HESI Pharmacology Exam Study Guide 400
Q&A+200 MOST TESTED QUIZ REVIEW
FROM PASTPAERS 2026/2027
|Updated Questions with Verified Answers
And Detailed Rationales| Brand new!!
Contents
HESI Pharmacology Exam Study Guide ................................................................................... 1
MOST TESTED FROM PASTPAPERS REVIEW WITH ANSWERS AND RATIONALE ................. 137
HESI Pharmacology Exam Study Guide
1.
A nurse is reviewing a new prescription for phenelzine (Nardil), a monoamine oxidase inhibitor
(MAOI), for a client with depression on the psychiatric unit. Which information is most critical
for the nurse to assess prior to initiating therapy?
a. The client's consumption of any alcohol or tyramine-rich foods
b. The client's reports of nausea or vomiting
c. The client's therapeutic serum drug levels
d. The client's blood pressure and pulse prior to taking each dose
CORRECT ANS: a
EXPERT RATIONALE
Phenelzine is a monoamine oxidase inhibitor (MAOI) used to treat depression. MAOIs work by
inhibiting the breakdown of neurotransmitters such as serotonin, norepinephrine, and
dopamine. However, they also inhibit the breakdown of tyramine, an amino acid found in aged
cheeses, cured meats, and fermented products. Concurrent ingestion of tyramine-rich foods or
alcohol can precipitate a life-threatening hypertensive crisis characterized by severe headache,
tachycardia, hypertension, and potential stroke. Therefore, assessing the client's dietary intake
,and alcohol consumption is the most critical safety measure. Monitoring blood pressure (d) is
important but is a general safety measure, not the most critical specific risk. Nausea (b) is a
common side effect but not the primary concern. Serum drug levels (c) are not routinely
monitored for MAOIs.
DIF: Cognitive Level: Analyze (Application)
REF: Mental Health / Psychopharmacology
OBJ: Identify critical assessments for MAOI therapy
TOP: Safety / Assessment
MSC: NCLEX: Physiological Integrity – Pharmacological and Parenteral Therapies
2.
The nurse is administering haloperidol 0.5 mg intramuscularly (IM) as a PRN (as needed)
medication to a client for the first time. What acute extrapyramidal side effect should the nurse
prioritize assessing for during and immediately following the initial dose?
a. Bradykinesia
b. Dystonia
c. Somatization
d. Akathisia
CORRECT ANS: b
EXPERT RATIONALE
Haloperidol is a first-generation (typical) antipsychotic medication. Acute dystonia is a severe
and painful extrapyramidal side effect characterized by involuntary muscle spasms, particularly
of the head, neck, and tongue (e.g., oculogyric crisis, torticollis, trismus). It is most likely to
occur within the first few hours to days of initiating therapy, especially with parenteral
administration. While bradykinesia (a) and akathisia (d) are also extrapyramidal side effects,
they typically develop over a longer period (weeks to months) and are not the most immediate
concern following the first dose. Somatization (c) is the expression of psychological distress
through physical symptoms and is not a side effect of this medication.
DIF: Cognitive Level: Analyze (Application)
REF: Mental Health / Psychopharmacology
OBJ: Identify acute extrapyramidal side effects of antipsychotics
TOP: Assessment / Implementation
MSC: NCLEX: Physiological Integrity – Pharmacological and Parenteral Therapies
,3.
While reviewing a client's electronic medical record (EMR), the nurse assesses that the client is
at risk for a potential interaction with an over-the-counter (OTC) decongestant. Which client
health history findings should the nurse report to the healthcare provider concerning the use of
this OTC medication? (Select all that apply)
a. Type 1 diabetes mellitus (DM)
b. Closed-angle glaucoma
c. Chronic hypertension
d. Rheumatoid arthritis
e. Crohn's disease
CORRECT ANS: b, c
EXPERT RATIONALE
Over-the-counter decongestants, such as pseudoephedrine and phenylephrine, are
sympathomimetic agents that stimulate alpha-adrenergic receptors, causing vasoconstriction.
This mechanism makes them contraindicated or high-risk for clients with certain conditions.
Closed-angle glaucoma (b) is a significant contraindication because the vasoconstrictive and
mydriatic effects of decongestants can precipitate a dangerous increase in intraocular pressure.
Chronic hypertension (c) is a major risk factor, as the drug can further elevate blood pressure.
Type 1 diabetes mellitus (a) is not a direct contraindication to decongestant use. Rheumatoid
arthritis (d) and Crohn's disease (e) are autoimmune inflammatory conditions and are not
typically affected by decongestants.
DIF: Cognitive Level: Analyze (Application)
REF: Pharmacology / Over-the-Counter Medications
OBJ: Identify contraindications to OTC decongestants
TOP: Safety / Assessment
MSC: NCLEX: Physiological Integrity – Pharmacological and Parenteral Therapies
4.
