COURSE CODE: Pharmacology HESI Quiz EXAM TIME
COURSE TITLE: Pharmacology — HESI Comprehensive Quiz DATE ALLOWED
Examination —/—/ 120
INSTRUCTOR: — —— Minutes
◇
Pharmacology — HESI
Quiz
Comprehensive Examination — Drug Classes, Safety & Therapeutic Applications
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS (200 Marks)
Choose the single best answer for each question unless "Select All That Apply" is indicated. Write the correct letter(s) in the
space provided.
1. A client states, "I am allergic to penicillin." What related allergy to another type of anti-
infective agent should the nurse ask the client about?
A. Aminoglycosides
B. Cephalosporins
C. Sulfonamides
D. Tetracyclines
✦ CORRECT ANSWER: B — Cephalosporins.
There is documented cross-sensitivity between penicillins and first-generation cephalosporins due to structural
similarity of the beta-lactam ring side chains. Approximately 1–10% of penicillin-allergic clients will also react to
cephalosporins. The cross-reactivity is much lower with third- and fourth-generation cephalosporins.
Aminoglycosides, sulfonamides, and tetracyclines are chemically distinct classes with no cross-sensitivity to
penicillin. The nurse must assess for this potential allergy and communicate it to the provider before cephalosporin
administration.
,2. Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with
which condition?
A. Shock
B. Asthma
C. Hypotension
D. Heart failure
✦ CORRECT ANSWER: D — Heart failure.
Dobutamine is a beta-1 adrenergic agonist that increases myocardial contractility (positive inotrope) with minimal
chronotropic effects. It is indicated for short-term management of cardiac decompensation or heart failure due to
reduced cardiac contractility from organic heart disease or cardiac surgery. Epinephrine and dopamine (alpha and
beta agonists) are used for shock. Terbutaline (beta-2 agonist) is used for asthma. Although dobutamine improves
cardiac output, it is not first-line for hypotension alone.
3. The nurse is reviewing PCA pump use with a postoperative client. The client will receive
morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg
IV maximally per hour. What assessment has the highest priority before initiating the PCA
pump?
A. The expiration date on the morphine syringe in the pump
B. The rate and depth of the client's respirations
C. The type of anaesthesia used during the surgical procedure
D. The client's subjective and objective signs of pain
✦ CORRECT ANSWER: B — The rate and depth of the client's respirations.
The most life-threatening adverse effect of IV morphine is respiratory depression. Using the ABC priority framework,
the nurse must obtain a baseline respiratory rate and depth before initiating the PCA pump. If the respiratory rate is
below 12 breaths per minute, the PCA pump should be withheld and the healthcare provider notified immediately.
While checking expiration date, anaesthesia history, and pain assessment are important, they are secondary to
ensuring respiratory safety before opioid administration begins.
,4. A client has myxoedema from thyroid hormone deficiency. The nurse knows which
medication would be contraindicated for this client?
A. Liothyronine (Cytomel) to replace iodine
B. Furosemide (Lasix) for relief of fluid retention
C. Pentobarbital sodium (Nembutal Sodium) for sleep
D. Nitroglycerin (Nitrostat) for angina pain
✦ CORRECT ANSWER: C — Pentobarbital sodium (Nembutal Sodium) for sleep.
Clients with myxoedema (severe hypothyroidism) are dangerously hypersensitive to central nervous system
depressants including narcotics, barbiturates, and anaesthetics. Even standard doses can cause profound
respiratory depression and coma due to decreased metabolic rate and reduced drug clearance. Pentobarbital, a
barbiturate sedative-hypnotic, is contraindicated. Thyroid replacement (liothyronine) is the treatment for
myxoedema. Furosemide and nitroglycerin do not carry the same CNS sensitivity risk.
5. The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client
receiving an ACE inhibitor. Which action should the nurse implement?
A. Verify both prescriptions with the healthcare provider
B. Report the medication interactions to the nurse manager
C. Hold the ACE inhibitor and give the new prescription
D. Transcribe and send the prescription to the pharmacy
✦ CORRECT ANSWER: A — Verify both prescriptions with the healthcare provider.
