Pharmacology Evolve HESI
A 19-year-old male client who has sustained a severe head injury is intubated and placed on
assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from
"fighting" the ventilator, the health care provider administers pancuronium bromide IV, with
adjunctive opioid analgesia. What medication should be immediately accessible for a potential
complication with this drug?
A. Dantrolene sodium
B. Neostigmine bromide
C. Succinylcholine bromide
D. Epinephrine - ANS-B. Neostigmine bromide
Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory
muscle paralysis caused by pancuronium bromide. Options A, C, and D are not antagonists to
pancuronium bromide and would not be helpful in reversing the effects of the drug compared
with the use of anticholinergics.
A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred
injection site to administer this immunization?
A. Dorsal gluteal
B. Vastus lateralis
C. Ventral gluteal
D. Deltoid - ANS-B. Vastus lateralis
The preferred intramuscular site for children younger than 2 years is the vastus lateralis.
Options A, C, and D are not preferred injection sites for the infant at 2 months of age.
A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the
active phase of labor. She requests something for pain. Which analgesic should the nurse
anticipate administering?
A. Butorphanol
B. Hydromorphone
C. Morphine sulfate
D. Codeine sulfate - ANS-A. Butorphanol
Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less
respiratory depression, nausea, and vomiting compared with opioid agonist analgesics.
,A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount
of phenobarbital elixir prescribed for his brother's seizure disorder. Which nursing intervention
should the nurse implement first?
A. Administer syrup of ipecac.
B. Take the child's vital signs.
C. Draw a blood specimen for a phenobarbital level.
D. Teach the mother safe medication storage practices. - ANS-B. Take the child's vital signs.
Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital
signs. Options A, C, and D are actions that may all be used in the treatment of this child, but
they do not have the priority of option B.
A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory
result should the nurse examine to assess the child's risk for infection?
A. Neutrophil count
B. Platelet count
C. Reticulocyte count
D. Lymphocyte count - ANS-A. Neutrophil
During chemotherapy, granulocytes are significantly suppressed. Because neutrophils comprise
60% to 70% of the granulocyte count, these levels are the most useful laboratory results of the
options presented to determine the child's risk for infection. Options B, C, and D are not as
useful as option A in determining risk of infection.
A 42-year-old client is admitted to the emergency department after taking an overdose of
amitriptyline in a suicide attempt. Which drug should the nurse plan to administer to reverse the
cardiac and central nervous system effects of amitriptyline?
A. Sodium bicarbonate
B. Naloxone
C. Phentolamine mesylate
D. Atropine sulfate - ANS-A. Sodium bicarbonate
Sodium bicarbonate is an effective treatment for an overdose of tricyclic antidepressants such
as amitriptyline to reverse QRS prolongation. Options B, C, and D are not the preferred agents
for treating this drug overdose.
A 45-year-old female client is receiving alprazolam for anxiety. Which client behavior would
indicate that the drug is effective?
A. Personal hygiene is maintained by the client for the first time in a week.
B. The client has an average resting heart rate of 120 beats/min.
,C. The staff observes the client sitting in the day room reading a book.
D. The nurse records that the client lost 2 lb of body weight in the past week. - ANS-C. The staff
observes the client sitting in the day room reading a book.
The ability to sit and concentrate on reading indicates decreased anxiety. Options A, B, and D
are not related to the use of alprazolam for anxiety.
A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous
hospitalizations have occurred since the diagnosis because of noncompliance with the
prescribed medication regimen. Which drug might work best for this particular client?
A. Chlorpromazine HCl
B. Lithium carbonate
C. Fluphenazine decanoate
D. Diazepam - ANS-C. Fluphenazine decanoate
Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a
long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant
psychotic client. Option A is an antipsychotic drug used to treat schizophrenia and is usually
administered PO (IM doses are short-acting). The client must be compliant in taking this drug for
it to be effective. Option B is most effective with manic and depressive bipolar affective
disorders. Option D is an antianxiety drug and would not be effective for a psychotic disorder.
A 6-year-old child is admitted to the emergency department with status epilepticus. His parents
report that his seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past
year. Which drug should the nurse plan to administer in the emergency department?
