HESI Pharmacology Practice Exam
with Rationales
An antacid (Maalox) is prescribed for a client with peptic ulcer disease. The nurse
knows that the purpose of this medication is to
a. decrease production of gastric secretions.
b. produce an adherent barrier over the ulcer.
c. maintain a gastric pH of 3.5 or above.
d. decrease gastric motor activity. -
✓c. maintain a gastric pH of 3.5 or above.
The objective of antacids is to neutralize gastric acids and keep pH of 3.5 or above
(C) which is necessary for pepsinogen inactivity. (A) is the purpose of H2 receptor
antagonists (cimetidine, ranitidine). (B) is the purpose of sucralfate (Carafate). (D) is
the purpose of anticholinergic drugs which are often used in conjunction with
antacids to allow the antacid to remain in the stomach longer.
In evaluating the effects of lactulose (Cephulac), which outcome would indicate that
the drug is performing as intended?
a. An increase in urine output.
b. Two or three soft stools per day.
c. Watery, diarrhea stools.
d. Increased serum bilirubin. -
✓b. Two or three soft stools per day.
Lactulose is administered to reduce blood ammonia by excretion of ammonia
through the stool. Two to three stools a day indicate that lactulose is performing as
intended (B). (A) would be expected if the patient received a diuretic. (C) would
indicate an overdose of lactulose and is not expected. Lactulose does not affect (D).
The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with
congestive heart failure. Which intervention should the nurse implement prior to
administering the digoxin?
a. Observe respiratory rate and depth.
b. Assess the serum potassium level.
c. Obtain the client's blood pressure.
d. Monitor the serum glucose level. -
✓b. Assess the serum potassium level.
Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in
persons receiving digoxin (B). (A and C) will not affect the administration of digoxin.
(D) should be monitored if he/she is a diabetic and is perhaps receiving insulin.
,Following the administration of sublingual nitroglycerin to a client experiencing an
acute anginal attack, which assessment finding indicates to the nurse that the
desired effect has been achieved?
a. Client states chest pain is relieved.
b. Client's pulse decreases from 120 to 90.
c. Client's systolic blood pressure decreases from 180 to 90.
d. Client's SaO2 level increases from 92% to 96%. -
✓a. Client states chest pain is relieved.
Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia
and reduces chest pain (A). (B and D) would also occur if the angina was relieved,
but are not as significant as the client's subjective report of decreased pain. (C) may
indicate a reduction in pain, or a potentially serious side effect of the medication.
A client with congestive heart failure (CHF) is being discharged with a new
prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril
(Capoten). The nurse's discharge instruction should include reporting which problem
to the healthcare provider?
a. Weight loss.
b. Dizziness.
c. Muscle cramps.
d. Dry mucous membranes. -
✓b. Dizziness.
Angiotensin-converting enzyme (ACE) inhibitors are used in CHF to reduce afterload
by reversing vasoconstriction common in heart failure. This vasodilation can cause
hypotension and resultant dizziness (B). (A) is desired if fluid overload is present,
and may occur as the result of effective combination drug therapy such as diuretics
with ACE inhibitors. (C) often indicates hypokalemia in the client receiving diuretics.
Excessive diuretic administration may result in fluid volume deficit, manifested by
symptoms such as (D).
A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse
knows that the action of this drug is to
a. decrease the amount of thyroid-stimulating hormone circulating in the blood.
b. increase the amount of thyroid-stimulating hormone circulating in the blood.
c. increase the amount of T4 and decrease the amount of T3 produced by the
thyroid.
d. inhibit synthesis of T3 and T4 by the thyroid gland. -
✓d. inhibit synthesis of T3 and T4 by the thyroid gland.
PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of
thyroid hormones (D). It is often prescribed in preparation for thyroidectomy or
radioactive iodine therapy. Thyroid-stimulating hormone (TSH) is produced by the
pituitary gland, and PTU does not affect the pituitary (A and B). PTU inhibits the
synthesis of all thyroid hormones--both T3 and T4(C).
, A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which
observation by the nurse would indicate that the desired outcome of the medication
is being achieved?
a. Decreased blood pressure.
b. Lessening of tremors.
c. Increased salivation.
d. Increased attention span. -
✓b. Lessening of tremors.
