RN HESI Pharmacology V3 ACTUAL EXAM
2026/2027 | HESI RN Pharm V3 | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Pharmacology (12 Questions)
Q1. A 72-year-old male with atrial fibrillation is prescribed warfarin 5 mg daily. His INR today is 3.8. He
reports no bleeding, bruising, or dark stools. What should the nurse anticipate the provider will order?
A. Administer vitamin K 10 mg IV immediately
B. Hold the next warfarin dose and recheck INR in 2–3 days
C. Increase warfarin to 7.5 mg daily to reach therapeutic range faster
D. Discontinue warfarin permanently and switch to aspirin
Correct Answer: B
Rationale: An INR of 3.8 is mildly supratherapeutic (target 2.0–3.0 for atrial fibrillation) but does not
constitute a bleeding emergency. The standard management for INR 3.0–4.5 without bleeding is to hold
the next 1–2 warfarin doses and recheck the INR in 2–3 days, allowing the INR to drift down without
aggressive reversal. Vitamin K is reserved for INR >4.5 or active bleeding. Increasing the dose or
discontinuing warfarin entirely are inappropriate responses to a minimally elevated INR. Patient
education on dietary vitamin K consistency and potential drug interactions should be reinforced. (HESI
Strategy: Assess before acting; no bleeding = no emergency reversal)
Q2. A client receiving heparin IV infusion for deep vein thrombosis has an aPTT of 98 seconds
(therapeutic range 60–80 seconds). The client has no signs of bleeding. What is the nurse's priority
action?
A. Stop the heparin infusion immediately and notify the provider
B. Reduce the heparin infusion rate per protocol and recheck aPTT in 4–6 hours
C. Administer protamine sulfate 1 mg IV
D. Increase the heparin rate to achieve higher anticoagulation
Correct Answer: B
,Rationale: An aPTT of 98 seconds represents supratherapeutic anticoagulation (approximately 1.5–2.5×
control is therapeutic; >2.5× control is supratherapeutic). Without signs of bleeding, the appropriate
nursing action is to reduce the heparin infusion rate per institutional protocol (typically by 2–4
units/kg/hr) and recheck the aPTT in 4–6 hours. Protamine sulfate is the antidote for heparin overdose
but is reserved for severe bleeding or aPTT >100 seconds with bleeding risk. Stopping the infusion
entirely would cause rebound clotting; increasing the rate would worsen supratherapeutic
anticoagulation. (HESI Strategy: Protocol-driven dose adjustment for supratherapeutic labs without
bleeding)
Q3. A 68-year-old female with heart failure is prescribed lisinopril 10 mg daily and furosemide 40 mg
daily. Which laboratory value requires the most immediate nursing intervention?
A. Potassium 3.2 mEq/L
B. Sodium 138 mEq/L
C. BUN 22 mg/dL
D. Creatinine 1.1 mg/dL
Correct Answer: A
Rationale: A potassium of 3.2 mEq/L represents moderate hypokalemia requiring immediate
intervention in a patient receiving both an ACE inhibitor (which can cause hyperkalemia) and a loop
diuretic (which causes potassium wasting). Hypokalemia increases the risk of life-threatening cardiac
dysrhythmias, particularly in patients with heart failure who may be on digoxin. The nurse should notify
the provider for potassium supplementation and consider dietary education. While ACE inhibitors
typically spare potassium, the concurrent loop diuretic creates a net loss; levels below 3.5 mEq/L
warrant replacement. Normal BUN, creatinine, and sodium do not require immediate action. (HESI
Strategy: Safety priority—electrolyte imbalance causes lethal dysrhythmias)
Q4. A client with hypertension is prescribed metoprolol succinate 50 mg daily. The nurse notes the heart
rate is 52 bpm and the blood pressure is 108/68 mmHg. The client reports feeling dizzy when standing.
What is the nurse's priority action?
A. Hold the metoprolol and notify the provider
B. Administer the metoprolol as scheduled; these are expected effects
C. Check the client's blood glucose level
D. Encourage the client to increase fluid intake and rise slowly
Correct Answer: A
Rationale: Metoprolol is a cardioselective beta-1 blocker that reduces heart rate, blood pressure, and
myocardial contractility. A heart rate of 52 bpm with symptomatic orthostatic hypotension (dizziness on
,standing, BP 108/68) indicates excessive beta-blockade. The nurse should hold the dose and notify the
provider for potential dose reduction or medication change. While beta-blockers commonly cause
bradycardia, a rate <60 bpm with symptoms is not acceptable and increases the risk of syncope, falls,
and cardiac decompensation. Simply encouraging fluids or administering the dose ignores the safety
priority of preventing hemodynamic compromise. (HESI Strategy: Treat the patient, not the monitor—
symptoms + bradycardia = hold beta-blocker)
Q5. A client with hyperlipidemia is prescribed atorvastatin 40 mg daily at bedtime. Which client
statement indicates understanding of patient teaching?
