HESI RN PHARMACOLOGY V2 NGN QUESTIONS
WITH ANSWERS AND EXPLANATIONS
1. The nurse reviews the medication record, current assessment, and risk factors before making a decision.
A client with established atherosclerotic cardiovascular disease is prescribed high-intensity atorvastatin.
The nurse is ready to give the medication. Which action should be taken?
A. Give earlier in the day to reduce nocturia and maintain a consistent schedule.
B. Observe the required washout period after an ACE inhibitor before starting to reduce angioedema risk.
C. Give once daily with adherence emphasized; the dose can be taken with or without food.
D. Administer consistently and avoid automatic potassium replacement unless specifically prescribed.
Correct Answer: C. Give once daily with adherence emphasized; the dose can be taken with or without food.
Rationale: Give once daily with adherence emphasized; the dose can be taken with or without food. This
approach preserves the intended delivery and reduces preventable administration error.
2. The nurse must apply pharmacology principles to the current situation. Before the next dose, the nurse
performs an interaction check. A client with chronic osteoarthritis pain uses ibuprofen regularly. Which
issue deserves priority follow-up?
A. No sedative should be used to counter expected withdrawal while respiratory status remains unstable;
longer-acting opioids may outlast naloxone.
B. Anticoagulants, antiplatelets, corticosteroids, and other NSAIDs increase bleeding or renal risk; ACE
inhibitors plus diuretics can compound kidney injury.
C. Alcohol misuse and other hepatotoxic exposures increase liver-injury risk; hidden acetaminophen in
combination products can cause unintentional overdose.
D. MAO inhibitors and other serotonergic drugs increase serotonin-syndrome risk; NSAIDs or anticoagulants can
increase bleeding risk.
Correct Answer: B. Anticoagulants, antiplatelets, corticosteroids, and other NSAIDs increase bleeding or renal
risk; ACE inhibitors plus diuretics can compound kidney injury.
Rationale: Anticoagulants, antiplatelets, corticosteroids, and other NSAIDs increase bleeding or renal risk; ACE
inhibitors plus diuretics can compound kidney injury. Identifying this interaction prevents a predictable change in
exposure, effectiveness, or toxicity.
3. A client with heart failure and atrial fibrillation receives digoxin. Which nursing action is most
appropriate when administering this therapy?
A. Administer consistently and monitor renal function and potassium after starting or increasing the dose.
B. Administer consistently and avoid automatic potassium replacement unless specifically prescribed.
C. Give at a consistent time and adjust doses based on ordered INR targets rather than day-to-day symptom
changes.
D. Check the apical pulse and follow ordered hold parameters; use extra caution with renal impairment.
Correct Answer: D. Check the apical pulse and follow ordered hold parameters; use extra caution with renal
impairment.
Rationale: Check the apical pulse and follow ordered hold parameters; use extra caution with renal impairment.
This approach preserves the intended delivery and reduces preventable administration error.
4. Several factors could affect the next medication decision. The nurse integrates the indication, current
assessment, and toxicity risk. A nurse is preparing discharge instructions for this client: A client with
depression and generalized anxiety disorder is prescribed venlafaxine. Which teaching point should be
emphasized?
A. Teach the client not to stop the drug abruptly and to report severe headache, marked blood-pressure elevation,
or serotonin-toxicity symptoms.
B. Teach the client to maintain normal salt and fluid intake and to seek guidance during vomiting, diarrhea, fever,
or heavy sweating.
C. Teach family members using take-home naloxone to call emergency services, give naloxone, provide rescue
breathing if trained, and repeat doses as directed.
D. Teach the client never to cut the patch, to avoid heating devices, and to fold used patches adhesive sides
together for safe disposal.
Correct Answer: A. Teach the client not to stop the drug abruptly and to report severe headache, marked
blood-pressure elevation, or serotonin-toxicity symptoms.
,Rationale: Teach the client not to stop the drug abruptly and to report severe headache, marked blood-pressure
elevation, or serotonin-toxicity symptoms. This teaching directly reduces a high-yield medication-safety risk after
discharge.
5. During medication preparation for the following client, which action best promotes safe administration?
A client with coronary disease and hypertension is prescribed metoprolol.
