HESI Pharmacology Final Practice Exam 2024
[Actual Questions] Most Tested & Verified
Answers | Guaranteed A+
SECTION 1 – PHARMACOLOGICAL FUNDAMENTALS
20 questions × 2 marks = 40 marks
1. A new anti-arrhythmic has an onset of 2 min after IV push, a peak of 5 min, and duration of
30 min. These data best describe which pharmacokinetic parameter?
A. Half-life
B. Bioavailability
C. Therapeutic index
D. Time-action profile
Answer: D – Time-action profile integrates onset, peak, and duration; half-life (A) governs time
to steady-state; bioavailability (B) is the fraction that reaches circulation; therapeutic index
(C) is LD50/ED50.
2. A 72-kg patient receives 4 mg IV morphine (high hepatic-extraction drug). If hepatic blood
flow suddenly falls 50 %, the nurse should expect:
A. Increased oral first-pass but unchanged IV clearance
B. Decreased IV clearance and prolonged half-life
C. Increased protein binding and higher free drug
D. No change because IV avoids the liver
Answer: B – High-extraction drugs are flow-dependent; reduced hepatic flow decreases
clearance and lengthens half-life even when given IV.
3. Which cytochrome P450 isoenzyme is chiefly responsible for metabolising clopidogrel to its
active form?
A. CYP2D6
B. CYP3A4
C. CYP2C19
D. CYP1A2
Answer: C – 2C19 converts the pro-drug; poor metabolisers have higher stent-thrombosis
risk.
4. A patient takes phenelzine (MAOI) and develops a sudden occipital headache, palpitations,
and BP 210/110 mmHg after eating aged cheese. The nurse recognises:
A. Disulfiram reaction
B. Serotonin syndrome
C. Tyramine-induced hypertensive crisis
D. Neuroleptic malignant syndrome
Answer: C – Tyramine displaces norepinephrine in MAOI-treated patients.
, 5. A pharmacist prepares a paediatric digoxin elixir 50 mcg/mL. The label states concentration
is ±5 %. This variance is best described as:
A. Bioequivalence
B. Pharmaceutical equivalence
C. Therapeutic equivalence
D. Potency standard
Answer: B – Pharmaceutical equivalence = same active, dose, route, ± allowed potency
variance.
6. A nurse discovers that a 09:00 dose of metformin was omitted yesterday. Which action
follows the 2024 ISMP “omit-dose” guideline?
A. Give double dose now to “catch up”
B. Document and notify prescriber only if >24 h elapsed
C. Do NOT give the missed dose; document and inform prescriber
D. Give the dose if next scheduled dose is ≥6 h away
Answer: C – Never double-up; chronic meds omitted >12–24 h need prescriber evaluation.
7. The recommended colour-tray system for high-alert medications (2024 Joint Commission)
includes:
A. Yellow tray + red tall-man label
B. Orange lock-box + barcode scanning
C. Red tray + independent double-check
D. Blue label + auxiliary “high-alert” sticker
Answer: C – Red tray + IDC is the 2024 best-practice for IV high-alert meds.
8. Which factor most increases bioavailability of oral furosemide?
A. Taking with food
B. Concurrent ibuprofen
C. Right-sided heart failure
D. Acute pulmonary oedema
Answer: C – Gut oedema in RSHF slows absorption and decreases bioavailability; once
oedema resolves, bioavailability ↑.
9. A drug has Vd = 180 L, half-life 12 h. Approximately what loading dose is needed to achieve 4
mg/L in a 70-kg adult?
A. 280 mg
B. 520 mg
C. 720 mg
D. 960 mg
Answer: C – LD = Vd × Cp = 180 L × 4 mg/L = 720 mg.
10. The nurse is preparing insulin aspart and insulin glargine in the same syringe. Which
statement is correct for 2024?
A. Draw glargine first, then aspart
B. Do NOT mix; give separate injections
C. Mix only if patient agrees
D. Draw aspart first, then glargine
Answer: B – 2024 ADA/ISMP still prohibits mixing glargine with any other insulin.
