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WGU D441 HESI PHARMACOLOGY PRACTICE
EXAM – 200+ ORIGINAL NCLEX-STYLE
QUESTIONS WITH RATIONALES
# SECTION 1: CARDIOVASCULAR MEDICATIONS (Questions 1–35)
**1.** A nurse is administering digoxin 0.25 mg PO to a patient with
heart failure. Which finding requires the nurse to withhold the
medication and notify the provider?
A. Heart rate 58 bpm and blood pressure 110/70 mmHg
B. Serum potassium level 4.2 mEq/L
C. Patient reports nausea and yellow-tinged vision
D. Patient’s lungs are clear to auscultation
**Correct Answer:** C – Patient reports nausea and yellow-tinged
vision
**Rationale:** Nausea and yellow-tinged vision (xanthopsia) are classic
signs of digoxin toxicity. The nurse should hold the dose, assess the
digoxin level, and notify the provider. A heart rate of 58 bpm is
borderline but not an automatic hold unless symptomatic.
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**2.** A patient receiving IV heparin for a deep vein thrombosis has an
aPTT of 110 seconds (normal range 25–35 seconds; therapeutic goal 60–
80 seconds). What is the priority nursing action?
A. Continue the infusion at the same rate
B. Increase the infusion rate
C. Stop the infusion and notify the provider
D. Add a second anticoagulant
**Correct Answer:** C – Stop the infusion and notify the provider
**Rationale:** An aPTT above 100 seconds indicates a high risk of
bleeding. The heparin infusion should be stopped, and the provider
notified for possible protamine sulfate administration if bleeding occurs.
**3.** A patient is prescribed warfarin (Coumadin) after mechanical
valve replacement. The nurse teaches the patient to avoid which over-
the-counter medication due to increased bleeding risk?
A. Acetaminophen
B. Ibuprofen
C. Diphenhydramine
D. Loratadine
**Correct Answer:** B – Ibuprofen
**Rationale:** Ibuprofen (NSAID) increases bleeding risk by inhibiting
platelet function and can also displace warfarin from protein binding
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sites. Acetaminophen is preferred for mild pain in patients taking
warfarin.
**4.** A patient with hypertension is started on lisinopril. Which
finding is most concerning and requires immediate intervention?
A. Dry cough
B. Serum potassium 5.8 mEq/L
C. Dizziness when standing
D. Fatigue
**Correct Answer:** B – Serum potassium 5.8 mEq/L
**Rationale:** Lisinopril (ACE inhibitor) can cause hyperkalemia by
reducing aldosterone secretion. A potassium level of 5.8 mEq/L is
potentially dangerous and requires dose adjustment or discontinuation.
Dry cough is a common side effect but not immediately dangerous.
**5.** A patient taking metoprolol (Lopressor) has a blood pressure of
88/50 mmHg and a heart rate of 48 bpm. The patient reports dizziness.
What should the nurse do first?
A. Administer the next dose as ordered
B. Hold the metoprolol and assess further
C. Give a fluid bolus of 500 mL normal saline
D. Double the next dose
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**Correct Answer:** B – Hold the metoprolol and assess further
**Rationale:** Metoprolol (beta-blocker) causes bradycardia and
hypotension. With symptomatic bradycardia, the dose should be held,
and the provider notified. Fluid bolus may be needed but is not the first
action.
**6.** A patient is started on amiodarone for atrial fibrillation. Which
baseline and periodic test is most important to monitor for a life-
threatening pulmonary complication?
A. Chest X-ray and pulmonary function tests
B. Thyroid function tests
C. Liver function tests
D. Complete blood count
**Correct Answer:** A – Chest X-ray and pulmonary function tests
**Rationale:** Amiodarone pulmonary toxicity (fibrosis) is a potentially
fatal complication. Baseline and periodic chest X-ray and PFTs are
essential. Thyroid and liver labs are also monitored but pulmonary
toxicity is the most serious.
**7.** A nurse is teaching a patient about sublingual nitroglycerin for
angina. Which statement indicates correct understanding?
A. “I will take one tablet every 5 minutes for up to 3 doses. If pain
persists after the first tablet, I will call 911.”
