COURSE CODE: Pharmacology HESI EXAM DATE TIME
COURSE TITLE: Pharmacology — HESI Comprehensive
—/—/ ALLOWED
Examination
—— 120 Minutes
INSTRUCTOR: —
◇
Pharmacology — HESI
Comprehensive Examination — Anti-infectives, Endocrine, Respiratory & GI
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS (200 Marks)
Choose the single best answer for each question unless "Select All That Apply" is indicated. Write the correct letter(s) in the
space provided.
1. Which nursing action is the priority when administering chelation therapy for a toddler-
age client?
A. Assessing vital signs
B. Monitoring urine output
C. Conducting a behavioral assessment
D. Providing education to reduce lead exposure
✦ CORRECT ANSWER: B — Monitoring urine output.
Chelation therapy binds heavy metals (such as lead) so they can be excreted renally. The priority nursing action is
monitoring urine output because the metal-chelate complexes must be eliminated through the kidneys. Adequate
renal function and urine output are essential for the therapy to be both effective and safe — inadequate output risks
re-accumulation of the chelated metals and potential nephrotoxicity. Vital signs, behavioral assessment, and parent
education are all important but secondary to ensuring the drug is being eliminated.
,2. A 67-year-old client has tested positive for influenza A. The client also has asthma. Which
drug would the nurse recommend be avoided in this client?
A. Ribavirin
B. Zanamivir
C. Oseltamivir
D. Amantadine
✦ CORRECT ANSWER: B — Zanamivir.
Zanamivir is an inhaled neuraminidase inhibitor that can cause bronchospasm — a serious adverse effect that
makes it contraindicated in clients with asthma or COPD. Oseltamivir (oral) does not carry this risk and is preferred
for asthmatic clients. Ribavirin is not first-line for influenza. Amantadine is an older adamantane with significant
resistance and CNS side effects. The nurse must identify contraindications based on the client's comorbidities.
3. Which first-line medication would the nurse state is used to treat anaphylactic reactions?
A. Epinephrine
B. Norepinephrine
C. Dexamethasone
D. Diphenhydramine
✦ CORRECT ANSWER: A — Epinephrine.
Epinephrine is the first-line, life-saving medication for anaphylaxis. It is a non-selective adrenergic agonist that
reverses the key pathophysiological features: alpha-1 agonism causes vasoconstriction (reversing hypotension and
oedema), beta-1 agonism increases cardiac output, and beta-2 agonism causes bronchodilation. It should be
administered intramuscularly into the anterolateral thigh as soon as anaphylaxis is recognised. Antihistamines
(diphenhydramine) and corticosteroids (dexamethasone) are second-line adjuncts, not substitutes.
,4. A mother complains that her child's teeth have become yellow in color. With prolonged
use, which medication may be responsible for the child's condition?
A. Tetracycline
B. Promethazine
C. Chloramphenicol
D. Fluoroquinolones
✦ CORRECT ANSWER: A — Tetracycline.
Tetracyclines chelate calcium ions and are deposited in developing teeth and bones, causing permanent yellow-
brown discolouration and enamel hypoplasia. This is why tetracyclines are contraindicated in children under 8
years of age and during pregnancy (affects fetal tooth development). Fluoroquinolones can cause cartilage damage
in weight-bearing joints but not dental staining. Chloramphenicol is associated with bone marrow suppression and
gray baby syndrome.
5. What are the desired outcomes that the nurse expects when administering an NSAID?
(Select All That Apply)
A. Diuresis
B. Pain relief
C. Antipyresis
D. Bronchodilation
E. Anticoagulation
F. Reduced inflammation
✦ CORRECT ANSWER: B, C, F — Pain relief, antipyresis, reduced inflammation.
NSAIDs produce their therapeutic effects by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, which
decreases prostaglandin synthesis. This results in three primary outcomes: analgesia (pain relief), antipyresis (fever
reduction via hypothalamic action), and anti-inflammatory effects (reduced swelling, erythema). While NSAIDs do
affect platelet aggregation (via COX-1 inhibition), this is typically an adverse effect, not a desired therapeutic
outcome for most NSAID use. They do not produce diuresis or bronchodilation.
