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HESI PN NGN PHARMACOLOGY v2 EXAM QUESTIONS AND ANSWERS 2024 UPDATE
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HESI PN NGN PHARMACOLOGY v2 EXAM QUESTIONS AND ANSWERS 2024 UPDATE
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FOR MORE INFO EMAIL ME @ paulwesley692@gmail.comHESI PN NGN PHARMACOLOGY v2 EXAM QUESTIONS AND
ANSWERS 2024 UPDATE
1. What is the action of diltiazem (Cardizem)?
A) Increased heart rate
B) Decreased rate of contraction
C) Liver dysfunction
D) Impaired healing
Answer: B) Decreased rate of contraction
2. Mr Smythe is a 68-year-old gentleman who attends a planned appointment at the hypertension
clinic. He has had a history of hypertension for the last two years, which is managed with
nifedipine slow-release 10mg twice a day and perindopril 8mg daily. The perindopril was increased
from 4mg to 8mg on his last visit to the clinic a month ago, to improve control of his BP. Mr
Smythe also has type 2 diabetes, which is being managed with diet and lifestyle changes. His
presenting complaint is a swollen mouth, which he developed a few days ago. He was seen at the
Accident and Emergency Department and by his GP, who prescribed prednisolone tablets for five
days to reduce the swelling. Mr Smythe was advised that the swelling might be caused by his
tablets, but was not informed which of them were responsible. On examination, Mr Smythe
appears generally well, except for a swollen mouth, and his vital signs are within the normal range.
Blood pressure is assessed manually as 134/80mmHg. However, on further discussion, Mr Smythe
also reveals that he has slight swelling of his penis.
1. Outline the mechanism of action of perindopril.
Inhibition of Angiotensin II Production: Perindopril inhibits the ACE enzyme, which
converts angiotensin I to angiotensin II, a potent vasoconstrictor. This results in
vasodilation and a decrease in blood pressure.
Reduction of Aldosterone Secretion: By decreasing angiotensin II levels, perindopril
also reduces the secretion of aldosterone, leading to decreased sodium and water
retention, which further lowers blood pressure.
Improved Cardiac Output: The reduction in vascular resistance decreases the workload
on the heart and improves cardiac output, which is beneficial for patients with
hypertension and heart failure.
2. List the adverse effects of perindopril. What do you think could be the cause of Mr Smythe’s
swollen mouth and penis?
Cough: A dry, persistent cough is a well-known side effect of ACE inhibitors.
Hyperkalemia: Elevated potassium levels can occur due to reduced aldosterone
secretion.
Angioedema: This is a potentially serious reaction characterized by swelling, often of
the face, lips, or throat.
Hypotension: Particularly after the first dose or in patients who are volume-depleted.
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Renal Dysfunction: Changes in renal function, particularly in patients with pre-existing
renal issues.
3. What adjustments do you think the clinical nurse specialist and cardiologist will make to Mr
Smythe’s drug regime?
Discontinue Perindopril: Due to the likelihood of angioedema, the use of perindopril
should be stopped immediately.
Consider Alternative Antihypertensive: An alternative antihypertensive medication that
does not belong to the ACE inhibitor class should be prescribed.
Monitor and Evaluate: Close monitoring of Mr. Smythe’s blood pressure and renal
function after changing the medication will be important to ensure effective
management of his hypertension and to prevent any further complications.
3.What is crucial for a client with tuberculosis regarding drug therapy?
A) Drug therapy can be stopped after 1 month if symptoms improve
B) Requires compliance for 6 to 12 months
C) Only necessary for severe symptoms
D) Taken only when feeling unwell
Answer: B) Requires compliance for 6 to 12 months
4 How long should the antibiotics be taken for an upper respiratory infection?
A) Only when feeling unwell
B) Until all of the prescription is taken
C) Reduce dosage after a few days
D) Stop as soon as symptoms improve
Answer: B) Until all of the prescription is taken
5. What should a client with thrombocytopenia be instructed to do?
A) Use a soft toothbrush
B) Shave with a razor
C) Report sexual function issues
D) Rise quickly when standing
Answer: A) Use a soft toothbrush
6. What is the time frame for self-administration of lispro insulin?
A) 30 minutes before a meal
B) Immediately after a meal
C) Only when hypoglycemic
D) Within 15 minutes of beginning a meal
Answer: D) Within 15 minutes of beginning a meal
7. Which finding should be reported before prescribing celecoxib (Celebrex)?
A) Fatigue
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B) Dehydration
C) Peptic-ulcer disease
D) Gastric bleeding
Answer: C) Peptic-ulcer disease
8. What should the nurse ask to determine the effectiveness of phenazopyridine (Pyridium)?
A) Any new symptoms since starting?
B) Stopped due to side effects?
C) Changes in urine unrelated to the medication?
D) Relief from urinary pain, burning, or urgency?
Answer: D) Relief from urinary pain, burning, or urgency?
9.What should the nurse monitor for a client after a baclofen overdose?
A) Vital signs
B) Signs of respiratory arrest
C) Cardiac rhythm
D) Level of consciousness
Answer: B) Signs of respiratory arrest
10. Mr O’Connor is a 62-year-old man who loves walking. He comes to the rapid chest pain clinic
with a four-week history of breathlessness, brought on by walking uphill. He has noticed that he is
becoming short of breath even walking on a flat surface after 1 or 2 miles. Mr O’Connor has
experienced no chest pain either on exertion or at rest. He has a past medical history of type 2
diabetes, hypertension and cholesterol of 5.0mmol/l. His current medication is simvastatin 40mg
nocte, metformin 500mg tds, aspirin 75mg daily and Lantus insulin 39 units daily. On examination,
he appears well, with no shortness of breath (SOB), chest clear, heart sounds – early systolic
murmur (ESM), no peripheral oedema, pulse rate 81bpm, BP 156/86 mmHg and his ECG
demonstrated normal sinus rhythm.
1.Based on Mr O’Connor’s history, what diagnosis would you suspect?
Given Mr. O’Connor's symptoms of breathlessness that has progressed from walking uphill to
walking on flat surfaces, combined with his past medical history of diabetes, hypertension, and
hyperlipidemia, the most likely diagnosis is heart failure, potentially related to diastolic
dysfunction or ischemic heart disease. The early systolic murmur could suggest some degree of left
ventricular dysfunction. His lack of chest pain might suggest a less typical presentation, but heart
failure is a strong consideration, especially in the context of his risk factors.
2. Suggest a pharmacological management plan for Mr O’Connor based on the above case study
Diuretics: If there is evidence of fluid overload or heart failure, a loop diuretic (e.g.,
furosemide) can be initiated to help manage fluid retention and breathlessness.
ACE Inhibitor or ARB: To help manage hypertension and provide renal protection, an ACE
inhibitor (e.g., lisinopril) or an angiotensin receptor blocker (e.g., losartan) could be added.
This will also help reduce the workload on the heart.
Beta-Blocker: Consider adding a beta-blocker (e.g., bisoprolol or carvedilol) to help
manage heart rate and improve cardiac output in heart failure.
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