HESI RN PHARMACOLOGY V1 NGN QUESTIONS
WITH ANSWERS AND EXPLANATIONS
1. The nurse must apply pharmacology principles to the current situation. A client uses acetaminophen for
musculoskeletal pain and also takes several OTC cold products. Which follow-up decision best reflects safe
evaluation of the current regimen?
A. Escalating dose requirements or daytime somnolence suggests tolerance, accumulation, or an unsafe regimen
and warrants reassessment.
B. Severe headache, palpitations, neck stiffness, chest pain, or marked blood-pressure elevation requires
emergency evaluation.
C. Because recurrent respiratory depression can occur, continue observation and repeat naloxone when clinically
indicated.
D. Suspected overdose requires prompt serum-level assessment and treatment with N-acetylcysteine according to
timing and protocol.
Correct Answer: D. Suspected overdose requires prompt serum-level assessment and treatment with
N-acetylcysteine according to timing and protocol.
Rationale: Suspected overdose requires prompt serum-level assessment and treatment with N-acetylcysteine
according to timing and protocol. Ongoing therapy should be judged by both benefit and safety, not by
administration alone.
2. The nurse must apply pharmacology principles to the current situation. The client asks what is most
important to remember about the medication. An older adult with chronic kidney disease is started on a
medication eliminated primarily by the kidneys. Which response by the nurse is best?
A. Teach clients to swallow modified-release products intact unless the specific product instructions explicitly
allow another method.
B. Explain that blood sampling helps tailor dosing for effectiveness and safety rather than indicating that the drug
has already failed.
C. Teach clients with chronic organ disease to check before starting OTC drugs or supplements that may worsen
kidney or liver function.
D. Teach caregivers to use an oral syringe or calibrated device rather than household teaspoons for liquid
medications.
Correct Answer: C. Teach clients with chronic organ disease to check before starting OTC drugs or supplements
that may worsen kidney or liver function.
Rationale: Teach clients with chronic organ disease to check before starting OTC drugs or supplements that may
worsen kidney or liver function. This teaching directly reduces a high-yield medication-safety risk after discharge.
3. The nurse connects the client presentation with the relevant pharmacology. A client with hypertension
and diabetic kidney disease is prescribed lisinopril. The nurse is ready to give the medication. Which action
should be taken?
A. Administer once daily at a consistent time; dose changes are usually evaluated over days rather than by a single
reading.
B. Give consistently once daily and evaluate blood pressure, renal function, and potassium after initiation or dose
changes.
C. Give at a consistent time and adjust doses based on ordered INR targets rather than day-to-day symptom
changes.
D. Use an infusion pump and titrate to the ordered aPTT or anti-Xa protocol; independent verification may be
required.
Correct Answer: B. Give consistently once daily and evaluate blood pressure, renal function, and potassium after
initiation or dose changes.
Rationale: Give consistently once daily and evaluate blood pressure, renal function, and potassium after initiation
or dose changes. This approach preserves the intended delivery and reduces preventable administration error.
4. The nurse must apply pharmacology principles to the current situation. A client becomes difficult to
arouse with slow respirations after opioid administration. Which data should the nurse trend most closely
while the client receives this therapy?
,A. Monitor respiratory rate, level of consciousness, oxygenation, pain, recurrent sedation, and acute withdrawal
symptoms.
B. Assess pain, respiratory rate and quality, sedation, blood pressure, oxygenation, bowel function, and prior
opioid exposure.
C. Monitor seizure frequency, serum concentration when indicated, albumin, neurologic findings, oral health,
CBC, and liver status.
D. Monitor liver function, CBC/platelets, weight, pregnancy status, clinical response, and serum concentration
when ordered.
Correct Answer: A. Monitor respiratory rate, level of consciousness, oxygenation, pain, recurrent sedation, and
acute withdrawal symptoms.
Rationale: Monitor respiratory rate, level of consciousness, oxygenation, pain, recurrent sedation, and acute
withdrawal symptoms. These data detect clinically important loss of efficacy or toxicity early enough to act.
