has a small bruise
Rationale: Coolness, swelling, and pain at the IV site indicate infiltration or extravasation.
The nurse should stop the infusion immediately, remove the IV, elevate the extremity, and notify
the provider. Applying warm or cold compresses depends on the medication infiltrated.
11. A nurse is reviewing a medication order that reads "MSO4 2 mg IV push q2h prn." What is
the nurse's priority action?
A. Administer the medication as ordered
B. Clarify the order with the provider
C. Administer the medication IM instead
D. Hold the medication and document the refusal
Rationale: "MSO4" is an error-prone abbreviation for morphine sulfate. The Joint
Commission prohibits this abbreviation. The nurse should clarify the order with the provider
before administering. Other error-prone abbreviations include U for units, qd for daily, and MS
for morphine sulfate or magnesium sulfate.
12. Which of the following are appropriate nursing actions when administering a blood
transfusion? (Select All That Apply)
