HESI Pharmacology Exam Prep 2026:
Advanced Drug Calculations,
Therapeutic Class Analysis, and
Scenario-Based Quizzes
A nurse is administering vancomycin IV to a hospitalized client. Which finding requires the
nurse to immediately slow the infusion rate?
A) Decreased urine output
B) Flushing of the face and upper torso
C) Mild nausea
D) Elevated blood glucose
Rationale
Rapid infusion of vancomycin can cause “red man syndrome,” characterized by flushing of the
face, neck, and upper torso (B). Slowing the infusion rate usually resolves the reaction.
Decreased urine output relates to nephrotoxicity, not infusion rate. Nausea and elevated blood
glucose are unrelated.
A client receiving warfarin (Coumadin) therapy asks which laboratory value is used to monitor
the effectiveness of the medication. The nurse should respond:
A) Platelet count
B) Bleeding time
C) International normalized ratio (INR)
D) Activated partial thromboplastin time (aPTT)
Rationale
Warfarin therapy is monitored using the INR (C), which reflects the extrinsic coagulation
pathway. Platelet count and bleeding time do not measure warfarin effectiveness. aPTT is used to
monitor heparin therapy.
Which assessment finding indicates digoxin (Lanoxin) toxicity?
,A) Blood pressure of 140/90 mm Hg
B) Yellow-green halos around lights
C) Bounding peripheral pulses
D) Increased urine output
Rationale
Visual disturbances such as yellow or green halos are classic signs of digoxin toxicity (B).
Hypertension, bounding pulses, and increased urine output are not hallmark signs of digoxin
toxicity.
A nurse is caring for a client taking phenytoin (Dilantin) for seizure control. Which nursing
intervention is most important to include in the plan of care?
A) Encourage daily flossing
B) Restrict calcium intake
C) Monitor oral hygiene and gums
D) Administer medication with antacids
Rationale
Phenytoin can cause gingival hyperplasia, making meticulous oral care essential (C). Flossing
alone is insufficient. Calcium restriction is not indicated, and antacids can interfere with
absorption.
A client receiving gentamicin IV has an elevated trough level. What complication is the nurse
most concerned about?
A) Hepatotoxicity
B) Nephrotoxicity
C) Hyperglycemia
D) Hypertension
Rationale
Gentamicin is an aminoglycoside associated with nephrotoxicity and ototoxicity. Elevated trough
levels increase the risk of kidney damage (B). The other options are not typical complications.
A nurse is teaching a client prescribed prednisone for an autoimmune disorder. Which instruction
is most important?
A) Take the medication at bedtime
B) Discontinue the drug when symptoms improve
,C) Do not stop the medication abruptly
D) Avoid foods high in protein
Rationale
Abrupt discontinuation of corticosteroids can cause adrenal insufficiency (C). Prednisone should
be tapered. It is usually taken in the morning, not at bedtime. Protein restriction is not indicated.
Which medication order should the nurse question for a client with a history of asthma?
A) Acetaminophen
B) Loratadine
C) Propranolol
D) Ceftriaxone
Rationale
Propranolol is a nonselective beta-blocker that can cause bronchoconstriction and exacerbate
asthma (C). The other medications are generally safe for clients with asthma.
A client taking lithium carbonate for bipolar disorder reports nausea, diarrhea, and muscle
weakness. What is the nurse’s priority action?
A) Encourage increased sodium intake
B) Administer the next dose with food
C) Notify the healthcare provider
D) Document findings as expected side effects
Rationale
These findings suggest lithium toxicity (C). The provider must be notified immediately.
Increasing sodium may be part of long-term management but is not the priority in suspected
toxicity.
A nurse is caring for a client receiving insulin glargine (Lantus). Which statement by the client
indicates correct understanding?
A) “I will take this insulin before meals.”
B) “I should mix this insulin with regular insulin.”
C) “This insulin helps control my blood sugar throughout the day.”
D) “I will use this insulin to correct high blood sugar levels.”
, Rationale
Insulin glargine is a long-acting basal insulin providing steady glucose control over 24 hours (C).
It is not mixed with other insulins and is not used for rapid correction.
A nurse is preparing to administer heparin subcutaneously to a hospitalized client. Which
laboratory value should the nurse review to evaluate the effectiveness of this medication?
A) Prothrombin time (PT)
B) International normalized ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count
Rationale
Heparin therapy is monitored using the aPTT (C), which measures the intrinsic clotting pathway.
PT and INR are used to monitor warfarin therapy. Platelet count is monitored for heparin-
induced thrombocytopenia but does not indicate effectiveness.
A nurse is teaching a client prescribed nitroglycerin sublingual tablets for angina. Which
instruction is most important?
A) Swallow the tablet with water
B) Sit or lie down before taking the medication
C) Take the medication after meals
D) Store the tablets in a plastic pill organizer
Rationale
Nitroglycerin can cause hypotension and dizziness, so the client should sit or lie down before
administration (B). The tablet should not be swallowed. It is taken as needed, not related to
meals, and must be stored in its original dark container.
Which assessment finding indicates a therapeutic response to furosemide (Lasix)?
A) Decreased serum potassium
B) Reduction in peripheral edema
C) Elevated blood glucose
D) Increased heart rate
Rationale
Furosemide is a loop diuretic used to remove excess fluid; decreased edema indicates
effectiveness (B). Hypokalemia is a side effect, not a therapeutic response. Blood glucose and
heart rate changes are unrelated.