, 6. A client with tuberculosis is started on a chemotherapy protocol that includes rifampin.
The nurse evaluates that the teaching about rifampin is effective when the client makes
which statement?
A. "I need to drink a lot of fluid while I take this medication."
B. "I can expect my urine to turn orange from this medication."
C. "I should have my hearing tested while I take this medication."
D. "I might get a skin rash because it is an expected side effect of this medication."
✦ CORRECT ANSWER: B — "I can expect my urine to turn orange from this medication."
Rifampin predictably causes a harmless orange-red discolouration of body fluids including urine, tears, sweat, and
saliva. This is a benign effect that the client should be warned about in advance to prevent alarm. It can also
permanently stain soft contact lenses. Hearing testing is associated with streptomycin (ototoxicity), not rifampin.
Skin rash may indicate hypersensitivity and should be reported, not expected. Hepatotoxicity is a more serious
adverse effect requiring monitoring.
7. Which statement regarding treatment with interferon indicates that the client
understands the nurse's teaching?
A. "I will drink 2 to 3 quarts (2 to 3 liters) of fluid a day."
B. "Any reconstituted solution must be discarded in 1 week."
C. "I can continue driving my car as long as I have the stamina."
D. "While taking this medicine I should be able to continue my usual activity."
✦ CORRECT ANSWER: A — "I will drink 2 to 3 quarts of fluid a day."
Interferon therapy requires adequate hydration (2–3 L daily) to manage flu-like side effects (fever, myalgia, fatigue)
and prevent renal complications. Clients should be taught to pre-medicate with acetaminophen before injections.
Driving may be impaired due to fatigue and CNS effects. Activity levels typically need to be reduced because fatigue
is a prominent side effect. Reconstituted interferon must be refrigerated and used within 24 hours, not 1 week.
COURSE TITLE: Pharmacology — HESI Comprehensive
—/—/ ALLOWED
Examination
—— 120 Minutes
INSTRUCTOR: —
◇
Pharmacology — HESI
Comprehensive Examination — Anti-infectives, Endocrine, Respiratory & GI
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS (200 Marks)
Choose the single best answer for each question unless "Select All That Apply" is indicated. Write the correct letter(s) in the
space provided.
1. Which nursing action is the priority when administering chelation therapy for a toddler-
age client?
A. Assessing vital signs
B. Monitoring urine output
C. Conducting a behavioral assessment
D. Providing education to reduce lead exposure
✦ CORRECT ANSWER: B — Monitoring urine output.
Chelation therapy binds heavy metals (such as lead) so they can be excreted renally. The priority nursing action is
monitoring urine output because the metal-chelate complexes must be eliminated through the kidneys. Adequate
renal function and urine output are essential for the therapy to be both effective and safe — inadequate output risks
re-accumulation of the chelated metals and potential nephrotoxicity. Vital signs, behavioral assessment, and parent
education are all important but secondary to ensuring the drug is being eliminated.
,2. A 67-year-old client has tested positive for influenza A. The client also has asthma. Which
drug would the nurse recommend be avoided in this client?
A. Ribavirin
B. Zanamivir
C. Oseltamivir
D. Amantadine
✦ CORRECT ANSWER: B — Zanamivir.
Zanamivir is an inhaled neuraminidase inhibitor that can cause bronchospasm — a serious adverse effect that
makes it contraindicated in clients with asthma or COPD. Oseltamivir (oral) does not carry this risk and is preferred
for asthmatic clients. Ribavirin is not first-line for influenza. Amantadine is an older adamantane with significant
resistance and CNS side effects. The nurse must identify contraindications based on the client's comorbidities.
