COURSE: HESI PHARM
DATE TIME
TITLE: Pharmacology Practice Examination 1
— / — / —— 150 Minutes
INSTRUCTOR: —
◆
Pharmacology HESI Practice 1
Complete Assessment Examination
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS ◆ 65 Questions
Choose the single best answer for each question. Write the correct letter (A, B, C, or D) in the space provided.
1. Which medications should the nurse caution the client about taking while receiving an opioid
analgesic?
A. Antacids
B. Benzodiazepines
C. Antihypertensives
D. Oral antidiabetics
◆ B — Benzodiazepines
RATIONALE: Benzodiazepines combined with opioids produce additive CNS and respiratory depression, increasing the risk of
oversedation, respiratory arrest, and death. This is a black box warning combination. Antacids (A), antihypertensives (C), and
oral antidiabetics (D) do not have this dangerous synergistic effect.
2. An 88-year-old client on high-dose aspirin for arthritis reports that her ears are ringing and she can't
hear the nurse's questions. What action should the nurse implement?
A. Refer to audiologist for hearing evaluation
B. Advise that this is a common side effect of aspirin
C. Notify the healthcare provider immediately
D. Ask client to turn off her hearing aid
◆ C — Notify the healthcare provider immediately
RATIONALE: Tinnitus is a classic sign of salicylate toxicity (salicylism), especially in older adults with high-dose aspirin. This
requires immediate provider notification for dose adjustment or discontinuation. It is not simply a "common side effect" (B)—it
indicates toxic levels. Hearing aid (D) is irrelevant.
Page 1 of 23
,3. A client is admitted for possible myasthenia gravis testing. The nurse prepares IV edrophonium
chloride (Tensilon). What is the expected outcome following administration?
A. Progressive difficulty with swallowing
B. Decreased respiratory effort
C. Improvement in generalized fatigue
D. Decreased muscle weakness
◆ D — Decreased muscle weakness
RATIONALE: Edrophonium is a short-acting anticholinesterase used in the Tensilon test. In MG, it produces rapid, temporary
improvement in muscle strength by increasing acetylcholine at the neuromuscular junction. Decreased weakness confirms
MG. Worsening (A, B) would suggest cholinergic crisis.
4. A 43-year-old female is receiving thyroid replacement hormone post-thyroidectomy. What adverse
effects associated with thyroid hormone toxicity should the nurse instruct the client to report
promptly?
A. Tinnitus and dizziness
B. Tachycardia and chest pain
C. Dry skin and intolerance to cold
D. Weight gain and increased appetite
◆ B — Tachycardia and chest pain
RATIONALE: Thyroid hormone excess (hyperthyroidism/toxicity) increases metabolic rate and sympathetic activity, causing
tachycardia, palpitations, chest pain, and potentially cardiac dysrhythmias. Dry skin/cold intolerance (C) and weight gain (D)
indicate hypothyroidism (underdosing). Tinnitus (A) is salicylate toxicity.
5. A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) and is allergic to
sulfa. Which action is most important prior to administering the first dose?
A. Review hemoglobin results
B. Notify the healthcare provider
C. Inquire about the reaction to sulfa
D. Record vital signs
◆ B — Notify the healthcare provider
RATIONALE: Celecoxib contains a sulfonamide moiety and is contraindicated in clients with sulfa allergy due to cross-
sensitivity risk. The provider must be notified before administration. Inquiring about the reaction (C) is important but
notification (B) is the priority action to prevent potential anaphylaxis.
Page 2 of 23
, 6. The nurse is reviewing PCA pump use with a postoperative client: morphine 1 mg/hr basal, 1 mg
q15min PCA, max 5 mg/hr. What assessment has the highest priority before initiating the PCA
pump?
A. Expiration date on morphine syringe
B. Rate and depth of respirations
C. Type of anesthesia used
D. Subjective and objective signs of pain
◆ B — Rate and depth of respirations
RATIONALE: Respiratory depression is the most serious adverse effect of opioid therapy. Baseline respiratory assessment is
essential before initiating PCA. If respirations are <12/min or shallow, the nurse must withhold the medication and notify the
provider. Pain assessment (D) is secondary to safety.
7. A client receives methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an
increase in which laboratory value?
A. Serum glucose
B. Serum calcium
C. Red blood cells
D. Serum potassium
◆ A — Serum glucose
RATIONALE: Corticosteroids increase gluconeogenesis and decrease peripheral glucose uptake, causing hyperglycemia. Blood
glucose monitoring is essential during steroid therapy. Calcium (B) may decrease. Potassium (D) may decrease due to
mineralocorticoid effects. RBCs (C) are not directly affected.
8. In evaluating the effects of lactulose (Cephulac), which outcome indicates the drug is performing as
intended?
A. Increase in urine output
B. Two or three soft stools per day
C. Watery, diarrhea stools
D. Increased serum bilirubin
◆ B — Two or three soft stools per day
RATIONALE: Lactulose treats hepatic encephalopathy by acidifying the colon, trapping ammonia for excretion. The
therapeutic goal is 2–3 soft stools daily, indicating adequate ammonia elimination without excessive diarrhea. Watery stools
(C) indicate overdosing. Urine output (A) is unrelated.
