2026 HESI RN
Pharmacology/Pathophysiology
SPECIALTY EXAM
consists of 200 questions
(NGN-STYLE QUESTIONS & CASE SCENARIOS)
Answers with detailed Rationale
What You’ll Get:
RN Specialty Focus
Patho-Pharm Integration:
NGN Components:
quick review
Printable, easy-to-study PDF
Not affiliated with ATI, VATI or NCLEX. For study purposes only.
,PREVIEW QUESTIONS BELOW
GET THE COMPLETE PDF
AFTER PURCHASE
“ If you require further clarification
or in need of any study resources,
feel free to Message me.
”
,1. A client with peptic ulcer disease receives a new prescription for cimetidine.
Which statement provided by the client requires additional instruction by the
nurse?
A. "I will take this medication with meals."
B. "I will avoid taking antacids within 2 hours of this medication."
C. "Decrease cigarette use to a pack per day."
D. "I will report any black, tarry stools immediately."
Correct Answer: C
Rationale: Cimetidine is an H2-receptor antagonist used to reduce gastric acid
secretion. Smoking decreases the effectiveness of cimetidine by increasing gastric acid
secretion and reducing mucosal blood flow. The client should be instructed to quit
smoking entirely, not merely reduce it. Options A, B, and D represent appropriate
understanding of cimetidine therapy.
2. A client taking atorvastatin develops an increased serum creatine
phosphokinase (CK) level. The nurse should assess the client for the onset of
which problem?
A. Muscle tenderness
B. Jaundice
C. Peripheral edema
D. Visual disturbances
Correct Answer: A
Rationale: Atorvastatin is an HMG-CoA reductase inhibitor (statin) that can cause
myopathy, characterized by elevated CK levels and muscle tenderness. Severe cases
may progress to rhabdomyolysis. The nurse must assess for muscle pain, weakness, or
tenderness, as these are early indicators of statin-induced myopathy.
3. An increase in which serum laboratory value indicates to the nurse that a
prescription for atorvastatin is having the desired effect for a client at risk for
coronary artery disease?
A. Low-density lipoprotein (LDL)
B. High-density lipoprotein (HDL)
,C. Triglycerides
D. Total cholesterol
Correct Answer: B
Rationale: Atorvastatin primarily reduces LDL cholesterol (the "bad" cholesterol) and
modestly increases HDL cholesterol (the "good" cholesterol). An increase in HDL
indicates the medication is having a cardioprotective effect. While decreased LDL and
total cholesterol are also desired outcomes, the question specifically asks which
increase indicates effectiveness.
4. History and Physical: The client is a 36-year-old female with moderate persistent
asthma. She takes fluticasone/salmeterol 250mcg/50mcg 1 inhalation twice daily and
albuterol 90mcg/inhalation 2 inhalations every 4-6 hours as needed.
Nurse's Notes: The client states that she has had more severe asthma symptoms than
usual in the past week. Her forced expiratory volume has been 60-65% even with
multiple doses of albuterol for several days in a row. She came to the hospital feeling
dizzy, lightheaded, and complaining of "heart palpitations." Upon assessment, no
wheezes were found. Her oxygen saturation is 99%.
Which condition is the client most likely experiencing?
A. Status asthmaticus
B. Methemoglobinemia
C. Pneumothorax
D. Acute coronary syndrome
Correct Answer: B
Rationale: The client exhibits classic signs of methemoglobinemia: normal SpO2
(99%) despite symptoms of hypoxia (dizziness, lightheadedness, palpitations), absence
of wheezing despite severe asthma history, and excessive beta-agonist use. Excessive
albuterol use can cause methemoglobinemia. The normal oxygen saturation with clinical
cyanosis/hypoxia is pathognomonic—the pulse oximeter reads falsely normal because
methemoglobin absorbs light similarly to oxyhemoglobin.
5. For the client in Question 4, which two actions should the nurse take to
address this condition? (Select all that apply)
A. Administer 100% oxygen via non-rebreather mask
B. Draw blood for a CBC
,C. Administer methylene blue
D. Initiate continuous albuterol nebulization
E. Prepare for emergency intubation
Correct Answers: B and C
Rationale:
B (Draw blood for CBC): Essential to confirm methemoglobinemia via co-oximetry,
which quantifies methemoglobin percentage.
C (Administer methylene blue): This is the specific antidote for methemoglobinemia; it
reduces methemoglobin back to hemoglobin.
