HESI PHARMACOLOGY EXAM
QUESTIONS WITH RATIONALES
2026 QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Cardiovascular Medications (Questions 1-12)
1. A nurse is administering digoxin to a patient with heart failure. Which assessment
finding requires immediate intervention?
• A) Serum potassium level of 4.0 mEq/L
• B) Serum digoxin level of 2.5 ng/mL
• C) Apical pulse of 68 beats/minute
• D) Blood pressure of 120/80 mmHg
Rationale: The therapeutic digoxin level is 0.5-2.0 ng/mL. A level of 2.5 ng/mL
indicates digoxin toxicity, which can cause fatal dysrhythmias. The nurse should
withhold the medication and notify the provider. Potassium of 4.0 is normal, apical
pulse 68 is acceptable (hold if <60), and BP is normal.
2. A patient prescribed warfarin has an INR of 4.5. Which action should the nurse
take first?
• A) Administer vitamin K as ordered
• B) Hold the next dose of warfarin
• C) Increase the warfarin dose
• D) Apply pressure to any bleeding sites
,Rationale: Therapeutic INR for most indications is 2.0-3.0. An INR of 4.5 indicates
supratherapeutic anticoagulation with increased bleeding risk. The priority is to hold
the next warfarin dose, then the provider may order vitamin K for significant
elevation. Increasing the dose would worsen the condition.
3. A patient is started on lisinopril for hypertension. Which adverse effect requires
immediate discontinuation?
• A) Dry cough
• B) Angioedema of the lips and tongue
• C) Dizziness when standing
• D) Headache
Rationale: Angioedema (swelling of lips, tongue, larynx) is a life-threatening allergic
reaction to ACE inhibitors that can cause airway obstruction. Dry cough is a common
side effect but not immediately dangerous. Dizziness and headache may occur with
initial dosing but typically resolve.
4. The healthcare provider orders atorvastatin 40 mg daily. Which laboratory value
should the nurse monitor specifically for this medication?
• A) Creatinine
• B) Liver function tests (AST, ALT)
• C) Hemoglobin and hematocrit
• D) Thyroid-stimulating hormone
Rationale: Statins like atorvastatin can cause hepatotoxicity and elevation of liver
enzymes. Baseline and periodic LFT monitoring is essential. Creatinine monitors
kidney function, H&H monitors anemia, and TSH monitors thyroid - these are not
primary concerns with statin therapy.
5. A patient receiving intravenous heparin reports burning at the IV site and the
nurse observes erythema extending 3 cm above the insertion site. Which action is
most appropriate?
, • A) Slow the infusion rate
• B) Apply a warm compress
• C) Discontinue the IV line and restart at a new site
• D) Document the finding as a expected reaction
Rationale: These signs indicate phlebitis or infiltration. Heparin is irritating to vessels;
continuing infusion at the same site increases risk of tissue damage and
thrombophlebitis. The IV should be discontinued and restarted elsewhere. Slowing
the rate won't resolve the inflammation.
6. Clopidogrel is prescribed for a patient with a recent stent placement. Which
statement by the patient indicates understanding of the medication?
• A) "I can take ibuprofen if I get a headache"
• B) "I should report any black, tarry stools to my provider"
• C) "It's okay to stop this medication for a few days if I have surgery"
• D) "This medication dissolves existing blood clots"
Rationale: Clopidogrel is an antiplatelet agent that increases bleeding risk. Black,
tarry stools indicate gastrointestinal bleeding and require immediate evaluation.
NSAIDs like ibuprofen increase bleeding risk further. Stopping clopidogrel
prematurely after stent placement can cause stent thrombosis. It prevents new clot
formation, not dissolves existing clots.
7. A nurse is administering metoprolol to a patient with hypertension. Which finding
indicates the medication is having the desired therapeutic effect?
