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2026 PHARMACOLOGY HESI EXIT EXAM | NGN
QUESTIONS | ANSWERS WITH RATIONALES |
NCLEX-RN PREP 250 VERIFIED QUESTIONS
WITH CORRECT ANSWERS & DETAILED
RATIONALES Complete Exam Bank for Nursing
Students | Latest 2026 Edition
SECTION 1: CARDIOVASCULAR DRUGS
Questions 1–40
1. The nurse is preparing to administer digoxin to a patient with heart failure. The patient reports
nausea, vomiting, and visual halos around objects. The nurse notes a heart rate of 58 beats per
minute. What will the nurse do next?
a) Reassure the patient that these are common, self-limiting side effects
b) Administer the next dose as ordered since these are mild side effects
c) Hold the dose and notify the provider of possible digoxin toxicity
d) Request an order for an antiemetic and an analgesic medication
Answer: c) Hold the dose and notify the provider of possible digoxin toxicity
Rationale: Nausea, vomiting, visual halos, and bradycardia are classic signs of digoxin toxicity. The
nurse should withhold the dose and notify the provider immediately.
2. Which electrolyte abnormality increases the risk of digoxin toxicity?
a) Hypercalcemia
b) Hypernatremia
c) Hypokalemia
d) Hypoglycemia
Answer: c) Hypokalemia
Rationale: Hypokalemia enhances digoxin binding to the Na⁺/K⁺-ATPase pump, increasing the risk
of toxicity. Potassium levels should be monitored and maintained within normal range.
3. A patient is receiving warfarin for a chronic condition. Which patient statement requires
immediate action by the nurse?
a) “I will avoid contact sports.”
b) “I will take my medication in the early evening each day.”
c) “I will increase dark-green, leafy vegetables in my diet.”
d) “I will contact my HCP if I develop excessive bruising.”
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Answer: c) “I will increase dark-green, leafy vegetables in my diet.”
Rationale: Dark-green, leafy vegetables are high in vitamin K, which decreases warfarin’s
anticoagulant effect (lowers INR). Patients should maintain consistent vitamin K intake.
4. A patient has arrived at the emergency department and requires immediate surgery. He has been
receiving heparin. Which intervention is essential?
a) Teach the patient about phenytoin
b) Administer protamine sulfate
c) Assess the INR before surgery
d) Administer vitamin K
Answer: b) Administer protamine sulfate
Rationale: Protamine sulfate is the specific antidote for heparin. It rapidly reverses heparin’s
anticoagulant effect in emergency situations.
5. Which statement made by the patient indicates to the nurse that the patient needs additional
instruction about antihypertensive treatment?
a) “I will check my blood pressure daily and take my medication when it is over 140/90.”
b) “I will include rest periods during the day to help me tolerate the fatigue my medicine may
cause.”
c) “I will not mow my lawn until I see how this medication makes me feel.”
d) “I will change my position slowly to prevent feeling dizzy.”
Answer: a) “I will check my blood pressure daily and take my medication when it is over 140/90.”
Rationale: Antihypertensives must be taken daily as prescribed, not only when blood pressure is
elevated. Intermittent use leads to poor blood pressure control.
6. A nurse is caring for a patient who is taking an angiotensin-converting enzyme (ACE) inhibitor
and develops a dry, nonproductive cough. What is the nurse’s priority action?
a) Call the HCP to switch the medication
b) Assess the patient for other symptoms of upper respiratory infection
c) Instruct the patient to take antitussive medication until symptoms subside
d) Tell the patient that the cough will subside in a few days
Answer: a) Call the HCP to switch the medication
Rationale: A persistent dry cough is a well-known side effect of ACE inhibitors (due to bradykinin
accumulation). The provider may switch to an angiotensin II receptor blocker (ARB).
7. A patient on warfarin should avoid sudden increases in foods high in vitamin K because they can:
a) Increase INR
b) Decrease INR
,3|Page
c) Cause serotonin syndrome
d) Increase bleeding immediately
Answer: b) Decrease INR
Rationale: Vitamin K promotes clotting factor synthesis, counteracting warfarin’s effect
and lowering INR (reducing anticoagulation).
8. Which statement made by the patient demonstrates a need for additional instruction from the
nurse regarding the use of nitroglycerin?
a) “If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief.”
b) “I should keep my nitroglycerin in a cool, dry place.”
c) “I should change positions slowly to avoid getting dizzy.”
d) “I can take up to 5 tablets at 3-minute intervals for chest pain if necessary.”
Answer: d) “I can take up to 5 tablets at 3-minute intervals for chest pain if necessary.”
Rationale: The correct dosing for sublingual nitroglycerin is up to 3 tablets at 5-minute intervals.
Taking 5 tablets is incorrect and could cause severe hypotension.
