HESI Pharmacology Practice Exam With Answers (354 Solved Questions)

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HESI Pharmacology Exam Practice
QUESTIONS AND ANSWERS GRADED A
LATEST VERSION
A healthcare provider prescribes cephalexin monohydrate
(Keflex) for a client with a postoperative infection. It is most
important for the nurse to assess for what additional drug allergy
before administering this prescription?
A) Penicillins.
B) Aminoglycosides.
C) Erythromycins.
D) Sulfonamides. - CORRECT ANSWERS A) Penicillins.
Cross-allergies exist between penicillins (A) and cephalosporins,
such as cephalexin monohydrate (Keflex), so checking for
penicillin allergy is a wise precaution before administering this
drug.
Which nursing intervention is most important when caring for a
client receiving the antimetabolite cytosine arabinoside (Arc-C) for
chemotherapy?
A) Hydrate the client with IV fluids before and after infusion.
B) Assess the client for numbness and tingling of extremities.
C) Inspect the client's oral mucosa for ulcerations.
D) Monitor the client's urine pH for increased acidity. - CORRECT
ANSWERS C) Inspect the client's oral mucosa for ulcerations.
Cytosine arabinoside (Arc-C) affects the rapidly growing cells of
the body, therefore stomatitis and mucosal ulcerations are key
signs of antimetabolite toxicity (C). (A, B, and D) are not typical
interventions associated with the administration of
antimetabolites.

When assessing an adolescent who recently overdosed on
acetaminophen (Tylenol), it is most important for the nurse to
assess for pain in which area of the body?
A) Flank.
B) Abdomen.
C) Chest.
D) Head. - CORRECT ANSWERS B) Abdomen.
Acetaminophen toxicity can result in liver damage; therefore, it is
especially important for the nurse to assess for pain in the right
upper quadrant of the abdomen (B), which might indicate liver
damage. (A, C, and D) are not areas where pain would be
anticipated.
An adult client is given a prescription for a scopolamine patch
(Transderm Scop) to prevent motion sickness while on a cruise.
Which information should the nurse provide to the client?
A) Apply the patch at least 4 hours prior to departure.
B) Change the patch every other day while on the cruise.
C) Place the patch on a hairless area at the base of the skull.
D) Drink no more than 2 alcoholic drinks during the cruise. -
CORRECT ANSWERS A) Apply the patch at least 4 hours prior
to departure.
Scopolamine, an anticholinergic agent, is used to prevent motion
sickness and has a peak onset in 6 hours, so the client should be
instructed to apply the patch at least 4 hours before departure (A)
on the cruise ship. The duration of the transdermal patch is 72
hours, so (B) is not needed. Scolopamine blocks muscarinic
receptors in the inner ear and to the vomiting center, so the best
application site of the patch is behind the ear, not at the base of
the skull (C). Anticholinergic medications are CNS depressants,
so the client should be instructed to avoid alcohol (D) while using
the patch.

The nurse is reviewing the use of the patient-controlled analgesia
(PCA) pump with a client in the immediate postoperative period.
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 anesthesia used during the surgical procedure.
D) The client's subjective and objective signs of pain. -
CORRECT ANSWERS B) The rate and depth of the client's
respirations.
A life-threatening side effect of intravenous administration of
morphine sulfate, an opiate narcotic, is respiratory depression (B).
The PCA pump should be stopped and the healthcare provider
notified if the client's respiratory rate falls below 12 breaths per
minute, and the nurse should anticipate adjustments in the client's
dosage before the PCA pump is restarted. (A, C, and D) provide
helpful information, but are not as high a priority as the
assessment described in (B).
A medication that is classified as a beta-1 agonist is most
commonly prescribed for a client with which condition?
A) Glaucoma.
B) Hypertension.
C) Heart failure.
D) Asthma. - CORRECT ANSWERS C) Heart failure.
Beta-1 agonists improve cardiac output by increasing the heart
rate and blood pressure and are indicated in heart failure (C),
shock, atrioventricular block dysrhythmias, and cardiac arrest.
Glaucoma (A) is managed using adrenergic agents and beta-
adrenergic blocking agents. Beta-1 blocking agents are used in

