COURSE: HESI PHARM
DATE TIME
TITLE: Pharmacology Practice Examination 2
— / — / —— 150 Minutes
INSTRUCTOR: —
◆
Pharmacology HESI Practice 2
Complete 67-Question Assessment
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS ◆ 67 Questions
Choose the single best answer for each question. Write the correct letter (A, B, C, or D) in the space provided.
1. A client receives a prescription for esomeprazole (Nexium) for heartburn. Which finding in the
client's history should the nurse report to the healthcare provider before administering the
prescription?
A. Eats spicy food three times a week
B. History of deep vein thrombosis
C. Drinks 2 alcoholic beverages on weekends
D. Family history of diabetes mellitus
◆ B — History of deep vein thrombosis
RATIONALE: PPIs are associated with increased thrombotic risk. DVT history warrants caution and provider notification. Spicy
food (A), moderate alcohol (C), and family diabetes history (D) are not contraindications.
2. A male client in terminal cancer stage receives morphine for intractable pain. He awakens moaning
in severe pain, asking for increased morphine. Respirations are 10/min. Best action?
A. Titrate morphine dose upward until adequate pain relief
B. Suggest family give ibuprofen, a non-narcotic analgesic
C. Hold morphine until respirations are at least 16/min
D. Inform client increased dose increases side effects without additional pain control
◆ A — Titrate morphine dose upward until adequate pain relief
RATIONALE: In terminal cancer with intractable pain, pain control is the priority. RR of 10 is acceptable. The principle of double
effect supports titration upward for comfort. Holding morphine (C) causes unnecessary suffering.
Page 1 of 23
,3. A client with Paget's disease starts calcitonin (Calcimar) 500 mcg subcutaneously daily. During
initial treatment, what is the priority nursing action?
A. Assess injection site for inflammation
B. Evaluate client's level of pain
C. Monitor alkaline phosphatase levels
D. Observe for signs of hypersensitivity
◆ D — Observe for signs of hypersensitivity
RATIONALE: Calcitonin is salmon-derived; allergic reactions including anaphylaxis can occur, especially during initial therapy.
Hypersensitivity monitoring is the priority safety action. Skin testing may precede initial dosing.
4. A client takes cyclosporine for renal allograft rejection prevention. After 9 months, BUN is 36 mg/dL.
What additional finding should the nurse identify?
A. Hypotension
B. WBC 10,000
C. Creatinine 2.8 mg/dL
D. Anaphylactic reaction
◆ C — Creatinine 2.8 mg/dL
RATIONALE: Elevated BUN indicates nephrotoxicity, a known cyclosporine adverse effect. Elevated creatinine confirms renal
impairment. Hypertension (not hypotension) is more common. WBC is normal. Anaphylaxis is acute.
5. The nurse receives a unit of blood from the blood bank for a postoperative client currently in X-ray.
What action should the nurse implement?
A. Return blood to blood bank for refrigeration within 30 minutes
B. Hang blood transfusion as soon as client returns
C. Store blood bag in nursing unit's refrigerator
D. Take unit of blood to X-ray to initiate transfusion
◆ A — Return blood to blood bank for refrigeration within 30 minutes
RATIONALE: Blood cannot remain at room temperature. If transfusion cannot begin within 30 minutes of release, the unit must
be returned to the blood bank. Unit refrigerators are not approved for blood storage. Transporting to X-ray risks improper
handling.
Page 2 of 23
, 6. Which side effects should the nurse monitor for in a client receiving dexamethasone (Decadron)
following neurosurgery? (Select All That Apply)
A. Mood swings
B. Decreased appetite
C. Increased weight gain
D. Serum glucose 65 mg/dL
E. Delayed incisional wound healing
F. Serum hemoglobin 9 mg/dL
◆ A, C, E, F — Mood swings, weight gain, delayed wound healing, and decreased hemoglobin
RATIONALE: Dexamethasone causes neuropsychiatric effects (A), fluid retention with weight gain (C), impaired wound healing
(E), and GI bleeding risk with anemia (F). Appetite increases, not decreases (B). Corticosteroids cause hyperglycemia, not
hypoglycemia (D).
7. A client taking danazol (Danocrine) for endometriosis calls complaining of a dark, swollen, painful
leg. What instructions should the nurse provide?
A. Wear support stockings
B. Elevate both legs and apply heat
C. Proceed to the closest emergency room
D. Walk 20–30 minutes to reduce muscle cramps
◆ C — Proceed to the closest emergency room
RATIONALE: Dark, swollen, painful leg suggests DVT—a medical emergency. Danazol increases thrombotic risk. DVT can lead to
pulmonary embolism. Support stockings (A) are for prevention, not acute DVT. Elevation/heat (B) may dislodge clot. Walking
(D) increases embolization risk.
8. A client asks the nurse to explain the meaning of a narrow therapeutic index. What information
should the nurse use?
A. Onset of action occurs very quickly
B. Small margin exists between safe and toxic plasma levels
C. Bioavailability significantly reduced by first-pass effect
D. Minimum dosage needed for medication to be effective
◆ B — Small margin exists between safe and toxic plasma levels
RATIONALE: Narrow therapeutic index means the difference between minimum effective concentration and minimum toxic
concentration is small. Drugs like digoxin, lithium, and warfarin require close serum monitoring. Small dose changes can cause
toxicity or therapeutic failure.
