Pharmacology represents one of the most critical and high-yield content areas for HESI examinations, serving as a cornerstone topic that bridges theoretical knowledge with practical nursing application essential for both academic success and safe patient care. As a specialty exam topic within the HESI framework and a significant component of the HESI Exit Exam, pharmacology knowledge directly correlates with NCLEX-RN success rates, making mastery of this subject area paramount for nursing students approaching graduation and licensure. The complexity of modern healthcare demands that nurses possess comprehensive understanding of medication actions, interactions, adverse effects, contraindications, and nursing implications across all drug classifications, from basic analgesics to complex cardiovascular and psychotropic medications. HESI pharmacology questions emphasize critical thinking skills by presenting real-world clinical scenarios that require students to synthesize knowledge of drug mechanisms, patient assessment data, and nursing interventions to make safe medication administration decisions. Key focus areas include dosage calculations, therapeutic drug monitoring, patient education, recognition of adverse effects, understanding of drug interactions, and implementation of safety measures that prevent medication errors. The integration of pharmacokinetics and pharmacodynamics principles enables nurses to anticipate drug responses, monitor for therapeutic effectiveness, and identify potential complications before they become life-threatening situations. Given that medication errors remain a leading cause of preventable patient harm in healthcare settings, HESI pharmacology assessment serves as a crucial predictor of a nurse’s readiness to safely manage complex medication regimens in clinical practice. Students must demonstrate proficiency in applying the “five rights” of medication administration while also understanding the broader implications of polypharmacy, patient-specific factors affecting drug metabolism, and evidence-based practices for medication reconciliation. The evolving landscape of pharmacotherapy, including new drug approvals, updated guidelines, and emerging safety concerns, requires nurses to maintain current knowledge throughout their careers, making strong foundational understanding as measured by HESI examinations essential for lifelong learning and professional competence.
Practice Questions
Question 1
A nurse is preparing to administer digoxin 0.25 mg PO daily. The available medication is digoxin 0.125 mg tablets. How many tablets should the nurse administer?
A) 1 tablet
B) 2 tablets
C) 0.5 tablet
D) 3 tablets
Correct Answer: B) 2 tablets
Explanation: Using the formula: Desired dose ÷ Available dose = 0.25 mg ÷ 0.125 mg = 2 tablets. Always verify dosage calculations to ensure patient safety.
Question 2
Which assessment finding would indicate a therapeutic response to furosemide (Lasix)?
A) Increased blood pressure
B) Weight gain of 2 pounds
C) Decreased urine output
D) Decreased peripheral edema
Correct Answer: D) Decreased peripheral edema
Explanation: Furosemide is a loop diuretic that promotes fluid elimination. Therapeutic effects include decreased edema, weight loss, and increased urine output, indicating effective fluid removal.
Question 3
A patient is receiving warfarin therapy. Which laboratory value should the nurse monitor most closely?
A) Complete blood count (CBC)
B) International normalized ratio (INR)
C) Blood glucose level
D) Serum creatinine
Correct Answer: B) International normalized ratio (INR)
Explanation: INR measures the effectiveness of warfarin therapy and bleeding risk. The therapeutic range is typically 2.0-3.0 for most conditions. Regular monitoring prevents bleeding complications.
Question 4
Which medication requires the nurse to assess the apical pulse for one full minute before administration?
A) Metformin
B) Digoxin
C) Acetaminophen
D) Prednisone
Correct Answer: B) Digoxin
Explanation: Digoxin affects heart rate and rhythm. The apical pulse must be assessed for one full minute before administration. Hold the medication if the pulse is below 60 bpm in adults.
Question 5
A patient is prescribed lisinopril for hypertension. Which side effect should the nurse teach the patient to report immediately?
A) Mild headache
B) Dry, persistent cough
C) Angioedema (facial swelling)
D) Dizziness when standing
Correct Answer: C) Angioedema (facial swelling)
Explanation: Angioedema is a serious, potentially life-threatening allergic reaction to ACE inhibitors like lisinopril. It requires immediate medical attention and discontinuation of the medication.
Question 6
When administering insulin, which site provides the most predictable absorption?
