RN HESI Pharmacology V1 ACTUAL EXAM
2026/2027 | HESI RN Pharm V1 | Verified Q&A |
Pass Guaranteed - A+ Graded
Section A: Multiple Choice (Questions 1–40)
Q1: A 72-year-old patient with atrial fibrillation is taking warfarin 5 mg daily. The nurse reviews the
laboratory results and notes an INR of 4.8. The patient is asymptomatic with no signs of bleeding. What
is the nurse's priority action?
A. Hold the next dose of warfarin and notify the provider. [CORRECT]
B. Administer vitamin K as a reversal agent
C. Give the warfarin as ordered and recheck INR tomorrow
D. Apply pressure to any potential bleeding sites
Correct Answer: A
Rationale: An INR of 4.8 exceeds the typical therapeutic range for atrial fibrillation (2.0–3.0) and
significantly increases bleeding risk. The standard nursing action is to hold the next dose of warfarin and
notify the provider for dose adjustment or further management. Vitamin K is reserved for INRs >10 or
active bleeding, making holding the dose the appropriate first step for an asymptomatic
supratherapeutic INR.
Q2: A patient newly prescribed sertraline 50 mg daily for major depressive disorder asks the nurse when
they should expect to feel better. Which statement by the patient indicates understanding of the
medication teaching?
A. "I will take this medication for several weeks before I notice improvement." [CORRECT]
B. "I should feel better within 2–3 days."
C. "I can stop taking this medication once I feel better."
D. "I need to take this medication with grapefruit juice for better absorption."
Correct Answer: A
Rationale: Selective serotonin reuptake inhibitors (SSRIs) such as sertraline typically require 2–4 weeks
to achieve full therapeutic effect, with some patients requiring 6–8 weeks for optimal response.
,Educating patients about this delayed onset improves medication adherence, prevents premature
discontinuation, and reduces the risk of treatment failure due to perceived ineffectiveness.
Q3: A patient receiving IV vancomycin 1 g over 60 minutes reports flushing and itching on the face and
neck 10 minutes after the infusion starts. The nurse notes a maculopapular rash on the patient's upper
body and a blood pressure of 94/62 mmHg. The nurse recognizes these findings as:
A. Anaphylactic reaction
B. Red Man Syndrome. [CORRECT]
C. Stevens-Johnson syndrome
D. Sepsis
Correct Answer: B
Rationale: Red Man Syndrome is a histamine-mediated reaction caused by rapid infusion of vancomycin,
characterized by flushing, pruritus, and erythematous rash on the face, neck, and upper torso, often
accompanied by hypotension. The nurse should stop or slow the infusion, administer antihistamines as
ordered, and ensure future vancomycin infusions are given over at least 90–120 minutes to prevent
recurrence.
Q4: A patient with heart failure is prescribed digoxin 0.25 mg daily. The nurse reviews the morning
laboratory results and notes a potassium level of 2.8 mEq/L. Which action should the nurse take first?
A. Administer the digoxin as ordered
B. Hold the digoxin and notify the provider. [CORRECT]
C. Administer a potassium supplement and give the digoxin
D. Recheck the potassium level in 2 hours
Correct Answer: B
Rationale: Hypokalemia significantly increases the risk of digoxin toxicity because potassium and digoxin
compete for binding sites on the Na⁺/K⁺-ATPase pump. With a potassium level of 2.8 mEq/L, the nurse
must hold the digoxin to prevent life-threatening dysrhythmias and notify the provider for potassium
repletion orders before resuming cardiac glycoside therapy.
Q5: A patient with type 2 diabetes is prescribed metformin 1,000 mg twice daily. The nurse is teaching
the patient about potential adverse effects. Which statement by the patient indicates a need for further
teaching?
A. "I should take this medication with meals to reduce stomach upset."
B. "I need to have my kidney function checked regularly."
, C. "I can drink alcohol in moderation while taking this medication." [CORRECT]
D. "I should report any signs of infection to my provider."
Correct Answer: C
Rationale: Alcohol consumption while taking metformin increases the risk of lactic acidosis, a rare but
potentially fatal adverse effect characterized by weakness, myalgia, respiratory distress, and
somnolence. Patients must be instructed to avoid alcohol entirely or limit intake significantly, and to
seek immediate medical attention if symptoms of lactic acidosis develop.