A. Phenytoin
B. Diazepam
C. Phenobarbital
D. Carbamazepine - ANS-B. Diazepam
Diazepam is the drug of choice for treatment of status epilepticus. Options A, C, and D are used
for the long-term management of seizure disorders but are not as useful in the emergency
management of status epilepticus.
A 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily.
Which instruction should the nurse include in this client's discharge teaching plan?
A. Take the medication in the morning before rising.
B. Take and record radial pulse rate daily.
C. Expect some vision changes caused by the medication.
D. Increase intake of foods rich in vitamin K. - ANS-B. Take and record radial pulse rate daily.
, Monitoring pulse rate is very important when taking digoxin. The client should be further
instructed to report pulse rates <60 or >110 beats/min and to withhold the dosage until
consulting with the health care provider in such a case. Options A and D are not necessary.
Option C is an indication of drug toxicity, and the client should be instructed to report this
immediately.
A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently
diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating
this treatment?
A. Electrocardiogram (ECG)
B. Arterial blood gases (ABGs)
C. Serum cholesterol level
D. Pelvic ultrasound - ANS-A. Electrocardiogram (ECG)
Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of
doxorubicin HCl. Option B assesses disturbances of acid-base balance. Option C is not affected
by this chemotherapeutic agent. Option D is used to detect pelvic abnormalities such as tumors
but is not specific for the administration of doxorubicin HCl.
A child is being treated with mebendazole for pinworms. Which type of diet should the mother
be instructed to feed the child while the child is receiving this medication?
A. Lactose-free foods
B. High-fat diet
C. Vitamin C-enriched foods
D. High-fiber diet - ANS-B. High-fat diet
A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the
medication in eliminating the pinworms. Options A, C, and D are not related to the
administration of this medication.
A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. For
which adverse effect should the nurse assess and report promptly to the health care provider?
A. Petechiae
B. Tinnitus
C. Oliguria
D. Hypertension - ANS-A. Petechiae
Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet
adhesion, which can result in the presence of petechiae. Options B, C, and D are not adverse
effects primarily associated with the administration of ticarcillin disodium.
A 19-year-old male client who has sustained a severe head injury is intubated and placed on
assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from
"fighting" the ventilator, the health care provider administers pancuronium bromide IV, with
adjunctive opioid analgesia. What medication should be immediately accessible for a potential
complication with this drug?
A. Dantrolene sodium
B. Neostigmine bromide
C. Succinylcholine bromide
D. Epinephrine - ANS-B. Neostigmine bromide
Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory
muscle paralysis caused by pancuronium bromide. Options A, C, and D are not antagonists to
pancuronium bromide and would not be helpful in reversing the effects of the drug compared
with the use of anticholinergics.
A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred
injection site to administer this immunization?
A. Dorsal gluteal
B. Vastus lateralis
C. Ventral gluteal
D. Deltoid - ANS-B. Vastus lateralis
The preferred intramuscular site for children younger than 2 years is the vastus lateralis.
Options A, C, and D are not preferred injection sites for the infant at 2 months of age.
A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the
active phase of labor. She requests something for pain. Which analgesic should the nurse
anticipate administering?
A. Butorphanol
B. Hydromorphone
C. Morphine sulfate
D. Codeine sulfate - ANS-A. Butorphanol
Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less
respiratory depression, nausea, and vomiting compared with opioid agonist analgesics.
,A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount
of phenobarbital elixir prescribed for his brother's seizure disorder. Which nursing intervention
should the nurse implement first?
A. Administer syrup of ipecac.
B. Take the child's vital signs.
C. Draw a blood specimen for a phenobarbital level.
D. Teach the mother safe medication storage practices. - ANS-B. Take the child's vital signs.
Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital
signs. Options A, C, and D are actions that may all be used in the treatment of this child, but
they do not have the priority of option B.
A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory
result should the nurse examine to assess the child's risk for infection?
A. Neutrophil count
B. Platelet count
C. Reticulocyte count
D. Lymphocyte count - ANS-A. Neutrophil
During chemotherapy, granulocytes are significantly suppressed. Because neutrophils comprise
60% to 70% of the granulocyte count, these levels are the most useful laboratory results of the
options presented to determine the child's risk for infection. Options B, C, and D are not as
useful as option A in determining risk of infection.
