BSN 315 HESI Pharmacology II Exam - 3
Versions,| Nightingale College
Actual Questions & Verified Answers | Complete with
Rationales
1. A client with heart failure is prescribed carvedilol. Which assessment
finding indicates the medication is having the desired therapeutic
effect?
A) Heart rate 52 beats/min
B) Decreased shortness of breath and improved exercise tolerance
C) Blood pressure 148/90 mmHg
D) Weight gain of 2 kg in 3 days
Rationale: Carvedilol is a beta-blocker used in heart failure to reduce cardiac
workload and improve outcomes. Desired effects include decreased shortness
of breath, improved exercise tolerance, and reduced hospitalizations. Weight
gain and hypertension indicate worsening heart failure.
2. A patient is receiving IV potassium chloride. Which assessment
finding requires immediate intervention?
A) Serum potassium 3.8 mEq/L
B) Complaint of burning pain at the IV site
C) Urine output 40 mL/hr
D) Heart rate 82 beats/min
Rationale: IV potassium is irritating to veins and can cause phlebitis or tissue
necrosis if extravasation occurs. Burning pain at the IV site requires
,immediate assessment and possibly repositioning or stopping the infusion.
Potassium should never be given IV push.
3. A client prescribed hydralazine for severe hypertension should be
monitored for which adverse effect?
A) Bradycardia
B) Reflex tachycardia and fluid retention
C) Hypoglycemia
D) Bronchospasm
Rationale: Hydralazine is a direct vasodilator that can cause reflex
tachycardia and sodium/fluid retention. It is often prescribed with a beta-
blocker and diuretic to counteract these effects. It does not cause
hypoglycemia or bronchospasm.
4. A patient on SSRIs (fluoxetine) is started on phenelzine (MAOI). The
nurse should monitor for which life-threatening syndrome?
A) Neuroleptic malignant syndrome
B) Serotonin syndrome
C) Tardive dyskinesia
D) Malignant hyperthermia
Rationale: Combining SSRIs with MAOIs can cause serotonin syndrome,
characterized by agitation, confusion, hyperthermia, diaphoresis,
hyperreflexia, and rigidity. This combination is contraindicated; a washout
period of at least 14 days is required between these medications.
,5. A client is prescribed ondansetron for chemotherapy-induced
nausea. Which finding indicates the medication is effective?
A) Decreased pain
B) Decreased nausea and vomiting
C) Increased appetite
D) Decreased anxiety
Rationale: Ondansetron is a 5-HT3 receptor antagonist used to prevent
nausea and vomiting. Decreased nausea and vomiting indicates effectiveness.
It does not treat pain, anxiety, or directly increase appetite.
6. A patient is prescribed digoxin and furosemide concurrently. The
nurse should monitor for which complication?
A) Digoxin toxicity due to hypokalemia from furosemide
B) Hyperkalemia
C) Hypotension
D) Weight loss
Rationale: Furosemide causes potassium loss (hypokalemia). Hypokalemia
increases the risk of digoxin toxicity by enhancing its effects on the heart.
Serum potassium and digoxin levels should be monitored closely.
7. A client is prescribed tamsulosin for benign prostatic hyperplasia
(BPH). Which adverse effect should the nurse include in teaching?
A) Hypertension
B) Orthostatic hypotension
C) Tachycardia
D) Hyperglycemia
, Rationale: Tamsulosin is an alpha-1 blocker that can cause orthostatic
hypotension. Clients should be advised to rise slowly from sitting or lying
positions. It is not a beta-blocker, so tachycardia is not a primary concern.
8. A patient receiving vancomycin IV has a trough level of 25 mcg/mL.
Which action should the nurse take?
A) Administer the next dose as scheduled
B) Hold the next dose and notify the healthcare provider
C) Increase the infusion rate
D) Decrease the dose by half
Rationale: Therapeutic vancomycin trough levels are typically 10-20 mcg/mL
for most infections (15-20 for complicated infections). A level of 25 mcg/mL is
elevated and increases the risk of nephrotoxicity. The dose should be held,
and the provider notified.
9. A client prescribed carbamazepine should be monitored for which
serious adverse effect?
A) Weight gain
B) Bone marrow suppression
C) Hyperglycemia
D) Bradycardia
Rationale: Carbamazepine can cause bone marrow suppression (leukopenia,
thrombocytopenia, aplastic anemia) and hepatotoxicity. CBC and liver
function tests should be monitored regularly. Weight gain is common but not
the priority.
