1
HESI Pharmacology Practice Exam with Questions
and Answers Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Cardiovascular & Renal Pharmacology — Questions 1-25]
Q1: A patient with hypertension begins taking lisinopril. The nurse teaches the patient about
which common adverse effect of this medication that may necessitate a change to an ARB
(angiotensin II receptor blocker)?
A. Hyperkalemia
B. Dry, non-productive cough
C. Dry, non-productive cough [CORRECT]
D. First-dose orthostatic hypotension
Correct Answer: C
Rationale: A dry, persistent cough is a common adverse effect of ACE inhibitors like lisinopril,
caused by the accumulation of bradykinin. If this cough is intolerable for the patient, the provider
typically switches the patient to an ARB (such as losartan), which does not affect bradykinin and
thus avoids this side effect. While hyperkalemia (A) and orthostatic hypotension (D) can occur,
they are not the primary reason for switching to an ARB class. Edema is not associated with ACE
inhibitors.
Q2: A patient prescribed amlodipine reports swelling in their ankles and feet. The nurse
recognizes this as a common side effect of which drug class?
A. Beta-blockers
B. ACE inhibitors
C. Calcium Channel Blockers (CCBs) [CORRECT]
D. Diuretics
Correct Answer: C
,2
Rationale: Peripheral edema is a common adverse effect of dihydropyridine calcium channel
blockers like amlodipine. It results from the preferential dilation of precapillary sphincters over
post-capillary vessels, leading to increased capillary pressure. This is not typically an allergic
reaction but a dose-dependent vasodilatory effect. Beta-blockers (A) and ACE inhibitors (B) do
not typically cause peripheral edema.
Q3: The nurse is administering metoprolol, a beta-1 selective blocker, to a patient with heart
failure. What is the priority assessment before administering this medication?
A. Respiratory rate
B. Blood glucose
C. Heart rate and blood pressure [CORRECT]
D. Level of consciousness
Correct Answer: C
Rationale: Beta-blockers reduce heart rate and myocardial contractility. The nurse must assess
the apical heart rate (should be >60 bpm) and blood pressure before administration to prevent
bradycardia and hypotension. If the heart rate is too low (<60), the medication should be held per
protocol. While respiratory rate (A) is important (especially in non-selective blockers),
metoprolol is relatively cardioselective. Blood glucose (B) is relevant as beta-blockers can mask
signs of hypoglycemia, but hemodynamic stability is the immediate priority for safety.
Q4: A patient with atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value
must the nurse monitor to ensure the therapeutic range?
A. aPTT
B. PT/INR [CORRECT]
C. Platelet count
D. Bleeding time
Correct Answer: B
Rationale: Warfarin affects the synthesis of vitamin K-dependent clotting factors. The
Prothrombin Time (PT) is monitored, standardized as the International Normalized Ratio (INR).
,3
For atrial fibrillation, the therapeutic INR is typically 2.0 to 3.0. aPTT (A) is used to monitor
heparin therapy. Platelet count (C) is monitored for heparin-induced thrombocytopenia (HIT).
Q5: A patient is prescribed furosemide (Lasix) for edema related to heart failure. The nurse
instructs the patient to eat foods rich in which electrolyte to prevent a deficiency?
A. Sodium
B. Potassium [CORRECT]
C. Magnesium
D. Calcium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that acts on the ascending loop of Henle to inhibit
sodium and chloride reabsorption, leading to increased excretion of potassium. Hypokalemia is a
significant risk that can lead to cardiac arrhythmias. Patients should be encouraged to consume
potassium-rich foods (like bananas, oranges) or take supplements as prescribed. Sodium (A)
intake is usually restricted in heart failure.
Q6: The nurse is caring for a patient receiving digoxin (Lanoxin). Which finding indicates the
patient is experiencing digoxin toxicity?
