, HESI RN Pharmacology V1-V3 Exam (3 Set Exams) |
Actual Exams with Rationales
Question 1: A patient receiving a continuous infusion of heparin develops a sudden
drop in platelet count from 150,000 to 45,000/mm³. Which pharmacologic intervention
is most appropriate?
A. Administer protamine sulfate intravenously
B. Discontinue heparin and initiate argatroban infusion
C. Increase the heparin infusion rate to achieve therapeutic aPTT
D. Administer vitamin K subcutaneously
Answer: B
Rationale: The scenario describes heparin-induced thrombocytopenia (HIT), an
immune-mediated reaction. Heparin must be stopped immediately, and a direct
thrombin inhibitor like argatroban is indicated. Protamine reverses heparin but does not
treat HIT; vitamin K reverses warfarin .
Question 2: A patient with heart failure is receiving furosemide 40 mg IV twice daily and
digoxin 0.125 mg orally daily. Which laboratory value most warrants immediate nursing
intervention?
A. Serum potassium 3.1 mEq/L
B. Serum digoxin level 0.8 ng/mL
C. Serum magnesium 2.0 mEq/L
D. Serum creatinine 1.0 mg/dL
Answer: A
Rationale: Furosemide causes hypokalemia, which increases the risk of digoxin toxicity
even at therapeutic digoxin levels. A potassium of 3.1 mEq/L is hypokalemic and
requires repletion. Digoxin level 0.8 ng/mL is subtherapeutic; magnesium and creatinine
are normal .
,Question 3: A client taking atorvastatin develops an increased serum creatine
phosphokinase (CK) level. The nurse should assess the client for the onset of which
problem?
A. Muscle tenderness
B. Nausea and vomiting
C. Excessive bruising
D. Peripheral edema
Answer: A
Rationale: Statins (e.g., atorvastatin) can cause myopathy, which may progress to
rhabdomyolysis in severe cases. An elevated CK level often signifies muscle injury.
Muscle tenderness is a hallmark symptom .
Question 4: A nurse is administering IV vancomycin to a patient. The patient reports
sudden onset of flushing, pruritus, and hypotension. Which action should the nurse take
first?
A. Slow the infusion rate and notify the provider
B. Administer diphenhydramine intramuscularly
C. Stop the infusion immediately and assess vital signs
D. Increase the IV fluid rate and monitor for resolution
Answer: C
Rationale: These symptoms suggest Red Man Syndrome, a histamine-mediated infusion
reaction to vancomycin. The priority is to stop the infusion to prevent progression.
Slowing the rate may be done after the reaction is controlled .
Question 5: A patient on warfarin therapy has an INR of 5.8 and is not bleeding. Which
intervention is most appropriate?
A. Administer vitamin K 1 mg orally
B. Administer fresh frozen plasma
C. Hold warfarin and monitor INR daily
D. Administer protamine sulfate
, Answer: C
Rationale: An INR of 5.8 without bleeding indicates excessive anticoagulation. Holding
warfarin and monitoring INR is appropriate. Vitamin K is reserved for higher INR or
bleeding; fresh frozen plasma is for active bleeding; protamine reverses heparin .
Question 6: The nurse administers risedronate at 0700 to a client with osteoporosis. The
client requests milk to drink with the medication. Which action should the nurse take?
A. Instruct the client that only water is permitted with the medication
B. Assign a UAP to bring a glass of low-fat milk
C. Withhold the medication until the client's breakfast arrives
D. Consult with the pharmacist about scheduling the dose one hour after the client eats
Answer: A
Rationale: Risedronate and other bisphosphonates must be taken with plain water on
an empty stomach. Food or other beverages, including milk, interfere with absorption
and increase the risk of esophageal irritation. The client should remain upright for at
least 30 minutes after taking the drug .
Question 7: A patient with bipolar disorder is started on lithium. Which concurrent
condition would most likely increase the risk of lithium toxicity?
A. Hypothyroidism
B. Type 2 diabetes mellitus
C. Heart failure with reduced ejection fraction
D. Chronic obstructive pulmonary disease
Answer: C
Rationale: Lithium is excreted renally; heart failure reduces renal perfusion and
clearance, increasing lithium levels. Hypothyroidism is a side effect of lithium, not a risk
factor for toxicity; diabetes and COPD do not directly affect lithium clearance .
