HESI RN ADVANCED PHARMACOLOGY EXAM NEWEST 2025 ACTUAL EXAM
COMPLETE 100 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+
Question 1
A patient with chronic kidney disease is prescribed digoxin. The nurse understands that this
patient is at increased risk for digoxin toxicity due to alterations in which pharmacokinetic
process?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
E) Bioavailability
Correct Answer: D) Excretion
Rationale: Digoxin is primarily eliminated from the body by renal excretion. In patients with
chronic kidney disease, renal function is impaired, leading to decreased digoxin clearance and
an increased risk of drug accumulation and toxicity. Adjusting the dose based on renal function
is crucial.
Question 2
The nurse is educating a patient prescribed warfarin about potential drug-food interactions.
Which food group should the patient be advised to consume consistently, rather than varying
intake, to avoid altering warfarin's anticoagulant effect?
A) Dairy products
B) High-fiber foods
C) Foods rich in Vitamin K
D) Citrus fruits
E) Red meats
Correct Answer: C) Foods rich in Vitamin K
Rationale: Warfarin exerts its anticoagulant effect by antagonizing Vitamin K. Therefore,
consuming foods rich in Vitamin K (e.g., leafy green vegetables) can reduce warfarin's
effectiveness. Patients should be advised to maintain a consistent intake of Vitamin K-containing
foods rather than avoiding them entirely, to allow for stable dosing.
Question 3
A patient with a history of asthma is prescribed propranolol, a non-selective beta-blocker, for
hypertension. The nurse should monitor this patient closely for which adverse effect?
A) Tachycardia
B) Bronchospasm
C) Hyperglycemia
D) Diarrhea
,E) Hypotension
Correct Answer: B) Bronchospasm
Rationale: Non-selective beta-blockers, such as propranolol, block both beta-1 (cardiac) and
beta-2 (pulmonary) adrenergic receptors. Blocking beta-2 receptors in the lungs can cause
bronchoconstriction, which is dangerous for patients with asthma or COPD. Therefore, selective
beta-1 blockers are preferred for these patients if a beta-blocker is necessary.
Question 4
The nurse is preparing to administer intravenous furosemide to a patient with fluid overload.
The nurse should anticipate that this medication will primarily act on which part of the
nephron?
A) Proximal convoluted tubule
B) Distal convoluted tubule
C) Loop of Henle
D) Collecting duct
E) Bowman's capsule
Correct Answer: C) Loop of Henle
Rationale: Furosemide is a loop diuretic, meaning it primarily acts on the ascending limb of the
loop of Henle in the nephron. It inhibits the reabsorption of sodium and chloride, leading to
significant diuresis.
Question 5
A patient taking an ACE inhibitor develops a persistent, dry cough. The nurse understands this
adverse effect is primarily due to the accumulation of which substance?
A) Angiotensin II
B) Renin
C) Bradykinin
D) Aldosterone
E) Nitric oxide
Correct Answer: C) Bradykinin
Rationale: ACE inhibitors prevent the breakdown of bradykinin, a vasodilator peptide. The
accumulation of bradykinin in the lungs is thought to be the primary cause of the characteristic
dry, non-productive cough experienced by some patients taking ACE inhibitors.
Question 6
A patient with Type 2 Diabetes Mellitus is prescribed metformin. The nurse understands that
metformin reduces blood glucose by which primary mechanism of action?
A) Increasing insulin secretion from the pancreas.
B) Decreasing hepatic glucose production and improving insulin sensitivity.
,C) Delaying carbohydrate absorption in the gut.
D) Increasing glucose excretion in the urine.
E) Stimulating pancreatic beta-cell repair.
Correct Answer: B) Decreasing hepatic glucose production and improving insulin sensitivity.
Rationale: Metformin (a biguanide) primarily works by decreasing glucose production by the
liver (gluconeogenesis) and improving insulin sensitivity in peripheral tissues (muscle and
adipose), allowing for better glucose uptake and utilization. It does not directly stimulate insulin
secretion.
Question 7
Which of the following classes of antihypertensive medications is contraindicated in pregnant
women due to its potential teratogenic effects?
A) Beta-blockers
B) Calcium channel blockers
C) ACE inhibitors
D) Thiazide diuretics
E) Alpha-1 blockers
Correct Answer: C) ACE inhibitors
Rationale: ACE inhibitors are known to be teratogenic (cause birth defects) and are strictly
contraindicated in the second and third trimesters of pregnancy due to risks of fetal renal
failure, oligohydramnios, and other severe fetal anomalies.
Question 8
The nurse is administering intravenous vancomycin. To prevent "Red Man Syndrome," the nurse
should ensure the medication is infused over a minimum of how many minutes?
