Pharmacology HESI Practice Exam
The nurse is caring for a client who has taken atenolol for 2 years. The healthcare provider
recently changed the medication to enalapril to manage the client's blood pressure. Which
instruction should the nurse provide the client regarding the new medication?
A. Take the medication at bedtime.
B. Report presence of increased bruising.
C. Check pulse before taking medication.
D. Rise slowly when getting out of bed or chair. - ANS-D. Rise slowly when getting out of bed or
chair.
Rational: The client's new medication is an angiotensin-converting enzyme (ACE) inhibitor,
which has the side effect of orthostatic hypotension. Instructing the client to rise slowly from a
sitting or lying down position is important to teach the client to avoid dizziness and potentially
falling.
A female client calls the clinic and talks with the nurse to inquire about a possible reaction after
taking amoxicillin for 5 days. She reports having vaginal discomfort, itching, and a white
discharge. The nurse should discuss which action with the client?
A. Discontinue the antibiotic because original symptoms have subsided.
B. Continue taking medication until finished until the symptoms subside.
C. Consult with healthcare provider about another treatment for this effect.
D. Use an over-the-counter (OTC) vaginal wash to flush out the secretions. - ANS-C. Consult
with healthcare provider about another treatment for this effect.
Rationale: A superinfection with normal flora yeast may occur during antibiotic therapy. If
suspected, the new onset of findings should be reported to the healthcare provider for another
prescribed treatment to treat the superinfection.
The nurse is making early morning rounds on a group of clients when a client begins exhibiting
symptoms of an acute asthma attack. The nurse administers a PRN prescription for a Beta 2
receptor agonist agent. Which client response should the nurse expect? Select all that apply.
A. Tachycardia.
B. Increased blood pressure.
C. Rapid resolution of wheezing.
D. Improved pulse oximetry values.
E. Reduce fever airway inflammation. - ANS-C. Rapid resolution of wheezing.
D. Improved pulse oximetry values.
,Rationale: Beta 2 receptor agonist agents should provide immediate return of airflow and
resolve wheezing and improve oxygenation.
A client prescribed atenolol has a blood pressure of 120/68 mmHg, displaying a sinus
bradycardia with a rate of 58 beats/minute, and a P-R interval of 0.24. Which action should the
nurse take?
A. Lower the head of the bed and assess the client for orthostatic vital sign changes.
B. Give the medication as prescribed and continue to monitor the client.
C. Prepare to administer atropine sulfate IV push.
D. Hold the prescribed dose and contact the healthcare provider. - ANS-B. Give the medication
as prescribed and continue to monitor the client.
Rationale: Since the client's blood pressure is within normal limits, and the pulse is above 50
beats/min with a first degree block, the medication can be administered. Atenolol is a
beta-blocker that slows the heart rate and lowers the blood pressure; this drug is generally held
if the heart rate is less than 50 beats/min or the client exhibits dizziness related to hypotension.
The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker
(ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory
results and notes that the client's serum potassium level is 5.9 mEq/L. Which action should the
nurse take first?
A. Withhold the scheduled dose.
B. Check the client's apical pulse.
C. Notify the healthcare provider.
D. Repeat the serum potassium level. - ANS-A. Withhold the scheduled dose.
Rationale: The nurse should first withhold the scheduled dose of Cozaar because the client is
hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with
diuretic therapy in heart failure, hyperkalemia is associated with several heart failure
medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the
nurse should check the apical pulse for rate and rhythm, and blood pressure.
Upon admission to the emergency center, an adult client with acute status asthmaticus is
prescribed this series of medications. In which order should the nurse administer the prescribed
medications? (Arrange from first to last.)
Prednisone (Deltasone) orally.
Albuterol (Proventil) puffs.
Gentamicin (Garamycin) IM.
Salmeterol (Serevent Diskus). - ANS-1. Albuterol (Proventil) puffs.
2. Salmeterol (Serevent Diskus).
3. Prednisone (Deltasone) orally.
, 4. Gentamicin (Garamycin) IM.
Rationale: Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a
beta2 adrenergic agonist and short acting bronchodilator, should be administered by inhalation
first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the
bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a
long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of
action should be given next. Prednisone, an oral corticosteroid, provides prolonged
anti-inflammatory effects and should be given after the client's respiratory distress begins to
resolves. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require
repositioning the client, so should be last in the sequence.
An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent
motion sickness while on a cruise. Which information should the nurse provide to the client?
A. Apply the patch at least 4 hours prior to departure.
B. Change the patch every other day while on the cruise.
C. Place the patch on a hairless area at the base of the skull.
D. Drink no more than 2 alcoholic drinks during the cruise. - ANS-A. Apply the patch at least 4
hours prior to departure.
Rationale: Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a
peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours
before departure on the cruise ship. The duration of the transdermal patch is 72 hours.
Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best
application site of the patch is behind the ear. Anticholinergic medications are CNS depressants,
so the client should be instructed to avoid alcohol while using the patch.
A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should
the nurse include in the client's instruction?
A. Notify the clinic of any changes in the color of urine.
B. Avoid overexposure to the sun.
C. Stop the medication after the diarrhea resolves.
D. Take the medication with food. - ANS-D. Take the medication with food.
Rationale: Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the
client should be instructed to take the medication on a full stomach. Urine may be red-brown or
dark from taking Flagyl, but this side effect is an expectant finding and not necessary to report
tot he healthcare provider.
A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a day. To
prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which
information is most important for the nurse to include in client teaching?
