HESI Pharmacology V2 | 2026 Q&A with
Rationale (HESI Pharm Exam)
1. A nurse is preparing to administer digoxin to a client with heart failure. Which assessment
finding should the nurse prioritize before administering the medication?
A. Apical pulse of 52 beats per minute
B. Blood pressure of 140/90 mmHg
C. Respiratory rate of 22 breaths per minute
D. Potassium level of 4.8 mEq/L
Correct Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate while increasing
contractility. The nurse must assess the apical pulse for one full minute and withhold the
dose if the heart rate is less than 60 beats per minute. Bradycardia is a primary sign of
digoxin toxicity that requires immediate intervention.
2. A client is prescribed lisinopril for hypertension. The nurse should instruct the client to seek
medical attention immediately if which adverse effect occurs?
A. A persistent dry cough
B. Swelling of the lips and tongue
C. Occasional dizziness when standing
,D. Increased frequency of urination
Correct Answer: B
Rationale: Angioedema is a life-threatening adverse effect of ACE inhibitors like lisinopril
that can compromise the airway. While a dry cough is common, it is not an emergency,
whereas facial or tongue swelling indicates a hypersensitivity reaction. The nurse must
educate the client on identifying this potential airway obstruction early.
3. The nurse is reviewing the lab results of a client taking warfarin. The International
Normalized Ratio (INR) is 5.2. Which medication should the nurse anticipate administering?
A. Protamine sulfate
B. Vitamin K
C. Enoxaparin
D. Aspirin
Correct Answer: B
Rationale: Vitamin K is the specific antagonist used to reverse the effects of warfarin when
the INR is dangerously elevated. An INR of 5.2 puts the client at a high risk for spontaneous
bleeding and requires rapid correction. Protamine sulfate is the antidote for heparin, not
warfarin.
4. A client with type 2 diabetes is prescribed metformin. Which diagnostic test result would
require the nurse to hold the medication and notify the provider?
A. Hemoglobin A1C of 7.5%
,B. Elevated serum creatinine
C. Decreased serum albumin
D. Increased white blood cell count
Correct Answer: B
Rationale: Metformin is primarily excreted by the kidneys and can cause lactic acidosis if
renal function is impaired. A high serum creatinine level indicates renal insufficiency,
which is a contraindication for metformin therapy. The nurse must monitor kidney
function closely to prevent this rare but fatal metabolic complication.
5. A nurse is caring for a client receiving a heparin infusion for a pulmonary embolism. Which
laboratory value should the nurse monitor to adjust the infusion rate?
A. Prothrombin time (PT)
B. Hemoglobin level
C. Platelet count
D. Activated partial thromboplastin time (aPTT)
Correct Answer: D
Rationale: The aPTT is used to monitor the effectiveness of unfractionated heparin and
guide dosage adjustments. PT and INR are typically used for warfarin monitoring rather
than heparin. While platelet counts are monitored for Heparin-Induced Thrombocytopenia,
the aPTT is the specific test for therapeutic dosing.
, 6. Select All That Apply (SATA): A nurse is providing discharge teaching to a client prescribed
prednisone for an autoimmune flare-up. Which instructions should the nurse include? (Select
all that apply)
A. Do not stop taking the medication abruptly.
B. Avoid large crowds and people who are sick.
C. Report any signs of black, tarry stools.
D. Increase intake of sodium-rich foods.
E. Monitor your blood glucose levels regularly.
F. Expect to lose weight while on this medication.
Correct Answer: ABCE
Rationale: Corticosteroids like prednisone must be tapered to prevent adrenal
insufficiency and carry a high risk of immunosuppression. They can also cause gastric
ulcers (indicated by melena) and hyperglycemia, requiring careful glucose monitoring.
Clients usually experience weight gain and fluid retention rather than weight loss, and
should limit sodium intake.
7. A client is starting lithium carbonate for the treatment of bipolar disorder. Which
statement by the client indicates a need for further teaching?