the management of hypertension (B). Medications that stimulate
beta-2 receptors in the bronchi are effective for
bronchoconstriction in respiratory disorders, such as asthma (D).
A female client with rheumatoid arthritis take ibuprofen (Motrin)
600 mg PO 4 times a day. To prevent gastrointestinal bleeding,
misoprostol (Cytotec) 100 mcg PO is prescribed. Which
information is most important for the nurse to include in client
teaching?
A) Use contraception during intercourse.
B) Ensure the Cytotec is taken on an empty stomach.
C) Encourage oral fluid intake to prevent constipation.
D) Take Cytotec 30 minutes prior to Motrin. - CORRECT
ANSWERS A) Use contraception during intercourse.
Cytotec, a synthetic form of a prostaglandin, is classified as
pregnancy Category X and can act as an abortifacient, so the
client should be instructed to use contraception during intercourse
(A) to prevent loss of an early pregnancy. (B) is not necessary. A
common side effect of Cytotec is diarrhea, so constipation
prevention strategies are usually not needed (C). Cytotec and
Motrin should be taken together (D) to provide protective
properties against gastrointestinal bleeding.
A client with heart failure is prescribed spironolactone
(Aldactone). Which information is most important for the nurse to
provide to the client about diet modifications?
A) Do not add salt to foods during preparation.
B) Refrain for eating foods high in potassium.
C) Restrict fluid intake to 1000 ml per day.
D) Increase intake of milk and milk products. - CORRECT
ANSWERS B) Refrain for eating foods high in potassium.
Spironolactone (Aldactone), an aldosterone antagonist, is a
potassium-sparing diuretic, so a diet high in potassium should be

avoided (B), including potassium salt substitutes, which can lead
to hyperkalemia. Although (A) is a common diet modification in
heart failure, the risk of hyperkalemia is more important with
Aldactone. Restriction of fluids (C) or increasing milk and milk
products (D) are not indicated with this prescription.
In evaluating the effects of lactulose (Cephulac), which outcome
should indicate that the drug is performing as intended?
A) An increase in urine output.
B) Two or three soft stools per day.
C) Watery, diarrhea stools.
D) Increased serum bilirubin. - CORRECT ANSWERS B) Two
or three soft stools per day.
Lactulose is administered to reduce blood ammonia by excretion
of ammonia through the stool. Two to three stools a day indicate
that lactulose is performing as intended (B). (A) would be
expected if the patient received a diuretic. (C) would indicate an
overdose of lactulose and is not expected. Lactulose does not
affect (D).
The healthcare provider prescribes naproxen (Naproxen) twice
daily for a client with osteoarthritis of the hands. The client tells
the nurse that the drug does not seem to be effective after three
weeks. Which is the best response for the nurse to provide?
A) The frequency of the dosing is necessary to increase the
effectiveness.
B) Therapeutic blood levels of this drug are reached in 4 to 6
weeks.
C) Another type of nonsteroidal antiinflammatory drug may be
indicated.
D) Systemic corticosteroids are the next drugs of choice for pain
relief. - CORRECT ANSWERS C) Another type of nonsteroidal
antiinflammatory drug may be indicated.

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Individual responses to nonsteroidal antiinflammatory drugs are
variable, so (C) is the best response. Naproxen is usually
prescribed every 8 hours, so (A) is not indicated. The peak for
naproxen is one to two hours, not (B). Corticosteroids are not
indicated for osteoarthritis (D).
Which instruction(s) should the nurse give to a female client who
just received a prescription for oral metronidazole (Flagyl) for
treatment of trichomonas vaginalis? (Select all that apply.)
A) Increase fluid intake, especially cranberry juice.
B) Do not abruptly discontinue the medication; taper use.
C) Check blood pressure daily to detect hypertension.
D) Avoid drinking alcohol while taking this medication.
E) Use condoms until treatment is completed.
F) Ensure that all sexual partners are treated at the same time. -
CORRECT ANSWERS A) Increase fluid intake, especially
cranberry juice.
D) Avoid drinking alcohol while taking this medication.
E) Use condoms until treatment is completed.
F) Ensure that all sexual partners are treated at the same time.
Correct selections are (A, D, E, and F). Increased fluid intake and
cranberry juice (A) are recommended for prevention and
treatment of urinary tract infections, which frequently accompany
vaginal infections. It is not necessary to taper use of this drug (B)
or to check the blood pressure daily (C), as this condition is not
related to hypertension. Flagyl can cause a disulfiram-like
reaction if taken in conjunction with ingestion of alcohol, so the
client should be instructed to avoid alcohol (D). All sexual partners
should be treated at the same time (E) and condoms should be
used until after treatment is completed to avoid reinfection (F).
A client receiving albuterol (Proventil) tablets complains of nausea
every evening with her 9 p.m. dose. What action should the nurse
take to alleviate this side effect?