5. The nurse must apply pharmacology principles to the current situation. The nurse reviews the client's
course after repeated doses. A client is prescribed subcutaneous enoxaparin after orthopedic surgery.
Which evaluation step is most appropriate?
A. Marked electrolyte disturbance, orthostasis, or worsening kidney function indicates the regimen needs
reassessment.
B. Persistent troublesome edema or dizziness despite blood-pressure benefit may require a dose or regimen
change.
C. Renal decline, major bleeding, or unexpected thrombocytopenia requires prompt reassessment of dose and
therapy.
D. Potassium elevation or a substantial decline in renal function requires prompt medication review.
Correct Answer: C. Renal decline, major bleeding, or unexpected thrombocytopenia requires prompt
reassessment of dose and therapy.
Rationale: Renal decline, major bleeding, or unexpected thrombocytopenia requires prompt reassessment of dose
and therapy. Ongoing therapy should be judged by both benefit and safety, not by administration alone.
6. The nurse checks the arithmetic before administering the medication. Before administering the next dose
for a medication-safety order, an IV medication is diluted in 500 mL and must infuse evenly over 5 hours.
What pump rate should the nurse set? Round to the nearest whole mL/hr. Calculation data Values
supplied 500 mL, 5 hours Task Calculate the ordered dose or administration rate using the stated units.
A. 100 mL/hr
B. 200 mL/hr
C. 125 mL/hr
D. 50 mL/hr
Correct Answer: A. 100 mL/hr
Rationale: Rate = total volume / time = 500 mL / 5 hr = 100 mL/hr.
7. The nurse must apply pharmacology principles to the current situation. A client with chronic
opioid-tolerant cancer pain is prescribed a fentanyl patch. Which nursing action is most appropriate when
administering this therapy?
A. Give on a consistent schedule; large protein loads can interfere with levodopa absorption in some clients and
should be managed individually.
B. Dispense and administer according to current safety-monitoring requirements and titrate gradually to reduce
hypotension and seizure risk.
C. Administer using the prescribed route and rate, titrating cautiously to pain and sedation while using fall and
respiratory precautions.
D. Use patches only for appropriate opioid-tolerant clients, remove the old patch before applying a new one, and
avoid external heat over the site.
Correct Answer: D. Use patches only for appropriate opioid-tolerant clients, remove the old patch before
applying a new one, and avoid external heat over the site.
Rationale: Use patches only for appropriate opioid-tolerant clients, remove the old patch before applying a new
one, and avoid external heat over the site. This approach preserves the intended delivery and reduces preventable
administration error.
8. The nurse must apply pharmacology principles to the current situation. The nurse reviews the full
,medication and supplement list for this client. A client asks whether a large extended-release tablet can be
crushed to make it easier to swallow. Which interaction is most clinically relevant?
A. Do not force-flush a catheter when infiltration or extravasation is suspected.
B. Do not assume all scored tablets are crushable or that all capsules may be opened.
C. Never share access credentials or delay reporting a controlled-substance count discrepancy.
D. Avoid unsafe abbreviations and do not bypass dose-range checks or infusion-pump safeguards.
Correct Answer: B. Do not assume all scored tablets are crushable or that all capsules may be opened.
Rationale: Do not assume all scored tablets are crushable or that all capsules may be opened. Identifying this
interaction prevents a predictable change in exposure, effectiveness, or toxicity.
9. During the preadministration safety check for a cardiovascular medication, dopamine 400 mg in 250 mL
is ordered at 7 mcg/kg/min for a client weighing 80 kg. What pump rate is required? Round to the nearest
tenth. Calculation data Values supplied 400 mg, 250 mL, 7 mcg, 80 kg Task Calculate the ordered dose or
administration rate using the stated units.
A. 26.2 mL/hr
B. 42.0 mL/hr
C. 21.0 mL/hr
D. 10.5 mL/hr
Correct Answer: C. 21.0 mL/hr
Rationale: Concentration = 400,000 mcg/250 mL = 1600 mcg/mL. Required rate = (7 x 80 x 60)/1600 = 21.0
mL/hr.
