2025/2026 WGU Pharmacology HESI
Practice 2 Comprehensive Review -
Master Your Exam on the First Attempt
and Avoid Resits
Cardiovascular Medications
1. A client is prescribed enalapril (Vasotec) for heart failure.
Which finding requires immediate action?
A) Dry cough
*B) Serum potassium 5.8 mEq/L*
*C) Blood pressure 110/70 mmHg*
D) Dizziness when standing
Answer: B
Rationale: ACE inhibitors can cause hyperkalemia. A potassium of
5.8 mEq/L is critically high and increases the risk of cardiac
dysrhythmias. The nurse should hold the medication and notify
the provider. Dry cough is a common side effect but not
immediately dangerous.
2. A client on spironolactone (Aldactone) and lisinopril
(Prinivil) has a potassium level of 3.2 mEq/L. What is the
,nurse’s priority action?
A) Administer both medications as ordered
B) Hold spironolactone only
C) Hold lisinopril only
D) Hold both medications and notify provider
Answer: D
Rationale: Spironolactone is potassium-sparing; lisinopril also
increases potassium. A low potassium (3.2) is unusual with this
combination and may indicate another issue. However, the
combination itself can cause severe hyperkalemia, not
hypokalemia. The priority is to reassess and notify the provider.
(Note: If potassium were high, hold both. With low potassium, the
provider may adjust therapy.)
3. A client with angina takes nitroglycerin sublingually. After
one tablet, chest pain persists. What should the nurse instruct
the client to do?
A) Wait 15 minutes and take a second tablet
B) Take a second tablet after 5 minutes
C) Go to the emergency room immediately
D) Take a baby aspirin and rest
Answer: B
Rationale: The standard regimen is one tablet every 5 minutes for
up to 3 doses. If pain is not relieved after the first tablet, the
second is taken at 5 minutes. If pain persists after 3 tablets, seek
emergency care.
,4. Which laboratory value places a client at highest risk for
digoxin (Lanoxin) toxicity?
*A) Sodium 135 mEq/L*
*B) Calcium 9.5 mg/dL*
*C) Potassium 3.2 mEq/L*
*D) Magnesium 2.0 mg/dL*
Answer: C
Rationale: Hypokalemia (low potassium) increases the risk of
digoxin toxicity by making cardiac cells more sensitive to digoxin.
Normal potassium is 3.5–5.0 mEq/L.
5. A client receiving a fentanyl (Duragesic) patch reports a
pain score of 7/10 one hour after application. What should
the nurse do?
A) Remove the patch and apply a new one
B) Administer a breakthrough pain medication as ordered
C) Increase the fentanyl patch dose
D) Document that the patch is ineffective
Answer: B
Rationale: Fentanyl patches provide steady-state analgesia but
do not treat breakthrough pain. The nurse should administer a
short-acting opioid as ordered for breakthrough pain. The patch
should not be removed or increased without a provider order.
, 6. A client with heart failure is prescribed carvedilol (Coreg).
Which assessment finding indicates the medication is
effective?
A) Heart rate 52 bpm
*B) Blood pressure 90/60 mmHg*
C) Weight loss of 2 lbs in 24 hours
D) Improved ejection fraction on echocardiogram
Answer: D
Rationale: Carvedilol (beta-blocker) improves cardiac remodeling
and ejection fraction in heart failure over time. Weight loss
indicates diuresis, not carvedilol effect. Bradycardia and
hypotension are side effects, not therapeutic goals.
7. A client on warfarin (Coumadin) has an INR of 1.2. The
nurse anticipates which order?
A) Increase the warfarin dose
B) Administer vitamin K
C) Hold the next dose of warfarin
D) Continue the same dose
Answer: A
Rationale: Therapeutic INR for most indications (e.g., atrial
fibrillation, DVT) is 2–3. An INR of 1.2 is subtherapeutic, so the
dose should be increased. Vitamin K is given for supratherapeutic
INR with bleeding risk.
