HESI RN Pharmacology V2 –
2025 Real Exam Questions &
Verified A+ Answers
Cardiovascular Medications (Questions 1–15)
1. A client with hypertension is prescribed lisinopril 20 mg daily. The nurse
should monitor for which common side effect? A. Hyperkalemia B. Dry,
nonproductive cough C. Weight gain D. Bradycardia
Rationale: Lisinopril, an ACE inhibitor, commonly causes a dry cough due to
bradykinin accumulation (up to 20% of patients). Safe dosing starts at 10 mg,
titrating to 20–40 mg based on BP response; monitor renal function and potassium,
as hyperkalemia is a risk but less common than cough.
2. For a client experiencing acute angina, the initial dose of sublingual
nitroglycerin is: A. 0.3 mg, repeat every 10 minutes up to 3 doses B. 0.3–0.6 mg,
repeat every 5 minutes up to 3 doses C. 0.4 mg IV D. 1 mg PO
Rationale: Sublingual nitroglycerin provides rapid vasodilation (onset 2–5 min)
for angina relief; safe dosing limits to 3 tablets/15 min, followed by ER evaluation
if unrelieved, to avoid hypotension (BP <90/60 mmHg).
3. A client on warfarin therapy has an INR of 3.5. The nurse anticipates: A.
Increasing the dose B. Holding the next dose and monitoring for bleeding C.
Administering vitamin K D. Switching to heparin
Rationale: Therapeutic INR for AFib/DVT is 2–3; 3.5 indicates over-
anticoagulation, risking hemorrhage. Safe management holds 1–2 doses, resumes
lower (e.g., 2.5–5 mg), and monitors closely without routine reversal unless
bleeding.
, 4. The priority nursing action for a client on digoxin with a heart rate of 52
bpm is: A. Administer the next dose B. Withhold the dose and notify the provider
C. Give potassium supplement D. Increase fluid intake
Rationale: Digoxin's therapeutic effect requires HR >60 bpm; bradycardia signals
toxicity (nausea, vision changes). Safe dosing is 0.125–0.25 mg daily, with levels
0.5–2 ng/mL and K+ >4 mEq/L to prevent arrhythmias.
5. A client newly prescribed metoprolol for heart failure should receive: A. 50
mg BID immediately B. 12.5 mg daily, titrating slowly C. 25 mg IV D. 100 mg
daily
Rationale: Beta-blockers like metoprolol reduce mortality in HF but risk
decompensation; safe initiation is low-dose (6.25–12.5 mg), doubling q2 weeks if
tolerated, monitoring HR/BP to avoid <50 bpm or <90/60 mmHg.
6. For a client with atrial fibrillation, the target INR on warfarin is: A. 1.5–2.0
B. 2.0–3.0 C. 3.0–4.0 D. <1.5
Rationale: INR 2–3 balances anticoagulation for stroke prevention without
bleeding risk; safe monitoring is weekly initially, with diet/genetic factors
(CYP2C9/VKORC1) influencing dosing (2–10 mg daily).
7. A client on furosemide 40 mg IV develops hypokalemia. The nurse should:
A. Discontinue the drug B. Administer potassium chloride supplement C. Increase
furosemide dose D. Switch to spironolactone
Rationale: Loop diuretics like furosemide cause K+ loss (aldosterone-mediated);
safe repletion is 10–20 mEq IV if <3.5 mEq/L, with ECG monitoring for
arrhythmias.
8. The common side effect of amlodipine in a client with hypertension is: A.
Reflex tachycardia B. Peripheral edema C. Hyperglycemia D. Dry mouth
Rationale: Dihydropyridine CCB causes arteriolar vasodilation leading to ankle
swelling (10–30%); safe dosing 2.5–10 mg daily, elevate legs if needed.