A client prescribed ipratropium (an anticholinergic bronchodilator) reports experiencing nausea,
blurred vision, headaches, and insomnia after using the inhaler. Which action should the nurse
implement first?
a. Withhold the medication and report the symptoms and vital signs to the healthcare provider
b. Administer a PRN medication for nausea and vomiting and re-evaluate the client in 30
minutes
c. Reassure the client that ipratropium will alleviate the symptoms over time
d. Delay administration of ipratropium until the next maintenance medication is scheduled
, CORRECT ANS: a
EXPERT RATIONALE
The client is exhibiting a cluster of systemic adverse effects (nausea, blurred vision, headache,
insomnia) suggestive of anticholinergic toxicity or an atypical reaction to ipratropium. The
nurse's priority is to withhold the medication to prevent further adverse effects and
immediately report the findings to the healthcare provider for further evaluation and potential
prescription changes. Administering PRN medications (b) or reassuring the client (c) does not
address the potentially serious nature of the symptoms. Delaying administration (d) is
insufficient and does not involve reporting the concerning findings.
DIF: Cognitive Level: Analyze (Application)
REF: Respiratory Pharmacology
OBJ: Identify adverse effects of anticholinergics
TOP: Safety / Implementation
MSC: NCLEX: Physiological Integrity – Pharmacological and Parenteral Therapies
5.
A client diagnosed with multiple sclerosis (MS) is experiencing a sudden exacerbation
characterized by profound weakness, blurry vision, and shooting pains in both legs. Which
medication is considered the most appropriate and best course of treatment for the nurse to
administer during this acute relapse?
a. High-dose intravenous methylprednisolone
b. Baclofen administered orally three times a day
c. Broad-spectrum oral antibiotic coverage
d. Chronic immunomodulatory drug therapy
CORRECT ANS: a
EXPERT RATIONALE
An acute exacerbation of multiple sclerosis is characterized by a sudden worsening of
neurological function due to inflammation and demyelination in the central nervous system.
High-dose intravenous corticosteroids, such as methylprednisolone, are the standard of care for
treating acute relapses. They work by reducing inflammation and edema, thereby shortening
the duration of the exacerbation and hastening recovery. Baclofen (b) is a muscle relaxant used
to treat spasticity, a chronic symptom of MS. Antibiotics (c) are not indicated unless an infection
is present. Immunomodulatory therapies (d) are used as long-term disease-modifying agents to
prevent future relapses, not to treat an acute attack.
Q&A+200 MOST TESTED QUIZ REVIEW
FROM PASTPAERS 2026/2027
|Updated Questions with Verified Answers
And Detailed Rationales| Brand new!!
Contents
HESI Pharmacology Exam Study Guide ................................................................................... 1
MOST TESTED FROM PASTPAPERS REVIEW WITH ANSWERS AND RATIONALE ................. 137
HESI Pharmacology Exam Study Guide
1.
A nurse is reviewing a new prescription for phenelzine (Nardil), a monoamine oxidase inhibitor
(MAOI), for a client with depression on the psychiatric unit. Which information is most critical
for the nurse to assess prior to initiating therapy?
a. The client's consumption of any alcohol or tyramine-rich foods
b. The client's reports of nausea or vomiting
c. The client's therapeutic serum drug levels
d. The client's blood pressure and pulse prior to taking each dose
CORRECT ANS: a
EXPERT RATIONALE
Phenelzine is a monoamine oxidase inhibitor (MAOI) used to treat depression. MAOIs work by
inhibiting the breakdown of neurotransmitters such as serotonin, norepinephrine, and
dopamine. However, they also inhibit the breakdown of tyramine, an amino acid found in aged
cheeses, cured meats, and fermented products. Concurrent ingestion of tyramine-rich foods or
alcohol can precipitate a life-threatening hypertensive crisis characterized by severe headache,
tachycardia, hypertension, and potential stroke. Therefore, assessing the client's dietary intake
,and alcohol consumption is the most critical safety measure. Monitoring blood pressure (d) is
important but is a general safety measure, not the most critical specific risk. Nausea (b) is a
common side effect but not the primary concern. Serum drug levels (c) are not routinely
monitored for MAOIs.
DIF: Cognitive Level: Analyze (Application)
REF: Mental Health / Psychopharmacology
OBJ: Identify critical assessments for MAOI therapy
TOP: Safety / Assessment
MSC: NCLEX: Physiological Integrity – Pharmacological and Parenteral Therapies
2.