A. I will drink 2 to 3 liters of fluid daily.
B. I will limit my salt intake to lower my blood pressure.
Rationale (HESI Pharm Exam)
1. A nurse is preparing to administer digoxin to a client with heart failure. Which assessment
finding should the nurse prioritize before administering the medication?
A. Apical pulse of 52 beats per minute
B. Blood pressure of 140/90 mmHg
C. Respiratory rate of 22 breaths per minute
D. Potassium level of 4.8 mEq/L
Correct Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate while increasing
contractility. The nurse must assess the apical pulse for one full minute and withhold the
dose if the heart rate is less than 60 beats per minute. Bradycardia is a primary sign of
digoxin toxicity that requires immediate intervention.
2. A client is prescribed lisinopril for hypertension. The nurse should instruct the client to seek
medical attention immediately if which adverse effect occurs?
A. A persistent dry cough
B. Swelling of the lips and tongue
C. Occasional dizziness when standing
,D. Increased frequency of urination
Correct Answer: B
Rationale: Angioedema is a life-threatening adverse effect of ACE inhibitors like lisinopril
that can compromise the airway. While a dry cough is common, it is not an emergency,
whereas facial or tongue swelling indicates a hypersensitivity reaction. The nurse must
educate the client on identifying this potential airway obstruction early.
3. The nurse is reviewing the lab results of a client taking warfarin. The International
Normalized Ratio (INR) is 5.2. Which medication should the nurse anticipate administering?
A. Protamine sulfate
B. Vitamin K
C. Enoxaparin
D. Aspirin
Correct Answer: B
Rationale: Vitamin K is the specific antagonist used to reverse the effects of warfarin when
the INR is dangerously elevated. An INR of 5.2 puts the client at a high risk for spontaneous
bleeding and requires rapid correction. Protamine sulfate is the antidote for heparin, not
warfarin.
4. A client with type 2 diabetes is prescribed metformin. Which diagnostic test result would
require the nurse to hold the medication and notify the provider?
A. Hemoglobin A1C of 7.5%
,B. Elevated serum creatinine
C. Decreased serum albumin
D. Increased white blood cell count
Correct Answer: B
Rationale: Metformin is primarily excreted by the kidneys and can cause lactic acidosis if
renal function is impaired. A high serum creatinine level indicates renal insufficiency,
which is a contraindication for metformin therapy. The nurse must monitor kidney
function closely to prevent this rare but fatal metabolic complication.
5. A nurse is caring for a client receiving a heparin infusion for a pulmonary embolism. Which
laboratory value should the nurse monitor to adjust the infusion rate?
A. Prothrombin time (PT)
B. Hemoglobin level
C. Platelet count
D. Activated partial thromboplastin time (aPTT)
Correct Answer: D
Rationale: The aPTT is used to monitor the effectiveness of unfractionated heparin and
guide dosage adjustments. PT and INR are typically used for warfarin monitoring rather
than heparin. While platelet counts are monitored for Heparin-Induced Thrombocytopenia,
the aPTT is the specific test for therapeutic dosing.
, 6. Select All That Apply (SATA): A nurse is providing discharge teaching to a client prescribed
prednisone for an autoimmune flare-up. Which instructions should the nurse include? (Select
all that apply)
A. Do not stop taking the medication abruptly.
B. Avoid large crowds and people who are sick.
C. Report any signs of black, tarry stools.
D. Increase intake of sodium-rich foods.
E. Monitor your blood glucose levels regularly.
F. Expect to lose weight while on this medication.
Correct Answer: ABCE
Rationale: Corticosteroids like prednisone must be tapered to prevent adrenal
insufficiency and carry a high risk of immunosuppression. They can also cause gastric
ulcers (indicated by melena) and hyperglycemia, requiring careful glucose monitoring.
Clients usually experience weight gain and fluid retention rather than weight loss, and
should limit sodium intake.
7. A client is starting lithium carbonate for the treatment of bipolar disorder. Which
statement by the client indicates a need for further teaching?
A. I will drink 2 to 3 liters of fluid daily.
B. I will limit my salt intake to lower my blood pressure.
