,HESI RN Pharmacology Advanced Prep:
Master NGN-Style Medication Management
Practice Questions
Subject: Pharmacology, Medication Safety, and Pharmacokinetics/Dynamics
Question 1: A client with chronic heart failure is prescribed digoxin 0.25 mg orally daily. Before
administering the medication, the nurse reviews the client's laboratory results and notes a serum
potassium level of 3.2 mEq/L and a serum digoxin level of 1.4 ng/mL. Which action should the
nurse take?
A) Administer the digoxin as prescribed because the serum level is within the therapeutic range.
B) Hold the dose and notify the provider of the client’s hypokalemia.
C) Administer the dose and document the findings in the client's medical record.
D) Request an order to increase the digoxin dose to compensate for the hypokalemia.
Correct Answer: B) Hold the dose and notify the provider of the client’s hypokalemia.
Explanation: Digoxin toxicity is significantly potentiated by hypokalemia. Even though the serum
digoxin level is currently within the therapeutic range (0.5–2.0 ng/mL), the low potassium level
increases the risk of life-threatening cardiac arrhythmias. The nurse’s priority is to prevent
toxicity, not just rely on the serum drug level. Administering the dose without addressing the
electrolyte imbalance is unsafe.
Question 2: A client is receiving an intravenous infusion of vancomycin for a severe MRSA
infection. During the infusion, the client develops flushing of the face, neck, and upper chest,
along with hypotension. Which action is the nurse’s priority?
A) Discontinue the infusion immediately and notify the rapid response team.
B) Slow the infusion rate and assess the client’s vital signs.
C) Administer a PRN dose of diphenhydramine as ordered for an allergic reaction.
D) Increase the infusion rate to clear the medication from the system faster.
Correct Answer: B) Slow the infusion rate and assess the client’s vital signs.
Explanation: The client is experiencing "Red Man Syndrome," which is a rate-dependent infusion
reaction, not a true immunoglobulin-mediated allergic reaction. The standard nursing
,intervention is to slow the infusion rate, which typically resolves the flushing and hypotension.
Stopping the infusion completely is unnecessary unless the reaction is severe or persistent, and
increasing the rate would exacerbate the issue.
Question 3: A client is prescribed phenelzine, a monoamine oxidase inhibitor (MAOI), for
treatment-resistant depression. Which dietary restriction must the nurse emphasize during
discharge teaching?
A) Avoiding grapefruit juice to prevent drug-level elevation.
B) Restricting intake of aged cheeses, cured meats, and red wines.
C) Limiting consumption of leafy green vegetables to prevent interference with warfarin.
D) Reducing intake of potassium-rich foods to prevent hyperkalemia.
Correct Answer: B) Restricting intake of aged cheeses, cured meats, and red wines.
Explanation: MAOIs prevent the breakdown of tyramine in the diet. High intake of tyramine-rich
foods (aged cheeses, cured meats, fermented products) can lead to a hypertensive crisis due to
an excessive release of norepinephrine. Grapefruit juice interaction (Option A) is typically
associated with calcium channel blockers or statins, not MAOIs.
Question 4: A client with a history of asthma is prescribed propranolol for stage fright and
performance anxiety. What is the most important assessment for the nurse to perform before
administering the first dose?
A) Assess the client's current pain level.
B) Check the client’s apical pulse rate.
C) Assess for current wheezing or a history of bronchospasm.
D) Review the client’s blood glucose levels.
Correct Answer: C) Assess for current wheezing or a history of bronchospasm.
Explanation: Propranolol is a non-selective beta-blocker that blocks both beta-1 (cardiac) and
beta-2 (bronchial) receptors. Beta-2 blockade can cause bronchoconstriction, which can be fatal
in clients with asthma. While monitoring pulse (Option B) is standard for all beta-blockers, the
risk of inducing an asthma attack is the highest priority assessment.
Question 5: A client is receiving warfarin for atrial fibrillation. The client’s INR is 4.5. The nurse
should anticipate an order for which intervention?
A) Administering protamine sulfate.
, B) Administering vitamin K (phytonadione).
C) Holding the warfarin dose and rechecking the INR in 24–48 hours.
D) Transitioning the client to subcutaneous enoxaparin.
Correct Answer: C) Holding the warfarin dose and rechecking the INR in 24–48 hours.
Explanation: An INR of 4.5 is elevated but usually does not require the administration of vitamin
K (an antidote) unless there is active bleeding. The standard practice for an INR slightly above
the therapeutic range (usually 2.0–3.0) without bleeding is to hold the dose and monitor.
Protamine sulfate is the antidote for heparin, not warfarin.
Question 6: A client is prescribed lithium carbonate for bipolar disorder. The nurse should
instruct the client to maintain adequate intake of which of the following?
A) Sodium and fluids.
B) Potassium and iron.
C) Calcium and vitamin D.
D) Magnesium and protein.
Correct Answer: A) Sodium and fluids.
Explanation: Lithium is excreted by the kidneys similarly to sodium. If sodium intake is low or
the client is dehydrated, the kidneys will reabsorb more lithium, leading to toxic serum levels.
Clients must maintain consistent sodium and fluid intake to keep lithium levels within a narrow
therapeutic window.
Question 7: A client receiving chemotherapy for cancer develops a neutrophil count of 450/mm³.
The provider orders filgrastim. How should the nurse explain the purpose of this medication?
A) "This medication helps reduce your risk of anemia by stimulating red blood cell production."
B) "This drug will help your bone marrow produce more white blood cells to fight infection."
C) "This medication is used to prevent nausea and vomiting associated with chemotherapy."
D) "This medication will help your blood clot more effectively."
Correct Answer: B) "This drug will help your bone marrow produce more white blood cells
to fight infection."