A) 15 minutes
B) 30 minutes
C) 60 minutes
D) 90 minutes
E) 120 minutes
Correct Answer: C) 60 minutes
Rationale: Red Man Syndrome (characterized by flushing, rash, pruritus, tachycardia, and
hypotension) is an infusion-related reaction associated with vancomycin. It is usually caused by
rapid infusion, which leads to histamine release. Infusing vancomycin over at least 60 minutes
(and often longer for higher doses or sensitive patients) helps to prevent this reaction.
Question 9
A patient is receiving heparin intravenously. The nurse should monitor which laboratory value to
assess the therapeutic effectiveness of heparin?
, A) Prothrombin Time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet count
E) D-dimer
Correct Answer: C) Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin, an anticoagulant, inhibits various clotting factors, primarily Factor Xa and
thrombin. Its therapeutic effect is typically monitored using the activated Partial Thromboplastin
Time (aPTT), which assesses the intrinsic and common pathways of coagulation.
Question 10
Which medication class is commonly used to treat anxiety disorders by enhancing the effects of
gamma-aminobutyric acid (GABA) in the brain?
A) Selective Serotonin Reuptake Inhibitors (SSRIs)
B) Tricyclic Antidepressants (TCAs)
C) Benzodiazepines
D) Atypical antipsychotics
E) Monoamine Oxidase Inhibitors (MAOIs)
Correct Answer: C) Benzodiazepines
Rationale: Benzodiazepines (e.g., lorazepam, alprazolam) are a class of anxiolytic medications
that work by binding to GABA-A receptors in the central nervous system. This binding enhances
the inhibitory effects of GABA, leading to CNS depression and a reduction in anxiety.
Question 11
A patient with glaucoma is prescribed timolol eye drops. The nurse understands this medication
works by which mechanism?
A) Increasing aqueous humor production.
B) Dilating the pupil to improve drainage.
C) Decreasing aqueous humor production.
D) Constricting the ciliary muscle.
E) Stimulating cholinergic receptors.
Correct Answer: C) Decreasing aqueous humor production.
Rationale: Timolol is a beta-adrenergic blocker that, when administered as eye drops, primarily
acts to decrease the production of aqueous humor in the ciliary body. This reduction in fluid
production lowers intraocular pressure, which is beneficial in treating glaucoma.
Question 12
The nurse is teaching a patient about the proper use of an albuterol metered-dose inhaler
(MDI). Which statement indicates the patient understands the primary action of albuterol?
COMPLETE 100 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+
Question 1
A patient with chronic kidney disease is prescribed digoxin. The nurse understands that this
patient is at increased risk for digoxin toxicity due to alterations in which pharmacokinetic
process?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
E) Bioavailability
Correct Answer: D) Excretion
Rationale: Digoxin is primarily eliminated from the body by renal excretion. In patients with
chronic kidney disease, renal function is impaired, leading to decreased digoxin clearance and
an increased risk of drug accumulation and toxicity. Adjusting the dose based on renal function
is crucial.
Question 2
The nurse is educating a patient prescribed warfarin about potential drug-food interactions.
Which food group should the patient be advised to consume consistently, rather than varying
intake, to avoid altering warfarin's anticoagulant effect?
A) Dairy products
B) High-fiber foods
C) Foods rich in Vitamin K
D) Citrus fruits
E) Red meats
Correct Answer: C) Foods rich in Vitamin K
Rationale: Warfarin exerts its anticoagulant effect by antagonizing Vitamin K. Therefore,
consuming foods rich in Vitamin K (e.g., leafy green vegetables) can reduce warfarin's
effectiveness. Patients should be advised to maintain a consistent intake of Vitamin K-containing
foods rather than avoiding them entirely, to allow for stable dosing.
Question 3
A patient with a history of asthma is prescribed propranolol, a non-selective beta-blocker, for
hypertension. The nurse should monitor this patient closely for which adverse effect?
A) Tachycardia
B) Bronchospasm
C) Hyperglycemia
D) Diarrhea
,E) Hypotension
Correct Answer: B) Bronchospasm
Rationale: Non-selective beta-blockers, such as propranolol, block both beta-1 (cardiac) and
beta-2 (pulmonary) adrenergic receptors. Blocking beta-2 receptors in the lungs can cause
bronchoconstriction, which is dangerous for patients with asthma or COPD. Therefore, selective
beta-1 blockers are preferred for these patients if a beta-blocker is necessary.
Question 4
The nurse is preparing to administer intravenous furosemide to a patient with fluid overload.
The nurse should anticipate that this medication will primarily act on which part of the
nephron?