Oxygen therapy alone is ineffective because the hemoglobin is structurally unable to
carry oxygen. More albuterol would worsen the condition. Intubation is unnecessary as
the airway is not compromised.
6. For the client in Question 4, which two parameters should the nurse monitor to
assess the client's progress? (Select all that apply)
A. Arterial blood gas (ABG) results
B. Methemoglobin level
C. Forced expiratory volume in 1 second (FEV1)
D. Heart rate and rhythm
E. Peak expiratory flow rate
Correct Answers: B and D
Rationale:
B (Methemoglobin level): Directly monitors the effectiveness of methylene blue
therapy; target is <10%.
D (Heart rate and rhythm): The client presented with palpitations; methemoglobinemia
causes tissue hypoxia, leading to compensatory tachycardia and potential arrhythmias.
ABG may show normal PaO2 with decreased SaO2 (oxygen saturation gap), but co-
oximetry is more specific. FEV1 and peak flow are asthma monitoring tools and less
relevant to this metabolic condition.
7. The nurse provides discharge instructions to a client who has been prescribed
gabapentin 300mg by mouth three times a day for post-herpetic neuralgia. Which
symptoms should the nurse tell the client to report to the healthcare provider?
,A. Gastric irritation
B. Drowsiness
C. Peripheral edema
D. Dry mouth
Correct Answer: A
Rationale: While drowsiness, peripheral edema, and dry mouth are common side
effects of gabapentin, gastric irritation is not typical and may indicate a more serious
gastrointestinal adverse reaction requiring medical evaluation. The nurse should instruct
the client to report any unusual or severe symptoms promptly.
8. A client with chronic lower back pain has been taking nonsteroidal anti-
inflammatory (NSAID) drug ibuprofen by mouth twice a day for several months.
Which assessment is most important for the nurse to complete?
A. Determine presence of abdominal pain
B. Assess range of motion of the spine
C. Evaluate pain level using a numeric scale
D. Monitor blood pressure
Correct Answer: A
Rationale: Chronic NSAID use carries significant risk for gastric ulceration, bleeding,
and perforation. Abdominal pain may indicate developing peptic ulcer disease or GI
bleeding. While pain assessment (C) and ROM (B) are relevant to the underlying
condition, and NSAIDs can elevate BP (D), GI toxicity is the most life-threatening
complication of chronic NSAID therapy.
9. The nurse administers risedronate to a client with osteoporosis at 0700. The
client asks for a glass of milk to drink with the medication. Which action should
the nurse take?
A. Allow the milk, as calcium enhances the medication's effect
B. Instruct the client that it is necessary to take nothing but water with the medication
C. Suggest orange juice as an alternative
D. Reschedule the medication for after breakfast
Correct Answer: B
,Rationale: Risedronate is a bisphosphonate that requires administration with plain
water only on an empty stomach. Food, milk, calcium supplements, and other
medications significantly reduce absorption. The client must remain upright for 30
minutes after administration to prevent esophageal irritation.
10. Which action should the nurse implement to assess the effectiveness of
calcium channel blocker amlodipine?
A. Measure the client's blood pressure
B. Assess for peripheral edema
C. Monitor heart rate
D. Evaluate liver function tests
Correct Answer: A
Rationale: Amlodipine is a dihydropyridine calcium channel blocker prescribed primarily
for hypertension and angina. The primary indicator of effectiveness is blood pressure
reduction. While peripheral edema (B) is a common side effect requiring monitoring, it
does not indicate therapeutic effectiveness.
11. A client is receiving tamsulosin, an alpha-adrenergic-blocking agent for the
management of urinary retention due to benign prostatic hyperplasia (BPH).
Which instruction is most important for the nurse to provide?
A. "Take the medication with food to reduce nausea."
B. "Stand and sit up slowly."
C. "Avoid driving until you know how this medication affects you."
D. "Increase your fluid intake to 3 liters daily."
Correct Answer: B
Rationale: Tamsulosin causes orthostatic hypotension by blocking alpha-1 receptors in
vascular smooth muscle. The "first-dose effect" can cause syncope. Standing slowly
allows the cardiovascular system to compensate for reduced vascular tone, preventing
falls and injury.
12. A client with chemotherapy-induced nausea receives a prescription for
metoclopramide. Which adverse effect is most important for the nurse to report?
