HESI
PHARMACOLOGY
2026 EXAM
CONTAINS:
✓ HESI-style nursing exam questions
✓ Multiple-choice questions with correct answers
✓ Detailed rationales/explanations for answers
✓ Nursing clinical judgment and critical-thinking questions
✓ Pharmacology questions (medications, indications, side effects, nursing
considerations)
✓ Medical–surgical nursing concepts
✓ Fundamentals of nursing content
✓ Patient safety and prioritization questions
✓ Infection control principles
✓ Assessment and nursing interventions
✓ NCLEX-style question formatting
✓ Exam-preparation content aligned with HESI testing standards
,A client with hypertension is prescribed Lisinopril. The nurse teaches the client about the mechanism
of action of this medication. Which statement by the client indicates a need for further teaching?
A) "This medication will help relax my blood vessels so my blood pressure goes down."
B) "I need to avoid salt substitutes that contain potassium while taking this drug."
C) "This drug works by preventing my kidneys from reabsorbing too much water."
D) "I should call my doctor if I develop a persistent, dry cough."
Correct Answer: C) "This drug works by preventing my kidneys from reabsorbing too much
water."
Explanation / Rationale:
Lisinopril is an Angiotensin-Converting Enzyme (ACE) inhibitor. It works by inhibiting the conversion of
angiotensin I to angiotensin II, a potent vasoconstrictor, and by preventing the breakdown of
bradykinin. This results in vasodilation and reduced aldosterone secretion (leading to mild diuresis),
but its primary mechanism is vasodilation, not the direct prevention of water reabsorption in the
kidneys (which describes diuretics like hydrochlorothiazide). Options A, B, and D are correct: ACE
inhibitors relax blood vessels, cause hyperkalemia (necessitating avoidance of potassium substitutes),
and induce a dry cough due to bradykinin accumulation.
The nurse is preparing to administer Vancomycin via IV infusion to a client with a severe MRSA
infection. Which nursing intervention is the priority to prevent a serious adverse reaction?
A) Administering an oral antihistamine 30 minutes prior to the infusion.
B) Ensuring the infusion runs over at least 60 minutes.
C) Monitoring the client's blood pressure every 5 minutes during the infusion.
D) Flushing the line with normal saline before and after the infusion.
Correct Answer: B) Ensuring the infusion runs over at least 60 minutes.
,Explanation / Rationale:
Vancomycin is associated with "Red Man Syndrome," a histamine-mediated infusion reaction
characterized by flushing, rash, and hypotension. The primary prevention method is infusing the drug
over at least 60 minutes (or 2 hours for higher doses) to minimize rapid histamine release. While
premedication with antihistamines (Option A) may be used for patients with a history of Red Man
Syndrome, controlling the infusion rate is the standard priority intervention. Option D is standard for
all IVs but does not prevent Red Man Syndrome. Option C is excessive for routine monitoring unless a
reaction is suspected.
A client with type 2 diabetes mellitus is prescribed Metformin. The nurse reviews the client's medical
history. Which condition would contraindicate the administration of this medication?
A) Diabetic neuropathy
B) Hypothyroidism
C) Renal insufficiency
D) Chronic obstructive pulmonary disease (COPD)
Correct Answer: C) Renal insufficiency
Explanation / Rationale:
Metformin is contraindicated in clients with renal insufficiency (e.g., serum creatinine ≥1.5 mg/dL for
men, ≥1.4 mg/dL for women, or eGFR <30 mL/min) because it is excreted by the kidneys. Impaired
renal function can lead to the accumulation of Metformin, resulting in lactic acidosis, a rare but fatal
complication. Diabetic neuropathy (A) and hypothyroidism (B) are not contraindications. COPD (D) is
not directly contraindicated, though severe acidosis in general is a concern.
A client is taking Digoxin for heart failure. The nurse identifies which serum potassium level as putting
the client at highest risk for Digoxin toxicity?
A) 3.0 mEq/L
B) 4.0 mEq/L
C) 5.0 mEq/L
D) 5.5 mEq/L
Correct Answer: A) 3.0 mEq/L
, Explanation / Rationale:
Hypokalemia (low potassium) increases the risk of Digoxin toxicity because potassium competes with
Digoxin for binding sites on the cardiac muscle. When potassium levels are low, more Digoxin binds to
the myocardium, increasing its effects and toxicity. A level of 3.0 mEq/L indicates hypokalemia.
Normal potassium is typically 3.5 to 5.0 mEq/L. Hyperkalemia (C, D) actually reduces the binding of
Digoxin but carries its own cardiac risks.
A client is prescribed Furosemide, a loop diuretic. The nurse should instruct the client to increase their
intake of which foods?
A) Bananas and oranges
B) Cheese and milk
C) Green leafy vegetables
D) Lean meats and eggs
Correct Answer: A) Bananas and oranges
Explanation / Rationale:
Furosemide causes the loss of potassium, sodium, and water. This can lead to hypokalemia. Bananas
and oranges are rich in potassium and should be encouraged to supplement potassium loss, unless the
client has renal restrictions. While leafy greens contain some potassium, fruits are the highest source
among the options. Cheese/milk and meats are high in sodium or protein, not specifically potassium-
focused for this electrolyte need.
The nurse is caring for a client receiving Heparin therapy. Which laboratory value is specifically
monitored to evaluate the therapeutic effectiveness of Heparin?
