HESI Advanced Pharmacology Exit Exam Practice Quiz Book 2026/2027: Comprehensive Assessment and Rationales for Success

A client with hyperparathyroidism reports increasing fatigue, constipation, and generalized muscle weakness. Laboratory testing reveals a serum calcium level of 13 mg/dL. Which prescribed medication should the nurse anticipate administering to address the client’s electrolyte imbalance? A. Calcium chloride B. Calcium gluconate C. Calcitonin D. Vitamin D Correct Answer: C. Calcitonin Rationale: Calcitonin lowers serum calcium by inhibiting osteoclast-mediated bone resorption and increasing calcium excretion. A calcium level of 13 mg/dL indicates hypercalcemia. Calcium chloride and calcium gluconate are used to treat significant hypocalcemia, not hypercalcemia. Vitamin D increases intestinal calcium absorption and could worsen the client’s condition. Question 2 A 6-year-old child is prescribed oral ferrous sulfate for iron-deficiency anemia. Which beverage should the parent use when administering the medication to maximize iron absorption? A. Whole milk B. Plain water C. Apple juice D. Orange juice Correct Answer: D. Orange juice Rationale: Orange juice contains vitamin C, which enhances the gastrointestinal absorption of nonheme iron by maintaining it in a more absorbable form. Milk contains calcium, which can interfere with iron absorption. Water does not enhance absorption, and although apple juice may be acceptable, it generally contains substantially less vitamin C than orange juice. Question 3 A client with extensive psoriasis applies salicylic acid to several affected areas. During a follow-up assessment, which finding should alert the nurse to possible systemic salicylate toxicity? A. Ringing in the ears B. Constipation C. Reduced respiratory rate D. Mild localized itching Correct Answer: A. Ringing in the ears Rationale: Salicylic acid can be absorbed through damaged or extensively treated skin, leading to salicylism. Tinnitus is an early and characteristic manifestation. Other findings may include dizziness, rapid breathing, nausea, and mental-status changes. Constipation and localized itching are not typical indicators of systemic toxicity, while salicylate toxicity more often causes increased rather than decreased respirations. Question 4 A camp nurse is teaching children how to use chemical sunscreen before swimming in a lake. Which instruction provides the greatest protection from ultraviolet radiation? A. Apply sunscreen immediately before entering the water. B. Apply sunscreen 15 minutes after sun exposure begins. C. Apply sunscreen only to areas not covered by clothing. D. Apply sunscreen at least 30 minutes before sun exposure. Correct Answer: D. Apply sunscreen at least 30 minutes before sun exposure. Rationale: Chemical sunscreens require time to penetrate the skin and become effective; therefore, they should generally be applied approximately 30 minutes before sun exposure. Applying sunscreen immediately before swimming may not allow adequate absorption. It should cover all exposed skin and must be reapplied after swimming, heavy sweating, or towel drying. Question 5 A client with a deep partial-thickness burn reports intense burning immediately after topical mafenide acetate is applied. The skin surrounding the wound is unchanged. Which response by the nurse is most appropriate? A. “The medication must be discontinued immediately.” B. “This discomfort is an expected local effect of the medication.” C. “The burning indicates that the wound has become infected.” D. “I will remove the medication and apply a thinner layer.” Correct Answer: B. “This discomfort is an expected local effect of the medication.” Rationale: Mafenide acetate commonly causes temporary local pain or burning when applied to burn wounds. This expected reaction does not automatically require discontinuation or a reduction in the prescribed amount. The medication penetrates avascular burn tissue and provides broad antibacterial activity. New systemic findings or evidence of severe hypersensitivity would require further evaluation. Question 6 A client with extensive burns is receiving topical mafenide acetate. Which assessment finding is most concerning for a systemic adverse effect of the medication? A. Rapid, deep respirations B. Mild pain at the application site C. Localized erythema around the burn D. Temporarily elevated blood pressure Correct Answer: A. Rapid, deep respirations Rationale: Mafenide inhibits carbonic anhydrase and may contribute to metabolic acidosis. Rapid, deep respirations represent respiratory compensation for the acidbase disturbance and require prompt evaluation. Local pain and mild skin reactions may occur at the application site. Elevated blood pressure may result from pain or stress and is not the characteristic systemic effect of mafenide. Question 7 A client is scheduled to begin isotretinoin therapy for severe nodulocystic acne. Which laboratory value is particularly important to obtain before treatment and periodically during therapy? A. Platelet count B. Serum triglyceride level C. Serum sodium level D. White blood cell count Correct Answer: B. Serum triglyceride level Rationale: Isotretinoin may significantly elevate serum triglycerides and other lipid levels. A baseline lipid profile should therefore be obtained and repeated during treatment. Liver function and pregnancy status are also important considerations. Platelet, sodium, and white blood cell levels are not the primary laboratory values specifically associated with isotretinoin-induced metabolic toxicity. Question 8 A client is prescribed isotretinoin for treatment-resistant acne. Which product listed in the client’s medication history should the nurse identify as a potential safety concern? A. Vitamin A supplement B. Furosemide C. Digoxin D. Phenytoin Correct Answer: A. Vitamin A supplement Rationale: Isotretinoin is a vitamin A derivative. Taking additional vitamin A can intensify retinoid toxicity, producing headache, visual changes, dry skin, liver injury, or increased intracranial pressure. Vitamin A supplements should therefore be avoided unless specifically approved. Furosemide, digoxin, and phenytoin do not have the same direct additive toxicity with isotretinoin. Question 9 The nurse is teaching a client to apply a topical corticosteroid for eczema. Application to which body area creates the greatest risk of increased systemic absorption? A. Upper back B. Axilla C. Palm of the hand D. Sole of the foot Correct Answer: B. Axilla Rationale: Topical corticosteroid absorption is greatest through thin, moist, highly permeable skin, including the axillae, face, eyelids, neck, groin, and genital area. The palms, soles, and back have thicker skin and lower permeability. Applying potent corticosteroids to highly absorptive areas or under occlusive dressings increases the risk of systemic effects and skin atrophy. Question 10 During medication reconciliation, the nurse notes that a client uses topical azelaic acid. Which condition is the client most likely treating? A. Mild-to-moderate acne B. Atopic eczema C. Herpes simplex infection D. Alopecia areata Correct Answer: A. Mild-to-moderate acne Rationale: Azelaic acid is a topical medication commonly used for mild-to-moderate inflammatory or comedonal acne. It decreases keratinocyte proliferation and inhibits acne-associated bacterial growth. It may also be used for rosacea in some formulations. It is not a standard treatment for eczema, herpes simplex infection, or autoimmune hair loss.