Q6: A patient with community-acquired pneumonia is prescribed azithromycin 500 mg on day 1, then
250 mg daily for 4 days. The patient is also taking warfarin 5 mg daily for atrial fibrillation. Which nursing
action is the priority?
A. Instruct the patient to increase warfarin dosage
B. Monitor INR closely during and after antibiotic therapy. [CORRECT]
C. Advise the patient to stop warfarin during antibiotic treatment
D. Administer vitamin K prophylactically
Correct Answer: B
Rationale: Macrolide antibiotics such as azithromycin inhibit cytochrome P450 enzymes and gut flora
that produce vitamin K, potentially potentiating warfarin's anticoagulant effect and increasing bleeding
risk. Close INR monitoring during and for several days after antibiotic completion allows for timely
warfarin dose adjustments to maintain therapeutic anticoagulation without excessive bleeding.
Q7: A patient with chronic obstructive pulmonary disease (COPD) is prescribed albuterol via metered-
dose inhaler (MDI) every 4–6 hours as needed for shortness of breath. The nurse is teaching proper
inhaler technique. Which action by the patient demonstrates correct technique?
A. Exhaling fully, then placing the inhaler in the mouth and breathing in slowly while depressing the
canister. [CORRECT]
B. Inhaling quickly and deeply through the nose while activating the inhaler
C. Holding the breath for 2 seconds after inhalation
D. Rinsing the mouth immediately after each use
Correct Answer: A
Rationale: Correct MDI technique requires exhaling fully to empty the lungs, placing the mouthpiece in
the mouth with lips sealed, and inhaling slowly and deeply through the mouth while simultaneously
depressing the canister. This coordinated action ensures optimal drug deposition in the lower airways.
The patient should hold their breath for 10 seconds, not 2, and mouth rinsing is important after
corticosteroid inhalers, not short-acting beta-agonists.
2026/2027 | HESI RN Pharm V1 | Verified Q&A |
Pass Guaranteed - A+ Graded
Section A: Multiple Choice (Questions 1–40)
Q1: A 72-year-old patient with atrial fibrillation is taking warfarin 5 mg daily. The nurse reviews the
laboratory results and notes an INR of 4.8. The patient is asymptomatic with no signs of bleeding. What
is the nurse's priority action?
A. Hold the next dose of warfarin and notify the provider. [CORRECT]
B. Administer vitamin K as a reversal agent
C. Give the warfarin as ordered and recheck INR tomorrow
D. Apply pressure to any potential bleeding sites
Correct Answer: A
Rationale: An INR of 4.8 exceeds the typical therapeutic range for atrial fibrillation (2.0–3.0) and
significantly increases bleeding risk. The standard nursing action is to hold the next dose of warfarin and
notify the provider for dose adjustment or further management. Vitamin K is reserved for INRs >10 or
active bleeding, making holding the dose the appropriate first step for an asymptomatic
supratherapeutic INR.
Q2: A patient newly prescribed sertraline 50 mg daily for major depressive disorder asks the nurse when
they should expect to feel better. Which statement by the patient indicates understanding of the
medication teaching?
A. "I will take this medication for several weeks before I notice improvement." [CORRECT]
B. "I should feel better within 2–3 days."
C. "I can stop taking this medication once I feel better."
D. "I need to take this medication with grapefruit juice for better absorption."
Correct Answer: A
Rationale: Selective serotonin reuptake inhibitors (SSRIs) such as sertraline typically require 2–4 weeks
to achieve full therapeutic effect, with some patients requiring 6–8 weeks for optimal response.
,Educating patients about this delayed onset improves medication adherence, prevents premature
discontinuation, and reduces the risk of treatment failure due to perceived ineffectiveness.