A) Prothrombin Time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet count
Correct Answer: C) Activated Partial Thromboplastin Time (aPTT)
PHARMACOLOGY
2026 EXAM
CONTAINS:
✓ HESI-style nursing exam questions
✓ Multiple-choice questions with correct answers
✓ Detailed rationales/explanations for answers
✓ Nursing clinical judgment and critical-thinking questions
✓ Pharmacology questions (medications, indications, side effects, nursing
considerations)
✓ Medical–surgical nursing concepts
✓ Fundamentals of nursing content
✓ Patient safety and prioritization questions
✓ Infection control principles
✓ Assessment and nursing interventions
✓ NCLEX-style question formatting
✓ Exam-preparation content aligned with HESI testing standards
,A client with hypertension is prescribed Lisinopril. The nurse teaches the client about the mechanism
of action of this medication. Which statement by the client indicates a need for further teaching?
A) "This medication will help relax my blood vessels so my blood pressure goes down."
B) "I need to avoid salt substitutes that contain potassium while taking this drug."
C) "This drug works by preventing my kidneys from reabsorbing too much water."
D) "I should call my doctor if I develop a persistent, dry cough."
Correct Answer: C) "This drug works by preventing my kidneys from reabsorbing too much
water."
Explanation / Rationale:
Lisinopril is an Angiotensin-Converting Enzyme (ACE) inhibitor. It works by inhibiting the conversion of
angiotensin I to angiotensin II, a potent vasoconstrictor, and by preventing the breakdown of
bradykinin. This results in vasodilation and reduced aldosterone secretion (leading to mild diuresis),
but its primary mechanism is vasodilation, not the direct prevention of water reabsorption in the
kidneys (which describes diuretics like hydrochlorothiazide). Options A, B, and D are correct: ACE
inhibitors relax blood vessels, cause hyperkalemia (necessitating avoidance of potassium substitutes),
and induce a dry cough due to bradykinin accumulation.
The nurse is preparing to administer Vancomycin via IV infusion to a client with a severe MRSA
infection. Which nursing intervention is the priority to prevent a serious adverse reaction?
A) Administering an oral antihistamine 30 minutes prior to the infusion.
B) Ensuring the infusion runs over at least 60 minutes.
C) Monitoring the client's blood pressure every 5 minutes during the infusion.
D) Flushing the line with normal saline before and after the infusion.
Correct Answer: B) Ensuring the infusion runs over at least 60 minutes.
,Explanation / Rationale:
Vancomycin is associated with "Red Man Syndrome," a histamine-mediated infusion reaction
characterized by flushing, rash, and hypotension. The primary prevention method is infusing the drug
over at least 60 minutes (or 2 hours for higher doses) to minimize rapid histamine release. While
premedication with antihistamines (Option A) may be used for patients with a history of Red Man
Syndrome, controlling the infusion rate is the standard priority intervention. Option D is standard for
all IVs but does not prevent Red Man Syndrome. Option C is excessive for routine monitoring unless a
reaction is suspected.
A client with type 2 diabetes mellitus is prescribed Metformin. The nurse reviews the client's medical
history. Which condition would contraindicate the administration of this medication?
A) Diabetic neuropathy
B) Hypothyroidism
C) Renal insufficiency
D) Chronic obstructive pulmonary disease (COPD)
Correct Answer: C) Renal insufficiency
Explanation / Rationale:
Metformin is contraindicated in clients with renal insufficiency (e.g., serum creatinine ≥1.5 mg/dL for
men, ≥1.4 mg/dL for women, or eGFR <30 mL/min) because it is excreted by the kidneys. Impaired
renal function can lead to the accumulation of Metformin, resulting in lactic acidosis, a rare but fatal
complication. Diabetic neuropathy (A) and hypothyroidism (B) are not contraindications. COPD (D) is
not directly contraindicated, though severe acidosis in general is a concern.
A client is taking Digoxin for heart failure. The nurse identifies which serum potassium level as putting
the client at highest risk for Digoxin toxicity?
A) 3.0 mEq/L
B) 4.0 mEq/L
C) 5.0 mEq/L
D) 5.5 mEq/L
Correct Answer: A) 3.0 mEq/L
, Explanation / Rationale:
Hypokalemia (low potassium) increases the risk of Digoxin toxicity because potassium competes with
Digoxin for binding sites on the cardiac muscle. When potassium levels are low, more Digoxin binds to
the myocardium, increasing its effects and toxicity. A level of 3.0 mEq/L indicates hypokalemia.
Normal potassium is typically 3.5 to 5.0 mEq/L. Hyperkalemia (C, D) actually reduces the binding of
Digoxin but carries its own cardiac risks.
A client is prescribed Furosemide, a loop diuretic. The nurse should instruct the client to increase their
intake of which foods?
A) Bananas and oranges
B) Cheese and milk
C) Green leafy vegetables
D) Lean meats and eggs
Correct Answer: A) Bananas and oranges
Explanation / Rationale:
Furosemide causes the loss of potassium, sodium, and water. This can lead to hypokalemia. Bananas
and oranges are rich in potassium and should be encouraged to supplement potassium loss, unless the
client has renal restrictions. While leafy greens contain some potassium, fruits are the highest source
among the options. Cheese/milk and meats are high in sodium or protein, not specifically potassium-
focused for this electrolyte need.
The nurse is caring for a client receiving Heparin therapy. Which laboratory value is specifically
monitored to evaluate the therapeutic effectiveness of Heparin?
A) Prothrombin Time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet count
Correct Answer: C) Activated Partial Thromboplastin Time (aPTT)