• A) Heart rate increase from 72 to 88 bpm
• B) Blood pressure decrease from 150/90 to 128/78 mmHg
• C) Respiratory rate decrease from 18 to 14 breaths/min
• D) Cardiac output decrease
Rationale: Metoprolol is a beta-blocker used to lower blood pressure by decreasing
heart rate and myocardial contractility. The desired effect is reduced blood pressure.
Bradycardia (not tachycardia) is expected. Respiratory changes are not therapeutic
endpoints.
, 8. A patient with atrial fibrillation is prescribed amiodarone. Which baseline
assessment is most important before starting this medication?
• A) Blood glucose level
• B) Chest X-ray and pulmonary function tests
• C) Renal ultrasound
• D) Coagulation studies
Rationale: Amiodarone causes pulmonary toxicity (interstitial lung disease,
pulmonary fibrosis) in up to 10-17% of patients. Baseline pulmonary assessment is
critical to identify pre-existing lung disease and monitor for changes. Thyroid, liver,
and eye assessments are also important, but pulmonary toxicity is the most serious.
9. A patient takes furosemide 40 mg daily for heart failure. Which electrolyte
imbalance is most concerning with this medication?
• A) Hyperkalemia
• B) Hypokalemia
• C) Hypernatremia
• D) Hypercalcemia
Rationale: Furosemide is a loop diuretic that blocks sodium and chloride
reabsorption in the loop of Henle, causing potassium wasting. Hypokalemia increases
risk of digoxin toxicity and cardiac dysrhythmias. Patients may require potassium
supplements or potassium-sparing diuretics.
10. A patient is receiving a nitroglycerin infusion for acute coronary syndrome. Which
parameter should the nurse assess most frequently?
• A) Respiratory rate
• B) Blood pressure
• C) Urine output
• D) Level of consciousness
Rationale: Nitroglycerin causes venodilation and arterial dilation, leading to
hypotension. Severe hypotension can reduce coronary perfusion and worsen
ischemia. BP should be monitored every 5-15 minutes during infusion. Changes in
LOC typically follow BP changes.
QUESTIONS WITH RATIONALES
2026 QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Cardiovascular Medications (Questions 1-12)
1. A nurse is administering digoxin to a patient with heart failure. Which assessment
finding requires immediate intervention?
• A) Serum potassium level of 4.0 mEq/L
• B) Serum digoxin level of 2.5 ng/mL
• C) Apical pulse of 68 beats/minute
• D) Blood pressure of 120/80 mmHg
Rationale: The therapeutic digoxin level is 0.5-2.0 ng/mL. A level of 2.5 ng/mL
indicates digoxin toxicity, which can cause fatal dysrhythmias. The nurse should
withhold the medication and notify the provider. Potassium of 4.0 is normal, apical
pulse 68 is acceptable (hold if <60), and BP is normal.
2. A patient prescribed warfarin has an INR of 4.5. Which action should the nurse
take first?
• A) Administer vitamin K as ordered
• B) Hold the next dose of warfarin
• C) Increase the warfarin dose
• D) Apply pressure to any bleeding sites
,Rationale: Therapeutic INR for most indications is 2.0-3.0. An INR of 4.5 indicates
supratherapeutic anticoagulation with increased bleeding risk. The priority is to hold
the next warfarin dose, then the provider may order vitamin K for significant
elevation. Increasing the dose would worsen the condition.
3. A patient is started on lisinopril for hypertension. Which adverse effect requires
immediate discontinuation?
• A) Dry cough
• B) Angioedema of the lips and tongue
• C) Dizziness when standing
• D) Headache
Rationale: Angioedema (swelling of lips, tongue, larynx) is a life-threatening allergic
reaction to ACE inhibitors that can cause airway obstruction. Dry cough is a common
side effect but not immediately dangerous. Dizziness and headache may occur with
initial dosing but typically resolve.
4. The healthcare provider orders atorvastatin 40 mg daily. Which laboratory value
should the nurse monitor specifically for this medication?
