Page 1 of 46
HESI PHARMACOLOGY PRACTICE TEST ASSESSMENT WITH VERIFIED ANSWERS
AND RATIONALES 2026
What pathophysiological action supports the expected outcome for a
client with chronic cancer pain who is treated with imipramine
(Tofranil), a tricyclic antidepressant?
Increases pain threshold by stimulating opiate receptors in the CNS to release of
endogenous enkephalins.
Decreases perception of pain by blocking opiate receptors in the brain and
descending inhibitory nerves.
Decreases transmission of pain impulses by altering serotonin and
norepinephrine activity at nerve synapses.
Increases pain tolerance through relief of depression by increasing the amounts
of norepinephrine in the brain.
Rationale
Tricyclic antidepressants reduce neuropathic pain due to cancer invasion by blocking the reuptake of
serotonin and norepinephrine in the CNS, and thereby inhibit pain transmission in the spinal cord dorsal
horn, which are part of the descending pain-modulating system.
, Page 2 of 46
A 48-year-old client is experiencing a severe anaphylactic reaction to an
injection of contrast media. What pharmacologic agent is of greatest use
in this situation?
Dopamine (Intropin).
Loratadine (Claritin).
Nitroprusside (Nipride).
Epinephrine (Adrenalin).
Rationale
Epinephrine is the drug of choice in treating hypotension and circulatory failure associated with
anaphylaxis because it is a potent vasoconstrictor. An anaphylactic reaction is an acute systemic
hypersensitivity reaction that occurs within minutes of antigen exposure (such as with contrast material
containing iodine) that can result in peripheral vascular collapse.
What teaching should the nurse provide a client who has received a new
prescription for sildenafil (Viagra)? (Select all that apply.)
Select all that apply
, Page 3 of 46
Frequent use can lead to the development of hypertension.
Most effective if taken after at least 6 hours of REM sleep.
Take within 30 to 60 minutes of sexual stimulation.
Report rebound priapism that occurs for 4 hours or more.
Can cause facial flushing and headache.
Rationale
Sildenafil (Viagra) enhances the natural response to sexual stimuli, so a client should be instructed to
take Viagra within 30 to 60 minutes before sexual intercourse to provide adequate time to enhance
penile erection. Sildenafil does not cause erection directly, but priapism can occur and should be
reported to the healthcare provider if it persists. Common side effects include headaches, facial flushing,
and diarrhea. Viagra can potentiate vasodilators, such as alpha-adrenergic blockers, nitroglycerin, and
other nitrates used for angina pectoris, and may cause hypotension, which decreases perfusion to vital
organs.
A client is receiving fentanyl via an epidural infusion. Which side effect
should the nurse anticipate in the first 24 hours of epidural analgesia?
Headache.
Agitation.
Urinary retention.
Abdominal cramping and diarrhea.
, Page 4 of 46
Rationale
Anticipated common side effects of epidural opioids include nausea, itching, and urinary retention which
may require urinary catheterization.
A client with chronic schizophrenia illness is admitted after taking
risperidone (Risperdal) 10 mg/day for three months. The nurse
implements a daily assessment using the Abnormal Involuntary
Movement Scale (AIMS). What findings should the nurse report to
the healthcare provider?
Cogwheel rigidity.
Drowsiness and dizziness.
Tremors and muscle twitching.
Dry mouth, constipation, and blurred vision.
Rationale
For a client with chronic mental illness, evidence-based pharmacological guidelines recommend first-line
treatment using an atypical antipsychotic, such as risperidone (Risperdal), which can cause
extrapyramidal symptoms (EPS) at dosages above 10 mg/day. The AIMS criteria measures tardive
dyskinesia movements, such as facial, oral, tongue, teeth, and other akinesias of the trunk and
extremity, such as tremors and muscle twitching, which should be reported.
A client with depression receives a prescription for amitriptyline (Elavil).
HESI PHARMACOLOGY PRACTICE TEST ASSESSMENT WITH VERIFIED ANSWERS
AND RATIONALES 2026
What pathophysiological action supports the expected outcome for a
client with chronic cancer pain who is treated with imipramine
(Tofranil), a tricyclic antidepressant?
Increases pain threshold by stimulating opiate receptors in the CNS to release of
endogenous enkephalins.
Decreases perception of pain by blocking opiate receptors in the brain and
descending inhibitory nerves.
Decreases transmission of pain impulses by altering serotonin and
norepinephrine activity at nerve synapses.
Increases pain tolerance through relief of depression by increasing the amounts
of norepinephrine in the brain.
Rationale
Tricyclic antidepressants reduce neuropathic pain due to cancer invasion by blocking the reuptake of
serotonin and norepinephrine in the CNS, and thereby inhibit pain transmission in the spinal cord dorsal
horn, which are part of the descending pain-modulating system.
, Page 2 of 46
A 48-year-old client is experiencing a severe anaphylactic reaction to an
injection of contrast media. What pharmacologic agent is of greatest use
in this situation?
Dopamine (Intropin).
Loratadine (Claritin).
Nitroprusside (Nipride).
Epinephrine (Adrenalin).
Rationale
Epinephrine is the drug of choice in treating hypotension and circulatory failure associated with
anaphylaxis because it is a potent vasoconstrictor. An anaphylactic reaction is an acute systemic
hypersensitivity reaction that occurs within minutes of antigen exposure (such as with contrast material
containing iodine) that can result in peripheral vascular collapse.
What teaching should the nurse provide a client who has received a new
prescription for sildenafil (Viagra)? (Select all that apply.)
Select all that apply
, Page 3 of 46
Frequent use can lead to the development of hypertension.
Most effective if taken after at least 6 hours of REM sleep.
Take within 30 to 60 minutes of sexual stimulation.
Report rebound priapism that occurs for 4 hours or more.
Can cause facial flushing and headache.
Rationale
Sildenafil (Viagra) enhances the natural response to sexual stimuli, so a client should be instructed to
take Viagra within 30 to 60 minutes before sexual intercourse to provide adequate time to enhance
penile erection. Sildenafil does not cause erection directly, but priapism can occur and should be
reported to the healthcare provider if it persists. Common side effects include headaches, facial flushing,
and diarrhea. Viagra can potentiate vasodilators, such as alpha-adrenergic blockers, nitroglycerin, and
other nitrates used for angina pectoris, and may cause hypotension, which decreases perfusion to vital
organs.
A client is receiving fentanyl via an epidural infusion. Which side effect
should the nurse anticipate in the first 24 hours of epidural analgesia?
Headache.
Agitation.
Urinary retention.
Abdominal cramping and diarrhea.
, Page 4 of 46
Rationale
Anticipated common side effects of epidural opioids include nausea, itching, and urinary retention which
may require urinary catheterization.
A client with chronic schizophrenia illness is admitted after taking
risperidone (Risperdal) 10 mg/day for three months. The nurse
implements a daily assessment using the Abnormal Involuntary
Movement Scale (AIMS). What findings should the nurse report to
the healthcare provider?
Cogwheel rigidity.
Drowsiness and dizziness.
Tremors and muscle twitching.
Dry mouth, constipation, and blurred vision.
Rationale
For a client with chronic mental illness, evidence-based pharmacological guidelines recommend first-line
treatment using an atypical antipsychotic, such as risperidone (Risperdal), which can cause
extrapyramidal symptoms (EPS) at dosages above 10 mg/day. The AIMS criteria measures tardive
dyskinesia movements, such as facial, oral, tongue, teeth, and other akinesias of the trunk and
extremity, such as tremors and muscle twitching, which should be reported.
A client with depression receives a prescription for amitriptyline (Elavil).
