HESI Pharmacology V3 | 2026 Q&A with
Rationale (HESI Pharm Exam)
1. A nurse is caring for a client with congestive heart failure who is receiving Digoxin. Which
clinical finding should the nurse identify as a common early sign of digoxin toxicity?
A. Anorexia and nausea
B. Increased urinary output
C. Sudden increase in blood pressure
D. Tinnitus and hearing loss
Correct Answer: A
Rationale: Early signs of digoxin toxicity typically involve the gastrointestinal system,
including anorexia, nausea, and vomiting. Neurological symptoms such as visual
disturbances (yellow-green halos) are also classic indicators. The nurse must monitor
serum digoxin levels closely, as the therapeutic range is narrow (0.5 to 2.0 ng/mL).
2. The nurse is preparing to administer Furosemide to a client with peripheral edema. Which
laboratory value should the nurse evaluate prior to administration?
A. Serum Potassium level
B. Blood Urea Nitrogen (BUN)
C. White Blood Cell (WBC) count
,D. Serum Calcium level
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes the excretion of potassium, which can
lead to life-threatening hypokalemia. It is essential to check the potassium level to ensure it
is within the normal range of 3.5 to 5.0 mEq/L before giving the dose. If the level is low, the
nurse should hold the medication and contact the healthcare provider.
3. A client is prescribed Warfarin for the treatment of deep vein thrombosis (DVT). Which
instruction should the nurse provide to the client regarding their diet?
A. Avoid all foods containing Vitamin K entirely.
B. Maintain a consistent intake of foods high in Vitamin K.
C. Increase the intake of dark green leafy vegetables to improve clotting.
D. Drink at least 3 liters of water daily to prevent dehydration.
Correct Answer: B
Rationale: Vitamin K is the antagonist for warfarin, and sudden changes in dietary intake
can fluctuate the International Normalized Ratio (INR). Consistency in the diet allows the
healthcare provider to adjust the warfarin dose accurately based on the client’s baseline
habits. Clients should be taught that spinach, kale, and broccoli are high in Vitamin K and
should not be increased or decreased suddenly.
,4. A client with type 1 diabetes mellitus is prescribed Regular insulin and NPH insulin to be
administered at 0730. When should the nurse expect the Regular insulin to peak?
A. 0930 to 1030
B. 0800 to 0830
C. 1300 to 1500
D. 1800 to 2000
Correct Answer: A
Rationale: Regular insulin is a short-acting insulin that typically has an onset of 30 to 60
minutes and peaks in 2 to 4 hours. Given at 0730, the peak effect would most likely occur
between 0930 and 1130. Identifying peak times is critical for the nurse to monitor for
potential hypoglycemic reactions.
5. A client taking Lisinopril for hypertension reports a persistent, dry, non-productive cough.
Which action should the nurse take?
A. Instruct the client to use an over-the-counter cough suppressant.
B. Notify the healthcare provider of the side effect.
C. Suggest the client drink more fluids to soothe the throat.
D. Advise the client that this is a normal reaction that will subside in a week.
Correct Answer: B
, Rationale: A dry, hacking cough is a common side effect of Angiotensin-Converting
Enzyme (ACE) inhibitors like Lisinopril due to the accumulation of bradykinin. This side
effect often leads to non-compliance, so the provider may need to switch the client to an
Angiotensin II Receptor Blocker (ARB). The nurse should document the finding and
facilitate a medication review.
6. A client is receiving an intravenous infusion of Heparin for a pulmonary embolism. Which
laboratory test should the nurse monitor to adjust the Heparin dosage?
A. Prothrombin Time (PT)
B. Activated Partial Thromboplastin Time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
Correct Answer: B
Rationale: The aPTT is used to monitor the effectiveness of unfractionated heparin
therapy. The goal is typically to maintain the aPTT at 1.5 to 2.5 times the normal control
value. While platelet counts are monitored for Heparin-Induced Thrombocytopenia (HIT),
the aPTT is the primary indicator for dosage titration.
7. The nurse is reviewing the medication list for a client with a history of hyperkalemia. Which
medication should the nurse question?