A) Upper arm
B) Thigh
C) Abdomen
D) Buttocks
Correct Answer: C) Abdomen
Explanation: The abdomen provides the most consistent and predictable insulin absorption. Avoid areas within 2 inches of the umbilicus and rotate injection sites to prevent lipodystrophy.
Question 7
A patient taking phenytoin (Dilantin) should be monitored for which serious adverse effect?
A) Hypertension
B) Gingival hyperplasia
C) Constipation
D) Weight gain
Correct Answer: B) Gingival hyperplasia
Explanation: Gingival hyperplasia (gum overgrowth) is a common adverse effect of phenytoin. Good oral hygiene and regular dental care are essential for patients on long-term therapy.
Question 8
Which instruction is most important when teaching a patient about sublingual nitroglycerin?
A) Swallow the tablet with water
B) Store tablets in a clear container
C) Replace tablets every 6 months
D) Take with food to prevent nausea
Correct Answer: C) Replace tablets every 6 months
Explanation: Nitroglycerin tablets lose potency over time and with exposure to light, heat, and moisture. Fresh tablets should be obtained every 6 months and stored in the original dark container.
Question 9
A patient is receiving heparin therapy. Which medication should be readily available as an antidote?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Flumazenil
Correct Answer: B) Protamine sulfate
Explanation: Protamine sulfate is the specific antidote for heparin overdose or bleeding complications. It binds to heparin and neutralizes its anticoagulant effects.
Question 10
Which assessment is priority before administering morphine to a patient?
A) Blood pressure
B) Respiratory rate
C) Heart rate
D) Temperature
Correct Answer: B) Respiratory rate
Explanation: Morphine can cause respiratory depression, which is the most serious adverse effect. Assess respiratory rate and quality before administration. Hold if respirations are less than 12 per minute.
Question 11
A patient is prescribed metformin for type 2 diabetes. Which condition would be a contraindication for this medication?
A) Mild hypertension
B) Kidney disease
C) Osteoarthritis
D) Seasonal allergies
Correct Answer: B) Kidney disease
Explanation: Metformin is contraindicated in patients with kidney disease due to the risk of lactic acidosis. Kidney function must be assessed before starting and monitored during therapy.
Question 12
When administering eye drops, which technique is correct?
A) Drop medication directly onto the cornea
B) Pull down the lower eyelid and drop into the conjunctival sac
C) Have the patient blink rapidly after instillation
D) Press firmly on the eyeball after administration
Correct Answer: B) Pull down the lower eyelid and drop into the conjunctival sac
Explanation: Proper technique involves pulling down the lower eyelid to create a pocket (conjunctival sac) and instilling drops there. This prevents corneal damage and improves medication retention.
Question 13
A patient taking lithium should be taught to maintain adequate intake of which electrolyte?
A) Potassium
B) Calcium
C) Sodium
D) Magnesium
Correct Answer: C) Sodium
Explanation: Sodium depletion can lead to lithium toxicity because the kidneys retain lithium when sodium levels are low. Patients should maintain consistent sodium intake and stay well-hydrated.
Question 14
Which medication classification requires the nurse to monitor for signs of bleeding?
A) Beta-blockers
B) Anticoagulants
C) Bronchodilators
D) Proton pump inhibitors
Correct Answer: B) Anticoagulants
Explanation: Anticoagulants (warfarin, heparin, DOACs) prevent blood clotting and increase bleeding risk. Monitor for signs of bleeding including bruising, petechiae, blood in urine/stool, and prolonged bleeding.
Question 15
A patient is prescribed prednisone for an inflammatory condition. Which instruction is most important?
A) Take with food to reduce gastric irritation
B) Stop the medication immediately when symptoms improve
C) Avoid exposure to sunlight
D) Increase calcium intake
Correct Answer: A) Take with food to reduce gastric irritation
Explanation: Corticosteroids like prednisone can cause gastric irritation and ulcers. Taking with food helps protect the stomach lining. Never stop corticosteroids abruptly due to risk of adrenal insufficiency.
This practice test is designed to help you prepare for the HESI examination. Focus on understanding the rationale behind each answer to build comprehensive knowledge of pharmacology principles essential for safe nursing practice.