A. Dry mouth
B. Diarrhea
,C. Involuntary movements
D. Headache
Correct Answer: C
Rationale: Metoclopramide is a dopamine antagonist that can cause extrapyramidal
symptoms (EPS), including tardive dyskinesia, dystonia, and akathisia. These
involuntary movements may become irreversible with prolonged use and require
immediate discontinuation of the drug and medical intervention.
13. A client is receiving orlistat as part of a weight management program. Which
ongoing assessment should be included in the plan of care to determine the
effectiveness of the medication?
A. Daily weights
B. Body mass index (BMI)
C. Waist circumference
D. Caloric intake log
Correct Answer: B
Rationale: Orlistat is a lipase inhibitor that reduces dietary fat absorption by 30%. BMI
is the standard metric for evaluating long-term effectiveness of weight management
interventions. While daily weights (A) fluctuate and waist circumference (C) measures
central adiposity, BMI provides the standardized assessment for obesity management
outcomes.
14. Before administering the initial dose of sumatriptan succinate to a client with
a migraine headache, it is most important to determine if the client's history
includes which problem?
A. Peptic ulcer disease
B. Coronary artery disease
C. Hypothyroidism
D. Glaucoma
Correct Answer: B
Rationale: Sumatriptan is a 5-HT1B/1D receptor agonist that causes coronary
vasospasm and is contraindicated in clients with coronary artery disease, Prinzmetal's
angina, or risk factors for CAD. It can precipitate myocardial ischemia, infarction, or life-
threatening arrhythmias. Cardiovascular screening is mandatory before administration.
,15. Before administering a laxative to a bedfast client, it is most important for the
nurse to perform which assessment?
A. Determine the frequency and consistency of bowel movements
B. Auscultate bowel sounds in all four quadrants
C. Palpate for abdominal distention
D. Review current medication list
Correct Answer: A
Rationale: Establishing baseline bowel function is essential before administering
laxatives to prevent over-treatment or masking of underlying pathology. The frequency
and consistency of bowel movements (Bristol Stool Scale) guides appropriate laxative
selection and dosing. Bedfast clients are at risk for both constipation and fecal
impaction.
16. The nurse is caring for a client who takes methotrexate for rheumatoid
arthritis and is now prescribed adalimumab. Which instructions should the nurse
provide the client?
A. "Take both medications together for enhanced effect."
B. "Have a chest x-ray prior to your first dose."
C. "Expect improvement within 24-48 hours."
D. "Discontinue methotrexate immediately."
Correct Answer: B
Rationale: Adalimumab is a TNF-alpha inhibitor that increases risk of tuberculosis
reactivation. A chest x-ray (and TB screening) is required before initiation. Methotrexate
is often continued with adalimumab for synergistic effect. TNF inhibitors require weeks
to months for therapeutic effect, not days.
17. The nurse is reviewing the history and physical examination of a client who
will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse
consults with the registered nurse regarding the administration of the medication
if which of the following is documented in the client's history?
A. History of asthma
B. Pancreatitis
C. Hypertension
, D. Migraine headaches
Correct Answer: B
Rationale: Asparaginase is contraindicated in clients with a history of pancreatitis
because it can cause severe, sometimes fatal, pancreatitis. This is a black box warning
for the medication. The nurse must verify this history before administration to prevent
life-threatening complications.
18. Hormone replacement therapy with levothyroxine sodium is prescribed for a
client with hypothyroidism. The nurse should instruct the client to report which
symptom because it indicates that the client is taking too much of the hormonal
agent?
A. Fatigue
B. Weight gain
C. Restlessness
D. Cold intolerance
Correct Answer: C
Rationale: Restlessness, anxiety, insomnia, and palpitations are signs of
hyperthyroidism from levothyroxine overdose (iatrogenic thyrotoxicosis). Fatigue (A),
weight gain (B), and cold intolerance (D) are symptoms of hypothyroidism—indicating
insufficient dosing, not excess.
19. The nurse initiates an infusion of piperacillin-tazobactam for a client with a
urinary tract infection. Five minutes into the infusion, the client reports not
feeling well. Which client manifestation should the nurse identify as a reason to
stop the infusion?
A. Nausea
B. Scratchy throat
C. Mild headache
D. Warmth at IV site
Correct Answer: B
Rationale: A scratchy throat is an early symptom of anaphylaxis and indicates
immediate hypersensitivity reaction to the beta-lactam antibiotic. The nurse must stop
the infusion immediately, maintain IV access, and prepare for emergency intervention.