A. Hydrochlorothiazide
B. Spironolactone
Rationale (HESI Pharm Exam)
1. A nurse is caring for a client with congestive heart failure who is receiving Digoxin. Which
clinical finding should the nurse identify as a common early sign of digoxin toxicity?
A. Anorexia and nausea
B. Increased urinary output
C. Sudden increase in blood pressure
D. Tinnitus and hearing loss
Correct Answer: A
Rationale: Early signs of digoxin toxicity typically involve the gastrointestinal system,
including anorexia, nausea, and vomiting. Neurological symptoms such as visual
disturbances (yellow-green halos) are also classic indicators. The nurse must monitor
serum digoxin levels closely, as the therapeutic range is narrow (0.5 to 2.0 ng/mL).
2. The nurse is preparing to administer Furosemide to a client with peripheral edema. Which
laboratory value should the nurse evaluate prior to administration?
A. Serum Potassium level
B. Blood Urea Nitrogen (BUN)
C. White Blood Cell (WBC) count
,D. Serum Calcium level
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes the excretion of potassium, which can
lead to life-threatening hypokalemia. It is essential to check the potassium level to ensure it
is within the normal range of 3.5 to 5.0 mEq/L before giving the dose. If the level is low, the
nurse should hold the medication and contact the healthcare provider.
3. A client is prescribed Warfarin for the treatment of deep vein thrombosis (DVT). Which
instruction should the nurse provide to the client regarding their diet?
A. Avoid all foods containing Vitamin K entirely.
B. Maintain a consistent intake of foods high in Vitamin K.
C. Increase the intake of dark green leafy vegetables to improve clotting.
D. Drink at least 3 liters of water daily to prevent dehydration.
Correct Answer: B
Rationale: Vitamin K is the antagonist for warfarin, and sudden changes in dietary intake
can fluctuate the International Normalized Ratio (INR). Consistency in the diet allows the
healthcare provider to adjust the warfarin dose accurately based on the client’s baseline
habits. Clients should be taught that spinach, kale, and broccoli are high in Vitamin K and
should not be increased or decreased suddenly.
,4. A client with type 1 diabetes mellitus is prescribed Regular insulin and NPH insulin to be
administered at 0730. When should the nurse expect the Regular insulin to peak?
A. 0930 to 1030
B. 0800 to 0830
C. 1300 to 1500
D. 1800 to 2000
Correct Answer: A
Rationale: Regular insulin is a short-acting insulin that typically has an onset of 30 to 60
minutes and peaks in 2 to 4 hours. Given at 0730, the peak effect would most likely occur
between 0930 and 1130. Identifying peak times is critical for the nurse to monitor for
potential hypoglycemic reactions.
5. A client taking Lisinopril for hypertension reports a persistent, dry, non-productive cough.
Which action should the nurse take?
A. Instruct the client to use an over-the-counter cough suppressant.
B. Notify the healthcare provider of the side effect.
C. Suggest the client drink more fluids to soothe the throat.
D. Advise the client that this is a normal reaction that will subside in a week.
Correct Answer: B
, Rationale: A dry, hacking cough is a common side effect of Angiotensin-Converting
Enzyme (ACE) inhibitors like Lisinopril due to the accumulation of bradykinin. This side
effect often leads to non-compliance, so the provider may need to switch the client to an
Angiotensin II Receptor Blocker (ARB). The nurse should document the finding and
facilitate a medication review.
6. A client is receiving an intravenous infusion of Heparin for a pulmonary embolism. Which
laboratory test should the nurse monitor to adjust the Heparin dosage?
A. Prothrombin Time (PT)
B. Activated Partial Thromboplastin Time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
Correct Answer: B
Rationale: The aPTT is used to monitor the effectiveness of unfractionated heparin
therapy. The goal is typically to maintain the aPTT at 1.5 to 2.5 times the normal control
value. While platelet counts are monitored for Heparin-Induced Thrombocytopenia (HIT),
the aPTT is the primary indicator for dosage titration.
7. The nurse is reviewing the medication list for a client with a history of hyperkalemia. Which
medication should the nurse question?
A. Hydrochlorothiazide
B. Spironolactone