A. Give consistently once daily and evaluate blood pressure, renal function, and potassium after initiation or dose
changes.
B. Give on the prescribed schedule and adjust only when specific age, weight, renal, or drug-interaction criteria
are met.
C. At onset of angina, stop activity and use the prescribed sublingual dose while following emergency
instructions if pain persists or is atypical.
D. Check pulse and blood pressure before dosing and follow ordered hold parameters rather than stopping chronic
therapy abruptly.
Correct Answer: D. Check pulse and blood pressure before dosing and follow ordered hold parameters rather
than stopping chronic therapy abruptly.
Rationale: Check pulse and blood pressure before dosing and follow ordered hold parameters rather than
stopping chronic therapy abruptly. This approach preserves the intended delivery and reduces preventable
administration error.
6. The nurse connects the client presentation with the relevant pharmacology. A client with neuropathic
pain is prescribed low-dose amitriptyline at bedtime. Which assessment or laboratory parameter is most
important to monitor during therapy?
A. Monitor respiratory rate, level of consciousness, oxygenation, pain, recurrent sedation, and acute withdrawal
symptoms.
B. Monitor orthostatic blood pressure, anticholinergic effects, sedation, cardiac history, and suicide/overdose risk.
C. Monitor liver function, CBC/platelets, weight, pregnancy status, clinical response, and serum concentration
when ordered.
D. Monitor mood, suicidal thinking, blood pressure, heart rate, sodium in susceptible clients, and withdrawal
symptoms.
Correct Answer: B. Monitor orthostatic blood pressure, anticholinergic effects, sedation, cardiac history, and
suicide/overdose risk.
Rationale: Monitor orthostatic blood pressure, anticholinergic effects, sedation, cardiac history, and
suicide/overdose risk. These data detect clinically important loss of efficacy or toxicity early enough to act.
7. The nurse must apply pharmacology principles to the current situation. Before the next dose, the nurse
performs an interaction check. A client with symptomatic heart failure with reduced ejection fraction is
switched from an ACE inhibitor to sacubitril-valsartan. Which issue deserves priority follow-up?
A. ACE inhibitors, ARBs, potassium supplements, and potassium-containing salt substitutes can raise potassium
further.
B. Other antihypertensives can add to hypotension, while strong CYP3A4 modifiers may alter exposure.
C. ACE inhibitors must not be used concurrently, and potassium-raising drugs may compound hyperkalemia.
D. Other ototoxic or nephrotoxic drugs can increase toxicity; NSAIDs may reduce diuretic effect.
Correct Answer: C. ACE inhibitors must not be used concurrently, and potassium-raising drugs may compound
hyperkalemia.
Rationale: ACE inhibitors must not be used concurrently, and potassium-raising drugs may compound
hyperkalemia. Identifying this interaction prevents a predictable change in exposure, effectiveness, or toxicity.
8. The nurse applies the medication order to the available supply. While validating the dose for a new order
for a pain or neurologic medication, an IV medication is diluted in 500 mL and must infuse evenly over 10
hours. What pump rate should the nurse set? Round to the nearest whole mL/hr. Calculation data Values
supplied 500 mL, 10 hours Task Calculate the ordered dose or administration rate using the stated units.
A. 50 mL/hr
B. 100 mL/hr
C. 25 mL/hr
D. 62 mL/hr
Correct Answer: A. 50 mL/hr
Rationale: Rate = total volume / time = 500 mL / 10 hr = 50 mL/hr.
,9. The nurse connects the client presentation with the relevant pharmacology. A nurse removes an opioid
from an automated dispensing cabinet for a client with severe postoperative pain. Which instruction would
best help this client use the medication safely at home?
A. Teach clients to report burning, tightness, swelling, redness, or leaking at an IV site immediately.
B. Teach the client about sedation, fall risk, constipation prevention, safe storage, and not sharing opioids.
C. Teach the client to fold used patches adhesive sides together and keep new and used patches away from
children and pets.
D. Teach clients receiving high-alert drugs to know the purpose, major warning signs, and when to seek urgent
care.
Correct Answer: B. Teach the client about sedation, fall risk, constipation prevention, safe storage, and not
sharing opioids.
Rationale: Teach the client about sedation, fall risk, constipation prevention, safe storage, and not sharing
opioids. This teaching directly reduces a high-yield medication-safety risk after discharge.