10. The nurse must apply pharmacology principles to the current situation. A client with bipolar disorder
is maintained on lithium. Which nursing action is most appropriate when administering this therapy?
A. Give consistently and taper gradually if discontinuing because abrupt withdrawal symptoms can be
pronounced.
B. Give with consistent fluid and sodium intake and obtain trough concentrations at the ordered time after dose
changes.
C. Use the lowest effective dose for the shortest appropriate duration and administer with food if GI upset occurs.
D. Use the lowest effective dose and administer IV lorazepam slowly when that route is ordered, with appropriate
respiratory monitoring.
Correct Answer: B. Give with consistent fluid and sodium intake and obtain trough concentrations at the ordered
time after dose changes.
Rationale: Give with consistent fluid and sodium intake and obtain trough concentrations at the ordered time
after dose changes. This approach preserves the intended delivery and reduces preventable administration error.
11. The nurse connects the client presentation with the relevant pharmacology. A client with a susceptible
complicated urinary infection is prescribed ciprofloxacin. Which statement best explains the
pharmacologic principle that is most relevant to this therapy?
A. Doxycycline binds the 30S ribosomal subunit and inhibits bacterial protein synthesis.
B. Vancomycin inhibits bacterial cell-wall synthesis and is used for selected serious gram-positive infections.
C. Amphotericin B binds ergosterol in fungal cell membranes, creating pores that disrupt membrane integrity.
D. Fluoroquinolones inhibit bacterial DNA gyrase and topoisomerase IV, disrupting DNA replication.
Correct Answer: D. Fluoroquinolones inhibit bacterial DNA gyrase and topoisomerase IV, disrupting DNA
replication.
Rationale: Fluoroquinolones inhibit bacterial DNA gyrase and topoisomerase IV, disrupting DNA replication.
This mechanism explains the intended pharmacologic effect in the scenario.
12. The nurse must apply pharmacology principles to the current situation. A nurse is implementing the
medication plan. A client with heart failure is prescribed spironolactone in addition to other
guideline-directed therapy. Which administration step is the priority?
A. Administer consistently and avoid automatic potassium replacement unless specifically prescribed.
B. Administer consistently and monitor renal function and potassium after starting or increasing the dose.
C. For IV dosing, administer at the recommended rate and schedule oral doses early enough to reduce nocturia.
D. Check the apical pulse and follow ordered hold parameters; use extra caution with renal impairment.
Correct Answer: A. Administer consistently and avoid automatic potassium replacement unless specifically
prescribed.
, Rationale: Administer consistently and avoid automatic potassium replacement unless specifically prescribed.
This approach preserves the intended delivery and reduces preventable administration error.
13. The nurse reviews the medication record, current assessment, and risk factors before making a
decision. The nurse is evaluating risk before the next dose. A nurse removes an opioid from an automated
dispensing cabinet for a client with severe postoperative pain. Which monitoring focus is most
appropriate?
A. Confirm the exact draw time, infusion end time, dose time, renal function, and current dose before interpreting
the result.
B. Consider renal and hepatic function because impaired clearance can prolong half-life and increase
accumulation.
C. Assess for residual old patches, skin integrity, heat exposure, dose strength, and signs of excessive drug effect.
D. Before dosing, assess pain, respiratory rate, sedation level, blood pressure, allergies, and recent opioid
exposure.
Correct Answer: D. Before dosing, assess pain, respiratory rate, sedation level, blood pressure, allergies, and
recent opioid exposure.
Rationale: Before dosing, assess pain, respiratory rate, sedation level, blood pressure, allergies, and recent opioid
exposure. These data detect clinically important loss of efficacy or toxicity early enough to act.
14. The nurse connects the client presentation with the relevant pharmacology. Before the next dose, the
nurse performs an interaction check. A hospitalized client with a serious susceptible infection receives
ceftriaxone. Which issue deserves priority follow-up?
A. Rifampin is a potent enzyme inducer that can lower concentrations of oral contraceptives, warfarin, many
antiretrovirals, and numerous other drugs.
