Evolve HESI Pharmacology Exam Script 2026
A client with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium
bromide (Atrovent). What is the primary mechanism of action of this medication?
A) Beta-2 adrenergic receptor stimulation
B) Anticholinergic (muscarinic receptor blockade)
C) Phosphodiesterase inhibition
D) Corticosteroid anti-inflammatory effect
Answer: B) Anticholinergic (muscarinic receptor blockade)
Rationale: Ipratropium is an anticholinergic agent that works by blocking muscarinic
receptors in the bronchial smooth muscle, leading to bronchodilation . It is not a beta-2
agonist (A) like albuterol, a phosphodiesterase inhibitor (C) like theophylline, or a
corticosteroid (D).
Question 2
A client prescribed isoniazid (INH) for tuberculosis should be monitored for which
adverse effect?
A) Hepatotoxicity
B) Nephrotoxicity
C) Ototoxicity
D) Cardiotoxicity
Answer: A) Hepatotoxicity
Rationale: Isoniazid can cause hepatotoxicity and peripheral neuropathy. Liver function
tests should be monitored. Vitamin B6 (pyridoxine) is often given to prevent peripheral
neuropathy. Nephrotoxicity (B), ototoxicity (C), and cardiotoxicity (D) are not primary
concerns with INH.
,Question 3
A client with Parkinson's disease is prescribed carbidopa-levodopa. What is the purpose
of carbidopa in this combination?
A) It increases the effectiveness of levodopa in the CNS
B) It prevents the peripheral breakdown of levodopa
C) It is a dopamine agonist
D) It treats the side effects of levodopa
Answer: B) It prevents the peripheral breakdown of levodopa
Rationale: Carbidopa is a peripheral decarboxylase inhibitor that prevents the conversion
of levodopa to dopamine in the periphery, allowing more levodopa to reach the brain and
reducing peripheral side effects . Carbidopa itself is not a dopamine agonist (C) and does
not directly treat side effects (D).
Question 4
The nurse is teaching a client who has a new prescription for a nitroglycerin patch.
Which statement by the client indicates understanding?
A) "I will apply the patch to the same site every day."
B) "I will leave the patch on for 24 hours each day."
C) "I will remove the patch for 10-12 hours each day."
D) "I will apply the patch to a hairy area for better adhesion."
Answer: C) "I will remove the patch for 10-12 hours each day."
Rationale: Transdermal nitroglycerin patches require a nitrate-free interval of 10-12 hours
daily to prevent tolerance. Sites should be rotated (A). Patches should be applied to clean,
dry, hairless skin (D). Continuous wear (B) leads to tolerance.
Question 5
,A client with Alzheimer's disease is prescribed donepezil. What is the mechanism of
action of this medication?
A) Acetylcholinesterase inhibition
B) NMDA receptor antagonism
C) Dopamine receptor agonism
D) Serotonin reuptake inhibition
Answer: A) Acetylcholinesterase inhibition
Rationale: Donepezil is a cholinesterase inhibitor that increases acetylcholine levels in the
brain, potentially improving cognitive function . Memantine is an NMDA receptor
antagonist (B). Antipsychotics affect dopamine (C). SSRIs affect serotonin (D).
Question 6
A client receiving chemotherapy is prescribed ondansetron (Zofran). What side effect
should the nurse monitor for?
A) Diarrhea
B) Constipation
C) Headache
D) Hypotension
Answer: B) Constipation
Rationale: Ondansetron, a 5-HT3 receptor antagonist used for chemotherapy-induced
nausea, commonly causes constipation and headache. Diarrhea (A) is not a primary side
effect. Headache (C) is possible but less common. Hypotension (D) is associated with other
antiemetics.
Question 7
The healthcare provider orders phenytoin (Dilantin) for a client with seizures. Which
assessment finding indicates a common side effect of this medication?
A) Gingival hyperplasia
B) Alopecia
, C) Tachycardia
D) Hyperglycemia
Answer: A) Gingival hyperplasia
Rationale: Phenytoin commonly causes gingival hyperplasia (overgrowth of gum tissue)
and hirsutism. Good oral hygiene and regular dental care are important. Alopecia (B),
tachycardia (C), and hyperglycemia (D) are not common side effects of phenytoin.
Question 8
A client is prescribed a selective serotonin reuptake inhibitor (SSRI) for depression.
Which dietary concern should the nurse address?
A) The client should avoid foods containing tyramine
B) The client should avoid grapefruit juice
C) The client should limit caffeine intake
D) The client should avoid foods containing vitamin K
Answer: B) The client should avoid grapefruit juice
Rationale: Grapefruit juice can inhibit the metabolism of certain SSRIs, leading to
increased blood levels and risk of toxicity . Tyramine restriction (A) is for MAOIs. Caffeine
(C) and vitamin K (D) concerns are not specific to SSRIs.
Question 9
A client with type 2 diabetes is prescribed pioglitazone. Which adverse effect is a
concern with this medication?
A) Weight loss
B) Fluid retention and edema
C) Hypoglycemia
D) Hepatotoxicity
Answer: B) Fluid retention and edema
A client with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium
bromide (Atrovent). What is the primary mechanism of action of this medication?