A. "I will take this medication in the morning with grapefruit juice."
B. "I should report any unexplained muscle pain or weakness immediately."
C. "This medication will cure my high cholesterol permanently."
D. "I can stop taking this once my cholesterol returns to normal."
Correct Answer: B
Rationale: HMG-CoA reductase inhibitors (statins) can cause myopathy ranging from mild myalgia to
life-threatening rhabdomyolysis, particularly at higher doses and in combination with certain
medications (fibrates, azole antifungals, macrolides). The client must understand to report unexplained
muscle pain, tenderness, or weakness immediately, as early detection prevents progression to
rhabdomyolysis with acute kidney injury. Statins require lifelong therapy for chronic cholesterol
management; they do not cure hyperlipidemia, and discontinuation leads to rebound elevation.
Grapefruit juice inhibits CYP3A4 metabolism, increasing statin toxicity risk and should be avoided. (HESI
Strategy: Patient safety education—recognize statin myopathy early)
Q6. A client with chronic stable angina is prescribed nitroglycerin 0.4 mg sublingual PRN for chest pain.
Which instruction should the nurse include in discharge teaching?
A. "Store the tablets in a clear plastic container in your bathroom."
B. "If chest pain is not relieved after three tablets taken 5 minutes apart, call 911."
C. "Chew the tablet slowly for maximum absorption."
D. "Take a tablet every 2 hours to prevent chest pain."
Correct Answer: B
Rationale: The standard nitroglycerin protocol for acute angina is: take one 0.3–0.4 mg sublingual tablet
at onset of chest pain; if pain persists after 5 minutes, take a second tablet; if pain persists after another
5 minutes, take a third tablet; if pain is still not relieved after 15 minutes and three tablets, this indicates
possible myocardial infarction and the client must call 911 immediately. Nitroglycerin tablets must be
stored in the original dark glass container (light and moisture degrade the drug), placed under the
, tongue (not chewed), and taken PRN only—not on a scheduled basis for prophylaxis unless prescribed as
a long-acting formulation. (HESI Strategy: High-alert medication safety—proper use prevents MI
progression)
Q7. A client receiving digoxin 0.25 mg daily has a serum digoxin level of 2.8 ng/mL (therapeutic 0.5–2.0
ng/mL). The client reports nausea, vomiting, and seeing yellow-green halos around lights. Which nursing
action is the priority?
A. Administer the scheduled digoxin dose; the level is only slightly elevated
B. Hold the digoxin, notify the provider, and monitor for worsening toxicity
C. Administer potassium chloride IV push to counteract toxicity
D. Increase the client's fluid intake to enhance digoxin elimination
Correct Answer: B
Rationale: A digoxin level of 2.8 ng/mL with classic toxicity symptoms (nausea, vomiting, visual
disturbances—yellow-green halos, blurred vision) confirms digoxin toxicity. The nurse must hold the
next dose immediately and notify the provider for further management, which may include digoxin-
specific antibody fragments (Digibind) for severe toxicity, potassium monitoring (hypokalemia worsens
toxicity), and cardiac monitoring for dysrhythmias. Visual disturbances are pathognomonic for digoxin
toxicity and should never be dismissed. Administering the dose or giving potassium without orders
would worsen toxicity; potassium chloride is never given IV push due to cardiac arrest risk. (HESI
Strategy: Recognize classic toxicity signs—hold high-alert medication and notify provider)
Q8. A client with newly diagnosed heart failure is prescribed sacubitril/valsartan (Entresto). Which client
history finding is a contraindication to this medication?
A. History of hypertension controlled with metoprolol
B. History of angioedema with previous ACE inhibitor use
C. History of osteoarthritis managed with acetaminophen
D. History of type 2 diabetes controlled with metformin
Correct Answer: B
Rationale: Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) that combines
valsartan (ARB) with sacubitril (neprilysin inhibitor). A history of angioedema with ACE inhibitors is an
absolute contraindication due to the increased risk of recurrent angioedema with ARNI therapy—both
drug classes affect the kinin-bradykinin pathway. Additionally, sacubitril/valsartan must not be initiated
within 36 hours of the last ACE inhibitor dose due to additive angioedema risk. The medication is
contraindicated in pregnancy and requires baseline renal function and potassium monitoring. Other
2026/2027 | HESI RN Pharm V3 | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Pharmacology (12 Questions)
Q1. A 72-year-old male with atrial fibrillation is prescribed warfarin 5 mg daily. His INR today is 3.8. He
reports no bleeding, bruising, or dark stools. What should the nurse anticipate the provider will order?
