PHARMACOLOGY EVOLVE HESI EXAMS 1 ALL
ANSWERS AND QUESTIONS SET A+
✔✔The nurse performs a client assessment prior to the administration of a prescribed
dose of dipyridamole and aspirin PO. The nurse notes that the client's carotid bruit is
louder than previously assessed. Which action should the nurse implement?
A. Administer the prescribed dose as scheduled.
B. Hold the dose until the health care provider is contacted.
C. Advise the client to take nothing by mouth until further assessment is completed.
D. Elevate the head of the bed and apply oxygen by nasal cannula - ✔✔A. Administer
the prescribed dose as scheduled.
A carotid bruit reflects the degree of blood vessel turbulence, which is typically the result
of atherosclerosis. Aspirin is prescribed to reduce platelet aggregation and should be
administered to this client, who is at high risk for thrombus occlusion. Options B, C, and
D are not necessary interventions at this time.
✔✔A client who is HIV-positive is receiving epoetin alfa for the management of anemia
secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for
the nurse to report to the health care provider?
A. Hematocrit (HCT) of 58%
B. Hemoglobin of 10.8 g/dL
C. White blood cell count of 5000 mm3
D. Serum potassium level of 5 mEq/L - ✔✔A. Hematocrit (HCT) of 58%
Option A should be reported to the health care provider immediately because of the
likelihood of a hypertensive crisis and because seizure activity increases with an
increase in HCT of more than 4 points, or an HCT above 36%. Epoetin alfa stimulates
erythropoiesis (production of red blood cells), thereby decreasing the need for blood
transfusions. Uncontrolled hypertension can occur if erythropoietin levels are too high.
,Option B is the reason why the client is receiving epoetin alpha. Options C and D are
within normal limits.
✔✔A client is receiving pyridostigmine bromide to control the symptoms of myasthenia
gravis. Which client behavior would indicate that the drug therapy is effective?
A. Decreased oral secretions
B. Clear speech
C. Diminished hand tremors
D. Increased ptosis - ✔✔B. Clear speech
Clear speech is the result of increased muscle strength. Muscle weakness characteristic
of myasthenia gravis often first appears in the muscles of the neck and face. Options A
and D are symptoms of multiple sclerosis that would persist if the medication was
ineffective. Hand tremors are not typical symptoms of the disease.
✔✔A client is experiencing an adverse effect of the gastrointestinal stimulant
metoclopramide HCl. Which assessment finding would require immediate intervention
by the nurse?
A. Reports dizziness when first getting up.
B. Describes an unpleasant metallic taste in the mouth.
C. Demonstrates Parkinson-like symptoms, such as cogwheel rigidity.
D. Refuses to drive after 6 pm because of an inability to see well at night. - ✔✔C.
Demonstrates Parkinson-like symptoms, such as cogwheel rigidity.
Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the
extrapyramidal symptoms associated with Parkinson disease. Reglan has been
associated with hypertension, not option A. Option B is often associated with
metronidazole, not metoclopramide HCl. Option D, and other vision problems, have not
been associated with metoclopramide HCl.
✔✔For which clients should the nurse withhold the initial dose of a cyclooxygenase 2
(COX-2) inhibitor until notifying the health care provider? (Select all that apply.)
A. A middle-aged adult with a history of tinnitus while taking aspirin
B. A middle-aged adult with a history of polycystic ovarian disease
C. An older adult with a history of a skin rash while taking glyburide (DiaBeta)
D. An adolescent with a history of an anaphylactic reaction to penicillin
E. An older adult with a history of gastrointestinal upset while taking naproxen sodium
(Naprosyn)
F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema - ✔✔C, D, F
COX-2 inhibitors are contraindicated for those who are allergic to sulfa drugs (C),
aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety for adolescents
(D and F) is not yet established, and COX-2 inhibitors, as well as NSAIDs, are
,contraindicated during the third trimester of pregnancy (F) because they can cause a
premature closure of the patent ductus arteriosus. Tinnitus, an adverse reaction of
aspirin (A), and ovarian disease (B) are not contraindications for the use of COX-2
inhibitors. Gastrointestinal upset is a common adverse reaction of NSAIDs (E) but is not
a contraindication for the use of a COX-2 inhibitor.