10. The nurse reviews the medication record, current assessment, and risk factors before making a
decision. The nurse evaluates whether the treatment goal has been reached. A client with a susceptible
urinary infection is prescribed trimethoprim-sulfamethoxazole. Which finding best supports effectiveness?
A. Effective therapy prevents progression or contributes to microbiologic cure as part of an appropriate TB
regimen.
B. Effective therapy improves the infection while renal function remains stable and target exposure is achieved.
C. Desired response is resolution of infection without rash, cytopenia, or electrolyte disturbance.
D. Desired response is resolution of the targeted infection without significant GI injury or photosensitivity.
Correct Answer: C. Desired response is resolution of infection without rash, cytopenia, or electrolyte
disturbance.
Rationale: Desired response is resolution of infection without rash, cytopenia, or electrolyte disturbance. This
outcome reflects the intended treatment goal rather than merely a medication side effect.
11. The nurse reviews the medication record, current assessment, and risk factors before making a
decision. A client with coronary disease and hypertension is prescribed metoprolol. Which client-teaching
statement is the priority for safe self-management?
A. Teach the client not to stop the drug suddenly because rebound tachycardia or ischemia may occur.
B. Teach the client to change positions slowly, report severe weakness or cramps, and use sun protection.
C. Teach the client to report bleeding, severe headache, new limb pain, or shortness of breath promptly.
D. Teach the client that dependent ankle swelling can occur and should be reported if progressive or accompanied
by dyspnea.
Correct Answer: A. Teach the client not to stop the drug suddenly because rebound tachycardia or ischemia may
occur.
Rationale: Teach the client not to stop the drug suddenly because rebound tachycardia or ischemia may occur.
This teaching directly reduces a high-yield medication-safety risk after discharge.
12. Several factors could affect the next medication decision. The nurse integrates the indication, current
assessment, and toxicity risk. A nurse is implementing the medication plan. A client with tonic-clonic
seizures takes phenytoin. Which administration step is the priority?
A. Calculate the total daily acetaminophen from all prescription and OTC products and keep it within the
recommended limit for the individual client.
B. Give on a consistent schedule; large protein loads can interfere with levodopa absorption in some clients and
should be managed individually.
C. Use patches only for appropriate opioid-tolerant clients, remove the old patch before applying a new one, and
avoid external heat over the site.
D. Give consistently; IV phenytoin requires the correct compatible solution and controlled rate, while enteral
feeds may need timing adjustments.
Correct Answer: D. Give consistently; IV phenytoin requires the correct compatible solution and controlled rate,
while enteral feeds may need timing adjustments.
Rationale: Give consistently; IV phenytoin requires the correct compatible solution and controlled rate, while
enteral feeds may need timing adjustments. This approach preserves the intended delivery and reduces
preventable administration error.
, 13. The nurse must apply pharmacology principles to the current situation. A nurse is preparing discharge
instructions for this client: A client is prescribed subcutaneous enoxaparin after orthopedic surgery. Which
teaching point should be emphasized?
A. Teach the client proper injection technique, bleeding precautions, and not to rub the injection site after dosing.
B. Teach the client that dependent ankle swelling can occur and should be reported if progressive or accompanied
by dyspnea.
C. Teach the client to avoid unapproved potassium supplements and to report weakness, palpitations, or decreased
urine output.
D. Teach the client to change positions slowly, report severe weakness or cramps, and use sun protection.
Correct Answer: A. Teach the client proper injection technique, bleeding precautions, and not to rub the
injection site after dosing.
Rationale: Teach the client proper injection technique, bleeding precautions, and not to rub the injection site after
dosing. This teaching directly reduces a high-yield medication-safety risk after discharge.
14. The nurse applies the medication order to the available supply. During an independent
medication-safety review for an anti-infective medication, an IV medication is diluted in 250 mL and must
infuse evenly over 5 hours. What pump rate should the nurse set? Round to the nearest whole mL/hr.
Calculation data Values supplied 250 mL, 5 hours Task Calculate the ordered dose or administration rate
using the stated units.