9. The nurse is caring for several patients who are all being treated for hypertension. Which patient
will the nurse assess first?
a) The patient who has been on beta blockers for 1 day
b) The patient who is on a beta blocker and a thiazide diuretic
c) The patient who is taking a beta blocker and furosemide
d) The patient who has stopped taking a beta blocker due to cost
Answer: d) The patient who has stopped taking a beta blocker due to cost
Rationale: Abrupt withdrawal of beta blockers can cause rebound hypertension, tachycardia, and
myocardial ischemia. This patient is at highest risk and should be assessed first.
10. A common side effect of ACE inhibitors is:
a) Persistent dry cough
b) Hyperglycemia
c) Tinnitus
d) Bradyarrhythmia
Answer: a) Persistent dry cough
Rationale: Bradykinin accumulation from ACE inhibition causes a dry, nonproductive cough.
11. Which diuretic is potassium-sparing?
a) Furosemide
b) Hydrochlorothiazide
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c) Spironolactone
d) Mannitol
Answer: c) Spironolactone
Rationale: Spironolactone antagonizes aldosterone, causing potassium retention. Loop diuretics
(furosemide) and thiazides cause potassium loss.
12. The nurse is teaching a patient about newly prescribed furosemide. Which statement by the
patient indicates understanding?
a) “I will take this medication at bedtime to avoid side effects.”
b) “I should eat bananas and oranges to replace potassium.”
c) “This medication will help keep my potassium levels high.”
d) “I will not need to have my blood pressure checked as often.”
Answer: b) “I should eat bananas and oranges to replace potassium.”
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Patients should increase
dietary potassium (bananas, oranges, potatoes).
13. A patient receiving heparin therapy has an activated partial thromboplastin time (aPTT) of 110
seconds (normal 25–35 seconds). The nurse should:
a) Continue the heparin infusion as ordered
b) Decrease the heparin infusion rate
c) Hold the heparin and notify the provider
d) Administer protamine sulfate immediately
Answer: c) Hold the heparin and notify the provider
Rationale: The therapeutic aPTT range for heparin is typically 1.5–2.5 times normal (approximately
45–85 seconds). 110 seconds indicates supratherapeutic levels and bleeding risk.
14. A patient is prescribed metoprolol for hypertension. The nurse should monitor the patient for
which adverse effect?
a) Tachycardia
b) Bradycardia
c) Hypotension
d) Hyperglycemia
Answer: b) Bradycardia
Rationale: Metoprolol is a beta₁-selective blocker that decreases heart rate and contractility.
Bradycardia is an expected adverse effect.
2026 PHARMACOLOGY HESI EXIT EXAM | NGN
QUESTIONS | ANSWERS WITH RATIONALES |
NCLEX-RN PREP 250 VERIFIED QUESTIONS
WITH CORRECT ANSWERS & DETAILED
RATIONALES Complete Exam Bank for Nursing
Students | Latest 2026 Edition
SECTION 1: CARDIOVASCULAR DRUGS
Questions 1–40
1. The nurse is preparing to administer digoxin to a patient with heart failure. The patient reports
nausea, vomiting, and visual halos around objects. The nurse notes a heart rate of 58 beats per
minute. What will the nurse do next?
a) Reassure the patient that these are common, self-limiting side effects
b) Administer the next dose as ordered since these are mild side effects
c) Hold the dose and notify the provider of possible digoxin toxicity
d) Request an order for an antiemetic and an analgesic medication
Answer: c) Hold the dose and notify the provider of possible digoxin toxicity
Rationale: Nausea, vomiting, visual halos, and bradycardia are classic signs of digoxin toxicity. The
nurse should withhold the dose and notify the provider immediately.
2. Which electrolyte abnormality increases the risk of digoxin toxicity?
a) Hypercalcemia
b) Hypernatremia
c) Hypokalemia
d) Hypoglycemia
Answer: c) Hypokalemia
Rationale: Hypokalemia enhances digoxin binding to the Na⁺/K⁺-ATPase pump, increasing the risk
of toxicity. Potassium levels should be monitored and maintained within normal range.
3. A patient is receiving warfarin for a chronic condition. Which patient statement requires
immediate action by the nurse?
a) “I will avoid contact sports.”
b) “I will take my medication in the early evening each day.”
c) “I will increase dark-green, leafy vegetables in my diet.”
d) “I will contact my HCP if I develop excessive bruising.”
,2|Page
Answer: c) “I will increase dark-green, leafy vegetables in my diet.”
Rationale: Dark-green, leafy vegetables are high in vitamin K, which decreases warfarin’s
anticoagulant effect (lowers INR). Patients should maintain consistent vitamin K intake.
4. A patient has arrived at the emergency department and requires immediate surgery. He has been
receiving heparin. Which intervention is essential?
a) Teach the patient about phenytoin
b) Administer protamine sulfate
c) Assess the INR before surgery
d) Administer vitamin K
Answer: b) Administer protamine sulfate
Rationale: Protamine sulfate is the specific antidote for heparin. It rapidly reverses heparin’s
anticoagulant effect in emergency situations.
