HESI RN PHARMACOLOGY NEXTGEN
EXAM
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).
A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level
should the nurse report to the health care provider to determine the therapeutic outcome?
Uric acid level
Rationale:
The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels
with a lower frequency of acute gouty attacks, so uric acid level should be reported to the health care
provider.
EXAM
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).
A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level
should the nurse report to the health care provider to determine the therapeutic outcome?
Uric acid level
Rationale:
The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels
with a lower frequency of acute gouty attacks, so uric acid level should be reported to the health care
provider.