Q3: A patient receiving IV vancomycin 1 g over 60 minutes reports flushing and itching on the face and
neck 10 minutes after the infusion starts. The nurse notes a maculopapular rash on the patient's upper
body and a blood pressure of 94/62 mmHg. The nurse recognizes these findings as:
A. Anaphylactic reaction
B. Red Man Syndrome. [CORRECT]
C. Stevens-Johnson syndrome
D. Sepsis
Correct Answer: B
Rationale: Red Man Syndrome is a histamine-mediated reaction caused by rapid infusion of vancomycin,
characterized by flushing, pruritus, and erythematous rash on the face, neck, and upper torso, often
accompanied by hypotension. The nurse should stop or slow the infusion, administer antihistamines as
ordered, and ensure future vancomycin infusions are given over at least 90–120 minutes to prevent
recurrence.
Q4: A patient with heart failure is prescribed digoxin 0.25 mg daily. The nurse reviews the morning
laboratory results and notes a potassium level of 2.8 mEq/L. Which action should the nurse take first?
A. Administer the digoxin as ordered
B. Hold the digoxin and notify the provider. [CORRECT]
C. Administer a potassium supplement and give the digoxin
D. Recheck the potassium level in 2 hours
Correct Answer: B
Rationale: Hypokalemia significantly increases the risk of digoxin toxicity because potassium and digoxin
compete for binding sites on the Na⁺/K⁺-ATPase pump. With a potassium level of 2.8 mEq/L, the nurse
must hold the digoxin to prevent life-threatening dysrhythmias and notify the provider for potassium
repletion orders before resuming cardiac glycoside therapy.
Q5: A patient with type 2 diabetes is prescribed metformin 1,000 mg twice daily. The nurse is teaching
the patient about potential adverse effects. Which statement by the patient indicates a need for further
teaching?
A. "I should take this medication with meals to reduce stomach upset."
B. "I need to have my kidney function checked regularly."
, C. "I can drink alcohol in moderation while taking this medication." [CORRECT]
D. "I should report any signs of infection to my provider."
Correct Answer: C
Rationale: Alcohol consumption while taking metformin increases the risk of lactic acidosis, a rare but
potentially fatal adverse effect characterized by weakness, myalgia, respiratory distress, and
somnolence. Patients must be instructed to avoid alcohol entirely or limit intake significantly, and to
seek immediate medical attention if symptoms of lactic acidosis develop.
Q6: A patient with community-acquired pneumonia is prescribed azithromycin 500 mg on day 1, then
250 mg daily for 4 days. The patient is also taking warfarin 5 mg daily for atrial fibrillation. Which nursing
action is the priority?
A. Instruct the patient to increase warfarin dosage
B. Monitor INR closely during and after antibiotic therapy. [CORRECT]
C. Advise the patient to stop warfarin during antibiotic treatment
D. Administer vitamin K prophylactically
Correct Answer: B
Rationale: Macrolide antibiotics such as azithromycin inhibit cytochrome P450 enzymes and gut flora
that produce vitamin K, potentially potentiating warfarin's anticoagulant effect and increasing bleeding
risk. Close INR monitoring during and for several days after antibiotic completion allows for timely
warfarin dose adjustments to maintain therapeutic anticoagulation without excessive bleeding.
Q7: A patient with chronic obstructive pulmonary disease (COPD) is prescribed albuterol via metered-
dose inhaler (MDI) every 4–6 hours as needed for shortness of breath. The nurse is teaching proper
inhaler technique. Which action by the patient demonstrates correct technique?
A. Exhaling fully, then placing the inhaler in the mouth and breathing in slowly while depressing the
canister. [CORRECT]
B. Inhaling quickly and deeply through the nose while activating the inhaler
C. Holding the breath for 2 seconds after inhalation
D. Rinsing the mouth immediately after each use
Correct Answer: A
Rationale: Correct MDI technique requires exhaling fully to empty the lungs, placing the mouthpiece in
the mouth with lips sealed, and inhaling slowly and deeply through the mouth while simultaneously
depressing the canister. This coordinated action ensures optimal drug deposition in the lower airways.
The patient should hold their breath for 10 seconds, not 2, and mouth rinsing is important after
corticosteroid inhalers, not short-acting beta-agonists.