A. 25 mL/hr
B. 62 mL/hr
C. 100 mL/hr
D. 50 mL/hr
Correct Answer: D. 50 mL/hr
Rationale: Rate = total volume / time = 250 mL / 5 hr = 50 mL/hr.
15. The nurse connects the client presentation with the relevant pharmacology. A client with bipolar
disorder or generalized seizures is prescribed valproate. When analyzing how the prescribed therapy
works, which explanation is most accurate?
A. Serotonin-norepinephrine reuptake inhibition increases both neurotransmitters, with norepinephrine effects
becoming more prominent at higher doses.
B. Irreversible monoamine oxidase inhibition increases norepinephrine, serotonin, and dopamine but also
prevents breakdown of dietary tyramine.
C. Valproate increases inhibitory GABA activity and affects voltage-gated ion channels, providing broad
anticonvulsant and mood-stabilizing effects.
D. Levodopa is converted to dopamine in the brain, while carbidopa reduces peripheral levodopa metabolism and
improves CNS delivery.
Correct Answer: C. Valproate increases inhibitory GABA activity and affects voltage-gated ion channels,
providing broad anticonvulsant and mood-stabilizing effects.
Rationale: Valproate increases inhibitory GABA activity and affects voltage-gated ion channels, providing broad
anticonvulsant and mood-stabilizing effects. This mechanism explains the intended pharmacologic effect in the
scenario.
16. Several factors could affect the next medication decision. The nurse integrates the indication, current
assessment, and toxicity risk. A nurse removes an opioid from an automated dispensing cabinet for a client
with severe postoperative pain. Which nursing action is most appropriate when administering this
therapy?
A. Use renal- or hepatic-adjusted dosing recommendations and avoid nephrotoxic or hepatotoxic combinations
when safer alternatives exist.
B. Document removal and administration accurately, secure unused medication, and waste any remainder with the
required witness when policy requires.
C. Convert pounds to kilograms when necessary, calculate the ordered mg/kg dose, and verify the final dose
against the recommended range.
D. Remove the old patch, apply the new patch to clean dry intact skin as directed, rotate sites, and date/time the
patch when appropriate.
Correct Answer: B. Document removal and administration accurately, secure unused medication, and waste any
remainder with the required witness when policy requires.
WITH ANSWERS AND EXPLANATIONS
1. The nurse reviews the medication record, current assessment, and risk factors before making a decision.
A client with established atherosclerotic cardiovascular disease is prescribed high-intensity atorvastatin.
The nurse is ready to give the medication. Which action should be taken?
A. Give earlier in the day to reduce nocturia and maintain a consistent schedule.
B. Observe the required washout period after an ACE inhibitor before starting to reduce angioedema risk.
C. Give once daily with adherence emphasized; the dose can be taken with or without food.
D. Administer consistently and avoid automatic potassium replacement unless specifically prescribed.
Correct Answer: C. Give once daily with adherence emphasized; the dose can be taken with or without food.
Rationale: Give once daily with adherence emphasized; the dose can be taken with or without food. This
approach preserves the intended delivery and reduces preventable administration error.
2. The nurse must apply pharmacology principles to the current situation. Before the next dose, the nurse
performs an interaction check. A client with chronic osteoarthritis pain uses ibuprofen regularly. Which
issue deserves priority follow-up?
A. No sedative should be used to counter expected withdrawal while respiratory status remains unstable;
longer-acting opioids may outlast naloxone.
B. Anticoagulants, antiplatelets, corticosteroids, and other NSAIDs increase bleeding or renal risk; ACE
inhibitors plus diuretics can compound kidney injury.
C. Alcohol misuse and other hepatotoxic exposures increase liver-injury risk; hidden acetaminophen in
combination products can cause unintentional overdose.
D. MAO inhibitors and other serotonergic drugs increase serotonin-syndrome risk; NSAIDs or anticoagulants can
increase bleeding risk.
Correct Answer: B. Anticoagulants, antiplatelets, corticosteroids, and other NSAIDs increase bleeding or renal
risk; ACE inhibitors plus diuretics can compound kidney injury.
Rationale: Anticoagulants, antiplatelets, corticosteroids, and other NSAIDs increase bleeding or renal risk; ACE
inhibitors plus diuretics can compound kidney injury. Identifying this interaction prevents a predictable change in
exposure, effectiveness, or toxicity.
