1
HESI Pharmacology Test Bank 2025 (120+ NCLEX-Style
Questions) | Drug Class, Side Effects, Nursing Rationales
& Answers
1. ACE Inhibitor: Lisinopril
Question:
A 62-year-old male patient with a history of hypertension and type 2
diabetes mellitus is prescribed lisinopril 10 mg PO daily. During a follow-
up visit, the patient reports a persistent, dry, tickling cough that started a few
days after beginning the medication. The nurse recognizes this as a possible
adverse effect of the drug. Which action should the nurse take next?
A. Instruct the patient to take the medication with food
B. Suggest using an over-the-counter cough suppressant
, 2
C. Notify the healthcare provider of the patient’s symptoms
D. Reassure the patient that the cough will subside with time
Correct Answer: C. Notify the healthcare provider of the patient’s
symptoms
Drug Class: Angiotensin-Converting Enzyme (ACE) Inhibitor
Key Side Effects: Persistent dry cough, hyperkalemia, angioedema,
hypotension, renal dysfunction
Rationale (Super Detailed):
Lisinopril is an ACE inhibitor commonly prescribed for hypertension, heart
failure, and nephropathy in diabetics. One of its hallmark side effects is a
persistent dry cough, which is caused by the accumulation of bradykinin,
a vasodilator that is not broken down due to ACE inhibition. This adverse
effect is non-life-threatening but often intolerable to patients. It does not
improve with time, and cough suppressants are generally ineffective. The
provider should be notified so the medication can be discontinued and
possibly replaced with an angiotensin II receptor blocker (ARB) like
losartan, which does not affect bradykinin. The nurse’s role includes
recognizing this adverse effect, documenting it, and notifying the provider
promptly for appropriate management.
2. Anticoagulant: Warfarin
Question:
A 73-year-old female patient is on long-term warfarin therapy following a
mechanical heart valve replacement. She presents to the anticoagulation
clinic for routine monitoring. Her current INR is 5.2, and she reports minor
, 3
bleeding from her gums while brushing and a small amount of bruising on
her forearms. What is the most appropriate nursing action?
A. Document findings and recheck INR in 24 hours
B. Administer vitamin K immediately
C. Hold the next warfarin dose and notify the healthcare provider
D. Instruct the patient to skip one dose and resume as normal
Correct Answer: C. Hold the next warfarin dose and notify the healthcare
provider
Drug Class: Vitamin K Antagonist (Oral Anticoagulant)
Key Side Effects: Bleeding, bruising, GI upset, hepatotoxicity, skin necrosis
(rare)
Rationale (Super Detailed):
Warfarin inhibits vitamin K–dependent clotting factors (II, VII, IX, X),
which prolongs the INR (international normalized ratio). For most
indications, the therapeutic INR range is 2.0–3.0, and for mechanical heart
valves, it may be slightly higher (2.5–3.5). An INR of 5.2 indicates
supratherapeutic anticoagulation, significantly increasing the risk of
serious bleeding. The presence of bleeding symptoms, even if minor,
requires immediate intervention. The nurse should hold the next scheduled
dose of warfarin and contact the healthcare provider, who may order a
dose adjustment or administer vitamin K depending on severity and
bleeding risk. Immediate vitamin K is not always necessary unless bleeding
is severe. The patient should be re-educated about consistent dietary intake
of vitamin K and avoiding NSAIDs or other drugs that increase bleeding
risk.
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3. Cardiac Glycoside: Digoxin
Question:
A 76-year-old patient with a history of chronic heart failure is being
treated with digoxin 0.125 mg PO daily. During a routine clinic visit, the
patient complains of nausea, loss of appetite, and blurred vision with
yellow-green halos. The nurse reviews the latest labs and notes a serum
digoxin level of 2.6 ng/mL (therapeutic range: 0.5–2.0 ng/mL). Which is
the priority nursing action?
A. Administer an antiemetic and continue monitoring
B. Document findings and educate the patient about digoxin
C. Withhold the next dose and notify the healthcare provider
D. Encourage increased fluid intake
Correct Answer: C. Withhold the next dose and notify the healthcare
provider
Drug Class: Cardiac Glycoside
Key Side Effects: Bradycardia, nausea, vomiting, fatigue, visual
disturbances, arrhythmias
Toxic Range: > 2.0 ng/mL
Rationale (Super Detailed):
Digoxin increases myocardial contractility and is used to treat heart failure
and atrial fibrillation. However, it has a narrow therapeutic index, making
toxicity common, especially in older adults or those with renal
impairment. Classic early signs of digoxin toxicity include gastrointestinal
symptoms (nausea, vomiting, anorexia) and visual changes, notably
HESI Pharmacology Test Bank 2025 (120+ NCLEX-Style
Questions) | Drug Class, Side Effects, Nursing Rationales
& Answers
1. ACE Inhibitor: Lisinopril
Question:
A 62-year-old male patient with a history of hypertension and type 2
diabetes mellitus is prescribed lisinopril 10 mg PO daily. During a follow-
up visit, the patient reports a persistent, dry, tickling cough that started a few
days after beginning the medication. The nurse recognizes this as a possible
adverse effect of the drug. Which action should the nurse take next?