Advanced Drug Calculations,
Therapeutic Class Analysis, and
Scenario-Based Quizzes
A nurse is administering vancomycin IV to a hospitalized client. Which finding requires the
nurse to immediately slow the infusion rate?
A) Decreased urine output
B) Flushing of the face and upper torso
C) Mild nausea
D) Elevated blood glucose
Rationale
Rapid infusion of vancomycin can cause “red man syndrome,” characterized by flushing of the
face, neck, and upper torso (B). Slowing the infusion rate usually resolves the reaction.
Decreased urine output relates to nephrotoxicity, not infusion rate. Nausea and elevated blood
glucose are unrelated.
A client receiving warfarin (Coumadin) therapy asks which laboratory value is used to monitor
the effectiveness of the medication. The nurse should respond:
A) Platelet count
B) Bleeding time
C) International normalized ratio (INR)
D) Activated partial thromboplastin time (aPTT)
Rationale
Warfarin therapy is monitored using the INR (C), which reflects the extrinsic coagulation
pathway. Platelet count and bleeding time do not measure warfarin effectiveness. aPTT is used to
monitor heparin therapy.
Which assessment finding indicates digoxin (Lanoxin) toxicity?
,A) Blood pressure of 140/90 mm Hg
B) Yellow-green halos around lights
C) Bounding peripheral pulses
D) Increased urine output
Rationale
Visual disturbances such as yellow or green halos are classic signs of digoxin toxicity (B).
Hypertension, bounding pulses, and increased urine output are not hallmark signs of digoxin
toxicity.
A nurse is caring for a client taking phenytoin (Dilantin) for seizure control. Which nursing
intervention is most important to include in the plan of care?
A) Encourage daily flossing
B) Restrict calcium intake
C) Monitor oral hygiene and gums
D) Administer medication with antacids
Rationale
Phenytoin can cause gingival hyperplasia, making meticulous oral care essential (C). Flossing
alone is insufficient. Calcium restriction is not indicated, and antacids can interfere with
absorption.
A client receiving gentamicin IV has an elevated trough level. What complication is the nurse
most concerned about?
A) Hepatotoxicity
B) Nephrotoxicity
C) Hyperglycemia
D) Hypertension
Rationale
Gentamicin is an aminoglycoside associated with nephrotoxicity and ototoxicity. Elevated trough
levels increase the risk of kidney damage (B). The other options are not typical complications.
A nurse is teaching a client prescribed prednisone for an autoimmune disorder. Which instruction
is most important?
A) Take the medication at bedtime
B) Discontinue the drug when symptoms improve
,C) Do not stop the medication abruptly
D) Avoid foods high in protein
Rationale
Abrupt discontinuation of corticosteroids can cause adrenal insufficiency (C). Prednisone should
be tapered. It is usually taken in the morning, not at bedtime. Protein restriction is not indicated.
Which medication order should the nurse question for a client with a history of asthma?
A) Acetaminophen
B) Loratadine
C) Propranolol
D) Ceftriaxone
Rationale
Propranolol is a nonselective beta-blocker that can cause bronchoconstriction and exacerbate
asthma (C). The other medications are generally safe for clients with asthma.
A client taking lithium carbonate for bipolar disorder reports nausea, diarrhea, and muscle
weakness. What is the nurse’s priority action?
A) Encourage increased sodium intake
B) Administer the next dose with food
C) Notify the healthcare provider
D) Document findings as expected side effects
Rationale
These findings suggest lithium toxicity (C). The provider must be notified immediately.
Increasing sodium may be part of long-term management but is not the priority in suspected
toxicity.
A nurse is caring for a client receiving insulin glargine (Lantus). Which statement by the client
indicates correct understanding?
A) “I will take this insulin before meals.”
B) “I should mix this insulin with regular insulin.”
C) “This insulin helps control my blood sugar throughout the day.”
D) “I will use this insulin to correct high blood sugar levels.”
, Rationale
Insulin glargine is a long-acting basal insulin providing steady glucose control over 24 hours (C).
It is not mixed with other insulins and is not used for rapid correction.
A nurse is preparing to administer heparin subcutaneously to a hospitalized client. Which
laboratory value should the nurse review to evaluate the effectiveness of this medication?
A) Prothrombin time (PT)
B) International normalized ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count
Rationale
Heparin therapy is monitored using the aPTT (C), which measures the intrinsic clotting pathway.
PT and INR are used to monitor warfarin therapy. Platelet count is monitored for heparin-
induced thrombocytopenia but does not indicate effectiveness.
A nurse is teaching a client prescribed nitroglycerin sublingual tablets for angina. Which
instruction is most important?
A) Swallow the tablet with water
B) Sit or lie down before taking the medication
C) Take the medication after meals
D) Store the tablets in a plastic pill organizer
Rationale
Nitroglycerin can cause hypotension and dizziness, so the client should sit or lie down before
administration (B). The tablet should not be swallowed. It is taken as needed, not related to
meals, and must be stored in its original dark container.
Which assessment finding indicates a therapeutic response to furosemide (Lasix)?
A) Decreased serum potassium
B) Reduction in peripheral edema
C) Elevated blood glucose
D) Increased heart rate
Rationale
Furosemide is a loop diuretic used to remove excess fluid; decreased edema indicates
effectiveness (B). Hypokalemia is a side effect, not a therapeutic response. Blood glucose and
heart rate changes are unrelated.