Versions,| Nightingale College
Actual Questions & Verified Answers | Complete with
Rationales
1. A client with heart failure is prescribed carvedilol. Which assessment
finding indicates the medication is having the desired therapeutic
effect?
A) Heart rate 52 beats/min
B) Decreased shortness of breath and improved exercise tolerance
C) Blood pressure 148/90 mmHg
D) Weight gain of 2 kg in 3 days
Rationale: Carvedilol is a beta-blocker used in heart failure to reduce cardiac
workload and improve outcomes. Desired effects include decreased shortness
of breath, improved exercise tolerance, and reduced hospitalizations. Weight
gain and hypertension indicate worsening heart failure.
2. A patient is receiving IV potassium chloride. Which assessment
finding requires immediate intervention?
A) Serum potassium 3.8 mEq/L
B) Complaint of burning pain at the IV site
C) Urine output 40 mL/hr
D) Heart rate 82 beats/min
Rationale: IV potassium is irritating to veins and can cause phlebitis or tissue
necrosis if extravasation occurs. Burning pain at the IV site requires
,immediate assessment and possibly repositioning or stopping the infusion.
Potassium should never be given IV push.
3. A client prescribed hydralazine for severe hypertension should be
monitored for which adverse effect?
A) Bradycardia
B) Reflex tachycardia and fluid retention
C) Hypoglycemia
D) Bronchospasm
Rationale: Hydralazine is a direct vasodilator that can cause reflex
tachycardia and sodium/fluid retention. It is often prescribed with a beta-
blocker and diuretic to counteract these effects. It does not cause
hypoglycemia or bronchospasm.
4. A patient on SSRIs (fluoxetine) is started on phenelzine (MAOI). The
nurse should monitor for which life-threatening syndrome?
A) Neuroleptic malignant syndrome
B) Serotonin syndrome
C) Tardive dyskinesia
D) Malignant hyperthermia
Rationale: Combining SSRIs with MAOIs can cause serotonin syndrome,
characterized by agitation, confusion, hyperthermia, diaphoresis,
hyperreflexia, and rigidity. This combination is contraindicated; a washout
period of at least 14 days is required between these medications.
,5. A client is prescribed ondansetron for chemotherapy-induced
nausea. Which finding indicates the medication is effective?
A) Decreased pain
B) Decreased nausea and vomiting
C) Increased appetite
D) Decreased anxiety
Rationale: Ondansetron is a 5-HT3 receptor antagonist used to prevent
nausea and vomiting. Decreased nausea and vomiting indicates effectiveness.
It does not treat pain, anxiety, or directly increase appetite.
6. A patient is prescribed digoxin and furosemide concurrently. The
nurse should monitor for which complication?
A) Digoxin toxicity due to hypokalemia from furosemide
B) Hyperkalemia
C) Hypotension
D) Weight loss
Rationale: Furosemide causes potassium loss (hypokalemia). Hypokalemia
increases the risk of digoxin toxicity by enhancing its effects on the heart.
Serum potassium and digoxin levels should be monitored closely.
7. A client is prescribed tamsulosin for benign prostatic hyperplasia
(BPH). Which adverse effect should the nurse include in teaching?
A) Hypertension
B) Orthostatic hypotension
C) Tachycardia
D) Hyperglycemia
, Rationale: Tamsulosin is an alpha-1 blocker that can cause orthostatic
hypotension. Clients should be advised to rise slowly from sitting or lying
positions. It is not a beta-blocker, so tachycardia is not a primary concern.
8. A patient receiving vancomycin IV has a trough level of 25 mcg/mL.
Which action should the nurse take?
A) Administer the next dose as scheduled
B) Hold the next dose and notify the healthcare provider
C) Increase the infusion rate
D) Decrease the dose by half
Rationale: Therapeutic vancomycin trough levels are typically 10-20 mcg/mL
for most infections (15-20 for complicated infections). A level of 25 mcg/mL is
elevated and increases the risk of nephrotoxicity. The dose should be held,
and the provider notified.
9. A client prescribed carbamazepine should be monitored for which
serious adverse effect?
A) Weight gain
B) Bone marrow suppression
C) Hyperglycemia
D) Bradycardia
Rationale: Carbamazepine can cause bone marrow suppression (leukopenia,
thrombocytopenia, aplastic anemia) and hepatotoxicity. CBC and liver
function tests should be monitored regularly. Weight gain is common but not
the priority.
