,Pharmacology HESI RN Advanced Prep:
Master High-Stakes Clinical Pharmacology
Practice Questions & Detailed Explanations
Subject: Pharmacological Management & Clinical Nursing Interventions
Question 1: A client with a severe head injury is intubated and receiving a continuous infusion
of pancuronium bromide to facilitate mechanical ventilation. During the shift assessment, the
nurse notes the client's oxygen saturation is dropping rapidly. Which medication should the nurse
ensure is immediately accessible at the bedside?
A) Dantrolene sodium
B) Neostigmine bromide
C) Succinylcholine chloride
D) Epinephrine
Correct Answer: B) Neostigmine bromide
Explanation: Pancuronium is a non-depolarizing neuromuscular blocking agent that causes
paralysis of skeletal muscles, including the diaphragm, necessitating mechanical ventilation. If
respiratory distress or equipment failure occurs, the nurse must be prepared to reverse the
paralysis. Neostigmine is an acetylcholinesterase inhibitor used to reverse the effects of non-
depolarizing neuromuscular blockers. Dantrolene (A) is used for malignant hyperthermia.
Succinylcholine (C) is a depolarizing blocker, which would worsen the situation. Epinephrine
(D) is not the reversal agent for neuromuscular blockade.
Question 2: A client is prescribed oral isotretinoin for severe, recalcitrant nodular acne. Before
the nurse initiates the first dose, which laboratory parameter must be verified as part of the
clinical safety protocol?
A) Baseline serum creatinine
B) Fasting triglyceride levels
C) White blood cell count
D) Liver function studies (ALT/AST)
Correct Answer: B) Fasting triglyceride levels
,Explanation: Isotretinoin is a potent retinoid known to cause significant lipid profile alterations,
specifically hypertriglyceridemia, which can increase the risk of pancreatitis. While liver
function (D) may be monitored, the most specific and high-priority baseline metabolic screening
for this agent is the fasting lipid panel. Options A, C, and D are not the primary, immediate
safety-critical baseline screenings required to initiate therapy compared to the risk of severe
hypertriglyceridemia.
Question 3: A client with heart failure is receiving digoxin. The nurse reviews the morning labs
and notes the following: Sodium 138 mEq/L, Potassium 3.1 mEq/L, BUN 18 mg/dL, and
Creatinine 0.9 mg/dL. Which action is the priority for the nurse?
A) Administer the dose as scheduled because the digoxin level is not provided.
B) Hold the dose and notify the healthcare provider due to the risk of toxicity.
C) Administer the dose with a potassium supplement to prevent hyperkalemia.
D) Document the values and request a stat EKG to assess for arrhythmias.
Correct Answer: B) Hold the dose and notify the healthcare provider due to the risk of
toxicity.
Explanation: Digoxin toxicity is highly correlated with hypokalemia, as potassium and digoxin
compete for the same binding site on the Na+/K+-ATPase pump. When potassium levels are low
(normal range 3.5–5.0 mEq/L), digoxin binding increases, significantly raising the risk of fatal
cardiac dysrhythmias. Holding the dose and addressing the hypokalemia is the standard of care
to ensure patient safety.
Question 4: A nurse is caring for a client newly prescribed lisinopril for hypertension. Which
assessment finding requires the most immediate follow-up by the nurse?
A) The client reports a persistent, dry, hacking cough.
B) The client complains of dizziness when rising from a seated position.
C) The client presents with edema of the lips, tongue, and pharynx.
D) The client’s serum potassium level is 5.0 mEq/L.
Correct Answer: C) The client presents with edema of the lips, tongue, and pharynx.
Explanation: Angioedema is a rare but life-threatening adverse reaction associated with ACE
inhibitors like lisinopril. It can cause airway obstruction and death if not managed immediately.
A dry cough (A) is a common, non-emergent side effect. Orthostatic hypotension (B) and mild
hyperkalemia (D) are expected side effects or lab findings requiring monitoring, but angioedema
is a medical emergency.
, Question 5: A client with a history of asthma is diagnosed with hypertension. Which medication
should the nurse question if ordered for this client?
A) Lisinopril
B) Amlodipine
C) Propranolol
D) Hydrochlorothiazide
Correct Answer: C) Propranolol
Explanation: Propranolol is a non-selective beta-blocker that blocks both beta-1 (cardiac) and
beta-2 (bronchial) receptors. Blocking beta-2 receptors in the lungs can cause
bronchoconstriction, which is dangerous for a client with asthma. Options A, B, and D do not
carry the same risk of inducing bronchospasm.
Question 6: A client is receiving intravenous cytosine arabinoside (Ara-C) for the treatment of
acute leukemia. Which nursing intervention is most critical to prevent drug-induced toxicity?
A) Infuse the medication rapidly to prevent local tissue extravasation.
B) Administer the medication only through a peripheral IV line.
C) Hydrate the client with IV fluids before and after the infusion.
D) Assess the client for numbness and tingling of the extremities.
Correct Answer: C) Hydrate the client with IV fluids before and after the infusion.
Explanation: Cytosine arabinoside is an antimetabolite that can cause significant renal stress
due to the breakdown of cancer cells (tumor lysis syndrome) and the excretion of drug
metabolites. Maintaining high urine output through aggressive IV hydration is a standard
prophylactic nursing intervention. Extravasation risk (A/B) is important but hydration is the
systemic priority. Neurological assessment (D) is specific to specific doses/types but hydration is
universal.
Question 7: A nurse is providing discharge teaching for a client with a new transdermal
nitroglycerin patch. Which statement by the client indicates a need for further teaching?
A) "I will apply the patch to a hairless area of my upper body."
B) "I will remove the patch at night to prevent drug tolerance."