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A) Change the time of the dose.
B) Hold the 9 p.m. dose.
C) Administer the dose with a snack.
D) Administer an antiemetic with the dose. - CORRECT
ANSWERS C) Administer the dose with a snack.
Administering oral doses with food (C) helps minimize GI
discomfort. (A) would be appropriate only if changing the time of
the dose corresponds to meal times while at the same time
maintaining an appropriate time interval between doses. (B)
would disrupt the dosing schedule, and could result in a
nontherapeutic serum level of the medication. (D) should not be
attempted before other interventions, such as (C), have been
proven ineffective in relieving the nausea.
A client receiving Doxorubicin (Adriamycin) intravenously (IV)
complains of pain at the insertion site, and the nurse notes edema
at the site. Which intervention is most important for the nurse to
implement?
A) Assess for erythema.
B) Administer the antidote.
C) Apply warm compresses.
D) Discontinue the IV fluids. - CORRECT ANSWERS D)
Discontinue the IV fluids.
Doxorubicin is an antineoplastic agent that causes inflammation,
blistering, and necrosis of tissue upon extravasation. First, all IV
fluids should be discontinued at the site (D) to prevent further
tissue damage by the vesicant. Erythema is one sign of infiltration
and should be noted, but edema and pain at the infusion site
require stopping the IV fluids (A). Although an antidote may be
available (B), additional fluids contribute to the trauma of the
subcutaneous tissues. Depending on the type of vesicant, warm
or cold compresses (C) may be prescribed after the infusion is
discontinued.

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A client with congestive heart failure (CHF) is being discharged
with a new prescription for the angiotensin-converting enzyme
(ACE) inhibitor captopril (Capoten). The nurse's discharge
instruction should include reporting which problem to the
healthcare provider?
A) Weight loss.
B) Dizziness.
C) Muscle cramps.
D) Dry mucous membranes. - CORRECT ANSWERS B)
Dizziness.
Angiotensin-converting enzyme (ACE) inhibitors are used in CHF
to reduce afterload by reversing vasoconstriction common in heart
failure. This vasodilation can cause hypotension and resultant
dizziness (B). (A) is desired if fluid overload is present, and may
occur as the result of effective combination drug therapy such as
diuretics with ACE inhibitors. (C) often indicates hypokalemia in
the client receiving diuretics. Excessive diuretic administration
may result in fluid volume deficit, manifested by symptoms such
as (D).
The nurse is preparing the 0900 dose of losartan (Cozaar), an
angiotensin II receptor blocker (ARB), for a client with
hypertension and heart failure. The nurse reviews the client's
laboratory results and notes that the client's serum potassium
level is 5.9 mEq/L. What action should the nurse take first?
A) Withhold the scheduled dose.
B) Check the client's apical pulse.
C) Notify the healthcare provider.
D) Repeat the serum potassium level. - CORRECT ANSWERS
A) Withhold the scheduled dose.
The nurse should first withhold the scheduled dose of Cozaar (A)
because the client is hyperkalemic (normal range 3.5 to 5 mEq/L).

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Although hypokalemia is usually associated with diuretic therapy
in heart failure, hyperkalemia is associated with several heart
failure medications, including ARBs. Because hyperkalemia may
lead to cardiac dysrhythmias, the nurse should check the apical
pulse for rate and rhythm (B), and the blood pressure. Before
repeating the serum study (D), the nurse should notify the
healthcare provider (C) of the findings.
The nurse is assessing the effectiveness of high dose aspirin
therapy for an 88-year-old client with arthritis. The client reports
that she can't hear the nurse's questions because her ears are
ringing. What action should the nurse implement?
A) Refer the client to an audiologist for evaluation of her hearing.
B) Advise the client that this is a common side effect of aspirin
therapy.
C) Notify the healthcare provider of this finding immediately.
D) Ask the client to turn off her hearing aid during the exam. -
CORRECT ANSWERS C) Notify the healthcare provider of this
finding immediately.
Tinnitus is an early sign of salicylate toxicity. The healthcare
provider should be notified immediately (C), and the medication
discontinued. (A and D) are not needed, and (B) is inaccurate.
The healthcare provider prescribes digitalis (Digoxin) for a client
diagnosed with congestive heart failure. Which intervention
should the nurse implement prior to administering the digoxin?
A) Observe respiratory rate and depth.
B) Assess the serum potassium level.
C) Obtain the client's blood pressure.
D) Monitor the serum glucose level. - CORRECT ANSWERS B)
Assess the serum potassium level.
Hypokalemia (decreased serum potassium) will precipitate
digitalis toxicity in persons receiving digoxin (B). (A and C) will not

