HESI Pharmacology Exit Exam 2024 – 100% Verified
Questions with Detailed Clinical Rationales
80 Expertly Designed Questions for HESI RN Pharmacology Exit Exam
2024
Instructions
This document contains 80 unique multiple-choice questions for the HESI RN Pharmacol-
ogy Exit Exam 2024, focusing on drug mechanisms, side effects, therapeutic classes, and
patient safety. Each question includes four answer options, a verified correct answer, and
a detailed clinical rationale aligned with 2024 pharmacological standards. Questions are
designed to reflect Next Generation NCLEX (NGN) principles, ensuring comprehensive
preparation for nursing licensure.
Exam Questions
Question 1: A nurse is administering lisinopril to a client with hypertension. Which adverse
effect should the nurse monitor for most closely?
A. Persistent dry cough
B. Hypoglycemia
C. Hyperkalemia
D. Bradycardia
Answer: A. Persistent dry cough
Rationale: Lisinopril, an ACE inhibitor, commonly causes a persistent dry cough
due to increased bradykinin levels. Hyperkalemia (C) is a concern but less frequent.
Hypoglycemia (B) is unrelated, and bradycardia (D) is more associated with beta-
blockers. Reference: 2024 Pharmacological Guidelines, ACE Inhibitors [Side
Effects]
Question 2: A client is prescribed warfarin for atrial fibrillation. Which laboratory value should
the nurse monitor to ensure therapeutic dosing?
A. Partial thromboplastin time (PTT)
B. International normalized ratio (INR)
C. Platelet count
1
, D. Activated clotting time (ACT)
Answer: B. International normalized ratio (INR)
Rationale: Warfarin’s effect is monitored via INR (target 2–3 for atrial fibrilla-
tion). PTT (A) is for heparin, platelet count (C) is not specific to warfarin, and
ACT (D) is used in acute settings. Reference: 2024 Anticoagulant Guidelines
[Therapeutics]
Question 3: A nurse is teaching a client about metronidazole for a bacterial infection. Which
instruction enhances patient safety?
A. Avoid alcohol consumption
B. Take with a high-fat meal
C. Expect permanent urine discoloration
D. Stop if nausea occurs
Answer: A. Avoid alcohol consumption
Rationale: Metronidazole can cause a disulfiram-like reaction with alcohol. It can
be taken with or without food (B), urine darkening is temporary (C), and nausea
should be reported, not prompt discontinuation (D). Reference: 2024
Antimicrobial Guidelines [Patient Safety]
Question 4: A client on morphine via PCA reports shortness of breath. Which finding warrants
immediate naloxone administration?
A. Respiratory rate of 8 breaths/min
B. Pulse oximetry of 92% on room air
C. Blood pressure of 140/90 mmHg
D. Pain level of 6/10
Answer: A. Respiratory rate of 8 breaths/min
Rationale: A respiratory rate of 8 indicates opioid-induced respiratory depression,
requiring naloxone. Oximetry of 92% (B) is concerning but less urgent, and C and
D are unrelated to toxicity. Reference: 2024 Opioid Guidelines [Patient Safety]
Question 5: A nurse is preparing to administer digoxin to a client with heart failure. Which lab
result prompts withholding the dose?
A. Potassium level of 3.2 mEq/L
B. Sodium level of 135 mEq/L
C. Calcium level of 9.0 mg/dL
D. Magnesium level of 1.8 mEq/L
Answer: A. Potassium level of 3.2 mEq/L
2
, Rationale: Hypokalemia (<3.5 mEq/L) increases digoxin toxicity risk. Normal
sodium (B), calcium (C), and magnesium (D) levels do not affect digoxin safety.
Reference: 2024 Cardiac Medications [Drug Mechanisms]
Question 6: A client is prescribed levothyroxine for hypothyroidism. Which side effect should
the nurse teach to report immediately?
A. Weight gain
B. Palpitations
C. Constipation
D. Fatigue
Answer: B. Palpitations
Rationale: Palpitations may indicate levothyroxine overdose, risking hyperthy-
roidism. Weight gain (A), constipation (C), and fatigue (D) are hypothyroidism
symptoms, not side effects. Reference: 2024 Thyroid Medications [Side Effects]
Question 7: A nurse is administering furosemide to a client with heart failure. Which electrolyte
imbalance is most likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B. Hypokalemia
Rationale: Furosemide, a loop diuretic, increases potassium excretion, causing
hypokalemia. Hyperkalemia (A), hypernatremia (C), and hypocalcemia (D) are
less common. Reference: 2024 Diuretic Guidelines [Side Effects]
Question 8: A client with a UTI is prescribed sulfamethoxazole-trimethoprim. Which teaching
is most important?
A. Avoid sunlight exposure
B. Take with grapefruit juice
C. Reduce fluid intake
D. Expect immediate symptom relief
Answer: A. Avoid sunlight exposure
Rationale: Sulfamethoxazole-trimethoprim causes photosensitivity. Grapefruit
juice (B) is not recommended, fluids should increase (C), and relief takes days (D).
Reference: 2024 Antimicrobial Guidelines [Patient Safety]
Question 9: A nurse is caring for a client on phenytoin for seizures. Which serum level is
therapeutic?