A) Proximal convoluted tubule
B) Distal convoluted tubule
C) Loop of Henle
D) Collecting duct
E) Bowman's capsule
Correct Answer: C) Loop of Henle
Rationale: Furosemide is a loop diuretic, meaning it primarily acts on the ascending limb of the
loop of Henle in the nephron. It inhibits the reabsorption of sodium and chloride, leading to
significant diuresis.
Question 5
A patient taking an ACE inhibitor develops a persistent, dry cough. The nurse understands this
adverse effect is primarily due to the accumulation of which substance?
A) Angiotensin II
B) Renin
C) Bradykinin
D) Aldosterone
E) Nitric oxide
Correct Answer: C) Bradykinin
Rationale: ACE inhibitors prevent the breakdown of bradykinin, a vasodilator peptide. The
accumulation of bradykinin in the lungs is thought to be the primary cause of the characteristic
dry, non-productive cough experienced by some patients taking ACE inhibitors.
Question 6
A patient with Type 2 Diabetes Mellitus is prescribed metformin. The nurse understands that
metformin reduces blood glucose by which primary mechanism of action?
A) Increasing insulin secretion from the pancreas.
B) Decreasing hepatic glucose production and improving insulin sensitivity.
,C) Delaying carbohydrate absorption in the gut.
D) Increasing glucose excretion in the urine.
E) Stimulating pancreatic beta-cell repair.
Correct Answer: B) Decreasing hepatic glucose production and improving insulin sensitivity.
Rationale: Metformin (a biguanide) primarily works by decreasing glucose production by the
liver (gluconeogenesis) and improving insulin sensitivity in peripheral tissues (muscle and
adipose), allowing for better glucose uptake and utilization. It does not directly stimulate insulin
secretion.
Question 7
Which of the following classes of antihypertensive medications is contraindicated in pregnant
women due to its potential teratogenic effects?
A) Beta-blockers
B) Calcium channel blockers
C) ACE inhibitors
D) Thiazide diuretics
E) Alpha-1 blockers
Correct Answer: C) ACE inhibitors
Rationale: ACE inhibitors are known to be teratogenic (cause birth defects) and are strictly
contraindicated in the second and third trimesters of pregnancy due to risks of fetal renal
failure, oligohydramnios, and other severe fetal anomalies.
Question 8
The nurse is administering intravenous vancomycin. To prevent "Red Man Syndrome," the nurse
should ensure the medication is infused over a minimum of how many minutes?
A) 15 minutes
B) 30 minutes
C) 60 minutes
D) 90 minutes
E) 120 minutes
Correct Answer: C) 60 minutes
Rationale: Red Man Syndrome (characterized by flushing, rash, pruritus, tachycardia, and
hypotension) is an infusion-related reaction associated with vancomycin. It is usually caused by
rapid infusion, which leads to histamine release. Infusing vancomycin over at least 60 minutes
(and often longer for higher doses or sensitive patients) helps to prevent this reaction.
Question 9
A patient is receiving heparin intravenously. The nurse should monitor which laboratory value to
assess the therapeutic effectiveness of heparin?
, A) Prothrombin Time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet count
E) D-dimer
Correct Answer: C) Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin, an anticoagulant, inhibits various clotting factors, primarily Factor Xa and
thrombin. Its therapeutic effect is typically monitored using the activated Partial Thromboplastin
Time (aPTT), which assesses the intrinsic and common pathways of coagulation.
Question 10
Which medication class is commonly used to treat anxiety disorders by enhancing the effects of
gamma-aminobutyric acid (GABA) in the brain?
A) Selective Serotonin Reuptake Inhibitors (SSRIs)
B) Tricyclic Antidepressants (TCAs)
C) Benzodiazepines
D) Atypical antipsychotics
E) Monoamine Oxidase Inhibitors (MAOIs)
Correct Answer: C) Benzodiazepines
Rationale: Benzodiazepines (e.g., lorazepam, alprazolam) are a class of anxiolytic medications
that work by binding to GABA-A receptors in the central nervous system. This binding enhances
the inhibitory effects of GABA, leading to CNS depression and a reduction in anxiety.
Question 11
A patient with glaucoma is prescribed timolol eye drops. The nurse understands this medication
works by which mechanism?
A) Increasing aqueous humor production.
B) Dilating the pupil to improve drainage.
C) Decreasing aqueous humor production.
D) Constricting the ciliary muscle.
E) Stimulating cholinergic receptors.
Correct Answer: C) Decreasing aqueous humor production.
Rationale: Timolol is a beta-adrenergic blocker that, when administered as eye drops, primarily
acts to decrease the production of aqueous humor in the ciliary body. This reduction in fluid
production lowers intraocular pressure, which is beneficial in treating glaucoma.
Question 12
The nurse is teaching a patient about the proper use of an albuterol metered-dose inhaler
(MDI). Which statement indicates the patient understands the primary action of albuterol?