The nurse is caring for a client who has taken atenolol for 2 years. The healthcare provider
recently changed the medication to enalapril to manage the client's blood pressure. Which
instruction should the nurse provide the client regarding the new medication?
A. Take the medication at bedtime.
B. Report presence of increased bruising.
C. Check pulse before taking medication.
D. Rise slowly when getting out of bed or chair. - ANS-D. Rise slowly when getting out of bed or
chair.
Rational: The client's new medication is an angiotensin-converting enzyme (ACE) inhibitor,
which has the side effect of orthostatic hypotension. Instructing the client to rise slowly from a
sitting or lying down position is important to teach the client to avoid dizziness and potentially
falling.
A female client calls the clinic and talks with the nurse to inquire about a possible reaction after
taking amoxicillin for 5 days. She reports having vaginal discomfort, itching, and a white
discharge. The nurse should discuss which action with the client?
A. Discontinue the antibiotic because original symptoms have subsided.
B. Continue taking medication until finished until the symptoms subside.
C. Consult with healthcare provider about another treatment for this effect.
D. Use an over-the-counter (OTC) vaginal wash to flush out the secretions. - ANS-C. Consult
with healthcare provider about another treatment for this effect.
Rationale: A superinfection with normal flora yeast may occur during antibiotic therapy. If
suspected, the new onset of findings should be reported to the healthcare provider for another
prescribed treatment to treat the superinfection.
The nurse is making early morning rounds on a group of clients when a client begins exhibiting
symptoms of an acute asthma attack. The nurse administers a PRN prescription for a Beta 2
receptor agonist agent. Which client response should the nurse expect? Select all that apply.
A. Tachycardia.
B. Increased blood pressure.
C. Rapid resolution of wheezing.
D. Improved pulse oximetry values.
E. Reduce fever airway inflammation. - ANS-C. Rapid resolution of wheezing.
D. Improved pulse oximetry values.
,Rationale: Beta 2 receptor agonist agents should provide immediate return of airflow and
resolve wheezing and improve oxygenation.
A client prescribed atenolol has a blood pressure of 120/68 mmHg, displaying a sinus
bradycardia with a rate of 58 beats/minute, and a P-R interval of 0.24. Which action should the
nurse take?
A. Lower the head of the bed and assess the client for orthostatic vital sign changes.
B. Give the medication as prescribed and continue to monitor the client.
C. Prepare to administer atropine sulfate IV push.
D. Hold the prescribed dose and contact the healthcare provider. - ANS-B. Give the medication
as prescribed and continue to monitor the client.
Rationale: Since the client's blood pressure is within normal limits, and the pulse is above 50
beats/min with a first degree block, the medication can be administered. Atenolol is a
beta-blocker that slows the heart rate and lowers the blood pressure; this drug is generally held
if the heart rate is less than 50 beats/min or the client exhibits dizziness related to hypotension.
The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker
(ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory
results and notes that the client's serum potassium level is 5.9 mEq/L. Which action should the
nurse take first?
A. Withhold the scheduled dose.
B. Check the client's apical pulse.
C. Notify the healthcare provider.
D. Repeat the serum potassium level. - ANS-A. Withhold the scheduled dose.
Rationale: The nurse should first withhold the scheduled dose of Cozaar because the client is
hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with
diuretic therapy in heart failure, hyperkalemia is associated with several heart failure
medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the
nurse should check the apical pulse for rate and rhythm, and blood pressure.
Upon admission to the emergency center, an adult client with acute status asthmaticus is
prescribed this series of medications. In which order should the nurse administer the prescribed
medications? (Arrange from first to last.)
Prednisone (Deltasone) orally.
Albuterol (Proventil) puffs.
Gentamicin (Garamycin) IM.
Salmeterol (Serevent Diskus). - ANS-1. Albuterol (Proventil) puffs.
2. Salmeterol (Serevent Diskus).
3. Prednisone (Deltasone) orally.
, 4. Gentamicin (Garamycin) IM.
Rationale: Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a
beta2 adrenergic agonist and short acting bronchodilator, should be administered by inhalation
first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the
bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a
long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of
action should be given next. Prednisone, an oral corticosteroid, provides prolonged
anti-inflammatory effects and should be given after the client's respiratory distress begins to
resolves. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require
repositioning the client, so should be last in the sequence.
An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent
motion sickness while on a cruise. Which information should the nurse provide to the client?
A. Apply the patch at least 4 hours prior to departure.
B. Change the patch every other day while on the cruise.
C. Place the patch on a hairless area at the base of the skull.
D. Drink no more than 2 alcoholic drinks during the cruise. - ANS-A. Apply the patch at least 4
hours prior to departure.
Rationale: Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a
peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours
before departure on the cruise ship. The duration of the transdermal patch is 72 hours.
Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best
application site of the patch is behind the ear. Anticholinergic medications are CNS depressants,
so the client should be instructed to avoid alcohol while using the patch.
A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should
the nurse include in the client's instruction?
A. Notify the clinic of any changes in the color of urine.
B. Avoid overexposure to the sun.
C. Stop the medication after the diarrhea resolves.
D. Take the medication with food. - ANS-D. Take the medication with food.
Rationale: Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the
client should be instructed to take the medication on a full stomach. Urine may be red-brown or
dark from taking Flagyl, but this side effect is an expectant finding and not necessary to report
tot he healthcare provider.
A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a day. To
prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which
information is most important for the nurse to include in client teaching?
