COURSE CODE: PHARMACOLOGY HESI EXAM TIME
COURSE TITLE: Evolve Pharmacology — Comprehensive HESI Practice DATE ALLOWED
Examination —/—/ 150
INSTRUCTOR: — —— Minutes
Pharmacology Evolve HESI
Comprehensive Pharmacology Assessment — Therapeutic Agents, Adverse Effects, Drug Interactions & Client
Safety
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS (90 Marks)
Choose the single best answer for each question. Write the correct letter (A, B, C, or D) in the space provided.
1. A 19-year-old male client who has sustained a severe head injury is intubated and
placed on assisted mechanical ventilation. To facilitate optimal ventilation and
prevent the client from "fighting" the ventilator, the health care provider administers
pancuronium bromide IV, with adjunctive opioid analgesia. What medication should
be immediately accessible for a potential complication with this drug?
A. Dantrolene sodium
B. Neostigmine bromide
C. Succinylcholine bromide
D. Epinephrine
✦ CORRECT ANSWER: B — Neostigmine bromide
Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory muscle
paralysis caused by pancuronium bromide, a non-depolarising neuromuscular blocker. Dantrolene treats
malignant hyperthermia; succinylcholine is a depolarising neuromuscular blocker; epinephrine treats
anaphylaxis — none reverse pancuronium-induced paralysis.
,2. A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and
acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care
provider to report that the client has developed diarrhea. Which change in
prescriptions should the nurse anticipate?
A. Change the acetaminophen to ibuprofen.
B. Change the elixir to an injectable route.
C. Decrease the dose of vitamin C.
D. Begin treatment with an antibiotic.
✦ CORRECT ANSWER: C — Decrease the dose of vitamin C.
High-dose vitamin C (ascorbic acid) commonly causes gastrointestinal disturbances including diarrhoea.
Reducing the dose typically resolves this side effect. Acetaminophen is not typically associated with diarrhoea;
ibuprofen would not address the underlying cause. An antibiotic is not indicated for viral influenza.
3. When providing nursing care for a client receiving pyridostigmine bromide for
myasthenia gravis, which nursing intervention has the highest priority?
A. Monitor the client frequently for urinary retention.
B. Assess respiratory status and breath sounds often.
C. Monitor blood pressure each shift to screen for hypertension.
D. Administer most medications after meals to decrease gastrointestinal irritation.
✦ CORRECT ANSWER: B — Assess respiratory status and breath sounds often.
Myasthenia gravis affects respiratory muscles, and pyridostigmine (cholinesterase inhibitor) improves muscle
strength. Respiratory assessment is the highest priority per ABCs. Cholinergic crisis (overmedication) also
causes respiratory muscle weakness. The client should take the medication 30–45 minutes before meals to
improve chewing and swallowing strength.
,4. A client with a dislocated shoulder is being prepared for a closed manual reduction
using conscious sedation. Which medication should the nurse explain as a sedative
used during the procedure?
A. Inhaled nitrous oxide
B. Midazolam IV
C. Ketamine IM
D. Fentanyl and droperidol IM
✦ CORRECT ANSWER: B — Midazolam IV
Midazolam is a short-acting benzodiazepine commonly used for conscious sedation due to its anxiolytic,
amnestic, and sedative properties with rapid onset when given IV. Nitrous oxide is an inhaled anaesthetic.
Ketamine produces dissociative anaesthesia. Fentanyl/droperidol is a neuroleptanalgesic combination.
5. A client is being discharged with a prescription for sulfasalazine to treat ulcerative
colitis. Which instruction should the nurse provide to this client prior to discharge?
A. Maintain good oral hygiene.
B. Take the medication 30 minutes before a meal.
C. Discontinue use of the drug gradually.
D. Drink at least eight glasses of fluid a day.
✦ CORRECT ANSWER: D — Drink at least eight glasses of fluid a day.
Sulfasalazine can cause crystalluria and nephrotoxicity. Adequate hydration (at least 8 glasses of water daily)
maintains high urine output to prevent crystal formation in the renal tubules. The medication should be taken
after meals to reduce GI irritation, not on an empty stomach.
, 6. The health care provider prescribes carbamazepine for a child whose tonic-clonic
seizures have been poorly controlled. The nurse informs the mother that the child
must have blood tests every week. The mother asks why so many blood tests are
necessary. Which complication is assessed through frequent laboratory testing that
the nurse should explain to this mother?
A. Nephrotoxicity
B. Ototoxicity
C. Myelosuppression
D. Hepatotoxicity
✦ CORRECT ANSWER: C — Myelosuppression
Carbamazepine carries a black box warning for serious blood dyscrasias including aplastic anaemia,
leukopenia, and thrombocytopenia. Weekly CBC monitoring is essential, especially during the first months of
therapy. Sore throat, fever, and pallor are signs of developing blood dyscrasia that require immediate
reporting.
7. When developing a written nursing care plan for a client receiving chemotherapy for
treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The
administration of which type of chemotherapeutic agent would prompt the nurse to
add this intervention?
A. Vincristine
B. Bleomycin sulfate
C. Chlorambucil
D. Cyclophosphamide
✦ CORRECT ANSWER: D — Cyclophosphamide
Cyclophosphamide's metabolite acrolein causes haemorrhagic cystitis — a sterile, chemical inflammation of
the bladder wall leading to haematuria. Mesna is administered concurrently to bind acrolein and prevent this
complication. Vigorous hydration and frequent voiding are also protective measures.