Actual Exams with Rationales
Question 1: A patient receiving a continuous infusion of heparin develops a sudden
drop in platelet count from 150,000 to 45,000/mm³. Which pharmacologic intervention
is most appropriate?
A. Administer protamine sulfate intravenously
B. Discontinue heparin and initiate argatroban infusion
C. Increase the heparin infusion rate to achieve therapeutic aPTT
D. Administer vitamin K subcutaneously
Answer: B
Rationale: The scenario describes heparin-induced thrombocytopenia (HIT), an
immune-mediated reaction. Heparin must be stopped immediately, and a direct
thrombin inhibitor like argatroban is indicated. Protamine reverses heparin but does not
treat HIT; vitamin K reverses warfarin .
Question 2: A patient with heart failure is receiving furosemide 40 mg IV twice daily and
digoxin 0.125 mg orally daily. Which laboratory value most warrants immediate nursing
intervention?
A. Serum potassium 3.1 mEq/L
B. Serum digoxin level 0.8 ng/mL
C. Serum magnesium 2.0 mEq/L
D. Serum creatinine 1.0 mg/dL
Answer: A
Rationale: Furosemide causes hypokalemia, which increases the risk of digoxin toxicity
even at therapeutic digoxin levels. A potassium of 3.1 mEq/L is hypokalemic and
requires repletion. Digoxin level 0.8 ng/mL is subtherapeutic; magnesium and creatinine
are normal .
,Question 3: A client taking atorvastatin develops an increased serum creatine
phosphokinase (CK) level. The nurse should assess the client for the onset of which
problem?
A. Muscle tenderness
B. Nausea and vomiting
C. Excessive bruising
D. Peripheral edema
Answer: A
Rationale: Statins (e.g., atorvastatin) can cause myopathy, which may progress to
rhabdomyolysis in severe cases. An elevated CK level often signifies muscle injury.
Muscle tenderness is a hallmark symptom .
Question 4: A nurse is administering IV vancomycin to a patient. The patient reports
sudden onset of flushing, pruritus, and hypotension. Which action should the nurse take
first?
A. Slow the infusion rate and notify the provider
B. Administer diphenhydramine intramuscularly
C. Stop the infusion immediately and assess vital signs
D. Increase the IV fluid rate and monitor for resolution
Answer: C
Rationale: These symptoms suggest Red Man Syndrome, a histamine-mediated infusion
reaction to vancomycin. The priority is to stop the infusion to prevent progression.
Slowing the rate may be done after the reaction is controlled .
Question 5: A patient on warfarin therapy has an INR of 5.8 and is not bleeding. Which
intervention is most appropriate?
A. Administer vitamin K 1 mg orally
B. Administer fresh frozen plasma
C. Hold warfarin and monitor INR daily
D. Administer protamine sulfate
, Answer: C
Rationale: An INR of 5.8 without bleeding indicates excessive anticoagulation. Holding
warfarin and monitoring INR is appropriate. Vitamin K is reserved for higher INR or
bleeding; fresh frozen plasma is for active bleeding; protamine reverses heparin .
Question 6: The nurse administers risedronate at 0700 to a client with osteoporosis. The
client requests milk to drink with the medication. Which action should the nurse take?
A. Instruct the client that only water is permitted with the medication
B. Assign a UAP to bring a glass of low-fat milk
C. Withhold the medication until the client's breakfast arrives
D. Consult with the pharmacist about scheduling the dose one hour after the client eats
Answer: A
Rationale: Risedronate and other bisphosphonates must be taken with plain water on
an empty stomach. Food or other beverages, including milk, interfere with absorption
and increase the risk of esophageal irritation. The client should remain upright for at
least 30 minutes after taking the drug .
Question 7: A patient with bipolar disorder is started on lithium. Which concurrent
condition would most likely increase the risk of lithium toxicity?
A. Hypothyroidism
B. Type 2 diabetes mellitus
C. Heart failure with reduced ejection fraction
D. Chronic obstructive pulmonary disease
Answer: C
Rationale: Lithium is excreted renally; heart failure reduces renal perfusion and
clearance, increasing lithium levels. Hypothyroidism is a side effect of lithium, not a risk
factor for toxicity; diabetes and COPD do not directly affect lithium clearance .
