HESI Pharmacology Evolve Exam
1. A 19-year-old male client who has sustained a severe head
injury is in- tubated and placed on assisted mechanical
ventilation. To facilitate optimal ventilation and prevent the
client from "fighting" the ventilator, the health care provider
administers pancuronium bromide IV, with adjunctive opioid
analgesia. What medication should be immediately
accessible for a potential complication with this drug?
A. Dantrolene sodium
B. Neostigmine bromide
C. Succinylcholine bromide
D. Epinephrine: B. Neostigmine bromide
Neostigmine bromide and atropine sulfate, both anticholinergic
drugs, reverse the respiratory muscle paralysis caused by
pancuronium bromide. Options A, C, and D are not antagonists to
pancuronium bromide and would not be helpful in reversing the
effects of the drug compared with the use of anticholinergics.
2. A client with viral influenza is receiving vitamin C, 1000 mg
PO daily, and acetaminophen elixir, 650 mg PO every 4 hours

PRN.The nurse calls the health care provider to report that
the client has developed diarrhea. Which change in
prescriptions should the nurse anticipate?
A. Change the acetaminophen to ibuprofen. B. Change the
elixir to an injectable route. C. Decrease the dose of vitamin
C.
D. Begin treatment with an antibiotic.: C. Decrease the dose of
vitamin C.
3. When providing nursing care for a client receiving
pyridostigmine bromide for myasthenia gravis, which nursing
intervention has the highest priority?
A. Monitor the client frequently for urinary retention.
B. Assess respiratory status and breath sounds often.
C. Monitor blood pressure each shift to screen for
hypertension.
D. Administer most medications after meals to decrease
gastrointestinal irri- tation.: B. Assess respiratory status and
breath sounds often.
4. A client with a dislocated shoulder is being prepared for a
closed manual reduction using conscious sedation. Which

medication should the nurse ex- plain as a sedative used
during the procedure?
A.Inhaled nitrous oxide
B.Midazolam IV
C.Ketamine IM
D.Fentanyl and droperidol IM: B. Midazolam IV
5. A client is being discharged with a prescription for
sulfasalazine to treat ulcerative colitis. Which instruction
should the nurse provide to this client prior to discharge?
A. Maintain good oral hygiene.
B. Take the medication 30 minutes before a meal. C.
Discontinue use of the drug gradually.
D. Drink at least eight glasses of fluid a day.: D. Drink at least
eight glasses of fluid a day.
6. The health care provider prescribes carbamazepine for a
child whose ton- ic-clonic seizures have been poorly
controlled. The nurse informs the mother that the child must
have blood tests every week.The mother asks why so many
blood tests are necessary. Which complication is assessed
through frequent laboratory testing that the nurse should
explain to this mother?

A. Nephrotoxicity
B. Ototoxicity
C. Myelosuppression
D.Hepatotoxicity: C. Myelosuppression
Myelosuppression is the highest priority complication that can
potentially affect clients managed with carbamazepine therapy.
The client requires close monitoring for this condition by weekly
laboratory testing. Hepatic function may be altered, but this
complication does not have as great a potential for occurrence as
option C. Options A and B are not typical complications of
carbamazepine therapy.
7. When developing a written nursing care plan for a client
receiving chemotherapy for treatment of cancer, the nurse
writes, "Assess each voiding for hematuria." The
administration of which type of chemotherapeutic agent
would prompt the nurse to add this intervention?
A. Vincristine
B. Bleomycin sulfate
C. Chlorambucil
D. Cyclophosphamide: D. Cyclophosphamide