A. Administer vitamin K 10 mg IV immediately
B. Hold the next warfarin dose and recheck INR in 2–3 days
C. Increase warfarin to 7.5 mg daily to reach therapeutic range faster
D. Discontinue warfarin permanently and switch to aspirin
Correct Answer: B
Rationale: An INR of 3.8 is mildly supratherapeutic (target 2.0–3.0 for atrial fibrillation) but does not
constitute a bleeding emergency. The standard management for INR 3.0–4.5 without bleeding is to hold
the next 1–2 warfarin doses and recheck the INR in 2–3 days, allowing the INR to drift down without
aggressive reversal. Vitamin K is reserved for INR >4.5 or active bleeding. Increasing the dose or
discontinuing warfarin entirely are inappropriate responses to a minimally elevated INR. Patient
education on dietary vitamin K consistency and potential drug interactions should be reinforced. (HESI
Strategy: Assess before acting; no bleeding = no emergency reversal)
Q2. A client receiving heparin IV infusion for deep vein thrombosis has an aPTT of 98 seconds
(therapeutic range 60–80 seconds). The client has no signs of bleeding. What is the nurse's priority
action?
A. Stop the heparin infusion immediately and notify the provider
B. Reduce the heparin infusion rate per protocol and recheck aPTT in 4–6 hours
C. Administer protamine sulfate 1 mg IV
D. Increase the heparin rate to achieve higher anticoagulation
Correct Answer: B
,Rationale: An aPTT of 98 seconds represents supratherapeutic anticoagulation (approximately 1.5–2.5×
control is therapeutic; >2.5× control is supratherapeutic). Without signs of bleeding, the appropriate
nursing action is to reduce the heparin infusion rate per institutional protocol (typically by 2–4
units/kg/hr) and recheck the aPTT in 4–6 hours. Protamine sulfate is the antidote for heparin overdose
but is reserved for severe bleeding or aPTT >100 seconds with bleeding risk. Stopping the infusion
entirely would cause rebound clotting; increasing the rate would worsen supratherapeutic
anticoagulation. (HESI Strategy: Protocol-driven dose adjustment for supratherapeutic labs without
bleeding)
Q3. A 68-year-old female with heart failure is prescribed lisinopril 10 mg daily and furosemide 40 mg
daily. Which laboratory value requires the most immediate nursing intervention?
A. Potassium 3.2 mEq/L
B. Sodium 138 mEq/L
C. BUN 22 mg/dL
D. Creatinine 1.1 mg/dL
Correct Answer: A
Rationale: A potassium of 3.2 mEq/L represents moderate hypokalemia requiring immediate
intervention in a patient receiving both an ACE inhibitor (which can cause hyperkalemia) and a loop
diuretic (which causes potassium wasting). Hypokalemia increases the risk of life-threatening cardiac
dysrhythmias, particularly in patients with heart failure who may be on digoxin. The nurse should notify
the provider for potassium supplementation and consider dietary education. While ACE inhibitors
typically spare potassium, the concurrent loop diuretic creates a net loss; levels below 3.5 mEq/L
warrant replacement. Normal BUN, creatinine, and sodium do not require immediate action. (HESI
Strategy: Safety priority—electrolyte imbalance causes lethal dysrhythmias)
Q4. A client with hypertension is prescribed metoprolol succinate 50 mg daily. The nurse notes the heart
rate is 52 bpm and the blood pressure is 108/68 mmHg. The client reports feeling dizzy when standing.
What is the nurse's priority action?
A. Hold the metoprolol and notify the provider
B. Administer the metoprolol as scheduled; these are expected effects
C. Check the client's blood glucose level
D. Encourage the client to increase fluid intake and rise slowly
Correct Answer: A
Rationale: Metoprolol is a cardioselective beta-1 blocker that reduces heart rate, blood pressure, and
myocardial contractility. A heart rate of 52 bpm with symptomatic orthostatic hypotension (dizziness on
,standing, BP 108/68) indicates excessive beta-blockade. The nurse should hold the dose and notify the
provider for potential dose reduction or medication change. While beta-blockers commonly cause
bradycardia, a rate <60 bpm with symptoms is not acceptable and increases the risk of syncope, falls,
and cardiac decompensation. Simply encouraging fluids or administering the dose ignores the safety
priority of preventing hemodynamic compromise. (HESI Strategy: Treat the patient, not the monitor—
symptoms + bradycardia = hold beta-blocker)
Q5. A client with hyperlipidemia is prescribed atorvastatin 40 mg daily at bedtime. Which client
statement indicates understanding of patient teaching?