Pharmacology/Pathophysiology
SPECIALTY EXAM
consists of 200 questions
(NGN-STYLE QUESTIONS & CASE SCENARIOS)
Answers with detailed Rationale
What You’ll Get:
RN Specialty Focus
Patho-Pharm Integration:
NGN Components:
quick review
Printable, easy-to-study PDF
Not affiliated with ATI, VATI or NCLEX. For study purposes only.
,PREVIEW QUESTIONS BELOW
GET THE COMPLETE PDF
AFTER PURCHASE
“ If you require further clarification
or in need of any study resources,
feel free to Message me.
”
,1. A client with peptic ulcer disease receives a new prescription for cimetidine.
Which statement provided by the client requires additional instruction by the
nurse?
A. "I will take this medication with meals."
B. "I will avoid taking antacids within 2 hours of this medication."
C. "Decrease cigarette use to a pack per day."
D. "I will report any black, tarry stools immediately."
Correct Answer: C
Rationale: Cimetidine is an H2-receptor antagonist used to reduce gastric acid
secretion. Smoking decreases the effectiveness of cimetidine by increasing gastric acid
secretion and reducing mucosal blood flow. The client should be instructed to quit
smoking entirely, not merely reduce it. Options A, B, and D represent appropriate
understanding of cimetidine therapy.
2. A client taking atorvastatin develops an increased serum creatine
phosphokinase (CK) level. The nurse should assess the client for the onset of
which problem?
A. Muscle tenderness
B. Jaundice
C. Peripheral edema
D. Visual disturbances
Correct Answer: A
Rationale: Atorvastatin is an HMG-CoA reductase inhibitor (statin) that can cause
myopathy, characterized by elevated CK levels and muscle tenderness. Severe cases
may progress to rhabdomyolysis. The nurse must assess for muscle pain, weakness, or
tenderness, as these are early indicators of statin-induced myopathy.
3. An increase in which serum laboratory value indicates to the nurse that a
prescription for atorvastatin is having the desired effect for a client at risk for
coronary artery disease?
A. Low-density lipoprotein (LDL)
B. High-density lipoprotein (HDL)
,C. Triglycerides
D. Total cholesterol
Correct Answer: B
Rationale: Atorvastatin primarily reduces LDL cholesterol (the "bad" cholesterol) and
modestly increases HDL cholesterol (the "good" cholesterol). An increase in HDL
indicates the medication is having a cardioprotective effect. While decreased LDL and
total cholesterol are also desired outcomes, the question specifically asks which
increase indicates effectiveness.
4. History and Physical: The client is a 36-year-old female with moderate persistent
asthma. She takes fluticasone/salmeterol 250mcg/50mcg 1 inhalation twice daily and
albuterol 90mcg/inhalation 2 inhalations every 4-6 hours as needed.
Nurse's Notes: The client states that she has had more severe asthma symptoms than
usual in the past week. Her forced expiratory volume has been 60-65% even with
multiple doses of albuterol for several days in a row. She came to the hospital feeling
dizzy, lightheaded, and complaining of "heart palpitations." Upon assessment, no
wheezes were found. Her oxygen saturation is 99%.
Which condition is the client most likely experiencing?
A. Status asthmaticus
B. Methemoglobinemia
C. Pneumothorax
D. Acute coronary syndrome
Correct Answer: B
Rationale: The client exhibits classic signs of methemoglobinemia: normal SpO2
(99%) despite symptoms of hypoxia (dizziness, lightheadedness, palpitations), absence
of wheezing despite severe asthma history, and excessive beta-agonist use. Excessive
albuterol use can cause methemoglobinemia. The normal oxygen saturation with clinical
cyanosis/hypoxia is pathognomonic—the pulse oximeter reads falsely normal because
methemoglobin absorbs light similarly to oxyhemoglobin.
5. For the client in Question 4, which two actions should the nurse take to
address this condition? (Select all that apply)
A. Administer 100% oxygen via non-rebreather mask
B. Draw blood for a CBC
,C. Administer methylene blue
D. Initiate continuous albuterol nebulization
E. Prepare for emergency intubation
Correct Answers: B and C
Rationale:
B (Draw blood for CBC): Essential to confirm methemoglobinemia via co-oximetry,
which quantifies methemoglobin percentage.
C (Administer methylene blue): This is the specific antidote for methemoglobinemia; it
reduces methemoglobin back to hemoglobin.
