COURSE: HESI PHARM
DATE TIME
TITLE: Pharmacology Final Examination
— / — / —— 150 Minutes
INSTRUCTOR: —
◆
HESI Pharmacology Final Exam
Comprehensive Assessment Examination
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS ◆ 50 Questions
Choose the single best answer for each question. Write the correct letter (A, B, C, or D) in the space provided.
1. What are the 5 rights of medication administration?
A. Right Patient, Drug, Route, Time, Dose
B. Right Patient, Drug, Route, Time, Documentation
C. Right Patient, Drug, Dose, Time, Room
D. Right Patient, Drug, Route, Dose, Diagnosis
◆ A — Right Patient, Drug, Route, Time, Dose
RATIONALE: The five rights are the foundation of safe medication administration: Right Patient (verify with two identifiers),
Right Drug (check label three times), Right Route (as prescribed), Right Time (correct frequency and timing), and Right Dose
(correct amount). Documentation is a sixth right often added but is not one of the original five.
2. How would the nurse administer medication via the intramuscular (IM) route?
A. Inject at 45° angle into the fatty tissue
B. Inject at 90° angle using the Z-Track method
C. Inject at 15° angle into the dermal layer
D. Inject at 25° angle into the subcutaneous tissue
◆ B — Inject at 90° angle using the Z-Track method
RATIONALE: IM injections use a 90-degree angle to penetrate into muscle tissue. The Z-Track method displaces tissue before
injection and releases it after, sealing the medication in the muscle and preventing leakage into subcutaneous tissue.
Subcutaneous injections use 45° or 90° (A). Intradermal uses 10–15° (C).
Page 1 of 17
,3. Which IM injection site is used for children and adults as the preferred site?
A. Dorsogluteal
B. Rectus femoris
C. Ventrogluteal
D. Deltoid
◆ C — Ventrogluteal
RATIONALE: The ventrogluteal site is the preferred and safest IM injection site for children and adults because it is free of
major blood vessels and nerves, has the thickest muscle, and provides the best absorption. The dorsogluteal (A) risks sciatic
nerve injury. Rectus femoris (B) is primarily for infants. Deltoid (D) is for small volumes.
4. What is the peak time for rapid-acting insulin (aspart, lispro, glulisine)?
A. 2–4 hours
B. 4–12 hours
C. 30–60 minutes
D. 8–10 hours
◆ C — 30–60 minutes
RATIONALE: Rapid-acting insulins (aspart/Novolog, lispro/Humalog, glulisine/Apidra) peak at 30–60 minutes. This quick peak
requires that meals be available when administering to prevent hypoglycemia. Regular insulin peaks at 2–4 hours (A).
Intermediate (NPH) peaks at 4–12 hours (B). Long-acting peaks at 8–10 hours (D).
5. What are the signs and symptoms of hypoglycemia?
A. Polyphagia, polydipsia, polyuria, fruity breath
B. Cool clammy skin, confusion, weakness, palpitations, hunger, blood glucose < 60 mg/dL
C. Dry mouth, pruritus, blurred vision, acetone breath
D. Hypertension, tachycardia, diaphoresis, blood glucose > 200 mg/dL
◆ B — Cool clammy skin, confusion, weakness, palpitations, hunger, blood glucose < 60 mg/dL
RATIONALE: Hypoglycemia presents with sympathetic nervous system activation: cool clammy skin, confusion, weakness,
palpitations, irritability, hunger, and numbness/tingling of lips or tongue. Blood glucose is below 60 mg/dL. Options A and C
describe hyperglycemia (the 3 Ps, fruity/acetone breath, blood glucose > 200 mg/dL).
Page 2 of 17
, 6. What is the antidote for opioid (narcotic) overdose?
A. Acetylcysteine (Mucomyst)
B. Protamine sulfate
C. Naloxone (Narcan)
D. Vitamin K (Phytonadione)
◆ C — Naloxone (Narcan)
RATIONALE: Naloxone is a pure opioid antagonist that reverses opioid-induced respiratory depression. Acetylcysteine (A) is for
acetaminophen overdose. Protamine sulfate (B) reverses heparin. Vitamin K (D) reverses warfarin. Naloxone may need
repeated dosing due to its short half-life compared to most opioids.
7. What is the antidote for warfarin (Coumadin) overdose?
A. Protamine sulfate
B. Vitamin K (Phytonadione)
C. Digoxin immune Fab
D. Glucose D50
◆ B — Vitamin K (Phytonadione)
RATIONALE: Vitamin K reverses warfarin's anticoagulant effect by restoring the synthesis of vitamin K-dependent clotting
factors (II, VII, IX, X). Protamine sulfate (A) reverses heparin. Digoxin immune Fab (C) treats digoxin toxicity. Glucose D50 (D)
treats insulin overdose.
8. Which insulin is cloudy in appearance and requires rolling before administration?
A. Glargine (Lantus)
B. Aspart (Novolog)
C. NPH insulin (Humulin N)
D. Regular insulin (Humulin R)
◆ C — NPH insulin (Humulin N)
RATIONALE: Only intermediate-acting NPH insulin is cloudy because it contains protamine, which slows absorption. It must be
gently rolled (not shaken) to resuspend the insulin before drawing up. All other insulins—rapid, short, and long-acting—are
clear solutions. When mixing, draw up clear (regular) before cloudy (NPH).