A) Beta-2 adrenergic receptor stimulation
B) Anticholinergic (muscarinic receptor blockade)
C) Phosphodiesterase inhibition
D) Corticosteroid anti-inflammatory effect
Answer: B) Anticholinergic (muscarinic receptor blockade)
Rationale: Ipratropium is an anticholinergic agent that works by blocking muscarinic
receptors in the bronchial smooth muscle, leading to bronchodilation . It is not a beta-2
agonist (A) like albuterol, a phosphodiesterase inhibitor (C) like theophylline, or a
corticosteroid (D).
Question 2
A client prescribed isoniazid (INH) for tuberculosis should be monitored for which
adverse effect?
A) Hepatotoxicity
B) Nephrotoxicity
C) Ototoxicity
D) Cardiotoxicity
Answer: A) Hepatotoxicity
Rationale: Isoniazid can cause hepatotoxicity and peripheral neuropathy. Liver function
tests should be monitored. Vitamin B6 (pyridoxine) is often given to prevent peripheral
neuropathy. Nephrotoxicity (B), ototoxicity (C), and cardiotoxicity (D) are not primary
concerns with INH.
,Question 3
A client with Parkinson's disease is prescribed carbidopa-levodopa. What is the purpose
of carbidopa in this combination?
A) It increases the effectiveness of levodopa in the CNS
B) It prevents the peripheral breakdown of levodopa
C) It is a dopamine agonist
D) It treats the side effects of levodopa
Answer: B) It prevents the peripheral breakdown of levodopa
Rationale: Carbidopa is a peripheral decarboxylase inhibitor that prevents the conversion
of levodopa to dopamine in the periphery, allowing more levodopa to reach the brain and
reducing peripheral side effects . Carbidopa itself is not a dopamine agonist (C) and does
not directly treat side effects (D).
Question 4
The nurse is teaching a client who has a new prescription for a nitroglycerin patch.
Which statement by the client indicates understanding?
A) "I will apply the patch to the same site every day."
B) "I will leave the patch on for 24 hours each day."
C) "I will remove the patch for 10-12 hours each day."
D) "I will apply the patch to a hairy area for better adhesion."
Answer: C) "I will remove the patch for 10-12 hours each day."
Rationale: Transdermal nitroglycerin patches require a nitrate-free interval of 10-12 hours
daily to prevent tolerance. Sites should be rotated (A). Patches should be applied to clean,
dry, hairless skin (D). Continuous wear (B) leads to tolerance.
Question 5
,A client with Alzheimer's disease is prescribed donepezil. What is the mechanism of
action of this medication?
A) Acetylcholinesterase inhibition
B) NMDA receptor antagonism
C) Dopamine receptor agonism
D) Serotonin reuptake inhibition
Answer: A) Acetylcholinesterase inhibition
Rationale: Donepezil is a cholinesterase inhibitor that increases acetylcholine levels in the
brain, potentially improving cognitive function . Memantine is an NMDA receptor
antagonist (B). Antipsychotics affect dopamine (C). SSRIs affect serotonin (D).
Question 6
A client receiving chemotherapy is prescribed ondansetron (Zofran). What side effect
should the nurse monitor for?
A) Diarrhea
B) Constipation
C) Headache
D) Hypotension
Answer: B) Constipation
Rationale: Ondansetron, a 5-HT3 receptor antagonist used for chemotherapy-induced
nausea, commonly causes constipation and headache. Diarrhea (A) is not a primary side
effect. Headache (C) is possible but less common. Hypotension (D) is associated with other
antiemetics.
Question 7
The healthcare provider orders phenytoin (Dilantin) for a client with seizures. Which
assessment finding indicates a common side effect of this medication?
A) Gingival hyperplasia
B) Alopecia
, C) Tachycardia
D) Hyperglycemia
Answer: A) Gingival hyperplasia
Rationale: Phenytoin commonly causes gingival hyperplasia (overgrowth of gum tissue)
and hirsutism. Good oral hygiene and regular dental care are important. Alopecia (B),
tachycardia (C), and hyperglycemia (D) are not common side effects of phenytoin.
Question 8
A client is prescribed a selective serotonin reuptake inhibitor (SSRI) for depression.
Which dietary concern should the nurse address?
A) The client should avoid foods containing tyramine
B) The client should avoid grapefruit juice
C) The client should limit caffeine intake
D) The client should avoid foods containing vitamin K
Answer: B) The client should avoid grapefruit juice
Rationale: Grapefruit juice can inhibit the metabolism of certain SSRIs, leading to
increased blood levels and risk of toxicity . Tyramine restriction (A) is for MAOIs. Caffeine
(C) and vitamin K (D) concerns are not specific to SSRIs.
Question 9
A client with type 2 diabetes is prescribed pioglitazone. Which adverse effect is a
concern with this medication?
A) Weight loss
B) Fluid retention and edema
C) Hypoglycemia
D) Hepatotoxicity
Answer: B) Fluid retention and edema