Practice 2 Comprehensive Review -
Master Your Exam on the First Attempt
and Avoid Resits
Cardiovascular Medications
1. A client is prescribed enalapril (Vasotec) for heart failure.
Which finding requires immediate action?
A) Dry cough
*B) Serum potassium 5.8 mEq/L*
*C) Blood pressure 110/70 mmHg*
D) Dizziness when standing
Answer: B
Rationale: ACE inhibitors can cause hyperkalemia. A potassium of
5.8 mEq/L is critically high and increases the risk of cardiac
dysrhythmias. The nurse should hold the medication and notify
the provider. Dry cough is a common side effect but not
immediately dangerous.
2. A client on spironolactone (Aldactone) and lisinopril
(Prinivil) has a potassium level of 3.2 mEq/L. What is the
,nurse’s priority action?
A) Administer both medications as ordered
B) Hold spironolactone only
C) Hold lisinopril only
D) Hold both medications and notify provider
Answer: D
Rationale: Spironolactone is potassium-sparing; lisinopril also
increases potassium. A low potassium (3.2) is unusual with this
combination and may indicate another issue. However, the
combination itself can cause severe hyperkalemia, not
hypokalemia. The priority is to reassess and notify the provider.
(Note: If potassium were high, hold both. With low potassium, the
provider may adjust therapy.)
3. A client with angina takes nitroglycerin sublingually. After
one tablet, chest pain persists. What should the nurse instruct
the client to do?
A) Wait 15 minutes and take a second tablet
B) Take a second tablet after 5 minutes
C) Go to the emergency room immediately
D) Take a baby aspirin and rest
Answer: B
Rationale: The standard regimen is one tablet every 5 minutes for
up to 3 doses. If pain is not relieved after the first tablet, the
second is taken at 5 minutes. If pain persists after 3 tablets, seek
emergency care.
,4. Which laboratory value places a client at highest risk for
digoxin (Lanoxin) toxicity?
*A) Sodium 135 mEq/L*
*B) Calcium 9.5 mg/dL*
*C) Potassium 3.2 mEq/L*
*D) Magnesium 2.0 mg/dL*
Answer: C
Rationale: Hypokalemia (low potassium) increases the risk of
digoxin toxicity by making cardiac cells more sensitive to digoxin.
Normal potassium is 3.5–5.0 mEq/L.
5. A client receiving a fentanyl (Duragesic) patch reports a
pain score of 7/10 one hour after application. What should
the nurse do?
A) Remove the patch and apply a new one
B) Administer a breakthrough pain medication as ordered
C) Increase the fentanyl patch dose
D) Document that the patch is ineffective
Answer: B
Rationale: Fentanyl patches provide steady-state analgesia but
do not treat breakthrough pain. The nurse should administer a
short-acting opioid as ordered for breakthrough pain. The patch
should not be removed or increased without a provider order.
, 6. A client with heart failure is prescribed carvedilol (Coreg).
Which assessment finding indicates the medication is
effective?
A) Heart rate 52 bpm
*B) Blood pressure 90/60 mmHg*
C) Weight loss of 2 lbs in 24 hours
D) Improved ejection fraction on echocardiogram
Answer: D
Rationale: Carvedilol (beta-blocker) improves cardiac remodeling
and ejection fraction in heart failure over time. Weight loss
indicates diuresis, not carvedilol effect. Bradycardia and
hypotension are side effects, not therapeutic goals.
7. A client on warfarin (Coumadin) has an INR of 1.2. The
nurse anticipates which order?
A) Increase the warfarin dose
B) Administer vitamin K
C) Hold the next dose of warfarin
D) Continue the same dose
Answer: A
Rationale: Therapeutic INR for most indications (e.g., atrial
fibrillation, DVT) is 2–3. An INR of 1.2 is subtherapeutic, so the
dose should be increased. Vitamin K is given for supratherapeutic
INR with bleeding risk.