A. Weight gain of 2 lbs in one day
B. Blood pressure of 110/70 mmHg
C. Heart rate of 52 bpm and visual halos [CORRECT]
D. Urinary output of 40 mL/hr
Correct Answer: C
Rationale: Signs of digoxin toxicity include bradycardia (heart rate <60 bpm in adults),
gastrointestinal disturbances (nausea, vomiting, anorexia), and visual changes such as yellow-
green halos. These occur due to the narrow therapeutic index of the drug. Weight gain (A) may
indicate fluid retention, not toxicity. Normal vitals (B) and urine output (D) are not signs of
toxicity.
, 4
Q7: A patient who recently started taking spironolactone (Aldactone) has a serum potassium
level of 5.5 mEq/L. What is the nurse’s priority action?
A. Administer the next dose as scheduled.
B. Encourage the patient to drink orange juice.
C. Hold the medication and notify the provider. [CORRECT]
D. Administer sodium polystyrene sulfonate (Kayexalate).
Correct Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic. A potassium level of 5.5 mEq/L
indicates hyperkalemia. The nurse should hold the medication to prevent further potassium
retention and notify the healthcare provider. Encouraging orange juice (B) (high in potassium) is
contraindicated. Kayexalate (D) is an antidote for severe hyperkalemia but requires a specific
order; holding the drug is the immediate nursing intervention.
Q8: Which instruction is most important for the nurse to teach a patient prescribed atorvastatin
(Lipitor)?
A. Take this medication in the evening.
B. Avoid grapefruit juice. [CORRECT]
C. Take with food to prevent upset stomach.
D. Increase intake of green leafy vegetables.
Correct Answer: B
Rationale: Grapefruit juice inhibits CYP3A4, the enzyme responsible for metabolizing certain
statins like atorvastatin, leading to increased plasma levels and a higher risk of myopathy and
rhabdomyolysis. While some sources suggest taking statins in the evening (A) because
endogenous cholesterol synthesis is higher at night, the safety risk of grapefruit interaction is
often prioritized in patient education. Taking with food (C) is not required for all statins. Green
leafy vegetables (D) contain Vitamin K, which affects warfarin, not statins.
Q9: A patient is being discharged on a beta-blocker. Which statement by the patient indicates a
need for further teaching?
HESI Pharmacology Practice Exam with Questions
and Answers Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Cardiovascular & Renal Pharmacology — Questions 1-25]
Q1: A patient with hypertension begins taking lisinopril. The nurse teaches the patient about
which common adverse effect of this medication that may necessitate a change to an ARB
(angiotensin II receptor blocker)?
A. Hyperkalemia
B. Dry, non-productive cough
C. Dry, non-productive cough [CORRECT]
D. First-dose orthostatic hypotension
Correct Answer: C
Rationale: A dry, persistent cough is a common adverse effect of ACE inhibitors like lisinopril,
caused by the accumulation of bradykinin. If this cough is intolerable for the patient, the provider
typically switches the patient to an ARB (such as losartan), which does not affect bradykinin and
thus avoids this side effect. While hyperkalemia (A) and orthostatic hypotension (D) can occur,
they are not the primary reason for switching to an ARB class. Edema is not associated with ACE
inhibitors.
Q2: A patient prescribed amlodipine reports swelling in their ankles and feet. The nurse
recognizes this as a common side effect of which drug class?
A. Beta-blockers
B. ACE inhibitors
C. Calcium Channel Blockers (CCBs) [CORRECT]
D. Diuretics
Correct Answer: C
,2
Rationale: Peripheral edema is a common adverse effect of dihydropyridine calcium channel
blockers like amlodipine. It results from the preferential dilation of precapillary sphincters over
post-capillary vessels, leading to increased capillary pressure. This is not typically an allergic
reaction but a dose-dependent vasodilatory effect. Beta-blockers (A) and ACE inhibitors (B) do
not typically cause peripheral edema.
Q3: The nurse is administering metoprolol, a beta-1 selective blocker, to a patient with heart
failure. What is the priority assessment before administering this medication?