• A) Creatinine
• B) Liver function tests (AST, ALT)
• C) Hemoglobin and hematocrit
• D) Thyroid-stimulating hormone
Rationale: Statins like atorvastatin can cause hepatotoxicity and elevation of liver
enzymes. Baseline and periodic LFT monitoring is essential. Creatinine monitors
kidney function, H&H monitors anemia, and TSH monitors thyroid - these are not
primary concerns with statin therapy.
5. A patient receiving intravenous heparin reports burning at the IV site and the
nurse observes erythema extending 3 cm above the insertion site. Which action is
most appropriate?
, • A) Slow the infusion rate
• B) Apply a warm compress
• C) Discontinue the IV line and restart at a new site
• D) Document the finding as a expected reaction
Rationale: These signs indicate phlebitis or infiltration. Heparin is irritating to vessels;
continuing infusion at the same site increases risk of tissue damage and
thrombophlebitis. The IV should be discontinued and restarted elsewhere. Slowing
the rate won't resolve the inflammation.
6. Clopidogrel is prescribed for a patient with a recent stent placement. Which
statement by the patient indicates understanding of the medication?
• A) "I can take ibuprofen if I get a headache"
• B) "I should report any black, tarry stools to my provider"
• C) "It's okay to stop this medication for a few days if I have surgery"
• D) "This medication dissolves existing blood clots"
Rationale: Clopidogrel is an antiplatelet agent that increases bleeding risk. Black,
tarry stools indicate gastrointestinal bleeding and require immediate evaluation.
NSAIDs like ibuprofen increase bleeding risk further. Stopping clopidogrel
prematurely after stent placement can cause stent thrombosis. It prevents new clot
formation, not dissolves existing clots.
7. A nurse is administering metoprolol to a patient with hypertension. Which finding
indicates the medication is having the desired therapeutic effect?
• A) Heart rate increase from 72 to 88 bpm
• B) Blood pressure decrease from 150/90 to 128/78 mmHg
• C) Respiratory rate decrease from 18 to 14 breaths/min
• D) Cardiac output decrease
Rationale: Metoprolol is a beta-blocker used to lower blood pressure by decreasing
heart rate and myocardial contractility. The desired effect is reduced blood pressure.
Bradycardia (not tachycardia) is expected. Respiratory changes are not therapeutic
endpoints.
, 8. A patient with atrial fibrillation is prescribed amiodarone. Which baseline
assessment is most important before starting this medication?
• A) Blood glucose level
• B) Chest X-ray and pulmonary function tests
• C) Renal ultrasound
• D) Coagulation studies
Rationale: Amiodarone causes pulmonary toxicity (interstitial lung disease,
pulmonary fibrosis) in up to 10-17% of patients. Baseline pulmonary assessment is
critical to identify pre-existing lung disease and monitor for changes. Thyroid, liver,
and eye assessments are also important, but pulmonary toxicity is the most serious.
9. A patient takes furosemide 40 mg daily for heart failure. Which electrolyte
imbalance is most concerning with this medication?
• A) Hyperkalemia
• B) Hypokalemia
• C) Hypernatremia
• D) Hypercalcemia
Rationale: Furosemide is a loop diuretic that blocks sodium and chloride
reabsorption in the loop of Henle, causing potassium wasting. Hypokalemia increases
risk of digoxin toxicity and cardiac dysrhythmias. Patients may require potassium
supplements or potassium-sparing diuretics.
10. A patient is receiving a nitroglycerin infusion for acute coronary syndrome. Which
parameter should the nurse assess most frequently?
• A) Respiratory rate
• B) Blood pressure
• C) Urine output
• D) Level of consciousness
Rationale: Nitroglycerin causes venodilation and arterial dilation, leading to
hypotension. Severe hypotension can reduce coronary perfusion and worsen
ischemia. BP should be monitored every 5-15 minutes during infusion. Changes in
LOC typically follow BP changes.