Oxygen therapy alone is ineffective because the hemoglobin is structurally unable to
carry oxygen. More albuterol would worsen the condition. Intubation is unnecessary as
the airway is not compromised.
6. For the client in Question 4, which two parameters should the nurse monitor to
assess the client's progress? (Select all that apply)
A. Arterial blood gas (ABG) results
B. Methemoglobin level
C. Forced expiratory volume in 1 second (FEV1)
D. Heart rate and rhythm
E. Peak expiratory flow rate
Correct Answers: B and D
Rationale:
B (Methemoglobin level): Directly monitors the effectiveness of methylene blue
therapy; target is <10%.
D (Heart rate and rhythm): The client presented with palpitations; methemoglobinemia
causes tissue hypoxia, leading to compensatory tachycardia and potential arrhythmias.
ABG may show normal PaO2 with decreased SaO2 (oxygen saturation gap), but co-
oximetry is more specific. FEV1 and peak flow are asthma monitoring tools and less
relevant to this metabolic condition.
7. The nurse provides discharge instructions to a client who has been prescribed
gabapentin 300mg by mouth three times a day for post-herpetic neuralgia. Which
symptoms should the nurse tell the client to report to the healthcare provider?
,A. Gastric irritation
B. Drowsiness
C. Peripheral edema
D. Dry mouth
Correct Answer: A
Rationale: While drowsiness, peripheral edema, and dry mouth are common side
effects of gabapentin, gastric irritation is not typical and may indicate a more serious
gastrointestinal adverse reaction requiring medical evaluation. The nurse should instruct
the client to report any unusual or severe symptoms promptly.
8. A client with chronic lower back pain has been taking nonsteroidal anti-
inflammatory (NSAID) drug ibuprofen by mouth twice a day for several months.
Which assessment is most important for the nurse to complete?
A. Determine presence of abdominal pain
B. Assess range of motion of the spine
C. Evaluate pain level using a numeric scale
D. Monitor blood pressure
Correct Answer: A
Rationale: Chronic NSAID use carries significant risk for gastric ulceration, bleeding,
and perforation. Abdominal pain may indicate developing peptic ulcer disease or GI
bleeding. While pain assessment (C) and ROM (B) are relevant to the underlying
condition, and NSAIDs can elevate BP (D), GI toxicity is the most life-threatening
complication of chronic NSAID therapy.
9. The nurse administers risedronate to a client with osteoporosis at 0700. The
client asks for a glass of milk to drink with the medication. Which action should
the nurse take?
A. Allow the milk, as calcium enhances the medication's effect
B. Instruct the client that it is necessary to take nothing but water with the medication
C. Suggest orange juice as an alternative
D. Reschedule the medication for after breakfast
Correct Answer: B
,Rationale: Risedronate is a bisphosphonate that requires administration with plain
water only on an empty stomach. Food, milk, calcium supplements, and other
medications significantly reduce absorption. The client must remain upright for 30
minutes after administration to prevent esophageal irritation.
10. Which action should the nurse implement to assess the effectiveness of
calcium channel blocker amlodipine?
A. Measure the client's blood pressure
B. Assess for peripheral edema
C. Monitor heart rate
D. Evaluate liver function tests
Correct Answer: A
Rationale: Amlodipine is a dihydropyridine calcium channel blocker prescribed primarily
for hypertension and angina. The primary indicator of effectiveness is blood pressure
reduction. While peripheral edema (B) is a common side effect requiring monitoring, it
does not indicate therapeutic effectiveness.
11. A client is receiving tamsulosin, an alpha-adrenergic-blocking agent for the
management of urinary retention due to benign prostatic hyperplasia (BPH).
Which instruction is most important for the nurse to provide?
A. "Take the medication with food to reduce nausea."
B. "Stand and sit up slowly."
C. "Avoid driving until you know how this medication affects you."
D. "Increase your fluid intake to 3 liters daily."
Correct Answer: B
Rationale: Tamsulosin causes orthostatic hypotension by blocking alpha-1 receptors in
vascular smooth muscle. The "first-dose effect" can cause syncope. Standing slowly
allows the cardiovascular system to compensate for reduced vascular tone, preventing
falls and injury.
12. A client with chemotherapy-induced nausea receives a prescription for
metoclopramide. Which adverse effect is most important for the nurse to report?