✔✔A client who is hypertensive receives a prescription for hydrochlorothiazide. When
teaching about the side effects of this drug, which symptoms are most important for the
nurse to instruct the client to report?
A. Fatigue and muscle weakness
B. Anxiety and heart palpitations
C. Abdominal cramping and diarrhea
D. Confusion and personality changes - ✔✔A. Fatigue and muscle weakness
Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client
should be instructed to report fatigue and muscle weakness, which are characteristic of
hypokalemia. Although options B, C, and D should be reported, they are not indicative
of hypokalemia, which is a side effect of hiazides that can cause cardiac dysrhythmias.
✔✔A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous
hospitalizations have occurred since the diagnosis because of noncompliance with the
prescribed medication regimen. Which drug might work best for this particular client?
A. Chlorpromazine HCl
B. Lithium carbonate
C. Fluphenazine decanoate
D. Diazepam - ✔✔C. Fluphenazine decanoate
Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2
hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of
choice for a noncompliant psychotic client. Option A is an antipsychotic drug used to
treat schizophrenia and is usually administered PO (IM doses are short-acting). The
client must be compliant in taking this drug for it to be effective. Option B is most
effective with manic and depressive bipolar affective disorders. Option D is an
antianxiety drug and would not be effective for a psychotic disorder.
✔✔The nurse is administering the early morning dose of insulin aspart, 5 units
subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum
glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the
nurse ensure that the client's breakfast be given?
A. 5 minutes after subcutaneous administration
B. 30 minutes after subcutaneous administration
C. 1 to 2 hours after administration
, D. At any time because of a flat peak of action - ✔✔A. 5 minutes after subcutaneous
administration
Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin
aspart should be administered when the client's tray is available. Insulin aspart peaks in
45 minutes to 1½ hours and has a duration of 3 to 4 hours. The client should have
eaten to ensure absorption of the meal so that serum glucose levels will coincide with
the peak. Insulin glargine has a flat peak of action and is usually given at bedtime.
✔✔A mother brings her 18-month-old child to the community health center because the
child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid
at the pharmacy and gave my daughter a half-ounce." The nurse sees that the bottle
contains loperamide. Which intervention is most important for the nurse to implement
initially?
A. Tell the mother never to give this drug to her toddler.
B. Ask if any other siblings have experienced diarrhea.
C. Take the child's oral and tympanic temperatures.
D. Ask the mother when the child last voided. - ✔✔D. Ask the mother when the child
last voided.
Determining when the child last voided is most important because urine output is
decreased with dehydration and an 18-month-old with a 3-day history of diarrhea could
be severely dehydrated. Although the manufacturer states that loperamide should not
be given to a child younger than 2 years except under the direction of a health care
provider, option A is not the best answer for this question. In addition, loperamide
causes an anticholinergic effect of urinary retention. Data obtained in options B and C
are not as high a priority as option D in this situation.
✔✔In administering the antiinfective agent chloramphenicol IV to a client with bacterial
meningitis, the nurse observes the client closely for signs of bone marrow depression.
Which laboratory data would be most important for the nurse to monitor?
A. Platelet count
B. Blood urea nitrogen level
C. Culture and sensitivity
D. Serum calcium level - ✔✔A. Platelet count
Chloramphenicol can cause irreversible, fatal bone marrow depression, so the nurse
should monitor the client's platelet count. Options B, C, and D do not provide data
related to bone marrow depression when monitoring a client who has been prescribed
this medication.
✔✔Which assessment datum indicates to the nurse that a dose of granisetron
administered IV prior to chemotherapy has had the desired effect?