A. 5–10 mcg/mL
3
Questions with Detailed Clinical Rationales
80 Expertly Designed Questions for HESI RN Pharmacology Exit Exam
2024
Instructions
This document contains 80 unique multiple-choice questions for the HESI RN Pharmacol-
ogy Exit Exam 2024, focusing on drug mechanisms, side effects, therapeutic classes, and
patient safety. Each question includes four answer options, a verified correct answer, and
a detailed clinical rationale aligned with 2024 pharmacological standards. Questions are
designed to reflect Next Generation NCLEX (NGN) principles, ensuring comprehensive
preparation for nursing licensure.
Exam Questions
Question 1: A nurse is administering lisinopril to a client with hypertension. Which adverse
effect should the nurse monitor for most closely?
A. Persistent dry cough
B. Hypoglycemia
C. Hyperkalemia
D. Bradycardia
Answer: A. Persistent dry cough
Rationale: Lisinopril, an ACE inhibitor, commonly causes a persistent dry cough
due to increased bradykinin levels. Hyperkalemia (C) is a concern but less frequent.
Hypoglycemia (B) is unrelated, and bradycardia (D) is more associated with beta-
blockers. Reference: 2024 Pharmacological Guidelines, ACE Inhibitors [Side
Effects]
Question 2: A client is prescribed warfarin for atrial fibrillation. Which laboratory value should
the nurse monitor to ensure therapeutic dosing?
A. Partial thromboplastin time (PTT)
B. International normalized ratio (INR)
C. Platelet count
1
, D. Activated clotting time (ACT)
Answer: B. International normalized ratio (INR)
Rationale: Warfarin’s effect is monitored via INR (target 2–3 for atrial fibrilla-
tion). PTT (A) is for heparin, platelet count (C) is not specific to warfarin, and
ACT (D) is used in acute settings. Reference: 2024 Anticoagulant Guidelines
[Therapeutics]
Question 3: A nurse is teaching a client about metronidazole for a bacterial infection. Which
instruction enhances patient safety?
A. Avoid alcohol consumption
B. Take with a high-fat meal
C. Expect permanent urine discoloration
D. Stop if nausea occurs
Answer: A. Avoid alcohol consumption
Rationale: Metronidazole can cause a disulfiram-like reaction with alcohol. It can
be taken with or without food (B), urine darkening is temporary (C), and nausea
should be reported, not prompt discontinuation (D). Reference: 2024
Antimicrobial Guidelines [Patient Safety]
Question 4: A client on morphine via PCA reports shortness of breath. Which finding warrants
immediate naloxone administration?
A. Respiratory rate of 8 breaths/min
B. Pulse oximetry of 92% on room air
C. Blood pressure of 140/90 mmHg
D. Pain level of 6/10
Answer: A. Respiratory rate of 8 breaths/min
Rationale: A respiratory rate of 8 indicates opioid-induced respiratory depression,
requiring naloxone. Oximetry of 92% (B) is concerning but less urgent, and C and
D are unrelated to toxicity. Reference: 2024 Opioid Guidelines [Patient Safety]
Question 5: A nurse is preparing to administer digoxin to a client with heart failure. Which lab
result prompts withholding the dose?
A. Potassium level of 3.2 mEq/L
B. Sodium level of 135 mEq/L
C. Calcium level of 9.0 mg/dL
D. Magnesium level of 1.8 mEq/L
Answer: A. Potassium level of 3.2 mEq/L
2
, Rationale: Hypokalemia (<3.5 mEq/L) increases digoxin toxicity risk. Normal
sodium (B), calcium (C), and magnesium (D) levels do not affect digoxin safety.
Reference: 2024 Cardiac Medications [Drug Mechanisms]
Question 6: A client is prescribed levothyroxine for hypothyroidism. Which side effect should
the nurse teach to report immediately?
A. Weight gain
B. Palpitations
C. Constipation
D. Fatigue
Answer: B. Palpitations
Rationale: Palpitations may indicate levothyroxine overdose, risking hyperthy-
roidism. Weight gain (A), constipation (C), and fatigue (D) are hypothyroidism
symptoms, not side effects. Reference: 2024 Thyroid Medications [Side Effects]
Question 7: A nurse is administering furosemide to a client with heart failure. Which electrolyte
imbalance is most likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B. Hypokalemia
Rationale: Furosemide, a loop diuretic, increases potassium excretion, causing
hypokalemia. Hyperkalemia (A), hypernatremia (C), and hypocalcemia (D) are
less common. Reference: 2024 Diuretic Guidelines [Side Effects]
Question 8: A client with a UTI is prescribed sulfamethoxazole-trimethoprim. Which teaching
is most important?
A. Avoid sunlight exposure
B. Take with grapefruit juice
C. Reduce fluid intake
D. Expect immediate symptom relief
Answer: A. Avoid sunlight exposure
Rationale: Sulfamethoxazole-trimethoprim causes photosensitivity. Grapefruit
juice (B) is not recommended, fluids should increase (C), and relief takes days (D).
Reference: 2024 Antimicrobial Guidelines [Patient Safety]
Question 9: A nurse is caring for a client on phenytoin for seizures. Which serum level is
therapeutic?
A. 5–10 mcg/mL
3
