PHARMACOLOGY PRACTICE HESI
LATEST UPDATE EXAM WITH
CORRECT ANSWERS AND
RATIONALE
A client calls the clinic and states that she forgot to take her oral contraceptives for the past two
days. Which instruction is best or the nurse to provide to t his client? - ANSWER --A. take
2 pills a day for 2 days and use an alternate method of contraception for 7 days
Rationale: if two pills are missed the client should implement (A).
A 48-year-old client is experiencing a severe anaphylactic reaction to an injection of contrast
media. What pharmacologic agent is of greatest use in this situation? - ANSWER --D.
Epinephrine (Adrenalin)
Rationale: Epinephrine is the drug of choice in treating hypotension and circulatory failure
associated with anaphylaxis because it is a potent vasoconstrictor. An anaphylactic reaction is an
acute systemic hypersensitivity reaction that occurs within minutes of antigen exposure (such as
with contrast material containing iodine) that can result in peripheral vascular collapse.
An emergency department triage nurse is interviewing a female client who has a history of
epilepsy with tonic-clonic seizures controlled by penguin (Dilantin). Which information is most
significant in planning this client's care? - ANSWER --C. she ran out of her medication 4
days ago
,Rationale: abruptly stopping anticonvulsant medications can precipitate seizures or the
development of status epilepticus
The nurse should instruct a client to avoid which product while taking carisoprodol (Soma) for
muscle spasms? - ANSWER --C. alcoholic beverages
Rationale: Soma is a centrally-acting muscle relaxant that can cause CNS depression, and can
have an additive effect when taken with other CNS depressants, such as alcohol.
A resident of a long-term care facility is taking lithium carbonate (Eskalith) to treat bipolar
disorder. Which instruction should the nurse provide to this client's caregivers? -
ANSWER --D. Report symptoms of hypothyroidism such as fatigue and constipation
Rationale: Lithium carbonate (Eskalith) causes hypothyroidism in 1 to 4% of those clients
receiving the medication, so caregivers should assess for signs of hypothyroidism including
fatigue and constipation (early signs) and myxedema or goiter (late symptoms)
A 38-year-old gravid 2 para 2 is diagnosed with bacterial vaginosis 9-months postpartum. A
prescription is written for metronidazole (Flagyl). Which information is most important for the
nurse to obtain from the client before initiating treatment? - ANSWER --C. Method of
infant feeding
Rationale: Flagyl is contraindicated if the woman is breastfeeding because high concentrations
have been found in infants. If flatly must be prescribed, the woman should be instructed to
pump and discard the milk during treatment and for 48 to 72 hours after the last dose.
,The nurse receives a unit of blood from the blood bank for a postoperative client who is
currently in the X-ray department. What action should the nurse implement? - ANSWER --
A. Return the blood to the blood bank for refrigeration within 30 minutes.
Rationale: A blood transfusion should be hung for administration within 30 minutes of its arrival
from the blood bank. If it is not used within this time frame, it must be returned to the blood
bank for refrigeration.
What action should the nurse implement to provide analgesic titration for a client in pain? -
ANSWER --D. Determine the optimal analgesic dosage required that causes the least side
effects
Rationale: No given dosage of an analgesic provides the same level of pain relief for every
patient, and so titration upward or downward is determined based on the client's response, so
that the optimal dosage achieves adequate pain relief with minimal side effects for the client.
What pathophysiological action supports the expected outcome for a client with chronic cancer
pain who is treated with imipramine (Tofranil), a tricyclic antidepressant? - ANSWER --C.
Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at
nerve synapses.
Rationale: Tricyclic antidepressants reduce neuropathic pain due to cancer invasion by blocking
the reuptake of serotonin and norepinephrine in the CNS, and thereby inhibit pain transmission
in the spinal cord dorsal horn, which are part of the deciding pain-modulating system.
A client receives a new prescription for pentazocine (Talwin), a mixed opioid agonist-antagonist,
after an opioid agonist is discontinued. What is the advantage for the client when the are
prescription is implemented? - ANSWER --D. Respiratory depression is less
, Rationale: Mixed agonist-antagonists bind as an agonist at the Kappa receptor and as
antagonists or partial agonists on the mu receptor, which produces less respiratory depression
than opioid agonists that are pure mu agonists.
A client is receiving fentanyl via an epidural infusion. Which side effect should the nurse
anticipate in the first 24 hours of epidural analgesia? - ANSWER --C. Urinary retention
Rationale: Common side effects of epidural opioids include nausea, itching, and urinary
retention, which may require urinary catheterization.
A male client who is in the terminal stage of cancer is cared for at home by his family and
receives a prescription for morphine at a rate to control intractable pain. When the hospice
nurse visits, the client awakens, moans in severe pain, and asks for an increase in the morphine
dosage. After determining the client's respirations are 10 per minute, what is the best action for
the nurse to implement? - ANSWER --A. Titrate the morphine dose upward until the client
has adequate pain relief
Rationale: Tolerance can occur in a client who requires large doses of opioids or intractable pain
management, and an increased titration of the analgesic or an additional drug in the same or a
different classification may provide more effective pain management.
A client with Paget's disease is started on calcitonin (Calcimar) 500 mpg subcutaneously daily.
During the initial treatment, what is the priority nursing action? - ANSWER --D. The
nurse's highest priority is to observe for signs of hypersensitivity, such as skin rash, hives, or
anaphylaxis.
When assessing a client prior to the administration of digoxin (Lanoxin), which data is most
important for the nurse to consider? - ANSWER --C. Irregular apical pulse with a rate of
87.