3. Which first-line medication would the nurse state is used to treat anaphylactic reactions?
A. Epinephrine
B. Norepinephrine
C. Dexamethasone
D. Diphenhydramine
✦ CORRECT ANSWER: A — Epinephrine.
Epinephrine is the first-line, life-saving medication for anaphylaxis. It is a non-selective adrenergic agonist that
reverses the key pathophysiological features: alpha-1 agonism causes vasoconstriction (reversing hypotension and
oedema), beta-1 agonism increases cardiac output, and beta-2 agonism causes bronchodilation. It should be
administered intramuscularly into the anterolateral thigh as soon as anaphylaxis is recognised. Antihistamines
(diphenhydramine) and corticosteroids (dexamethasone) are second-line adjuncts, not substitutes.
,4. A mother complains that her child's teeth have become yellow in color. With prolonged
use, which medication may be responsible for the child's condition?
A. Tetracycline
B. Promethazine
C. Chloramphenicol
D. Fluoroquinolones
✦ CORRECT ANSWER: A — Tetracycline.
Tetracyclines chelate calcium ions and are deposited in developing teeth and bones, causing permanent yellow-
brown discolouration and enamel hypoplasia. This is why tetracyclines are contraindicated in children under 8
years of age and during pregnancy (affects fetal tooth development). Fluoroquinolones can cause cartilage damage
in weight-bearing joints but not dental staining. Chloramphenicol is associated with bone marrow suppression and
gray baby syndrome.
5. What are the desired outcomes that the nurse expects when administering an NSAID?
(Select All That Apply)
A. Diuresis
B. Pain relief
C. Antipyresis
D. Bronchodilation
E. Anticoagulation
F. Reduced inflammation
✦ CORRECT ANSWER: B, C, F — Pain relief, antipyresis, reduced inflammation.
NSAIDs produce their therapeutic effects by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, which
decreases prostaglandin synthesis. This results in three primary outcomes: analgesia (pain relief), antipyresis (fever
reduction via hypothalamic action), and anti-inflammatory effects (reduced swelling, erythema). While NSAIDs do
affect platelet aggregation (via COX-1 inhibition), this is typically an adverse effect, not a desired therapeutic
outcome for most NSAID use. They do not produce diuresis or bronchodilation.
, 6. A client with tuberculosis is started on a chemotherapy protocol that includes rifampin.
The nurse evaluates that the teaching about rifampin is effective when the client makes
which statement?
A. "I need to drink a lot of fluid while I take this medication."
B. "I can expect my urine to turn orange from this medication."
C. "I should have my hearing tested while I take this medication."
D. "I might get a skin rash because it is an expected side effect of this medication."
✦ CORRECT ANSWER: B — "I can expect my urine to turn orange from this medication."
Rifampin predictably causes a harmless orange-red discolouration of body fluids including urine, tears, sweat, and
saliva. This is a benign effect that the client should be warned about in advance to prevent alarm. It can also
permanently stain soft contact lenses. Hearing testing is associated with streptomycin (ototoxicity), not rifampin.
Skin rash may indicate hypersensitivity and should be reported, not expected. Hepatotoxicity is a more serious
adverse effect requiring monitoring.
7. Which statement regarding treatment with interferon indicates that the client
understands the nurse's teaching?
A. "I will drink 2 to 3 quarts (2 to 3 liters) of fluid a day."
B. "Any reconstituted solution must be discarded in 1 week."
C. "I can continue driving my car as long as I have the stamina."
D. "While taking this medicine I should be able to continue my usual activity."
✦ CORRECT ANSWER: A — "I will drink 2 to 3 quarts of fluid a day."
Interferon therapy requires adequate hydration (2–3 L daily) to manage flu-like side effects (fever, myalgia, fatigue)
and prevent renal complications. Clients should be taught to pre-medicate with acetaminophen before injections.
Driving may be impaired due to fatigue and CNS effects. Activity levels typically need to be reduced because fatigue
is a prominent side effect. Reconstituted interferon must be refrigerated and used within 24 hours, not 1 week.