B. Calcium-containing IV solutions create special compatibility concerns in neonates; anticoagulants may
increase bleeding risk in susceptible clients.
C. Warfarin effect may change during infection or antibiotic therapy, and allopurinol can increase
amoxicillin-associated rash.
D. ACE inhibitors, ARBs, spironolactone, and other potassium-raising drugs increase hyperkalemia risk; warfarin
effect can increase.
Correct Answer: B. Calcium-containing IV solutions create special compatibility concerns in neonates;
anticoagulants may increase bleeding risk in susceptible clients.
Rationale: Calcium-containing IV solutions create special compatibility concerns in neonates; anticoagulants
may increase bleeding risk in susceptible clients. Identifying this interaction prevents a predictable change in
exposure, effectiveness, or toxicity.
15. The nurse reviews the client's course after repeated doses. A nurse is reviewing why the serum
concentration of a newly started maintenance medication changes over several days. Which evaluation step
is most appropriate?
A. Evaluate the client after administration for the intended effect and for unexpected reactions, then document the
response.
B. Reassess the affected limb and document the site, symptoms, intervention, and client response after stopping
the infusion.
C. When toxicity is suspected after a dosing change, interpret the timing of the level in relation to half-life and the
last dose.
D. If the infusion is unexpectedly interrupted, monitor for hypoglycemia and follow the prescribed contingency
plan.
Correct Answer: C. When toxicity is suspected after a dosing change, interpret the timing of the level in relation
to half-life and the last dose.
Rationale: When toxicity is suspected after a dosing change, interpret the timing of the level in relation to
half-life and the last dose. Ongoing therapy should be judged by both benefit and safety, not by administration
alone.
16. The nurse connects the client presentation with the relevant pharmacology. The nurse reviews the full
medication and supplement list for this client. A client with established atherosclerotic cardiovascular
disease is prescribed high-intensity atorvastatin. Which interaction is most clinically relevant?
A. Strong CYP3A4 inhibitors can increase atorvastatin exposure; heavy grapefruit intake may also increase
levels.
WITH ANSWERS AND EXPLANATIONS
1. The nurse must apply pharmacology principles to the current situation. A client uses acetaminophen for
musculoskeletal pain and also takes several OTC cold products. Which follow-up decision best reflects safe
evaluation of the current regimen?
A. Escalating dose requirements or daytime somnolence suggests tolerance, accumulation, or an unsafe regimen
and warrants reassessment.
B. Severe headache, palpitations, neck stiffness, chest pain, or marked blood-pressure elevation requires
emergency evaluation.
C. Because recurrent respiratory depression can occur, continue observation and repeat naloxone when clinically
indicated.
D. Suspected overdose requires prompt serum-level assessment and treatment with N-acetylcysteine according to
timing and protocol.
Correct Answer: D. Suspected overdose requires prompt serum-level assessment and treatment with
N-acetylcysteine according to timing and protocol.
Rationale: Suspected overdose requires prompt serum-level assessment and treatment with N-acetylcysteine
according to timing and protocol. Ongoing therapy should be judged by both benefit and safety, not by
administration alone.
2. The nurse must apply pharmacology principles to the current situation. The client asks what is most
important to remember about the medication. An older adult with chronic kidney disease is started on a
medication eliminated primarily by the kidneys. Which response by the nurse is best?
A. Teach clients to swallow modified-release products intact unless the specific product instructions explicitly
allow another method.
B. Explain that blood sampling helps tailor dosing for effectiveness and safety rather than indicating that the drug
has already failed.
C. Teach clients with chronic organ disease to check before starting OTC drugs or supplements that may worsen
kidney or liver function.
D. Teach caregivers to use an oral syringe or calibrated device rather than household teaspoons for liquid
medications.
Correct Answer: C. Teach clients with chronic organ disease to check before starting OTC drugs or supplements
that may worsen kidney or liver function.
Rationale: Teach clients with chronic organ disease to check before starting OTC drugs or supplements that may
worsen kidney or liver function. This teaching directly reduces a high-yield medication-safety risk after discharge.
