HESI Pharmacology Exam Practice with
Actual Answers and Detailed Rationales
134.) A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The
nurse tells the client to take the medication:
1. With food
2. At lunchtime
3. On an empty stomach
4. At bedtime with a snack ✔️✔️Rationale:
Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance
absorption. Dosing should be done in the morning before breakfast.
**Note that options 1, 2, and 4 are comparable or alike in that these options address
administering the medication with food.**
135.) A nurse reinforces medication instructions to a client who is taking levothyroxine
(Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of
the following occurs?
1. Fatigue
2. Tremors
3. Cold intolerance
4. Excessively dry skin ✔️✔️2. Tremors
Rationale:
,Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of
hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia,
hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if
these occur. Options 1, 3, and 4 are signs of hypothyroidism.
136.) A nurse performs an admission assessment on a client who visits a health care clinic for the
first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse
continues to collect data from the client, suspecting that the client has a history of:
1. Myxedema
2. Graves' disease
3. Addison's disease
4. Cushing's syndrome ✔️✔️2. Graves' disease
Rationale:
PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease.
Myxedema indicates hypothyroidism.
Cushing's syndrome and Addison's disease are disorders related to adrenal function.
137.) A nurse is reinforcing instructions for a client regarding intranasal desmopressin acetate
(DDAVP). The nurse tells the client that which of the following is a side effect of the
medication?
1. Headache
2. Vulval pain
3. Runny nose
,4. Flushed skin ✔️✔️3. Runny nose
Rationale:
Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache,
vulval pain, and flushed skin are side effects if the medication is administered by the intravenous
(IV) route.
138.) A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the
client regarding administration of the medication and instructs the client that the best time to take
this medication is:
1. At noon
2. At bedtime
3. Early morning
4. Anytime, at the same time, each day ✔️✔️3. Early morning
Rationale:
Corticosteroids (glucocorticoids) should be administered before 9:00 AM. Administration at this
time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released
naturally by the adrenal glands each morning.
**Note the suffix "-sone," and recall that medication names that end with these letters are
corticosteroids.**
139.) Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral
protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the
nurse anticipate during therapy with the prednisone?
, 1. An additional dose of prednisone daily
2. A decreased amount of daily Humulin NPH insulin
3. An increased amount of daily Humulin NPH insulin
4. The addition of an oral hypoglycemic medication daily ✔️✔️3. An increased amount of
daily Humulin NPH insulin
Rationale:
Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their
dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy.
Therefore the other options are incorrect.
140.) The client has a new prescription for metoclopramide (Reglan). On review of the chart, the
nurse identifies that this medication can be safely administered with which condition?
1. Intestinal obstruction
2. Peptic ulcer with melena
3. Diverticulitis with perforation
4. Vomiting following cancer chemotherapy ✔️✔️4. Vomiting following cancer
chemotherapy
Rationale:
Metoclopramide is a gastrointestinal (GI) stimulant and antiemetic. Because it is a GI stimulant,
it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of
emesis after surgery, chemotherapy, and radiation.
Actual Answers and Detailed Rationales
134.) A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The
nurse tells the client to take the medication:
1. With food
2. At lunchtime
3. On an empty stomach
4. At bedtime with a snack ✔️✔️Rationale:
Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance
absorption. Dosing should be done in the morning before breakfast.
**Note that options 1, 2, and 4 are comparable or alike in that these options address
administering the medication with food.**
135.) A nurse reinforces medication instructions to a client who is taking levothyroxine
(Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of
the following occurs?
1. Fatigue
2. Tremors
3. Cold intolerance
4. Excessively dry skin ✔️✔️2. Tremors
Rationale:
,Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of
hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia,
hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if
these occur. Options 1, 3, and 4 are signs of hypothyroidism.
136.) A nurse performs an admission assessment on a client who visits a health care clinic for the
first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse
continues to collect data from the client, suspecting that the client has a history of:
1. Myxedema
2. Graves' disease
3. Addison's disease
4. Cushing's syndrome ✔️✔️2. Graves' disease
Rationale:
PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease.
Myxedema indicates hypothyroidism.
Cushing's syndrome and Addison's disease are disorders related to adrenal function.
137.) A nurse is reinforcing instructions for a client regarding intranasal desmopressin acetate
(DDAVP). The nurse tells the client that which of the following is a side effect of the
medication?
1. Headache
2. Vulval pain
3. Runny nose
,4. Flushed skin ✔️✔️3. Runny nose
Rationale:
Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache,
vulval pain, and flushed skin are side effects if the medication is administered by the intravenous
(IV) route.
138.) A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the
client regarding administration of the medication and instructs the client that the best time to take
this medication is:
1. At noon
2. At bedtime
3. Early morning
4. Anytime, at the same time, each day ✔️✔️3. Early morning
Rationale:
Corticosteroids (glucocorticoids) should be administered before 9:00 AM. Administration at this
time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released
naturally by the adrenal glands each morning.
**Note the suffix "-sone," and recall that medication names that end with these letters are
corticosteroids.**
139.) Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral
protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the
nurse anticipate during therapy with the prednisone?
, 1. An additional dose of prednisone daily
2. A decreased amount of daily Humulin NPH insulin
3. An increased amount of daily Humulin NPH insulin
4. The addition of an oral hypoglycemic medication daily ✔️✔️3. An increased amount of
daily Humulin NPH insulin
Rationale:
Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their
dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy.
Therefore the other options are incorrect.
140.) The client has a new prescription for metoclopramide (Reglan). On review of the chart, the
nurse identifies that this medication can be safely administered with which condition?
1. Intestinal obstruction
2. Peptic ulcer with melena
3. Diverticulitis with perforation
4. Vomiting following cancer chemotherapy ✔️✔️4. Vomiting following cancer
chemotherapy
Rationale:
Metoclopramide is a gastrointestinal (GI) stimulant and antiemetic. Because it is a GI stimulant,
it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of
emesis after surgery, chemotherapy, and radiation.