A. Respiratory rate
B. Blood glucose
C. Heart rate and blood pressure [CORRECT]
D. Level of consciousness
Correct Answer: C
Rationale: Beta-blockers reduce heart rate and myocardial contractility. The nurse must assess
the apical heart rate (should be >60 bpm) and blood pressure before administration to prevent
bradycardia and hypotension. If the heart rate is too low (<60), the medication should be held per
protocol. While respiratory rate (A) is important (especially in non-selective blockers),
metoprolol is relatively cardioselective. Blood glucose (B) is relevant as beta-blockers can mask
signs of hypoglycemia, but hemodynamic stability is the immediate priority for safety.
Q4: A patient with atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value
must the nurse monitor to ensure the therapeutic range?
A. aPTT
B. PT/INR [CORRECT]
C. Platelet count
D. Bleeding time
Correct Answer: B
Rationale: Warfarin affects the synthesis of vitamin K-dependent clotting factors. The
Prothrombin Time (PT) is monitored, standardized as the International Normalized Ratio (INR).
,3
For atrial fibrillation, the therapeutic INR is typically 2.0 to 3.0. aPTT (A) is used to monitor
heparin therapy. Platelet count (C) is monitored for heparin-induced thrombocytopenia (HIT).
Q5: A patient is prescribed furosemide (Lasix) for edema related to heart failure. The nurse
instructs the patient to eat foods rich in which electrolyte to prevent a deficiency?
A. Sodium
B. Potassium [CORRECT]
C. Magnesium
D. Calcium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that acts on the ascending loop of Henle to inhibit
sodium and chloride reabsorption, leading to increased excretion of potassium. Hypokalemia is a
significant risk that can lead to cardiac arrhythmias. Patients should be encouraged to consume
potassium-rich foods (like bananas, oranges) or take supplements as prescribed. Sodium (A)
intake is usually restricted in heart failure.
Q6: The nurse is caring for a patient receiving digoxin (Lanoxin). Which finding indicates the
patient is experiencing digoxin toxicity?
A. Weight gain of 2 lbs in one day
B. Blood pressure of 110/70 mmHg
C. Heart rate of 52 bpm and visual halos [CORRECT]
D. Urinary output of 40 mL/hr
Correct Answer: C
Rationale: Signs of digoxin toxicity include bradycardia (heart rate <60 bpm in adults),
gastrointestinal disturbances (nausea, vomiting, anorexia), and visual changes such as yellow-
green halos. These occur due to the narrow therapeutic index of the drug. Weight gain (A) may
indicate fluid retention, not toxicity. Normal vitals (B) and urine output (D) are not signs of
toxicity.
, 4
Q7: A patient who recently started taking spironolactone (Aldactone) has a serum potassium
level of 5.5 mEq/L. What is the nurse’s priority action?
A. Administer the next dose as scheduled.
B. Encourage the patient to drink orange juice.
C. Hold the medication and notify the provider. [CORRECT]
D. Administer sodium polystyrene sulfonate (Kayexalate).
Correct Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic. A potassium level of 5.5 mEq/L
indicates hyperkalemia. The nurse should hold the medication to prevent further potassium
retention and notify the healthcare provider. Encouraging orange juice (B) (high in potassium) is
contraindicated. Kayexalate (D) is an antidote for severe hyperkalemia but requires a specific
order; holding the drug is the immediate nursing intervention.
Q8: Which instruction is most important for the nurse to teach a patient prescribed atorvastatin
(Lipitor)?
A. Take this medication in the evening.
B. Avoid grapefruit juice. [CORRECT]
C. Take with food to prevent upset stomach.
D. Increase intake of green leafy vegetables.
Correct Answer: B
Rationale: Grapefruit juice inhibits CYP3A4, the enzyme responsible for metabolizing certain
statins like atorvastatin, leading to increased plasma levels and a higher risk of myopathy and
rhabdomyolysis. While some sources suggest taking statins in the evening (A) because
endogenous cholesterol synthesis is higher at night, the safety risk of grapefruit interaction is
often prioritized in patient education. Taking with food (C) is not required for all statins. Green
leafy vegetables (D) contain Vitamin K, which affects warfarin, not statins.
Q9: A patient is being discharged on a beta-blocker. Which statement by the patient indicates a
need for further teaching?