C) "I will rotate the application site with each new patch."
Master High-Stakes Clinical Pharmacology
Practice Questions & Detailed Explanations
Subject: Pharmacological Management & Clinical Nursing Interventions
Question 1: A client with a severe head injury is intubated and receiving a continuous infusion
of pancuronium bromide to facilitate mechanical ventilation. During the shift assessment, the
nurse notes the client's oxygen saturation is dropping rapidly. Which medication should the nurse
ensure is immediately accessible at the bedside?
A) Dantrolene sodium
B) Neostigmine bromide
C) Succinylcholine chloride
D) Epinephrine
Correct Answer: B) Neostigmine bromide
Explanation: Pancuronium is a non-depolarizing neuromuscular blocking agent that causes
paralysis of skeletal muscles, including the diaphragm, necessitating mechanical ventilation. If
respiratory distress or equipment failure occurs, the nurse must be prepared to reverse the
paralysis. Neostigmine is an acetylcholinesterase inhibitor used to reverse the effects of non-
depolarizing neuromuscular blockers. Dantrolene (A) is used for malignant hyperthermia.
Succinylcholine (C) is a depolarizing blocker, which would worsen the situation. Epinephrine
(D) is not the reversal agent for neuromuscular blockade.
Question 2: A client is prescribed oral isotretinoin for severe, recalcitrant nodular acne. Before
the nurse initiates the first dose, which laboratory parameter must be verified as part of the
clinical safety protocol?
A) Baseline serum creatinine
B) Fasting triglyceride levels
C) White blood cell count
D) Liver function studies (ALT/AST)
Correct Answer: B) Fasting triglyceride levels
,Explanation: Isotretinoin is a potent retinoid known to cause significant lipid profile alterations,
specifically hypertriglyceridemia, which can increase the risk of pancreatitis. While liver
function (D) may be monitored, the most specific and high-priority baseline metabolic screening
for this agent is the fasting lipid panel. Options A, C, and D are not the primary, immediate
safety-critical baseline screenings required to initiate therapy compared to the risk of severe
hypertriglyceridemia.
Question 3: A client with heart failure is receiving digoxin. The nurse reviews the morning labs
and notes the following: Sodium 138 mEq/L, Potassium 3.1 mEq/L, BUN 18 mg/dL, and
Creatinine 0.9 mg/dL. Which action is the priority for the nurse?
A) Administer the dose as scheduled because the digoxin level is not provided.
B) Hold the dose and notify the healthcare provider due to the risk of toxicity.
C) Administer the dose with a potassium supplement to prevent hyperkalemia.
D) Document the values and request a stat EKG to assess for arrhythmias.
Correct Answer: B) Hold the dose and notify the healthcare provider due to the risk of
toxicity.
Explanation: Digoxin toxicity is highly correlated with hypokalemia, as potassium and digoxin
compete for the same binding site on the Na+/K+-ATPase pump. When potassium levels are low
(normal range 3.5–5.0 mEq/L), digoxin binding increases, significantly raising the risk of fatal
cardiac dysrhythmias. Holding the dose and addressing the hypokalemia is the standard of care
to ensure patient safety.
Question 4: A nurse is caring for a client newly prescribed lisinopril for hypertension. Which
assessment finding requires the most immediate follow-up by the nurse?
A) The client reports a persistent, dry, hacking cough.
B) The client complains of dizziness when rising from a seated position.
C) The client presents with edema of the lips, tongue, and pharynx.
D) The client’s serum potassium level is 5.0 mEq/L.
Correct Answer: C) The client presents with edema of the lips, tongue, and pharynx.
Explanation: Angioedema is a rare but life-threatening adverse reaction associated with ACE
inhibitors like lisinopril. It can cause airway obstruction and death if not managed immediately.
A dry cough (A) is a common, non-emergent side effect. Orthostatic hypotension (B) and mild
hyperkalemia (D) are expected side effects or lab findings requiring monitoring, but angioedema
is a medical emergency.
, Question 5: A client with a history of asthma is diagnosed with hypertension. Which medication
should the nurse question if ordered for this client?
A) Lisinopril
B) Amlodipine
C) Propranolol
D) Hydrochlorothiazide
Correct Answer: C) Propranolol
Explanation: Propranolol is a non-selective beta-blocker that blocks both beta-1 (cardiac) and
beta-2 (bronchial) receptors. Blocking beta-2 receptors in the lungs can cause
bronchoconstriction, which is dangerous for a client with asthma. Options A, B, and D do not
carry the same risk of inducing bronchospasm.
Question 6: A client is receiving intravenous cytosine arabinoside (Ara-C) for the treatment of
acute leukemia. Which nursing intervention is most critical to prevent drug-induced toxicity?
A) Infuse the medication rapidly to prevent local tissue extravasation.
B) Administer the medication only through a peripheral IV line.
C) Hydrate the client with IV fluids before and after the infusion.
D) Assess the client for numbness and tingling of the extremities.
Correct Answer: C) Hydrate the client with IV fluids before and after the infusion.
Explanation: Cytosine arabinoside is an antimetabolite that can cause significant renal stress
due to the breakdown of cancer cells (tumor lysis syndrome) and the excretion of drug
metabolites. Maintaining high urine output through aggressive IV hydration is a standard
prophylactic nursing intervention. Extravasation risk (A/B) is important but hydration is the
systemic priority. Neurological assessment (D) is specific to specific doses/types but hydration is
universal.
Question 7: A nurse is providing discharge teaching for a client with a new transdermal
nitroglycerin patch. Which statement by the client indicates a need for further teaching?
A) "I will apply the patch to a hairless area of my upper body."
B) "I will remove the patch at night to prevent drug tolerance."
C) "I will rotate the application site with each new patch."