5. Which statement made by the patient indicates to the nurse that the patient needs additional
instruction about antihypertensive treatment?
a) “I will check my blood pressure daily and take my medication when it is over 140/90.”
b) “I will include rest periods during the day to help me tolerate the fatigue my medicine may
cause.”
c) “I will not mow my lawn until I see how this medication makes me feel.”
d) “I will change my position slowly to prevent feeling dizzy.”
Answer: a) “I will check my blood pressure daily and take my medication when it is over 140/90.”
Rationale: Antihypertensives must be taken daily as prescribed, not only when blood pressure is
elevated. Intermittent use leads to poor blood pressure control.
6. A nurse is caring for a patient who is taking an angiotensin-converting enzyme (ACE) inhibitor
and develops a dry, nonproductive cough. What is the nurse’s priority action?
a) Call the HCP to switch the medication
b) Assess the patient for other symptoms of upper respiratory infection
c) Instruct the patient to take antitussive medication until symptoms subside
d) Tell the patient that the cough will subside in a few days
Answer: a) Call the HCP to switch the medication
Rationale: A persistent dry cough is a well-known side effect of ACE inhibitors (due to bradykinin
accumulation). The provider may switch to an angiotensin II receptor blocker (ARB).
7. A patient on warfarin should avoid sudden increases in foods high in vitamin K because they can:
a) Increase INR
b) Decrease INR
,3|Page
c) Cause serotonin syndrome
d) Increase bleeding immediately
Answer: b) Decrease INR
Rationale: Vitamin K promotes clotting factor synthesis, counteracting warfarin’s effect
and lowering INR (reducing anticoagulation).
8. Which statement made by the patient demonstrates a need for additional instruction from the
nurse regarding the use of nitroglycerin?
a) “If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief.”
b) “I should keep my nitroglycerin in a cool, dry place.”
c) “I should change positions slowly to avoid getting dizzy.”
d) “I can take up to 5 tablets at 3-minute intervals for chest pain if necessary.”
Answer: d) “I can take up to 5 tablets at 3-minute intervals for chest pain if necessary.”
Rationale: The correct dosing for sublingual nitroglycerin is up to 3 tablets at 5-minute intervals.
Taking 5 tablets is incorrect and could cause severe hypotension.
9. The nurse is caring for several patients who are all being treated for hypertension. Which patient
will the nurse assess first?
a) The patient who has been on beta blockers for 1 day
b) The patient who is on a beta blocker and a thiazide diuretic
c) The patient who is taking a beta blocker and furosemide
d) The patient who has stopped taking a beta blocker due to cost
Answer: d) The patient who has stopped taking a beta blocker due to cost
Rationale: Abrupt withdrawal of beta blockers can cause rebound hypertension, tachycardia, and
myocardial ischemia. This patient is at highest risk and should be assessed first.
10. A common side effect of ACE inhibitors is:
a) Persistent dry cough
b) Hyperglycemia
c) Tinnitus
d) Bradyarrhythmia
Answer: a) Persistent dry cough
Rationale: Bradykinin accumulation from ACE inhibition causes a dry, nonproductive cough.
11. Which diuretic is potassium-sparing?
a) Furosemide
b) Hydrochlorothiazide
, 4|Page
c) Spironolactone
d) Mannitol
Answer: c) Spironolactone
Rationale: Spironolactone antagonizes aldosterone, causing potassium retention. Loop diuretics
(furosemide) and thiazides cause potassium loss.
12. The nurse is teaching a patient about newly prescribed furosemide. Which statement by the
patient indicates understanding?
a) “I will take this medication at bedtime to avoid side effects.”
b) “I should eat bananas and oranges to replace potassium.”
c) “This medication will help keep my potassium levels high.”
d) “I will not need to have my blood pressure checked as often.”
Answer: b) “I should eat bananas and oranges to replace potassium.”
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Patients should increase
dietary potassium (bananas, oranges, potatoes).
13. A patient receiving heparin therapy has an activated partial thromboplastin time (aPTT) of 110
seconds (normal 25–35 seconds). The nurse should:
a) Continue the heparin infusion as ordered
b) Decrease the heparin infusion rate
c) Hold the heparin and notify the provider
d) Administer protamine sulfate immediately
Answer: c) Hold the heparin and notify the provider
Rationale: The therapeutic aPTT range for heparin is typically 1.5–2.5 times normal (approximately
45–85 seconds). 110 seconds indicates supratherapeutic levels and bleeding risk.
14. A patient is prescribed metoprolol for hypertension. The nurse should monitor the patient for
which adverse effect?
a) Tachycardia
b) Bradycardia
c) Hypotension
d) Hyperglycemia
Answer: b) Bradycardia
Rationale: Metoprolol is a beta₁-selective blocker that decreases heart rate and contractility.
Bradycardia is an expected adverse effect.