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affect the administration of digoxin. (D) should be monitored if
he/she is a diabetic and is perhaps receiving insulin.
A client who has been taking levodopa PO TID to control the
symptoms of Parkinson's disease has a new prescription for
sustained release levodopa/carbidopa (Sinemet 25/100) PO BID.
The client took his levodopa at 0800. Which instruction should the
nurse include in the teaching plan for this client?
A) Take the first dose of Sinemet today, as soon as your
prescription is filled.
B) Since you already took your levodopa, wait until tomorrow to
take the Sinemet.
C) Take both drugs for the first week, then switch to taking only
the Sinemet.
D) You can begin taking the Sinemet this evening, but do not take
any more levodopa. - CORRECT ANSWERS D) You can begin
taking the Sinemet this evening, but do not take any more
levodopa.
Carbidopa significantly reduces the need for levodopa in clients
with Parkinson's disease, so the new prescription should not be
started until eight hours after the previous dose of levodopa (D),
but can be started the same day (B). (A and C) may result in
toxicity.
A client with a dysrhythmia is to receive procainamide (Pronestyl)
in 4 divided doses over the next 24 hours. What dosing schedule
is best for the nurse to implement?
A) q6h.
B) QID.
C) AC and bedtime.
D) PC and bedtime. - CORRECT ANSWERS A) q6h.
Pronestyl is a class 1A antidysrhythmic. It should be taken
around-the-clock (A) so that a stable blood level of the drug can

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be maintained, thereby decreasing the possibility of hypotension
(an adverse effect) occurring because of too much of the drug
circulating systemically at any particular time of day. (B, C, and D)
do not provide an around-the-clock dosing schedule. Pronestyl
may be given with food if GI distress is a problem, but an around-
the-clock schedule should still be maintained.
A client is receiving ampicillin sodium (Omnipen) for a sinus
infection. The nurse should instruct the client to notify the
healthcare provider immediately if which symptom occurs?
A) Rash.
B) Nausea.
C) Headache.
D) Dizziness. - CORRECT ANSWERS A) Rash.
Rash (A) is the most common adverse effect of all penicillins,
indicating an allergy to the medication which could result in
anaphylactic shock, a medical emergency. (B, C, and D) are
common side effects of penicillins that should subside after the
body adjusts to the medication. These would not require
immediate medical care unless the symptoms persist beyond the
first few days or become extremely severe.
A client is being treated for hyperthyroidism with propylthiouracil
(PTU). The nurse knows that the action of this drug is to
A) decrease the amount of thyroid-stimulating hormone circulating
in the blood.
B) increase the amount of thyroid-stimulating hormone circulating
in the blood.
C) increase the amount of T4 and decrease the amount of T3
produced by the thyroid.
D) inhibit synthesis of T3 and T4 by the thyroid gland. -
CORRECT ANSWERS D) inhibit synthesis of T3 and T4 by the
thyroid gland.

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PTU is an adjunct therapy used to control hyperthyroidism by
inhibiting production of thyroid hormones (D). It is often prescribed
in preparation for thyroidectomy or radioactive iodine therapy.
Thyroid-stimulating hormone (TSH) is produced by the pituitary
gland, and PTU does not affect the pituitary (A and B). PTU
inhibits the synthesis of all thyroid hormones--both T3 and T4(C).
A client has myxedema, which results from a deficiency of thyroid
hormone synthesis in adults. The nurse knows that which
medication should 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
ANSWERS C) Pentobarbital sodium (Nembutal Sodium) for
sleep.
Persons with myxedema are dangerously hypersensitive to
narcotics, barbiturates (C), and anesthetics. They do tolerate
liothyronine (Cytomel) (A) and usually receive iodine replacement
therapy. These clients are also susceptible to heart problems
such as angina for which nitroglycerin (Nitrostat) (D) would be
indicated, and congestive heart failure for which furosemide
(Lasix) (B) would be indicated.
Which change in data indicates to the nurse that the desired
effect of the angiotensin II receptor antagonist valsartan (Diovan)
has been achieved?
A) Dependent edema reduced from +3 to +1.
B) Serum HDL increased from 35 to 55 mg/dl.
C) Pulse rate reduced from 150 to 90 beats/minute.
D) Blood pressure reduced from 160/90 to 130/80. - CORRECT
ANSWERS D) Blood pressure reduced from 160/90 to 130/80.