Page 3 of 23
DATE TIME
TITLE: Pharmacology Practice Examination 2
— / — / —— 150 Minutes
INSTRUCTOR: —
◆
Pharmacology HESI Practice 2
Complete 67-Question Assessment
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS ◆ 67 Questions
Choose the single best answer for each question. Write the correct letter (A, B, C, or D) in the space provided.
1. A client receives a prescription for esomeprazole (Nexium) for heartburn. Which finding in the
client's history should the nurse report to the healthcare provider before administering the
prescription?
A. Eats spicy food three times a week
B. History of deep vein thrombosis
C. Drinks 2 alcoholic beverages on weekends
D. Family history of diabetes mellitus
◆ B — History of deep vein thrombosis
RATIONALE: PPIs are associated with increased thrombotic risk. DVT history warrants caution and provider notification. Spicy
food (A), moderate alcohol (C), and family diabetes history (D) are not contraindications.
2. A male client in terminal cancer stage receives morphine for intractable pain. He awakens moaning
in severe pain, asking for increased morphine. Respirations are 10/min. Best action?
A. Titrate morphine dose upward until adequate pain relief
B. Suggest family give ibuprofen, a non-narcotic analgesic
C. Hold morphine until respirations are at least 16/min
D. Inform client increased dose increases side effects without additional pain control
◆ A — Titrate morphine dose upward until adequate pain relief
RATIONALE: In terminal cancer with intractable pain, pain control is the priority. RR of 10 is acceptable. The principle of double
effect supports titration upward for comfort. Holding morphine (C) causes unnecessary suffering.
Page 1 of 23
,3. A client with Paget's disease starts calcitonin (Calcimar) 500 mcg subcutaneously daily. During
initial treatment, what is the priority nursing action?
A. Assess injection site for inflammation
B. Evaluate client's level of pain
C. Monitor alkaline phosphatase levels
D. Observe for signs of hypersensitivity
◆ D — Observe for signs of hypersensitivity
RATIONALE: Calcitonin is salmon-derived; allergic reactions including anaphylaxis can occur, especially during initial therapy.
Hypersensitivity monitoring is the priority safety action. Skin testing may precede initial dosing.
4. A client takes cyclosporine for renal allograft rejection prevention. After 9 months, BUN is 36 mg/dL.
What additional finding should the nurse identify?
A. Hypotension
B. WBC 10,000
C. Creatinine 2.8 mg/dL
D. Anaphylactic reaction
◆ C — Creatinine 2.8 mg/dL
RATIONALE: Elevated BUN indicates nephrotoxicity, a known cyclosporine adverse effect. Elevated creatinine confirms renal
impairment. Hypertension (not hypotension) is more common. WBC is normal. Anaphylaxis is acute.
5. The nurse receives a unit of blood from the blood bank for a postoperative client currently in X-ray.
What action should the nurse implement?
A. Return blood to blood bank for refrigeration within 30 minutes
B. Hang blood transfusion as soon as client returns
C. Store blood bag in nursing unit's refrigerator
D. Take unit of blood to X-ray to initiate transfusion
◆ A — Return blood to blood bank for refrigeration within 30 minutes
RATIONALE: Blood cannot remain at room temperature. If transfusion cannot begin within 30 minutes of release, the unit must
be returned to the blood bank. Unit refrigerators are not approved for blood storage. Transporting to X-ray risks improper
handling.
Page 2 of 23
, 6. Which side effects should the nurse monitor for in a client receiving dexamethasone (Decadron)
following neurosurgery? (Select All That Apply)
A. Mood swings
B. Decreased appetite
C. Increased weight gain
D. Serum glucose 65 mg/dL
E. Delayed incisional wound healing
F. Serum hemoglobin 9 mg/dL
◆ A, C, E, F — Mood swings, weight gain, delayed wound healing, and decreased hemoglobin
RATIONALE: Dexamethasone causes neuropsychiatric effects (A), fluid retention with weight gain (C), impaired wound healing
(E), and GI bleeding risk with anemia (F). Appetite increases, not decreases (B). Corticosteroids cause hyperglycemia, not
hypoglycemia (D).
7. A client taking danazol (Danocrine) for endometriosis calls complaining of a dark, swollen, painful
leg. What instructions should the nurse provide?
A. Wear support stockings
B. Elevate both legs and apply heat
C. Proceed to the closest emergency room
D. Walk 20–30 minutes to reduce muscle cramps
◆ C — Proceed to the closest emergency room
RATIONALE: Dark, swollen, painful leg suggests DVT—a medical emergency. Danazol increases thrombotic risk. DVT can lead to
pulmonary embolism. Support stockings (A) are for prevention, not acute DVT. Elevation/heat (B) may dislodge clot. Walking
(D) increases embolization risk.
8. A client asks the nurse to explain the meaning of a narrow therapeutic index. What information
should the nurse use?
A. Onset of action occurs very quickly
B. Small margin exists between safe and toxic plasma levels
C. Bioavailability significantly reduced by first-pass effect
D. Minimum dosage needed for medication to be effective
◆ B — Small margin exists between safe and toxic plasma levels
RATIONALE: Narrow therapeutic index means the difference between minimum effective concentration and minimum toxic
concentration is small. Drugs like digoxin, lithium, and warfarin require close serum monitoring. Small dose changes can cause
toxicity or therapeutic failure.
Page 3 of 23