LATEST UPDATE EXAM WITH
CORRECT ANSWERS AND
RATIONALE
A client calls the clinic and states that she forgot to take her oral contraceptives for the past two
days. Which instruction is best or the nurse to provide to t his client? - ANSWER --A. take
2 pills a day for 2 days and use an alternate method of contraception for 7 days
Rationale: if two pills are missed the client should implement (A).
A 48-year-old client is experiencing a severe anaphylactic reaction to an injection of contrast
media. What pharmacologic agent is of greatest use in this situation? - ANSWER --D.
Epinephrine (Adrenalin)
Rationale: Epinephrine is the drug of choice in treating hypotension and circulatory failure
associated with anaphylaxis because it is a potent vasoconstrictor. An anaphylactic reaction is an
acute systemic hypersensitivity reaction that occurs within minutes of antigen exposure (such as
with contrast material containing iodine) that can result in peripheral vascular collapse.
An emergency department triage nurse is interviewing a female client who has a history of
epilepsy with tonic-clonic seizures controlled by penguin (Dilantin). Which information is most
significant in planning this client's care? - ANSWER --C. she ran out of her medication 4
days ago
,Rationale: abruptly stopping anticonvulsant medications can precipitate seizures or the
development of status epilepticus
The nurse should instruct a client to avoid which product while taking carisoprodol (Soma) for
muscle spasms? - ANSWER --C. alcoholic beverages
Rationale: Soma is a centrally-acting muscle relaxant that can cause CNS depression, and can
have an additive effect when taken with other CNS depressants, such as alcohol.
A resident of a long-term care facility is taking lithium carbonate (Eskalith) to treat bipolar
disorder. Which instruction should the nurse provide to this client's caregivers? -
ANSWER --D. Report symptoms of hypothyroidism such as fatigue and constipation
Rationale: Lithium carbonate (Eskalith) causes hypothyroidism in 1 to 4% of those clients
receiving the medication, so caregivers should assess for signs of hypothyroidism including
fatigue and constipation (early signs) and myxedema or goiter (late symptoms)
A 38-year-old gravid 2 para 2 is diagnosed with bacterial vaginosis 9-months postpartum. A
prescription is written for metronidazole (Flagyl). Which information is most important for the
nurse to obtain from the client before initiating treatment? - ANSWER --C. Method of
infant feeding
Rationale: Flagyl is contraindicated if the woman is breastfeeding because high concentrations
have been found in infants. If flatly must be prescribed, the woman should be instructed to
pump and discard the milk during treatment and for 48 to 72 hours after the last dose.
,The nurse receives a unit of blood from the blood bank for a postoperative client who is
currently in the X-ray department. What action should the nurse implement? - ANSWER --
A. Return the blood to the blood bank for refrigeration within 30 minutes.
Rationale: A blood transfusion should be hung for administration within 30 minutes of its arrival
from the blood bank. If it is not used within this time frame, it must be returned to the blood
bank for refrigeration.
What action should the nurse implement to provide analgesic titration for a client in pain? -
ANSWER --D. Determine the optimal analgesic dosage required that causes the least side
effects
Rationale: No given dosage of an analgesic provides the same level of pain relief for every
patient, and so titration upward or downward is determined based on the client's response, so
that the optimal dosage achieves adequate pain relief with minimal side effects for the client.
What pathophysiological action supports the expected outcome for a client with chronic cancer
pain who is treated with imipramine (Tofranil), a tricyclic antidepressant? - ANSWER --C.
Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at
nerve synapses.
Rationale: Tricyclic antidepressants reduce neuropathic pain due to cancer invasion by blocking
the reuptake of serotonin and norepinephrine in the CNS, and thereby inhibit pain transmission
in the spinal cord dorsal horn, which are part of the deciding pain-modulating system.
A client receives a new prescription for pentazocine (Talwin), a mixed opioid agonist-antagonist,
after an opioid agonist is discontinued. What is the advantage for the client when the are
prescription is implemented? - ANSWER --D. Respiratory depression is less
, Rationale: Mixed agonist-antagonists bind as an agonist at the Kappa receptor and as
antagonists or partial agonists on the mu receptor, which produces less respiratory depression
than opioid agonists that are pure mu agonists.
A client is receiving fentanyl via an epidural infusion. Which side effect should the nurse
anticipate in the first 24 hours of epidural analgesia? - ANSWER --C. Urinary retention
Rationale: Common side effects of epidural opioids include nausea, itching, and urinary
retention, which may require urinary catheterization.
A male client who is in the terminal stage of cancer is cared for at home by his family and
receives a prescription for morphine at a rate to control intractable pain. When the hospice
nurse visits, the client awakens, moans in severe pain, and asks for an increase in the morphine
dosage. After determining the client's respirations are 10 per minute, what is the best action for
the nurse to implement? - ANSWER --A. Titrate the morphine dose upward until the client
has adequate pain relief
Rationale: Tolerance can occur in a client who requires large doses of opioids or intractable pain
management, and an increased titration of the analgesic or an additional drug in the same or a
different classification may provide more effective pain management.
A client with Paget's disease is started on calcitonin (Calcimar) 500 mpg subcutaneously daily.
During the initial treatment, what is the priority nursing action? - ANSWER --D. The
nurse's highest priority is to observe for signs of hypersensitivity, such as skin rash, hives, or
anaphylaxis.
When assessing a client prior to the administration of digoxin (Lanoxin), which data is most
important for the nurse to consider? - ANSWER --C. Irregular apical pulse with a rate of
87.