A 42-year-old client is admitted to the emergency department after taking an overdose of
amitriptyline in a suicide attempt. Which drug should the nurse plan to administer to reverse the
cardiac and central nervous system effects of amitriptyline?
A. Sodium bicarbonate
B. Naloxone
C. Phentolamine mesylate
D. Atropine sulfate - ANS-A. Sodium bicarbonate
Sodium bicarbonate is an effective treatment for an overdose of tricyclic antidepressants such
as amitriptyline to reverse QRS prolongation. Options B, C, and D are not the preferred agents
for treating this drug overdose.
A 45-year-old female client is receiving alprazolam for anxiety. Which client behavior would
indicate that the drug is effective?
A. Personal hygiene is maintained by the client for the first time in a week.
B. The client has an average resting heart rate of 120 beats/min.
,C. The staff observes the client sitting in the day room reading a book.
D. The nurse records that the client lost 2 lb of body weight in the past week. - ANS-C. The staff
observes the client sitting in the day room reading a book.
The ability to sit and concentrate on reading indicates decreased anxiety. Options A, B, and D
are not related to the use of alprazolam for anxiety.
A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous
hospitalizations have occurred since the diagnosis because of noncompliance with the
prescribed medication regimen. Which drug might work best for this particular client?
A. Chlorpromazine HCl
B. Lithium carbonate
C. Fluphenazine decanoate
D. Diazepam - ANS-C. Fluphenazine decanoate
Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a
long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant
psychotic client. Option A is an antipsychotic drug used to treat schizophrenia and is usually
administered PO (IM doses are short-acting). The client must be compliant in taking this drug for
it to be effective. Option B is most effective with manic and depressive bipolar affective
disorders. Option D is an antianxiety drug and would not be effective for a psychotic disorder.
A 6-year-old child is admitted to the emergency department with status epilepticus. His parents
report that his seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past
year. Which drug should the nurse plan to administer in the emergency department?
A. Phenytoin
B. Diazepam
C. Phenobarbital
D. Carbamazepine - ANS-B. Diazepam
Diazepam is the drug of choice for treatment of status epilepticus. Options A, C, and D are used
for the long-term management of seizure disorders but are not as useful in the emergency
management of status epilepticus.
A 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily.
Which instruction should the nurse include in this client's discharge teaching plan?
A. Take the medication in the morning before rising.
B. Take and record radial pulse rate daily.
C. Expect some vision changes caused by the medication.
D. Increase intake of foods rich in vitamin K. - ANS-B. Take and record radial pulse rate daily.
, Monitoring pulse rate is very important when taking digoxin. The client should be further
instructed to report pulse rates <60 or >110 beats/min and to withhold the dosage until
consulting with the health care provider in such a case. Options A and D are not necessary.
Option C is an indication of drug toxicity, and the client should be instructed to report this
immediately.
A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently
diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating
this treatment?
A. Electrocardiogram (ECG)
B. Arterial blood gases (ABGs)
C. Serum cholesterol level
D. Pelvic ultrasound - ANS-A. Electrocardiogram (ECG)
Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of
doxorubicin HCl. Option B assesses disturbances of acid-base balance. Option C is not affected
by this chemotherapeutic agent. Option D is used to detect pelvic abnormalities such as tumors
but is not specific for the administration of doxorubicin HCl.
A child is being treated with mebendazole for pinworms. Which type of diet should the mother
be instructed to feed the child while the child is receiving this medication?
A. Lactose-free foods
B. High-fat diet
C. Vitamin C-enriched foods
D. High-fiber diet - ANS-B. High-fat diet
A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the
medication in eliminating the pinworms. Options A, C, and D are not related to the
administration of this medication.
A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. For
which adverse effect should the nurse assess and report promptly to the health care provider?
A. Petechiae
B. Tinnitus
C. Oliguria
D. Hypertension - ANS-A. Petechiae
Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet
adhesion, which can result in the presence of petechiae. Options B, C, and D are not adverse
effects primarily associated with the administration of ticarcillin disodium.