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Diovan is an angiotensin receptor blocker, prescribed for the
treatment of hypertension. The desired effect is a decrease in
blood pressure (D). (A, B, and C) do not describe effects of
Diovan.
A client is receiving digoxin for the onset of supraventricular
tachycardia (SVT). Which laboratory findings should the nurse
identify that places this client at risk?
A) Hypokalemia.
B) Hyponatremia.
C) Hypercalcemia.
D) Low uric acid levels. - CORRECT ANSWERS A)
Hypokalemia.
Hypokalemia affects myocardial contractility, so (A) places this
client at greatest risk for dysrhythmias that may be unresponsive
to drug therapy. Although an imbalance of serum electrolytes, (B
and C), can effect cardiac rhythm, the greatest risk for the client
receiving digoxin is (A). (D) does not cause any interactions
related to digoxin therapy for supraventricular tachycardia (SVT).
Which dosing schedule should the nurse teach the client to
observe for a controlled-release oxycodone prescription?
A) As needed.
B) Every 12 hours.
C) Every 24 hours.
D) Every 4 to 6 hours. - CORRECT ANSWERS B) Every 12
hours.
A controlled-release oxycodone provides long-acting analgesia to
relieve moderate to severe pain, so a dosing schedule of every 12
hours (B) provides the best around-the-clock pain management.
Controlled-release oxycodone is not prescribed for breakthrough
pain on a PRN or as needed schedule (A). (C) is inadequate for

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continuous pain management. Using a schedule of every 4 to 6
hours (D) may jeopardize patient safety due to cumulative effects.
A postoperative client has been receiving a continuous IV infusion
of meperidine (Demerol) 35 mg/hr for four days. The client has a
PRN prescription for Demerol 100 mg PO q3h. The nurse notes
that the client has become increasingly restless, irritable and
confused, stating that there are bugs all over the walls. What
action should the nurse take first?
A) Administer a PRN dose of the PO meperidine (Demerol).
B) Administer naloxone (Narcan) IV per PRN protocol.
C) Decrease the IV infusion rate of the meperidine (Demerol) per
protocol.
D) Notify the healthcare provider of the client's confusion and
hallucinations. - CORRECT ANSWERS C) Decrease the IV
infusion rate of the meperidine (Demerol) per protocol.
The client is exhibiting symptoms of Demerol toxicity, which is
consistent with the large dose of Demerol received over four
days. (C) is the most effective action to immediately decrease the
amount of serum Demerol. (A) will increase the toxic level of
medication in the bloodstream. Naloxone (B) is an opioid
antagonist that is used during an opioid overdose, but it is not
beneficial during Demerol toxicity and can precipitate seizures.
The healthcare provider should be notified (D), but that is not the
initial action the nurse should take; first the amount of drug
infusing should be decreased.
A client is being treated for osteoporosis with alendronate
(Fosamax), and the nurse has completed discharge teaching
regarding medication administration. Which morning schedule
would indicate to the nurse that the client teaching has been
effective?
A) Take medication, go for a 30 minute morning walk, then eat
breakfast.

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B) Take medication, rest in bed for 30 minutes, eat breakfast, go
for morning walk.
C) Take medication with breakfast, then take a 30 minute morning
walk.
D) Go for a 30 minute morning walk, eat breakfast, then take
medication. - CORRECT ANSWERS A) Take medication, go for
a 30 minute morning walk, then eat breakfast.
Alendronate (Fosamax) is best absorbed when taken thirty
minutes before eating in the morning. The client should also be
advised to remain in an upright position for at least thirty minutes
after taking the medication to reduce the risk of esophageal reflux
and irritation. (A) is the best schedule to meet these needs. (B, C,
and D) do not meet these criteria.
In teaching a client who had a liver transplant about cyclosporine
(Sandimmune), the nurse should encourage the client to report
which adverse response to the healthcare provider?
A) Changes in urine color.
B) Presence of hand tremors.
C) Increasing body hirsutism.
D) Nausea and vomiting. - CORRECT ANSWERS B) Presence
of hand tremors.
Neurological complications, such as hand tremors (B), occur in
about 50% of clients taking cyclosporine and should be reported.
Although this drug can be nephrotoxic, (A) typically does not
occur. (C and D) are common side effects, but are not usually
severe.
While taking a nursing history, the client states, "I am allergic to
penicillin." What related allergy to another type of antiinfective
agent should the nurse ask the client about when taking the
nursing history?
A) Aminoglycosides.

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HESI Pharmacology Practice Exam With Answers (354 Solved Questions)

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