B. “I will swallow the tablet with a full glass of water.”
WGU D441 HESI PHARMACOLOGY PRACTICE
EXAM – 200+ ORIGINAL NCLEX-STYLE
QUESTIONS WITH RATIONALES
# SECTION 1: CARDIOVASCULAR MEDICATIONS (Questions 1–35)
**1.** A nurse is administering digoxin 0.25 mg PO to a patient with
heart failure. Which finding requires the nurse to withhold the
medication and notify the provider?
A. Heart rate 58 bpm and blood pressure 110/70 mmHg
B. Serum potassium level 4.2 mEq/L
C. Patient reports nausea and yellow-tinged vision
D. Patient’s lungs are clear to auscultation
**Correct Answer:** C – Patient reports nausea and yellow-tinged
vision
**Rationale:** Nausea and yellow-tinged vision (xanthopsia) are classic
signs of digoxin toxicity. The nurse should hold the dose, assess the
digoxin level, and notify the provider. A heart rate of 58 bpm is
borderline but not an automatic hold unless symptomatic.
,2|Page
**2.** A patient receiving IV heparin for a deep vein thrombosis has an
aPTT of 110 seconds (normal range 25–35 seconds; therapeutic goal 60–
80 seconds). What is the priority nursing action?
A. Continue the infusion at the same rate
B. Increase the infusion rate
C. Stop the infusion and notify the provider
D. Add a second anticoagulant
**Correct Answer:** C – Stop the infusion and notify the provider
**Rationale:** An aPTT above 100 seconds indicates a high risk of
bleeding. The heparin infusion should be stopped, and the provider
notified for possible protamine sulfate administration if bleeding occurs.
**3.** A patient is prescribed warfarin (Coumadin) after mechanical
valve replacement. The nurse teaches the patient to avoid which over-
the-counter medication due to increased bleeding risk?
A. Acetaminophen
B. Ibuprofen
C. Diphenhydramine
D. Loratadine
**Correct Answer:** B – Ibuprofen
**Rationale:** Ibuprofen (NSAID) increases bleeding risk by inhibiting
platelet function and can also displace warfarin from protein binding
,3|Page
sites. Acetaminophen is preferred for mild pain in patients taking
warfarin.
**4.** A patient with hypertension is started on lisinopril. Which
finding is most concerning and requires immediate intervention?
A. Dry cough
B. Serum potassium 5.8 mEq/L
C. Dizziness when standing
D. Fatigue
**Correct Answer:** B – Serum potassium 5.8 mEq/L
**Rationale:** Lisinopril (ACE inhibitor) can cause hyperkalemia by
reducing aldosterone secretion. A potassium level of 5.8 mEq/L is
potentially dangerous and requires dose adjustment or discontinuation.
Dry cough is a common side effect but not immediately dangerous.
**5.** A patient taking metoprolol (Lopressor) has a blood pressure of
88/50 mmHg and a heart rate of 48 bpm. The patient reports dizziness.
What should the nurse do first?
A. Administer the next dose as ordered
B. Hold the metoprolol and assess further
C. Give a fluid bolus of 500 mL normal saline
D. Double the next dose
, 4|Page
**Correct Answer:** B – Hold the metoprolol and assess further
**Rationale:** Metoprolol (beta-blocker) causes bradycardia and
hypotension. With symptomatic bradycardia, the dose should be held,
and the provider notified. Fluid bolus may be needed but is not the first
action.
**6.** A patient is started on amiodarone for atrial fibrillation. Which
baseline and periodic test is most important to monitor for a life-
threatening pulmonary complication?
A. Chest X-ray and pulmonary function tests
B. Thyroid function tests
C. Liver function tests
D. Complete blood count
**Correct Answer:** A – Chest X-ray and pulmonary function tests
**Rationale:** Amiodarone pulmonary toxicity (fibrosis) is a potentially
fatal complication. Baseline and periodic chest X-ray and PFTs are
essential. Thyroid and liver labs are also monitored but pulmonary
toxicity is the most serious.
**7.** A nurse is teaching a patient about sublingual nitroglycerin for
angina. Which statement indicates correct understanding?
A. “I will take one tablet every 5 minutes for up to 3 doses. If pain
persists after the first tablet, I will call 911.”
B. “I will swallow the tablet with a full glass of water.”
