HESI PN Pharmacology Exam |
Updated 2025/2026 Real
Questions & Answers
1. A client is prescribed levothyroxine 75 mcg PO daily. Which lab value
indicates the dose is therapeutic?TSH 1.2 mIU/L (0.4–4.0) Rationale:
Mechanism: Synthetic T4 → ↑ thyroid hormone. Therapeutic: TSH normalizes
4–6 weeks. Contraindication: Uncorrected adrenal insufficiency. Admin: Empty
stomach, 30–60 min before food.
2. The nurse administers furosemide 20 mg IV. What electrolyte must be
monitored closely?Potassium Rationale: Mechanism: Inhibits Na-K-2Cl in loop
of Henle → K⁺ loss. Safe admin: ≤10 mEq/h peripheral; check K⁺ >3.5 mEq/L.
Contraindication: Anuria.
3. A client on warfarin has INR 5.8. What is the priority action?Hold warfarin
and give vitamin K 2.5 mg PO Rationale: Mechanism: Inhibits vitamin K epoxide
reductase. Therapeutic INR: 2–3. Contraindication: Active bleeding. Admin:
Evening dose; consistent vitamin K intake.
4. Which symptom indicates digoxin toxicity in a client with level 2.4
ng/mL?Yellow vision (xanthopsia) Rationale: Mechanism: Na/K-ATPase inhibitor
→ ↑ Ca²⁺ inotropy. Therapeutic: 0.5–2.0 ng/mL. Toxicity antidote: Digoxin immune
Fab. Admin: Check apical pulse >60 bpm.
5. The nurse gives epinephrine 0.3 mg IM for anaphylaxis. How soon should
reassessment occur?5–15 minutes Rationale: Mechanism: α/β agonist →
bronchodilation, vasoconstriction. Safe admin: 1:1000 IM vastus lateralis.
Contraindication: None in emergency. Repeat q5–15min.
6. A client on heparin infusion has aPTT 95 sec (control 30 sec). What is the
action?Stop infusion; protamine sulfate ready Rationale: Mechanism: Enhances
antithrombin → Xa/IIa inhibition. Therapeutic aPTT: 60–80 sec. Antidote: 1 mg
protamine/100 units heparin. Admin: Weight-based nomogram.
7. Which drug requires peak and trough levels?Vancomycin Rationale:
Mechanism: Inhibits cell wall peptidoglycan. Therapeutic trough: 10–20 mcg/mL.
Safe admin: Infuse over 60 min/gram. Contraindication: Red man syndrome →
slow rate.
8. A client on metformin is scheduled for CT with contrast. What is the
order?Hold metformin 48 hours before and after Rationale: Mechanism: ↓
, Hepatic gluconeogenesis. Contraindication: GFR <30 mL/min (lactic acidosis).
Admin: With food; max 2550 mg/day.
9. The nurse administers morphine 2 mg IV. When is peak analgesia
expected?15–30 minutes Rationale: Mechanism: Mu-opioid agonist. Safe
admin: Assess RR >12; naloxone at bedside. Contraindication: Respiratory
depression. Duration: 3–4 hr.
10.Which lab indicates phenytoin toxicity (>20 mcg/mL)?Horizontal nystagmus
Rationale: Mechanism: Na⁺ channel stabilizer. Therapeutic: 10–20 mcg/mL.
Admin: IV ≤50 mg/min; avoid IM. Contraindication: Sinus bradycardia.
11.A client on lithium has level 1.8 mEq/L. What is the priority?Hold lithium;
force fluids Rationale: Mechanism: Alters Na⁺ transport in neurons. Therapeutic:
0.6–1.2 mEq/L. Toxicity: >1.5 → tremor; >2.0 → seizures. Admin: With food.
12.The nurse gives albuterol nebulizer. What side effect is
expected?Tachycardia and tremor Rationale: Mechanism: β₂ agonist →
bronchodilation. Safe admin: 2.5 mg/3 mL q4–6h. Contraindication: Tachycardia
>120 bpm.
13.Which medication requires holding parameters for HR <60?Metoprolol
Rationale: Mechanism: β₁ blocker → ↓ HR/contractility. Safe admin: PO with food;
IV push over 2 min. Contraindication: Heart block.
14.A client on gentamicin reports dizziness. What is the action?Stop infusion;
notify provider Rationale: Mechanism: Aminoglycoside → 30S inhibition.
Therapeutic peak: 5–10 mcg/mL. Toxicity: Ototoxicity (irreversible). Admin:
Once-daily dosing.
15.The nurse administers regular insulin IV. How often to check BG?q30–60
minutes Rationale: Mechanism: Glucose uptake via GLUT4. Onset IV:
Immediate. Safe admin: Only clear insulin IV. Contraindication: Hypoglycemia.
16.Which drug has black box warning for tendon rupture?Levofloxacin
Rationale: Mechanism: DNA gyrase inhibitor. Contraindication: Age >60 +
steroids. Admin: Avoid antacids (↓ absorption).
17.A client on spironolactone reports gynecomastia. Why?Anti-androgenic
effect Rationale: Mechanism: Aldosterone antagonist. Therapeutic: K⁺ sparing.
Monitor K⁺: <5.0 mEq/L. Admin: With food.
18.The nurse gives nitroglycerin SL. How many doses before EMS?3 doses, 5
min apart Rationale: Mechanism: NO donor → venous dilation. Onset: 1–3 min.
Contraindication: Sildenafil use (hypotension).
19.Which lab shows therapeutic response to epoetin alfa?Hgb 10–11 g/dL
Rationale: Mechanism: Erythropoietin analog. Target: <11 g/dL (↓ thrombosis).