The nurse is administering haloperidol 0.5 mg intramuscularly (IM) as a PRN (as needed)
medication to a client for the first time. What acute extrapyramidal side effect should the nurse
prioritize assessing for during and immediately following the initial dose?
a. Bradykinesia
b. Dystonia
c. Somatization
d. Akathisia
CORRECT ANS: b
EXPERT RATIONALE
Haloperidol is a first-generation (typical) antipsychotic medication. Acute dystonia is a severe
and painful extrapyramidal side effect characterized by involuntary muscle spasms, particularly
of the head, neck, and tongue (e.g., oculogyric crisis, torticollis, trismus). It is most likely to
occur within the first few hours to days of initiating therapy, especially with parenteral
administration. While bradykinesia (a) and akathisia (d) are also extrapyramidal side effects,
they typically develop over a longer period (weeks to months) and are not the most immediate
concern following the first dose. Somatization (c) is the expression of psychological distress
through physical symptoms and is not a side effect of this medication.
DIF: Cognitive Level: Analyze (Application)
REF: Mental Health / Psychopharmacology
OBJ: Identify acute extrapyramidal side effects of antipsychotics
TOP: Assessment / Implementation
MSC: NCLEX: Physiological Integrity – Pharmacological and Parenteral Therapies
,3.
While reviewing a client's electronic medical record (EMR), the nurse assesses that the client is
at risk for a potential interaction with an over-the-counter (OTC) decongestant. Which client
health history findings should the nurse report to the healthcare provider concerning the use of
this OTC medication? (Select all that apply)
a. Type 1 diabetes mellitus (DM)
b. Closed-angle glaucoma
c. Chronic hypertension
d. Rheumatoid arthritis
e. Crohn's disease
CORRECT ANS: b, c
EXPERT RATIONALE
Over-the-counter decongestants, such as pseudoephedrine and phenylephrine, are
sympathomimetic agents that stimulate alpha-adrenergic receptors, causing vasoconstriction.
This mechanism makes them contraindicated or high-risk for clients with certain conditions.
Closed-angle glaucoma (b) is a significant contraindication because the vasoconstrictive and
mydriatic effects of decongestants can precipitate a dangerous increase in intraocular pressure.
Chronic hypertension (c) is a major risk factor, as the drug can further elevate blood pressure.
Type 1 diabetes mellitus (a) is not a direct contraindication to decongestant use. Rheumatoid
arthritis (d) and Crohn's disease (e) are autoimmune inflammatory conditions and are not
typically affected by decongestants.
DIF: Cognitive Level: Analyze (Application)
REF: Pharmacology / Over-the-Counter Medications
OBJ: Identify contraindications to OTC decongestants
TOP: Safety / Assessment
MSC: NCLEX: Physiological Integrity – Pharmacological and Parenteral Therapies
4.
A client prescribed ipratropium (an anticholinergic bronchodilator) reports experiencing nausea,
blurred vision, headaches, and insomnia after using the inhaler. Which action should the nurse
implement first?
a. Withhold the medication and report the symptoms and vital signs to the healthcare provider
b. Administer a PRN medication for nausea and vomiting and re-evaluate the client in 30
minutes
c. Reassure the client that ipratropium will alleviate the symptoms over time
d. Delay administration of ipratropium until the next maintenance medication is scheduled
, CORRECT ANS: a
EXPERT RATIONALE
The client is exhibiting a cluster of systemic adverse effects (nausea, blurred vision, headache,
insomnia) suggestive of anticholinergic toxicity or an atypical reaction to ipratropium. The
nurse's priority is to withhold the medication to prevent further adverse effects and
immediately report the findings to the healthcare provider for further evaluation and potential
prescription changes. Administering PRN medications (b) or reassuring the client (c) does not
address the potentially serious nature of the symptoms. Delaying administration (d) is
insufficient and does not involve reporting the concerning findings.
DIF: Cognitive Level: Analyze (Application)
REF: Respiratory Pharmacology
OBJ: Identify adverse effects of anticholinergics
TOP: Safety / Implementation
MSC: NCLEX: Physiological Integrity – Pharmacological and Parenteral Therapies
5.
A client diagnosed with multiple sclerosis (MS) is experiencing a sudden exacerbation
characterized by profound weakness, blurry vision, and shooting pains in both legs. Which
medication is considered the most appropriate and best course of treatment for the nurse to
administer during this acute relapse?
a. High-dose intravenous methylprednisolone
b. Baclofen administered orally three times a day
c. Broad-spectrum oral antibiotic coverage
d. Chronic immunomodulatory drug therapy
CORRECT ANS: a
EXPERT RATIONALE
An acute exacerbation of multiple sclerosis is characterized by a sudden worsening of
neurological function due to inflammation and demyelination in the central nervous system.
High-dose intravenous corticosteroids, such as methylprednisolone, are the standard of care for
treating acute relapses. They work by reducing inflammation and edema, thereby shortening
the duration of the exacerbation and hastening recovery. Baclofen (b) is a muscle relaxant used
to treat spasticity, a chronic symptom of MS. Antibiotics (c) are not indicated unless an infection
is present. Immunomodulatory therapies (d) are used as long-term disease-modifying agents to
prevent future relapses, not to treat an acute attack.