9. For a client with stable angina, aspirin is prescribed at: A. 325 mg daily B.
81 mg daily C. 162 mg PRN D. 650 mg BID
2025 Real Exam Questions &
Verified A+ Answers
Cardiovascular Medications (Questions 1–15)
1. A client with hypertension is prescribed lisinopril 20 mg daily. The nurse
should monitor for which common side effect? A. Hyperkalemia B. Dry,
nonproductive cough C. Weight gain D. Bradycardia
Rationale: Lisinopril, an ACE inhibitor, commonly causes a dry cough due to
bradykinin accumulation (up to 20% of patients). Safe dosing starts at 10 mg,
titrating to 20–40 mg based on BP response; monitor renal function and potassium,
as hyperkalemia is a risk but less common than cough.
2. For a client experiencing acute angina, the initial dose of sublingual
nitroglycerin is: A. 0.3 mg, repeat every 10 minutes up to 3 doses B. 0.3–0.6 mg,
repeat every 5 minutes up to 3 doses C. 0.4 mg IV D. 1 mg PO
Rationale: Sublingual nitroglycerin provides rapid vasodilation (onset 2–5 min)
for angina relief; safe dosing limits to 3 tablets/15 min, followed by ER evaluation
if unrelieved, to avoid hypotension (BP <90/60 mmHg).
3. A client on warfarin therapy has an INR of 3.5. The nurse anticipates: A.
Increasing the dose B. Holding the next dose and monitoring for bleeding C.
Administering vitamin K D. Switching to heparin
Rationale: Therapeutic INR for AFib/DVT is 2–3; 3.5 indicates over-
anticoagulation, risking hemorrhage. Safe management holds 1–2 doses, resumes
lower (e.g., 2.5–5 mg), and monitors closely without routine reversal unless
bleeding.
, 4. The priority nursing action for a client on digoxin with a heart rate of 52
bpm is: A. Administer the next dose B. Withhold the dose and notify the provider
C. Give potassium supplement D. Increase fluid intake
Rationale: Digoxin's therapeutic effect requires HR >60 bpm; bradycardia signals
toxicity (nausea, vision changes). Safe dosing is 0.125–0.25 mg daily, with levels
0.5–2 ng/mL and K+ >4 mEq/L to prevent arrhythmias.
5. A client newly prescribed metoprolol for heart failure should receive: A. 50
mg BID immediately B. 12.5 mg daily, titrating slowly C. 25 mg IV D. 100 mg
daily
Rationale: Beta-blockers like metoprolol reduce mortality in HF but risk
decompensation; safe initiation is low-dose (6.25–12.5 mg), doubling q2 weeks if
tolerated, monitoring HR/BP to avoid <50 bpm or <90/60 mmHg.
6. For a client with atrial fibrillation, the target INR on warfarin is: A. 1.5–2.0
B. 2.0–3.0 C. 3.0–4.0 D. <1.5
Rationale: INR 2–3 balances anticoagulation for stroke prevention without
bleeding risk; safe monitoring is weekly initially, with diet/genetic factors
(CYP2C9/VKORC1) influencing dosing (2–10 mg daily).
7. A client on furosemide 40 mg IV develops hypokalemia. The nurse should:
A. Discontinue the drug B. Administer potassium chloride supplement C. Increase
furosemide dose D. Switch to spironolactone
Rationale: Loop diuretics like furosemide cause K+ loss (aldosterone-mediated);
safe repletion is 10–20 mEq IV if <3.5 mEq/L, with ECG monitoring for
arrhythmias.
8. The common side effect of amlodipine in a client with hypertension is: A.
Reflex tachycardia B. Peripheral edema C. Hyperglycemia D. Dry mouth
Rationale: Dihydropyridine CCB causes arteriolar vasodilation leading to ankle
swelling (10–30%); safe dosing 2.5–10 mg daily, elevate legs if needed.
9. For a client with stable angina, aspirin is prescribed at: A. 325 mg daily B.
81 mg daily C. 162 mg PRN D. 650 mg BID