3. The nurse connects the client presentation with the relevant pharmacology. A client with hypertension
and diabetic kidney disease is prescribed lisinopril. The nurse is ready to give the medication. Which action
should be taken?
A. Administer once daily at a consistent time; dose changes are usually evaluated over days rather than by a single
reading.
B. Give consistently once daily and evaluate blood pressure, renal function, and potassium after initiation or dose
changes.
C. Give at a consistent time and adjust doses based on ordered INR targets rather than day-to-day symptom
changes.
D. Use an infusion pump and titrate to the ordered aPTT or anti-Xa protocol; independent verification may be
required.
Correct Answer: B. Give consistently once daily and evaluate blood pressure, renal function, and potassium after
initiation or dose changes.
Rationale: Give consistently once daily and evaluate blood pressure, renal function, and potassium after initiation
or dose changes. This approach preserves the intended delivery and reduces preventable administration error.
4. The nurse must apply pharmacology principles to the current situation. A client becomes difficult to
arouse with slow respirations after opioid administration. Which data should the nurse trend most closely
while the client receives this therapy?
,A. Monitor respiratory rate, level of consciousness, oxygenation, pain, recurrent sedation, and acute withdrawal
symptoms.
B. Assess pain, respiratory rate and quality, sedation, blood pressure, oxygenation, bowel function, and prior
opioid exposure.
C. Monitor seizure frequency, serum concentration when indicated, albumin, neurologic findings, oral health,
CBC, and liver status.
D. Monitor liver function, CBC/platelets, weight, pregnancy status, clinical response, and serum concentration
when ordered.
Correct Answer: A. Monitor respiratory rate, level of consciousness, oxygenation, pain, recurrent sedation, and
acute withdrawal symptoms.
Rationale: Monitor respiratory rate, level of consciousness, oxygenation, pain, recurrent sedation, and acute
withdrawal symptoms. These data detect clinically important loss of efficacy or toxicity early enough to act.
5. The nurse must apply pharmacology principles to the current situation. The nurse reviews the client's
course after repeated doses. A client is prescribed subcutaneous enoxaparin after orthopedic surgery.
Which evaluation step is most appropriate?
A. Marked electrolyte disturbance, orthostasis, or worsening kidney function indicates the regimen needs
reassessment.
B. Persistent troublesome edema or dizziness despite blood-pressure benefit may require a dose or regimen
change.
C. Renal decline, major bleeding, or unexpected thrombocytopenia requires prompt reassessment of dose and
therapy.
D. Potassium elevation or a substantial decline in renal function requires prompt medication review.
Correct Answer: C. Renal decline, major bleeding, or unexpected thrombocytopenia requires prompt
reassessment of dose and therapy.
Rationale: Renal decline, major bleeding, or unexpected thrombocytopenia requires prompt reassessment of dose
and therapy. Ongoing therapy should be judged by both benefit and safety, not by administration alone.
6. The nurse checks the arithmetic before administering the medication. Before administering the next dose
for a medication-safety order, an IV medication is diluted in 500 mL and must infuse evenly over 5 hours.
What pump rate should the nurse set? Round to the nearest whole mL/hr. Calculation data Values
supplied 500 mL, 5 hours Task Calculate the ordered dose or administration rate using the stated units.
A. 100 mL/hr
B. 200 mL/hr
C. 125 mL/hr
D. 50 mL/hr
Correct Answer: A. 100 mL/hr
Rationale: Rate = total volume / time = 500 mL / 5 hr = 100 mL/hr.
7. The nurse must apply pharmacology principles to the current situation. A client with chronic
opioid-tolerant cancer pain is prescribed a fentanyl patch. Which nursing action is most appropriate when
administering this therapy?
A. Give on a consistent schedule; large protein loads can interfere with levodopa absorption in some clients and
should be managed individually.
B. Dispense and administer according to current safety-monitoring requirements and titrate gradually to reduce
hypotension and seizure risk.
C. Administer using the prescribed route and rate, titrating cautiously to pain and sedation while using fall and
respiratory precautions.