The concomitant use of an ACE inhibitor and a potassium-sparing diuretic (spironolactone) creates a significant risk
of life-threatening hyperkalaemia because both drugs independently increase serum potassium — ACE inhibitors by
reducing aldosterone, and spironolactone by blocking aldosterone receptors. The nurse must verify both
prescriptions with the provider to ensure the prescriber is aware of the combination and intends this therapy with
appropriate monitoring. This is the safest action before administering the medication.
, 6. Which method of medication administration provides the client with the greatest first-
pass effect?
A. Oral
B. Sublingual
C. Intravenous
D. Subcutaneous
✦ CORRECT ANSWER: A — Oral.
The first-pass effect is the hepatic metabolism of a drug before it reaches systemic circulation. After oral
administration, the drug is absorbed from the GI tract and transported via the hepatic portal vein directly to the
liver, where a significant portion may be metabolised and inactivated before reaching the general circulation —
reducing bioavailability. Sublingual, IV, and subcutaneous routes bypass the hepatic portal system and thus avoid
the first-pass effect. This is why some drugs (e.g., nitroglycerin) are given sublingually rather than orally.
7. A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally. The
nurse notes the client is allergic to sulfa. Which action is most important for the nurse to
implement prior to administering the first dose?
A. Review the client's haemoglobin results
B. Notify the healthcare provider
C. Inquire about the reaction to sulfa
D. Record the client's vital signs
✦ CORRECT ANSWER: B — Notify the healthcare provider.
Celecoxib contains a sulfonamide moiety and is contraindicated in clients with sulfa allergy due to risk of cross-
hypersensitivity, including Stevens-Johnson syndrome. The nurse must hold the medication and notify the provider
immediately so an alternative non-sulfonamide NSAID or COX-2 inhibitor can be prescribed. While inquiring about
the nature of the allergic reaction (C) is valuable, the priority is to prevent administration of a potentially dangerous
drug by alerting the prescriber first.
COURSE TITLE: Pharmacology — HESI Comprehensive Quiz DATE ALLOWED
Examination —/—/ 120
INSTRUCTOR: — —— Minutes
◇
Pharmacology — HESI
Quiz
Comprehensive Examination — Drug Classes, Safety & Therapeutic Applications
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS (200 Marks)
Choose the single best answer for each question unless "Select All That Apply" is indicated. Write the correct letter(s) in the
space provided.
1. A client states, "I am allergic to penicillin." What related allergy to another type of anti-
infective agent should the nurse ask the client about?
A. Aminoglycosides
B. Cephalosporins
C. Sulfonamides
D. Tetracyclines
✦ CORRECT ANSWER: B — Cephalosporins.
There is documented cross-sensitivity between penicillins and first-generation cephalosporins due to structural
similarity of the beta-lactam ring side chains. Approximately 1–10% of penicillin-allergic clients will also react to
cephalosporins. The cross-reactivity is much lower with third- and fourth-generation cephalosporins.
Aminoglycosides, sulfonamides, and tetracyclines are chemically distinct classes with no cross-sensitivity to
penicillin. The nurse must assess for this potential allergy and communicate it to the provider before cephalosporin
administration.
,2. Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with
which condition?
A. Shock
B. Asthma
C. Hypotension
D. Heart failure
✦ CORRECT ANSWER: D — Heart failure.
Dobutamine is a beta-1 adrenergic agonist that increases myocardial contractility (positive inotrope) with minimal
chronotropic effects. It is indicated for short-term management of cardiac decompensation or heart failure due to
reduced cardiac contractility from organic heart disease or cardiac surgery. Epinephrine and dopamine (alpha and
beta agonists) are used for shock. Terbutaline (beta-2 agonist) is used for asthma. Although dobutamine improves
cardiac output, it is not first-line for hypotension alone.
3. The nurse is reviewing PCA pump use with a postoperative client. The client will receive
morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg
IV maximally per hour. What assessment has the highest priority before initiating the PCA
pump?