ANSWERS AND QUESTIONS SET A+
✔✔The nurse performs a client assessment prior to the administration of a prescribed
dose of dipyridamole and aspirin PO. The nurse notes that the client's carotid bruit is
louder than previously assessed. Which action should the nurse implement?
A. Administer the prescribed dose as scheduled.
B. Hold the dose until the health care provider is contacted.
C. Advise the client to take nothing by mouth until further assessment is completed.
D. Elevate the head of the bed and apply oxygen by nasal cannula - ✔✔A. Administer
the prescribed dose as scheduled.
A carotid bruit reflects the degree of blood vessel turbulence, which is typically the result
of atherosclerosis. Aspirin is prescribed to reduce platelet aggregation and should be
administered to this client, who is at high risk for thrombus occlusion. Options B, C, and
D are not necessary interventions at this time.
✔✔A client who is HIV-positive is receiving epoetin alfa for the management of anemia
secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for
the nurse to report to the health care provider?
A. Hematocrit (HCT) of 58%
B. Hemoglobin of 10.8 g/dL
C. White blood cell count of 5000 mm3
D. Serum potassium level of 5 mEq/L - ✔✔A. Hematocrit (HCT) of 58%
Option A should be reported to the health care provider immediately because of the
likelihood of a hypertensive crisis and because seizure activity increases with an
increase in HCT of more than 4 points, or an HCT above 36%. Epoetin alfa stimulates
erythropoiesis (production of red blood cells), thereby decreasing the need for blood
transfusions. Uncontrolled hypertension can occur if erythropoietin levels are too high.
,Option B is the reason why the client is receiving epoetin alpha. Options C and D are
within normal limits.
✔✔A client is receiving pyridostigmine bromide to control the symptoms of myasthenia
gravis. Which client behavior would indicate that the drug therapy is effective?
A. Decreased oral secretions
B. Clear speech
C. Diminished hand tremors
D. Increased ptosis - ✔✔B. Clear speech
Clear speech is the result of increased muscle strength. Muscle weakness characteristic
of myasthenia gravis often first appears in the muscles of the neck and face. Options A
and D are symptoms of multiple sclerosis that would persist if the medication was
ineffective. Hand tremors are not typical symptoms of the disease.
✔✔A client is experiencing an adverse effect of the gastrointestinal stimulant
metoclopramide HCl. Which assessment finding would require immediate intervention
by the nurse?
A. Reports dizziness when first getting up.
B. Describes an unpleasant metallic taste in the mouth.
C. Demonstrates Parkinson-like symptoms, such as cogwheel rigidity.
D. Refuses to drive after 6 pm because of an inability to see well at night. - ✔✔C.
Demonstrates Parkinson-like symptoms, such as cogwheel rigidity.
Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the
extrapyramidal symptoms associated with Parkinson disease. Reglan has been
associated with hypertension, not option A. Option B is often associated with
metronidazole, not metoclopramide HCl. Option D, and other vision problems, have not
been associated with metoclopramide HCl.
✔✔For which clients should the nurse withhold the initial dose of a cyclooxygenase 2
(COX-2) inhibitor until notifying the health care provider? (Select all that apply.)
A. A middle-aged adult with a history of tinnitus while taking aspirin
B. A middle-aged adult with a history of polycystic ovarian disease
C. An older adult with a history of a skin rash while taking glyburide (DiaBeta)
D. An adolescent with a history of an anaphylactic reaction to penicillin
E. An older adult with a history of gastrointestinal upset while taking naproxen sodium
(Naprosyn)
F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema - ✔✔C, D, F
COX-2 inhibitors are contraindicated for those who are allergic to sulfa drugs (C),
aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety for adolescents
(D and F) is not yet established, and COX-2 inhibitors, as well as NSAIDs, are
,contraindicated during the third trimester of pregnancy (F) because they can cause a
premature closure of the patent ductus arteriosus. Tinnitus, an adverse reaction of
aspirin (A), and ovarian disease (B) are not contraindications for the use of COX-2
inhibitors. Gastrointestinal upset is a common adverse reaction of NSAIDs (E) but is not
a contraindication for the use of a COX-2 inhibitor.
