BSN 315 Pharmacology HESI V4 —
COMPREHENSIVE EXAM QUESTIONS AND
ANSWERS|NEW 2026-2027 UPDATE
Question 1
A patient with postoperative pain receives morphine sulfate 4 mg IV push. Fifteen
minutes later, the nurse notes respiratory rate of 8 breaths/min, pinpoint pupils, and
decreased level of consciousness. What is the FIRST priority nursing action?
A. Apply oxygen at 2L NC and continue monitoring
B. Administer naloxone (Narcan) 0.4-2 mg IV immediately
C. Encourage deep breathing exercises
D. Document findings and notify provider in 30 minutes
Correct Answer: B
Rationale: Respiratory rate of 8 breaths/min with pinpoint pupils after opioid
administration indicates opioid-induced respiratory depression — a medical
emergency. Naloxone (opioid antagonist) 0.4-2 mg IV/IM/IN should be administered
immediately to reverse respiratory depression. Repeat every 2-3 minutes as needed
(max 10 mg). Oxygen alone is insufficient. Deep breathing exercises are ineffective.
Delaying treatment risks respiratory arrest.
Question 2
A patient with chronic cancer pain is prescribed a fentanyl transdermal patch 25
mcg/hr. Which instruction is MOST important for the nurse to provide?
A. Change the patch every 24 hours
B. Apply heat to the patch site to increase absorption
C. Change the patch every 72 hours and avoid applying heat which can cause
overdose
D. Cut the patch in half if the dose needs to be reduced
Correct Answer: C
1
, Rationale: Fentanyl patches are changed every 72 hours (3 days). Heat (heating pads,
hot baths, fever) increases absorption and can cause fatal overdose — patients must
avoid heat exposure over the patch site. Patches should NEVER be cut (alters drug
delivery and can cause rapid release). Fentanyl patches are ONLY for opioid-tolerant
patients (on ≥60 mg oral morphine equivalent daily for ≥1 week).
Question 3
A patient with severe osteoarthritis pain is prescribed tramadol 50 mg PO Q6H PRN.
The nurse should monitor for which adverse effect that is unique to tramadol?
A. Severe constipation
B. Respiratory depression
C. Lowered seizure threshold and serotonin syndrome risk
D. Hepatotoxicity
Correct Answer: C
Rationale: Tramadol is a weak mu-opioid agonist AND a serotonin-norepinephrine
reuptake inhibitor (SNRI). It uniquely lowers the seizure threshold (contraindicated
in seizure disorders) and increases serotonin syndrome risk when combined with
SSRIs, SNRIs, MAOIs, or triptans. While it can cause constipation and respiratory
depression (less than traditional opioids), the seizure and serotonin risks are
distinctive. Hepatotoxicity is not characteristic.
Question 4
A patient with chronic low back pain is prescribed oxycodone 5 mg PO Q4H PRN. After
3 weeks, the patient reports the medication is less effective. The nurse recognizes this
as:
A. Addiction
B. Tolerance
C. Physical dependence
D. Pseudoaddiction
2
COMPREHENSIVE EXAM QUESTIONS AND
ANSWERS|NEW 2026-2027 UPDATE
Question 1
A patient with postoperative pain receives morphine sulfate 4 mg IV push. Fifteen
minutes later, the nurse notes respiratory rate of 8 breaths/min, pinpoint pupils, and
decreased level of consciousness. What is the FIRST priority nursing action?
A. Apply oxygen at 2L NC and continue monitoring
B. Administer naloxone (Narcan) 0.4-2 mg IV immediately
C. Encourage deep breathing exercises
D. Document findings and notify provider in 30 minutes
Correct Answer: B
Rationale: Respiratory rate of 8 breaths/min with pinpoint pupils after opioid
administration indicates opioid-induced respiratory depression — a medical
emergency. Naloxone (opioid antagonist) 0.4-2 mg IV/IM/IN should be administered
immediately to reverse respiratory depression. Repeat every 2-3 minutes as needed
(max 10 mg). Oxygen alone is insufficient. Deep breathing exercises are ineffective.
Delaying treatment risks respiratory arrest.
Question 2
A patient with chronic cancer pain is prescribed a fentanyl transdermal patch 25
mcg/hr. Which instruction is MOST important for the nurse to provide?
A. Change the patch every 24 hours
B. Apply heat to the patch site to increase absorption
C. Change the patch every 72 hours and avoid applying heat which can cause
overdose
D. Cut the patch in half if the dose needs to be reduced
Correct Answer: C
1
, Rationale: Fentanyl patches are changed every 72 hours (3 days). Heat (heating pads,
hot baths, fever) increases absorption and can cause fatal overdose — patients must
avoid heat exposure over the patch site. Patches should NEVER be cut (alters drug
delivery and can cause rapid release). Fentanyl patches are ONLY for opioid-tolerant
patients (on ≥60 mg oral morphine equivalent daily for ≥1 week).
Question 3
A patient with severe osteoarthritis pain is prescribed tramadol 50 mg PO Q6H PRN.
The nurse should monitor for which adverse effect that is unique to tramadol?
A. Severe constipation
B. Respiratory depression
C. Lowered seizure threshold and serotonin syndrome risk
D. Hepatotoxicity
Correct Answer: C
Rationale: Tramadol is a weak mu-opioid agonist AND a serotonin-norepinephrine
reuptake inhibitor (SNRI). It uniquely lowers the seizure threshold (contraindicated
in seizure disorders) and increases serotonin syndrome risk when combined with
SSRIs, SNRIs, MAOIs, or triptans. While it can cause constipation and respiratory
depression (less than traditional opioids), the seizure and serotonin risks are
distinctive. Hepatotoxicity is not characteristic.
Question 4
A patient with chronic low back pain is prescribed oxycodone 5 mg PO Q4H PRN. After
3 weeks, the patient reports the medication is less effective. The nurse recognizes this
as:
A. Addiction
B. Tolerance
C. Physical dependence
D. Pseudoaddiction
2