Sinemet increases the amount of levodopa to the CNS (dopamine to the brain).
Increased amounts of dopamine improve the symptoms of Parkinson's, such as
involuntary movements, resting tremors (B), shuffling gait, etc. (A) is a side effect of
Sinemet. Decreased drooling would be a desired effect, not (C). Sinemet does not
affect (D).
Following heparin treatment for a pulmonary embolism, a client is being discharged
with a prescription for warfarin (Coumadin). In conducting discharge teaching, the
nurse advises the client to have which diagnostic test monitored regularly after
discharge?
a. Perfusion scan.
b. Prothrombin Time (PT/INR).
c. Activated partial thromboplastin (APTT).
d. Serum Coumadin level (SCL). -
✓b. Prothrombin Time (PT/INR).
When used for a client with pulmonary embolus, the therapeutic goal for warfarin
therapy is a PT 1 to 2 times greater than the control, or an INR of 2 to 3 (B). A
perfusion might be performed to monitor lung function, but not monthly (A). APTT is
monitored for the client receiving heparin therapy (C). A blood level for Coumadin
cannot be measured (D).
A postoperative client has been receiving a continuous IV infusion of meperidine
(Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100
mg PO q3h. The nurse notes that the client has become increasingly restless,
irritable and confused, stating that there are bugs all over the walls. What action
should the nurse take first?
a. Administer a PRN dose of the PO meperidine (Demerol).
b. Administer naloxone (Narcan) IV per PRN protocol.
c. Decrease the IV infusion rate of the meperidine (Demerol) per protocol.
d. Notify the healthcare provider of the client's confusion and hallucinations. -
✓c. Decrease the IV infusion rate of the meperidine (Demerol) per protocol.
The client is exhibiting symptoms of Demerol toxicity, which is consistent with the
large dose of Demerol received over four days. (C) is the most effective action to
immediately decrease the amount of serum Demerol. (A) will increase the toxic level
of medication in the bloodstream. Naloxone (B) is an opioid antagonist that is used
during an opioid overdose, but it is not beneficial during Demerol toxicity and can
with Rationales
An antacid (Maalox) is prescribed for a client with peptic ulcer disease. The nurse
knows that the purpose of this medication is to
a. decrease production of gastric secretions.
b. produce an adherent barrier over the ulcer.
c. maintain a gastric pH of 3.5 or above.
d. decrease gastric motor activity. -
✓c. maintain a gastric pH of 3.5 or above.
The objective of antacids is to neutralize gastric acids and keep pH of 3.5 or above
(C) which is necessary for pepsinogen inactivity. (A) is the purpose of H2 receptor
antagonists (cimetidine, ranitidine). (B) is the purpose of sucralfate (Carafate). (D) is
the purpose of anticholinergic drugs which are often used in conjunction with
antacids to allow the antacid to remain in the stomach longer.
In evaluating the effects of lactulose (Cephulac), which outcome would indicate that
the drug is performing as intended?
a. An increase in urine output.
b. Two or three soft stools per day.
c. Watery, diarrhea stools.
d. Increased serum bilirubin. -
✓b. Two or three soft stools per day.
Lactulose is administered to reduce blood ammonia by excretion of ammonia
through the stool. Two to three stools a day indicate that lactulose is performing as
intended (B). (A) would be expected if the patient received a diuretic. (C) would
indicate an overdose of lactulose and is not expected. Lactulose does not affect (D).
The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with
congestive heart failure. Which intervention should the nurse implement prior to
administering the digoxin?
a. Observe respiratory rate and depth.
b. Assess the serum potassium level.
c. Obtain the client's blood pressure.
d. Monitor the serum glucose level. -
✓b. Assess the serum potassium level.
Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in
persons receiving digoxin (B). (A and C) will not affect the administration of digoxin.
(D) should be monitored if he/she is a diabetic and is perhaps receiving insulin.
,Following the administration of sublingual nitroglycerin to a client experiencing an
acute anginal attack, which assessment finding indicates to the nurse that the
desired effect has been achieved?
a. Client states chest pain is relieved.
b. Client's pulse decreases from 120 to 90.
c. Client's systolic blood pressure decreases from 180 to 90.
d. Client's SaO2 level increases from 92% to 96%. -
✓a. Client states chest pain is relieved.
Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia
and reduces chest pain (A). (B and D) would also occur if the angina was relieved,
but are not as significant as the client's subjective report of decreased pain. (C) may
indicate a reduction in pain, or a potentially serious side effect of the medication.
A client with congestive heart failure (CHF) is being discharged with a new
prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril
(Capoten). The nurse's discharge instruction should include reporting which problem
to the healthcare provider?
a. Weight loss.
b. Dizziness.
c. Muscle cramps.
d. Dry mucous membranes. -
✓b. Dizziness.
Angiotensin-converting enzyme (ACE) inhibitors are used in CHF to reduce afterload
by reversing vasoconstriction common in heart failure. This vasodilation can cause
hypotension and resultant dizziness (B). (A) is desired if fluid overload is present,
and may occur as the result of effective combination drug therapy such as diuretics
with ACE inhibitors. (C) often indicates hypokalemia in the client receiving diuretics.
Excessive diuretic administration may result in fluid volume deficit, manifested by
symptoms such as (D).
A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse
knows that the action of this drug is to
a. decrease the amount of thyroid-stimulating hormone circulating in the blood.
b. increase the amount of thyroid-stimulating hormone circulating in the blood.
c. increase the amount of T4 and decrease the amount of T3 produced by the
thyroid.
d. inhibit synthesis of T3 and T4 by the thyroid gland. -
✓d. inhibit synthesis of T3 and T4 by the thyroid gland.
PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of
thyroid hormones (D). It is often prescribed in preparation for thyroidectomy or
radioactive iodine therapy. Thyroid-stimulating hormone (TSH) is produced by the
pituitary gland, and PTU does not affect the pituitary (A and B). PTU inhibits the
synthesis of all thyroid hormones--both T3 and T4(C).
, A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which
observation by the nurse would indicate that the desired outcome of the medication
is being achieved?
a. Decreased blood pressure.
b. Lessening of tremors.
c. Increased salivation.
d. Increased attention span. -
✓b. Lessening of tremors.
Sinemet increases the amount of levodopa to the CNS (dopamine to the brain).
Increased amounts of dopamine improve the symptoms of Parkinson's, such as
involuntary movements, resting tremors (B), shuffling gait, etc. (A) is a side effect of
Sinemet. Decreased drooling would be a desired effect, not (C). Sinemet does not
affect (D).
Following heparin treatment for a pulmonary embolism, a client is being discharged
with a prescription for warfarin (Coumadin). In conducting discharge teaching, the
nurse advises the client to have which diagnostic test monitored regularly after
discharge?
a. Perfusion scan.
b. Prothrombin Time (PT/INR).
c. Activated partial thromboplastin (APTT).
d. Serum Coumadin level (SCL). -
✓b. Prothrombin Time (PT/INR).
When used for a client with pulmonary embolus, the therapeutic goal for warfarin
therapy is a PT 1 to 2 times greater than the control, or an INR of 2 to 3 (B). A
perfusion might be performed to monitor lung function, but not monthly (A). APTT is
monitored for the client receiving heparin therapy (C). A blood level for Coumadin
cannot be measured (D).
A postoperative client has been receiving a continuous IV infusion of meperidine
(Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100
mg PO q3h. The nurse notes that the client has become increasingly restless,
irritable and confused, stating that there are bugs all over the walls. What action
should the nurse take first?
a. Administer a PRN dose of the PO meperidine (Demerol).
b. Administer naloxone (Narcan) IV per PRN protocol.
c. Decrease the IV infusion rate of the meperidine (Demerol) per protocol.
d. Notify the healthcare provider of the client's confusion and hallucinations. -
✓c. Decrease the IV infusion rate of the meperidine (Demerol) per protocol.
The client is exhibiting symptoms of Demerol toxicity, which is consistent with the
large dose of Demerol received over four days. (C) is the most effective action to
immediately decrease the amount of serum Demerol. (A) will increase the toxic level
of medication in the bloodstream. Naloxone (B) is an opioid antagonist that is used
during an opioid overdose, but it is not beneficial during Demerol toxicity and can
