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HESI Specialty Exam Bank: Drug
Interactions, Adverse Reactions &
High-Risk Medication Safety
Table of Contents
Subtopic 1: Common Drug-Drug Interactions in Clinical Practice....................3
Subtopic 2: Adverse Drug Reactions in High-Risk Populations (Elderly,
Pediatrics, Renal & Hepatic Impairment).......................................................11
Subtopic 3: Food-Drug and Supplement-Drug Interactions............................20
Subtopic 4: Life-Threatening Medication Reactions & Black Box Warnings....29
Subtopic 5: Drug Interactions in Polypharmacy and Chronic Conditions.......37
Subtopic 6: Medication Interactions in Emergency and Critical Care Settings
.......................................................................................................................46
Subtopic 7: Pediatric and Neonatal Medication Interactions and Adverse Drug
Reactions.......................................................................................................55
Subtopic 8: Medication Interactions and ADRs in Psychiatric and Neurological
Nursing..........................................................................................................64
Subtopic 9: Medication Interactions and ADRs in Cardiovascular and
Anticoagulation Therapy................................................................................72
Subtopic 10: Medication Interactions and ADRs in Pediatric and Geriatric
Populations....................................................................................................81
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Subtopic 1: Common Drug-Drug Interactions
in Clinical Practice
Questions 1–20
Question 1
A client prescribed warfarin for atrial fibrillation is started on trimethoprim-
sulfamethoxazole for a urinary tract infection. Which outcome is the nurse
most concerned about?
A. Decreased INR and risk for thrombus formation
B. Increased INR and risk of bleeding
C. Hyperkalemia leading to cardiac arrhythmias
D. Decreased effectiveness of antibiotics
Rationale:
Trimethoprim-sulfamethoxazole can inhibit warfarin metabolism, increase INR
levels and significantly raise bleeding risk. Monitoring INR and assessing for
signs of bleeding is essential.
Question 2
A client taking digoxin is prescribed furosemide. Which clinical finding would
indicate a serious drug interaction?
A. Increased urine output and mild dizziness
B. Bradycardia and normal potassium
C. Nausea, visual disturbances, and hypokalemia
D. Constipation and abdominal cramping
Rationale:
, 4
Furosemide can cause hypokalemia, increasing the risk of digoxin toxicity.
Symptoms such as nausea and visual changes suggest digoxin toxicity.
Monitor potassium levels closely.
Question 3
The nurse is reviewing medications for a client on lithium therapy. Which
newly prescribed medication requires immediate provider notification?
A. Loratadine
B. Acetaminophen
C. Ibuprofen
D. Docusate sodium
Rationale:
NSAIDs like ibuprofen reduce renal clearance of lithium, increasing its levels
and risk of toxicity. Acetaminophen is a safer analgesic alternative in clients
taking lithium.
Question 4
A client is taking levothyroxine and begins calcium carbonate for heartburn.
What is the nurse’s priority teaching?
A. Take both medications together with food.
B. Avoid dairy products for 48 hours.
C. Take calcium carbonate at least 4 hours after levothyroxine.
D. Double the levothyroxine dose when taking calcium.
Rationale:
Calcium interferes with levothyroxine absorption. They should be separated
by at least 4 hours to maintain therapeutic hormone levels.
HESI Specialty Exam Bank: Drug
Interactions, Adverse Reactions &
High-Risk Medication Safety
Table of Contents
Subtopic 1: Common Drug-Drug Interactions in Clinical Practice....................3
Subtopic 2: Adverse Drug Reactions in High-Risk Populations (Elderly,
Pediatrics, Renal & Hepatic Impairment).......................................................11
Subtopic 3: Food-Drug and Supplement-Drug Interactions............................20
Subtopic 4: Life-Threatening Medication Reactions & Black Box Warnings....29
Subtopic 5: Drug Interactions in Polypharmacy and Chronic Conditions.......37
Subtopic 6: Medication Interactions in Emergency and Critical Care Settings
.......................................................................................................................46
Subtopic 7: Pediatric and Neonatal Medication Interactions and Adverse Drug
Reactions.......................................................................................................55
Subtopic 8: Medication Interactions and ADRs in Psychiatric and Neurological
Nursing..........................................................................................................64
Subtopic 9: Medication Interactions and ADRs in Cardiovascular and
Anticoagulation Therapy................................................................................72
Subtopic 10: Medication Interactions and ADRs in Pediatric and Geriatric
Populations....................................................................................................81
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, 3
Subtopic 1: Common Drug-Drug Interactions
in Clinical Practice
Questions 1–20
Question 1
A client prescribed warfarin for atrial fibrillation is started on trimethoprim-
sulfamethoxazole for a urinary tract infection. Which outcome is the nurse
most concerned about?
A. Decreased INR and risk for thrombus formation
B. Increased INR and risk of bleeding
C. Hyperkalemia leading to cardiac arrhythmias
D. Decreased effectiveness of antibiotics
Rationale:
Trimethoprim-sulfamethoxazole can inhibit warfarin metabolism, increase INR
levels and significantly raise bleeding risk. Monitoring INR and assessing for
signs of bleeding is essential.
Question 2
A client taking digoxin is prescribed furosemide. Which clinical finding would
indicate a serious drug interaction?
A. Increased urine output and mild dizziness
B. Bradycardia and normal potassium
C. Nausea, visual disturbances, and hypokalemia
D. Constipation and abdominal cramping
Rationale:
, 4
Furosemide can cause hypokalemia, increasing the risk of digoxin toxicity.
Symptoms such as nausea and visual changes suggest digoxin toxicity.
Monitor potassium levels closely.
Question 3
The nurse is reviewing medications for a client on lithium therapy. Which
newly prescribed medication requires immediate provider notification?
A. Loratadine
B. Acetaminophen
C. Ibuprofen
D. Docusate sodium
Rationale:
NSAIDs like ibuprofen reduce renal clearance of lithium, increasing its levels
and risk of toxicity. Acetaminophen is a safer analgesic alternative in clients
taking lithium.
Question 4
A client is taking levothyroxine and begins calcium carbonate for heartburn.
What is the nurse’s priority teaching?
A. Take both medications together with food.
B. Avoid dairy products for 48 hours.
C. Take calcium carbonate at least 4 hours after levothyroxine.
D. Double the levothyroxine dose when taking calcium.
Rationale:
Calcium interferes with levothyroxine absorption. They should be separated
by at least 4 hours to maintain therapeutic hormone levels.