A. Instruct the patient to take the medication with food
B. Suggest using an over-the-counter cough suppressant
, 2
C. Notify the healthcare provider of the patient’s symptoms
D. Reassure the patient that the cough will subside with time
Correct Answer: C. Notify the healthcare provider of the patient’s
symptoms
Drug Class: Angiotensin-Converting Enzyme (ACE) Inhibitor
Key Side Effects: Persistent dry cough, hyperkalemia, angioedema,
hypotension, renal dysfunction
Rationale (Super Detailed):
Lisinopril is an ACE inhibitor commonly prescribed for hypertension, heart
failure, and nephropathy in diabetics. One of its hallmark side effects is a
persistent dry cough, which is caused by the accumulation of bradykinin,
a vasodilator that is not broken down due to ACE inhibition. This adverse
effect is non-life-threatening but often intolerable to patients. It does not
improve with time, and cough suppressants are generally ineffective. The
provider should be notified so the medication can be discontinued and
possibly replaced with an angiotensin II receptor blocker (ARB) like
losartan, which does not affect bradykinin. The nurse’s role includes
recognizing this adverse effect, documenting it, and notifying the provider
promptly for appropriate management.
2. Anticoagulant: Warfarin
Question:
A 73-year-old female patient is on long-term warfarin therapy following a
mechanical heart valve replacement. She presents to the anticoagulation
clinic for routine monitoring. Her current INR is 5.2, and she reports minor
, 3
bleeding from her gums while brushing and a small amount of bruising on
her forearms. What is the most appropriate nursing action?
A. Document findings and recheck INR in 24 hours
B. Administer vitamin K immediately
C. Hold the next warfarin dose and notify the healthcare provider
D. Instruct the patient to skip one dose and resume as normal
Correct Answer: C. Hold the next warfarin dose and notify the healthcare
provider
Drug Class: Vitamin K Antagonist (Oral Anticoagulant)
Key Side Effects: Bleeding, bruising, GI upset, hepatotoxicity, skin necrosis
(rare)
Rationale (Super Detailed):
Warfarin inhibits vitamin K–dependent clotting factors (II, VII, IX, X),
which prolongs the INR (international normalized ratio). For most
indications, the therapeutic INR range is 2.0–3.0, and for mechanical heart
valves, it may be slightly higher (2.5–3.5). An INR of 5.2 indicates
supratherapeutic anticoagulation, significantly increasing the risk of
serious bleeding. The presence of bleeding symptoms, even if minor,
requires immediate intervention. The nurse should hold the next scheduled
dose of warfarin and contact the healthcare provider, who may order a
dose adjustment or administer vitamin K depending on severity and
bleeding risk. Immediate vitamin K is not always necessary unless bleeding
is severe. The patient should be re-educated about consistent dietary intake
of vitamin K and avoiding NSAIDs or other drugs that increase bleeding
risk.
, 4
3. Cardiac Glycoside: Digoxin
Question:
A 76-year-old patient with a history of chronic heart failure is being
treated with digoxin 0.125 mg PO daily. During a routine clinic visit, the
patient complains of nausea, loss of appetite, and blurred vision with
yellow-green halos. The nurse reviews the latest labs and notes a serum
digoxin level of 2.6 ng/mL (therapeutic range: 0.5–2.0 ng/mL). Which is
the priority nursing action?
A. Administer an antiemetic and continue monitoring
B. Document findings and educate the patient about digoxin
C. Withhold the next dose and notify the healthcare provider
D. Encourage increased fluid intake
Correct Answer: C. Withhold the next dose and notify the healthcare
provider
Drug Class: Cardiac Glycoside
Key Side Effects: Bradycardia, nausea, vomiting, fatigue, visual
disturbances, arrhythmias
Toxic Range: > 2.0 ng/mL
Rationale (Super Detailed):
Digoxin increases myocardial contractility and is used to treat heart failure
and atrial fibrillation. However, it has a narrow therapeutic index, making
toxicity common, especially in older adults or those with renal
impairment. Classic early signs of digoxin toxicity include gastrointestinal
symptoms (nausea, vomiting, anorexia) and visual changes, notably