Admin: SC; avoid shaking.
Updated 2025/2026 Real
Questions & Answers
1. A client is prescribed levothyroxine 75 mcg PO daily. Which lab value
indicates the dose is therapeutic?TSH 1.2 mIU/L (0.4–4.0) Rationale:
Mechanism: Synthetic T4 → ↑ thyroid hormone. Therapeutic: TSH normalizes
4–6 weeks. Contraindication: Uncorrected adrenal insufficiency. Admin: Empty
stomach, 30–60 min before food.
2. The nurse administers furosemide 20 mg IV. What electrolyte must be
monitored closely?Potassium Rationale: Mechanism: Inhibits Na-K-2Cl in loop
of Henle → K⁺ loss. Safe admin: ≤10 mEq/h peripheral; check K⁺ >3.5 mEq/L.
Contraindication: Anuria.
3. A client on warfarin has INR 5.8. What is the priority action?Hold warfarin
and give vitamin K 2.5 mg PO Rationale: Mechanism: Inhibits vitamin K epoxide
reductase. Therapeutic INR: 2–3. Contraindication: Active bleeding. Admin:
Evening dose; consistent vitamin K intake.
4. Which symptom indicates digoxin toxicity in a client with level 2.4
ng/mL?Yellow vision (xanthopsia) Rationale: Mechanism: Na/K-ATPase inhibitor
→ ↑ Ca²⁺ inotropy. Therapeutic: 0.5–2.0 ng/mL. Toxicity antidote: Digoxin immune
Fab. Admin: Check apical pulse >60 bpm.
5. The nurse gives epinephrine 0.3 mg IM for anaphylaxis. How soon should
reassessment occur?5–15 minutes Rationale: Mechanism: α/β agonist →
bronchodilation, vasoconstriction. Safe admin: 1:1000 IM vastus lateralis.
Contraindication: None in emergency. Repeat q5–15min.
6. A client on heparin infusion has aPTT 95 sec (control 30 sec). What is the
action?Stop infusion; protamine sulfate ready Rationale: Mechanism: Enhances
antithrombin → Xa/IIa inhibition. Therapeutic aPTT: 60–80 sec. Antidote: 1 mg
protamine/100 units heparin. Admin: Weight-based nomogram.
7. Which drug requires peak and trough levels?Vancomycin Rationale:
Mechanism: Inhibits cell wall peptidoglycan. Therapeutic trough: 10–20 mcg/mL.
Safe admin: Infuse over 60 min/gram. Contraindication: Red man syndrome →
slow rate.
8. A client on metformin is scheduled for CT with contrast. What is the
order?Hold metformin 48 hours before and after Rationale: Mechanism: ↓
, Hepatic gluconeogenesis. Contraindication: GFR <30 mL/min (lactic acidosis).
Admin: With food; max 2550 mg/day.
9. The nurse administers morphine 2 mg IV. When is peak analgesia
expected?15–30 minutes Rationale: Mechanism: Mu-opioid agonist. Safe
admin: Assess RR >12; naloxone at bedside. Contraindication: Respiratory
depression. Duration: 3–4 hr.
10.Which lab indicates phenytoin toxicity (>20 mcg/mL)?Horizontal nystagmus
Rationale: Mechanism: Na⁺ channel stabilizer. Therapeutic: 10–20 mcg/mL.
Admin: IV ≤50 mg/min; avoid IM. Contraindication: Sinus bradycardia.
11.A client on lithium has level 1.8 mEq/L. What is the priority?Hold lithium;
force fluids Rationale: Mechanism: Alters Na⁺ transport in neurons. Therapeutic:
0.6–1.2 mEq/L. Toxicity: >1.5 → tremor; >2.0 → seizures. Admin: With food.
12.The nurse gives albuterol nebulizer. What side effect is
expected?Tachycardia and tremor Rationale: Mechanism: β₂ agonist →
bronchodilation. Safe admin: 2.5 mg/3 mL q4–6h. Contraindication: Tachycardia
>120 bpm.
13.Which medication requires holding parameters for HR <60?Metoprolol
Rationale: Mechanism: β₁ blocker → ↓ HR/contractility. Safe admin: PO with food;
IV push over 2 min. Contraindication: Heart block.
14.A client on gentamicin reports dizziness. What is the action?Stop infusion;
notify provider Rationale: Mechanism: Aminoglycoside → 30S inhibition.
Therapeutic peak: 5–10 mcg/mL. Toxicity: Ototoxicity (irreversible). Admin:
Once-daily dosing.
15.The nurse administers regular insulin IV. How often to check BG?q30–60
minutes Rationale: Mechanism: Glucose uptake via GLUT4. Onset IV:
Immediate. Safe admin: Only clear insulin IV. Contraindication: Hypoglycemia.
16.Which drug has black box warning for tendon rupture?Levofloxacin
Rationale: Mechanism: DNA gyrase inhibitor. Contraindication: Age >60 +
steroids. Admin: Avoid antacids (↓ absorption).
17.A client on spironolactone reports gynecomastia. Why?Anti-androgenic
effect Rationale: Mechanism: Aldosterone antagonist. Therapeutic: K⁺ sparing.
Monitor K⁺: <5.0 mEq/L. Admin: With food.
18.The nurse gives nitroglycerin SL. How many doses before EMS?3 doses, 5
min apart Rationale: Mechanism: NO donor → venous dilation. Onset: 1–3 min.
Contraindication: Sildenafil use (hypotension).
19.Which lab shows therapeutic response to epoetin alfa?Hgb 10–11 g/dL
Rationale: Mechanism: Erythropoietin analog. Target: <11 g/dL (↓ thrombosis).
Admin: SC; avoid shaking.