D. Use patches only for appropriate opioid-tolerant clients, remove the old patch before applying a new one, and
avoid external heat over the site.
Correct Answer: D. Use patches only for appropriate opioid-tolerant clients, remove the old patch before
applying a new one, and avoid external heat over the site.
Rationale: Use patches only for appropriate opioid-tolerant clients, remove the old patch before applying a new
one, and avoid external heat over the site. This approach preserves the intended delivery and reduces preventable
administration error.
8. The nurse must apply pharmacology principles to the current situation. The nurse reviews the full
,medication and supplement list for this client. A client asks whether a large extended-release tablet can be
crushed to make it easier to swallow. Which interaction is most clinically relevant?
A. Do not force-flush a catheter when infiltration or extravasation is suspected.
B. Do not assume all scored tablets are crushable or that all capsules may be opened.
C. Never share access credentials or delay reporting a controlled-substance count discrepancy.
D. Avoid unsafe abbreviations and do not bypass dose-range checks or infusion-pump safeguards.
Correct Answer: B. Do not assume all scored tablets are crushable or that all capsules may be opened.
Rationale: Do not assume all scored tablets are crushable or that all capsules may be opened. Identifying this
interaction prevents a predictable change in exposure, effectiveness, or toxicity.
9. During the preadministration safety check for a cardiovascular medication, dopamine 400 mg in 250 mL
is ordered at 7 mcg/kg/min for a client weighing 80 kg. What pump rate is required? Round to the nearest
tenth. Calculation data Values supplied 400 mg, 250 mL, 7 mcg, 80 kg Task Calculate the ordered dose or
administration rate using the stated units.
A. 26.2 mL/hr
B. 42.0 mL/hr
C. 21.0 mL/hr
D. 10.5 mL/hr
Correct Answer: C. 21.0 mL/hr
Rationale: Concentration = 400,000 mcg/250 mL = 1600 mcg/mL. Required rate = (7 x 80 x 60)/1600 = 21.0
mL/hr.
10. The nurse must apply pharmacology principles to the current situation. A client with bipolar disorder
is maintained on lithium. Which nursing action is most appropriate when administering this therapy?
A. Give consistently and taper gradually if discontinuing because abrupt withdrawal symptoms can be
pronounced.
B. Give with consistent fluid and sodium intake and obtain trough concentrations at the ordered time after dose
changes.
C. Use the lowest effective dose for the shortest appropriate duration and administer with food if GI upset occurs.
D. Use the lowest effective dose and administer IV lorazepam slowly when that route is ordered, with appropriate
respiratory monitoring.
Correct Answer: B. Give with consistent fluid and sodium intake and obtain trough concentrations at the ordered
time after dose changes.
Rationale: Give with consistent fluid and sodium intake and obtain trough concentrations at the ordered time
after dose changes. This approach preserves the intended delivery and reduces preventable administration error.
11. The nurse connects the client presentation with the relevant pharmacology. A client with a susceptible
complicated urinary infection is prescribed ciprofloxacin. Which statement best explains the
pharmacologic principle that is most relevant to this therapy?
A. Doxycycline binds the 30S ribosomal subunit and inhibits bacterial protein synthesis.
B. Vancomycin inhibits bacterial cell-wall synthesis and is used for selected serious gram-positive infections.
C. Amphotericin B binds ergosterol in fungal cell membranes, creating pores that disrupt membrane integrity.
D. Fluoroquinolones inhibit bacterial DNA gyrase and topoisomerase IV, disrupting DNA replication.
Correct Answer: D. Fluoroquinolones inhibit bacterial DNA gyrase and topoisomerase IV, disrupting DNA
replication.
Rationale: Fluoroquinolones inhibit bacterial DNA gyrase and topoisomerase IV, disrupting DNA replication.
This mechanism explains the intended pharmacologic effect in the scenario.
12. The nurse must apply pharmacology principles to the current situation. A nurse is implementing the
medication plan. A client with heart failure is prescribed spironolactone in addition to other
guideline-directed therapy. Which administration step is the priority?
