BSN 246 PHARMACOLOGY EVOLVE HESI – EXAM
QUESTIONS & VERIFIED ANSWERS, 2025
COMPREHENSIVE STUDY MATERIAL
Which nursing intervention has the highest priority during IV administration of
mechlorethamine HCl and actinomycin?
A. Assess for extravasation at the IV site during infusion.
B. Premedicate with antiemetics 30 to 60 minutes before infusion.
C. Monitor cardiac rate and rhythm during the IV infusion.
D. Check the granulocyte count daily for the presence of neutropenia.
A. Assess for extravasation at the IV site during infusion.
Mechlorethamine HCl and actinomycin are vesicants; therefore, assessment for blister
formation and/or tissue sloughing that can occur with leakage of these agents into
surrounding subcutaneous tissues is essential to ensure client safety during the IV
infusion. Options B, C, and D do not have the priority of option A during the administration
of vesicants.
Which instructions should the nurse provide to an adolescent female client who is
initiating treatment with isotretinoin for acne vulgaris? (Select all that apply.)
A. "Notify the health care provider immediately if you think you are pregnant."
B. "If your acne gets worse, stop the medication and call the health care provider."
C. "Take a daily multiple vitamin to prevent deficiencies and promote dermal healing."
D. "Dermabrasion for deep acne scars should be postponed for 1 month after therapy is
stopped."
,E. "If you begin crying more than usual and feel sad, stop the drug and call the health care
provider."
F. "Before, during, and after therapy, two effective forms of birth control must be used at the
same time."
A, E, F
Isotretinoin has been found to cause pregnancy category D drug-related birth defects,
premature births, and fetal death (A), which necessitates the use of effective birth control
methods before, during, and after therapy (F). Isotretinoin is associated with sadness (E),
depression, suicidal ideations, and other serious mental health problems. An initial
exacerbation of acne (B) is common when starting drug therapy. Isotretinoin is a retinoid
related to vitamin A, and taking additional multivitamin supplements (C) can predispose
the client to vitamin A toxicity. The client should stop taking isotretinoin at least 6 months
before cosmetic procedures, such as dermabrasion (D), because the drug can increase the
chances of scarring.
A client who has chronic back pain is on long-term pain medication management and asks
the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should
the nurse respond?
A. The phenomenon occurs when opiates are used for more than 6 months to relieve pain.
B. Withdrawal occurs if the drug is not tapered slowly while being discontinued.
C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect.
D. A consistent dosage with around-the-clock administration is the most effective.
C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect.
Pharmacodynamic tolerance explains the client's need for an increased drug level to
produce effects that formerly occurred at lower drug levels. Tolerance can occur with
opioids during shorter periods of use. Although a withdrawal syndrome can occur if the
client develops a dependency, this does not address the client's immediate concern of
,drug effectiveness. Although a stable serum drug level provides effective pain
management, the client's complaint is consistent with a tolerance to his current pain
management regimen.
A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor.
She is started on a terbutaline sulfate continuous IV infusion via pump. This therapy is
ineffective, and the baby is delivered vaginally. For which complication should the nurse
monitor in this infant during the first few hours after delivery?
A. Hypokalemia
B. Hypermagnesia
C. Hypoglycemia
D. Hypernatremia
C. Hypoglycemia
Hypoglycemia may occur in the neonate because a side effect of terbutaline sulfate is
increased maternal serum glucose levels. Although monitoring for imbalances in options
A, B, and D is important, option C is the priority following the maternal administration of
terbutaline sulfate.
A client with metastatic cancer who has been receiving fentanyl for several weeks reports
to the nurse that the medication is not effectively controlling the pain. Which intervention
should the nurse initiate?
A. Instruct the client about the indications of opioid dependence.
B. Monitor the client for symptoms of opioid withdrawal.
C. Notify the health care provider of the need to increase the dose.
, D. Administer naloxone per PRN protocol for reversal.
C. Notify the health care provider of the need to increase the dose.
Clients can develop a tolerance to the analgesic effect of opioids and may require an
increased dose for effective long-term pain relief. The client is not exhibiting indications of
dependence, withdrawal, or toxicity.
The charge nurse is reviewing the admission history and physical data for four clients newly
admitted to the unit. Which client is at greatest risk for adverse reactions to medications?
A. 30-year-old man with a fracture
B. 7-year-old child with an ear infection
C. 75-year-old woman with liver disease
D. 50-year-old man with an upper respiratory tract infection
C. 75-year-old woman with liver disease
Impaired hepatic metabolic pathways for drug and chemical degradation place option C at
greatest risk for adverse reactions to medications based on advancing age and liver
disease. Options A and D have no predisposing factors, such as genetics, pathophysiologic
dysfunction, or drug allergies, that would increase the risk for cumulative toxicity or
adverse drug reactions. Option B is at risk for dose-related adverse reactions but is at less
risk than option C.
A client is ordered 22 mg of gentamicin by IM injection. The drug is available in 20 mg/2 mL.
