HESI Pharmacology Exam Practice
The health care provider prescribes carbamazepine for a child whose tonic-
clonic seizures have been poorly controlled. The nurse informs the mother
that the child must have blood tests every week. The mother asks why so
many blood tests are necessary. Which complication is assessed through
frequent laboratory testing that the nurse should explain to this mother?
Myelosuppression
Rationale:
Myelosuppression is the highest priority complication that can potentially
affect clients managed with carbamazepine therapy. The client requires
close monitoring for this condition by weekly laboratory testing. Hepatic
function may be altered, but this complication does not have as great a
potential for occurrence as Myelosupression
A client is prescribed a cholinesterase inhibitor, and a family member asks
the nurse how this medication works. Which pharmacophysiologic
explanation should the nurse use to describe this class of drug?
Improves nerve impulse transmission
Rationale:
Cholinesterase inhibitors work to increase the availability of acetylcholine at
cholinergic synapses, which aids in neuronal transmission and assists in
memory formation.
A client is ordered 22 mg of gentamicin by IM injection. The drug is available
in 20 mg/2 mL. How many milliliters should be administered?
2.2 mL
Rationale:
(22 mg/20 mg) × (x mL/2 mL) = 22x = 40
x = 2.2 mL
,In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every
6 hours. The nurse should plan to observe for which common side effect of
this treatment regimen?
Hypotension
Rationale:
Nifedipine reduces peripheral vascular resistance and nitrates produce
vasodilation, so concurrent use of nitrates with nifedipine can cause
hypotension with the initial administration of these agents.
Which response best supports the observations that the nurse identifies in a
client who is experiencing a placebo effect?
Psychological response to inert medication
Rationale:
The placebo effect is a response in the client that is caused by the
psychological impact of taking an inert drug that has no biochemical
properties. A placebo effect can be therapeutic, negative, or ineffective but
provides no cure or benefit to the client's progress. The placebo effect may
evoke behavioral changes but does not affect neurochemical psychotropic
changes. Malingering and drug seeking are behaviors that a client exhibits to
obtain treatment for nonexistent disorders or obtain prescription
medications.
A 42-year-old client is admitted to the emergency department after taking an
overdose of amitriptyline in a suicide attempt. Which drug should the nurse
plan to administer to reverse the cardiac and central nervous system effects
of amitriptyline?
Sodium bicarbonate
Rationale:
Sodium bicarbonate is an effective treatment for an overdose of tricyclic
antidepressants such as amitriptyline to reverse QRS prolongation.
,A 67-year-old client is discharged from the hospital with a prescription for
digoxin, 0.25 mg daily. Which instruction should the nurse include in this
client's discharge teaching plan?
Take and record radial pulse rate daily.
Rationale:
Monitoring pulse rate is very important when taking digoxin. The client
should be further instructed to report pulse rates <60 or >110 beats/min and
to withhold the dosage until consulting with the health care provider in such
a case. Vision change is an indication of drug toxicity, and the client should
be instructed to report this immediately.
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?
Fluphenazine decanoate
Rationale:
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. Chlorpromazine
HCl 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. Lithium carbonate is most effective
with manic and depressive bipolar affective disorders. Diazepam is an anti-
anxiety drug and would not be effective for a psychotic disorder.
A client is being discharged with a prescription for sulfasalazine to treat
ulcerative colitis. Which instruction should the nurse provide to this client
prior to discharge?
, Drink at least eight glasses of fluid a day
Rationale:
Adequate hydration is important for all sulfa drugs because they can
crystallize in the urine. If possible, the drug should be taken after eating to
provide longer intestinal transit time. Maintaining good oral hygiene is
important for other medications, such as phenytoin, because of the incidence
of gingival hyperplasia, Discontinue use of the drug gradually is important for
steroid administration.
Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an
infection. The drug is available in a suspension of 125 mg/5 mL. How many
milliliters should the nurse administer with each dose?
20 mL
Rationale:
500 mg/x mL = 125 mg/5 mL
125x = 2500
x = 20 mL
A client with acute lymphocytic leukemia is to begin chemotherapy today.
The health care provider's prescription specifies that ondansetron is to be
administered IV 30 minutes prior to the infusion of cisplatin. What is the
rationale for administering Zofran prior to the chemotherapy induction?
Reduction or elimination of nausea and vomiting
Rationale:
Ondansetron is a type 3 receptor (5-HT3) antagonist that is recognized for
improved control of acute nausea and vomiting associated with
chemotherapy. 5-HT3 antagonists are most effective when administered IV
prior to the induction of the chemotherapeutic agent(s).