Master NGN-Style Medication Management
Practice Questions
Subject: Pharmacology, Medication Safety, and Pharmacokinetics/Dynamics
Question 1: A client with chronic heart failure is prescribed digoxin 0.25 mg orally daily. Before
administering the medication, the nurse reviews the client's laboratory results and notes a serum
potassium level of 3.2 mEq/L and a serum digoxin level of 1.4 ng/mL. Which action should the
nurse take?
A) Administer the digoxin as prescribed because the serum level is within the therapeutic range.
B) Hold the dose and notify the provider of the client’s hypokalemia.
C) Administer the dose and document the findings in the client's medical record.
D) Request an order to increase the digoxin dose to compensate for the hypokalemia.
Correct Answer: B) Hold the dose and notify the provider of the client’s hypokalemia.
Explanation: Digoxin toxicity is significantly potentiated by hypokalemia. Even though the serum
digoxin level is currently within the therapeutic range (0.5–2.0 ng/mL), the low potassium level
increases the risk of life-threatening cardiac arrhythmias. The nurse’s priority is to prevent
toxicity, not just rely on the serum drug level. Administering the dose without addressing the
electrolyte imbalance is unsafe.
Question 2: A client is receiving an intravenous infusion of vancomycin for a severe MRSA
infection. During the infusion, the client develops flushing of the face, neck, and upper chest,
along with hypotension. Which action is the nurse’s priority?
A) Discontinue the infusion immediately and notify the rapid response team.
B) Slow the infusion rate and assess the client’s vital signs.
C) Administer a PRN dose of diphenhydramine as ordered for an allergic reaction.
D) Increase the infusion rate to clear the medication from the system faster.
Correct Answer: B) Slow the infusion rate and assess the client’s vital signs.
Explanation: The client is experiencing "Red Man Syndrome," which is a rate-dependent infusion
reaction, not a true immunoglobulin-mediated allergic reaction. The standard nursing
,intervention is to slow the infusion rate, which typically resolves the flushing and hypotension.
Stopping the infusion completely is unnecessary unless the reaction is severe or persistent, and
increasing the rate would exacerbate the issue.
Question 3: A client is prescribed phenelzine, a monoamine oxidase inhibitor (MAOI), for
treatment-resistant depression. Which dietary restriction must the nurse emphasize during
discharge teaching?
A) Avoiding grapefruit juice to prevent drug-level elevation.
B) Restricting intake of aged cheeses, cured meats, and red wines.
C) Limiting consumption of leafy green vegetables to prevent interference with warfarin.
D) Reducing intake of potassium-rich foods to prevent hyperkalemia.
Correct Answer: B) Restricting intake of aged cheeses, cured meats, and red wines.
Explanation: MAOIs prevent the breakdown of tyramine in the diet. High intake of tyramine-rich
foods (aged cheeses, cured meats, fermented products) can lead to a hypertensive crisis due to
an excessive release of norepinephrine. Grapefruit juice interaction (Option A) is typically
associated with calcium channel blockers or statins, not MAOIs.
Question 4: A client with a history of asthma is prescribed propranolol for stage fright and
performance anxiety. What is the most important assessment for the nurse to perform before
administering the first dose?
A) Assess the client's current pain level.
B) Check the client’s apical pulse rate.
C) Assess for current wheezing or a history of bronchospasm.
D) Review the client’s blood glucose levels.
Correct Answer: C) Assess for current wheezing or a history of bronchospasm.
Explanation: Propranolol is a non-selective beta-blocker that blocks both beta-1 (cardiac) and
beta-2 (bronchial) receptors. Beta-2 blockade can cause bronchoconstriction, which can be fatal
in clients with asthma. While monitoring pulse (Option B) is standard for all beta-blockers, the
risk of inducing an asthma attack is the highest priority assessment.
Question 5: A client is receiving warfarin for atrial fibrillation. The client’s INR is 4.5. The nurse
should anticipate an order for which intervention?
A) Administering protamine sulfate.
, B) Administering vitamin K (phytonadione).
C) Holding the warfarin dose and rechecking the INR in 24–48 hours.
D) Transitioning the client to subcutaneous enoxaparin.
Correct Answer: C) Holding the warfarin dose and rechecking the INR in 24–48 hours.
Explanation: An INR of 4.5 is elevated but usually does not require the administration of vitamin
K (an antidote) unless there is active bleeding. The standard practice for an INR slightly above
the therapeutic range (usually 2.0–3.0) without bleeding is to hold the dose and monitor.
Protamine sulfate is the antidote for heparin, not warfarin.
Question 6: A client is prescribed lithium carbonate for bipolar disorder. The nurse should
instruct the client to maintain adequate intake of which of the following?
A) Sodium and fluids.
B) Potassium and iron.
C) Calcium and vitamin D.
D) Magnesium and protein.
Correct Answer: A) Sodium and fluids.
Explanation: Lithium is excreted by the kidneys similarly to sodium. If sodium intake is low or
the client is dehydrated, the kidneys will reabsorb more lithium, leading to toxic serum levels.
Clients must maintain consistent sodium and fluid intake to keep lithium levels within a narrow
therapeutic window.
Question 7: A client receiving chemotherapy for cancer develops a neutrophil count of 450/mm³.
The provider orders filgrastim. How should the nurse explain the purpose of this medication?
A) "This medication helps reduce your risk of anemia by stimulating red blood cell production."
B) "This drug will help your bone marrow produce more white blood cells to fight infection."
C) "This medication is used to prevent nausea and vomiting associated with chemotherapy."
D) "This medication will help your blood clot more effectively."
Correct Answer: B) "This drug will help your bone marrow produce more white blood cells
to fight infection."
