RN HESI Pharmacology V2 (2026) PDF | Actual
Exams with Rationales
Section 1: Medication Administration & Safety (Questions 1–20)
1. A patient is prescribed a medication that has a high first-pass effect. Which
route of administration would be most appropriate to bypass this effect?
A. Oral
B. Intramuscular
C. Topical
D. Sublingual
Correct Answer: D
Rationale: Sublingual administration bypasses the first-pass effect because
the medication is absorbed directly into the bloodstream through the sublingual
mucosa, avoiding the hepatic portal system. Oral administration is subject to first-
pass metabolism. Intramuscular and topical routes do not primarily bypass the
first-pass effect in the same way sublingual does.
2. What are the "Five Rights" of medication administration?
A. Right Patient, Drug, Dose, Route, Time
B. Right Patient, Dose, Frequency, Route, Documentation
C. Right Drug, Dose, Route, Time, Refill
D. Right Patient, Drug, Dose, Route, Education
Correct Answer: A
Rationale: The "Five Rights" are fundamental to medication safety: right
patient, drug, dose, route, and time. Right documentation, indication, and patient
education are often considered additional rights.
3. A nurse is preparing to administer medications. Which action is the highest
priority?
A. Check the client's room number
B. Verify the client's insurance information
C. Check the client's name band using two identifiers
D. Ask the client their height and weight
, Correct Answer: C
Rationale: Patient safety is paramount. The "Rights of Medication
Administration" include using two client identifiers (name and date of birth) to
ensure the right patient receives the medication. Checking a room number is
unsafe as clients may change rooms.
4. How should the nurse safely prepare medications for a client?
A. Prepare medications for multiple clients at the same time
B. Prepare one client's medications at a time and check them against the MAR
C. Have another nurse prepare the medications
D. Prepare medications in advance for the entire shift
Correct Answer: B
Rationale: Medications should be prepared for one client at a time and
verified against the Medication Administration Record (MAR) to prevent errors.
Preparing for multiple clients simultaneously increases the risk of medication
errors.
5. A nurse is administering a medication via a nasogastric (NG) tube. What is the
priority action?
A. Crush the medication into a fine powder
B. Mix the medication with 30 mL of water
C. Verify tube placement
D. Administer the medication with a syringe
Correct Answer: C
Rationale: Before administering any medication through an NG tube, the
nurse must first verify its placement to ensure it is in the stomach and not in the
lungs or esophagus. Administering medication into the lungs can cause severe
aspiration pneumonia.
6. A nurse is teaching a client about the use of a metered-dose inhaler (MDI)
with a spacer. Which instruction should the nurse include?
A. "Inhale rapidly and forcefully after activating the inhaler."
B. "Hold your breath for 10 seconds after inhaling the medication."
C. "Wait 2 minutes between puffs of the same medication."
D. "Rinse your mouth with a mouthwash immediately after use."
, Correct Answer: B
Rationale: Holding the breath for at least 10 seconds allows the
medication to settle in the airways. A slow, deep inhalation is recommended, not
a rapid one. Waiting 1–2 minutes between puffs of the same medication is
common, but not 2 minutes. Rinsing with water (not mouthwash) is important,
especially for corticosteroids, to prevent oral thrush.
7. A nurse is preparing to administer heparin subcutaneously. Which action is
correct?
A. Aspirate for blood return before injecting.
B. Massage the site vigorously after injection.
C. Use a 25-gauge needle.
D. Inject into the deltoid muscle.
Correct Answer: C
Rationale: A 25- to 27-gauge needle is appropriate for subcutaneous
injections. Aspiration is not recommended for heparin injections as it can cause
tissue damage and hematoma. The site should not be massaged for the same
reason. Heparin is administered subcutaneously, typically in the abdomen, not
intramuscularly.
8. A client has an order for a medication to be given "qid." How many times per
day will the nurse administer this medication?
A. One
B. Two
C. Three
D. Four
Correct Answer: D
Rationale: "qid" is the abbreviation for "quater in die," which means four
times a day. "qd" is once a day, "bid" is twice a day, and "tid" is three times a day.
9. The nurse is preparing to administer a blood transfusion. Which fluid is the
only one compatible for use with blood products?
A. Lactated Ringer's
B. Dextrose 5% in water
, C. 0.9% Sodium Chloride
D. Sterile water
Correct Answer: C
Rationale: 0.9% Sodium Chloride (normal saline) is the only IV fluid that is
compatible with blood products. Lactated Ringer's contains calcium and can cause
clotting when mixed with citrated blood. Dextrose solutions can cause hemolysis
(destruction) of red blood cells.
10. A nurse is caring for a client who is receiving a high-alert medication. What is
the best practice to ensure safety?
A. Have another nurse independently calculate the dose and verify the pump
settings.
B. Administer the medication as quickly as possible to save time.
C. Document the medication administration before giving it.
D. Use a standard syringe for all high-alert medications.
Correct Answer: A
Rationale: High-alert medications have a heightened risk of causing
significant client harm when used in error. An independent double-check by a
second nurse is a key safety strategy. This involves verifying the drug,
concentration, dose calculation, and pump programming. Documentation should
always occur after administration.
11. A client is prescribed an oral medication that is available in an elixir. The
client has a history of alcohol use disorder. What is the nurse's best action?
A. Administer the elixir as prescribed.
B. Request a different formulation from the provider.
C. Inform the client that the elixir contains a small amount of alcohol.
D. Hold the medication and document the reason.
Correct Answer: B
Rationale: Elixirs contain alcohol. Administering an alcohol-containing
medication to a client with a history of alcohol use disorder could be
inappropriate and potentially harmful. The best action is to request an alternative
formulation (e.g., a tablet) from the provider.