The health care provider prescribes carbamazepine for a child whose tonic-
clonic seizures have been poorly controlled. The nurse informs the mother
that the child must have blood tests every week. The mother asks why so
many blood tests are necessary. Which complication is assessed through
frequent laboratory testing that the nurse should explain to this mother?
Myelosuppression
Rationale:
Myelosuppression is the highest priority complication that can potentially
affect clients managed with carbamazepine therapy. The client requires
close monitoring for this condition by weekly laboratory testing. Hepatic
function may be altered, but this complication does not have as great a
potential for occurrence as Myelosupression
A client is prescribed a cholinesterase inhibitor, and a family member asks
the nurse how this medication works. Which pharmacophysiologic
explanation should the nurse use to describe this class of drug?
Improves nerve impulse transmission
Rationale:
Cholinesterase inhibitors work to increase the availability of acetylcholine at
cholinergic synapses, which aids in neuronal transmission and assists in
memory formation.
A client is ordered 22 mg of gentamicin by IM injection. The drug is available
in 20 mg/2 mL. How many milliliters should be administered?
2.2 mL
Rationale:
(22 mg/20 mg) × (x mL/2 mL) = 22x = 40
x = 2.2 mL
,In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every
6 hours. The nurse should plan to observe for which common side effect of
this treatment regimen?
Hypotension
Rationale:
Nifedipine reduces peripheral vascular resistance and nitrates produce
vasodilation, so concurrent use of nitrates with nifedipine can cause
hypotension with the initial administration of these agents.
Which response best supports the observations that the nurse identifies in a
client who is experiencing a placebo effect?
Psychological response to inert medication
Rationale:
The placebo effect is a response in the client that is caused by the
psychological impact of taking an inert drug that has no biochemical
properties. A placebo effect can be therapeutic, negative, or ineffective but
provides no cure or benefit to the client's progress. The placebo effect may
evoke behavioral changes but does not affect neurochemical psychotropic
changes. Malingering and drug seeking are behaviors that a client exhibits to
obtain treatment for nonexistent disorders or obtain prescription
medications.
A 42-year-old client is admitted to the emergency department after taking an
overdose of amitriptyline in a suicide attempt. Which drug should the nurse
plan to administer to reverse the cardiac and central nervous system effects
of amitriptyline?
Sodium bicarbonate
Rationale:
Sodium bicarbonate is an effective treatment for an overdose of tricyclic
antidepressants such as amitriptyline to reverse QRS prolongation.
,A 67-year-old client is discharged from the hospital with a prescription for
digoxin, 0.25 mg daily. Which instruction should the nurse include in this
client's discharge teaching plan?
Take and record radial pulse rate daily.
Rationale:
Monitoring pulse rate is very important when taking digoxin. The client
should be further instructed to report pulse rates <60 or >110 beats/min and
to withhold the dosage until consulting with the health care provider in such
a case. Vision change is an indication of drug toxicity, and the client should
be instructed to report this immediately.
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?
Fluphenazine decanoate
Rationale:
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. Chlorpromazine
HCl 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. Lithium carbonate is most effective
with manic and depressive bipolar affective disorders. Diazepam is an anti-
anxiety drug and would not be effective for a psychotic disorder.
A client is being discharged with a prescription for sulfasalazine to treat
ulcerative colitis. Which instruction should the nurse provide to this client
prior to discharge?
, Drink at least eight glasses of fluid a day
Rationale:
Adequate hydration is important for all sulfa drugs because they can
crystallize in the urine. If possible, the drug should be taken after eating to
provide longer intestinal transit time. Maintaining good oral hygiene is
important for other medications, such as phenytoin, because of the incidence
of gingival hyperplasia, Discontinue use of the drug gradually is important for
steroid administration.
Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an
infection. The drug is available in a suspension of 125 mg/5 mL. How many
milliliters should the nurse administer with each dose?
20 mL
Rationale:
500 mg/x mL = 125 mg/5 mL
125x = 2500
x = 20 mL
A client with acute lymphocytic leukemia is to begin chemotherapy today.
The health care provider's prescription specifies that ondansetron is to be
administered IV 30 minutes prior to the infusion of cisplatin. What is the
rationale for administering Zofran prior to the chemotherapy induction?
Reduction or elimination of nausea and vomiting
Rationale:
Ondansetron is a type 3 receptor (5-HT3) antagonist that is recognized for
improved control of acute nausea and vomiting associated with
chemotherapy. 5-HT3 antagonists are most effective when administered IV
prior to the induction of the chemotherapeutic agent(s).