✔✔A client who is hypertensive receives a prescription for hydrochlorothiazide. When
teaching about the side effects of this drug, which symptoms are most important for the
nurse to instruct the client to report?
A. Fatigue and muscle weakness
B. Anxiety and heart palpitations
C. Abdominal cramping and diarrhea
D. Confusion and personality changes - ✔✔A. Fatigue and muscle weakness
Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client
should be instructed to report fatigue and muscle weakness, which are characteristic of
hypokalemia. Although options B, C, and D should be reported, they are not indicative
of hypokalemia, which is a side effect of hiazides that can cause cardiac dysrhythmias.
✔✔A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous
hospitalizations have occurred since the diagnosis because of noncompliance with the
prescribed medication regimen. Which drug might work best for this particular client?
A. Chlorpromazine HCl
B. Lithium carbonate
C. Fluphenazine decanoate
D. Diazepam - ✔✔C. Fluphenazine decanoate
Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2
hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of
choice for a noncompliant psychotic client. Option A is an antipsychotic drug used to
treat schizophrenia and is usually administered PO (IM doses are short-acting). The
client must be compliant in taking this drug for it to be effective. Option B is most
effective with manic and depressive bipolar affective disorders. Option D is an
antianxiety drug and would not be effective for a psychotic disorder.
✔✔The nurse is administering the early morning dose of insulin aspart, 5 units
subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum
glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the
nurse ensure that the client's breakfast be given?
A. 5 minutes after subcutaneous administration
B. 30 minutes after subcutaneous administration
C. 1 to 2 hours after administration
, D. At any time because of a flat peak of action - ✔✔A. 5 minutes after subcutaneous
administration
Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin
aspart should be administered when the client's tray is available. Insulin aspart peaks in
45 minutes to 1½ hours and has a duration of 3 to 4 hours. The client should have
eaten to ensure absorption of the meal so that serum glucose levels will coincide with
the peak. Insulin glargine has a flat peak of action and is usually given at bedtime.
✔✔A mother brings her 18-month-old child to the community health center because the
child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid
at the pharmacy and gave my daughter a half-ounce." The nurse sees that the bottle
contains loperamide. Which intervention is most important for the nurse to implement
initially?
A. Tell the mother never to give this drug to her toddler.
B. Ask if any other siblings have experienced diarrhea.
C. Take the child's oral and tympanic temperatures.
D. Ask the mother when the child last voided. - ✔✔D. Ask the mother when the child
last voided.
Determining when the child last voided is most important because urine output is
decreased with dehydration and an 18-month-old with a 3-day history of diarrhea could
be severely dehydrated. Although the manufacturer states that loperamide should not
be given to a child younger than 2 years except under the direction of a health care
provider, option A is not the best answer for this question. In addition, loperamide
causes an anticholinergic effect of urinary retention. Data obtained in options B and C
are not as high a priority as option D in this situation.
✔✔In administering the antiinfective agent chloramphenicol IV to a client with bacterial
meningitis, the nurse observes the client closely for signs of bone marrow depression.
Which laboratory data would be most important for the nurse to monitor?
A. Platelet count
B. Blood urea nitrogen level
C. Culture and sensitivity
D. Serum calcium level - ✔✔A. Platelet count
Chloramphenicol can cause irreversible, fatal bone marrow depression, so the nurse
should monitor the client's platelet count. Options B, C, and D do not provide data
related to bone marrow depression when monitoring a client who has been prescribed
this medication.
✔✔Which assessment datum indicates to the nurse that a dose of granisetron
administered IV prior to chemotherapy has had the desired effect?