A. Dry mouth
B. Diarrhea
,C. Involuntary movements
D. Headache
Correct Answer: C
Rationale: Metoclopramide is a dopamine antagonist that can cause extrapyramidal
symptoms (EPS), including tardive dyskinesia, dystonia, and akathisia. These
involuntary movements may become irreversible with prolonged use and require
immediate discontinuation of the drug and medical intervention.
13. A client is receiving orlistat as part of a weight management program. Which
ongoing assessment should be included in the plan of care to determine the
effectiveness of the medication?
A. Daily weights
B. Body mass index (BMI)
C. Waist circumference
D. Caloric intake log
Correct Answer: B
Rationale: Orlistat is a lipase inhibitor that reduces dietary fat absorption by 30%. BMI
is the standard metric for evaluating long-term effectiveness of weight management
interventions. While daily weights (A) fluctuate and waist circumference (C) measures
central adiposity, BMI provides the standardized assessment for obesity management
outcomes.
14. Before administering the initial dose of sumatriptan succinate to a client with
a migraine headache, it is most important to determine if the client's history
includes which problem?
A. Peptic ulcer disease
B. Coronary artery disease
C. Hypothyroidism
D. Glaucoma
Correct Answer: B
Rationale: Sumatriptan is a 5-HT1B/1D receptor agonist that causes coronary
vasospasm and is contraindicated in clients with coronary artery disease, Prinzmetal's
angina, or risk factors for CAD. It can precipitate myocardial ischemia, infarction, or life-
threatening arrhythmias. Cardiovascular screening is mandatory before administration.
,15. Before administering a laxative to a bedfast client, it is most important for the
nurse to perform which assessment?
A. Determine the frequency and consistency of bowel movements
B. Auscultate bowel sounds in all four quadrants
C. Palpate for abdominal distention
D. Review current medication list
Correct Answer: A
Rationale: Establishing baseline bowel function is essential before administering
laxatives to prevent over-treatment or masking of underlying pathology. The frequency
and consistency of bowel movements (Bristol Stool Scale) guides appropriate laxative
selection and dosing. Bedfast clients are at risk for both constipation and fecal
impaction.
16. The nurse is caring for a client who takes methotrexate for rheumatoid
arthritis and is now prescribed adalimumab. Which instructions should the nurse
provide the client?
A. "Take both medications together for enhanced effect."
B. "Have a chest x-ray prior to your first dose."
C. "Expect improvement within 24-48 hours."
D. "Discontinue methotrexate immediately."
Correct Answer: B
Rationale: Adalimumab is a TNF-alpha inhibitor that increases risk of tuberculosis
reactivation. A chest x-ray (and TB screening) is required before initiation. Methotrexate
is often continued with adalimumab for synergistic effect. TNF inhibitors require weeks
to months for therapeutic effect, not days.
17. The nurse is reviewing the history and physical examination of a client who
will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse
consults with the registered nurse regarding the administration of the medication
if which of the following is documented in the client's history?
A. History of asthma
B. Pancreatitis
C. Hypertension
, D. Migraine headaches
Correct Answer: B
Rationale: Asparaginase is contraindicated in clients with a history of pancreatitis
because it can cause severe, sometimes fatal, pancreatitis. This is a black box warning
for the medication. The nurse must verify this history before administration to prevent
life-threatening complications.
18. Hormone replacement therapy with levothyroxine sodium is prescribed for a
client with hypothyroidism. The nurse should instruct the client to report which
symptom because it indicates that the client is taking too much of the hormonal
agent?
A. Fatigue
B. Weight gain
C. Restlessness
D. Cold intolerance
Correct Answer: C
Rationale: Restlessness, anxiety, insomnia, and palpitations are signs of
hyperthyroidism from levothyroxine overdose (iatrogenic thyrotoxicosis). Fatigue (A),
weight gain (B), and cold intolerance (D) are symptoms of hypothyroidism—indicating
insufficient dosing, not excess.
19. The nurse initiates an infusion of piperacillin-tazobactam for a client with a
urinary tract infection. Five minutes into the infusion, the client reports not
feeling well. Which client manifestation should the nurse identify as a reason to
stop the infusion?
A. Nausea
B. Scratchy throat
C. Mild headache
D. Warmth at IV site
Correct Answer: B
Rationale: A scratchy throat is an early symptom of anaphylaxis and indicates
immediate hypersensitivity reaction to the beta-lactam antibiotic. The nurse must stop
the infusion immediately, maintain IV access, and prepare for emergency intervention.