A. "I will take this medication in the morning with grapefruit juice."
B. "I should report any unexplained muscle pain or weakness immediately."
C. "This medication will cure my high cholesterol permanently."
D. "I can stop taking this once my cholesterol returns to normal."
Correct Answer: B
Rationale: HMG-CoA reductase inhibitors (statins) can cause myopathy ranging from mild myalgia to
life-threatening rhabdomyolysis, particularly at higher doses and in combination with certain
medications (fibrates, azole antifungals, macrolides). The client must understand to report unexplained
muscle pain, tenderness, or weakness immediately, as early detection prevents progression to
rhabdomyolysis with acute kidney injury. Statins require lifelong therapy for chronic cholesterol
management; they do not cure hyperlipidemia, and discontinuation leads to rebound elevation.
Grapefruit juice inhibits CYP3A4 metabolism, increasing statin toxicity risk and should be avoided. (HESI
Strategy: Patient safety education—recognize statin myopathy early)
Q6. A client with chronic stable angina is prescribed nitroglycerin 0.4 mg sublingual PRN for chest pain.
Which instruction should the nurse include in discharge teaching?
A. "Store the tablets in a clear plastic container in your bathroom."
B. "If chest pain is not relieved after three tablets taken 5 minutes apart, call 911."
C. "Chew the tablet slowly for maximum absorption."
D. "Take a tablet every 2 hours to prevent chest pain."
Correct Answer: B
Rationale: The standard nitroglycerin protocol for acute angina is: take one 0.3–0.4 mg sublingual tablet
at onset of chest pain; if pain persists after 5 minutes, take a second tablet; if pain persists after another
5 minutes, take a third tablet; if pain is still not relieved after 15 minutes and three tablets, this indicates
possible myocardial infarction and the client must call 911 immediately. Nitroglycerin tablets must be
stored in the original dark glass container (light and moisture degrade the drug), placed under the
, tongue (not chewed), and taken PRN only—not on a scheduled basis for prophylaxis unless prescribed as
a long-acting formulation. (HESI Strategy: High-alert medication safety—proper use prevents MI
progression)
Q7. A client receiving digoxin 0.25 mg daily has a serum digoxin level of 2.8 ng/mL (therapeutic 0.5–2.0
ng/mL). The client reports nausea, vomiting, and seeing yellow-green halos around lights. Which nursing
action is the priority?
A. Administer the scheduled digoxin dose; the level is only slightly elevated
B. Hold the digoxin, notify the provider, and monitor for worsening toxicity
C. Administer potassium chloride IV push to counteract toxicity
D. Increase the client's fluid intake to enhance digoxin elimination
Correct Answer: B
Rationale: A digoxin level of 2.8 ng/mL with classic toxicity symptoms (nausea, vomiting, visual
disturbances—yellow-green halos, blurred vision) confirms digoxin toxicity. The nurse must hold the
next dose immediately and notify the provider for further management, which may include digoxin-
specific antibody fragments (Digibind) for severe toxicity, potassium monitoring (hypokalemia worsens
toxicity), and cardiac monitoring for dysrhythmias. Visual disturbances are pathognomonic for digoxin
toxicity and should never be dismissed. Administering the dose or giving potassium without orders
would worsen toxicity; potassium chloride is never given IV push due to cardiac arrest risk. (HESI
Strategy: Recognize classic toxicity signs—hold high-alert medication and notify provider)
Q8. A client with newly diagnosed heart failure is prescribed sacubitril/valsartan (Entresto). Which client
history finding is a contraindication to this medication?
A. History of hypertension controlled with metoprolol
B. History of angioedema with previous ACE inhibitor use
C. History of osteoarthritis managed with acetaminophen
D. History of type 2 diabetes controlled with metformin
Correct Answer: B
Rationale: Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) that combines
valsartan (ARB) with sacubitril (neprilysin inhibitor). A history of angioedema with ACE inhibitors is an
absolute contraindication due to the increased risk of recurrent angioedema with ARNI therapy—both
drug classes affect the kinin-bradykinin pathway. Additionally, sacubitril/valsartan must not be initiated
within 36 hours of the last ACE inhibitor dose due to additive angioedema risk. The medication is
contraindicated in pregnancy and requires baseline renal function and potassium monitoring. Other