How many milliliters should be administered?
A. 1.8
QUESTIONS & VERIFIED ANSWERS, 2025
COMPREHENSIVE STUDY MATERIAL
Which nursing intervention has the highest priority during IV administration of
mechlorethamine HCl and actinomycin?
A. Assess for extravasation at the IV site during infusion.
B. Premedicate with antiemetics 30 to 60 minutes before infusion.
C. Monitor cardiac rate and rhythm during the IV infusion.
D. Check the granulocyte count daily for the presence of neutropenia.
A. Assess for extravasation at the IV site during infusion.
Mechlorethamine HCl and actinomycin are vesicants; therefore, assessment for blister
formation and/or tissue sloughing that can occur with leakage of these agents into
surrounding subcutaneous tissues is essential to ensure client safety during the IV
infusion. Options B, C, and D do not have the priority of option A during the administration
of vesicants.
Which instructions should the nurse provide to an adolescent female client who is
initiating treatment with isotretinoin for acne vulgaris? (Select all that apply.)
A. "Notify the health care provider immediately if you think you are pregnant."
B. "If your acne gets worse, stop the medication and call the health care provider."
C. "Take a daily multiple vitamin to prevent deficiencies and promote dermal healing."
D. "Dermabrasion for deep acne scars should be postponed for 1 month after therapy is
stopped."
,E. "If you begin crying more than usual and feel sad, stop the drug and call the health care
provider."
F. "Before, during, and after therapy, two effective forms of birth control must be used at the
same time."
A, E, F
Isotretinoin has been found to cause pregnancy category D drug-related birth defects,
premature births, and fetal death (A), which necessitates the use of effective birth control
methods before, during, and after therapy (F). Isotretinoin is associated with sadness (E),
depression, suicidal ideations, and other serious mental health problems. An initial
exacerbation of acne (B) is common when starting drug therapy. Isotretinoin is a retinoid
related to vitamin A, and taking additional multivitamin supplements (C) can predispose
the client to vitamin A toxicity. The client should stop taking isotretinoin at least 6 months
before cosmetic procedures, such as dermabrasion (D), because the drug can increase the
chances of scarring.
A client who has chronic back pain is on long-term pain medication management and asks
the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should
the nurse respond?
A. The phenomenon occurs when opiates are used for more than 6 months to relieve pain.
B. Withdrawal occurs if the drug is not tapered slowly while being discontinued.
C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect.
D. A consistent dosage with around-the-clock administration is the most effective.
C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect.
Pharmacodynamic tolerance explains the client's need for an increased drug level to
produce effects that formerly occurred at lower drug levels. Tolerance can occur with
opioids during shorter periods of use. Although a withdrawal syndrome can occur if the
client develops a dependency, this does not address the client's immediate concern of
,drug effectiveness. Although a stable serum drug level provides effective pain
management, the client's complaint is consistent with a tolerance to his current pain
management regimen.
A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor.
She is started on a terbutaline sulfate continuous IV infusion via pump. This therapy is
ineffective, and the baby is delivered vaginally. For which complication should the nurse
monitor in this infant during the first few hours after delivery?
A. Hypokalemia
B. Hypermagnesia
C. Hypoglycemia
D. Hypernatremia
C. Hypoglycemia
Hypoglycemia may occur in the neonate because a side effect of terbutaline sulfate is
increased maternal serum glucose levels. Although monitoring for imbalances in options
A, B, and D is important, option C is the priority following the maternal administration of
terbutaline sulfate.
A client with metastatic cancer who has been receiving fentanyl for several weeks reports
to the nurse that the medication is not effectively controlling the pain. Which intervention
should the nurse initiate?
A. Instruct the client about the indications of opioid dependence.
B. Monitor the client for symptoms of opioid withdrawal.
C. Notify the health care provider of the need to increase the dose.
, D. Administer naloxone per PRN protocol for reversal.
C. Notify the health care provider of the need to increase the dose.
Clients can develop a tolerance to the analgesic effect of opioids and may require an
increased dose for effective long-term pain relief. The client is not exhibiting indications of
dependence, withdrawal, or toxicity.
The charge nurse is reviewing the admission history and physical data for four clients newly
admitted to the unit. Which client is at greatest risk for adverse reactions to medications?
A. 30-year-old man with a fracture
B. 7-year-old child with an ear infection
C. 75-year-old woman with liver disease
D. 50-year-old man with an upper respiratory tract infection
C. 75-year-old woman with liver disease
Impaired hepatic metabolic pathways for drug and chemical degradation place option C at
greatest risk for adverse reactions to medications based on advancing age and liver
disease. Options A and D have no predisposing factors, such as genetics, pathophysiologic
dysfunction, or drug allergies, that would increase the risk for cumulative toxicity or
adverse drug reactions. Option B is at risk for dose-related adverse reactions but is at less
risk than option C.
A client is ordered 22 mg of gentamicin by IM injection. The drug is available in 20 mg/2 mL.
How many milliliters should be administered?
A. 1.8