Page 3 of 23
DATE TIME
TITLE: Pharmacology Practice Examination 1
— / — / —— 150 Minutes
INSTRUCTOR: —
◆
Pharmacology HESI Practice 1
Complete Assessment Examination
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS ◆ 65 Questions
Choose the single best answer for each question. Write the correct letter (A, B, C, or D) in the space provided.
1. Which medications should the nurse caution the client about taking while receiving an opioid
analgesic?
A. Antacids
B. Benzodiazepines
C. Antihypertensives
D. Oral antidiabetics
◆ B — Benzodiazepines
RATIONALE: Benzodiazepines combined with opioids produce additive CNS and respiratory depression, increasing the risk of
oversedation, respiratory arrest, and death. This is a black box warning combination. Antacids (A), antihypertensives (C), and
oral antidiabetics (D) do not have this dangerous synergistic effect.
2. An 88-year-old client on high-dose aspirin for arthritis reports that her ears are ringing and she can't
hear the nurse's questions. What action should the nurse implement?
A. Refer to audiologist for hearing evaluation
B. Advise that this is a common side effect of aspirin
C. Notify the healthcare provider immediately
D. Ask client to turn off her hearing aid
◆ C — Notify the healthcare provider immediately
RATIONALE: Tinnitus is a classic sign of salicylate toxicity (salicylism), especially in older adults with high-dose aspirin. This
requires immediate provider notification for dose adjustment or discontinuation. It is not simply a "common side effect" (B)—it
indicates toxic levels. Hearing aid (D) is irrelevant.
Page 1 of 23
,3. A client is admitted for possible myasthenia gravis testing. The nurse prepares IV edrophonium
chloride (Tensilon). What is the expected outcome following administration?
A. Progressive difficulty with swallowing
B. Decreased respiratory effort
C. Improvement in generalized fatigue
D. Decreased muscle weakness
◆ D — Decreased muscle weakness
RATIONALE: Edrophonium is a short-acting anticholinesterase used in the Tensilon test. In MG, it produces rapid, temporary
improvement in muscle strength by increasing acetylcholine at the neuromuscular junction. Decreased weakness confirms
MG. Worsening (A, B) would suggest cholinergic crisis.
4. A 43-year-old female is receiving thyroid replacement hormone post-thyroidectomy. What adverse
effects associated with thyroid hormone toxicity should the nurse instruct the client to report
promptly?
A. Tinnitus and dizziness
B. Tachycardia and chest pain
C. Dry skin and intolerance to cold
D. Weight gain and increased appetite
◆ B — Tachycardia and chest pain
RATIONALE: Thyroid hormone excess (hyperthyroidism/toxicity) increases metabolic rate and sympathetic activity, causing
tachycardia, palpitations, chest pain, and potentially cardiac dysrhythmias. Dry skin/cold intolerance (C) and weight gain (D)
indicate hypothyroidism (underdosing). Tinnitus (A) is salicylate toxicity.
5. A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) and is allergic to
sulfa. Which action is most important prior to administering the first dose?
A. Review hemoglobin results
B. Notify the healthcare provider
C. Inquire about the reaction to sulfa
D. Record vital signs
◆ B — Notify the healthcare provider
RATIONALE: Celecoxib contains a sulfonamide moiety and is contraindicated in clients with sulfa allergy due to cross-
sensitivity risk. The provider must be notified before administration. Inquiring about the reaction (C) is important but
notification (B) is the priority action to prevent potential anaphylaxis.
Page 2 of 23
, 6. The nurse is reviewing PCA pump use with a postoperative client: morphine 1 mg/hr basal, 1 mg
q15min PCA, max 5 mg/hr. What assessment has the highest priority before initiating the PCA
pump?
A. Expiration date on morphine syringe
B. Rate and depth of respirations
C. Type of anesthesia used
D. Subjective and objective signs of pain
◆ B — Rate and depth of respirations
RATIONALE: Respiratory depression is the most serious adverse effect of opioid therapy. Baseline respiratory assessment is
essential before initiating PCA. If respirations are <12/min or shallow, the nurse must withhold the medication and notify the
provider. Pain assessment (D) is secondary to safety.
7. A client receives methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an
increase in which laboratory value?
A. Serum glucose
B. Serum calcium
C. Red blood cells
D. Serum potassium
◆ A — Serum glucose
RATIONALE: Corticosteroids increase gluconeogenesis and decrease peripheral glucose uptake, causing hyperglycemia. Blood
glucose monitoring is essential during steroid therapy. Calcium (B) may decrease. Potassium (D) may decrease due to
mineralocorticoid effects. RBCs (C) are not directly affected.
8. In evaluating the effects of lactulose (Cephulac), which outcome indicates the drug is performing as
intended?
A. Increase in urine output
B. Two or three soft stools per day
C. Watery, diarrhea stools
D. Increased serum bilirubin
◆ B — Two or three soft stools per day
RATIONALE: Lactulose treats hepatic encephalopathy by acidifying the colon, trapping ammonia for excretion. The
therapeutic goal is 2–3 soft stools daily, indicating adequate ammonia elimination without excessive diarrhea. Watery stools
(C) indicate overdosing. Urine output (A) is unrelated.
Page 3 of 23