A. The expiration date on the morphine syringe in the pump
B. The rate and depth of the client's respirations
C. The type of anaesthesia used during the surgical procedure
D. The client's subjective and objective signs of pain
✦ CORRECT ANSWER: B — The rate and depth of the client's respirations.
The most life-threatening adverse effect of IV morphine is respiratory depression. Using the ABC priority framework,
the nurse must obtain a baseline respiratory rate and depth before initiating the PCA pump. If the respiratory rate is
below 12 breaths per minute, the PCA pump should be withheld and the healthcare provider notified immediately.
While checking expiration date, anaesthesia history, and pain assessment are important, they are secondary to
ensuring respiratory safety before opioid administration begins.
,4. A client has myxoedema from thyroid hormone deficiency. The nurse knows which
medication would be contraindicated for this client?
A. Liothyronine (Cytomel) to replace iodine
B. Furosemide (Lasix) for relief of fluid retention
C. Pentobarbital sodium (Nembutal Sodium) for sleep
D. Nitroglycerin (Nitrostat) for angina pain
✦ CORRECT ANSWER: C — Pentobarbital sodium (Nembutal Sodium) for sleep.
Clients with myxoedema (severe hypothyroidism) are dangerously hypersensitive to central nervous system
depressants including narcotics, barbiturates, and anaesthetics. Even standard doses can cause profound
respiratory depression and coma due to decreased metabolic rate and reduced drug clearance. Pentobarbital, a
barbiturate sedative-hypnotic, is contraindicated. Thyroid replacement (liothyronine) is the treatment for
myxoedema. Furosemide and nitroglycerin do not carry the same CNS sensitivity risk.
5. The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client
receiving an ACE inhibitor. Which action should the nurse implement?
A. Verify both prescriptions with the healthcare provider
B. Report the medication interactions to the nurse manager
C. Hold the ACE inhibitor and give the new prescription
D. Transcribe and send the prescription to the pharmacy
✦ CORRECT ANSWER: A — Verify both prescriptions with the healthcare provider.
The concomitant use of an ACE inhibitor and a potassium-sparing diuretic (spironolactone) creates a significant risk
of life-threatening hyperkalaemia because both drugs independently increase serum potassium — ACE inhibitors by
reducing aldosterone, and spironolactone by blocking aldosterone receptors. The nurse must verify both
prescriptions with the provider to ensure the prescriber is aware of the combination and intends this therapy with
appropriate monitoring. This is the safest action before administering the medication.
, 6. Which method of medication administration provides the client with the greatest first-
pass effect?
A. Oral
B. Sublingual
C. Intravenous
D. Subcutaneous
✦ CORRECT ANSWER: A — Oral.
The first-pass effect is the hepatic metabolism of a drug before it reaches systemic circulation. After oral
administration, the drug is absorbed from the GI tract and transported via the hepatic portal vein directly to the
liver, where a significant portion may be metabolised and inactivated before reaching the general circulation —
reducing bioavailability. Sublingual, IV, and subcutaneous routes bypass the hepatic portal system and thus avoid
the first-pass effect. This is why some drugs (e.g., nitroglycerin) are given sublingually rather than orally.
7. A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally. The
nurse notes the client is allergic to sulfa. Which action is most important for the nurse to
implement prior to administering the first dose?
A. Review the client's haemoglobin results
B. Notify the healthcare provider
C. Inquire about the reaction to sulfa
D. Record the client's vital signs
✦ CORRECT ANSWER: B — Notify the healthcare provider.
Celecoxib contains a sulfonamide moiety and is contraindicated in clients with sulfa allergy due to risk of cross-
hypersensitivity, including Stevens-Johnson syndrome. The nurse must hold the medication and notify the provider
immediately so an alternative non-sulfonamide NSAID or COX-2 inhibitor can be prescribed. While inquiring about
the nature of the allergic reaction (C) is valuable, the priority is to prevent administration of a potentially dangerous
drug by alerting the prescriber first.