Hemorrhagic cystitis is the characteristic adverse reaction of
cyclophosphamide. Administration of options A, B, and C does not
typically cause hemorrhagic cystitis.
8. A client is receiving oral griseofulvin for a persistent tinea
corporis infec- tion. Which response by the client indicates an
accurate understanding of the drug teaching conducted by
the nurse?
A. "I'll wear sunscreen whenever I mow the lawn."
B. "This is the worse bacterial infection I've ever had." C. "I
will need to take the medication for 7 days."
D. "My urine will probably turn brown due to this drug.": A. "I'll
wear sunscreen whenever I mow the lawn."
Photosensitivity is a side effect of griseofulvin, so clients should be
cautioned to wear protective sunscreen during sun exposure.
Options B, C, and D are not accurate statements about side
effects of this medication.
9. A 6-year-old child is admitted to the emergency department
with status epilepticus. His parents report that his seizure
disorder has been managed with phenytoin, 50 mg PO bid,
for the past year. Which drug should the nurse plan to
administer in the emergency department?

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A. Phenytoin
B. Diazepam
C. Phenobarbital
D. Carbamazepine: B. Diazepam
Diazepam is the drug of choice for treatment of status epilepticus.
Options A, C, and D are used for the long-term management of
seizure disorders but are not as useful in the emergency
management of status epilepticus.
10. A client who has trouble swallowing pills intermittently
has been pre- scribed venlafaxine (XR) for depression. The
medication comes in capsule form. What should the nurse
include in the discharge teaching plan for this client?
A. Capsule contents can be sprinkled on pudding or
applesauce. B. Chew the medication thoroughly to enhance
absorption.
C. Take the medication with a large glass of water or juice.
D. Contact the health care provider for another form of
medication.: D. Contact the health care provider for another form
of medication.

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to prevent decomposition of the drug in the acidic pH of the
stomach. The client should notify the health care provider about
the inability to swallow the capsule. This medication should not be
chewed or opened so that the delayed-release, en- teric-coated
granules can remain intact. Water or juice will not affect the
medication.
11. The nurse is preparing to apply a surface anesthetic
agent for a client. Which action should the nurse implement
to reduce the risk of systemic absorption?
A. Apply the anesthetic to mucous membranes. B. Limit the
area of application to inflamed areas.
C. Avoid abraded skin areas when applying the anesthetic.
D. Spread the topical agent over a large surface area.: C.
Avoid abraded skin areas when applying the anesthetic.
To minimize systemic absorption of topical anesthetics, the
anesthetic agent should be applied to the smallest surface area of
intact skin. Application to the mucous membranes poses the
greatest risk of systemic absorption because absorption occurs
more readily through mucous membranes than through the skin.
Inflamed areas generally have an increased blood supply, which
increases the risk of systemic absorption, so option B should be

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avoided. A large surface area increases the amount of topical
drug that is available for transdermal absorption, so the smallest
area should be covered, not option D.
12. A client experiencing dysrhythmias is given quinidine,
300 mg PO every 6 hours. The nurse plans to observe this
client for which common side effect associated with the use
of this medication?
A. Diarrhea
B. Hypothermia
C. Seizures
D. Dysphagia: A. Diarrhea
The most common side effects associated with quinidine therapy
are gastrointestinal complaints, such as diarrhea. Options B, C,
and D are not usually associated with quinidine therapy.
13. The health care provider prescribes the H2 antagonist
famotidine, 20 mg PO in the morning and at bedtime. Which
statement regarding the action of H2 antagonists offers the
correct rationale for administering the medication at
bedtime?

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A. Gastric acid secreted at night is buffered, preventing
pepsin formation. B. Hydrochloric acid secreted during the
night is blocked.
C. The drug relaxes stomach muscles at night to reduce acid.
D. Ingestion of the medication at night offers a sedative
effect, promoting sleep.: B. Hydrochloric acid secreted during
the night is blocked.
H2 antagonists act on the parietal cells to inhibit gastric secretion.
Some gastric secretion occurs all the time, even when the
stomach is empty, unless medications are taken to inhibit this
action. Options C and D are not actions of famotidine. Option A is
the action of antacids. Antacids do not affect healing or prevent
the recurrence of ulcers; they merely provide symptomatic relief.
Knowing the difference between H2 antagonists and antacids is
important when teaching clients.
14. The nurse is preparing to administer the disease-
modifying antirheumatic drug (DMARD) methotrexate to a
client diagnosed with rheumatoid arthritis. Which
intervention is most important to implement prior to
administering this medication?