3. A client with heart failure and atrial fibrillation receives digoxin. Which nursing action is most
appropriate when administering this therapy?
A. Administer consistently and monitor renal function and potassium after starting or increasing the dose.
B. Administer consistently and avoid automatic potassium replacement unless specifically prescribed.
C. Give at a consistent time and adjust doses based on ordered INR targets rather than day-to-day symptom
changes.
D. Check the apical pulse and follow ordered hold parameters; use extra caution with renal impairment.
Correct Answer: D. Check the apical pulse and follow ordered hold parameters; use extra caution with renal
impairment.
Rationale: Check the apical pulse and follow ordered hold parameters; use extra caution with renal impairment.
This approach preserves the intended delivery and reduces preventable administration error.
4. Several factors could affect the next medication decision. The nurse integrates the indication, current
assessment, and toxicity risk. A nurse is preparing discharge instructions for this client: A client with
depression and generalized anxiety disorder is prescribed venlafaxine. Which teaching point should be
emphasized?
A. Teach the client not to stop the drug abruptly and to report severe headache, marked blood-pressure elevation,
or serotonin-toxicity symptoms.
B. Teach the client to maintain normal salt and fluid intake and to seek guidance during vomiting, diarrhea, fever,
or heavy sweating.
C. Teach family members using take-home naloxone to call emergency services, give naloxone, provide rescue
breathing if trained, and repeat doses as directed.
D. Teach the client never to cut the patch, to avoid heating devices, and to fold used patches adhesive sides
together for safe disposal.
Correct Answer: A. Teach the client not to stop the drug abruptly and to report severe headache, marked
blood-pressure elevation, or serotonin-toxicity symptoms.
,Rationale: Teach the client not to stop the drug abruptly and to report severe headache, marked blood-pressure
elevation, or serotonin-toxicity symptoms. This teaching directly reduces a high-yield medication-safety risk after
discharge.
5. During medication preparation for the following client, which action best promotes safe administration?
A client with coronary disease and hypertension is prescribed metoprolol.
A. Give consistently once daily and evaluate blood pressure, renal function, and potassium after initiation or dose
changes.
B. Give on the prescribed schedule and adjust only when specific age, weight, renal, or drug-interaction criteria
are met.
C. At onset of angina, stop activity and use the prescribed sublingual dose while following emergency
instructions if pain persists or is atypical.
D. Check pulse and blood pressure before dosing and follow ordered hold parameters rather than stopping chronic
therapy abruptly.
Correct Answer: D. Check pulse and blood pressure before dosing and follow ordered hold parameters rather
than stopping chronic therapy abruptly.
Rationale: Check pulse and blood pressure before dosing and follow ordered hold parameters rather than
stopping chronic therapy abruptly. This approach preserves the intended delivery and reduces preventable
administration error.
6. The nurse connects the client presentation with the relevant pharmacology. A client with neuropathic
pain is prescribed low-dose amitriptyline at bedtime. Which assessment or laboratory parameter is most
important to monitor during therapy?
A. Monitor respiratory rate, level of consciousness, oxygenation, pain, recurrent sedation, and acute withdrawal
symptoms.
B. Monitor orthostatic blood pressure, anticholinergic effects, sedation, cardiac history, and suicide/overdose risk.
C. Monitor liver function, CBC/platelets, weight, pregnancy status, clinical response, and serum concentration
when ordered.
D. Monitor mood, suicidal thinking, blood pressure, heart rate, sodium in susceptible clients, and withdrawal
symptoms.
Correct Answer: B. Monitor orthostatic blood pressure, anticholinergic effects, sedation, cardiac history, and
suicide/overdose risk.
Rationale: Monitor orthostatic blood pressure, anticholinergic effects, sedation, cardiac history, and
suicide/overdose risk. These data detect clinically important loss of efficacy or toxicity early enough to act.
7. The nurse must apply pharmacology principles to the current situation. Before the next dose, the nurse
performs an interaction check. A client with symptomatic heart failure with reduced ejection fraction is
switched from an ACE inhibitor to sacubitril-valsartan. Which issue deserves priority follow-up?
A. ACE inhibitors, ARBs, potassium supplements, and potassium-containing salt substitutes can raise potassium
further.
