HESI Pharmacology Exam – 100 Multiple-Choice
Questions with Rationale
1. A nurse is administering IV vancomycin. Which
finding would be most important to monitor?
A. Serum potassium level
B. Peak and trough levels
C. Urine output
D. Heart rate
Answer: B
Rationale: Vancomycin has a narrow therapeutic
index; monitoring peak and trough levels helps ensure
efficacy while preventing nephrotoxicity and
ototoxicity.
2. Which medication is the antidote for
acetaminophen overdose?
A. Naloxone
B. Flumazenil
C. N-acetylcysteine
D. Protamine sulfate
Answer: C
Rationale: N-acetylcysteine replenishes glutathione
stores in the liver, preventing acetaminophen-induced
hepatotoxicity.
3. A client receiving a beta-blocker complains of
fatigue and cold extremities. Which drug likely
causes these side effects?
, A. Propranolol
B. Lisinopril
C. Hydralazine
D. Furosemide
Answer: A
Rationale: Nonselective beta-blockers like
propranolol reduce cardiac output and peripheral
perfusion, resulting in fatigue and cold extremities.
4. Which diuretic promotes calcium reabsorption
and could be beneficial in a patient with
osteoporosis?
A. Furosemide
B. Mannitol
C. Hydrochlorothiazide
D. Spironolactone
Answer: C
Rationale: Thiazide diuretics decrease urinary
calcium excretion, aiding in bone density
preservation.
5. To prevent the “first-dose” hypotension effect,
which antihypertensive should be taken at
bedtime?
A. Metoprolol
B. Captopril
C. Amlodipine
D. Hydralazine
Answer: B
Rationale: ACE inhibitors like captopril can cause
, significant initial hypotension; taking them at night
reduces risk of dizziness when upright.
6. Which insulin has the quickest onset of action?
A. Regular insulin
B. Insulin glargine
C. Insulin lispro
D. NPH insulin
Answer: C
Rationale: Rapid-acting analogs (e.g., lispro) begin
working within 15 minutes, closely mimicking
postprandial insulin response.
7. A patient on warfarin therapy should avoid which
food to prevent altered INR?
A. Bananas
B. Leafy green vegetables
C. Apples
D. Rice
Answer: B
Rationale: Leafy greens are high in vitamin K, which
antagonizes warfarin’s anticoagulant effect, lowering
INR.
8. Which medication is indicated for opioid-induced
respiratory depression?
A. Naloxone
B. Flumazenil
C. Naltrexone
D. Methadone
Answer: A
, Rationale: Naloxone competitively binds opioid
receptors, reversing life-threatening respiratory
depression.
9. A client with asthma is prescribed a leukotriene
receptor antagonist. Which drug is this?
A. Albuterol
B. Montelukast
C. Ipratropium
D. Theophylline
Answer: B
Rationale: Montelukast blocks leukotriene receptors,
reducing bronchoconstriction and inflammation.
10. Which antibiotic requires peak level
monitoring to ensure efficacy against
Pseudomonas?
A. Gentamicin
B. Azithromycin
C. Vancomycin
D. Ceftriaxone
Answer: A
Rationale: Aminoglycosides have concentration-
dependent killing; peak levels guide dosing for optimal
bacterial eradication.
11. What is the primary adverse effect of
amiodarone therapy requiring routine monitoring?
A. Nephrotoxicity
B. Ototoxicity
C. Pulmonary toxicity
Questions with Rationale
1. A nurse is administering IV vancomycin. Which
finding would be most important to monitor?
A. Serum potassium level
B. Peak and trough levels
C. Urine output
D. Heart rate
Answer: B
Rationale: Vancomycin has a narrow therapeutic
index; monitoring peak and trough levels helps ensure
efficacy while preventing nephrotoxicity and
ototoxicity.
2. Which medication is the antidote for
acetaminophen overdose?
A. Naloxone
B. Flumazenil
C. N-acetylcysteine
D. Protamine sulfate
Answer: C
Rationale: N-acetylcysteine replenishes glutathione
stores in the liver, preventing acetaminophen-induced
hepatotoxicity.
3. A client receiving a beta-blocker complains of
fatigue and cold extremities. Which drug likely
causes these side effects?
, A. Propranolol
B. Lisinopril
C. Hydralazine
D. Furosemide
Answer: A
Rationale: Nonselective beta-blockers like
propranolol reduce cardiac output and peripheral
perfusion, resulting in fatigue and cold extremities.
4. Which diuretic promotes calcium reabsorption
and could be beneficial in a patient with
osteoporosis?
A. Furosemide
B. Mannitol
C. Hydrochlorothiazide
D. Spironolactone
Answer: C
Rationale: Thiazide diuretics decrease urinary
calcium excretion, aiding in bone density
preservation.
5. To prevent the “first-dose” hypotension effect,
which antihypertensive should be taken at
bedtime?
A. Metoprolol
B. Captopril
C. Amlodipine
D. Hydralazine
Answer: B
Rationale: ACE inhibitors like captopril can cause
, significant initial hypotension; taking them at night
reduces risk of dizziness when upright.
6. Which insulin has the quickest onset of action?
A. Regular insulin
B. Insulin glargine
C. Insulin lispro
D. NPH insulin
Answer: C
Rationale: Rapid-acting analogs (e.g., lispro) begin
working within 15 minutes, closely mimicking
postprandial insulin response.
7. A patient on warfarin therapy should avoid which
food to prevent altered INR?
A. Bananas
B. Leafy green vegetables
C. Apples
D. Rice
Answer: B
Rationale: Leafy greens are high in vitamin K, which
antagonizes warfarin’s anticoagulant effect, lowering
INR.
8. Which medication is indicated for opioid-induced
respiratory depression?
A. Naloxone
B. Flumazenil
C. Naltrexone
D. Methadone
Answer: A
, Rationale: Naloxone competitively binds opioid
receptors, reversing life-threatening respiratory
depression.
9. A client with asthma is prescribed a leukotriene
receptor antagonist. Which drug is this?
A. Albuterol
B. Montelukast
C. Ipratropium
D. Theophylline
Answer: B
Rationale: Montelukast blocks leukotriene receptors,
reducing bronchoconstriction and inflammation.
10. Which antibiotic requires peak level
monitoring to ensure efficacy against
Pseudomonas?
A. Gentamicin
B. Azithromycin
C. Vancomycin
D. Ceftriaxone
Answer: A
Rationale: Aminoglycosides have concentration-
dependent killing; peak levels guide dosing for optimal
bacterial eradication.
11. What is the primary adverse effect of
amiodarone therapy requiring routine monitoring?
A. Nephrotoxicity
B. Ototoxicity
C. Pulmonary toxicity