Exams with Rationales
Section 1: Medication Administration & Safety (Questions 1–20)
1. A patient is prescribed a medication that has a high first-pass effect. Which
route of administration would be most appropriate to bypass this effect?
A. Oral
B. Intramuscular
C. Topical
D. Sublingual
Correct Answer: D
Rationale: Sublingual administration bypasses the first-pass effect because
the medication is absorbed directly into the bloodstream through the sublingual
mucosa, avoiding the hepatic portal system. Oral administration is subject to first-
pass metabolism. Intramuscular and topical routes do not primarily bypass the
first-pass effect in the same way sublingual does.
2. What are the "Five Rights" of medication administration?
A. Right Patient, Drug, Dose, Route, Time
B. Right Patient, Dose, Frequency, Route, Documentation
C. Right Drug, Dose, Route, Time, Refill
D. Right Patient, Drug, Dose, Route, Education
Correct Answer: A
Rationale: The "Five Rights" are fundamental to medication safety: right
patient, drug, dose, route, and time. Right documentation, indication, and patient
education are often considered additional rights.
3. A nurse is preparing to administer medications. Which action is the highest
priority?
A. Check the client's room number
B. Verify the client's insurance information
C. Check the client's name band using two identifiers
D. Ask the client their height and weight
, Correct Answer: C
Rationale: Patient safety is paramount. The "Rights of Medication
Administration" include using two client identifiers (name and date of birth) to
ensure the right patient receives the medication. Checking a room number is
unsafe as clients may change rooms.
4. How should the nurse safely prepare medications for a client?
A. Prepare medications for multiple clients at the same time
B. Prepare one client's medications at a time and check them against the MAR
C. Have another nurse prepare the medications
D. Prepare medications in advance for the entire shift
Correct Answer: B
Rationale: Medications should be prepared for one client at a time and
verified against the Medication Administration Record (MAR) to prevent errors.
Preparing for multiple clients simultaneously increases the risk of medication
errors.
5. A nurse is administering a medication via a nasogastric (NG) tube. What is the
priority action?
A. Crush the medication into a fine powder
B. Mix the medication with 30 mL of water
C. Verify tube placement
D. Administer the medication with a syringe
Correct Answer: C
Rationale: Before administering any medication through an NG tube, the
nurse must first verify its placement to ensure it is in the stomach and not in the
lungs or esophagus. Administering medication into the lungs can cause severe
aspiration pneumonia.
6. A nurse is teaching a client about the use of a metered-dose inhaler (MDI)
with a spacer. Which instruction should the nurse include?
A. "Inhale rapidly and forcefully after activating the inhaler."
B. "Hold your breath for 10 seconds after inhaling the medication."
C. "Wait 2 minutes between puffs of the same medication."
D. "Rinse your mouth with a mouthwash immediately after use."
, Correct Answer: B
Rationale: Holding the breath for at least 10 seconds allows the
medication to settle in the airways. A slow, deep inhalation is recommended, not
a rapid one. Waiting 1–2 minutes between puffs of the same medication is
common, but not 2 minutes. Rinsing with water (not mouthwash) is important,
especially for corticosteroids, to prevent oral thrush.
7. A nurse is preparing to administer heparin subcutaneously. Which action is
correct?
A. Aspirate for blood return before injecting.
B. Massage the site vigorously after injection.
C. Use a 25-gauge needle.
D. Inject into the deltoid muscle.
Correct Answer: C
Rationale: A 25- to 27-gauge needle is appropriate for subcutaneous
injections. Aspiration is not recommended for heparin injections as it can cause
tissue damage and hematoma. The site should not be massaged for the same
reason. Heparin is administered subcutaneously, typically in the abdomen, not
intramuscularly.
8. A client has an order for a medication to be given "qid." How many times per
day will the nurse administer this medication?
A. One
B. Two
C. Three
D. Four
Correct Answer: D
Rationale: "qid" is the abbreviation for "quater in die," which means four
times a day. "qd" is once a day, "bid" is twice a day, and "tid" is three times a day.
9. The nurse is preparing to administer a blood transfusion. Which fluid is the
only one compatible for use with blood products?
A. Lactated Ringer's
B. Dextrose 5% in water
, C. 0.9% Sodium Chloride
D. Sterile water
Correct Answer: C
Rationale: 0.9% Sodium Chloride (normal saline) is the only IV fluid that is
compatible with blood products. Lactated Ringer's contains calcium and can cause
clotting when mixed with citrated blood. Dextrose solutions can cause hemolysis
(destruction) of red blood cells.
10. A nurse is caring for a client who is receiving a high-alert medication. What is
the best practice to ensure safety?
A. Have another nurse independently calculate the dose and verify the pump
settings.
B. Administer the medication as quickly as possible to save time.
C. Document the medication administration before giving it.
D. Use a standard syringe for all high-alert medications.
Correct Answer: A
Rationale: High-alert medications have a heightened risk of causing
significant client harm when used in error. An independent double-check by a
second nurse is a key safety strategy. This involves verifying the drug,
concentration, dose calculation, and pump programming. Documentation should
always occur after administration.
11. A client is prescribed an oral medication that is available in an elixir. The
client has a history of alcohol use disorder. What is the nurse's best action?
A. Administer the elixir as prescribed.
B. Request a different formulation from the provider.
C. Inform the client that the elixir contains a small amount of alcohol.
D. Hold the medication and document the reason.
Correct Answer: B
Rationale: Elixirs contain alcohol. Administering an alcohol-containing
medication to a client with a history of alcohol use disorder could be
inappropriate and potentially harmful. The best action is to request an alternative
formulation (e.g., a tablet) from the provider.