B. Other antihypertensives can add to hypotension, while strong CYP3A4 modifiers may alter exposure.
C. ACE inhibitors must not be used concurrently, and potassium-raising drugs may compound hyperkalemia.
D. Other ototoxic or nephrotoxic drugs can increase toxicity; NSAIDs may reduce diuretic effect.
Correct Answer: C. ACE inhibitors must not be used concurrently, and potassium-raising drugs may compound
hyperkalemia.
Rationale: ACE inhibitors must not be used concurrently, and potassium-raising drugs may compound
hyperkalemia. Identifying this interaction prevents a predictable change in exposure, effectiveness, or toxicity.
8. The nurse applies the medication order to the available supply. While validating the dose for a new order
for a pain or neurologic medication, an IV medication is diluted in 500 mL and must infuse evenly over 10
hours. What pump rate should the nurse set? Round to the nearest whole mL/hr. Calculation data Values
supplied 500 mL, 10 hours Task Calculate the ordered dose or administration rate using the stated units.
A. 50 mL/hr
B. 100 mL/hr
C. 25 mL/hr
D. 62 mL/hr
Correct Answer: A. 50 mL/hr
Rationale: Rate = total volume / time = 500 mL / 10 hr = 50 mL/hr.
,9. The nurse connects the client presentation with the relevant pharmacology. A nurse removes an opioid
from an automated dispensing cabinet for a client with severe postoperative pain. Which instruction would
best help this client use the medication safely at home?
A. Teach clients to report burning, tightness, swelling, redness, or leaking at an IV site immediately.
B. Teach the client about sedation, fall risk, constipation prevention, safe storage, and not sharing opioids.
C. Teach the client to fold used patches adhesive sides together and keep new and used patches away from
children and pets.
D. Teach clients receiving high-alert drugs to know the purpose, major warning signs, and when to seek urgent
care.
Correct Answer: B. Teach the client about sedation, fall risk, constipation prevention, safe storage, and not
sharing opioids.
Rationale: Teach the client about sedation, fall risk, constipation prevention, safe storage, and not sharing
opioids. This teaching directly reduces a high-yield medication-safety risk after discharge.
10. The nurse reviews the medication record, current assessment, and risk factors before making a
decision. The nurse evaluates whether the treatment goal has been reached. A client with a susceptible
urinary infection is prescribed trimethoprim-sulfamethoxazole. Which finding best supports effectiveness?
A. Effective therapy prevents progression or contributes to microbiologic cure as part of an appropriate TB
regimen.
B. Effective therapy improves the infection while renal function remains stable and target exposure is achieved.
C. Desired response is resolution of infection without rash, cytopenia, or electrolyte disturbance.
D. Desired response is resolution of the targeted infection without significant GI injury or photosensitivity.
Correct Answer: C. Desired response is resolution of infection without rash, cytopenia, or electrolyte
disturbance.
Rationale: Desired response is resolution of infection without rash, cytopenia, or electrolyte disturbance. This
outcome reflects the intended treatment goal rather than merely a medication side effect.
11. The nurse reviews the medication record, current assessment, and risk factors before making a
decision. A client with coronary disease and hypertension is prescribed metoprolol. Which client-teaching
statement is the priority for safe self-management?
A. Teach the client not to stop the drug suddenly because rebound tachycardia or ischemia may occur.
B. Teach the client to change positions slowly, report severe weakness or cramps, and use sun protection.
C. Teach the client to report bleeding, severe headache, new limb pain, or shortness of breath promptly.
D. Teach the client that dependent ankle swelling can occur and should be reported if progressive or accompanied
by dyspnea.
Correct Answer: A. Teach the client not to stop the drug suddenly because rebound tachycardia or ischemia may
occur.
Rationale: Teach the client not to stop the drug suddenly because rebound tachycardia or ischemia may occur.
This teaching directly reduces a high-yield medication-safety risk after discharge.
12. Several factors could affect the next medication decision. The nurse integrates the indication, current
assessment, and toxicity risk. A nurse is implementing the medication plan. A client with tonic-clonic
seizures takes phenytoin. Which administration step is the priority?
A. Calculate the total daily acetaminophen from all prescription and OTC products and keep it within the
recommended limit for the individual client.