Page 3 of 17
DATE TIME
TITLE: Pharmacology Final Examination
— / — / —— 150 Minutes
INSTRUCTOR: —
◆
HESI Pharmacology Final Exam
Comprehensive Assessment Examination
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS ◆ 50 Questions
Choose the single best answer for each question. Write the correct letter (A, B, C, or D) in the space provided.
1. What are the 5 rights of medication administration?
A. Right Patient, Drug, Route, Time, Dose
B. Right Patient, Drug, Route, Time, Documentation
C. Right Patient, Drug, Dose, Time, Room
D. Right Patient, Drug, Route, Dose, Diagnosis
◆ A — Right Patient, Drug, Route, Time, Dose
RATIONALE: The five rights are the foundation of safe medication administration: Right Patient (verify with two identifiers),
Right Drug (check label three times), Right Route (as prescribed), Right Time (correct frequency and timing), and Right Dose
(correct amount). Documentation is a sixth right often added but is not one of the original five.
2. How would the nurse administer medication via the intramuscular (IM) route?
A. Inject at 45° angle into the fatty tissue
B. Inject at 90° angle using the Z-Track method
C. Inject at 15° angle into the dermal layer
D. Inject at 25° angle into the subcutaneous tissue
◆ B — Inject at 90° angle using the Z-Track method
RATIONALE: IM injections use a 90-degree angle to penetrate into muscle tissue. The Z-Track method displaces tissue before
injection and releases it after, sealing the medication in the muscle and preventing leakage into subcutaneous tissue.
Subcutaneous injections use 45° or 90° (A). Intradermal uses 10–15° (C).
Page 1 of 17
,3. Which IM injection site is used for children and adults as the preferred site?
A. Dorsogluteal
B. Rectus femoris
C. Ventrogluteal
D. Deltoid
◆ C — Ventrogluteal
RATIONALE: The ventrogluteal site is the preferred and safest IM injection site for children and adults because it is free of
major blood vessels and nerves, has the thickest muscle, and provides the best absorption. The dorsogluteal (A) risks sciatic
nerve injury. Rectus femoris (B) is primarily for infants. Deltoid (D) is for small volumes.
4. What is the peak time for rapid-acting insulin (aspart, lispro, glulisine)?
A. 2–4 hours
B. 4–12 hours
C. 30–60 minutes
D. 8–10 hours
◆ C — 30–60 minutes
RATIONALE: Rapid-acting insulins (aspart/Novolog, lispro/Humalog, glulisine/Apidra) peak at 30–60 minutes. This quick peak
requires that meals be available when administering to prevent hypoglycemia. Regular insulin peaks at 2–4 hours (A).
Intermediate (NPH) peaks at 4–12 hours (B). Long-acting peaks at 8–10 hours (D).
5. What are the signs and symptoms of hypoglycemia?
A. Polyphagia, polydipsia, polyuria, fruity breath
B. Cool clammy skin, confusion, weakness, palpitations, hunger, blood glucose < 60 mg/dL
C. Dry mouth, pruritus, blurred vision, acetone breath
D. Hypertension, tachycardia, diaphoresis, blood glucose > 200 mg/dL
◆ B — Cool clammy skin, confusion, weakness, palpitations, hunger, blood glucose < 60 mg/dL
RATIONALE: Hypoglycemia presents with sympathetic nervous system activation: cool clammy skin, confusion, weakness,
palpitations, irritability, hunger, and numbness/tingling of lips or tongue. Blood glucose is below 60 mg/dL. Options A and C
describe hyperglycemia (the 3 Ps, fruity/acetone breath, blood glucose > 200 mg/dL).
Page 2 of 17
, 6. What is the antidote for opioid (narcotic) overdose?
A. Acetylcysteine (Mucomyst)
B. Protamine sulfate
C. Naloxone (Narcan)
D. Vitamin K (Phytonadione)
◆ C — Naloxone (Narcan)
RATIONALE: Naloxone is a pure opioid antagonist that reverses opioid-induced respiratory depression. Acetylcysteine (A) is for
acetaminophen overdose. Protamine sulfate (B) reverses heparin. Vitamin K (D) reverses warfarin. Naloxone may need
repeated dosing due to its short half-life compared to most opioids.
7. What is the antidote for warfarin (Coumadin) overdose?
A. Protamine sulfate
B. Vitamin K (Phytonadione)
C. Digoxin immune Fab
D. Glucose D50
◆ B — Vitamin K (Phytonadione)
RATIONALE: Vitamin K reverses warfarin's anticoagulant effect by restoring the synthesis of vitamin K-dependent clotting
factors (II, VII, IX, X). Protamine sulfate (A) reverses heparin. Digoxin immune Fab (C) treats digoxin toxicity. Glucose D50 (D)
treats insulin overdose.
8. Which insulin is cloudy in appearance and requires rolling before administration?
A. Glargine (Lantus)
B. Aspart (Novolog)
C. NPH insulin (Humulin N)
D. Regular insulin (Humulin R)
◆ C — NPH insulin (Humulin N)
RATIONALE: Only intermediate-acting NPH insulin is cloudy because it contains protamine, which slows absorption. It must be
gently rolled (not shaken) to resuspend the insulin before drawing up. All other insulins—rapid, short, and long-acting—are
clear solutions. When mixing, draw up clear (regular) before cloudy (NPH).
Page 3 of 17
