2026
HESI Pharmacology 2026 Study Guide:
In-Depth Medication Principles, Safety
Alerts, and High-Yield Practice Questions
A nurse is assessing a client with suspected hyperthyroidism. Which finding is most consistent
with this condition?
A. Bradycardia
B. Cold intolerance
C. Heat intolerance
D. Dry, coarse skin
Rationale: Hyperthyroidism increases metabolic rate, leading to heat intolerance. Bradycardia,
cold intolerance, and dry, coarse skin are associated with hypothyroidism.
A client with Graves’ disease is at greatest risk for which complication if untreated?
A. Myxedema coma
B. Thyroid storm
C. Addisonian crisis
D. Hypoparathyroidism
Rationale: Thyroid storm is a life-threatening complication of untreated or poorly managed
hyperthyroidism. Myxedema coma occurs in severe hypothyroidism. Addisonian crisis and
hypoparathyroidism are unrelated.
The nurse is caring for a client after a thyroidectomy. Which assessment finding requires
immediate intervention?
A. Mild incisional pain
B. Hoarse voice
C. Tingling around the mouth
D. Small amount of serosanguinous drainage
,2026
Rationale: Tingling around the mouth indicates hypocalcemia due to possible
hypoparathyroidism, which can lead to tetany and requires immediate treatment. Hoarseness and
mild pain are common post-operative findings.
A client with hypothyroidism is prescribed levothyroxine. Which instruction is most important
for the nurse to include?
A. Take the medication with meals
B. Stop the medication once symptoms improve
C. Take the medication every morning on an empty stomach
D. Expect immediate relief of symptoms
Rationale: Levothyroxine should be taken daily on an empty stomach for optimal absorption. It
is a lifelong therapy, and symptom improvement takes several weeks.
Which laboratory finding supports a diagnosis of primary hypothyroidism?
A. Decreased TSH and increased T4
B. Increased TSH and decreased T4
C. Decreased TSH and decreased T4
D. Increased TSH and increased T4
Rationale: In primary hypothyroidism, the thyroid gland fails to produce sufficient thyroid
hormones, leading to low T4 levels and a compensatory increase in TSH.
A nurse is teaching a client with hyperthyroidism about nutritional needs. Which diet is most
appropriate?
A. Low-calorie, low-protein
B. High-calorie, high-protein
C. Low-iodine, low-fat
D. High-fiber, low-calorie
Rationale: Hyperthyroidism causes increased metabolic demands, so a high-calorie, high-protein
diet is needed to prevent weight loss and muscle wasting.
A client receiving radioactive iodine therapy asks why pregnancy must be avoided. What is the
best response by the nurse?
,2026
A. “The drug causes permanent infertility.”
B. “The medication increases estrogen levels.”
C. “Radiation can harm fetal thyroid tissue.”
D. “Pregnancy worsens hyperthyroidism.”
Rationale: Radioactive iodine crosses the placenta and can destroy fetal thyroid tissue. It does
not cause infertility or alter estrogen levels.
A nurse is monitoring a client with severe hypothyroidism. Which assessment finding is most
concerning?
A. Weight gain
B. Cold intolerance
C. Decreased level of consciousness
D. Constipation
Rationale: A decreased level of consciousness may indicate progression toward myxedema
coma, a life-threatening complication of hypothyroidism. Weight gain, cold intolerance, and
constipation are expected findings.
Which assessment finding best differentiates Graves’ disease from other causes of
hyperthyroidism?
A. Weight loss
B. Tachycardia
C. Nervousness
D. Exophthalmos
Rationale: Exophthalmos is a characteristic finding of Graves’ disease due to autoimmune
inflammation of the orbital tissues. The other findings occur in most forms of hyperthyroidism.
The nurse is preparing a client for a thyroidectomy. Which intervention is most important to
include in the plan of care?
A. Encourage coughing and deep breathing
B. Place suction and tracheostomy equipment at bedside
C. Restrict fluids 24 hours before surgery
D. Administer iodine after surgery
Rationale: Airway compromise is the highest risk after thyroid surgery, so suction and
tracheostomy equipment must be readily available. Fluids are not restricted, and iodine is given
preoperatively.
, 2026
A client taking levothyroxine reports palpitations and nervousness. What is the nurse’s priority
action?
A. Reassure the client that symptoms will resolve
B. Instruct the client to stop the medication
C. Notify the health care provider
D. Tell the client to take the medication with food
Rationale: Palpitations and nervousness suggest excessive thyroid hormone replacement. The
provider must be notified for dose adjustment. The nurse should not stop the medication
independently.
Which client statement indicates correct understanding of radioactive iodine therapy?
A. “I will need weekly treatments.”
B. “This treatment will cure my thyroid permanently.”
C. “My thyroid hormone levels will need lifelong monitoring.”
D. “I should expect immediate improvement.”
Rationale: Radioactive iodine often leads to hypothyroidism, requiring lifelong monitoring and
possible hormone replacement. Improvement is gradual, not immediate.
A nurse is caring for a client experiencing thyroid storm. Which intervention is the highest
priority?
A. Administer antithyroid medication
B. Apply cooling blankets
C. Maintain airway and administer oxygen
D. Monitor intake and output
Rationale: Thyroid storm is a medical emergency. Airway, breathing, and oxygenation take
priority before other interventions.
Which finding indicates that treatment for hypothyroidism is effective?