[Actual Questions] Most Tested & Verified
Answers | Guaranteed A+
SECTION 1 – PHARMACOLOGICAL FUNDAMENTALS
20 questions × 2 marks = 40 marks
1. A new anti-arrhythmic has an onset of 2 min after IV push, a peak of 5 min, and duration of
30 min. These data best describe which pharmacokinetic parameter?
A. Half-life
B. Bioavailability
C. Therapeutic index
D. Time-action profile
Answer: D – Time-action profile integrates onset, peak, and duration; half-life (A) governs time
to steady-state; bioavailability (B) is the fraction that reaches circulation; therapeutic index
(C) is LD50/ED50.
2. A 72-kg patient receives 4 mg IV morphine (high hepatic-extraction drug). If hepatic blood
flow suddenly falls 50 %, the nurse should expect:
A. Increased oral first-pass but unchanged IV clearance
B. Decreased IV clearance and prolonged half-life
C. Increased protein binding and higher free drug
D. No change because IV avoids the liver
Answer: B – High-extraction drugs are flow-dependent; reduced hepatic flow decreases
clearance and lengthens half-life even when given IV.
3. Which cytochrome P450 isoenzyme is chiefly responsible for metabolising clopidogrel to its
active form?
A. CYP2D6
B. CYP3A4
C. CYP2C19
D. CYP1A2
Answer: C – 2C19 converts the pro-drug; poor metabolisers have higher stent-thrombosis
risk.
4. A patient takes phenelzine (MAOI) and develops a sudden occipital headache, palpitations,
and BP 210/110 mmHg after eating aged cheese. The nurse recognises:
A. Disulfiram reaction
B. Serotonin syndrome
C. Tyramine-induced hypertensive crisis
D. Neuroleptic malignant syndrome
Answer: C – Tyramine displaces norepinephrine in MAOI-treated patients.
, 5. A pharmacist prepares a paediatric digoxin elixir 50 mcg/mL. The label states concentration
is ±5 %. This variance is best described as:
A. Bioequivalence
B. Pharmaceutical equivalence
C. Therapeutic equivalence
D. Potency standard
Answer: B – Pharmaceutical equivalence = same active, dose, route, ± allowed potency
variance.
6. A nurse discovers that a 09:00 dose of metformin was omitted yesterday. Which action
follows the 2024 ISMP “omit-dose” guideline?
A. Give double dose now to “catch up”
B. Document and notify prescriber only if >24 h elapsed
C. Do NOT give the missed dose; document and inform prescriber
D. Give the dose if next scheduled dose is ≥6 h away
Answer: C – Never double-up; chronic meds omitted >12–24 h need prescriber evaluation.
7. The recommended colour-tray system for high-alert medications (2024 Joint Commission)
includes:
A. Yellow tray + red tall-man label
B. Orange lock-box + barcode scanning
C. Red tray + independent double-check
D. Blue label + auxiliary “high-alert” sticker
Answer: C – Red tray + IDC is the 2024 best-practice for IV high-alert meds.
8. Which factor most increases bioavailability of oral furosemide?
A. Taking with food
B. Concurrent ibuprofen
C. Right-sided heart failure
D. Acute pulmonary oedema
Answer: C – Gut oedema in RSHF slows absorption and decreases bioavailability; once
oedema resolves, bioavailability ↑.
9. A drug has Vd = 180 L, half-life 12 h. Approximately what loading dose is needed to achieve 4
mg/L in a 70-kg adult?
A. 280 mg
B. 520 mg
C. 720 mg
D. 960 mg
Answer: C – LD = Vd × Cp = 180 L × 4 mg/L = 720 mg.
10. The nurse is preparing insulin aspart and insulin glargine in the same syringe. Which
statement is correct for 2024?
A. Draw glargine first, then aspart
B. Do NOT mix; give separate injections
C. Mix only if patient agrees
D. Draw aspart first, then glargine
Answer: B – 2024 ADA/ISMP still prohibits mixing glargine with any other insulin.