B. Give on a consistent schedule; large protein loads can interfere with levodopa absorption in some clients and
should be managed individually.
C. Use patches only for appropriate opioid-tolerant clients, remove the old patch before applying a new one, and
avoid external heat over the site.
D. Give consistently; IV phenytoin requires the correct compatible solution and controlled rate, while enteral
feeds may need timing adjustments.
Correct Answer: D. Give consistently; IV phenytoin requires the correct compatible solution and controlled rate,
while enteral feeds may need timing adjustments.
Rationale: Give consistently; IV phenytoin requires the correct compatible solution and controlled rate, while
enteral feeds may need timing adjustments. This approach preserves the intended delivery and reduces
preventable administration error.
, 13. The nurse must apply pharmacology principles to the current situation. A nurse is preparing discharge
instructions for this client: A client is prescribed subcutaneous enoxaparin after orthopedic surgery. Which
teaching point should be emphasized?
A. Teach the client proper injection technique, bleeding precautions, and not to rub the injection site after dosing.
B. Teach the client that dependent ankle swelling can occur and should be reported if progressive or accompanied
by dyspnea.
C. Teach the client to avoid unapproved potassium supplements and to report weakness, palpitations, or decreased
urine output.
D. Teach the client to change positions slowly, report severe weakness or cramps, and use sun protection.
Correct Answer: A. Teach the client proper injection technique, bleeding precautions, and not to rub the
injection site after dosing.
Rationale: Teach the client proper injection technique, bleeding precautions, and not to rub the injection site after
dosing. This teaching directly reduces a high-yield medication-safety risk after discharge.
14. The nurse applies the medication order to the available supply. During an independent
medication-safety review for an anti-infective medication, an IV medication is diluted in 250 mL and must
infuse evenly over 5 hours. What pump rate should the nurse set? Round to the nearest whole mL/hr.
Calculation data Values supplied 250 mL, 5 hours Task Calculate the ordered dose or administration rate
using the stated units.
A. 25 mL/hr
B. 62 mL/hr
C. 100 mL/hr
D. 50 mL/hr
Correct Answer: D. 50 mL/hr
Rationale: Rate = total volume / time = 250 mL / 5 hr = 50 mL/hr.
15. The nurse connects the client presentation with the relevant pharmacology. A client with bipolar
disorder or generalized seizures is prescribed valproate. When analyzing how the prescribed therapy
works, which explanation is most accurate?
A. Serotonin-norepinephrine reuptake inhibition increases both neurotransmitters, with norepinephrine effects
becoming more prominent at higher doses.
B. Irreversible monoamine oxidase inhibition increases norepinephrine, serotonin, and dopamine but also
prevents breakdown of dietary tyramine.
C. Valproate increases inhibitory GABA activity and affects voltage-gated ion channels, providing broad
anticonvulsant and mood-stabilizing effects.
D. Levodopa is converted to dopamine in the brain, while carbidopa reduces peripheral levodopa metabolism and
improves CNS delivery.
Correct Answer: C. Valproate increases inhibitory GABA activity and affects voltage-gated ion channels,
providing broad anticonvulsant and mood-stabilizing effects.
Rationale: Valproate increases inhibitory GABA activity and affects voltage-gated ion channels, providing broad
anticonvulsant and mood-stabilizing effects. This mechanism explains the intended pharmacologic effect in the
scenario.
16. Several factors could affect the next medication decision. The nurse integrates the indication, current
assessment, and toxicity risk. A nurse removes an opioid from an automated dispensing cabinet for a client
with severe postoperative pain. Which nursing action is most appropriate when administering this
therapy?
A. Use renal- or hepatic-adjusted dosing recommendations and avoid nephrotoxic or hepatotoxic combinations
when safer alternatives exist.
B. Document removal and administration accurately, secure unused medication, and waste any remainder with the
required witness when policy requires.
C. Convert pounds to kilograms when necessary, calculate the ordered mg/kg dose, and verify the final dose
against the recommended range.
D. Remove the old patch, apply the new patch to clean dry intact skin as directed, rotate sites, and date/time the
patch when appropriate.
Correct Answer: B. Document removal and administration accurately, secure unused medication, and waste any
remainder with the required witness when policy requires.