A. Increased appetite
B. Improved mental alertness
HESI Pharmacology 2026 Study Guide:
In-Depth Medication Principles, Safety
Alerts, and High-Yield Practice Questions
A nurse is assessing a client with suspected hyperthyroidism. Which finding is most consistent
with this condition?
A. Bradycardia
B. Cold intolerance
C. Heat intolerance
D. Dry, coarse skin
Rationale: Hyperthyroidism increases metabolic rate, leading to heat intolerance. Bradycardia,
cold intolerance, and dry, coarse skin are associated with hypothyroidism.
A client with Graves’ disease is at greatest risk for which complication if untreated?
A. Myxedema coma
B. Thyroid storm
C. Addisonian crisis
D. Hypoparathyroidism
Rationale: Thyroid storm is a life-threatening complication of untreated or poorly managed
hyperthyroidism. Myxedema coma occurs in severe hypothyroidism. Addisonian crisis and
hypoparathyroidism are unrelated.
The nurse is caring for a client after a thyroidectomy. Which assessment finding requires
immediate intervention?
A. Mild incisional pain
B. Hoarse voice
C. Tingling around the mouth
D. Small amount of serosanguinous drainage
,2026
Rationale: Tingling around the mouth indicates hypocalcemia due to possible
hypoparathyroidism, which can lead to tetany and requires immediate treatment. Hoarseness and
mild pain are common post-operative findings.
A client with hypothyroidism is prescribed levothyroxine. Which instruction is most important
for the nurse to include?
A. Take the medication with meals
B. Stop the medication once symptoms improve
C. Take the medication every morning on an empty stomach
D. Expect immediate relief of symptoms
Rationale: Levothyroxine should be taken daily on an empty stomach for optimal absorption. It
is a lifelong therapy, and symptom improvement takes several weeks.
Which laboratory finding supports a diagnosis of primary hypothyroidism?
A. Decreased TSH and increased T4
B. Increased TSH and decreased T4
C. Decreased TSH and decreased T4
D. Increased TSH and increased T4
Rationale: In primary hypothyroidism, the thyroid gland fails to produce sufficient thyroid
hormones, leading to low T4 levels and a compensatory increase in TSH.
A nurse is teaching a client with hyperthyroidism about nutritional needs. Which diet is most
appropriate?
A. Low-calorie, low-protein
B. High-calorie, high-protein
C. Low-iodine, low-fat
D. High-fiber, low-calorie
Rationale: Hyperthyroidism causes increased metabolic demands, so a high-calorie, high-protein
diet is needed to prevent weight loss and muscle wasting.
A client receiving radioactive iodine therapy asks why pregnancy must be avoided. What is the
best response by the nurse?
,2026
A. “The drug causes permanent infertility.”
B. “The medication increases estrogen levels.”
C. “Radiation can harm fetal thyroid tissue.”
D. “Pregnancy worsens hyperthyroidism.”
Rationale: Radioactive iodine crosses the placenta and can destroy fetal thyroid tissue. It does
not cause infertility or alter estrogen levels.
A nurse is monitoring a client with severe hypothyroidism. Which assessment finding is most
concerning?
A. Weight gain
B. Cold intolerance
C. Decreased level of consciousness
D. Constipation
Rationale: A decreased level of consciousness may indicate progression toward myxedema
coma, a life-threatening complication of hypothyroidism. Weight gain, cold intolerance, and
constipation are expected findings.
Which assessment finding best differentiates Graves’ disease from other causes of
hyperthyroidism?
A. Weight loss
B. Tachycardia
C. Nervousness
D. Exophthalmos
Rationale: Exophthalmos is a characteristic finding of Graves’ disease due to autoimmune
inflammation of the orbital tissues. The other findings occur in most forms of hyperthyroidism.
The nurse is preparing a client for a thyroidectomy. Which intervention is most important to
include in the plan of care?
A. Encourage coughing and deep breathing
B. Place suction and tracheostomy equipment at bedside
C. Restrict fluids 24 hours before surgery
D. Administer iodine after surgery
Rationale: Airway compromise is the highest risk after thyroid surgery, so suction and
tracheostomy equipment must be readily available. Fluids are not restricted, and iodine is given
preoperatively.
, 2026
A client taking levothyroxine reports palpitations and nervousness. What is the nurse’s priority
action?
A. Reassure the client that symptoms will resolve
B. Instruct the client to stop the medication
C. Notify the health care provider
D. Tell the client to take the medication with food
Rationale: Palpitations and nervousness suggest excessive thyroid hormone replacement. The
provider must be notified for dose adjustment. The nurse should not stop the medication
independently.
Which client statement indicates correct understanding of radioactive iodine therapy?
A. “I will need weekly treatments.”
B. “This treatment will cure my thyroid permanently.”
C. “My thyroid hormone levels will need lifelong monitoring.”
D. “I should expect immediate improvement.”
Rationale: Radioactive iodine often leads to hypothyroidism, requiring lifelong monitoring and
possible hormone replacement. Improvement is gradual, not immediate.
A nurse is caring for a client experiencing thyroid storm. Which intervention is the highest
priority?
A. Administer antithyroid medication
B. Apply cooling blankets
C. Maintain airway and administer oxygen
D. Monitor intake and output
Rationale: Thyroid storm is a medical emergency. Airway, breathing, and oxygenation take
priority before other interventions.
Which finding indicates that treatment for hypothyroidism is effective?
A. Increased appetite
B. Improved mental alertness