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A. Assess the client's liver function test results. B. Monitor
the client's intake and output.
C. Have another nurse check the prescription.
D. Assess the client's oral mucosa.: C. Have another nurse check
the prescription.
Double-checking the prescription is an important intervention
because death can occur from an overdose. This medication is
administered weekly and in low doses for rheumatoid arthritis and
should not be confused with administration of the drug as a
chemotherapeutic agent. Options A and B are appropriate
interventions for those who are receiving this drug, but they are not
the most important interventions. Stomatitis is an expected side
effect of this medication.
15. A female client with myasthenia gravis is taking a
cholinesterase inhibitor and asks the nurse what can be done
to remedy her fatigue and difficulty swallowing. What action
should the nurse implement?
A. Explore a plan for development of coping strategies for the
symptoms with the client.
B. Explain to the client that the dosage is too high, so she
should skip every other dose of medication.

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in response to symptoms.: D. Develop a teaching plan for the
client to self-adjust the dose of medication in response to
symptoms.
Maintaining optimal dosage for cholinesterase inhibitors can be
challenging for clients with myasthenia gravis. Clients should be
taught to recognize signs of over- medication and
undermedication so that they can modify the dosage themselves
based on a prescribed sliding scale. Options A, B, and C do not
adequately address the client's concerns.
16. A female client is receiving tetracycline for acne. Which
client teaching should the nurse include?
A. Oral contraceptives may not be effective.
B. Drinking cranberry juice will promote healing. C. Breast
tenderness may occur as a side effect.
D. The urine will turn a red-orange color.: A. Oral
contraceptives may not be effective.
Certain antibiotics, such as tetracycline, decrease the
effectiveness of oral contra- ceptives. Options B, C, and D do not
convey accurate information related to client teaching about this
medication.

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17. A client who is experiencing an acute attack of gouty
arthritis is prescribed colchicine USP, 1 mg PO daily. Which
information is most important for the nurse to provide the
client?
A. Take the medication with meals.
B. Limit fluid intake until the attack subsides.
C. Stop the medication when the pain resolves.
D. Report any vomiting to the clinic.: D. Report any vomiting to
the clinic.
The client should be instructed to report signs of colchicine
toxicity, such as nau- sea, diarrhea, vomiting, and/or abdominal
pain, to the health care provider. Food inhibits the absorption of
colchicine when ingested concurrently. Limited fluid intake
decreases the excretion of the uric acid crystals, which contributes
to painful attacks. Typically, a client should remain on a daily dose of
colchicine to decrease the number and severity of acute attacks,
so stopping the medication after the pain resolves is not indicated.
18. Amoxicillin, 500 mg PO every 8 hours, is prescribed for a
client with an infection. The drug is available in a suspension
of 125 mg/5 mL. How many milliliters should the nurse
administer with each dose?

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A. 10
B. 15
C. 20
D. 25: C. 20
500 mg/x mL = 125 mg/5 mL
125x = 2500 x = 20 mL
19. Methenamine mandelate is prescribed for a client with a
urinary tract infec- tion and renal calculi. Which finding
indicates to the nurse that the medication is effective?
A. The frequency of urinary tract infections decreases. B. The
urine changes color and pain is diminished.
C. The dipstick test changes from +1 to trace.
D. The daily urinary output increases by 10%.: A. The
frequency of urinary tract infections decreases.
Mandelamine is prescribed to acidify the urine, decreasing the
incidence of calcium phosphate calculi and urinary tract infections.
Option B is related to the administra- tion of pyridine. Mandelamine
has no effect on option C or D.

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HESI Pharmacology Evolve Exam With Answers (125 Solved Questions)

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