COURSE TITLE: Evolve Pharmacology — Comprehensive HESI Practice DATE ALLOWED
Examination —/—/ 150
INSTRUCTOR: — —— Minutes
Pharmacology Evolve HESI
Comprehensive Pharmacology Assessment — Therapeutic Agents, Adverse Effects, Drug Interactions & Client
Safety
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS (90 Marks)
Choose the single best answer for each question. Write the correct letter (A, B, C, or D) in the space provided.
1. A 19-year-old male client who has sustained a severe head injury is intubated and
placed on assisted mechanical ventilation. To facilitate optimal ventilation and
prevent the client from "fighting" the ventilator, the health care provider administers
pancuronium bromide IV, with adjunctive opioid analgesia. What medication should
be immediately accessible for a potential complication with this drug?
A. Dantrolene sodium
B. Neostigmine bromide
C. Succinylcholine bromide
D. Epinephrine
✦ CORRECT ANSWER: B — Neostigmine bromide
Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory muscle
paralysis caused by pancuronium bromide, a non-depolarising neuromuscular blocker. Dantrolene treats
malignant hyperthermia; succinylcholine is a depolarising neuromuscular blocker; epinephrine treats
anaphylaxis — none reverse pancuronium-induced paralysis.
,2. A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and
acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care
provider to report that the client has developed diarrhea. Which change in
prescriptions should the nurse anticipate?
A. Change the acetaminophen to ibuprofen.
B. Change the elixir to an injectable route.
C. Decrease the dose of vitamin C.
D. Begin treatment with an antibiotic.
✦ CORRECT ANSWER: C — Decrease the dose of vitamin C.
High-dose vitamin C (ascorbic acid) commonly causes gastrointestinal disturbances including diarrhoea.
Reducing the dose typically resolves this side effect. Acetaminophen is not typically associated with diarrhoea;
ibuprofen would not address the underlying cause. An antibiotic is not indicated for viral influenza.
3. When providing nursing care for a client receiving pyridostigmine bromide for
myasthenia gravis, which nursing intervention has the highest priority?
A. Monitor the client frequently for urinary retention.
B. Assess respiratory status and breath sounds often.
C. Monitor blood pressure each shift to screen for hypertension.
D. Administer most medications after meals to decrease gastrointestinal irritation.
✦ CORRECT ANSWER: B — Assess respiratory status and breath sounds often.
Myasthenia gravis affects respiratory muscles, and pyridostigmine (cholinesterase inhibitor) improves muscle
strength. Respiratory assessment is the highest priority per ABCs. Cholinergic crisis (overmedication) also
causes respiratory muscle weakness. The client should take the medication 30–45 minutes before meals to
improve chewing and swallowing strength.
,4. A client with a dislocated shoulder is being prepared for a closed manual reduction
using conscious sedation. Which medication should the nurse explain as a sedative
used during the procedure?
A. Inhaled nitrous oxide
B. Midazolam IV
C. Ketamine IM
D. Fentanyl and droperidol IM
✦ CORRECT ANSWER: B — Midazolam IV
Midazolam is a short-acting benzodiazepine commonly used for conscious sedation due to its anxiolytic,
amnestic, and sedative properties with rapid onset when given IV. Nitrous oxide is an inhaled anaesthetic.
Ketamine produces dissociative anaesthesia. Fentanyl/droperidol is a neuroleptanalgesic combination.
5. A client is being discharged with a prescription for sulfasalazine to treat ulcerative
colitis. Which instruction should the nurse provide to this client prior to discharge?
A. Maintain good oral hygiene.
B. Take the medication 30 minutes before a meal.
C. Discontinue use of the drug gradually.
D. Drink at least eight glasses of fluid a day.
✦ CORRECT ANSWER: D — Drink at least eight glasses of fluid a day.
Sulfasalazine can cause crystalluria and nephrotoxicity. Adequate hydration (at least 8 glasses of water daily)
maintains high urine output to prevent crystal formation in the renal tubules. The medication should be taken
after meals to reduce GI irritation, not on an empty stomach.
, 6. The health care provider prescribes carbamazepine for a child whose tonic-clonic
seizures have been poorly controlled. The nurse informs the mother that the child
must have blood tests every week. The mother asks why so many blood tests are
necessary. Which complication is assessed through frequent laboratory testing that
the nurse should explain to this mother?
A. Nephrotoxicity
B. Ototoxicity
C. Myelosuppression
D. Hepatotoxicity
✦ CORRECT ANSWER: C — Myelosuppression
Carbamazepine carries a black box warning for serious blood dyscrasias including aplastic anaemia,
leukopenia, and thrombocytopenia. Weekly CBC monitoring is essential, especially during the first months of
therapy. Sore throat, fever, and pallor are signs of developing blood dyscrasia that require immediate
reporting.
7. When developing a written nursing care plan for a client receiving chemotherapy for
treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The
administration of which type of chemotherapeutic agent would prompt the nurse to
add this intervention?
A. Vincristine
B. Bleomycin sulfate
C. Chlorambucil
D. Cyclophosphamide
✦ CORRECT ANSWER: D — Cyclophosphamide
Cyclophosphamide's metabolite acrolein causes haemorrhagic cystitis — a sterile, chemical inflammation of
the bladder wall leading to haematuria. Mesna is administered concurrently to bind acrolein and prevent this
complication. Vigorous hydration and frequent voiding are also protective measures.