A. Administer consistently and avoid automatic potassium replacement unless specifically prescribed.
B. Administer consistently and monitor renal function and potassium after starting or increasing the dose.
C. For IV dosing, administer at the recommended rate and schedule oral doses early enough to reduce nocturia.
D. Check the apical pulse and follow ordered hold parameters; use extra caution with renal impairment.
Correct Answer: A. Administer consistently and avoid automatic potassium replacement unless specifically
prescribed.
, Rationale: Administer consistently and avoid automatic potassium replacement unless specifically prescribed.
This approach preserves the intended delivery and reduces preventable administration error.
13. The nurse reviews the medication record, current assessment, and risk factors before making a
decision. The nurse is evaluating risk before the next dose. A nurse removes an opioid from an automated
dispensing cabinet for a client with severe postoperative pain. Which monitoring focus is most
appropriate?
A. Confirm the exact draw time, infusion end time, dose time, renal function, and current dose before interpreting
the result.
B. Consider renal and hepatic function because impaired clearance can prolong half-life and increase
accumulation.
C. Assess for residual old patches, skin integrity, heat exposure, dose strength, and signs of excessive drug effect.
D. Before dosing, assess pain, respiratory rate, sedation level, blood pressure, allergies, and recent opioid
exposure.
Correct Answer: D. Before dosing, assess pain, respiratory rate, sedation level, blood pressure, allergies, and
recent opioid exposure.
Rationale: Before dosing, assess pain, respiratory rate, sedation level, blood pressure, allergies, and recent opioid
exposure. These data detect clinically important loss of efficacy or toxicity early enough to act.
14. The nurse connects the client presentation with the relevant pharmacology. Before the next dose, the
nurse performs an interaction check. A hospitalized client with a serious susceptible infection receives
ceftriaxone. Which issue deserves priority follow-up?
A. Rifampin is a potent enzyme inducer that can lower concentrations of oral contraceptives, warfarin, many
antiretrovirals, and numerous other drugs.
B. Calcium-containing IV solutions create special compatibility concerns in neonates; anticoagulants may
increase bleeding risk in susceptible clients.
C. Warfarin effect may change during infection or antibiotic therapy, and allopurinol can increase
amoxicillin-associated rash.
D. ACE inhibitors, ARBs, spironolactone, and other potassium-raising drugs increase hyperkalemia risk; warfarin
effect can increase.
Correct Answer: B. Calcium-containing IV solutions create special compatibility concerns in neonates;
anticoagulants may increase bleeding risk in susceptible clients.
Rationale: Calcium-containing IV solutions create special compatibility concerns in neonates; anticoagulants
may increase bleeding risk in susceptible clients. Identifying this interaction prevents a predictable change in
exposure, effectiveness, or toxicity.
15. The nurse reviews the client's course after repeated doses. A nurse is reviewing why the serum
concentration of a newly started maintenance medication changes over several days. Which evaluation step
is most appropriate?
A. Evaluate the client after administration for the intended effect and for unexpected reactions, then document the
response.
B. Reassess the affected limb and document the site, symptoms, intervention, and client response after stopping
the infusion.
C. When toxicity is suspected after a dosing change, interpret the timing of the level in relation to half-life and the
last dose.
D. If the infusion is unexpectedly interrupted, monitor for hypoglycemia and follow the prescribed contingency
plan.
Correct Answer: C. When toxicity is suspected after a dosing change, interpret the timing of the level in relation
to half-life and the last dose.
Rationale: When toxicity is suspected after a dosing change, interpret the timing of the level in relation to
half-life and the last dose. Ongoing therapy should be judged by both benefit and safety, not by administration
alone.
16. The nurse connects the client presentation with the relevant pharmacology. The nurse reviews the full
medication and supplement list for this client. A client with established atherosclerotic cardiovascular
disease is prescribed high-intensity atorvastatin. Which interaction is most clinically relevant?
A. Strong CYP3A4 inhibitors can increase atorvastatin exposure; heavy grapefruit intake may also increase
levels.
